Stress, Coping and Health Behaviors in Pregnancy

Health behaviors are important modifiable factors for promoting maternal-infant health
during pregnancy, and include behaviors such as diet, exercise, and avoidance of harmful
substances. During pregnancy, women are often motivated to improve their lifestyle to
achieve positive pregnancy outcomes; however, they may struggle to do so because certain
behaviors such as excessive eating, smoking and drinking have become a means for coping with
stress. Stress prior to and during pregnancy negatively impacts birth outcomes via complex
behavioral and physiologic pathways. From a behavioral perspective, stress diminishes
women's engagement in positive health behaviors during pregnancy. From a physiologic
perspective, stress affects the regulation of cortisol, a hormone involved in fetal
development and timing of delivery. Women use various coping styles to manage stress. It is
unknown, however, whether certain coping styles attenuate the negative behavioral and
physiologic effects of stress on birth outcomes. Therefore, the purpose of this descriptive,
cross-sectional study is to examine the influence of coping styles on stress, physiologic
cortisol regulation and health behaviors in a diverse sample of pregnant women (N=55) during
24-28 weeks gestation.

A quantitative design with a qualitative arm will be used to:

1. explain the relationship between cortisol regulation and lifetime stress,

2. determine whether coping styles (active vs. disengaged) moderate the effect of stress
on cortisol, health behaviors, and birth outcomes, and

3. describe women's qualitative experience of stress and coping and determine the extent
to which the qualitative findings converge with the quantitative findings.

Data will be collected over three prenatal visits during the second half of pregnancy, and
will include self-report questionnaires, multiple salivary cortisol sampling, medical record
data, a structured stress interview and a semi-structured qualitative interview in a subset
of participants (n=12). This study will use an interview-based stress assessment in tandem
with physiologic (i.e. cortisol) stress measures in pregnancy. Additionally, the qualitative
data will provide a contextual understanding of pregnant women's stress and coping
experiences. The research findings will inform the future development and testing of a
psychosocial, coping-based intervention to promote positive health behaviors in pregnancy
and birth outcomes. Furthermore, this training will provide a solid scientific foundation
for the applicant to develop a career as an independent nurse-scientist in maternal-infant
health promotion research, under the guidance of an experienced interdisciplinary team of
mentors with complementary expertise in stress, coping health behavior, and pregnancy
related research. The proposal is consistent with the National Institute of Nursing
Research's (NINR) mission to support research that promotes health and prevents disease
across the lifespan, builds the scientific foundation for clinical practice, and invests in
the training of the next generation of nurse-scientists.

Inclusion Criteria:

- Single intrauterine pregnancy at least 20 weeks gestation

- Aged 19 to 45

- Ability to read and speak English

- Able to be reached by telephone or text most days of the week

Exclusion Criteria:

- Receiving or referred for care in the high-risk prenatal clinic

- Have any of the following pregnancy complications or medical issues existing prior to
recruitment:

Cervical or uterine abnormalities, renal, hepatic or cardiac disorders, insulin-dependent
diabetes, preeclampsia, regular oral steroid use in the month prior to data collection,
congenital fetal abnormalities, active placenta previa, blood group isoimmunization, or
other disorders/medication use that could affect cortisol levels

- Regular night-shift work or reversed sleep schedule