Patterns of stressful life events in pregnancy: A latent class approach linking trauma and birth outcomes

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Abstract

Background: Stressful life events during pregnancy, including relational, financial, and emotional stressors, are well-established risk factors for adverse birth outcomes. Additional exposures such as adverse childhood experiences (ACEs), intimate partner violence (IPV), material hardship, and substance use can contribute to stressful life experiences during pregnancy. However, few studies have examined how these factors cluster into distinct profiles of stressful life experiences during pregnancy, or how such profiles are associated with poor birth outcomes. Methods: Data were drawn from 5,280 pregnant individuals participating in the Kansas Pregnancy Risk Assessment Monitoring System (K-PRAMS). Latent class analysis (LCA) was performed to identify stress profiles and assess adverse birth outcomes as distal variables. Multinomial logistic regression models examined how ACEs predict latent class membership, controlling for maternal demographic characteristics. Analyses were conducted in Mplus v8.4. Results: Five distinct stress profiles were identified: (1) Multiple Overlapping Stressors (5%, n = 275), (2) Financial Insecurity (11%, n = 591), (3) Family Member Illness or Death (16%, n = 858), (4) Residential Instability and Family Conflict (9%, n = 455), and (5) Low Stress (59%, n = 3,083). Compared to the Low Stress class, individuals in all high-risk classes had significantly greater odds of reporting ACEs, IPV, material hardship during pregnancy, and substance use. Differential associations were observed between specific stress profiles and adverse birth outcomes . Conclusions: The findings highlight the heterogeneity of stress exposure during pregnancy and underscore the importance of identifying distinct antenatal stress profiles. Tailoring perinatal interventions to specific stress profiles—particularly for individuals with histories of early adversity—may improve outcomes for both mothers and infants .

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