Stress and low birth weight: a structural modeling approach using real life stressors.

This study presents a structural equation model describing the influence of stressful life experiences on low birth weight. Data were gathered prospectively in two waves from 5295 inner-city women as part of a city-wide preterm birth prevention project. Using interviews and the medical record, over 200 measures were gathered on each mother and her infant, where each measure was included because of its relevance documented in the risk factor literature. Seventeen of these measures reflected real life stressful experiences and through measurement modeling, eleven of these measures were chosen to represent three underlying measures of stress: economic stress, family stress, and the lack of social support. This study incorporates these psychosocial stressors into a full structural equation model to show their influence on addictive behavior and low birth weight. The full model emerged from tests of alternative causal conceptualizations of how these stressors influence each other and low birth weight--whether their influence on low birth weight in simple and direct, or whether their influence is mediated by addictive behaviors. The model was tested on the first wave, a sample of 3205, and cross-validated on the second wave, a sample of 2090. The model shows that economic stress influences both social support and family stress, but has no direct influence on low birth weight: that social support, or its absence, influences addictive behavior, but has no direct influence on low birth weight, and that family stress influences addictive behavior, and consistent with 30 years of research on humans, has no direct influence on low birth weight. Finally, the mother's history of medical risks shows an independent influence on low birth weight, while her age does not. Age, however, shows a strong influence on addictive behavior. The study demonstrates how structural equation modeling can be used to create and test alternative conceptualizations of how stress affects low birth weight. There are strong implications for planners of prenatal care programs.