摘要：Objectives . We assessed associations between psychosocial factors and preterm birth, stratified by race in a prospective cohort study. Methods . We surveyed 1898 women who used university and public health prenatal clinics regarding various psychosocial factors. Results . African Americans were at higher risk of preterm birth if they used distancing from problems as a coping mechanism or reported racial discrimination. Whites were at higher risk if they had high counts of negative life events or were not living with a partner. The association of pregnancy-related anxiety with preterm birth weakened when medical comorbidities were taken into account. No association with preterm birth was found for depression, general social support, or church attendance. Conclusions . Some associations between psychosocial variables and preterm birth differed by race. In the United States, African American women experience a higher level of preterm singleton birth compared with White women. 1 In perinatal research, race is often included in explanatory models, even though no known or postulated genetic or physiological factors linked to skin color have been identified that increase risk for preterm birth. Furthermore, racial groups in the United States tend to contain a highly heterogeneous mix of genetic traits, 2 which suggests that socioeconomic, environmental, and behavioral factors underlie racial disparities. Studies that have examined racial differences in low birthweight or in preterm birth often have focused on differences in income, education, health behaviors, and access to prenatal care as possible explanatory mechanisms 3– 11 ; however, these models have not completely explained the higher risk experienced by African Americans. Some researchers have postulated that increased risk for preterm birth among African American women may be attributable to psychosocial or environmental stressors that are specific to race or that differ in prevalence by race. 3, 5, 10– 16 Only a few studies have examined levels of stress, social support, or racial discrimination or other psychosocial factors as potential influences on preterm birth among African American and White women. To test the hypotheses that the effect of psychosocial factors might vary by race, we examined the association between an array of psychosocial factors and preterm birth in a cohort of pregnant women in central North Carolina. We considered both differing levels of stress and differing associations between stress and preterm birth across racial groups.
