Date of Award


Degree Type


Degree Name

Doctor of Philosophy


Social Work

Major Professor

Terri Combs-Orme

Committee Members

John Orme, Rebecca Bolen, Matthew Cooper


Background. Prenatal stress has negative effects on the developing fetus through the activation of the hypothalamic-pituitary-adrenal (HPA) axis. Programming of the stress response system during gestation has lifelong effects that put the infant at risk for multiple stress-related pathologies. Populations most vulnerable to prenatal stress are African-Americans and individuals of low socioeconomic status.

Methods. The Pregnancy Risk Assessment Monitoring System (PRAMS) research project, a collaboration between the Centers for Disease Control and Prevention and individual state health departments, was utilized for this study. Tennessee data from 2009 were compiled from individual birth certificates and PRAMS questionnaire responses to examine three constructs: fetal development, stressful life events, and poverty in order to examine the influence of maternal stressors and poverty on fetal development.

Results. Latent class analysis revealed two classes of mothers with quantitative and qualitative differences in stressful life events, but class membership was not a significant predictor of problematic birth outcomes. The number of stressors was only a significant predictor of having an infant small for gestational age when moderated by Medicaid status. Medicaid status proved to be a significant predictor of all four measures of fetal growth. The relationship between race and problematic birth overall was moderated by age, with young African-American mothers less likely than European-Americans and older African-American mothers to have problematic births.

Conclusion. Stressors, as measured in the field of social work through life events and daily hassles, could potentially be inadequate measures. Further examination of prenatal stress measures is needed.

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