Partner Influence on Women’s Perceptions of Pregnancy Charlan Kroelinger, MA, PhD c Department of Epidemiology and Biostatistics College of Public Health

Partner Influence on Women’s Perceptions of Pregnancy

Charlan Kroelinger, MA, PhDc

Department of Epidemiology and BiostatisticsCollege of Public Health

University of South Florida

Co-authors: Heather Stockwell, Sc.D.

Department of Epidemiology and Biostatistics University of South Florida

Kathryn Oths, Ph.D. Department of Anthropology, The University of Alabama

John Bolland, Ph.D. Institute for Social Science Research, The University of Alabama

Thomas Mason, Ph.D. Department of Epidemiology and Biostatistics

University of South Florida

Research Question

• Does the support of a woman’s current partner impact her reaction to stressors occurring during pregnancy?– If so, does partner social support buffer the

impact of specific stressors (e.g., pregnancy wantedness and physical and/or verbal abuse)?

Definitions of Partner Social Support

• Partner support– Has the partner provided support (emotional or

material) during the pregnancy? Yes or No– When he provided support, what was the magnitude?

Norbeck social support scale (score 0 – 6)• Please name all of the people you are close to in your

life who make you feel liked or loved.• …you are close to who make you feel important.• …you know for certain you could go to for comfort if you

were upset about something• Who would help you if you needed a ride somewhere.• …you needed to borrow some money.• …you were sick for a long time and couldn’t get out of

bed.

Definitions of Pregnancy Stressors

• Pregnancy stressors– Pregnancy Wantedness: When you first

found out you were pregnant, did you really feel like you wanted to have a baby? Yes or No

– Abuse: • Is there anyone who often says things to you

that hurt you? Yes or No

• Have you ever been hit, slapped, kicked, or hurt by someone? Yes or No

Study Population – Basic Demographic Characteristics*

Characteristic Alabama Tuscaloosa County

Mobile County

Population** 4,447,100 164,875 399,843

Ethnicity

Black 29.9% 31.9% 36.9%

White 71.1% 68.1% 63.1%

Median income $34,135 $34,436 $17,178

Below poverty level

16.1% 17.0% 18.5%

At least a high school education**

75.3% 78.8% 76.7%

Total # Live births 62,061 2,296 6,216

*All data are from the 1999 census unless otherwise specified **2000 census

Study Population

• Prospective Cohort– Pregnant women in the first trimester of

pregnancy at their initial prenatal visit– All participants had to be between 13 and

34 years of age, either black or white, and receiving Medicaid waiver services

• Each participant was followed forward through childbirth

• Each participant was interviewed twice during the pregnancy– First trimester and third trimester

Methodology

• Sampling (N = 506)– Consecutive random (at participating clinics)• Possible participants’ charts were reviewed to

assess inclusion/exclusion criteria• Upon inclusion, participants were approached

during the prenatal visit• Informed consent received• Initial interview conducted (1-14 weeks gestation)• Final interview conducted (28-40 weeks gestation)

– Approximately 4 years of data collection with each participant followed for the duration of one pregnancy

Research Model

EthnicityBlackWhite

Partner Social Support

Physical and/orVerbal Abuse

PregnancyWantedness

Buffers

Buffers

Interacts

Results – Descriptive Characteristics

Characteristic Frequency Proportion (%)

Ethnicity

Black 227 44.9

White 170 33.6

Missing 109 21.5

Educational Level

<9th grade (middle school) 53 10.5

<High school, >middle school 267 52.8

<College, >high school/GED 160 31.6

College or greater 26 5.1

Marital Status

Single 296 58.5

Single, ever-married 45 8.9

Married/Living with partner 165 32.6

Results – Descriptive Characteristics

Characteristic Range Mean Standard Deviation

Missing

Age 14-35 22.5 4.39 0

Pre-pregnant weight (lbs.) 82.0-411.0 151.5 46.07 0

Height (inches) 57-78 64.5 2.82 2

Body Mass Index 14.0-60.7 25.5 7.03 2

Results – Descriptive Statistics: Measures of Partner Support


Partner Support

No 116 22.9

Yes 390 77.1

Characteristic Range Mean Standard Deviation

Missing

Partner Support Scale 0-6 3.7 2.41 0

Categorical Measure of Partner Social Support

Partner Support Scale (0-6)

Results – Descriptive Statistics: Pregnancy Wantedness and Abuse


Pregnancy Wantedness

No 210 41.5%

Yes 225 44.5%

Missing 71 14.0%

Abuse

Yes 176 34.8

No 330 65.2

Results – Analysis of Pregnancy Wantedness

Partner social support (present or absent) and pregnancy wantedness (N = 433)

Characteristica Odds Ratio

P-value

95% Confidence Interval

Social support 2.23 0.004 1.28-3.87

• Women who lack their partner’s social support are over 2 times more likely to say their pregnancy is unwanted compared with women who have their partner’s social support.

a Logistic regression adjusting for age, educational attainment, marital status, pre-pregnant weight, BMI


• Subgroup analysis of partner social support and ethnicity (Full Model) N = 349


P-value 95% Confidence Interval

Social support 2.19 0.050 1.00-4.82

Ethnicity 0.49 0.018 0.28-0.89

Social support*ethnicity 1.77 0.383 0.49-6.34a Logistic regression adjusting for age, educational attainment, marital status, pre-pregnant weight, BMI

• No significant interaction


Predictor = Partner social support scale and pregnancy wantedness (N = 433)


P-value

95% Confidence Interval

Social support 1.16 0.009 1.04-1.30

• For every one point increase in the social support scale, women are 16% more likely to say their pregnancy is wanted compared with a decrease in the scale.

a Logistic regression adjusting for age, educational attainment, marital status, pre-pregnant weight, BMI


• Subgroup analysis of partner social support and ethnicity (Full Model) N = 349Characteristica Odds

RatioP-value 95% Confidence

Interval

Social support 0.90 0.112 0.78-1.03

Ethnicity 0.88 0.801 0.33-2.38

Social support*ethnicity 0.90 0.318 0.72-1.11a Logistic regression adjusting for age, educational attainment, marital status, pre-pregnant weight, BMI

• No significant interaction

Results – Analysis of Physical and/or Verbal Abuse

Partner social support (present or absent and abuse (N = 433)– No significant findings after adjusting for

confoundingSubgroup analysis of partner support and ethnicity

(Full model) N = 397Characteristica Odds


Interval

Social support 0.87 0.712 0.41-1.85

Ethnicity 1.30 0.370 0.73-2.32

Social support*ethnicity 2.43 0.144 0.74-8.00a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy

Results – Physical and/or Verbal Abuse Subgroup Analysis

• White women (N = 170)


Lacking Social Support 1.30a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy

• White women who lack partner support are 30% more likely to report physical and/or verbal abuse compared with socially supported white women (and 2.74 times more likely than black women with support).


• Black women (N = 227)Characteristica Odds

Ratio

Lacking social support 0.34a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy

• Black women lacking social support are less likely to report abuse than black women with social support (about 3 times less likely).

Results – Analysis of Physical and/or Verbal Abuse

Predictor = Partner social support scale and abuse (N = 433)– No significant findings after adjusting for

confoundingSubgroup analysis of partner support and ethnicity

(Full model) N = 397Characteristica Odds


Interval

Social support 0.97 0.609 0.85-1.10

Ethnicity 2.64 0.38 1.05-6.62

Social support*ethnicity 0.87 0.18 0.71-1.07a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy


• White women (N = 170)


Lacking Social Support 2.64a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy

• White women who lack partner support are 2.64 times more likely to report physical and/or verbal abuse compared with socially supported white women (and 2.22 times more likely compared with socially supported black women).


• Black women (N = 227)Characteristica Odds

Ratio

Lacking social support 0.46a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy

• Black women who lack partner support are less likely to report physical and/or verbal abuse compared with black women who have social support (over 2 times less likely).

Discussion of Findings

• Partner social support is significantly associated with pregnancy wantedness– Presence of support is significantly associated with

wantedness

– The magnitude of support is significantly associated with wantedness

• Findings are consistent across both ethnic groups/no interaction with ethnicity

• Findings are consistent with current research• Findings have an intuitive appeal


• Partner social support during pregnancy is significantly associated with abuse only in the presence of ethnicity– Presence or absence of support is significantly associated with

abuse (interactive with ethnicity)– The magnitude of support is significantly associated with abuse

(interactive with ethnicity)

• Findings are inconsistent across ethnic groups: white women with no support are MORE likely to report abuse whereas black women with no support are LESS likely to report abuse

• Findings appear counterintuitive


• Possible explanations for disparate findings– Type of abuse plays a role in reporting– Perceived abuse may differ among cultural groups– Cultural differences in the role and definition of social

support– Social support measures may be masking

associations on subscales (e.g., emotional versus instrumental support may vary between the two groups)

– The role of the partner in providing social support may differ among groups (e.g., familial support may play a more defined role compared with partner support in specific groups)


• Next steps in analysis– Abuse will be divided into physical and

verbal abuse– The social support scale will be divided

into it’s emotional and material components

– Roles other family members play in social support will be analyzed

– The role of bias will be further assessed• Response bias and interviewer bias

Conclusions – Recommendations to Practitioners

• Assessing the presence or absence of partner support during pregnancy is key to decreasing specific stressors

• Further, the magnitude of partner support plays a role in buffering the affects of stressors

• Practitioners can take a proactive role in primary prevention of stressors, and may alleviate existing stressors by intervening in current relationships and encouraging increased support throughout the pregnancy process

Conclusions – Recommendations for Further Research

• Ongoing analysis of the current study will enable further explanation of preliminary findings

• Other psychosocial and physical stressors may be analyzed for assessment of the buffering effect of social support

• Future studies may focus on specific culturally defined subgroups for studying the buffering effect of partner support on stressors during pregnancy

Documents

Partner Influence on Women’s Perceptions of Pregnancy Charlan Kroelinger, MA, PhD c Department of Epidemiology and Biostatistics College of Public Health