Support From the Father of the Baby and Preterm Birth Among Black Women

Purpose: Preterm birth (PTB; birth before 37 completed weeks of gestation) is the leading cause of infant mortality among Blacks.[1] Compared with non-Hispanic white women, Black women are more likely to have PTB (8.9% and 13.4%, respectively in the United States).[1] Maternal depressive symptoms have been related higher risk of PTB among Black women.[2,3] Pregnant Black women also report lower levels of social support than pregnant white women.[4] Lack of social support was related to higher levels of depressive symptoms among Black women.[5,6] However, little has been reported on potential buffering effect of support from the father of the baby on the association between depressive symptoms and PTB. Thus, the purpose of this study was to examine if support from the father of the baby moderated the associations between depressive symptoms and PTB among Black women.

Methods: Data were obtained from the Life-course Influences on Fetal Environments study (2009-2011), a cohort of 1,410 Black women in Metropolitan Detroit, Michigan (71% response rate) using maternal interviews and medical record abstraction collected during the postpartum hospitalization. The 20-item Center for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. CES-D scores of 23 or higher have been related to severe depressive symptoms. The 14-item Social Networks in Adult Relations Questionnaire (SNARQ) was used to assess support from the father of the baby. We split the SNARQ at the median (scores less than 60=less support; scores 60 or higher= more support). Logistic regression was used to explore the interaction between CES-D and SNARQ with regard to PTB risk. We adjusted for maternal advanced age, income, education level, smoking status, hypertension, prenatal care, and Body Mass Index.

Results: The PTB rate in this cohort was 17.7%. Among women with SNARQ sores <60 (less support), the odd ratio (OR) of PTB for women with CES-D scores ≥23 (severe depressive symptoms) as compared to CES-D scores <23 (no severe depressive symptoms) was 2.57 [95% confidence interval (CI): 1.68, 3.94, p<0.001]. Among women with SNARQ scores ≥60 (more support), the odds of PTB in women with CES-D scores ≥23 did not significantly differ from the odds of PTB in women with CES-D scores <23 (OR=1.34; 95% CI: 0.74, 2.44; p=0.3). After adjustment for covariates, among women with SNARQ scores <60, the OR of PTB for women with CES-D scores ≥23 as compared to CES-D scores <23 increased by 8.5%. Among women with SNARQ scores ≥60, the odds of PTB in women with CES-D scores ≥23 was not statistically significantly different from the odds of PTB in women with CES-D scores <23. The interaction term was statistically significant (p=0.04).

Conclusion: Complex processes are at work in the lives of pregnant Black parents. We found that among women whose fathers of their babies were less supportive, women who reported severe symptoms of depression were more likely to have preterm birth. The buffering effect of support from the father of the baby on the association between depressive symptoms and preterm birth may be one mechanism by which the father of the baby influences birth outcomes among Black women. Understanding the role of the father of the baby on birth outcomes will provide the foundation for designing interventions to eliminate disparities in PTB among Black women.