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I ROWELL, TIFFANY A., M.A. MAY 2020 PSYCHOLOGICAL ROWELL, TIFFANY A., M.A. MAY 2020 PSYCHOLOGICAL SCIENCES EXAMINING THE IMPACT OF PREGNANT BLACK WOMEN’S ADVERSE CHILDHOOD EXPERIENCES THROUGH MATERNAL HEALTH AND BIRTH OUTCOMES (74 PP.) Thesis Advisor: Angela Neal-Barnett, Ph.D. In the United States, Black mothers and their infants are dying at an alarming rate compared to White, Hispanic, Asian, and Native American infants. Psychosocial factors such as socioeconomic status, racism, and trauma have been cited as contributors to this health disparity. In order to better understand potential risk factors that contribute to the rising infant mortality rate of Black babies, this study aims to examine the impact of adverse childhood experiences (ACEs) on maternal health outcomes and infant birth outcomes. It was hypothesized that maternal ACEs would predict maternal distress, BMI, and blood pressure, as well as infant gestational age and birth weight. Additionally, it was hypothesized that maternal distress, BMI, and blood pressure would moderate the relationship between ACEs and birth outcomes. Results indicated that higher ACEs predicted lower levels of distress. There were no significant relationships between ACEs and maternal BMI, maternal, blood pressure, and infant birth outcomes. Lastly, the relationship between ACEs and birth outcomes was not moderated by maternal health variables. The findings from this study support an association between childhood trauma and distress that is likely found in trauma survivors who have difficulties with regulating their emotions and accurately conceptualizing their feelings of distress. Alternatively, the results may be explained by the resiliency of the mothers in this sample. Future work should continue to i examine the relationships between ACEs and maternal health and birth outcomes to understand risk and protective factors that influence the impact of trauma on maternal and infant health. ii EXAMINING THE IMPACT OF PREGNANT BLACK WOMEN’S ADVERSE CHILDHOOD EXPERIENCES THROUGH MATERNAL HEALTH AND BIRTH OUTCOMES A thesis submitted To Kent State University in partial Fulfillment of the requirements for the Degree of Master of Arts by Tiffany A. Rowell May, 2020 © Copyright All rights reserved Except for previously published materials iii Thesis written by Tiffany A. Rowell B.A., University of North Carolina at Chapel Hill, 2017 M.A., Kent State University, 2020 Approved by Angela Neal-Barnett, Ph.D. , Advisor Maria S. Zaragoza, Ph.D. , Chair, Department of Psychological Sciences James L. Blank, Ph.D. , Dean, College of Arts and Sciences iv TABLE OF CONTENTS .............................................................................................................. v LIST OF TABLES......................................................................................................................... vi ACKNOWLEDGEMENTS ......................................................................................................... vii CHAPTERS I. Introduction .............................................................................................................1 II. Methods..................................................................................................................18 III. Results ...................................................................................................................22 IV. Discussion .............................................................................................................25 REFERENCES .............................................................................................................................32 v LIST OF TABLES Table 1. Descriptive Information and Bivariate Correlations Among Variables…………..………...55 Table 2. One-Way Analysis of Variance of BMI by Trimester and Games-Howell Post-Hoc Comparisons…………………………………………………………………………………...……..56 Table 3. Regression Predicting Maternal Distress from ACEs………………………………..……..56 Table 4. Regression Predicting Maternal BMI from ACEs …….........................................................57 Table 5. Regression Predicting Systolic Blood Pressure from ACEs…………………………..........58 Table 6. Regression Predicting Diastolic Blood Pressure from ACEs……………………….……....58 Table 7. Regression Predicting Gestational Age from ACEs…………………………………...……59 Table 8. Regression Predicting Birth Weight from ACEs……………………...………………….…59 Table 9. Regression Predicting Gestational Age from the Interaction between ACEs and Distress…60 Table 10. Regression Predicting Gestational Age from the Interaction between ACEs and BMI.. …61 Table 11. Regression Predicting Gestational Age from the Interaction between ACEs and Systolic Blood Pressure…………………………………………………………………………………..........62 Table 12. Regression Predicting Gestational Age from the Interaction between ACEs and Diastolic Blood Pressure…………………………………………………………………………………..........63 Table 13. Regression Predicting Birth Weight from the Interaction between ACEs and Distress…..64 Table 14. Regression Predicting Birth Weight from the Interaction between ACEs and BMI………65 Table 15. Regression Predicting Birth Weight from the Interaction between ACEs and Systolic Blood Pressure………………...………………………………………………………………………..........66 Table 16. Regression Predicting Birth Weight from the Interaction between ACEs and Diastolic Blood Pressure…………………………………………………………………………………..........67 vi Acknowledgements My completion of this thesis would not have been possible without the continual support of many individuals. First, I would like to thank my advisor, Dr. Angela Neal- Barnett, for her guidance and dedication to my growth as a researcher. I am also grateful for the feedback that I received from the members of my committee, Dr. Robert Stadulis, Dr. Josefina Grau, and Dr. Jennifer Taber, who inspired me to think critically about this thesis. I am always thankful for my previous and current lab members, Dr. Martale Davis, Dana Pugh, Delilah Ellzey, Elizabeth Jean, and Keaton Somerville, for their endless encouragement. To my family, Robert, Berdell, and Leslie, thank you for your unconditional love and support throughout the completion of this project. Lastly, I would like to thank the previous project coordinator, Jordan Lally, and research assistants, Aliyah Moyé, Bobbi Broom, and Erika Daniels, for their hard work in data collection and preparation. vii Introduction Infant mortality is defined as the amount of infant deaths per 1,000 live births (Centers for Disease Control and Prevention [CDC], 2018). This rate was developed to measure a country’s health and progress, yet the United States continues to have one of the highest infant mortality rates among developed nations (Singh & Yu, 2019). One major area of concern focuses on the lives of Black infants. Black infants in the United States are far more likely to die before their first birthday compared to White, Hispanic, Asian, and Native American infants. In 2016, the infant mortality rate for Black infants was 11.4 deaths per 1,000 live births. This is greater than the 2017 national rate of 5.79 for all births (CDC, 2018). The racial/ethnic divide for infant mortality has been present since the earliest collection of this data in 1850, when the rate was 216.8 for Whites and 340 for Blacks (Haines, 2008). During this time, it was customary for infants to die due to weather, famine, war, and disease (Caplow, Hicks, Wattenberg, 2001). It was not until the 1880s when there were attempts to improve public health by implementing changes relating to hygiene, nutrition, and living conditions (Caplow, Hicks, Wattenberg, 2001). From that point forward, sewers were installed in cities, central heating became more commonplace to protect infants from the cold, and eventually, antibiotics and vaccinations were created to prevent fatal diseases. The national infant mortality rate drastically dropped as a result of these changes (Caplow, Hicks, Wattenberg, 2001). Despite the improvements in public health, Black infants were consistently dying at a higher rate compared to White infants (Haines, 2008; Singh & Yu, 2019). According to United 1 States National Vital Statistics System, between 1916 and 2017, the infant mortality rate declined annually by 3.1% for White infants and 2.6% for Black infants. This slow decline in Black infant mortality has led to a disparity that has worsened over time. For example, this gap changed from 87% in 1916, to 64% in 1950, and 112% in 2017 (Singh & Yu, 1995; Singh & Yu, 2019). The CDC (2018) cites birth defects, preterm birth, low birth weight, maternal pregnancy complications, sudden infant death syndrome, and injuries as the current leading physical causes of infant mortality. While these physical factors explain why the infant died in that moment, there are still questions about what led to these complications at birth. Literature concerning the reproductive outcomes of Black infants posit that psychological distress stress stemming various social determinants also leads to infant mortality (Dominguez, Dunkel-Schetter, Glynn, Hobel, & Sandman, 2008; Giurgescu et al., 2012; Lobel, Hamilton, & Cannella, 2008). Stress and Black Maternal and Infant Health For years, stress has proven to have harmful effects on the lives of Black women and their children (Hogue & Bremmer, 2005; Rich-Edwards et al., 2001; Rosenthal & Lobel, 2011; Pieterse, Carter, & Ray, 2013; Wadhwa et al., 2001). Chronic stress is more common and detrimental in the daily lives of Black women compared to White women (Lu, 2010; Renae Stancil, Hertz-Picciotto, Schramm, & Watt-Morse,
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