Profiles of stressful life experiences in pregnancy: a latent class approach linking early childhood adversity, intimate partner coercive control, and material hardship to adverse birth outcomes

Abstract

Acute antenatal stressful life events (SLEs) during pregnancy are well-established risk factors for adverse birth outcomes. However, little is known about how distinct constellations of antenatal SLEs, shaped by early adversity, material hardship, and intimate partner coercive control, combine to influence perinatal health. Data were drawn from 5,280 participants in the Kansas Pregnancy Risk Assessment Monitoring System. Thirteen antenatal SLEs were analyzed using latent class analysis to identify distinct stress profiles. Multinomial logistic regression examined predictors of class membership, including adverse childhood experiences (ACEs), intimate partner violence (IPV), material hardship, and behavioral risk factors, controlling for sociodemographic and health covariates. Low birth weight, small for gestational age, and preterm birth were modeled as distal outcomes. Analyses were conducted using Mplus v8.4. Five distinct SLE profiles were identified: (1) Family Member Illness and Death (16.3%); (2) Multiple Overlapping Stressors (5.2%); (3) Financial Insecurity (11.2%); (4) Residential Instability and Family Conflict (8.7%); and (5) Low Stress (58.6%). Compared with the Low Stress class, individuals in all high-risk classes had significantly higher odds of reporting ACEs, IPV, material hardship, and cigarette use before pregnancy. The Multiple Overlapping Stressors class showed the greatest risk of LBW, SGA, and PTB, followed by the Financial Insecurity and Residential Instability classes. Substantial heterogeneity in antenatal SLEs highlight distinct pathways through which early adversity, material hardship, and relational traumas shape perinatal health. Tailoring perinatal interventions to specific SLE profiles, particularly for individuals with histories of ACEs and IPV, may reduce poor birth outcomes.