352 - Acculturation in Pregnant Immigrants and Differences in Stress and Resilience by Nativity

Publication Number: 352.3831

Alicia Laguna Torres, Childrens Hospital of Philadelphia, Irving, TX, United States; Leo Velosa, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Alejandra Barreto, Yale School of Medicine, New Haven, CT, United States; Brielle Formanowski, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Safyer McKenzie-Sampson, Stanford University School of Medicine, Palo Alto, CA, United States; Elena Fuentes-Afflick, Association of American Medical Colleges, San Francisco, CA, United States; Scott A. Lorch, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Diana Montoya-Williams, Children’s Hospital of Philadelphia, Philadelphia, PA, United States

Background: Foreign-born (FB) people have lower risk of poor birth outcomes than US-born racial/ethnic counterparts, but this reduction in risk appears to erode over time and across generations. Acculturation—the process by which immigrants assimilate to a receiving culture—may help explain these results, perhaps by impacting stress before and during pregnancy and a person’s ability to deal with stress, also known as self-reported resilience.

Objective: To describe acculturation in an urban cohort and assess whether various forms of prenatal stress and self-reported resilience vary by nativity.

Design/Methods: We analyzed an ongoing, prospective longitudinal cohort study of pregnant people recruited during their first trimester at 5 prenatal clinics in Philadelphia. Participants were defined as US vs. FB based on country of birth. FB people self-reported 3 proxy measures for acculturation (preferred language, age at immigration, and time in the US) which were combined into composite acculturation scores that ranged from 0-5; low scores reflected low acculturation. Participants completed validated scales for remote childhood stress (Adverse Childhood Experiences, ACEs), chronic stress (Prenatal Social Environment Inventory, PSEI), acute stress (Perceived Stress Scale, PSS), and resilience (the Connor-Davidson Resilience Scale, CD-RISC). Differences in stress and resilience were examined by nativity using Chi-square or Fisher’s exact test. Associations between acculturation scores and high vs. low stress were examined via ordered logistic regression models.

Results: Among 237 participants, 66(28%) were FB and mainly Hispanic, younger, uninsured, and low income (Table 1). Most FB people had immigrated as an adult and preferred a language other than English. 71% of the FB subgroup reported low acculturation (Table 2). FB pregnant people reported higher levels of acute and chronic stress compared to US-born people, but there were no differences in ACEs or resilience scores (Figure 1). There were no significant associations between acculturation scores and either acute or chronic stress among FB people in regression models.

Conclusion(s): In this cohort, FB people reported higher rates of acute and chronic stress than US-born counterparts, while resilience did not differ; acculturation did not associate with stress. Nativity may serve as a proxy for different forms of risk and resilience to poor birth outcomes in the same way hypothesized for race and ethnicity. Given lower rates of poor birth outcomes among pregnant immigrants, nativity may represent structural rather than individual differences in resilience to stress.

Table 1. Sociodemographic characteristics of pregnant people in study cohort


Figure 1. Differences in Various Types of Stress and Resilience by Nativity
Figure 1. Prevalence of each type of maternal stress (remote childhood, chronic, and acute) and resilience self-reported by participants in their first trimester, compared by nativity.
1. Chronic stress in past year: Prenatal Social Environment Inventory (PSEI) score ranges from 0-41; categories were assigned as follows: Low (0-6); Moderate (7-11); High (≥12). 2. Acute Stress in past month: Perceived Stress Scale (PSS) scores range from 0-40; categories were assigned as follows: Low (0-13); Moderate (14-26); High (27-40). 3. Remote Childhood Stress: Adverse Childhood Experiences (ACEs) categories were assigned as follows: Low (0 experiences); Moderate (1-2) High (3+). 4. The Connor-Davidson Resilience Scale © scores range from 0-100; categories were assigned as follows: Poor ( <60), Normal (60-70); Good (70-80); Excellent (>80).

Table 2. Acculturation of Foreign-Born Individuals in the Cohort (n=66)