Carmen Giurgescu | Wayne State University (original) (raw)

Papers by Carmen Giurgescu

Nursing Research, 2006

The effects of uncertainty and social support on the psychological well-being of high-risk pregna... more The effects of uncertainty and social support on the psychological well-being of high-risk pregnant women may be influenced by their prenatal coping strategies. The purpose of this study was to investigate whether prenatal coping strategies (preparation for motherhood, avoidance, positive interpretation of events, and prayer) mediate the effects of uncertainty and social support on the psychological well-being of high-risk pregnant women. A cross-sectional, descriptive, correlational design was used. The convenience sample consisted of 105 high-risk pregnant women 18-34 years of age and at 24-36 weeks gestation. The main measures were Mishel Uncertainty in Illness Scale, Medical Outcomes Study Social Support Survey, Prenatal Coping Inventory, and Psychological General Well-Being Index. Data analysis included descriptive statistics, correlational techniques, and path analyses. The women reported low levels of uncertainty, moderate levels of distress, and high levels of social support. Prayer was the most frequently used prenatal coping strategy, whereas avoidance was used least often. Women who reported higher levels of uncertainty also reported less social support (r = -.45, p < .01), less psychological well-being (r = -.48, p < .01), less positive interpretation (r = -.30, p < .01), and more use of avoidance (r = .43, p < .01). The modified path analysis showed good fit with the data. Avoidance significantly mediated the effects of uncertainty on psychological well-being (z = -2.74, p < .01). Social support had a significant direct effect on preparation for motherhood (beta = .43, z = 3.94, p < .001). Avoidance mediated the effect of uncertainty on psychological well-being for the high-risk pregnant women in this sample. The results of the study may help perinatal nurses to better understand how high-risk pregnancy affects these women.

Journal of midwifery & women's health, 2015

African American women have higher rates of preterm birth and low-birth-weight infants compared w... more African American women have higher rates of preterm birth and low-birth-weight infants compared with non-Hispanic white women. Symptoms of depression have also been related to these negative birth outcomes. Lower levels of social support and higher levels of avoidance coping and cortisol have been related to more symptoms of depression in pregnant women. The purpose of this pilot study was to examine the relationships among symptoms of depression, social support, avoidance coping, cortisol, and negative birth outcomes (ie, preterm birth, low-birth-weight infants) in a sample of African American women. This study used a prospective design. A convenience sample of 90 African American women completed questionnaires and had blood drawn in the second trimester of pregnancy. Birth data were collected from medical records. Based on the Center for Epidemiological Studies-Depression (CES-D) Scale scores, 28% of women were at increased risk for clinical depression (CES-D ≥ 16). Compared to wo...

MCN. The American journal of maternal child nursing

This study examined the relationships among father of the baby involvement during pregnancy, depr... more This study examined the relationships among father of the baby involvement during pregnancy, depressive symptoms, and psychological well-being in African American women. Using a prospective study design, a sample of 95 pregnant African American women receiving prenatal care at a medical center in Chicago completed the self-report instruments about father of the baby involvement, depressive symptoms, and psychological well-being twice during pregnancy, once at between 15 and 25 weeks and once between 25 and 37 weeks. Eighty percent of women reported that the father of the baby was involved during their pregnancy. Twenty-eight percent of women had clinically relevant depressive symptoms (CES-D scores ≥16) at the first data collection and 25% of women had clinically relevant depressive symptoms at the second data collection. Compared with women who reported no father involvement during pregnancy, women who reported father involvement during pregnancy had lower levels of depressive symp...

American Journal of Epidemiology, 2015

Perceptions of the residential environment may be associated with preterm delivery (PTD), though ... more Perceptions of the residential environment may be associated with preterm delivery (PTD), though few studies exist. Data from the Life-course Influences on Fetal Environments (LIFE) Study (metropolitan Detroit, Michigan, 2009-2011) were used to examine whether perceptions of the current social and physical environment were associated with PTD rates among postpartum African-American women (n = 1,411). Perceptions of the following neighborhood characteristics were measured with validated multi-item scales: healthy food availability, walkability, safety, social cohesion, and social disorder. No significant associations between perceived residential environment and PTD were found in the total sample. However, education significantly modified 4 of the 5 associations (all interaction P's < 0.05). In women with ≤12 years of education, significant inverse associations were observed between PTD rates and perceptions of the following neighborhood characteristics: healthy food availability (unadjusted prevalence ratio (uPR) = 0.81, 95% confidence interval (CI): 0.68, 0.98), walkability (uPR = 0.77, 95% CI: 0.64, 0.95), and safety (uPR = 0.73, 95% CI: 0.56, 0.95). Women with ≤12 years of education also had higher PTD rates with higher social disorder (age-adjusted PR = 1.54, 95% CI: 1.10, 2.17). Null associations existed for women with >12 years of education. The PTD rates of women with lower education may be significantly affected by the physical and social residential environment.

Brain, Behavior, and Immunity, 2014

Women's health issues : official publication of the Jacobs Institute of Women's Health, Jan 31, 2015

Although depressive symptoms during pregnancy have been related to negative maternal and child he... more Although depressive symptoms during pregnancy have been related to negative maternal and child health outcomes such as preterm birth, low birth weight infants, postpartum depression, and maladaptive mother-infant interactions, studies on the impact of neighborhood environment on depressive symptoms in pregnant women are limited. Pregnant women residing in disadvantaged neighborhoods reported higher levels of depressive symptoms and lower levels of social support. No researchers have examined the relationship between neighborhood environment and avoidance coping in pregnant women. Guided by the Ecological model and Lazarus and Folkman's transactional model of stress and coping, we examined whether social support and avoidance coping mediated associations between the neighborhood environment and depressive symptoms in pregnant African-American women. Pregnant African-American women (n = 95) from a medical center in Chicago completed the instruments twice during pregnancy between 1...

Archives of Women's Mental Health, 2014

Low-income African-American women report elevated prenatal depressive symptoms more often (42 %) ... more Low-income African-American women report elevated prenatal depressive symptoms more often (42 %) than the national average (20 %). In the USA in 2012, 16.5 % of African-American women experienced a premature birth (less than 36 completed gestational weeks) compared to 10.3 % of white women. In addition, 13 % of African-American women had a low-birth weight infant (less than 2,500 g) compared to 7 % of white women. Variation in the neuropeptide, oxytocin has been implicated in perinatal depression, maternal behavior, regulation of stress responses, and may be associated with this health disparity. The purpose of this investigation was to examine factors associated with prenatal depressive symptoms, including plasma oxytocin levels and birth weight, in a sample of urban African-American women. Pregnant African-American women (N=57) completed surveys and had blood drawn twice during pregnancy at 15-22 weeks and 25-37 weeks. In addition, birth data were collected from medical records. A large number of participants reported elevated prenatal depressive symptoms at the first (n=20, 35 %) and the second (n=19, 33 %) data points. Depressive symptoms were higher in multigravidas (t(51)=−2.374, p= 0.02), women with higher anxiety (r(47)=0.71, p=0.001), women who delivered their infants at an earlier gestational age (r(51)=−0.285, p=0.04), and those without the support of the infant's father (F(4, 48)=2.676, p=0.04). Depressive symptoms were also higher in women with low oxytocin levels than in women with high oxytocin levels (F(2, 47)= 3.3, p=0.05). In addition, women who had low oxytocin tended to have infants with lower birth weights (F(2, 47)= 2.9, p=0.06). Neither prenatal depressive symptoms nor prenatal oxytocin levels were associated with premature birth. Pregnant multigravida African-American women with increased levels of anxiety and lacking the baby's father's support during the pregnancy are at higher risk for prenatal depressive symptoms. Prenatal depressive symptoms are associated with low oxytocin levels and lower infant birth weights. Further research is needed to understand the mechanisms between prenatal depressive symptoms, oxytocin, and birth weight in order to better understand this health disparity.

Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 2015

This study examined factors associated with postpartum depressive symptoms in mothers with premat... more This study examined factors associated with postpartum depressive symptoms in mothers with premature infants in the neonatal intensive care unit (NICU). A total of 113 new mothers with very low-birth-weight infants in their initial NICU admission were recruited from 2 urban hospitals servicing low-income minority communities. This study employed a cross-sectional design. Data were collected during the infants' postpartum NICU admission and included maternal demographic information (eg, age, education, race, living with the baby's father), infant illness severity (Neurobiologic Risk Score from infant's medical record), and maternal psychological measures (the Center for Epidemiologic Studies Depression Scale, the Perinatal Posttraumatic Stress Questionnaire, and the State-Trait Anxiety Inventory). The findings indicated that 47 (42%) women had elevated postpartum depressive symptoms and 33 (30%) women had elevated postpartum posttraumatic stress symptoms (PTSs). Factors a...

Nursing Research, 2006

The effects of uncertainty and social support on the psychological well-being of high-risk pregna... more The effects of uncertainty and social support on the psychological well-being of high-risk pregnant women may be influenced by their prenatal coping strategies. The purpose of this study was to investigate whether prenatal coping strategies (preparation for motherhood, avoidance, positive interpretation of events, and prayer) mediate the effects of uncertainty and social support on the psychological well-being of high-risk pregnant women. A cross-sectional, descriptive, correlational design was used. The convenience sample consisted of 105 high-risk pregnant women 18-34 years of age and at 24-36 weeks gestation. The main measures were Mishel Uncertainty in Illness Scale, Medical Outcomes Study Social Support Survey, Prenatal Coping Inventory, and Psychological General Well-Being Index. Data analysis included descriptive statistics, correlational techniques, and path analyses. The women reported low levels of uncertainty, moderate levels of distress, and high levels of social support. Prayer was the most frequently used prenatal coping strategy, whereas avoidance was used least often. Women who reported higher levels of uncertainty also reported less social support (r = -.45, p < .01), less psychological well-being (r = -.48, p < .01), less positive interpretation (r = -.30, p < .01), and more use of avoidance (r = .43, p < .01). The modified path analysis showed good fit with the data. Avoidance significantly mediated the effects of uncertainty on psychological well-being (z = -2.74, p < .01). Social support had a significant direct effect on preparation for motherhood (beta = .43, z = 3.94, p < .001). Avoidance mediated the effect of uncertainty on psychological well-being for the high-risk pregnant women in this sample. The results of the study may help perinatal nurses to better understand how high-risk pregnancy affects these women.

Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2009

Objective: To examine the evidence related to the relationship between maternal cortisol levels a... more Objective: To examine the evidence related to the relationship between maternal cortisol levels and preterm birth.

Journal of Midwifery & Women's Health, 2011

The purpose of this integrative review was to evaluate what is known about the relationship betwe... more The purpose of this integrative review was to evaluate what is known about the relationship between racial discrimination and adverse birth outcomes. Methods: A search of the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and PsycINFO was conducted. The keywords used were: preterm birth, premature birth, preterm delivery, preterm labor, low birth weight, very low birth weight, racism, racial discrimination, and prejudice. Ten research studies were reviewed. All of the studies included African American women in their samples, were conducted in the United States, and were written in English. We did not limit the year of publication for the studies. Data were extracted based on the birth outcomes of preterm birth, low birth weight, or very low birth weight. Results: A consistent positive relationship existed between perceptions of racial discrimination and preterm birth, low birth weight, and very low birth weight. No relationship was found between racial discrimination and gestational age at birth. Discussion: Future research should explore the effects of racial discrimination as a chronic stressor contributing to the persistent gap in birth outcomes between racial groups.

Journal of Midwifery & Women's Health, 2009

Pregnancy-associated breast cancer (PABC) is defined as cancer of the breast diagnosed during pre... more Pregnancy-associated breast cancer (PABC) is defined as cancer of the breast diagnosed during pregnancy and up to 1 year postpartum. Delays in diagnosis are frequently associated with increased morbidity and mortality. The aim of this article is to determine the significance of early detection of PABC and to alert health care providers to include PABC in the differential diagnosis when evaluating a breast mass in the perinatal period. This integrative literature review evaluated 15 research studies by using the hypothetical deductive model of clinical reasoning to determine factors related to diagnosis of PABC. As women delay childbearing, the incidence of PABC increases with age. In the reviewed studies, breast cancer was diagnosed with greater frequency in the postpartum period than during any trimester in pregnancy. Delay in diagnosis is complicated by axillary lymph node metastasis, high-grade tumors at diagnosis, and poor outcomes. Early detection is a significant predictor of improved outcomes. Diagnostic modalities such as ultrasound, mammography, and biopsy can be safely used for diagnostic purposes in the evaluation of potential cases of PABC during pregnancy. J Midwifery

Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG

To determine the effects of displacement due to flooding during pregnancy on birth outcomes (infa... more To determine the effects of displacement due to flooding during pregnancy on birth outcomes (infant birth weight and gestational age) and the moderating effect of perceived social support on the relationship between displacement and birth outcomes. A descriptive, longitudinal study. A university-affiliated hospital in Pathum Thani, Thailand. Pregnant women (N = 175) in the third trimester that had uncomplicated pregnancies and no history of mental illness. During pregnancy, the participants completed standardized measurements of depression symptoms, perceived social support, and questionnaires concerning the effect of the flood. After giving birth, infant birth weight and gestational age at birth were retrieved from delivery records. Seventy percent (n = 123) of the participants experienced displacement during the flood. The displaced women had a mean infant birth weight of 175 grams less than that of the nondisplaced women, t(173) = -2.38, p = .02, whereas infant gestational age wa...

Social Science & Medicine, 2015

Living in a lower-quality neighborhood is associated with higher levels of depressive symptoms in... more Living in a lower-quality neighborhood is associated with higher levels of depressive symptoms in the general population as well as among pregnant and postpartum women. However, little is known of the important pathways by which this association occurs. We proposed a model in which perceived stress and social support mediated the effects of neighborhood quality on depressive symptoms during pregnancy (measured by the 20-item Center for Epidemiologic Studies-Depression, CES-D, scale) in a sample of 1383 African American women from the Detroit metropolitan area interviewed during their delivery hospitalization. Using structural equation modeling (SEM), we built a latent variable of neighborhood quality using 4 measures (neighborhood disorder, neighborhood safety/danger, walking environment, overall rating). We then tested two SEM mediation models. We found that lower neighborhood quality was associated with higher prevalence of depressive symptoms during pregnancy (standardized total effect=.16, p=.011). We found that perceived stress partially mediated the neighborhood quality association with depressive symptoms. Although the association of social support with depressive symptoms was negligible, social support mediated associations of neighborhood quality with perceived stress [standardized path coefficient=.38 (.02), p=.009]. Our results point to the need for public health, health care, as well as non-health related interventions (e.g. crime prevention programs) to decrease overall exposure to stressors, as well as stress levels of women living in poor quality neighborhoods. Interventions that increase the levels of social support of women during pregnancy are also needed for their potential to decrease stress and ultimately improve mental health at this important time in the life course.

MCN The American Journal of Maternal/Child Nursing, 2013

To explore pregnant African American women&#3... more To explore pregnant African American women's views of factors that may impact preterm birth. Qualitative descriptive exploratory cross-sectional design. A convenience sample of 22 low-risk pregnant African American women participated in focus group interviews. Women were asked questions regarding their belief about why women have preterm birth and factors impacting preterm birth. Data were analyzed using content analysis. Pregnant African American women encounter multiple physical, psychological, and social stressors. The four themes included knowledge of preterm birth, risk factors for preterm birth, protective factors for preterm birth, and preterm birth inevitability. The risk factors for preterm birth were health-related conditions, stressors, and unhealthy behaviors. Stressors included lack of social and financial support, interpersonal conflicts, judging, dangerous neighborhoods, racism, and pregnancy- and mothering-related worries. Protective factors for preterm birth included social support and positive coping/self-care. Clinicians may use the results of this study to better understand women's perceptions of factors that affect preterm birth, to educate women about risk factors for preterm birth, and to develop programs and advocate for policies that have the potential to decrease health disparities in preterm birth.

Journal of the American Psychiatric Nurses Association, 2013

... Nancy G. Buccola1, Mary Rosedale2, and Tami Bryan3 ... Both the ERCAAP and WHO studies used a... more ... Nancy G. Buccola1, Mary Rosedale2, and Tami Bryan3 ... Both the ERCAAP and WHO studies used a sequen-tial sampling method, and although this is not a random-ized sample, it can becomeclose to representative of a population when the numbers are large, as they are in ...

The Journal of Perinatal & Neonatal Nursing, 2013

This research aimed to develop an initial understanding of the stressors, stress responses, and p... more This research aimed to develop an initial understanding of the stressors, stress responses, and personal resources that impact African American women during pregnancy, potentially leading to preterm birth. Guided by the ecological model, a prospective, mixed-methods, complementarity design was used with 11 pregnant women and 8 of their significant others. Our integrated analysis of quantitative

Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2012

To (a) examine the relationships among objective and perceived indicators of neighborhood environ... more To (a) examine the relationships among objective and perceived indicators of neighborhood environment, racial discrimination, psychological distress, and gestational age at birth; (b) determine if neighborhood environment and racial discrimination predicted psychological distress; (c) determine if neighborhood environment, racial discrimination, and psychological distress predicted preterm birth; and (d) determine if psychological distress mediated the effects of neighborhood environment and racial discrimination on preterm birth. Descriptive correlational comparative. Postpartum unit of a medical center in Chicago. African American women (n(1) = 33 with preterm birth; n(2) = 39 with full-term birth). Women completed the instruments 24 to 72 hours after birth. Objective measures of the neighborhood were derived using geographic information systems (GIS). Women who reported higher levels of perceived social and physical disorder and perceived crime also reported higher levels of psychological distress. Women who reported more experiences of racial discrimination also had higher levels of psychological distress. Objective social disorder and perceived crime predicted psychological distress. Objective physical disorder and psychological distress predicted preterm birth. Psychological distress mediated the effect of objective social disorder and perceived crime on preterm birth. Women's neighborhood environments and racial discrimination were related to psychological distress, and these factors may increase the risk for preterm birth.

Archives of Women's Mental Health, 2014

Most Thai women continue to work throughout their pregnancy; however, little is known about job s... more Most Thai women continue to work throughout their pregnancy; however, little is known about job strain and its relation to psychological distress. This study aimed to examine: (1) the direct effects of job strain, perceived workplace support, perceived family support, and coping strategies on psychological distress and (2) the moderating effect of perceived workplace support, perceived family support, and coping strategies on the relationship between job strain and psychological distress. Lazarus and Folkman's transactional model of stress and coping guided this cross-sectional study.

Nursing Research, 2006

The effects of uncertainty and social support on the psychological well-being of high-risk pregna... more The effects of uncertainty and social support on the psychological well-being of high-risk pregnant women may be influenced by their prenatal coping strategies. The purpose of this study was to investigate whether prenatal coping strategies (preparation for motherhood, avoidance, positive interpretation of events, and prayer) mediate the effects of uncertainty and social support on the psychological well-being of high-risk pregnant women. A cross-sectional, descriptive, correlational design was used. The convenience sample consisted of 105 high-risk pregnant women 18-34 years of age and at 24-36 weeks gestation. The main measures were Mishel Uncertainty in Illness Scale, Medical Outcomes Study Social Support Survey, Prenatal Coping Inventory, and Psychological General Well-Being Index. Data analysis included descriptive statistics, correlational techniques, and path analyses. The women reported low levels of uncertainty, moderate levels of distress, and high levels of social support. Prayer was the most frequently used prenatal coping strategy, whereas avoidance was used least often. Women who reported higher levels of uncertainty also reported less social support (r = -.45, p < .01), less psychological well-being (r = -.48, p < .01), less positive interpretation (r = -.30, p < .01), and more use of avoidance (r = .43, p < .01). The modified path analysis showed good fit with the data. Avoidance significantly mediated the effects of uncertainty on psychological well-being (z = -2.74, p < .01). Social support had a significant direct effect on preparation for motherhood (beta = .43, z = 3.94, p < .001). Avoidance mediated the effect of uncertainty on psychological well-being for the high-risk pregnant women in this sample. The results of the study may help perinatal nurses to better understand how high-risk pregnancy affects these women.

Journal of midwifery & women's health, 2015

African American women have higher rates of preterm birth and low-birth-weight infants compared w... more African American women have higher rates of preterm birth and low-birth-weight infants compared with non-Hispanic white women. Symptoms of depression have also been related to these negative birth outcomes. Lower levels of social support and higher levels of avoidance coping and cortisol have been related to more symptoms of depression in pregnant women. The purpose of this pilot study was to examine the relationships among symptoms of depression, social support, avoidance coping, cortisol, and negative birth outcomes (ie, preterm birth, low-birth-weight infants) in a sample of African American women. This study used a prospective design. A convenience sample of 90 African American women completed questionnaires and had blood drawn in the second trimester of pregnancy. Birth data were collected from medical records. Based on the Center for Epidemiological Studies-Depression (CES-D) Scale scores, 28% of women were at increased risk for clinical depression (CES-D ≥ 16). Compared to wo...

MCN. The American journal of maternal child nursing

This study examined the relationships among father of the baby involvement during pregnancy, depr... more This study examined the relationships among father of the baby involvement during pregnancy, depressive symptoms, and psychological well-being in African American women. Using a prospective study design, a sample of 95 pregnant African American women receiving prenatal care at a medical center in Chicago completed the self-report instruments about father of the baby involvement, depressive symptoms, and psychological well-being twice during pregnancy, once at between 15 and 25 weeks and once between 25 and 37 weeks. Eighty percent of women reported that the father of the baby was involved during their pregnancy. Twenty-eight percent of women had clinically relevant depressive symptoms (CES-D scores ≥16) at the first data collection and 25% of women had clinically relevant depressive symptoms at the second data collection. Compared with women who reported no father involvement during pregnancy, women who reported father involvement during pregnancy had lower levels of depressive symp...

American Journal of Epidemiology, 2015

Perceptions of the residential environment may be associated with preterm delivery (PTD), though ... more Perceptions of the residential environment may be associated with preterm delivery (PTD), though few studies exist. Data from the Life-course Influences on Fetal Environments (LIFE) Study (metropolitan Detroit, Michigan, 2009-2011) were used to examine whether perceptions of the current social and physical environment were associated with PTD rates among postpartum African-American women (n = 1,411). Perceptions of the following neighborhood characteristics were measured with validated multi-item scales: healthy food availability, walkability, safety, social cohesion, and social disorder. No significant associations between perceived residential environment and PTD were found in the total sample. However, education significantly modified 4 of the 5 associations (all interaction P's < 0.05). In women with ≤12 years of education, significant inverse associations were observed between PTD rates and perceptions of the following neighborhood characteristics: healthy food availability (unadjusted prevalence ratio (uPR) = 0.81, 95% confidence interval (CI): 0.68, 0.98), walkability (uPR = 0.77, 95% CI: 0.64, 0.95), and safety (uPR = 0.73, 95% CI: 0.56, 0.95). Women with ≤12 years of education also had higher PTD rates with higher social disorder (age-adjusted PR = 1.54, 95% CI: 1.10, 2.17). Null associations existed for women with >12 years of education. The PTD rates of women with lower education may be significantly affected by the physical and social residential environment.

Brain, Behavior, and Immunity, 2014

Women's health issues : official publication of the Jacobs Institute of Women's Health, Jan 31, 2015

Although depressive symptoms during pregnancy have been related to negative maternal and child he... more Although depressive symptoms during pregnancy have been related to negative maternal and child health outcomes such as preterm birth, low birth weight infants, postpartum depression, and maladaptive mother-infant interactions, studies on the impact of neighborhood environment on depressive symptoms in pregnant women are limited. Pregnant women residing in disadvantaged neighborhoods reported higher levels of depressive symptoms and lower levels of social support. No researchers have examined the relationship between neighborhood environment and avoidance coping in pregnant women. Guided by the Ecological model and Lazarus and Folkman's transactional model of stress and coping, we examined whether social support and avoidance coping mediated associations between the neighborhood environment and depressive symptoms in pregnant African-American women. Pregnant African-American women (n = 95) from a medical center in Chicago completed the instruments twice during pregnancy between 1...

Archives of Women's Mental Health, 2014

Low-income African-American women report elevated prenatal depressive symptoms more often (42 %) ... more Low-income African-American women report elevated prenatal depressive symptoms more often (42 %) than the national average (20 %). In the USA in 2012, 16.5 % of African-American women experienced a premature birth (less than 36 completed gestational weeks) compared to 10.3 % of white women. In addition, 13 % of African-American women had a low-birth weight infant (less than 2,500 g) compared to 7 % of white women. Variation in the neuropeptide, oxytocin has been implicated in perinatal depression, maternal behavior, regulation of stress responses, and may be associated with this health disparity. The purpose of this investigation was to examine factors associated with prenatal depressive symptoms, including plasma oxytocin levels and birth weight, in a sample of urban African-American women. Pregnant African-American women (N=57) completed surveys and had blood drawn twice during pregnancy at 15-22 weeks and 25-37 weeks. In addition, birth data were collected from medical records. A large number of participants reported elevated prenatal depressive symptoms at the first (n=20, 35 %) and the second (n=19, 33 %) data points. Depressive symptoms were higher in multigravidas (t(51)=−2.374, p= 0.02), women with higher anxiety (r(47)=0.71, p=0.001), women who delivered their infants at an earlier gestational age (r(51)=−0.285, p=0.04), and those without the support of the infant's father (F(4, 48)=2.676, p=0.04). Depressive symptoms were also higher in women with low oxytocin levels than in women with high oxytocin levels (F(2, 47)= 3.3, p=0.05). In addition, women who had low oxytocin tended to have infants with lower birth weights (F(2, 47)= 2.9, p=0.06). Neither prenatal depressive symptoms nor prenatal oxytocin levels were associated with premature birth. Pregnant multigravida African-American women with increased levels of anxiety and lacking the baby's father's support during the pregnancy are at higher risk for prenatal depressive symptoms. Prenatal depressive symptoms are associated with low oxytocin levels and lower infant birth weights. Further research is needed to understand the mechanisms between prenatal depressive symptoms, oxytocin, and birth weight in order to better understand this health disparity.

Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 2015

This study examined factors associated with postpartum depressive symptoms in mothers with premat... more This study examined factors associated with postpartum depressive symptoms in mothers with premature infants in the neonatal intensive care unit (NICU). A total of 113 new mothers with very low-birth-weight infants in their initial NICU admission were recruited from 2 urban hospitals servicing low-income minority communities. This study employed a cross-sectional design. Data were collected during the infants' postpartum NICU admission and included maternal demographic information (eg, age, education, race, living with the baby's father), infant illness severity (Neurobiologic Risk Score from infant's medical record), and maternal psychological measures (the Center for Epidemiologic Studies Depression Scale, the Perinatal Posttraumatic Stress Questionnaire, and the State-Trait Anxiety Inventory). The findings indicated that 47 (42%) women had elevated postpartum depressive symptoms and 33 (30%) women had elevated postpartum posttraumatic stress symptoms (PTSs). Factors a...

Nursing Research, 2006

The effects of uncertainty and social support on the psychological well-being of high-risk pregna... more The effects of uncertainty and social support on the psychological well-being of high-risk pregnant women may be influenced by their prenatal coping strategies. The purpose of this study was to investigate whether prenatal coping strategies (preparation for motherhood, avoidance, positive interpretation of events, and prayer) mediate the effects of uncertainty and social support on the psychological well-being of high-risk pregnant women. A cross-sectional, descriptive, correlational design was used. The convenience sample consisted of 105 high-risk pregnant women 18-34 years of age and at 24-36 weeks gestation. The main measures were Mishel Uncertainty in Illness Scale, Medical Outcomes Study Social Support Survey, Prenatal Coping Inventory, and Psychological General Well-Being Index. Data analysis included descriptive statistics, correlational techniques, and path analyses. The women reported low levels of uncertainty, moderate levels of distress, and high levels of social support. Prayer was the most frequently used prenatal coping strategy, whereas avoidance was used least often. Women who reported higher levels of uncertainty also reported less social support (r = -.45, p < .01), less psychological well-being (r = -.48, p < .01), less positive interpretation (r = -.30, p < .01), and more use of avoidance (r = .43, p < .01). The modified path analysis showed good fit with the data. Avoidance significantly mediated the effects of uncertainty on psychological well-being (z = -2.74, p < .01). Social support had a significant direct effect on preparation for motherhood (beta = .43, z = 3.94, p < .001). Avoidance mediated the effect of uncertainty on psychological well-being for the high-risk pregnant women in this sample. The results of the study may help perinatal nurses to better understand how high-risk pregnancy affects these women.

Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2009

Objective: To examine the evidence related to the relationship between maternal cortisol levels a... more Objective: To examine the evidence related to the relationship between maternal cortisol levels and preterm birth.

Journal of Midwifery & Women's Health, 2011

The purpose of this integrative review was to evaluate what is known about the relationship betwe... more The purpose of this integrative review was to evaluate what is known about the relationship between racial discrimination and adverse birth outcomes. Methods: A search of the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and PsycINFO was conducted. The keywords used were: preterm birth, premature birth, preterm delivery, preterm labor, low birth weight, very low birth weight, racism, racial discrimination, and prejudice. Ten research studies were reviewed. All of the studies included African American women in their samples, were conducted in the United States, and were written in English. We did not limit the year of publication for the studies. Data were extracted based on the birth outcomes of preterm birth, low birth weight, or very low birth weight. Results: A consistent positive relationship existed between perceptions of racial discrimination and preterm birth, low birth weight, and very low birth weight. No relationship was found between racial discrimination and gestational age at birth. Discussion: Future research should explore the effects of racial discrimination as a chronic stressor contributing to the persistent gap in birth outcomes between racial groups.

Journal of Midwifery & Women's Health, 2009

Pregnancy-associated breast cancer (PABC) is defined as cancer of the breast diagnosed during pre... more Pregnancy-associated breast cancer (PABC) is defined as cancer of the breast diagnosed during pregnancy and up to 1 year postpartum. Delays in diagnosis are frequently associated with increased morbidity and mortality. The aim of this article is to determine the significance of early detection of PABC and to alert health care providers to include PABC in the differential diagnosis when evaluating a breast mass in the perinatal period. This integrative literature review evaluated 15 research studies by using the hypothetical deductive model of clinical reasoning to determine factors related to diagnosis of PABC. As women delay childbearing, the incidence of PABC increases with age. In the reviewed studies, breast cancer was diagnosed with greater frequency in the postpartum period than during any trimester in pregnancy. Delay in diagnosis is complicated by axillary lymph node metastasis, high-grade tumors at diagnosis, and poor outcomes. Early detection is a significant predictor of improved outcomes. Diagnostic modalities such as ultrasound, mammography, and biopsy can be safely used for diagnostic purposes in the evaluation of potential cases of PABC during pregnancy. J Midwifery

Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG

To determine the effects of displacement due to flooding during pregnancy on birth outcomes (infa... more To determine the effects of displacement due to flooding during pregnancy on birth outcomes (infant birth weight and gestational age) and the moderating effect of perceived social support on the relationship between displacement and birth outcomes. A descriptive, longitudinal study. A university-affiliated hospital in Pathum Thani, Thailand. Pregnant women (N = 175) in the third trimester that had uncomplicated pregnancies and no history of mental illness. During pregnancy, the participants completed standardized measurements of depression symptoms, perceived social support, and questionnaires concerning the effect of the flood. After giving birth, infant birth weight and gestational age at birth were retrieved from delivery records. Seventy percent (n = 123) of the participants experienced displacement during the flood. The displaced women had a mean infant birth weight of 175 grams less than that of the nondisplaced women, t(173) = -2.38, p = .02, whereas infant gestational age wa...

Social Science & Medicine, 2015

Living in a lower-quality neighborhood is associated with higher levels of depressive symptoms in... more Living in a lower-quality neighborhood is associated with higher levels of depressive symptoms in the general population as well as among pregnant and postpartum women. However, little is known of the important pathways by which this association occurs. We proposed a model in which perceived stress and social support mediated the effects of neighborhood quality on depressive symptoms during pregnancy (measured by the 20-item Center for Epidemiologic Studies-Depression, CES-D, scale) in a sample of 1383 African American women from the Detroit metropolitan area interviewed during their delivery hospitalization. Using structural equation modeling (SEM), we built a latent variable of neighborhood quality using 4 measures (neighborhood disorder, neighborhood safety/danger, walking environment, overall rating). We then tested two SEM mediation models. We found that lower neighborhood quality was associated with higher prevalence of depressive symptoms during pregnancy (standardized total effect=.16, p=.011). We found that perceived stress partially mediated the neighborhood quality association with depressive symptoms. Although the association of social support with depressive symptoms was negligible, social support mediated associations of neighborhood quality with perceived stress [standardized path coefficient=.38 (.02), p=.009]. Our results point to the need for public health, health care, as well as non-health related interventions (e.g. crime prevention programs) to decrease overall exposure to stressors, as well as stress levels of women living in poor quality neighborhoods. Interventions that increase the levels of social support of women during pregnancy are also needed for their potential to decrease stress and ultimately improve mental health at this important time in the life course.

MCN The American Journal of Maternal/Child Nursing, 2013

To explore pregnant African American women&#3... more To explore pregnant African American women's views of factors that may impact preterm birth. Qualitative descriptive exploratory cross-sectional design. A convenience sample of 22 low-risk pregnant African American women participated in focus group interviews. Women were asked questions regarding their belief about why women have preterm birth and factors impacting preterm birth. Data were analyzed using content analysis. Pregnant African American women encounter multiple physical, psychological, and social stressors. The four themes included knowledge of preterm birth, risk factors for preterm birth, protective factors for preterm birth, and preterm birth inevitability. The risk factors for preterm birth were health-related conditions, stressors, and unhealthy behaviors. Stressors included lack of social and financial support, interpersonal conflicts, judging, dangerous neighborhoods, racism, and pregnancy- and mothering-related worries. Protective factors for preterm birth included social support and positive coping/self-care. Clinicians may use the results of this study to better understand women's perceptions of factors that affect preterm birth, to educate women about risk factors for preterm birth, and to develop programs and advocate for policies that have the potential to decrease health disparities in preterm birth.

Journal of the American Psychiatric Nurses Association, 2013

... Nancy G. Buccola1, Mary Rosedale2, and Tami Bryan3 ... Both the ERCAAP and WHO studies used a... more ... Nancy G. Buccola1, Mary Rosedale2, and Tami Bryan3 ... Both the ERCAAP and WHO studies used a sequen-tial sampling method, and although this is not a random-ized sample, it can becomeclose to representative of a population when the numbers are large, as they are in ...

The Journal of Perinatal & Neonatal Nursing, 2013

This research aimed to develop an initial understanding of the stressors, stress responses, and p... more This research aimed to develop an initial understanding of the stressors, stress responses, and personal resources that impact African American women during pregnancy, potentially leading to preterm birth. Guided by the ecological model, a prospective, mixed-methods, complementarity design was used with 11 pregnant women and 8 of their significant others. Our integrated analysis of quantitative

Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2012

To (a) examine the relationships among objective and perceived indicators of neighborhood environ... more To (a) examine the relationships among objective and perceived indicators of neighborhood environment, racial discrimination, psychological distress, and gestational age at birth; (b) determine if neighborhood environment and racial discrimination predicted psychological distress; (c) determine if neighborhood environment, racial discrimination, and psychological distress predicted preterm birth; and (d) determine if psychological distress mediated the effects of neighborhood environment and racial discrimination on preterm birth. Descriptive correlational comparative. Postpartum unit of a medical center in Chicago. African American women (n(1) = 33 with preterm birth; n(2) = 39 with full-term birth). Women completed the instruments 24 to 72 hours after birth. Objective measures of the neighborhood were derived using geographic information systems (GIS). Women who reported higher levels of perceived social and physical disorder and perceived crime also reported higher levels of psychological distress. Women who reported more experiences of racial discrimination also had higher levels of psychological distress. Objective social disorder and perceived crime predicted psychological distress. Objective physical disorder and psychological distress predicted preterm birth. Psychological distress mediated the effect of objective social disorder and perceived crime on preterm birth. Women's neighborhood environments and racial discrimination were related to psychological distress, and these factors may increase the risk for preterm birth.

Archives of Women's Mental Health, 2014

Most Thai women continue to work throughout their pregnancy; however, little is known about job s... more Most Thai women continue to work throughout their pregnancy; however, little is known about job strain and its relation to psychological distress. This study aimed to examine: (1) the direct effects of job strain, perceived workplace support, perceived family support, and coping strategies on psychological distress and (2) the moderating effect of perceived workplace support, perceived family support, and coping strategies on the relationship between job strain and psychological distress. Lazarus and Folkman's transactional model of stress and coping guided this cross-sectional study.