Overall, this longitudinal study of postpartum Latinas found several psychosocial and socio-demographic factors independently predicted perceived postpartum health status, with differential contributions noted for the three parameters of health status (i.e., overall, emotional well-being, physical health). Specifically, five prenatal factors emerged as significant predictors of postpartum health status at the 12-week time period: perceived stress, social support, recent IPV exposure, health problems experienced during pregnancy or delivery, and for foreign-born women, years lived in the United States.
Perceived stress during pregnancy demonstrated a particularly robust influence on general perceived health status and emotional well-being at 12 weeks postpartum. Women reported mean scores of perceived stress during pregnancy in the moderate range of severity, and higher levels of perceived stress were found to be inversely related to decreased health status. The importance of this finding is emphasized by the fact that it held even after controlling for symptoms of PTSD, trauma exposure and social support. As such, this result strengthens those of prior studies documenting that women may be particularly vulnerable to the effects of stress in early pregnancy in relation to postpartum health. After controlling for demographic and medical factors, Glynn and colleagues found that women who experienced an earthquake in the first trimester of pregnancy rated the event as more stressful than those in later pregnancy and that stress in early pregnancy contributed to gestation length [40
]. Taken together, these data and others provide compelling evidence that perceived stress during pregnancy should be monitored and should receive increased attention in similar research. This research should more fully explore the source(s) of the perceived stress during early pregnancy and determine whether there are differential contributions by stress type (e.g., health-related, interpersonal) associated with health status.
Consistent with other studies documenting the positive role of social support and health among pregnant Latinas, [33
] social support appeared to have a strong and protective influence on emotional well-being in this study. That is, increased levels of social support during pregnancy were significantly and positively related to increased levels of postpartum emotional well-being. However, this association was not substantiated in relation to overall health status or physical health status. In a cross-sectional study on multi-ethnic women in late pregnancy, McKee and colleagues did not find social support to be related to emotional well-being or physical health but it was weakly associated with overall health status [14
]. A possible explanation for this unexpected finding in the current study may be attributed to the limited variance of social support in the sample (the majority of the sample reported high levels of social support), along with the broader framework of psychosocial factors in which it was examined. High levels of social support in the sample may also help to explain why recent IPV exposure (i.e., in the previous 12 months) was related only to physical health status; social support may have inoculated participants from the more severe emotional distress associated with IPV exposure. Prior findings using several indicators to assess abuse have found childhood trauma and physical and sexual IPV to be associated with health status and emotional well-being but did not control for social support. Therefore, future research should confirm this finding while assessing more fully the type, duration and severity of IPV.
Problems experienced during pregnancy or delivery have been associated with health status, and in some cases, as far out as 14 years postpartum [41
]. In our study, such problems were negatively associated with scores on physical health status. Given that this scale assesses role functioning and women have reported difficulties in role functioning for as long as 12 weeks postpartum, this was not a surprising finding.
Foreign-born women who had lived in the United States <10 years had higher scores on overall health status and emotional well-being when compared to US-born women and foreign-born women who had lived in the US >10 years. This finding is generally congruent with the premise that the health and well-being of foreign-born Latinas tend to decrease with increased time lived in the US [42
]. Likewise, period of residency in the US is frequently used as a proxy for acculturation, which has been found to serve a protective role in some aspects of health among foreign-born Latinas [43
]. As the length of time immigrants live in the US increases, their exposure to new stressors (e.g., discrimination) likely increases, which might also help to explain this finding [44
Symptoms of PTSD were correlated with depressive symptoms and overall health status in this sample but did not emerge as an independent predictor. It is possible that this association was not confirmed because of the relatively low mean scores on both measures assessing symptoms of depression and PTSD reported in this sample. Also, the broad psychosocial context in which these symptoms were examined in this study may have influenced this finding (e.g., sub-clinical distress measured by perceived stress). Given that previous studies have found depressive symptoms during pregnancy to be a robust predictor of perceived health status, this finding should be interpreted with caution and replicated in future studies.
Several caveats to study interpretation deserve mention. First, culture-specific factors (e.g., cultural ties, discrimination), have been documented to moderate the effects of psychosocial distress among Latinas but were not examined in the present study [33
]. Additional studies are needed to examine the possible pathways of these factors. Second, because this was a convenience sample of women who were selected for study enrollment based on their lifetime histories of IPV exposure this is not a representative sample. Nonetheless, one study reported IPV exposure rates among US- and foreign-born Latinas in the range of 21–84%, throughout the lifespan [45
]. Third, a sizable portion of the sample was foreign-born (75%) and born in Mexico (53.4%). While approximately 52% of Latinas in the US are foreign-born [1
] and many Latinas residing in the US are of Mexican descent, it is worth noting that Latinas are not a monolithic group; therefore it is not possible to generalize study findings to women of the broader Latina population [19
]. Future studies should include larger samples comprising of foreign-born Latinas of different ethnic backgrounds to examine sub-ethnic variations. Fourth, the reliance of self-report, especially as it relates to the measurement of health problems experienced during pregnancy and delivery may have been influenced by recall bias. Finally, while the range of socio-demographic and psychosocial factors considered in the current study design reflects one of the most comprehensive to date, not all factors that have been associated with maternal health status, such as infant factors were included [47
These study limitations not withstanding, confidence in study findings center on the respectable sample size of low-income Latinas, the longitudinal design and the use of psychometrically sound instruments, strengths rarely seen in similar studies. To aid in promoting optimal health during the postpartum period, these data support clinician screening in early pregnancy. Screening need not be time-consuming or costly. For example, simply asking women or using brief measures (e.g., the number of years a foreign-born woman has resided in the United States, trauma history, stress and social support) during their initial obstetric appointments are both methods that can alert health providers to those women that should be provided with additional resources (e.g., education, support groups) and monitored closely during the postpartum period.. Finally, as health and well-being are increasingly emphasized by policy makers, healthcare providers and researchers, these results inform existing frameworks on the health of low-income Latinas and provide a basis for incorporating these factors in future interventions and studies.