Graduation Year


Document Type




Degree Granting Department

Public Health

Major Professor

Thomas J. Mason, Ph.D.

Co-Major Professor

Heather G. Stockwell, Sc.D.

Committee Member

Getachew A. Dagne, Ph.D.

Committee Member

William W. Dressler, Ph.D.


Reproductive Epidemiology, Pregnancy Stressors, High Birth Weight, Psychosocial Stressors, Pregnancy Screening Tests


The primary objective of this study was to evaluate the associations between psychosocial stressors, urine sugar levels, and subsequent birth outcomes, specifically high birth weight babies and Caesarean section births. In a prospective cohort study, 506 Black and White women of childbearing age were followed for the duration of one pregnancy in Tuscaloosa and Mobile counties in Alabama from 1990 to 2001. Participants were interviewed twice throughout pregnancy, during the first and third trimesters, respectively, and birth outcome data were collected via medical chart reviews. Six percent (6.1%) of the women in the sample had a high birth weight baby, and 18.4% received a C-section during childbirth. Adjusted logistic regression results indicate that urine sugar levels are predictive of high-weight births, with women who have higher urine sugar levels were more than three times likely to birth a high weight baby compared with women who have no detectable urine sugar spill (OR 3.25; 95% CI 1.30, 8.10). In addition, the interaction of familial social support throughout pregnancy, physical or verbal abuse during the second and third trimesters, and ethnicity is significantly associated with increased risk of having a high birth weight baby. For C-section, single participants are over two times less likely to receive a C-section during childbirth compared with currently married participants (OR 0.46; 95% CI 0.21-1.00). Examining structural equation modeling results; pathways leading from urine sugar levels, physical or verbal abuse during the latter half of the pregnancy, and a mother's social support among White participants are indicative of high weight births (R² = 0.65). White abused women who receive their mother's social support are more likely to have a high birth weight baby compared with both White and Black women who are not abused and receive the same amount of social support. Recommendations to public health practitioners include primary prevention through promotion of familial support during pregnancy, secondary prevention through urine sugar screening at every prenatal visit, and direct intervention by identifying and inquiring about instances of suspected abuse during pregnancy.