Associations of Maternal Trait Anger Expression and Lifetime Traumatic and Non-traumatic Experiences with Preterm Birth
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Associations of Maternal Trait Anger Expression and Lifetime Traumatic and Non‑traumatic Experiences with Preterm Birth Whitney Cowell1 · Lilly Taing2 · Talia Askowitz3 · Michelle Bosquet Enlow4,5 · Michele R. Hacker6,7,8 · Rosalind J. Wright1,3 Accepted: 4 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objectives Most studies examining psychosocial factors contributing to preterm birth (PTB) have focused on negative life events. Studies examining the influence of negative emotion, in particular maternal anger, remain sparse. We examined associations of maternal trait anger expression and lifetime traumatic and non-traumatic experiences with the risk of PTB. Methods Mother-newborn pairs were enrolled in the PRogramming of Intergenerational Stress Mechanisms pregnancy cohort based in Boston and New York City. Women completed the State-Trait Anger Expression Inventory-2 (STAXI-2), Life Stressor Checklist-Revised (LSC-R), and Childhood Trauma Questionnaire (CTQ) in pregnancy. We used modified Poisson regression to estimate the relative risk (RR) of PTB (1) in relation to continuous STAXI-2 Anger Expression-In (AXI) and Anger Expression-Out (AX-O) subscales, (2) in relation to continuous LSC-R scores, and (3) between women who did versus did not experience childhood sexual, emotional, and/or physical abuse in six separate models. We also examined interactions between maternal anger expression and lifetime stress/childhood trauma. Results Younger, single, minority women had higher outward anger expression and inward anger suppression. AX-I and AX-O scores were higher among women who experienced abuse in childhood and who had higher lifetime stress. Maternal lifetime stress, outward anger expression, and inward anger suppression were associated with an increased risk of PTB in separate models; however, stress, trauma and anger did not interact to further increase the risk of PTB. Conclusions for Practice Higher anger expression and higher lifetime stress experiences were associated with an increased risk of PTB among a racially and ethnically diverse sample of pregnant women. Keywords Stress · Trauma · Anger · Pregnancy · Preterm birth
Significance Statement Preterm birth (PTB) is a leading cause of infant mortality and morbidity and has consequences for long-term health. Accumulating evidence supports that psychosocial stress and * Whitney Cowell [email protected] 1
2
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
3
Department of Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
4
Department of Psychiatry, Harvard Medical School, Boston, MA, USA
stress correlates (e.g., depression) contribute to the pathophysiology underlying adverse obstetrical outcomes, including PTB. Few studies have examined the influence of negative emotions, including
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