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American Journal of Epidemiology Vol. 124, No. 2: 242-253
Copyright © 1986 by The Johns Hopkins University School of Hygiene and Public Health

research-article

SOCIAL AND CULTURAL FACTORS IN PREGNANCY COMPLICATIONS AMONG NAVAJO WOMEN

W. THOMAS BOYCE1,, CATHERINE SCHAEFER1, H. ROBERT HARRISON2, WILLIAM H. J. HAFFNER3, MARGUERITE LEWIS1 and ANNE L. WRIGHT1

1 Department of Pediatrics, College of Medicine, University of Arizona Tucson, AZ
2 Centers for Disease Control Atlanta, GA
3 Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. William H. J. Haffner was formerly with the Obstetrics and Gynecology Service, Navajo Area Indian Health Service, Gallup, NM

Reprint requests to Dr. W. Thomas Boyce, Department of Pediatrics, University Medical Center, University of Arizona, Tucson, AZ 85724

A population of 968 pregnant Navajo women was followed in a prospective study conducted from 1980 to 1983 at the Indian Health Service Hospitals in Gallup and Crownpoint, New Mexico. The purpose of the study was to examine social and cultural influences on obstetric and neonatal complications. The extent of traditional cultural practices and the availabilty of social support were ascertained in structured interviews completed during each woman's first prenatal visit. In a subsample of women, the occurrence of stressful life events was also measured during a final prenatal visit in the third trimester of pregnancy. Controlling for a variety of conventional risk factors and other potential confounders, traditional women sustained complications at a rate greater than twice that of the least traditional, most acculturated women (approximate relative risk=2.1; p=0.001). Social support and life events were modestly associated with maternal complications (approximate relative risk=0.7, 0.8, respectively; p=0.07), with poorer outcomes found among those with low social support and low numbers of life events. It is proposed that the relationship of maternal complications to all three sociocultural variables—traditionality, social support and life events—may reflect the influences of social isolation on the course and outcomes of pregnancy.

acculturation; pregnacy complications; stress; psychological


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