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American Journal of Epidemiology Vol. 129, No. 3: 604-615
Copyright © 1989 by The Johns Hopkins University School of Hygiene and Public Health

research-article

SOCIOCULTURAL FACTORS IN PUERPERAL INFECTIOUS MORBIDITY AMONG NAVAJO WOMEN

W. THOMAS BOYCE1,, CATHERINE SCHAEFER2, H. ROBERT HARRISON3, WILLIAM H. J. HAFFNER4, MARGUERITE LEWIS5 and ANNE L WRIGHT6

Dept of Pediatrics, U. of California San Francisco, CA 94143
1Division of Behavioral and Developmental Pediatrics, Department of Pediatrics, University of California San Francisco, CA
2Department of Epidemiology and Public Health, College of Medicine, Yale University New Haven, CT
3Centers for Disease Control Atlanta, GA
4Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences Bethesda, MD
5Seattle-King County Department of Public Health Seattle, WA
6Department of Pediatrics, University of Arizona Tucson, AZ

Reprint requests to Dr. W. Thomas Boyce, Division of Behavioral and Developmental Pediatrics, Department of Pediatrics, University of California, A-203,400 Parnassus Avenue, San Francisco, CA 94143

From 1980 to 1982, a sample of 968 pregnant Navajo women in New Mexico was enrolled in a prospective study of biologic and sociocultural factors in puerperal infectious morbidity. Past studies have independently implicated both genital infection and psychosocial stressors in perinatal complications, but, to the authors' knowledge, no previous work has concurrently investigated the interactive effects of genital pathogens and psychosocial processes. Endocervical cultures for Mycoplasma hominis and Chiamydie trachomatis were obtained during prenatal visits, and structured interviews were conducted assessing social support and the degree of cultural traditionality, in this context a proxy measure of acculturative stress. The incidences of postpartum fever, endometritis, and premature rupture of membranes were significantly associated with the concur rence of two factors: the presence of genital tract M. hominis and a highly traditional cultural orientation. When demographic and conventional obstetric risk factors were controlled for, women with both M. hominis and high traditionality experienced infectious complications at a rate twice that of women with either factor alone. Among the plausible explanations for this result is the possibility that acculturative stress undermines physiologic resistance to infectious genital tract disease.

acculturation; infection; pregnancy complications; stress, psychological


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