Skip to main content

Advertisement

SpringerLink
Log in

The Preconception Stress and Resiliency Pathways Model: A Multi-Level Framework on Maternal, Paternal, and Child Health Disparities Derived by Community-Based Participatory Research

  • Notes from the Field
  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Emerging evidence supports the theoretical and clinical importance of the preconception period in influencing pregnancy outcomes and child health. Collectively, this evidence affirms the need for a novel, integrative theoretical framework to design future investigations, integrate new findings, and identify promising, evidence-informed interventions to improve intergenerational health and reduce disparities. This article presents a transdisciplinary framework developed by the NIH Community Child Health Network (CCHN) through community-based participatory research processes. CCHN developed a Preconception Stress and Resiliency Pathways (PSRP) model by building local and multi-site community-academic participatory partnerships that established guidelines for research planning and decision-making; reviewed relevant findings diverse disciplinary and community perspectives; and identified the major themes of stress and resilience within the context of families and communities. The PSRP model focuses on inter-relating the multiple, complex, and dynamic biosocial influences theoretically linked to family health disparities. The PSRP model borrowed from and then added original constructs relating to developmental origins of lifelong health, epigenetics, and neighborhood and community influences on pregnancy outcome and family functioning (cf. MCHJ 2014). Novel elements include centrality of the preconception/inter-conception period, role of fathers and the parental relationship, maternal allostatic load (a composite biomarker index of cumulative wear-and-tear of stress), resilience resources of parents, and local neighborhood and community level influences (e.g., employment, housing, education, health care, and stability of basic necessities). CCHN’s integrative framework embraces new ways of thinking about how to improve outcomes for future generations, by starting before conception, by including all family members, and by engaging the community vigorously at multiple levels to promote resiliency, reduce chronic and acute stressors, and expand individualized health care that integrates promotive and prevention strategies. If widely adopted, the PSRP model may help realize the goal of sustaining engagement of communities, health and social services providers, and scientists to overcome the siloes, inefficiencies, and lack of innovation in efforts to reduce family health disparities. Model limitations include tremendous breadth and difficulty measuring all elements with precision and sensitivity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Kramer, M. R., & Hogue, C. R. (2009). What causes racial disparities in very preterm birth? A biosocial perspective. Epidemiologic Reviews, 31(1), 84–98. doi:10.1093/ajerev/mxp003.

    Article  PubMed  Google Scholar 

  2. Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life-course perspective. Maternal and Child Health Journal, 7(1), 13–30. doi:10.1023/a:1022537516969.

    Article  PubMed  Google Scholar 

  3. Dunkel Schetter, C. (2011). Psychological science on pregnancy: Stress processes, biopsychosocial models, and emerging research issues. Annual Review of Psychology, 62, 531–558. doi:10.1146/annurev.psych.031809.130727.

    Article  PubMed  Google Scholar 

  4. O’Campo, P., Burke, J. G., Culhane, J., et al. (2008). Neighborhood deprivation and preterm birth among non-Hispanic Black and White women in eight geographic areas in the United States. American Journal of Epidemiology, 167(2), 155–163.

    Article  PubMed  Google Scholar 

  5. Klerman, L. V., Ramey, S. L., Goldenberg, R. L., Marbury, S., Hou, J., & Cliver, S. P. (2001). A randomized trial of augmented prenatal care for multiple-risk, medicaid-eligible African American women. American Journal of Public Health, 91(1), 105–111.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Hedley, A. A., Ogden, C. L., Johnson, C. L., Carroll, M. D., Curtin, L. R., & Flegal, K. M. (2004). Prevalence of overweight and obesity among us children, adolescents, and adults, 1999–2002. JAMA, 291(23), 2847–2850. doi:10.1001/jama.291.23.2847.

    Article  CAS  PubMed  Google Scholar 

  7. McMahon, M. J., Thorp, J. M., Savitz, D. A., & Bagchee, R. (2000). Risk factors for preterm birth. Journal of the Society for Gynecologic Investigation, 7(1), 117A.

    Google Scholar 

  8. Lu, M., Kotelchuck, M., Culhane, J., Hobel, C., Klerman, L., & Thorp, J. (2006). Preconception care between pregnancies: The content of internatal care. Maternal and Child Health Journal, 10, 107–122. doi:10.1007/s10995-006-0118-7.

    Article  PubMed Central  Google Scholar 

  9. Pies, C., Kotelchuck, M., & Lu, M. (Eds.). (2014). Advancing MCH life course [Special Issue]. Maternal and Child Health Journal, 18(2). doi:10.1007/s10995-013-1408-5.

  10. Pies, C., & Kotelchuck, M. (2014). Bringing the MCH life course perspective to life. Maternal and Child Health Journal, 18(2), 335–338. doi:10.1007/s10995-013-1408-5.

    Article  PubMed  Google Scholar 

  11. Dunkel Schetter, C., Schafer, P., Lanzi, R. G., Clark-Kauffman, E., Raju, T. N. K., Hillemeier, M. M., et al. (2013). Shedding light on the mechanisms underlying health disparities through community participatory methods: The stress pathway. Perspectives on Psychological Science, 8(6), 613–633. doi:10.1177/1745691613506016.

    Article  Google Scholar 

  12. Shalowitz, M. U., Isacco, A., Barquin, N., et al. (2009). Community-based participatory research: A review of the literature with strategies for community engagement. Journal of Developmental and Behavioral Pediatrics, 30(4), 350–361. doi:10.1097/DBP.0b013e3181b0ef14.

    Article  PubMed  Google Scholar 

  13. Ramey, C. T., Ramey, S. L., & Lanzi, R. G. (2006). Children’s health and education. In I. Sigel & A. Remminger (Eds.), The handbook of child psychology (Vol. 4, pp. 864–892). Hoboken, NJ: Wiley.

    Google Scholar 

  14. Savitz, D. A., Dole, N., Henderson, L., & Thorp, J. M. (1999). Socioeconomic status, race, and pregnancy outcome. Epidemiology, 149, S28.

    Google Scholar 

  15. Akinbami, L. J., LaFleur, B. J., & Schoendorf, K. C. (2002). Racial and income disparities in childhood asthma in the United States. Ambulatory Pediatrics, 2(5), 382–387.

    Article  PubMed  Google Scholar 

  16. Ashley, O. S., Marsden, M. E., & Brady, T. M. (2003). Effectiveness of substance abuse treatment programming for women: A review. American Journal of Drug and Alcohol Abuse, 29(1), 19–53.

    Article  PubMed  Google Scholar 

  17. DiPietro, J. A., Novak, M. F. S. X., Costigan, K. A., Atella, L. D., & Reusing, S. P. (2006). Maternal psychological distress during pregnancy in relation to child development at age two. Child Development, 77(3), 573–587. doi:10.1111/j.1467-8624.2006.00891.x.

    Article  PubMed  Google Scholar 

  18. Feldman, P. J., Dunkel-Schetter, C., Sandman, C. A., & Wadhwa, P. D. (2000). Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosomatic Medicine, 62(5), 715–725.

    Article  CAS  PubMed  Google Scholar 

  19. National Research Council. (2007). Preterm birth: Causes, consequences, and prevention. Washington, DC: The National Academies Press.

  20. Strauss, R. S., & Pollack, H. A. (2001). Epidemic increase in childhood overweight, 1986–1998. JAMA, 286(22), 2845–2848. doi:10.1001/jama.286.22.2845.

    Article  CAS  PubMed  Google Scholar 

  21. Flores, G., Fuentes-Afflick, E., Barbot, O., et al. (2002). The health of Latino children: Urgent priorities, unanswered questions, and a research agenda. JAMA, 288(1), 82–90. doi:10.1001/jama.288.1.82.

    Article  PubMed  Google Scholar 

  22. McEwen, B. S., & Stellar, E. (1993). Stress and the individual: Mechanisms leading to disease. Archives of Internal Medicine, 153(18), 2093. doi:10.1001/archinte.1993.00410180039004.

    Article  CAS  PubMed  Google Scholar 

  23. Wells, K. B., & Norris, K. C. (Eds.). (2006). The Community health improvement collaborative: Building community-academic partnerships to reduce disparities. Ethnicity and Disease, 16(Suppl 1–17).

  24. Johnson, K., Gerada, C., & Greenough, A. (2003). Substance misuse during pregnancy. British Journal of Psychiatry, 183(3), 187–189. doi:10.1192/02-346.

    Article  CAS  PubMed  Google Scholar 

  25. Thorp, J. M., Jr, Hartmann, K. E., Berkman, N., et al. (2002). Antibiotic therapy for the treatment of preterm labor: A review of the evidence. American Journal of Obstetrics and Gynecology, 186(3), 587–592.

    Article  CAS  PubMed  Google Scholar 

  26. Vahratian, A., Siega-Riz, A. M., Savitz, D. A., & Thorp, J. M. (2004). Multivitamin use and the risk of preterm birth. American Journal of Epidemiology, 160(9), 886–892. doi:10.1093/aje/kwh305.

    Article  PubMed  Google Scholar 

  27. López, N. J., Smith, P. C., & Gutierrez, J. (2002). Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: A randomized controlled trial. Journal of Periodontology, 73(8), 911–924. doi:10.1902/jop.2002.73.8.911.

    Article  PubMed  Google Scholar 

  28. Lu, Q., Lu, M. C., & Dunkel Schetter, C. (2005). Learning from success and failure in psychosocial intervention: An evaluation of low birth weight prevention trials. Journal of Health Psychology, 10(2), 185–195. doi:10.1177/1359105305049763.

    Article  PubMed  Google Scholar 

  29. Tamura, T., Goldenberg, R. L., Ramey, S. L., Nelson, K. G., & Chapman, V. R. (2003). Effect of zinc supplementation of pregnant women on the mental and psychomotor development of their children at 5 y of age. American Journal of Clinical Nutrition, 77(6), 1512–1516.

    CAS  PubMed  Google Scholar 

  30. Wright, L. N., Pahel-Short, L., Hartmann, K., Kuller, J. A., & Thorp, J. M., Jr. (1996). Statewide assessment of a behavioral intervention to reduce cigarette smoking by pregnant women. American Journal of Obstetrics and Gynecology, 175(2), 283–288. doi:10.1016/S0002-9378(96)70136-9.

    Article  CAS  PubMed  Google Scholar 

  31. Thoits, P. A. (2010). Stress and health: Major findings and policy implications. Journal of Health and Social Behavior, 51(1 Suppl), S41–S53. doi:10.1177/0022146510383499.

    Article  PubMed  Google Scholar 

  32. Shonkoff, J. P., Garner, A. S., The Committee on Psychosocial Aspects of Child and Family Health, et al. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. doi:10.1542/peds.2011-2663.

    Article  PubMed  Google Scholar 

  33. Center for Disease Control and Prevention. (2012). Preconception health and health care: Information for health professionals recommendations. [Web post]. http://www.cdc.gov/preconception/hcp/recommendations.html.

  34. Lu, M. C. (2014). Improving maternal and child health across the life course: Where do we go from here? Maternal and Child Health Journal, 18(2), 339–343. doi:10.1007/s10995-013-1400-0.

    Article  PubMed  Google Scholar 

  35. Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19(1), 173–202. doi:10.1146/annurev.publhealth.19.1.173.

    Article  CAS  PubMed  Google Scholar 

  36. Israel, B., Eng, E., Schulz, A., & Parker, E. (Eds.). (2005). Methods in community-based participatory research for health. San Francisco: Jossey-Bass Publishers.

    Google Scholar 

  37. Jones, L., & Wells, K. (2007). Strategies for academic and clinician engagement in community-participatory partnered research. JAMA, 297(4), 407. doi:10.1001/jama.297.4.407.

    Article  CAS  PubMed  Google Scholar 

  38. Wells, K., & Jones, L. (2009). “Research” in community-partnered, participatory research. JAMA, 302(3), 320. doi:10.1001/jama.2009.1033.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Bilodeau, R., Gilmore, J., Jones, L., et al. (2009). Putting the “community” into community-based participatory research. American Journal of Preventive Medicine, 37(6), S192–S194. doi:10.1016/j.amepre.2009.08.019.

    Article  PubMed  Google Scholar 

  40. Jones, L., Lu, M. C., Lucas-Wright, A. et al. (2010). One hundred intentional acts of kindness toward a pregnant woman: Building reproductive social capital in Los Angeles. Ethnicity & Disease, 20(1 Suppl 2), S2–36–40.

  41. Dunkel Schetter, C., & Dolbier, C. (2011). Resilience in the context of chronic stress and health in adults. Social and Personality Psychology Compass, 5(9), 634–652. doi:10.1111/j.1751-9004.2011.00379.x.

    Article  Google Scholar 

  42. Karatsoreos, I. N., & McEwen, B. S. (2013). Annual research review: The neurobiology and physiology of resilience and adaptation across the life course. Journal of Child Psychology and Psychiatry, 54(4), 337–347. doi:10.1111/jcpp.12054.

    Article  PubMed  Google Scholar 

  43. McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179. doi:10.1056/NEJM199801153380307.

    Article  CAS  PubMed  Google Scholar 

  44. Lu, M. C., Jones, L., & Bond, M. J. et al. (2010). Where is the F in MCH? Father involvement in African American families. Ethnicity & Disease, 20(1 Suppl 2), S2–49–61.

  45. Seeman, T. E., Singer, B., Rowe, J., Horwitz, R., & McEwen, B. (1997). Price of adaptation—allostatic load and its health consequences. MacArthur studies of successful aging. Archives of Internal Medicine, 157(19), 2259. doi:10.1001/archinte.1997.00440400111013.

    Article  CAS  PubMed  Google Scholar 

  46. Seeman, T. E., McEwen, B. S., Rowe, J. W., & Singer, B. H. (2001). Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proceedings of the National Academy of Sciences of the United States of America, 98(8), 4770–4775. doi:10.1073/pnas.081072698.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Huang, J. S., Lee, T. A., & Lu, M. C. (2007). Prenatal programming of childhood overweight and obesity. Maternal and Child Health Journal, 11(5), 461–473. doi:10.1007/s10995-006-0141-8.

    Article  PubMed  Google Scholar 

  48. Barker, D. J. (1998). Mothers, babies, and health in later life (2nd ed.). Edinburgh: Churchill Livingston.

    Google Scholar 

  49. Carlson, E. D., & Chamberlain, R. M. (2005). Allostatic load and health disparities: A theoretical orientation. Research in Nursing & Health, 28(4), 306–315. doi:10.1002/nur.20084.

    Article  CAS  Google Scholar 

  50. Coe, C. L., & Lubach, G. R. (2008). Fetal programming prenatal origins of health and illness. Current Directions in Psychological Science, 17(1), 36–41.

  51. Cottrell, E. C., & Seckl, J. (2009). Prenatal stress, glucocorticoids and the programming of adult disease. Frontiers in Behavioral Neuroscience, 3(19), 1–9. doi:10.3389/neuro.08.019.2009.

    Google Scholar 

  52. Hertzman, C. (1999). The biological embedding of early experience and its effects on health in adulthood. Annals of the New York Academy of Sciences, 896, 85–95.

    Article  CAS  PubMed  Google Scholar 

  53. Ghosh, J. K. C., Wilhelm, M. H., Dunkel-Schetter, C., Lombardi, C. A., & Ritz, B. R. (2010). Paternal support and preterm birth, and the moderation of effects of chronic stress: A study in Los Angeles county mothers. Archives of Women’s Mental Health, 13(4), 327–338. doi:10.1007/s00737-009-0135-9.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Davis, E. P., Glynn, L. M., Dunkel Schetter, C., Hobel, C., Chicz-Demet, A., & Sandman, C. A. (2007). Prenatal exposure to maternal depression and cortisol influences infant temperament. Journal of the American Academy of Child and Adolescent Psychiatry, 46(6), 737–746. doi:10.1097/chi.0b013e318047b775.

    Article  PubMed  Google Scholar 

  55. Davis, E. P. (2010). The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development. Child Development, 81(1), 131–148.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Campbell, F., Conti, G., Heckman, J. J., et al. (2014). Early childhood investments substantially boost adult health. Science, 343(6178), 1478–1485. doi:10.1126/science.1248429.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The Child Community Health Network (CCHN) is a community-based participatory research network supported through cooperative agreements with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U HD44207, U HD44219, U HD44226, U HD44245, U HD44253, U HD54791, U HD54019, U HD44226-05S1, U HD44245-06S1, R03 HD59584) and the National Institute for Nursing Research (U NR008929). CCHN reflects joint endeavors of five local sites:

Baltimore: Baltimore City Healthy Start and Johns Hopkins University

Community PI: M. Vance; Academic PI: C. S. Minkovitz; Co-Invs: P. O’Campo, P. Schafer; Project Coordinators: N. Sankofa, K. Walton.

Lake County, Illinois: Lake County Health Department and Community Health Center and the NorthShore University Health System

Community PI: K. Wagenaar; Academic PI: M. Shalowitz; Co-Invs: E. Adam, G. Duncan*, A. Schoua-Glusberg, C. McKinney, T. McDade, C. Simon; Project Coordinator: B. Clark-Kauffman.

Los Angeles: Healthy African-American Families, Cedars-Sinai Medical Center, University of California, Los Angeles

Community PI: L. Jones, Academic PI: C. Hobel, Co-PIs: C. Dunkel Schetter, M. C. Lu, Co-I: B. Chung; Project Coordinators: F. Jones, D. Serafin, D. Young.

North Carolina: East Carolina University, NC Division of Public Health, NC Eastern Baby Love Plus Consortium, and University of North Carolina, Chapel Hill

Community PIs: S. Evans, J. Ruffin, R. Woolard; Academic PI: J. Thorp; Co-Invs: J. DeClerque, C. Dolbier, C. Lorenz; Project Coordinators: L. S. Sahadeo, K. Salisbury.

Washington, DC: Virginia Tech Carilion Research Institute, Virginia Tech, and Washington Hospital Center, and Developing Families Center

Community PI: L. Patchen, Academic PI: S. L. Ramey and L. Klerman; Academic Co-PI R. Lanzi; Co-Invs: M. Miodovnik, C. T. Ramey, L. Randolph; Project Coordinator: N. Timraz; Community Coordinator: R. German, J. Bond*.

Data Coordination and Analysis Center (Pennsylvania State University)

PI: V. M. Chinchilli; Project Coordinator: G. Snyder; Co-Invs: R. Belue, G. Brown Faulkner*, M. Hillemeier, I. Paul, M. L. Shaffer; Biostatisticians: E. Lehman, C. Stetter; Data Managers: J. Schmidt, K. Cerullo, S. Whisler; Programmers: J. Fisher, J. Boyer, M. Payton.

NIH

Program Scientists: V. J. Evans and T. Raju, Eunice Kennedy Shriver National Institute of Child Health and Human Development; L. Weglicki, National Institute of Nursing Research. Program Officers: M. Spittel,* and, M. Willinger, NICHD; and Y. Bryan*, NINR.

Steering Committee Chairs

E. Fuentes-Afflick* (University of California—San Francisco School of Medicine) and M. Phillippe (University of Vermont) and *Indicates those who participated in the planning phase of the CCHN. Special thanks to L. Bateman for assistance in preparing manuscript, figure, and tables.

Author information

Authors and Affiliations

  1. Virginia Tech Carilion Research Institute, Virginia Tech, 2 Riverside Circle, Roanoke, VA, 24016, USA

    Sharon Landesman Ramey

  2. Baltimore Healthy Start, Baltimore, MD, USA

    Peter Schafer

  3. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Julia L. DeClerque

  4. University of Alabama at Birmingham, Birmingham, AL, USA

    Robin G. Lanzi

  5. UCLA and Cedar Sinai Health System, Los Angles, CA, USA

    Calvin Hobel

  6. NorthShore University Health System and University of Chicago Pritzker School of Medicine, Evanston, IL, USA

    Madeleine Shalowitz

  7. Penn State University, University Park, PA, USA

    Vern Chinchilli

  8. Community Child Health Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA

    Tonse N. K. Raju

Authors
  1. Sharon Landesman Ramey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Schafer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julia L. DeClerque
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robin G. Lanzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Calvin Hobel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Madeleine Shalowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vern Chinchilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tonse N. K. Raju
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the Community Child Health Network

Corresponding author

Correspondence to Sharon Landesman Ramey.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramey, S.L., Schafer, P., DeClerque, J.L. et al. The Preconception Stress and Resiliency Pathways Model: A Multi-Level Framework on Maternal, Paternal, and Child Health Disparities Derived by Community-Based Participatory Research. Matern Child Health J 19, 707–719 (2015). https://doi.org/10.1007/s10995-014-1581-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-014-1581-1

Keywords

Search

Navigation