Literature Review

Literature Review
Kyle Dillman
HLTH 634
November 12, 2016

Literature Review

Introduction:
Pregnancy can often be a wonderful process; one that brings many joys to a
family, being able to bring a healthy baby into the world is truly an experience that can be
compared to no other. However, the women that often have such positive pregnancies
also usually have a talented support system of medical staff behind them, giving them
guidance along the way and creating a smooth path from conception all the way to labor
and delivery. For the women who do not have the appropriate means to receive such
care, or are not aware of the help that is available to them because of their socioeconomic
status (SES) often do not get to have the same positive experience. Whether these
women chose to keep the child that they have created, or to give it up for adoption they
still deserve the right to adequate care, and the right to give their future infant a chance at
a high quality of life from the beginning.
The United States is one of the most developed countries in the world, yet many
pregnant women of a lower SES struggle to deliver healthy babies because of the lack of
medical care and prenatal/pregnancy education that they receive. Developing a health
communication program that helps these women gain access to necessary medical care
and educational classes has the potential to make all the difference. Therefore the focus
of this particular intervention is to ultimately make these women aware of the help that is
available to them. Creating brochures, pamphlets, websites/blogs will be a start to the
intervention, helping to spread awareness to these women as best as possible by placing
such information in the areas of lower socioeconomic class. Targeting such communities
and providing them with information that can be spread by word of mouth and help to
direct women in need to the appropriate people and organizations that can help them will

Literature Review

hopefully be a start. Along with making these women aware of the help that they can
receive bringing educational classes to them within their community can help to make
them feel more comfortable about the overall situation. Many of these women may be
afraid to ask for help or are simply unaware of the options that they have, and while they
cannot be forced into reading information and attending classes if they are specifically
made to be the focus it may encourage them to seek help and further information.
The following literature review is a compilation of ten sources, eight of which are
peer-reviewed articles and two that are government or professional reports that give
adequate evidence to support the intended health communication intervention. Each
articles information/data is summarized and then following is an overall analysis of the
sources as a whole. While choosing the criteria I based selection off of the most recent
articles, ones that pointed towards the struggles that pregnant women of a lower SES
face, and gave an overall conclusion of needing to implement programs that would help
these women and their infants live healthier lives through pregnancy and beyond.
Body of Evidence:
The following sources reviewed all support the idea of implementing a health
communication intervention for pregnant women of a lower socioeconomic status. While
some focus on the overall negative affects that these women face throughout pregnancy
others specifically emphasize particular health complications, but the one thing that they
all recognize is that there is a need for these women to be further educated on prenatal
care as well as given proper medical attention in order to reduce the rates of health
problems in both the expecting mothers and infants.

Literature Review

The first article, Lean on me: Effects of social support on low socioeconomicstatus pregnant women, focuses on the social support stressors that many women face
throughout pregnancy, especially women who are of a lower class.1 These women often
times do not have strong social support systems, husbands or boyfriends, and it can
therefore lead to depressive symptoms that can potentially lead to physical pain and thus
lead to negative effects on the fetus.1 The overall concept of this article shows how
women of a lower SES are more likely to struggle with having an adequate support
system, and how in turn it can create physical health problems for the mother and
growing embryo.
The second article, Preconception Health of Low Socioeconomic Status Women:
Assessing Knowledge and Behaviors, explains a study that was done in order to depict
how much knowledge women of a low SES had about preconception health, because of
the high infant mortality rate and overall adverse pregnancy outcomes.2 Various phases
of pregnancy are pertinent to adequate developmental health of a child, and consequently
the actions of the mother at the initial stages of pregnancy can predispose the fetus to ill
effects. This particular study surveyed women, in two different community health centers
that serve low-income patients, on their knowledge and behaviors related to
preconception risk factors, and while the results showed that many women were aware of
certain risk factors they continued to participate in them.2 The overall results of the study
indicated that while some of the women that they surveyed are aware of the particular
risk factors, and how they should be treating their bodies when trying to get pregnant as

1Reference
2Reference

Literature Review

well as in the beginning stages there needs to be more comprehensive programs that
support behavior change.
Contribution of socioeconomic status to the risk of small for gestational age infants a
population based study of 1,390,165 singleton live births in Finland, collected data
from the Finnish Medical Birth Register from the year 1987 to 2010 on the percentage of
births that were small for gestational age (SGA).3 In this study the results showed that
the risk of SGA was 11-24% higher in the lower SES groups compared to groups of a
higher SES.3 If these women were able to have better access to health care and
educational seminars they may have a better potential of lowering the percentage of SGA.
While the fourth peer-reviewed article, Barriers to Prenatal Care Among Black Women
of Low Socioeconomic Status, focuses on African American women and the overall health
communication intervention is concentrated on all women of a lower SES the article is
still relevant in the fact that it presents evidence warranting such an intervention. Some
of the women in the study were hesitant on finding prenatal care because of their income
and education, unsatisfying clinical experiences, not wanting the pregnancy, and a lack of
knowledge of pregnancy signs and symptoms, which are all possible hesitations among
women of low SES.4 With such evidence it is apparent that an intervention may be able
to push women to receive prenatal care earlier in their pregnancy and therefore, lessen the
possibility of health complications for themselves and their infant.
The fifth article, The Relationship of Socioeconomic Status to Preterm Contractions and
Preterm Delivery, reported that women with an income in the lowest 5th percentile were
30% more likely to report preterm contractions than women who were in the top 5th
3Refrence
4Reference

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percentile, as well as women who had a lower income or education were 50% more likely
to have preterm contractions.5 Overall, the article gave sufficient evidence that women of
a lower SES are more likely to succumb to preterm contractions, which sometimes leads
to preterm delivery, and with preterm delivery comes the possibility of major health
issues and potentially death for the infant.5 Inadequate health care for these women can
lead to such circumstances, and therefore increases the infant fatality rate, however,
appropriate care could allow for such women to carry their fetus to full term giving them
a better chance at a healthy life.
Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study is the
sixth peer-reviewed article that gives evidence for the need of a health communication
intervention for pregnant women of a low SES. In this study data was analyzed from
3547 pregnant women with the objective of finding whether or not low SES was related
to developing preeclampsia, which is marked by hypertension and proteinuria and is the
leading cause of perinatal and maternal morbidity and mortality.6 Overall, after
adjusting for the confounding effects the results showed that women from a low
socioeconomic class do indeed have a strong risk factor for preeclampsia, giving a higher
chance of complications as well as death to both the mother and the baby.6
The seventh article, Social Support, Life Stress, and Anxiety as Predictors of Pregnancy
Complications in Low-Income Women, studied 111 low-income pregnant women between
the ages of 18 and 35 years on whether or not social support, stress and anxiety
associated with low SES women led to more pregnancy complications and low birth

5Reference
6Reference

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weight.7 The article states that research over the past two decades shows that women of a
low SES are proven to be at a higher risk for low birth weight, preterm birth, and infant
mortality, and while the study had some limitations the results did coincide with previous
research finding that social support is related to pregnancy complications in women of a
low SES.7
The Influence of gestational age and socioeconomic status on neonatal outcomes
in late preterm and early term gestation: a population-based study is the last peerreviewed article of the literature review. This cohort studied 25,312 infants and the
percentage of them that were born preterm and how many of those that were preterm
were also of a low SES.8 Out of the 6.1% that were born preterm 32.4% (8,203) of them
were of a low SES concluding that the socioeconomic status was associated with an
independent increased risk of preterm gestation.8
The second group of sources is comprised of government and professional reports
that do not focus on specific studies, but that have collected and compiled pertinent data
on the topic at hand. American Psychological Association (APA) has done extensive
research on how a low SES negatively affects human functioning including pregnancy,
this particular source points to the fact that not only does a low SES have a major role in
determining the quality of life for women but also for their infants.9 Psychologically
pregnant women of this class tend to be more depressed due to being deprived of needed
support as well as they receive less prenatal care, and experience higher levels of stress
that lead to more premature births.9
7Reference
8Reference
9Reference

Literature Review

Giving further evidence to the need for a health communication intervention is the
Centers for Disease Control and Prevention (CDC). The CDC found that women of a
low SES have less access to health care (including preventive services, screenings, and
medical treatments) as well as they are less likely to receive appropriate prenatal care and
get proper vaccinations for their then born infant.10 Each of the above references support
the need for some sort of change among pregnant women of a low SES, they each
analyze and explain the specific consequences that can and are more likely to occur
within this population. While some of the sources focus on the lack of social support and
health effects that these women go through and others are centered around the physical
issues that can ensue they all give evidence to needing to change the behavior of these
women as well as helping them to obtain adequate medical care throughout their
pregnancies.
Summary and Conclusions:
Overall, each of the references gives adequate and useful information for helping to
develop a health communication program. However, the most relevant sources,
Preconception Health of Low Socioeconomic Status Women: Assessing Knowledge and
Behaviors, Low socioeconomic economic status is a risk factor for preeclampsia: the
Generation R Study, Social Support, Life Stress, and Anxiety as Predictors of Pregnancy
Complications in Low-Income Women, and the CDC as well as the APA were what really
contributed to the need for such an intervention. While the CDC and APA gave solid
facts that stand on their own as being proof of a major issue each of the three studies
showed how social support is an issue among these women, how preterm birth can cause
10Reference

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major health issues for the infant, and how major medical issues such as preeclampsia
can be caused.
While each study had various differences amongst them the one thing that could
easily be concluded throughout all ten sources is that pregnant women of a low SES do
indeed have a higher chance of risky pregnancies, health risks to themselves and their
infant, as well as a greater percentage of mortality rates. Not one of the studies proved
otherwise, and while some of them listed limitations of having a small participant size
they still all showed evidence for future studies on the subject as well as a need for health
interventions. With the overall conclusion of each study proving that there is a real
problem here it is clear that health communication interventions helping to aid these
women find adequate medical care and appropriately teach them how to care for
themselves and their growing infant are in serious need. Living in such a developed
nation there should not be near the amount of premature babies delivered or infant deaths
occurring, and such interventions will help to bring those numbers down and make sure
this population is appropriately cared for.

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References
1. Byrd-Craven J, Massey AR. Lean on me: effects of social support on low
socioeconomic-status pregnant women. Nursing and Health Sciences. 2013;15(3): 374378. http://onlinelibrary.wiley.com.ezproxy.liberty.edu/doi/10.1111/nhs.12043/full.
Accessed November 11, 2016.
2. Harelick L, Viola D, Tahara D. Preconception health of low socioeconomic status
women: assessing knowledge and behaviors. Womens Health Issues. 2011; 21(4): 272276.
http://www.sciencedirect.com.ezproxy.liberty.edu/science/article/pii/S1049386711000508
. Accessed November 11, 2016.
3. Raisanen S, Gissler M, Sankilampi U, Saari J, Kramer MR, Heinonen S. Contribution
of socioeconomic status to the risk of small for gestational age infants a population
based study of 1,390,165 singleton live births in Finland. International Journal for Equity
in Health. 2013;12(28).
http://equityhealthj.biomedcentral.com.ezproxy.liberty.edu/articles/10.1186/1475-927612-28. Accessed November 11, 2016.
4. Daniels P, Godfrey FN, Mayberry R. Barriers to prenatal care among black women of
low socioeconomic status. American Journal of Health Behavior. 2006; 30(2): 188-198.
http://search.proquest.com.ezproxy.liberty.edu/docview/211873394?pqorigsite=summon&accountid=12085. Accessed November 11, 2016.
5. Whitehead NS. The relationship of socioeconomic status to preterm contractions and
preterm delivery. Maternal and Child Health Journal. 2012; 16(8): 1645-1656.

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http://link.springer.com.ezproxy.liberty.edu/article/10.1007%2Fs10995-012-0948-4.
Accessed November 11, 2016.
6. Silva LM, Coolman M, Steegers EAP, et al. Low socioeconomic status is a risk factor
for preeclampsia: the Generation R study. Journal of Hypertension. 2008; 26(6): 12001208. DOI: 10.1097/HJH.0b013e3282fcc36e.
7. Zachariah R. Social support, life stress, and anxiety as predictors of pregnancy
complications in low-income women. Research in Nursing and Health. 2009; 32: 391404. DOI: 10.1002/nur.20335.
8. Ruth CA, Roos N, Hildes-Ripstein E, Brownell M. The influence of gestational age
and socioeconomic status on neonatal outcomes in late preterm and early term gestation:
a population based study. BMC Pregnancy and Childbirth. 2012; 12(62): 2-8.
http://search.proquest.com.ezproxy.liberty.edu/docview/1030013816?pqorigsite=summon&accountid=12085. Accessed November 11, 2016.
9. American Psychological Association. Fact Sheet: Women & Socioeconomic Status.
APA Web site. http://www.apa.org/pi/ses/resources/publications/women.aspx. Published
2016. Accessed November 12, 2016.
10. Centers for Disease Control and Prevention. Health, United States, 2011: With
Special Feature on Socioeconomic Status and Health. CDC Web site.
http://www.cdc.gov/nchs/data/hus/hus11.pdf. Published 2011. Accessed November 12,
2016.