individual differences such as the mother's level of mastery, or relationship characteristics such as marital satisfaction, influence how much support is given by the baby's father during pregnancy? These questions can be optimally answered by involving both parents in research designs.
There are two further research directions that should be mentioned. Interestingly, they concern the generation before, and the generation after the pregnant mothers that are being studied today. With reference to earlier generations, newer research on intergenerational risk factors has developed in con junction with research on ethnicity and socioeconomic status in pregnancy. For example, a recent study by Coutinho, David, and J. W. Collins (1997) examined a transgenerational data set of Illinois vital records to test whether parental birth weight was related to infant birth weight among African Americans and Whites born between 1989 and 1991. The authors found that parental birth weights were important risk factors for low birth weight (LBW) in both ethnic groups. However, the effects were particularly dramatic in African Americans for whom the rate of LBW among those born to LBW mothers was 17.9% compared to 10.8% among African Americans born of non-LBW mothers (rates for Whites were 8.5 and 4.8, respectively). Similarly, a Dutch study by Lumey and Stein (1997) of women born between 1944 and 1946 during a Dutch famine found evidence of long-term biologic effects of maternal intrauterine undernutrition, extending even into the next generation (Lumey & Stein, 1997). Emanuel (1997) highlighted some of the research directions suggested by these remarkable findings. A similar set of results is emerging with respect to preterm delivery. Porter, Fraser, Hunter, Ward, and Vamer (1997) found that risk of preterm birth was higher among mothers who were themselves born before 37 weeks gestation. With respect to the focus of this chapter, these intergenerational effects suggest that a number of socioeconomic, cultural, and psychosocial factors may have long-term influences on maternal health and on the health of subsequent generations. Health psychology has much to bring to an understanding of these provocative and important issues.
A second future direction concerns the offspring of the pregnant women studied today. Work suggests that prenatal experience may have important consequences for the length of gestation and the growth of the fetus. Little research, however, has extended the paradigm to look at the influence of prenatal factors on infant health and well-being during infancy, childhood, adolescence, or adulthood. Hypotheses can be derived from current research concerning the consequences of prenatal stress for health and well-being of the offspring across the life span (Wadhwa, 1998). An evolving view is that the blueprint for brain development is not contained in genetic makeup alone, but is the result of a dynamic process involving interactions between genes and environment. The prenatal environment is the earliest setting in which such interactions may occur. Researchers working with animal and human models of pregnancy are discovering in numerous ways that the influence of the prenatal environment on brain and nervous system development may have far-reaching consequences for the cognitive and emotional functioning of the offspring later in life. These possibilities open up a new horizon for researchers interested in biopsychosocial models of pregnancy.
In conclusion, the study of stress in pregnancy and its many ramifications is a large research arena with numerous exciting frontiers. Biopsychosocial approaches to the study of pregnancy and birth are accepted across disciplines, and interdisciplinary research collaboration is essential. Health psychology is in a unique position to contribute to this endeavor in the next millenium.
This chapter draws from the results of Christine Dunkel-Schetter's collaborative research with Curt Sandman, Ph.D., Calvin Hobel, M.D., and Pathik Wadhwa, Ph.D., M.D. This program of research has been supported by several joint grants (NIH ROl HD28413, NIH ROl HD28202, NIH R01 HD29553). During the development of this chapter, R. Gurung was supported as a postdoctoral fellow by the UCLA Training Grant in Health Psychology (MH 15750), P. Wadhwa was supported in part by NIH grant R29 HD33506, and M. Lobe1 was supported in part by NIH grant R29 NR03443. The authors would like to thank Christine Rini for her valuable comments on this chapter and Sarah Roper for her assistance in the preparation of the chapter. Dunkel-Schetter would also like to acknowledge the contributions of Nancy Collins, Ph.D., Pam Feldman, Ph.D., Susan Scrimshaw, Ph.D., Grace Woo, Ph.D., and Ruth Zambrana, Ph.D.
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