Maternal stress is common, but its prevalence varies by the type of stressor, a mother’s circumstances, and the period measured. In a 2010 survey of women with a live birth across 27 U.S. PRAMS sites, 70.2% reported at least one stressful life event in the year before birth, with an average of 1.81 events per mother. Later COVID-19 supplement data show how economic, childcare, housing, food, partner, and illness pressures affected women with a live birth in April–December 2020.
Contents
- How common stressful life events were before birth
- Types and geographic distribution of maternal stressors
- Differences by age, race, and education
- Partnership and health coverage
- Pandemic-related stress in 2020
- Stress and postpartum depressive symptoms
How common stressful life events were before birth
The CDC report Stressful Life Events Experienced by Women in the Year Before Their Infants’ Births — United States, 2000–2010 examined women with a live birth in 27 U.S. PRAMS sites. In 2010, 70.2% reported at least one stressful life event during the year before birth. The mean was 1.81 stressful life events per mother.
The estimate depends on how the events are defined. When the 2010 sample was restricted to the same stressful-life-event items used in an earlier 1990–1995 study, 62.9% reported at least one event. These figures describe reported events in the survey populations; they are not a measure of every form of stress or a clinical diagnosis.
Across 10 continuously participating PRAMS sites, the percentage reporting at least one stressful life event fell by 0.54 percentage points per year from 2000 through 2010. Over the same period, financial stressor prevalence fell by 0.44 percentage points per year, emotional stressor prevalence by 0.35 percentage points per year, partner-related stressor prevalence by 0.58 percentage points per year, and traumatic stressor prevalence by 0.26 percentage points per year. These are reported trends for the participating sites and period, rather than current national estimates.
Types and geographic distribution of maternal stressors
Financial stress was the most frequently reported category in every year from 2000 through 2010. In the 27-site sample in 2010, 51.0% of mothers reported at least one financial stressor. Emotional stressors were reported by 29.6%, partner-related stressors by 28.5%, and traumatic stressors by 17.6%.
| Stressor type | Mothers reporting it, 2010 |
|---|---|
| Financial | 51.0% |
| Emotional | 29.6% |
| Partner-related | 28.5% |
| Traumatic | 17.6% |
The geographic range across PRAMS sites was substantial. The share reporting at least one stressful life event ranged from 58.5% in Georgia to 77.5% in West Virginia. The mean number of events ranged from 1.41 in New York City to 2.26 in Oklahoma.
Individual categories also varied by site. Financial stressor prevalence ranged from 42.2% in Georgia to 58.1% in Oklahoma. Emotional stressors ranged from 22.3% in Georgia to 40.0% in West Virginia. Partner-related stressors ranged from 22.7% in Utah to 35.5% in Arkansas, while traumatic stressors ranged from 11.3% in New Jersey to 25.9% in West Virginia.
These ranges should be read as differences among the listed PRAMS sites in 2010. They do not establish that every state had the same survey coverage or that one location represents all mothers in that state.
Differences by age, race, and education
Younger mothers reported more stressful life events in the 2010 PRAMS analysis. Among mothers younger than 25, 80.0% reported at least one event, compared with 69.5% among mothers aged 25–29 and 63.0% among mothers aged 30 or older. The mean number of events was 2.43 among mothers younger than 25 and 1.38 among mothers aged 30 or older.
The reported prevalence also differed across racial and ethnic groups. Non-Hispanic Black mothers had a 76.5% prevalence of at least one stressful life event, and Hispanic mothers had a prevalence of 73.9%. Non-Hispanic Asian/Pacific Islander mothers had the lowest reported prevalence among the groups listed, at 56.9%.
Some stressor categories showed additional differences. Non-Hispanic Black mothers reported partner-related stressors at 41.7%, the highest percentage among the listed racial and ethnic groups. They also reported traumatic stressors at 23.0%, again the highest percentage among those groups.
Education was associated with reported exposure in the same 2010 analysis. At least one stressful life event was reported by 75.6% of mothers with 12 or fewer years of education, 73.7% of mothers with 13–15 years, and 59.6% of mothers with at least 16 years of education.
These statistics describe differences in survey responses between groups. They do not by themselves identify why the differences occurred or show that education, age, or race caused a particular stressor.
Partnership and health coverage
Marital status was associated with both the prevalence and number of reported stressful events. In 2010, 79.6% of unmarried mothers reported at least one event, compared with 64.2% of married mothers. Unmarried mothers averaged 2.48 events, while married mothers averaged 1.38.
The difference was also visible in specific categories. Partner-related stressors were reported by 42.6% of unmarried mothers and 19.5% of married mothers. Traumatic stressors were reported by 28.1% of unmarried mothers and 10.9% of married mothers.
Health coverage showed a similar pattern. Among mothers covered by Medicaid, 78.7% reported at least one stressful life event, compared with 64.2% of mothers not covered by Medicaid. Medicaid-covered mothers averaged 2.41 events, compared with 1.38 among mothers not covered by Medicaid. Financial stressors affected 63.1% of Medicaid-covered mothers and 42.4% of mothers not covered by Medicaid.
The coverage and partnership figures are group comparisons from the 2010 PRAMS analysis. They should not be interpreted as evidence that insurance status or marital status alone explains maternal stress.
Pandemic-related stress in 2020
The CDC report Pandemic-related stressors and mental health among women with a live birth in 2020 used a weighted PRAMS COVID-19 supplement covering 29 U.S. jurisdictions. Among women with a live birth in April–December 2020, 50% reported economic stressors. Other reported stressor types were childcare, 41%; partner, 18%; food insecurity, 17%; housing, 12%; and COVID-19 illness, 10%.
Twenty-six percent reported no pandemic-related stressor types. Fifty-three percent reported one or two types, 19% reported three or four, and 2% reported five or six. Half of respondents felt more anxious than usual because of the pandemic, while 28% felt more depressed than usual.
| Pandemic-related measure | Percentage, April–December 2020 |
|---|---|
| Economic stressors | 50% |
| Childcare stressors | 41% |
| Partner stressors | 18% |
| Food-insecurity stressors | 17% |
| Housing stressors | 12% |
| COVID-19 illness stressors | 10% |
| More anxious than usual | 50% |
| More depressed than usual | 28% |
Reported stress also differed across racial and ethnic groups. Economic stressors affected 59% of non-Hispanic Black women and 60% of Hispanic women. Housing stressors affected 22% of non-Hispanic American Indian/Alaska Native women, compared with 9% of non-Hispanic White and Asian/Pacific Islander women. Food-insecurity stressors affected 32% of Hispanic women, 23% of non-Hispanic Black women, and 11% of non-Hispanic Asian/Pacific Islander women. Partner-related stressors were reported by 22% of non-Hispanic Black women, and COVID-19 illness stressors by 15% of Hispanic women, the highest percentage among the reported racial and ethnic groups.
Delivery coverage was also associated with reported pandemic stress. Among women with Medicaid at delivery, 64% reported economic stressors, 17% housing stressors, 44% childcare stressors, 29% food-insecurity stressors, 20% partner stressors, and 12% COVID-19 illness stressors. Among women with no delivery insurance, the corresponding percentages were 58%, 13%, 44%, 29%, 17%, and 12%.
Stress and postpartum depressive symptoms
The CDC’s Trends in Postpartum Depressive Symptoms — 27 States, 2004, 2008, and 2012 reported postpartum depressive symptoms among 11.5% of new mothers across 27 PRAMS states in 2012. In 13 states with data for all three periods, the overall percentage declined from 14.8% in 2004 to 9.8% in 2012.
Within those 13 states, the percentage reporting symptoms varied sharply by the number of stressful life events before birth. Among mothers reporting no events, symptoms affected 7.3% in 2004, 5.6% in 2008, and 6.4% in 2012. Among mothers reporting one or two events, the percentage fell from 12.2% in 2004 to 8.0% in 2012.
Higher event counts were associated with higher reported symptom percentages in both measured years. Symptoms affected 24.0% of mothers reporting three to five stressful events in 2004 and 14.4% in 2012. Among mothers reporting six to 13 events, the figures were 37.3% in 2004 and 24.2% in 2012.
| Stressful life events before birth | Symptoms in 2004 | Symptoms in 2012 |
|---|---|---|
| None | 7.3% | 6.4% |
| 1–2 | 12.2% | 8.0% |
| 3–5 | 24.0% | 14.4% |
| 6–13 | 37.3% | 24.2% |
In 2012, postpartum depressive symptoms were reported by 8.4% of married mothers and 12.7% of unmarried mothers in the 13-state comparison. They were reported by 8.0% of mothers with more than 12 years of education and 13.4% of mothers with fewer than 12 years.
The 2020 pandemic analysis also found a graded association between the number of pandemic-related stressor types and mental-health measures. Compared with women reporting no pandemic-related stressors, women reporting five or six types had an adjusted prevalence ratio of 3.41 for feeling more anxious and 6.51 for feeling more depressed. These are adjusted prevalence ratios from the 2020 supplement, not percentages of women diagnosed with an anxiety or depressive disorder.
Source: Stressful Life Events Experienced by Women in the Year Before Their Infants’ Births — United States, 2000–2010; Pandemic-related stressors and mental health among women with a live birth in 2020; Trends in Postpartum Depressive Symptoms — 27 States, 2004, 2008, and 2012