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sadness. In some subgroups in the United States, the expression of anxiety may be much more normative and accepted than in others, in which it may be frowned upon, misunderstood, or ignored. Languages may also differ in their abilities to translate the word “stress.” The Spanish language, for example, does not have a specific translation for the word “stress.” Anxiety, or nervios, is understood in Spanish, whereas stress in general is not. Thus, studies of stress as a risk factor by the use of standard scale assessments delivered in Spanish may or may not be assessing the same phenomenon that these scales assess when they are delivered in English. This poses a special challenge to researchers.

Similarly, African American women, whose rates of preterm delivery and infant mortality are the highest in the United States, have unique experiences of stress, yet there is a dearth of studies on African American cultural factors pertaining to stress, emotion, or pregnancy. Parker Dominguez and colleagues (2005) found that neither anxiety nor perceived stress was significantly correlated with gestational age or low birthweight among 179 pregnant African American women. Instead, a newer measure of the extent to which women experienced intrusive thoughts or rumination about their two most severe major life events was associated with lower birth weight when gestational age in linear multiple regression analyses was controlled for. Intrusive thought is a recognized symptom of trauma containing both cognitive and emotional components (and is often symptomatic of posttraumatic stress disorder).

The possibility that low-income African American women experience more symptoms of trauma and that these are more important risk factors for preterm birth than depression or anxiety for this or other groups is intriguing. More generally, researchers must address the possibility that the same aspects of stress may not pose a risk for preterm birth in the same manner for all racial and ethnic groups. In-depth studies of specific racialethnic and cultural groups that include culturally specific stress measures may yield answers to whether stress is a risk factor for preterm birth for specific groups. The answers may be more complex than has been imagined. Anxiety may be a stronger risk factor for Latinos and whites, whereas depression, posttraumatic stress disorder, or racial stressors may be more potent individual-level risk factors for African American women. These possibilities might help to explain why research on stress and pregnancy outcomes has yielded equivocal findings and also why the findings from studies in foreign countries with more homogeneous populations, such as Denmark, have been more definitive. Furthermore, these possibilities suggest very different intervention strategies for different racial and ethnic groups (Norbeck and Anderson, 1989).

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