Date of Award

Spring 4-1-2013

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Darna L. Dufour

Second Advisor

Paul Shankman

Third Advisor

Michelle Sauther

Fourth Advisor

Matthew Sponheimer

Fifth Advisor

Pei-San Tsai


This dissertation explores the association between chronic maternal psychosocial stress and neonate body size, size for gestational age and gestation length in Samoan women living on the Pacific island of Tutuila, American Samoa. Two interrelated studies were conducted to address this goal. First, the medical charts of all women of Samoan descent giving birth on island (n=1052) were reviewed to determine whether their marital status impacted the amount of prenatal care they accessed, the types and amounts of surgical interventions they received during pregnancy and their neonates' size and gestation length. Results indicated that married women accessed prenatal care earlier and more frequently and were less likely to have an episiotomy or operative vaginal delivery than unmarried women. However, women's marital status was not associated with any other medical interventions used during delivery. Although marital status was significantly related to some neonate outcomes, these differences are unlikely to be biologically significant and more likely to be an artifact of the large sample size. The second study recruited 151 women from their initial prenatal care appointments. Multiple measures of psychosocial stress were conducted throughout their pregnancies and their delivery and neonate outcomes were collected post-partum. A physiological response to psychosocial stress was measured using a minimally invasive indirect biomarker: Epstein-Barr Virus antibody levels (EBV). EBV was compared to three self-reported stress measures (status congruence, Perceived Stress Scale, Monthly Stress Questionnaire) in 78 pregnant women to determine if any of these self-reported scales accurately reflect psychosocial stress in Samoan women. There was no relationship between EBV and any of the self-reported measures of stress. Finally, the relationship between psychosocial stress (as measured by EBV), maternal characteristics and neonate outcomes was investigated. No relationship was found. Taken together, this study provides no evidence that psychosocial stress impacts pregnancy outcomes in Samoan women giving birth in American Samoa. These results were somewhat surprising in light of previous research conducted in the United States and Europe that has found a relationship between psychosocial stress and neonate outcomes.