Prenatal Maternal Stress

Dr. Lobel began her research career studying stress in the context of pregnancy and birth. Her early research developed a theoretically-guided, methodologically rigorous way to conceptualize and measure prenatal maternal stress (PNMS) (e.g., Lobel, 1994; Lobel & Dunkel-Schetter, 1990). Using this approach, Lobel and colleagues showed that PNMS was a potent contributor to adverse birth outcomes including low birthweight and preterm delivery (Lobel et al., 1992). Women with high PNMS were twelve times more likely to deliver a low birthweight infant and twice as likely to deliver preterm compared to women with low PNMS. These were among the most scientifically rigorous investigations of PNMS ever conducted, and they helped establish the impact of PNMS on birth outcomes, a phenomenon which has been replicated in many studies since (reviewed by Lobel & Dunkel-Schetter, 2016).

Because of the need for a brief yet reliable means of measuring PNMS in research and in clinical settings, Dr. Lobel developed the Prenatal Distress Questionnaire (PDQ) and its successor, the Revised Prenatal Distress Questionnaire (NuPDQ), and established their strong psychometric properties with members of the STAR Lab and other collaborators (Alderdice, Lynn, & Lobel, 2012; Ibrahim & Lobel, 2020; Lobel et al., 2008).  The PDQ and NuPDQ have been translated into numerous languages and are being used by researchers across six continents.  Dr. Lobel and STAR Lab members also address critical health issues related to PNMS, including racial disparities in birth outcomes (Giscombé & Lobel, 2005; Rosenthal & Lobel, 2011; 2016; 2018), rising rates of surgical delivery (DeLuca & Lobel, 2014; Lobel & DeLuca, 2007; Saunders et al., 2006), intimate partner violence in pregnancy (Cizmeli, Lobel, Saftlas, & Harland, 2018), stress related to the use of assisted reproductive technology (Nicoloro­SantaBarbara, Busso, Moyer, & Lobel, 2018), stress among pregnant women with Opioid Use Disorder (Preis, Inman, & Lobel, 2020), prenatal stress as a risk factor for autism (Whitaker-Azmitia, Lobel, & Moyer, 2014), and societal initiatives to reduce reproductive stress and improve perinatal mental and physical health (Lobel & Ibrahim, 2018; Mahaffey & Lobel, 2018). In the Spring of 2020, the STAR Lab initiated the COVID-19 Pregnancy Experiences (COPE) Study to examine contributors and effects of PNMS in women pregnant during the pandemic (Preis, Mahaffey, Heiselman, & Lobel, 2020a; 2020b; Preis, Mahaffey, & Lobel, 2020).

Alleviating the Effects of Stress  

Numerous studies (e.g. Griffin, Friend, Eitel, & Lobel, 1993) have confirmed that stress impedes health-promoting behaviors.  Research from the STAR Lab documents a variety of factors that lead people to take better care of their health, even under high stress.  These factors include appearance concerns (Darlow & Lobel, 2010), knowledge of health risks (Cannella, Lobel, & Monheit, 2010), flexible motivation (Darlow & Lobel, 2012), conscientiousness (Grey, Lobel, & Cannella, 2013), commitment (DeLuca & Lobel 1995), self-esteem (Auerbach, Lobel, & Cannella, 2014), and communication with health care providers (Nicoloro­SantaBarbara et al., 2017).  Studies conducted by STAR Lab members document that such factors reduce the impact of stress through healthy behaviors including nutritious eating, sleep, oral health care, and exercise.  In a major study from the STAR Lab, pregnant women at high risk of a poor birth outcome who were the most optimistic took better care of themselves and coped more effectively with stress, resulting in better birth outcomes (Lobel, DeVincent, Kaminer, & Meyer, 2000; Lobel, Yali, Zhu, DeVincent, & Meyer, 2002).  This study has been widely cited in the research literature and in the mass media (e.g. CBS, CNN, Parents Magazine, Wall Street Journal, Washington Post) as a powerful demonstration of the health benefits of optimism.

Perceived Risk

Other research from Dr. Lobel and the STAR Lab examines how perceived risk elevates stress and influences behaviors. An early study based on social comparison theories (e.g., Taylor & Lobel, 1989) showed that pregnant women at high risk of an adverse birth outcome relied on comparisons to one another to alleviate their emotional distress (Dias & Lobel, 1997).  A more recent study demonstrated that pregnant women’s perceptions of their risk predicted birth outcomes better than objective measures of risk (Cannella, Auerbach, & Lobel, 2013).  The STAR Lab has also conducted several projects that document the impact of an optimistic outlook in shaping people’s perceptions of their risk (e.g., Andersen & Lobel, 1995; Yali & Lobel, 1999).  Women who are most optimistic view themselves at lower risk of heart disease, breast cancer, and lung cancer (Hamilton & Lobel, 2012; 2015).

Coping

Dr. Lobel and STAR Lab members have conducted studies examining how different groups of people cope with stressful circumstances, including infertile couples (Cizmeli, Lobel, Franasiak, & Pastore, 2013; Dunkel-Schetter & Lobel, 1991; Nicoloro­SantaBarbara, Lobel, Bocca, Stelling, & Pastore, 2017), cancer patients (Taylor & Lobel, 1989), patients with rare diseases (Nicoloro­SantaBarbara, Lobel, & Wolfe, 2017), college students (Dunkel-Schetter & Lobel, 1990; Yusufov, Nicoloro-SantaBarbara, Grey, Moyer, & Lobel, 2018), and women pursuing nontraditional careers (London, Rosenthal, Levy, & Lobel, 2011).  Dr. Lobel developed the Prenatal Coping Inventory (PCI) to identify ways that women cope with the challenges that they endure in pregnancy.  Using this measure, the STAR Lab has shown how coping influences emotional distress during pregnancy and how women’s intrapersonal, interpersonal, and tangible resources promote adaptive coping to enhance their resistance to stress (Hamilton & Lobel, 2008; Ibrahim et al., 2017; Lobel et al., 2002; Yali & Lobel, 1999; 2002).  These are some of the first studies to investigate coping in pregnancy using rigorous research methods and a strong theoretical foundation.

Genetic Screening and Risk

The STAR Lab also examines how people respond to genetic screening as this experience relates to stress, health behaviors, and risk perception.  For example, a study conducted by the STAR Lab identified major contributors to emotional distress in pregnant women undergoing genetic screening for fetal abnormality (Lobel, Dias, & Meyer, 2005). In 2009, when genetic screening for breast cancer was becoming more prevalent, STAR Lab members conducted a meta-analysis of existing research to evaluate the potential emotional impact of such screening (Hamilton, Lobel, & Moyer, 2009).  Additionally, STAR Lab members have examined infertile women’s emotional reactions to testing for Fragile X carrier status (Cizmeli, Lobel, Franasiak, & Pastore, 2013); in a subsequent study, they compared the emotional status of women whose infertility was due to diminished ovarian reserve (DOR) or to anatomical causes of infertility and they examined contributors to infertile women’s distress (Nicoloro­SantaBarbara, Lobel, Bocca, Stelling, & Pastore, 2017).  Dr. Lobel and her collaborators have also conducted research about the experiences of people attempting parenthood who are considering preimplantation genetic testing (PGT). This research examines motivations that lead people to seek and use PGT, ethical quandaries they face, and other factors that influence the complex decision-making process about whether or not to use PGT (Genoff Garzon, Rubin, Lobel, Stelling, & Pastore, 2018;  Pastore, Cordeiro Mitchell, Rubin, Nicoloro-SantaBarbara, Genoff Garzon,  & Lobel, 2019; Pastore, Rubin, Nicoloro-SantaBarbara, Stelling, & Lobel, 2020).