The Role of Father Involvement during Pregnancy in the Prevention of Adverse Pregnancy Outcomes Open Access

Abstract

Preterm birth, defined as any live birth before 37 completed weeks of gestation, is a leading cause of infant morbidity and mortality. Rates of preterm birth in the United States are much higher than in both developed and developing nations. Traditional risk markers account for only 25-30% of occurrences of preterm birth. Paternal involvement has been extensively studied in relation to child development, but little attention has been paid to the role of fathers in reduction of adverse pregnancy outcomes. However, paternal involvement, as determined by presence of the father's name on the birth certificate, has been observed to be a predictor of both infant morbidity and mortality. The mechanism by which missing paternal demographics are associated with pregnancy outcomes is unknown. The literature is limited by vague measurements of paternal involvement and limited understanding of the mechanism through which paternal involvement acts to affect pregnancy outcomes. Thus, the overall theme of this dissertation proposal is to explore the concept of "paternal involvement", particularly as it applies to pregnancy outcomes. Mothers and fathers with at least a friendly relationship appear to give similar reports of father involvement, though fathers report higher levels of paternal involvement than mothers. Use of mothers' interviews may be a reasonable approach to assess paternal involvement, though findings can be applied only to fathers who are both accessible and willing to participate in studies.
In cohabiting couples, moderate or low paternal involvement may confer greater risk of preterm birth compared to high paternal involvement. Future research should explore the joint impact of relationship status and father involvement. Contrary to a priori hypotheses, pregnant women with psychiatric illness may experience a non-significant increased risk of preterm birth despite high levels of partner support. This finding may indicate a more complicated relationship between women and their partners during pregnancy. Future studies of father involvement and pregnancy outcomes should focus on further development of measures of father involvement during pregnancy, and place increased emphasis on recruiting mothers and fathers not in relationships.

Table of Contents

Table of Contents
List of Tables ................................................................................................................... ix
List of Figures ................................................................................................................. xi
Introduction ......................................................................................................................... 1
Chapter 1: Epidemiology of Preterm Birth ......................................................................... 3
Preterm Birth .................................................................................................................. 4
Mechanisms for preterm birth ........................................................................................ 6
Known Risk Factors for Preterm Birth ........................................................................... 6
Genetics and Heritability in Preterm Birth .................................................................... 14
Conclusion ...................................................................................................................... 15
Chapter 2: The Role of Fathers during Pregnancy and Pregnancy Outcomes .................. 17
Abstract .......................................................................................................................... 18
Introduction .................................................................................................................. 20
Racial Disparities in Pregnancy Outcomes ................................................................... 20
Father's Biological Impact on Pregnancy Outcomes .................................................... 22
Father Involvement in Pregnancy ................................................................................. 24
Measuring Father Involvement ...................................................................................... 31
Barriers to Unmarried Father Involvement .................................................................. 32
Limitations of the Current Literature ........................................................................... 34
Recommendations ........................................................................................................ 35
Conclusion ..................................................................................................................... 36
Chapter 3: Agreement between Maternal and Paternal Reports of Prenatal Father Involvement
........................................................................................................................................... 49
Abstract ......................................................................................................................... 50
Introduction ................................................................................................................... 51
Methods ......................................................................................................................... 52
Results ........................................................................................................................... 55
Discussion ..................................................................................................................... 58
Conclusion ..................................................................................................................... 62
Chapter 4: Father Involvement and Preterm Birth in the Fragile Families and Child Wellbeing
Study ................................................................................................................................. 78
Abstract ......................................................................................................................... 79
Introduction .................................................................................................................. 80
Methods .......................................................................................................................... 81
Results ........................................................................................................................... 83
Discussion ..................................................................................................................... 85
Conclusion ..................................................................................................................... 89
Chapter 5: Partner Support during Pregnancy and Risk of Preterm Birth ...................... 97
Abstract ......................................................................................................................... 98
Introduction .................................................................................................................. 99
Methods ....................................................................................................................... 100
Results ..........................................................................................................................103
Discussion ................................................................................................................... 106
Conclusion ................................................................................................................... 108
Chapter 6: The Dissertation in Context .......................................................................... 120
Contribution of Dissertation to Scientific Knowledge ................................................. 123
Future Directions ......................................................................................................... 124
References ........................................................................................................................125

About this Dissertation

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School	Laney Graduate School
Department	Epidemiology
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	social support pregnancy outcomes father involvement preterm birth agreement partner support
Committee Chair / Thesis Advisor	Hogue, Carol J, Emory University
Committee Members	Howards, Penelope, Emory University Pearce, Brad, Emory University Flanders, W Dana, Emory University Newport, D. Jeffrey, Emory University

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