While many studies document racial differences in medical outcomes, elucidating or excluding pathways to explain these differences can assist in the development of interventions to eliminate them. This paper summarizes the findings from a cross-sectional study using an established survey validated in pregnant women,  to better understand the relation of race with HRQoL during early pregnancy. Racial differences were identified in Physical Functioning, Bodily Pain, General Health, Vitality and Social Functioning. After adjustment for potential confounders, the differences in HRQoL scores were no longer statistically significant. Incremental adjustment (Table 3 and Table 4) indicated that much of the racial variation in physical functioning was due to insurance status and social support. Variation in social functioning was largely explained by the presence of social support.
Recent studies have emphasized the importance of HRQoL within the broader context of maternal health, pregnancy outcomes and neonatal growth and development. If poor functioning in pregnancy is associated with an increased risk of preterm birth [14, 28] and higher resource utilization, [29, 30] substantive prenatal interventions should be explored. A multidisciplinary approach to improving quality of life includes clinicians, social workers, and community resources, may be needed to promote better functioning during the course of pregnancy. The development of preconception-based interventions that address social support and depression symptoms before conception and extend into the early pregnancy period, may prove effective at increasing early pregnancy functioning.
The findings of this study are largely consistent with other studies in non-pregnant adults that report lower ratings of quality of life among blacks compared to whites [31, 32]. In contrast to other studies, however, the presence of medical conditions did not appear to have a substantial effect on HRQoL among women in early pregnancy. There were no statistically significant racial differences in the prevalence of chronic or current medical conditions in our sample of women. Moreover, adjustment for chronic or current conditions did not contribute substantially to the overall variation in physical or social functioning between racial groups. It may be that the effect of pregnancy-specific complications on physical and social functioning is cumulative and increases over the entire course of pregnancy, rather than contributing to a substantive effect in early pregnancy. Alternatively, both black and white women may expect to experience symptoms related to medical conditions or some physical discomfort during pregnancy, with the result that it does not influence their perception of their health-related quality of life.
Social support accounted for a modest amount of the variation in each dimension of physical functioning. Perceived social support has been correlated with depressive symptoms in some studies, particularly among pregnant women [33–35]. It may be that the black women in our study had different perceptions of partner support compared to white women. Social support networks other than spouses or significant others should be considered in future studies of psychosocial factors and their relation to perceptions of quality of life. Because racial differences in patients’ attitudes and preferences for management of psychosocial issues have been reported, [36–38] health care providers caring for expectant mothers should consider patients’ cultural, social and socioeconomic context when negotiating referrals for psychosocial interventions [37, 39]. Peer-mentoring among first-time mother has been shown to be effectively in improving infant health [40, 41]. Proposed interventions might include similar peer support groups where women can interact with other mothers experiencing depressive symptoms or mothers with a prior history of depression symptoms.
Differences in depressive symptoms between black and white women in our study is similar to other studies among pregnant women [8, 42]. Orr and colleagues reported in the rural south that 49% of Black women had CES-D scores of 16 or greater compared with 33% of white women, corresponding to a difference of 16 percentage points . In our sample, there was a 15 percentage point difference between black and white women (22% versus 7%). Findings from the current study confirm that depressive symptoms are prevalent in early pregnancy among a diverse population and suggest the need for effective and efficient screening measures .
There are several limitations of this study. First, because the sample included only black and white women from one urban area, the findings may not be generalizable to women of other racial groups or in other geographical regions. However, this survey has been established as a reliable instrument for measuring functional status and has been used in multiple populations in health services research. Depressive symptoms were measured rather than the diagnosis of clinical depression. However, subclinical depression, as a consequence of its high prevalence, is a significant clinical problem as manifested by its effect on health service use and social morbidity among adults in the general population, and our measure is one that has been well validated in numerous populations and settings. Also, there were other potential confounders we were unable to adjust for in the analysis (e.g. domestic violence) that might alter the presence or magnitude of associations between race and HRQoL. Regressions models were adjusted for the presence and level of partner support, but support from other sources than the partner was (e.g. family members, neighbors) was not collected or adjusted for in the multivariate analysis. The linear regression models were also not adjusted for women’s pre-pregnancy lifestyle behaviors or desire for pregnancy on physical and mental functioning during pregnancy. Future studies might assess the influence of pregnancy intent on physical and mental functioning during pregnancy. Rather than adjusting for past and current medical conditions individually in the regression analysis, these conditions were adjusted for as a composite variable (one or more medical conditions versus none). This composite variable is heterogeneous and may have reduced the magnitude of association of race with quality of life, as some conditions may have a greater impact on quality of life than others.