{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:18:50Z","timestamp":1787822330937,"version":"build-2784847793"},"reference-count":39,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["PA #96043"],"award-info":[{"award-number":["PA #96043"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["PA #02081"],"award-info":[{"award-number":["PA #02081"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["FOA #DD09\u2010001"],"award-info":[{"award-number":["FOA #DD09\u2010001"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["FOA #DD13\u2010003"],"award-info":[{"award-number":["FOA #DD13\u2010003"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NOFO #DD18\u2010001"],"award-info":[{"award-number":["NOFO #DD18\u2010001"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NOFO #DD23\u2010001"],"award-info":[{"award-number":["NOFO #DD23\u2010001"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U01 DD001304"],"award-info":[{"award-number":["U01 DD001304"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U01 DD001227"],"award-info":[{"award-number":["U01 DD001227"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prenatal stress and social support are associated with adverse birth outcomes, including stillbirth, in the general population. Their relationship to stillbirth among fetuses with birth defects is unclear. Using data from the National Birth Defects Prevention Study and the Birth Defects Study To Evaluate Pregnancy exposureS, we examined associations between maternal stress and social support and the risk of stillbirth among fetuses with birth defects and whether these associations differed by maternal race\/ethnicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants self\u2010reported exposure to stressors and social supports experienced 3\u2009months before conception through the first trimester. Using log\u2010binomial models, we estimated relative risks (RR) and 95% confidence intervals (CI) of stillbirth associated with high stress and low social support, adjusting for maternal age and race\/ethnicity. We assessed additive and multiplicative effect measure modification by maternal race\/ethnicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Neither stress nor social support was associated with stillbirth among fetuses with birth defects. Although we did not observe interaction, we observed increased risk of stillbirth among non\u2010Hispanic Black women with low stress (RR\u2009=\u20092.1, 95% CI\u2009=\u20091.3\u20133.6), Hispanic women with low stress (1.4, 1.0\u20132.1), and non\u2010Hispanic Black women with high stress (2.8, 1.4\u20135.2) compared to non\u2010Hispanic White women with low stress. We observed a similar pattern of results for low social support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Stress and social support were not associated with stillbirth in fetuses with birth defects. We observed elevated risk of stillbirth among non\u2010Hispanic Black women regardless of stress and social support levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bdr2.70096","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T07:42:16Z","timestamp":1784965336000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal Stressors and Social Support in Early Pregnancy and the Risk of Stillbirth Among Fetuses With Birth Defects: Exploring Effect Modification by Race\/Ethnicity"],"prefix":"10.1002","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8420-5040","authenticated-orcid":false,"given":"Meredith M.","family":"Howley","sequence":"first","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"},{"name":"Department of Epidemiology and Biostatistics, College of Integrated Health Sciences University at Albany  Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6523-3406","authenticated-orcid":false,"given":"Jada M.","family":"Scott","sequence":"additional","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3609-5665","authenticated-orcid":false,"given":"Eva M.","family":"Williford","sequence":"additional","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8599-6040","authenticated-orcid":false,"given":"Uma M.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Columbia University Irving Medical Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4355-7557","authenticated-orcid":false,"given":"Eleni A.","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzan L.","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University School of Medicine  Stanford California USA"},{"name":"Department of Obstetrics and Gynecology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris M.","family":"Cunniff","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Weill Cornell Medical College  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5874-4155","authenticated-orcid":false,"given":"A. J.","family":"Agopian","sequence":"additional","affiliation":[{"name":"Department of Epidemiology UTHealth School of Public Health  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0868-8420","authenticated-orcid":false,"given":"Nahed","family":"Elhassan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology University of Arkansas for Medical Sciences  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8318-4049","authenticated-orcid":false,"given":"Wendy N.","family":"Nembhard","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fay W. Boozman College of Public Health University of Arkansas for Medical Sciences  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4702-1007","authenticated-orcid":false,"given":"Sarah C.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the National Birth Defects Prevention Study and Birth Defects Study to Evaluate Pregnancy exposureS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010023\u201006089\u20100"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2014.02.003"},{"issue":"9","key":"e_1_2_11_4_1","first-page":"247","article-title":"Stressful Life Events Experienced by Women in the Year Before Their Infants' Births\u2014United States, 2000\u20132010","volume":"64","author":"Burns E. 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