Despite substantial interest in the effects of stress on pregnancy, few instruments are available to measure pregnancy-specific stressors. Moreover, research has typically focused on the distressing, negative aspects of pregnancy. This report examines the reliability and validity of the Pregnancy Experience Scale (PES), a 41-item scale that measures pregnancy-specific daily hassles and uplifts. The PES was administered to two cohorts of low risk women at 24, 30, and 36 weeks (n = 52) or 32 and 38 weeks (n = 137). Women perceived their pregnancies to be significantly more intensely and frequently uplifting than hassling. Internal scale reliability was high (α = 0.91 to 0.95). Frequency and intensity scores for hassles and uplifts were stable over time (r's = 0.56 to 0.83) and patterns of convergent and discriminant validity emerged between the PES and existing measures of general affective intensity, daily stressors, depressive symptoms, and anxiety. These results indicate that (1) failure to measure pregnancy-specific stress will underestimate the degree to which pregnant women experience distress and (2) measurement of only the negative aspects of pregnancy will overestimate distress and fail to portray the degree to which women are psychologically elevated by their pregnancies. Measurement of hassles relative to uplifts may provide the most balanced assessment of pregnancy appraisal.

Medical education in the twentieth century was largely influenced by the Flexner Report, with significant proportions of instruction dedicated to the molecular underpinnings of the pathologic pathways and minimal mention of the socio-ecological determinants of health. When examining the predominant diseases of the twenty first century landscape, widening health disparities, and significant changes in the United States healthcare system, it is imperative to view wellness and sickness in a broader public health context rather than a singular focus of the biomedical model. While undergraduate opportunities to study public health are on the rise in the United States, there is a parallel urgency for medical curricula to recognize the importance of the complex interrelated socio-ecological root causes of health, well-being, and illness. In order to reduce the risk of non-communicable diseases and increase health equity, it is necessary for medical education to integrate core public health knowledge and competencies. Contemporary health challenges require a public health approach, in addition to clinical skills, for physicians to provide equitable care. The COVID-19 pandemic further underscores the necessity to mitigate the effects of socio-ecological determinants of health. Seven key recommendations are presented from a training to practice timeline emphasizing the important linkages between medical education, socio-ecological influences on health, and public health. As the health challenges in society and communities shift, so too must training of future physicians. There is a need and an opportunity for medicine and public health to address the shared health challenges of our global society.