The Contribution of Maternal Stress to Preterm Birth: Issues and Considerations

Departments of Psychiatry & Human Behavior, Obstetrics & Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, 3177 Gillespie Neuroscience Research Facility, Irvine, CA 92697, USA.
Clinics in perinatology (Impact Factor: 2.44). 09/2011; 38(3):351-84. DOI: 10.1016/j.clp.2011.06.007
Source: PubMed


Preterm birth represents the most significant problem in maternal-child health, with maternal stress identified as a variable of interest. The effects of maternal stress on risk of preterm birth may vary as a function of context. This article focuses on select key issues and questions highlighting the need to develop a better understanding of which particular subgroups of pregnant women may be especially vulnerable to the potentially detrimental effects of maternal stress, and under what circumstances and at which stages of gestation. Issues related to the characterization and assessment of maternal stress and candidate biologic mechanisms are addressed.

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Available from: Sonja Entringer, Nov 13, 2014
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    • "Inflammation, infection and immune dysregulation may cause preterm labor and early delivery; abnormalities of placental formation and function may result in preterm, early term and IUGR delivery due to placental bleeding, fetal distress and preeclampsia ; and genetic variation and multiple gestation contributes to each of these etiologies (Gonçalves et al. 2002; Han et al. 2011; Leber et al. 2010; Muglia and Katz 2010; Saito et al. 2010; Wong and Grobman 2011). Social stressors have also been studied as causes of preterm, early term and IUGR delivery, due to variation in the rate of low-birth weight delivery among different racial, ethnic and socioeconomic groups (Kuzawa and Thayer 2011; Wadhwa et al. 2011). Environmental stressors such as changes in ambient air temperature may also contribute to these birth outcomes. "
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    ABSTRACT: Studies looking at air temperature (Ta) and birth outcomes are rare. We evaluated birth outcomes and average daily Ta during various prenatal exposure periods in Massachusetts (USA) using both traditional Ta stations and modeled address Ta. We used linear and logistic mixed models, and accelerated failure time models, to estimate associations between Ta and the following outcomes among live births > 22 weeks: term birth weight (≥ 37 weeks), low birth weight (LBW) (< 2,500g at term), gestational age and preterm delivery (PT) (< 37 weeks). Models were adjusted for individual level socioeconomic status, traffic density, PM2.5, random intercept for census tract and mothers health. Predicted Ta during multiple time windows before birth was negatively associated with birth weight: average birth weight was 16.7g lower (95% CI: -29.7, -3.7) in association with an IQR increase (8.4°C) in Ta during the last trimester. Ta over the entire pregnancy was positively associated with PT (OR = 1.02; 95% CI: 1.00, 1.05) and LBW (OR = 1.04; 95% CI: 0.96, 1.13). Ta during pregnancy was associated with lower birth weight and shorter gestational age in our study population.
    Environmental Health Perspectives 04/2015; 123(10). DOI:10.1289/ehp.1308075 · 7.98 Impact Factor
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    • "Chronic stress can have a cumulative effect on physiologic systems over the life course above and beyond effects of acute stressors (Giscombe and Lobel, 2005; Wadhwa et al., 2011; Geronimus et al., 2006). This is theorized to be one cause of smaller birth size in Black women, who may experience persistent stress due to intrapersonal/personal , and institutional racism (Wadhwa et al., 2011; Giscombe and Lobel, 2005; Mendez et al., 2012; Geronimus, 1996). We theorize that stress due to neighborhood deprivation may have a stronger effect on fetal growth restriction among Black women due to the cumulative effects of multiple sources of chronic stress. "
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    ABSTRACT: Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004-2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.
    Health & Place 09/2014; 30C:98-106. DOI:10.1016/j.healthplace.2014.08.010 · 2.81 Impact Factor
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    • "Because of their high risk circumstances, it is likely depression was a chronic underlying problem. Visit notes revealed intimate partner discord was important in perinatal depression [47, 64, 65, 68, 69]. Further study of family structure and paternal involvement in mother and infant care was needed [71, 72]. "
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    ABSTRACT: This research examined changes in maternal health literacy progression among 106 low income, high risk, rural perinatal African American and White women who received home visits by Registered Nurse Case Managers through the Enterprise Community Healthy Start Program. Maternal health literacy progression would enable women to better address intermediate factors in their lives that impacted birth outcomes, and ultimately infant mortality (Lu and Halfon in Mater Child Health J 7(1):13-30, 2003; Sharma et al. in J Natl Med Assoc 86(11):857-860, 1994). The Life Skills Progression Instrument (LSP) (Wollesen and Peifer, in Life skills progression. An outcome and intervention planning instrument for use with families at risk. Paul H. Brookes Publishing Co., Baltimore, 2006) measured changes in behaviors that represented intermediate factors in birth outcomes. Maternal Health Care Literacy (LSP/M-HCL) was a woman's use of information, critical thinking and health care services; Maternal Self Care Literacy (LSP/M-SCL) was a woman's management of personal and child health at home (Smith and Moore in Health literacy and depression in the context of home visitation. Mater Child Health J, 2011). Adequacy was set at a score of (≥4). Among 106 women in the study initial scores were inadequate (<4) on LSP/M-HCL (83 %), and on LSP/M-SCL (30 %). Significant positive changes were noted in maternal health literacy progression from the initial prenatal assessment to the first (p < .01) postpartum assessment and to the final (p < .01) postpartum assessment using McNemar's test of gain scores. Numeric comparison of first and last gain scores indicated women's scores progressed (LSP/M-HCL; p < .0001) and (LSP/M-SCL; p < .0001). Elevated depression scores were most frequent among women with <4 LSP/M-HCL and/or <4 LSP/M-SCL. Visit notes indicated lack or loss of relationship with the father of the baby and intimate partner discord contributed to higher depression scores.
    Maternal and Child Health Journal 01/2014; 18(8). DOI:10.1007/s10995-014-1432-0 · 2.24 Impact Factor
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