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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    • "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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    • "We and others have reported that after accounting for the influence of established obstetric and socio-demographic risk factors, maternal psychosocial stress is significantly and independently associated with an increased risk of preterm birth and restricted fetal growth [3] [4] [5] [6]. Alterations in stress-related maternal–placental–fetal endocrine and immune physiology have been suggested as pathways that may underlie this association [1]. In support of this suggested biological transmission pathway, elevated levels of maternal cortisol, Table 3 Results of the linear regression model showing the association between positive affect and the covariates included in the model and length of gestation "
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    ABSTRACT: The association between maternal psychological state during pregnancy and birth outcomes is well established. The focus of previous studies has been on the potentially detrimental consequences of maternal stress on pregnancy and birth outcomes, particularly shortened gestation and increased risk of preterm birth. Despite a growing literature linking positive affect with favorable health outcomes this construct has received little attention in the context of pregnancy. Therefore, in the current study, we tested the hypothesis that maternal positive affect during pregnancy is associated with beneficial consequences in terms of increased length of gestation and reduced risk of preterm birth above that of the absence of stress. In 169 pregnant women maternal positive affect and perceived stress were serially assessed at 15.2±0.9weeks (T1; mean±SD), 19.7±0.9weeks (T2) and 30.7±0.7weeks (T3) gestation. Pregnancy and birth outcomes were abstracted from the medical record. Higher maternal positive affect and a steeper increase in maternal positive affect over pregnancy were positively associated with length of gestation (p<.05) and reduced risk of preterm delivery (p<.01), whereas maternal perceived stress was not significantly associated with shorter length of gestation (p>.10). These findings suggest that maternal positive affect may be beneficial for outcomes related to the length gestation, and that this effect cannot be accounted for by the lower stress levels associated with higher positive affect. Interventions to increase maternal positive affect may be beneficial for fetal development.
    Journal of psychosomatic research 10/2013; 75(4):336-340. DOI:10.1016/j.jpsychores.2013.06.031 · 2.74 Impact Factor
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