Article

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

ABSTRACT

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.

    • "However, the windows of susceptibility to each environmental stressor may differ and this needs to be taken into account (Darrow et al., 2009a; Shah and Balkhair, 2011; Stieb et al., 2012; Strand et al., 2011). In fact, the mechanisms that have been suggested to underlie the association between air pollution and PTB may pertain to both the early and final periods of pregnancy, while for temperature , only the weeks immediately before birth seem pertinent (Dadvand et al., 2011; Wadhwa et al., 2011; Strand et al., 2011). "
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    ABSTRACT: Introduction: Environmental exposures have been linked to length of gestation but the question as to during which weeks of gestation pregnancies are most susceptible still remains little explored. We estimated the effect of maximum apparent temperature and air pollution levels on risk of birth by week of gestation. Methods: We analyzed two cohorts of singleton live births in Rome (2001-2010) and Barcelona (2007-2012). Maximum apparent temperature (MAT), PM10, O3 and NO2 were analyzed in the warm period (1st April-31st October). Gestational week-specific hazard ratios of giving birth associated to a 1-unit increase in exposure were estimated fitting Cox regression models adjusted for seasonality, and demographic and clinical characteristics of the mother. Results: We observed 78,633 births (5.5% preterm) in Rome and 27,255 (4.5% preterm) in Barcelona. The highest hazard ratios for 1°C increase in MAT were in the 22nd-26th weeks of gestation, 1.071, (95% CI 1.052-1.091) in Rome and 1.071 (95% CI 1.036-1.106) in Barcelona, and decreased to 1.032 (95% CI 1.026-1.038) and 1.033 (95% CI 1.020-1.045) at the 36th week of gestation, respectively. Similar associations and trends were observed for PM10 and NO2 after adjusting for MAT. O3 showed similar trends but weaker associations. Conclusions: We found, consistently in Rome and Barcelona, an increased risk of delivery for a unit increase in MAT, PM10, NO2 and O3, especially in the second half of the second trimester, thus effectively increasing the risk of preterm and particularly early preterm birth. Results may help to increase awareness of these risks among public-health regulators and clinicians, leading to better preventive strategies.
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    • "Placental corticotrophin-releasing hormone CRH secretion is stimulated by the maternal pituitary-adrenal stress hormones ACTH, beta-endorphin, and cortisol (Wadhwa et al., 1997). The prevalence of preterm deliveries is clearly associated with maternal stress through increased levels of maternal plasma concentrations of CRH, which is involved in the timing of parturition (see the revision byWadhwa et al., 2011). In contrast, studies on the association between maternal exposure to stressors and birth weight have yielded mixed results, the relationship being stronger when multiple exposures interact to affect foetal growth (Paarlberg et al., 1993). "

    Full-text · Article · Dec 2015 · Annals of Human Biology
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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.
    Full-text · Article · Apr 2015 · Environmental Health Perspectives
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