Psychosocial stress in pregnancy and preterm birth: associations and mechanisms.

Abstract:

AIMS:Psychosocial stress during pregnancy (PSP) is a risk factor of growing interest in the etiology of preterm birth (PTB). This literature review assesses the published evidence concerning the association between PSP and PTB, highlighting established and hypothesized physiological pathways mediating this association. METHOD:The PubMed and Web of Science databases were searched using the keywords "psychosocial stress", "pregnancy", "pregnancy stress", "preterm", "preterm birth", "gestational age", "anxiety", and "social support". After applying the exclusion criteria, the search produced 107 articles. RESULTS:The association of PSP with PTB varied according to the dimensions and timing of PSP. Stronger associations were generally found in early pregnancy, and most studies demonstrating positive results found moderate effect sizes, with risk ratios between 1.2 and 2.1. Subjective perception of stress and pregnancy-related anxiety appeared to be the stress measures most closely associated with PTB. Potential physiological pathways identified included behavioral, infectious, neuroinflammatory, and neuroendocrine mechanisms. CONCLUSIONS:Future research should examine the biological pathways of these different psychosocial stress dimensions and at multiple time points across pregnancy. Culture-independent characterization of the vaginal microbiome and noninvasive monitoring of cholinergic activity represent two exciting frontiers in this research.

journal_name

J Perinat Med

authors

Shapiro GD,Fraser WD,Frasch MG,Séguin JR

doi

10.1515/jpm-2012-0295

subject

Has Abstract

pub_date

2013-11-01 00:00:00

pages

631-45

issue

6

eissn

0300-5577

issn

1619-3997

pii

/j/jpme.2013.41.issue-6/jpm-2012-0295/jpm-2012-029

journal_volume

41

pub_type

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