II.

Psychosocial stress has been identified as a potential risk factor for preterm birth. However, an association has not consistently been found, and a consensus on the extent to which stress and preterm birth are linked is still lacking. A literature search was performed with a combination of keywords and MeSH terms to detect studies of psychosocial stress and preterm birth. Studies were included in the review if psychosocial stress was measured with a standardized, validated instrument and the outcomes included either preterm birth or low birth weight. Within the 138 studies that met inclusion criteria, 85 different instruments were used. Measures designed specifically for pregnancy were used infrequently, although scales were sometimes modified for the pregnant population. The many different measures used may be one factor that accounts for the inconsistent associations that have been observed.

ObjectiveRacial differences in chronic maternal stress may contribute to disparities in pregnancy outcomes. The objective is to identify racial and ethnic differences in self-reported and biologic measures of stress between non-Hispanic black (NHB) and non-Hispanic white (NHW) pregnant women.Study DesignNHB and NHW pregnant women were enrolled prior to 23 weeks gestation in this prospective cohort study. Equal numbers of women were recruited with public versus private insurance in each racial group. Self-reported stress was measured and blood samples collected in the 2nd and 3rd trimesters were analyzed for serum Epstein - Barr virus (EBV) antibody, C - reactive protein (CRP), corticotropin-releasing hormone (CRH), and adenocorticotropic hormone (ACTH).Results112 women were enrolled. NHW women reported more buffers against stress (p=0.04) and neighborhood satisfaction (p=0.02). NHB women reported more discrimination (p<0.001), food insecurity (p=0.04) and had significantly higher mean CRP levels and mean ACTH levels in the 2nd and 3rd trimesters.ConclusionSignificant differences in self-reported and biologic measures of chronic stress were identified between NHB and NHW pregnant women with similar economic characteristics. Future studies should investigate mechanisms underlying these differences and their relationship to pregnancy outcomes.

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