Disruptions to brain development associated with shortened gestation place individuals at risk for the development of behavioral and psychological dysfunction throughout the lifespan. The purpose of the present study was to determine if the benefit for brain development conferred by increased gestational length exists on a continuum across the gestational age spectrum among healthy children with a stable neonatal course. Neurodevelopment was evaluated with structural magnetic resonance imaging in 100 healthy right-handed 6- to 10-year-old children born between 28 and 41 gestational weeks with a stable neonatal course. Data indicate that a longer gestational period confers an advantage for neurodevelopment. Longer duration of gestation was associated with region-specific increases in gray matter density. Further, the benefit of longer gestation for brain development was present even when only children born full term were considered. These findings demonstrate that even modest decreases in the duration of gestation can exert profound and lasting effects on neurodevelopment for both term and preterm infants and may contribute to long-term risk for health and disease.

These data suggest that prenatal exposure to maternal stress has consequences for the development of infant temperament.

This article is intended to help clinicians better understand the ever-expanding body of research on whether psychosocial stress (both acute and chronic) is linked to 2 major adverse pregnancy outcomes: preterm birth and low birth weight. We summarize the existing literature and then review assessment tools commonly used to diagnose various types of psychosocial stress, with attention to how and when assessments should be made. After discussing the physiologic mechanisms hypothesized to underlie these relationships, we examine the range of existing interventions aimed at reducing psychosocial stress and review their efficacy at improving birth outcomes. Future directions for prevention of adverse pregnancy outcomes are discussed and suggest that an entirely new approach may be necessary.

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The purposes of this study were to determine the intervals when placental corticotrophic-releasing hormone (CRH) was most responsive to maternal cortisol. A sample of 203 women each were evaluated at 15, 19, 25 and 31 weeks gestation and followed to term. Placental CRH and maternal adrenocorticotropin hormone (ACTH), B-endorphin and cortisol were determined from plasma. CRH levels increased faster and were higher in women who delivered preterm compared with women who delivered at term (F3,603 = 5.73, p < .001). Simple effects indicated that CRH levels only at 31 weeks predicted preterm birth (F1,201 = 5.53, p = .02). Levels of cortisol were higher in women who delivered preterm at 15 weeks gestation (F1,201 = 4.45, p = .03) with a similar trend at 19 weeks gestation. Hierarchical regression suggested that the influence on birth outcome of maternal cortisol early in pregnancy was mediated by its influence on placental CRH at 31 weeks. Elevated cortisol at 15 weeks predicted the surge in placental CRH at 31 weeks (R = .49, d.f. = 1,199, Fchange = 61.78, p < .0001). Every unit of change in cortisol (microg/dl) at 15 weeks was associated with a 34 unit change of CRH (pg/ml) at 31 weeks. These findings suggested that early detection of stress signals by the placenta stimulated the subsequent release of CRH and resulted in increased risk for preterm delivery.

Objective-This study examined the role of psychosocial stress in racial differences in birth outcomes.Design-Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women.Main Outcome Measures-The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age.Results-Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In the sample as a whole, lifetime and childhood indicators of perceived racism predicted birth weight and attenuated racial differences, independent of medical and sociodemographic control variables. Models within each race group showed that perceived racism was a significant predictor of birth weight in African Americans, but not in non-Hispanic Whites.Conclusions-These findings provide further evidence that racism may play an important role in birth outcome disparities, and they are among the first to indicate the significance of psychosocial factors that occur early in the life course for these specific health outcomes. Keywords stress; racism; pregnancy; birth weight; health disparities African Americans are twice as likely as non-Hispanic Whites, the most common referent group, to die before their first birthday (Mathews, Menacker, & MacDorman, 2004). In this Correspondence concerning this article should be addressed to Tyan Parker Dominguez, School of Social Work, SWC 224, University of Southern California, Los Angeles, CA 90089-0411, or Christine Dunkel-Schetter, Department of Psychology, 405 Hilgard Avenue, University of California, Los Angeles, CA 90095-1563. tyanpark@usc.edu or dunkel@psych.ucla.edu. NIH Public Access Author ManuscriptHealth Psychol. Author manuscript; available in PMC 2010 May 12. Published in final edited form as:Health Psychol. 2008 March ; 27(2): 194-203. doi:10.1037/0278-6133.27.2.194. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript country, low birth weight (LBW; <2,500 g) and preterm delivery (PTD; <37 weeks) are leading causes of infant death in the overall population, behind congenital anomalies, and the leading causes of death for African American infants (Mathews et al., 2004). Compared with White infants, African American infants have two times the rate of LBW and PTD, and three times the rate of very low birth weight (<1,500 g) and very preterm delivery (<32 weeks) (Martin et al., 2005). These poorer birth outcomes have serious implications not only for infant survival, but also for childhood growth and development (e.g., Botting, Powls, Cooke, & Marlow, 1998) and some important health outcomes in adulthood (e.g., Rich-Edwards et al, 1997). Thus, understanding and eventually eliminating racial disparities in adverse birth outcomes is a major public health priority in the United ...

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These findings are the first to link both psychosocial and neuroendocrine factors to birth outcomes in a prospective design.