Psychological and Physiological Stress: Impact on Preterm Birth

Abstract

Stress increases corticotropin‐releasing hormone and may ultimately result in increased uterine contractility. Stress also increases cytokine production, which independently may lead to preterm birth or increase susceptibility to infection, thereby increasing the risk of preterm birth. Finally, stress may change health behaviors that lead to preterm birth. Research findings on the relationship between stress and preterm birth have been contradictory. In this article, the authors propose a model of the relationship between stress and preterm birth, evaluate the research on stress and pregnancy outcomes, and discuss the implications for nursing practice and research.

Relationships among psychosocial factors, biomarkers, preeclampsia, and preterm birth in African American women: A pilot

“…Cortisol down-regulates these same pro-inflammatory cytokines (Geiss, Varadi, Steinback, Bauer, & Anton, 1997) and stimulates the production of anti-inflammatory cytokines such as IL-1 receptor antagonist (IL-1ra) and soluble TNF-receptor 2 (sTNF-RII) (Barber et al, 1995;Elenkov & Chrousos, 2002), thereby limiting inflammatory responses. During chronic stress, however, cortisol is less effective at suppressing the immune system and inflammation (Elenkov & Chrousos, 2002;Gennaro & Hennessy, 2003;Ruiz, Fullerton, & Dudley, 2003), in part due to a reduced responsiveness of glucocorticoid receptors on immune cells. Hence, higher continuous levels of stress have been related to higher levels of pro-inflammatory cytokines, and lower levels of anti-inflammatory cytokines (Coussons-Read, Okun, & Nettles, 2007;Coussons-Read, Okun, Schmitt, & Giese, 2005).…”

Prenatal Attachment and Social Support in Risk Pregnancies

“…11 Kadının sosyal destek alması gebeliğe psikolojik açıdan uyum sağla-masını ve psikolojik sağlığın sürdürülmesini kolaylaşmaktadır. 4,12 Gebelik döneminde psikososyal ve duygusal desteğin yetersiz olması gebelikte ve doğum sonrasında depresyon riskini artırabilmek-tedir. 13 Gebelerin izlemlerinde tıbbi bakım verilirken psikososyal ve duygusal risklerin belirlenip sorunlara yönelik bakımın planlanması gereklidir.…”

“…Her biri dört maddeden oluşan desteğin kaynağına ilişkin üç grubu içermektedir. Bunlar; aile (11,4,3,8), arkadaş (7,6,12,9) ve özel bir insandır (10, 5, 2, 1).…”

Psychosocial Stress during Pregnancy

“…The relationship of the above maternal factors with psychosocial stress and the way in which they lead to adverse outcomes is unknown, but may occur via indirect behavioral and direct physiologic pathways. 47,48 Behavioral responses to stress may include alterations in nutrition, sleep, exercise, substance use, tobacco use, and/or use of prenatal services. 10,47 Physiologic responses to psychosocial stress may in- Identification of pregnant women experiencing significant psychosocial stress presents health care providers an opportunity to further assess the nature of the stress and alerts them to assess for associated risk factors.…”