Psychosocial Stress and Preterm Birth: The Impact of Parity and Race

Abstract

Objectives Studies examining risk factors for preterm birth (PTB) such as psychosocial stress are often focused on women with a history of PTB; however, most preterm babies are born to women with no history of preterm birth. Our objective was to determine if the relationship between psychosocial stress and PTB is altered by parity. Non-Hispanic black (NHB) women have increased psychosocial stress and PTB; therefore, we further aimed to determine if race alters the relationship between psychosocial stress, parity, and PTB. Methods We performed a secondary analysis of the Healthy Pregnancy, Healthy Baby Study comparing pregnant women who were primiparous (first pregnancy), multiparous with history of preterm birth, or multiparous with history of term birth. Perceived stress, perceived racism, interpersonal support, John Henryism and self-efficacy were measured using validated instruments. Logistic regression was used to model the effect of psychosocial stress on PTB stratified by parity and race. Results The analysis entire cohort included 1606 subjects, 426 were primiparous, 268 had a history of presterm birth, and 912 had a history of term birth. In women with a history of term birth, higher self-efficacy was associated with lower odds of spontaneous PTB, and this association was amplified in NHB women. In women with a history of spontaneous PTB, John Henryism Active Coping was associated with lower odds of spontaneous PTB in the index pregnancy. Conclusions for Practice The relationship between psychosocial stress and PTB may be mediated by parity and race.

Making “Good” Choices: Social Isolation in Mice Exacerbates the Effects of Chronic Stress on Decision Making

“…People living in poverty, LGBTQ+ individuals, and ethnic and racial minorities are some groups that experience both covert and overt discrimination in daily life, which can be thought of as chronic stress (Evans and Kim, 2013). A growing body of health-related research suggests that this chronic marginalization stress may negatively impact health and well-being in much the same way as more commonly studied forms of chronic stress (Brunner, 1997;Lehmiller, 2012;Borders et al, 2015;Wheeler et al, 2018). Findings from the current study support arguments that observed increases in preferences for immediate payoffs among these groups, often characterized as "irresponsible" behavior inherent among marginalized groups, may in fact be an adaptive response to chronic stress.…”

Making Good Choices: Social Interaction in Mice Mitigates Chronic Stress-Induced Adaptive Changes in Decision Making

“…People living in poverty, LGBTQ+ individuals, and ethnic and racial minorities are some groups that experience both covert and overt discrimination in daily life, which can be thought of as chronic stress [16]. A growing body of health-related research suggests that this chronic marginalisation stress may negatively impact health and well-being in much the same way as more commonly studied forms of chronic stress [4,6,31,57]. Findings from the current study support arguments that observed increases in preferences for immediate payoffs among these groups, often characterised as "irresponsible" behaviour inherent among marginalised groups, may in fact be an adaptive response to chronic stress.…”

Causal models: Specification, fitting, reporting, and interpretation

“…The latter two types of women have different risks of preterm birth and especially preeclampsia. [7][8][9][10] Other limitations in the example by Bandoli et al relate to clinical issues and some unexpected causal assumptions. The reference to preterm birth subtypes as "indications" for preterm birth suggests some lack of attention to substantive details.…”

“…Thus, the effect of previous preterm birth in Bandoli et al's analysis represents a contrast between multiparous women who had a previous preterm birth versus nulliparous women, and multiparous women without a history of previous preterm birth. The latter two types of women have different risks of preterm birth and especially preeclampsia …”