Psychosocial stress and severe prematurity

Lou, HansC.; Nordentoft, Merete; Jensen, Flemming; Pryds, Ole; Nim, J.; Hemmingsen, Ralf

doi:10.1016/0140-6736(92)92468-u

Cited by 31 publications

(13 citation statements)

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“…The belief that stress and maternal psychological factors can affect the course and outcome of pregnancy can be traced to Biblical times, 71 but it has been only recently that social scientists and epidemiologists have considered this area worthy of serious investigation. Associations have been reported between preterm birth and stressful life events, anxiety, depression, stressful work, physical abuse, and low level of social support 72 –77 . Recent reports suggest that the effects of psychosocial stressors may be mediated by cortisol‐induced positive feedback‐mediated increases in placental secretion of CRH, 78 –80 which can stimulate uterine contractility by potentiating the effects of oxytocin (perhaps via prostaglandins) or by fetal cortisol‐ or androgen‐induced oestriol synthesis 80 , 81 .…”

Section: Determinants Of Preterm Birth and Their Relationship To Sesmentioning

confidence: 99%

Socio‐economic disparities in preterm birth: causal pathways and mechanisms

Kramer

Goulet

Lydon³

et al. 2001

Paediatric Perinatal Epid

323

221

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SummaryPreterm birth is the leading cause of infant mortality in industrialised societies. Its incidence is greatly increased among the socially disadvantaged, but the reasons for this excess are unclear and have been relatively unexplored. We hypothesise two distinct sets of causal pathways and mechanisms that may explain social disparities in preterm birth. The first set involves chronic and acute psychosocial stressors, psychological distress caused by those stressors, increased secretion of placental corticotropin releasing hormone (CRH), changes in sexual behaviours or enhanced susceptibility to bacterial vaginosis and chorioamnionitis, cigarette smoking or cocaine use, and decidual vasculopathy. The second hypothesised pathway is a gene±environment interaction based on a highly prevalent mutation in the gene for methylenetetrahydrofolate reductase (MTHFR), combined with low folate intake from the diet and from prenatal vitamin supplements, consequent hyperhomocysteinemia, and decidual vasculopathy.We propose to test these hypothesised pathways and mechanisms in a nested casecontrol study within a prospectively recruited and followed cohort of pregnant women with singleton pregnancies who deliver at one of four Montreal hospitals that serve an ethnically and socio-economically diverse population. Following recruitment during the late first or early second trimester, participating women are seen at 24±26 weeks, when a research nurse obtains a detailed medical and obstetric history; administers several scales to assess chronic and acute stressors and psychological function; obtains blood samples for CRH, red blood cell and plasma folate, homocysteine, and DNA for the MTHFR mutation; and performs a digital and speculum examination to measure cervical length and vaginal pH and to obtain swabs for bacterial vaginosis and fetal fibronectin. After delivery, each case (delivery at 5 37 completed weeks following spontaneous onset of labour or prelabour rupture of membranes) and two controls are selected for placental pathological examination, hair analysis of cotinine, cocaine, and benzoylecgonine, and analysis of stored blood and vaginal specimens. Statistical analysis will be based on multiple logistic regression and structural equation modelling, with sequential construction of models of potential aetiological determinants and covariates to test the hypothesised causal pathways and mechanisms.The research we propose should improve understanding of the factors and processes that mediate social disparities in preterm birth. This improved understanding should help not only in developing strategies to reduce the disparities but also in suggesting preventive interventions applicable across the entire socioeconomic spectrum.

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Section: Determinants Of Preterm Birth and Their Relationship To Sesmentioning

confidence: 99%

Socio‐economic disparities in preterm birth: causal pathways and mechanisms

Kramer

Goulet

Lydon³

et al. 2001

Paediatric Perinatal Epid

323

221

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“…90 However, studies of pregnant women that have looked for links between external stressors or self‐reported manifestations of stress and PTD have produced mixed results. Many studies have found an excess of stressful life events in the background of women delivering prematurely, 91 –98 but other studies have not 99 , 100 . While there have been reports of excess anxiety, perceived stress, depression, and concerns about the pregnancy in women delivering preterm, 92 , 93 , 101 –106 there has been little consistency in the specific emotional state described.…”

Section: Biomarkers Of the Infection Pathwaymentioning

confidence: 99%

Pregnancy outcomes and community health: the POUCH study of preterm birth

Holzman¹,

Bullen²,

Fisher

et al. 2001

Paediatric Perinatal Epid

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In light of the social/ethnic disparity in preterm delivery (PTD) rates, the Pregnancy Outcomes and Community Health (POUCH) Study takes a broad view of the determinants of PTD by attempting to link underlying biological and psychosocial factors. The relationships between placental pathology, maternal biomarkers, and antecedent psychosocial factors are evaluated in three hypothesised pathways of PTD – one characterised primarily by infection, one by maternal vascular disease, and one by premature elevations in corticotropin releasing hormone in the absence of histological evidence of placental pathology. Within each pathway, an emphasis is placed on understanding the roles of stress and of maternal serum alpha‐fetoprotein, an early biomarker associated with PTD. The POUCH Study enrols pregnant women from five Michigan communities. Information about these women and their environments is gathered through detailed interviews and collection of biological samples including hair, urine, saliva, blood, vaginal fluid, and vaginal smear at 15–26 weeks of gestation. We have chosen to focus on the second trimester – a time when pathological processes may have evolved to a detectable stage, but generally before the onset of biological changes that accompany labour. This focus is consistent with the long‐range goal of early detection/intervention and prevention of PTD.

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“…cigarette smoking [2][3][4][9][10][11][14][15][16] and alcohol consumption 4) . Preterm birth has also been related to such social and environmental factors as stress 3,[17][18][19][20][21][22][23][24] , marital status 2,11,12) , maternal occupational activity and the situation at work 3,4,12,[25][26][27] , socioeconomic status 2,4,12) , and educational level [9][10][11]18) . In addition, there is a lack of consensus regarding the effect of maternal leisure-time physical activities during pregnancy with the shortening of gestational length.…”

Section: Introductionmentioning

confidence: 99%

Relationship between maternal physical activities and preterm birth

Cavalli

Tanaka

2001

Environ Health Prev Med

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A cross-sectional study was conducted in three Municipal Health Centers located in Aichi prefecture, central Japan. The main purpose of this study was to verify the interaction between maternal leisure-time physical activities prior to and/or during pregnancy and preterm birth and also, to determine the risk factors related to preterm birth. In this study of the 2,682 questionnaires delivered within one year to mothers or relatives at the Municipal Health Centers, 1,714 questionnaires were analyzed. In a univariate analysis the results showed that mothers who had a previous low birthweight or a premature baby, or who were hospitalized during pregnancy before the 37 th week of gestation, or had an occupational activity, or carried out their household chores, or were sick, or received much medical advice and did not exercise were more likely to have a preterm baby. In multivariable logistic regression analyses, maternal hospitalization before the 37 th week of gestation and occupational activities were significant determinants associated with preterm birth. Thus, it was verified that maternal leisure-time physical activities prior to and/or during pregnancy were not related to preterm birth.

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Psychosocial stress and severe prematurity

Cited by 31 publications

References 0 publications

Socio‐economic disparities in preterm birth: causal pathways and mechanisms

Socio‐economic disparities in preterm birth: causal pathways and mechanisms

Pregnancy outcomes and community health: the POUCH study of preterm birth

Relationship between maternal physical activities and preterm birth

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