Stress, infection and preterm birth: a biobehavioural perspective

Abstract

SummaryPreterm birth is currently the most important problem in maternal-child health in the United States. Epidemiological studies have suggested that two factors, maternal stress and maternal urogenital tract infection, are significantly and independently associated with an increased risk of spontaneous preterm birth. These factors are also more prevalent in the population of sociodemographically disadvantaged women who are at increased risk for preterm birth. Studies of the physiology of parturition suggest that neuroendocrine and immune processes play important roles in the physiology and pathophysiology of normal and preterm parturition. However, not all women with high levels of stress and/or infection deliver preterm, and little is understood about factors that modulate susceptibility to pathophysiological events of the endocrine and immune systems in pregnancy. We present here a comprehensive, biobehavioural model of maternal stress and spontaneous preterm delivery. According to this model, chronic maternal stress is a significant and independent risk factor for preterm birth. The effects of maternal stress on preterm birth may be mediated through biological and/or behavioural mechanisms. We propose that maternal stress may act via one or both of two physiological pathways: (a) a neuroendocrine pathway, wherein maternal stress may ultimately result in premature and/or greater degree of activation of the maternal-placental-fetal endocrine systems that promote parturition; and (b) an immune/ inflammatory pathway, wherein maternal stress may modulate characteristics of systemic and local (placental-decidual) immunity to increase susceptibility to intrauterine and fetal infectious-inflammatory processes and thereby promote parturition through proinflammatory mechanisms. We suggest that placental corticotropin-releasing hormone may play a key role in orchestrating the effects of endocrine and inflammatory/immune processes on preterm birth. Moreover, because neuroendocrine and immune processes extensively cross-regulate one another, we further posit that exposure to both high levels of chronic stress and infectious pathogens in pregnancy may produce an interaction and multiplicative effect in terms of their combined risk for preterm birth. Finally, we hypothesise that the effects of maternal stress are modulated by the nature, duration and timing of occurrence of stress during gestation. A discussion of the components of this model, including a theoretical rationale and review of the available empirical evidence, is presented. A major strength of this biobehavioural perspective is the ability to explore new questions and to do so in a manner that is more comprehensive than has been previously attempted. We expect findings from this line of proposed research to improve our present state of knowledge about obstetric risk assessment for preterm birth by determining the characteristics of pregnant women who are especially susceptible to stress and/or infection, and to broaden our understanding of biological (endoc...

Public Health Consequences of Terrorism on Maternal–Child Health in New York City and Madrid

“…In fact, the length of the temporary increase was longer than we anticipated. Stress experienced at any point during the pregnancy can put women at risk for a LBW or preterm birth [16][17][18][19] . Thus, feelings of fear and anxiety about the uncertainty of recurring terrorist attacks may have affected women in Madrid who became pregnant during a finite period after the attacks.…”

“…First, past disaster research suggests that women and children are at elevated risk for adverse health outcomes in the aftermath of disasters 2 . Second, several cohort studies of pregnant women [16][17][18][19] have indicated that stress during pregnancy is associated with preterm and low birth weight (LBW) deliveries through established biological pathways 20 . To date, these studies have mostly emphasized the role of perceived stress and chronic stressors, such as poverty, crowding, interpersonal violence, and work-related stress, but some research has also considered the influence of severe personal life events 21,22 and even terrorism.…”

“…More specifically, referencing the connection between stress and the poor birth outcomes of low birth weight and preterm birth 16,[18][19][20][21][22] , we predicted that "resilience" would best characterize the population-level trend in preterm or LBW births, which reflects the influence of acute stressors associated with the attack. That is, we expected to see an immediate increase in the incidence of these outcomes after terrorist attacks, followed by a fairly rapid recovery to the baseline pre-event trend.…”

Jenis dan Jumlah Mikroorganisme Aerob pada Persalinan Spontan Kurang dan Cukup Bulan tanpa Ketuban Pecah Dini

“…Setelah melewati barier serviks mikroorganisme akan menginisiasi persalinan melalui beberapa cara yang selanjutnya akan menstimulasi produksi prostaglandin dan pelepasan beberapa mediator imun yang akan menstimulasi kontraksi sel-sel otot polos. 5 Cara lainnya yaitu efek pelepasan toksin bakteri yang akan menginisiasi terjadinya proses inflamasi pada desidua dan korioamnion. Toksin tersebut akan secara langsung menstimulasi sintesis prostaglandin pada amnion dan korion serta melepaskan mediator inflamasi dari sel desidua yang dapat langsung menstimulasi sel miometrium, dan protease yang dihasilkan mampu merusak selaput membran.…”

Interpregnancy Primary Care and Social Support for African-American Women at Risk for Recurrent Very-low-birthweight Delivery: A Pilot Evaluation

“…Women with a VLBW delivery are also at increased risk of subsequently delivering a stillborn infant (5). The reasons for the increased occurrence and recurrence of adverse pregnancy outcomes are not well understood, but growing data link such adverse outcomes to the poor health of women (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), chronic stress and depression (17,18), and short interpregnancy intervals (19,20). Unaddressed health, social, and behavioral factors that may have contributed to the first VLBW delivery likely persist and affect subsequent pregnancies, particularly if the interpregnancy interval is short.…”