The Relationship between Prenatal Stress, Depression, Cortisol and Preterm Birth: A Review

Abstract

Preterm birth is one of the most common adverse pregnancy outcomes. Maternal risk factors such as stress and depression have been associated with preterm birth. Preterm infants are at a higher risk of poor growth and neuro developmental outcomes. The objective of this paper is to examine the relationship between maternal stress, depression, cortisol level, and preterm birth. Preterm birth is one of the most common adverse pregnancy outcomes with a global prevalence of 9.6% and one of the major contributors to infant mortality and morbidity. The association between psychosocial stress and preterm birth, although examined for more than 25 years, has not yet been fully established. A systemic review was conducted in which research studies and review articles from 1970 to 2012, published in English, focusing on human subjects, and addressing the relationship between stress, depression, cortisol and preterm birth were included in this review. The studies examining the relationship between stress, cortisol levels and preterm birth have shown inconsistent findings that may be explained by varied study designs, differences in defining and measuring stress, timing of stress measurement, sample characteristics, and study designs. The relationship between stress, cortisol levels and preterm birth may be multifactorial and complex with premature birth being the final common pathway. A longitudinal cohort study, with a large sample size and multiple measures of stress, depression, and cortisol level, as well as a measure of anxiety and other stress hormone biomarkers may add new knowledge and enhance our understanding about the contribution of psychosocial stress to preterm birth.

Maternal Stress and Pregnancy Outcomes

“…Based on the rate of distress which was also identified after delivery and varying from 22.1% to 52.9% of the whole obstetric population in Sao Paulo, Brazil [37], our prevalence indicates that the issue of maternal stress should be considered common in obstetric practice. Further comparison with previous global literature remains difficult to be carried out, due to differences in tools to assess emotional stress during pregnancy and depending on whether it is done with or without additional biochemical markers and during usual life circumstances or following exposure to catastrophic/traumatic events or particular situations of chronic stress [38]- [40]. Global broad variety in how to measure stress during pregnancy has been, however, offset by persistence of similar trends regarding high risk of prematurity and low birth weight.…”

The Impact of Maryam Exercise Towards the Stress Level and Cortisol Serum Level among Primiparous Pregnant Women

“…However, a review by sheikh, et al that discussed the relationship between stress and cortisol levels in pregnant women showed inconsistent results. It could be caused by differences in stress measurement instruments, stress measurement times, sample characteristics, and research designs (37).…”

Post‐traumatic Stress Disorder and Antepartum Complications: a Novel Risk Factor for Gestational Diabetes and Preeclampsia

“…Increasing evidence suggests that stress and poor mental health have negative impacts on pregnancy and birth outcomes . The majority of these studies have focussed on maternal stress, depression, or anxiety.…”