Accessible Requires Authentication Published by De Gruyter June 14, 2013

Psychosocial stress in pregnancy and preterm birth: associations and mechanisms

Gabriel D. Shapiro, William D. Fraser, Martin G. Frasch and Jean R. Séguin

Abstract

Aims: Psychosocial stress during pregnancy (PSP) is a risk factor of growing interest in the etiology of preterm birth (PTB). This literature review assesses the published evidence concerning the association between PSP and PTB, highlighting established and hypothesized physiological pathways mediating this association.

Method: The PubMed and Web of Science databases were searched using the keywords “psychosocial stress”, “pregnancy”, “pregnancy stress”, “preterm”, “preterm birth”, “gestational age”, “anxiety”, and “social support”. After applying the exclusion criteria, the search produced 107 articles.

Results: The association of PSP with PTB varied according to the dimensions and timing of PSP. Stronger associations were generally found in early pregnancy, and most studies demonstrating positive results found moderate effect sizes, with risk ratios between 1.2 and 2.1. Subjective perception of stress and pregnancy-related anxiety appeared to be the stress measures most closely associated with PTB. Potential physiological pathways identified included behavioral, infectious, neuroinflammatory, and neuroendocrine mechanisms.

Conclusions: Future research should examine the biological pathways of these different psychosocial stress dimensions and at multiple time points across pregnancy. Culture-independent characterization of the vaginal microbiome and noninvasive monitoring of cholinergic activity represent two exciting frontiers in this research.


Corresponding author: Jean R. Séguin, Department of Psychiatry Université de Montréal Centre de recherche de l’Hôpital Ste-Justine, Bloc 5, Local 1573 3175 Côte Ste-Catherine Montréal, QC Canada H3T 1C5, Tel.: +1-514-1-345-4931, ext. 4043, Fax: +1-514-345-2176, E-mail:

This work was supported via a CIHR training grant and a Sainte-Justine UHC Foundation training grant to G.D.S., a CIHR Canada Research Chair (Tier II) to W.D.F., and a CIHR operating grant and FRSQ salary award to M.G.F.

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The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2012-12-20
Accepted: 2013-5-14
Published Online: 2013-06-14
Published in Print: 2013-11-01

©2013 by Walter de Gruyter Berlin Boston