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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica


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Volume 41, Issue 6

Issues

Psychosocial stress in pregnancy and preterm birth: associations and mechanisms

Gabriel D. Shapiro
  • Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada
  • CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ William D. Fraser
  • CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada
  • Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Martin G. Frasch
  • CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada
  • Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jean R. Séguin
  • Corresponding author
  • CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada
  • Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2013-06-14 | DOI: https://doi.org/10.1515/jpm-2012-0295

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.

Keywords: Corticotropin-releasing hormone; gestation; inflammation; pregnancy; preterm birth; psychosocial stress; vagus nerve

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About the article

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:


Received: 2012-12-20

Accepted: 2013-05-14

Published Online: 2013-06-14

Published in Print: 2013-11-01


Citation Information: Journal of Perinatal Medicine, Volume 41, Issue 6, Pages 631–645, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2012-0295.

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