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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


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


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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Kristin J. Horsley, Lianne M. Tomfohr-Madsen, Blaine Ditto, and Suzanne C. Tough
Psychosomatic Medicine, 2019, Volume 81, Number 5, Page 458
Ehsan Saboory, Sedra Mohammadi, Sina Dindarian, and Hozan Mohammadi
Epilepsy & Behavior, 2019, Volume 96, Page 122
Cara Buskmiller, Cristie Columbus, and Jeffrey A. Gavard
Baylor University Medical Center Proceedings, 2019, Volume 32, Number 3, Page 348
María Ángeles García-León, Rafael A. Caparrós-González, Borja Romero-González, Raquel González-Perez, and Isabel Peralta-Ramírez
Midwifery, 2019, Volume 75, Page 138
Mingju Cao, James W. MacDonald, Hai L. Liu, Molly Weaver, Marina Cortes, Lucien D. Durosier, Patrick Burns, Gilles Fecteau, André Desrochers, Jay Schulkin, Marta C. Antonelli, Raphael A. Bernier, Michael Dorschner, Theo K. Bammler, and Martin G. Frasch
Frontiers in Immunology, 2019, Volume 10
Helen J. Chen and Tamar L. Gur
Trends in Neurosciences, 2019, Volume 42, Number 6, Page 402
Dorota T. Kopycka-Kedzierawski, Dongmei Li, Jin Xiao, Ronald J. Billings, Timothy D. Dye, and Kelli K. Ryckman
PLOS ONE, 2019, Volume 14, Number 4, Page e0215440
Carolina De Weerth
Development and Psychopathology, 2018, Volume 30, Number 3, Page 1129
Sarah Hartman and Jay Belsky
Development and Psychopathology, 2018, Volume 30, Number 3, Page 825
Harry Adynski, Catherine Zimmer, John Thorp, and Hudson P Santos
Research in Nursing & Health, 2019, Volume 42, Number 3, Page 205
Tiffany A. Moore, Adam J. Case, Therese L. Mathews, Crystal Modde Epstein, Katherine Laux Kaiser, and Matthew C. Zimmerman
Nursing Research, 2019, Volume 68, Number 2, Page 167
Shawnita Sealy-Jefferson, Faheemah N. Mustafaa, and Dawn P. Misra
SSM - Population Health, 2019, Volume 7, Page 100362
Emily S. Miller, Allie Sakowicz, Archana Roy, Amy Yang, John T. Sullivan, William A. Grobman, and Katherine L. Wisner
American Journal of Obstetrics and Gynecology, 2019, Volume 220, Number 3, Page 271.e1
Juliana Vergel, Silvia L. Gaviria, Marle Duque, Diana Restrepo, Marta Rondon, and Alejandro Colonia
Revista Colombiana de Psiquiatría (English ed.), 2019, Volume 48, Number 1, Page 26
Sarah Hartman, Kristina Sayler, and Jay Belsky
Developmental Psychobiology, 2018
Courtney Phillips, Zain Velji, Ciara Hanly, and Amy Metcalfe
BMJ Open, 2017, Volume 7, Number 6, Page e015402
Kelly K. Baker, William T. Story, Evan Walser-Kuntz, M. Bridget Zimmerman, and Cheryl A. Moyer
PLOS ONE, 2018, Volume 13, Number 10, Page e0205345
Emmanuel Amabebe and Dilly O. C. Anumba
Frontiers in Endocrinology, 2018, Volume 9
Sarah Hartman and Jay Belsky
Journal of Neural Transmission, 2018
Alyson Haslam, Trina Salm Ward, and Sara Wagner Robb
Holistic Nursing Practice, 2018, Volume 32, Number 5, Page 261
Dan Shan, Pei-Yuan Qiu, Yu-Xia Wu, Qian Chen, Ai-Lin Li, Sivakumar Ramadoss, Ran-Ran Wang, and Ya-Yi Hu
Scientific Reports, 2018, Volume 8, Number 1
Mary C. Wallingford, Ciara Benson, Nicholas W. Chavkin, Michael T. Chin, and Martin G. Frasch
Frontiers in Physiology, 2018, Volume 9
Bridget J. Goosby, Jacob E. Cheadle, and Colter Mitchell
Annual Review of Sociology, 2018, Volume 44, Number 1, Page 319
Maria Gilles, Henrike Otto, Isabell A.C. Wolf, Barbara Scharnholz, Verena Peus, Michael Schredl, Marc W. Sütterlin, Stephanie H. Witt, Marcella Rietschel, Manfred Laucht, and Michael Deuschle
Psychoneuroendocrinology, 2018, Volume 94, Page 152
Yu Li, Claire Margerison-Zilko, Kelly L. Strutz, and Claudia Holzman
Women's Health Issues, 2018
William A. Grobman, Corette B. Parker, Marian Willinger, Deborah A. Wing, Robert M. Silver, Ronald J. Wapner, Hyagriv N. Simhan, Samuel Parry, Brian M. Mercer, David M. Haas, Alan M. Peaceman, Shannon Hunter, Pathik Wadhwa, Michal A. Elovitz, Tatiana Foroud, George Saade, and Uma M. Reddy
Obstetrics & Gynecology, 2018, Volume 131, Number 2, Page 328
Pamela J. Surkan, Liming Dong, Yuelong Ji, Xiumei Hong, Hongkai Ji, Mary Kimmel, Wan-Yee Tang, and Xiaobin Wang
Journal of Psychosomatic Obstetrics & Gynecology, 2017, Page 1
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Journal of Midwifery & Women's Health, 2017
Kathrin Stoll, Emma Marie Swift, Nichole Fairbrother, Elizabeth Nethery, and Patricia Janssen
Birth, 2017
Konstantinos Douros, Maria Moustaki, Sophia Tsabouri, Anna Papadopoulou, Marios Papadopoulos, and Kostas N. Priftis
Frontiers in Pediatrics, 2017, Volume 5
Juliana Vergel, Silvia L. Gaviria, Marle Duque, Diana Restrepo, Marta Rondon, and Alejandro Colonia
Revista Colombiana de Psiquiatría, 2017
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DIGITAL HEALTH, 2016, Volume 2, Page 205520761662870
Viridiana Alcántara-Alonso, Pamela Panetta, Patricia de Gortari, and Dimitris K. Grammatopoulos
Frontiers in Endocrinology, 2017, Volume 8
Maartje A. C. Zijlmans, Roseriet Beijers, Marianne J. Riksen-Walraven, and Carolina de Weerth
Stress, 2017, Page 1
Katie L. Togher, Eimear Treacy, Gerard W. O’Keeffe, and Louise C. Kenny
Psychiatry Research, 2017, Volume 255, Page 17
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PLOS ONE, 2016, Volume 11, Number 6, Page e0157080
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Mental Health & Prevention, 2017, Volume 6, Page 51
Arijit Nandi, Mohammad Hajizadeh, Sam Harper, Alissa Koski, Erin C. Strumpf, Jody Heymann, and David Osrin
PLOS Medicine, 2016, Volume 13, Number 3, Page e1001985
Trina Salm Ward, Florence A. Kanu, and Sara Wagner Robb
Archives of Women's Mental Health, 2017, Volume 20, Number 1, Page 161
Jeanne L. Alhusen, Kelly M. Bower, Elizabeth Epstein, and Phyllis Sharps
Journal of Midwifery & Women's Health, 2016, Volume 61, Number 6, Page 707
Alexandra M. Robinson, Karen M. Benzies, Sharon L. Cairns, Tak Fung, and Suzanne C. Tough
BMC Pregnancy and Childbirth, 2016, Volume 16, Number 1
Kimberly Schmitt McKee, Christopher Seplaki, Susan Fisher, Susan W. Groth, and I. Diana Fernandez
Maternal and Child Health Journal, 2017, Volume 21, Number 1, Page 147
Josef Neu
Seminars in Fetal and Neonatal Medicine, 2016, Volume 21, Number 6, Page 373
C Liu, S Cnattingius, M Bergström, V Östberg, and A Hjern
BJOG: An International Journal of Obstetrics & Gynaecology, 2016, Volume 123, Number 12, Page 1973
MA Faucher, M Hastings-Tolsma, JJ Song, DS Willoughby, and S Gerding Bader
BJOG: An International Journal of Obstetrics & Gynaecology, 2016, Volume 123, Number 2, Page 199
Christine P. Stewart, Brietta M. Oaks, Kevin D. Laugero, Ulla Ashorn, Ulla Harjunmaa, Chiza Kumwenda, David Chaima, Kenneth Maleta, Per Ashorn, and Kathryn G. Dewey
BMC Pregnancy and Childbirth, 2015, Volume 15, Number 1
Brock Medsker, Erick Forno, Hyagriv Simhan, and Juan C. Celedón
Obstetrical & Gynecological Survey, 2015, Volume 70, Number 12, Page 773
Tuija Männistö, Pauline Mendola, Michele Kiely, Jennifer O'Loughlin, Emily Werder, Zhen Chen, Deborah B. Ehrenthal, and Katherine L. Grantz
Annals of Epidemiology, 2016, Volume 26, Number 1, Page 14
Guanhui Liu, Yulan Dong, Zixu Wang, Jing Cao, and Yaoxing Chen
Stress, 2015, Volume 18, Number 6, Page 699
Ruth Baron, Judith Manniën, Saskia J. te Velde, Trudy Klomp, Eileen K. Hutton, and Johannes Brug
BMC Pregnancy and Childbirth, 2015, Volume 15, Number 1
Jonathan E. Handelzalts, Haim Krissi, Sigal Levy, Yael Freund, Naama Carmiel, Eran Ashwal, and Yoav Peled
Archives of Gynecology and Obstetrics, 2016, Volume 293, Number 3, Page 575
Erin Hetherington, Chelsea Doktorchik, Shahirose S. Premji, Sheila W. McDonald, Suzanne C. Tough, and Reg S. Sauve
Paediatric and Perinatal Epidemiology, 2015, Volume 29, Number 6, Page 523
Mingju Cao, Marina Cortes, Craig S. Moore, Soo Yuen Leong, Lucien D. Durosier, Patrick Burns, Gilles Fecteau, Andre Desrochers, Roland N. Auer, Luis B. Barreiro, Jack P. Antel, and Martin G. Frasch
Frontiers in Cellular Neuroscience, 2015, Volume 9
Shannon L. Gillespie, Lisa M. Christian, and Jeremy L. Neal
Medical Hypotheses, 2015, Volume 85, Number 5, Page 558
Greta B. Raglan, Sophia M. Lannon, Katherine M. Jones, and Jay Schulkin
Maternal and Child Health Journal, 2016, Volume 20, Number 1, Page 16
A. L. Phelan, M. R. DiBenedetto, I. M. Paul, J. Zhu, and K. H. Kjerulff
Maternal and Child Health Journal, 2015, Volume 19, Number 12, Page 2587
A E B Borders, K Wolfe, S Qadir, K-Y Kim, J Holl, and W Grobman
Journal of Perinatology, 2015, Volume 35, Number 8, Page 580
Tamar L. Gur, Brett L. Worly, and Michael T. Bailey
Frontiers in Psychiatry, 2015, Volume 6
Martin G Frasch, Yawen Xu, Tamara Stampalija, Lucien D Durosier, Christophe Herry, Xiaogang Wang, Daniela Casati, Andrew JE Seely, Zarko Alfirevic, Xin Gao, and Enrico Ferrazzi
Physiological Measurement, 2014, Volume 35, Number 12, Page L1
SS Witkin
BJOG: An International Journal of Obstetrics & Gynaecology, 2015, Volume 122, Number 2, Page 213
Sharon Bernecki DeJoy and Krystle Bittner
Maternal and Child Health Journal, 2015, Volume 19, Number 4, Page 693
Roseriet Beijers, Jan K. Buitelaar, and Carolina de Weerth
European Child & Adolescent Psychiatry, 2014, Volume 23, Number 10, Page 943

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