Journal
JOURNAL OF PERINATAL MEDICINE
Volume 41, Issue 6, Pages 631-645Publisher
WALTER DE GRUYTER GMBH
DOI: 10.1515/jpm-2012-0295
Keywords
Corticotropin-releasing hormone; gestation; inflammation; pregnancy; preterm birth; psychosocial stress; vagus nerve
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Funding
- CIHR training grant
- Sainte-Justine UHC Foundation training grant
- CIHR Canada Research Chair
- CIHR operating grant
- FRSQ salary award
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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.
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