title: The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks' gestation. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
abstract: OBJECTIVE
  Our purpose was to determine whether various measures of poor psychosocial status in pregnancy are associated with spontaneous preterm birth, fetal growth restriction, or low birth weight.
  
  
  METHODS
  Anxiety, stress, self-esteem, mastery, and depression were assessed at 25 to 29 weeks in 2593 gravid women by use of a 28-item Likert scale. Scores for each psychosocial subscale were determined, and an overall psychosocial score was calculated. Scores were divided into quartiles, and the lowest quartile scores were used to define poor psychosocial status. The percent spontaneous preterm birth, low birth weight, and fetal growth restriction in women with low and high psychosocial scores were compared. Logistic regression analyses provided the odds ratios and 95% confidence intervals.
  
  
  RESULTS
  Analyses revealed that stress was significantly associated with spontaneous preterm birth and with low birth weight with odds ratios of 1.16, p = 0.003, and 1.08, p = 0.02, respectively, for each point on the scale. A low score on the combined scale or on any subscale other than stress did not predict spontaneous preterm birth, fetal growth restriction, or low birth weight. After multivariate adjustment was performed for psychosocial status, substance use, and demographic traits, black race was the only variable significantly associated with spontaneous preterm birth, fetal growth restriction, and low birth weight; stress and low education were associated with spontaneous preterm birth and low birth weight.
  
  
  CONCLUSIONS
  Stress was associated with spontaneous preterm birth and low birth weight even after adjustment for maternal demographic and behavioral characteristics. Black race continues to be a significant predictor of spontaneous preterm birth, fetal growth restriction, and low birth weight even after adjustment for stress, substance use, and other demographic factors.
authors.affiliation: National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, Maryland, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Copper
authors.forename: R L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: A
authors.initials: A
authors.lastname: Das
authors.forename: N
authors.initials: N
authors.lastname: Elder
authors.forename: M
authors.initials: M
authors.lastname: Swain
authors.forename: G
authors.initials: G
authors.lastname: Norman
authors.forename: R
authors.initials: R
authors.lastname: Ramsey
authors.forename: P
authors.initials: P
authors.lastname: Cotroneo
authors.forename: B A
authors.initials: BA
authors.lastname: Collins
authors.forename: F
authors.initials: F
authors.lastname: Johnson
authors.forename: P
authors.initials: P
authors.lastname: Jones
authors.forename: A M
authors.initials: AM
authors.lastname: Meier
mesh_terms: D000328:Adult; D001724:Birth Weight; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications; D013315:Stress, Psychological / Q000150:complications*