title: Psychosocial stress and neuroendocrine mechanisms in preterm delivery.
abstract: This review focuses on the contribution of psychosocial stress to the racial/ethnic disparities in preterm delivery in the United States and addresses the subset of psychosocial stressors that are disproportionately prevalent among minority women. We argue that chronic exposure to poverty, racism, and insecure neighborhoods may condition stress responses and physiologic changes in ways that increase the risk of preterm delivery. Cumulative stressors may impact pregnancy outcomes through several intersecting pathways, which include neuroendocrine, behavioral, immune, and vascular mechanisms. Many of these pathways also lead to chronic disease. It may be useful to consider preterm delivery as a chronic disease with roots in childhood, adolescence, and early adulthood. Like other physiologic systems, the female reproductive axis may be vulnerable to the physiologic "wear and tear" of cumulative stress, which results in preterm delivery.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass 02215, USA. Janet_Rich-Edwards@hphc.org
authors.forename: Janet W
authors.initials: JW
authors.lastname: Rich-Edwards
authors.forename: Tarayn A
authors.initials: TA
authors.lastname: Grizzard
mesh_terms: D003346:Corticotropin-Releasing Hormone / Q000502:physiology; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008913:Minority Groups; D009490:Neurosecretory Systems / Q000503:physiopathology*; D011247:Pregnancy; D011287:Prejudice; D047928:Premature Birth / Q000503:physiopathology*; D011584:Psychology; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications*; D014481:United States
chemical_list: D003346:Corticotropin-Releasing Hormone