Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress, and stress hormones.
The authors investigated a large number of stressors and measures of psychological distress in a multicenter, prospective cohort study of spontaneous preterm birth among 5,337 Montreal (Canada)-area women who delivered from October 1999 to April 2004. In addition, a nested case-control analysis (207 cases, 444 controls) was used to explore potential biologic pathways by analyzing maternal plasma corticotrophin-releasing hormone (CRH), placental histopathology, and (in a subset) maternal hair cortisol. Among the large number of stress and distress measures studied, only pregnancy-related anxiety was consistently and independently associated with spontaneous preterm birth (for values above the median, adjusted odds ratio = 1.8 (95% confidence interval: 1.3, 2.4)), with a dose-response relation across quartiles. The maternal plasma CRH concentration was significantly higher in cases than in controls in crude analyses but not after adjustment (for concentrations above the median, adjusted odds ratio = 1.1 (95% confidence interval: 0.8, 1.6)). In the subgroup (n = 117) of participants with a sufficient maternal hair sample, hair cortisol was positively associated with gestational age. Neither maternal plasma CRH, hair cortisol, nor placental histopathologic features of infection/inflammation, infarction, or maternal vasculopathy were significantly associated with pregnancy-related anxiety or any other stress or distress measure. The biologic pathways underlying stress-induced preterm birth remain poorly understood.
Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada. michael.kramer@mcgill.ca
Michael S
MS
Kramer
John
J
Lydon
Louise
L
Séguin
Lise
L
Goulet
Susan R
SR
Kahn
Helen
H
McNamara
Jacques
J
Genest
Clément
C
Dassa
Moy Fong
MF
Chen
Shakti
S
Sharma
Michael J
MJ
Meaney
Steven
S
Thomson
Stan
S
Van Uum
Gideon
G
Koren
Mourad
M
Dahhou
Julie
J
Lamoureux
Robert W
RW
Platt
D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003346:Corticotropin-Releasing Hormone / Q000097:blood*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000097:blood / Q000523:psychology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D011247:Pregnancy; D047928:Premature Birth / Q000378:metabolism* / Q000523:psychology*; D025341:Principal Component Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology; D016216:Ultrasonography, Prenatal
D015415:Biomarkers; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone