title: Perinatal distress in women in low- and middle-income countries: allostatic load as a framework to examine the effect of perinatal distress on preterm birth and infant health.
abstract: In low- and middle-income countries (LMIC), determinants of women's and children's health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother-infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic-pituitary-adrenal axis, sympathetic, immune and cardiovascular systems, and behavioral responses resulting in pathophysiological effects. We suggest cultural-neutral composite measures of allostatic mediators (i.e., several biomarkers) of maternal perinatal distress as objective indicators of dysregulation in body systems in pregnant women in LMIC. Understanding causal links of maternal perinatal distress to preterm birth in women in LMIC should be a priority. The roles of allostasis and allostatic load are considered within the context of the health of pregnant women and fetuses/newborns in LMIC with emphasis on identifying objective indicators of the level of perinatal distress and protective factors or processes contributing to resilience while facing toxic stress. We propose a prospective study design with multiple measures across pregnancy and postpartum requiring complex statistical modeling. Building research capacity through partnering researchers in high-income countries and LMIC and reflecting on unique ethical challenges will be important to generating new knowledge in LMIC.
authors.affiliation: Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada, premjis@ucalgary.ca.
authors.forename: Shahirose
authors.initials: S
authors.lastname: Premji
mesh_terms: D052636:Allostasis; D003906:Developing Countries; D005260:Female; D006801:Humans; D007182:Income; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D008016:Life Change Events; D008019:Life Style; D009035:Mothers / Q000193:education / Q000523:psychology / Q000706:statistics & numerical data; D018743:Perinatal Care; D011203:Poverty; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*; D047928:Premature Birth / Q000208:ethnology*; D013315:Stress, Psychological / Q000150:complications* / Q000208:ethnology
references.citation: Health Psychol. 2014 Jan;33(1):43-51
references.pmid: 23379383
references.citation: Am J Med Sci. 2008 Aug;336(2):111-5
references.pmid: 18703903
references.citation: Bull World Health Organ. 2012 Feb 1;90(2):139G-149G
references.pmid: 22423165
references.citation: Obstet Gynecol. 2010 Aug;116(2 Pt 1):393-401
references.pmid: 20664401
references.citation: Am J Epidemiol. 2002 Nov 1;156(9):797-802
references.pmid: 12396996
references.citation: Br Med Bull. 2012;101:57-79
references.pmid: 22130907
references.citation: Clin Dev Immunol. 2012;2012:985646
references.pmid: 22235228
references.citation: Matern Child Health J. 2012 May;16(4):887-93
references.pmid: 21559774
references.citation: Arch Dis Child. 2007 Jan;92(1):24-8
references.pmid: 16966339
references.citation: Hypertens Pregnancy. 2001;20(3):243-56
references.pmid: 12044333
references.citation: Neurosci Biobehav Rev. 2010 Sep;35(1):2-16
references.pmid: 19822172
references.citation: Arch Womens Ment Health. 2003 Nov;6(4):263-74
references.pmid: 14628179
references.citation: J Psychiatr Pract. 2005 Sep;11(5):353-8
references.pmid: 16184076
references.citation: Am J Epidemiol. 2002 Feb 15;155(4):293-301
references.pmid: 11836191
references.citation: Arch Dis Child Fetal Neonatal Ed. 2011 Jan;96(1):F59-64
references.pmid: 20667895
references.citation: Annu Rev Psychol. 2011;62:531-58
references.pmid: 21126184
references.citation: Arch Psychiatr Nurs. 1998 Feb;12(1):12-20
references.pmid: 9489170
references.citation: Med Hypotheses. 2011 May;76(5):755-60
references.pmid: 21382668
references.citation: Arch Gen Psychiatry. 2004 Sep;61(9):946-52
references.pmid: 15351773
references.citation: Epidemiology. 2006 Mar;17(2):178-82
references.pmid: 16477258
references.citation: Horm Behav. 2003 Jan;43(1):2-15
references.pmid: 12614627
references.citation: Gynecol Obstet Invest. 2010;70(1):40-6
references.pmid: 20160447
references.citation: Contemp Nurse. 2010 Apr-May;35(1):58-67
references.pmid: 20636178
references.citation: Psychosom Med. 2004 Sep-Oct;66(5):762-9
references.pmid: 15385704
references.citation: Psychol Med. 2011 Nov;41(11):2287-96
references.pmid: 21524332
references.citation: Paediatr Perinat Epidemiol. 2001 Apr;15(2):110-22
references.pmid: 11383575
references.citation: Trop Med Int Health. 2008 Apr;13(4):579-83
references.pmid: 18318697
references.citation: Child Care Health Dev. 2004 Jan;30(1):21-7
references.pmid: 14678308
references.citation: Neonatal Netw. 1993 Sep;12(6):67-74
references.pmid: 8413141
references.citation: Am J Obstet Gynecol. 1996 Sep;175(3 Pt 1):706-12
references.pmid: 8828438
references.citation: PLoS Negl Trop Dis. 2010 Jun 29;4(6):e619
references.pmid: 20614013
references.citation: BMC Pregnancy Childbirth. 2011 Nov 02;11:88
references.pmid: 22047209
references.citation: J Epidemiol Community Health. 2005 Jun;59(6):440-2
references.pmid: 15911636
references.citation: BMC Med Res Methodol. 2006 Jul 26;6:35
references.pmid: 16872487
references.citation: Pediatrics. 2006 Sep;118(3):e869-78
references.pmid: 16880249
references.citation: Psychol Rev. 2010 Jan;117(1):134-74
references.pmid: 20063966
references.citation: Proc Natl Acad Sci U S A. 2001 Apr 10;98(8):4770-5
references.pmid: 11287659
references.citation: Am J Obstet Gynecol. 2005 Oct;193(4):1312-22
references.pmid: 16202720
references.citation: Dev Psychol. 2004 Mar;40(2):234-43
references.pmid: 14979763
references.citation: Am J Obstet Gynecol. 2003 Jul;189(1):139-47
references.pmid: 12861153
references.citation: NeuroRx. 2004 Apr;1(2):182-8
references.pmid: 15717018
references.citation: Lancet. 2007 Jan 6;369(9555):60-70
references.pmid: 17208643
references.citation: Neurosci Biobehav Rev. 2005 Apr;29(2):295-312
references.pmid: 15811500
references.citation: Psychiatr Serv. 2011 Feb;62(2):123-5
references.pmid: 21285088
references.citation: J Affect Disord. 2008 May;108(1-2):191-3
references.pmid: 17997163
references.citation: Epidemiology. 2005 May;16(3):323-7
references.pmid: 15824547
references.citation: Am J Epidemiol. 2004 May 1;159(9):872-81
references.pmid: 15105180
references.citation: J Rural Health. 2009 Spring;25(2):158-66
references.pmid: 19785581
references.citation: Int J Tuberc Lung Dis. 2012 Dec;16(12):1582-7
references.pmid: 23131255
references.citation: J Perinat Med. 2013 Nov;41(6):631-45
references.pmid: 24216160
references.citation: Annu Rev Nutr. 2010 Aug 21;30:403-22
references.pmid: 20420523
references.citation: J Midwifery Womens Health. 2009 Jan-Feb;54(1):8-17
references.pmid: 19114234
references.citation: Int Rev Psychiatry. 2011 Dec;23(6):550-4
references.pmid: 22272593
references.citation: Brain Behav Immun. 2012 May;26(4):650-9
references.pmid: 22426431
references.citation: J Obstet Gynecol Neonatal Nurs. 2007 Mar-Apr;36(2):125-34
references.pmid: 17371513
references.citation: Am J Clin Nutr. 2009 Mar;89(3):951S-957S
references.pmid: 19176729
references.citation: Biol Res Nurs. 2012 Oct;14(4):311-46
references.pmid: 23007870
references.citation: Soc Sci Med. 2008 Sep;67(5):708-20
references.pmid: 18362046
references.citation: Arch Intern Med. 1997 Oct 27;157(19):2259-68
references.pmid: 9343003
references.citation: Ann Behav Med. 2005 Feb;29(1):12-21
references.pmid: 15677296
references.citation: J Obstet Gynecol Neonatal Nurs. 2003 Sep-Oct;32(5):668-75
references.pmid: 14565747
references.citation: Dialogues Clin Neurosci. 2006;8(4):367-81
references.pmid: 17290796
references.citation: Am J Epidemiol. 2009 Jun 1;169(11):1319-26
references.pmid: 19363098
references.citation: Am J Obstet Gynecol. 2007 Aug;197(2):162.e1-6
references.pmid: 17689635
references.citation: Midwifery. 2003 Sep;19(3):191-202
references.pmid: 12946335
references.citation: J Clin Endocrinol Metab. 2012 Nov;97(11):3917-25
references.pmid: 22933545
references.citation: Dev Psychopathol. 2012 Nov;24(4):1361-76
references.pmid: 23062303
references.citation: Curr Opin Psychiatry. 2012 Mar;25(2):141-8
references.pmid: 22262028
references.citation: BMC Pregnancy Childbirth. 2010 Feb 23;10 Suppl 1:S1
references.pmid: 20233382
references.citation: Am J Epidemiol. 2003 Jan 1;157(1):14-24
references.pmid: 12505886
references.citation: Stress. 2009 Jan;12(1):37-48
references.pmid: 18951244
references.citation: J Child Psychol Psychiatry. 2003 Sep;44(6):810-8
references.pmid: 12959490
references.citation: Paediatr Perinat Epidemiol. 2005 Sep;19(5):334-41
references.pmid: 16115284
references.citation: Gend Med. 2012 Dec;9(6):511-23
references.pmid: 23158957
references.citation: Dev Psychopathol. 2011 Aug;23(3):723-4
references.pmid: 21756429
references.citation: Int J Epidemiol. 2006 Jun;35(3):706-18
references.pmid: 16556647
references.citation: J Clin Endocrinol Metab. 2001 Jun;86(6):2544-52
references.pmid: 11397853
references.citation: Health Psychol. 2008 Jan;27(1):43-51
references.pmid: 18230013
references.citation: Soc Sci Med. 2004 Jun;58(12):2585-600
references.pmid: 15081207
references.citation: Dev Psychopathol. 2011 Nov;23(4):1001-16
references.pmid: 22018078
references.citation: Dev Psychopathol. 2011 Aug;23(3):881-896
references.pmid: 21756439
references.citation: Vaccine. 2012 Nov 6;30(48):6859-63
references.pmid: 22989686
references.citation: J Obstet Gynecol Neonatal Nurs. 2009 Jul-Aug;38(4):377-90
references.pmid: 19614873
references.citation: Am J Obstet Gynecol. 1999 Jan;180(1 Pt 3):S257-63
references.pmid: 9914629
references.citation: Trials. 2011 Jun 09;12:145
references.pmid: 21658262
references.citation: Nurs Res. 2001 Sep-Oct;50(5):275-85
references.pmid: 11570712
references.citation: Am J Obstet Gynecol. 2005 Sep;193(3 Pt 1):626-35
references.pmid: 16150253
references.citation: Am J Obstet Gynecol. 1996 Nov;175(5):1317-24
references.pmid: 8942508
references.citation: Biol Res Nurs. 2001 Jul;3(1):39-48
references.pmid: 11885913
references.citation: Lancet. 2008 Jan 5;371(9606):75-84
references.pmid: 18177778
references.citation: Pediatr Infect Dis J. 2010 Sep;29(9):801-5
references.pmid: 20803841
references.citation: Am J Obstet Gynecol. 2004 Oct;191(4):1063-9
references.pmid: 15507922