title: Allostatic Load and Preterm Birth.
abstract: Preterm birth is a universal health problem that is one of the largest unmet medical needs contributing to the global burden of disease. Adding to its complexity is that there are no means to predict who is at risk when pregnancy begins or when women will actually deliver. Until these problems are addressed, there will be no interventions to reduce the risk because those who should be treated will not be known. Considerable evidence now exists that chronic life, generational or accumulated stress is a risk factor for preterm delivery in animal models and in women. This wear and tear on the body and mind is called allostatic load. This review explores the evidence that chronic stress contributes to preterm birth and other adverse pregnancy outcomes in animal and human studies. It explores how allostatic load can be used to, firstly, model stress and preterm birth in animal models and, secondly, how it can be used to develop a predictive model to assess relative risk among women in early pregnancy. Once care providers know who is in the highest risk group, interventions can be developed and applied to mitigate their risk.
authors.affiliation: Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, AB T6G 2S2, Canada. david.olson@ualberta.ca.
authors.forename: David M
authors.initials: DM
authors.lastname: Olson
authors.affiliation: Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, AB T6G 2S2, Canada. eseverso@ualberta.ca.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Severson
authors.affiliation: Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, AB T6G 2S2, Canada. verstrae@ualberta.ca.
authors.forename: Barbara S E
authors.initials: BS
authors.lastname: Verstraeten
authors.affiliation: Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, AB T6G 2S2, Canada. jwng@ualberta.ca.
authors.forename: Jane W Y
authors.initials: JW
authors.lastname: Ng
authors.affiliation: Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada. keiko.mccreary2@uleth.ca.
authors.forename: J Keiko
authors.initials: JK
authors.lastname: McCreary
authors.affiliation: Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada. gerlinde.metz@uleth.ca.
authors.forename: Gerlinde A S
authors.initials: GA
authors.lastname: Metz
mesh_terms: D052636:Allostasis / Q000502:physiology*; D044127:Epigenesis, Genetic; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008954:Models, Biological; D011247:Pregnancy; D047928:Premature Birth / Q000235:genetics / Q000503:physiopathology*; D012307:Risk Factors
keywords: adverse pregnancy outcomes; allostasis; allostatic load; chronic stress; inflammation; multiple hit hypothesis; preterm birth; two hits