title: Stressors Across the Life-Course and Preterm Delivery: Evidence From a Pregnancy Cohort.
abstract: Objectives Growing evidence suggests that pre-conception stressors are associated with increased risk of preterm delivery (PTD). Our study assesses stressors in multiple domains at multiple points in the life course (i.e., childhood, adulthood, within 6 months of pregnancy) and their relation to PTD. We also examine heterogeneity of associations by race/ethnicity, PTD timing, and PTD clinical circumstance. Methods We assessed stressors retrospectively via mid-pregnancy questionnaires in the Pregnancy Outcomes and Community Health Study (1998-2004), a Michigan pregnancy cohort (n = 2559). Stressor domains included abuse/witnessing violence (hereafter "abuse"), loss, economic stress, and substance use. We used logistic and multinomial regression for the following outcomes: PTD (<37 weeks' gestation), PTD by timing (≤34 weeks, 35-36 weeks) and PTD by clinical circumstance (medically indicated, spontaneous). Covariates included race/ethnicity, education, parity, and marital status. Results Stressors in the previous 6 months were not associated with PTD. Experiencing abuse during both childhood and adulthood increased adjusted odds of PTD among women of white or other race/ethnicity only (aOR 1.6, 95 % CI 1.1, 2.5). Among all women, abuse in childhood increased odds of late PTD (aOR 1.5, 95 % CI 1.0, 2.2) while abuse in both childhood and adulthood non-significantly increased odds of early PTD (aOR 1.6, 95 % CI 0.9, 2.7). Sexual, but not physical, abuse in both childhood and adulthood increased odds of PTD (aOR 1.9, 95 % CI 1.0, 3.5). Conclusions Experiences of abuse-particularly sexual abuse-across the life-course may be important considerations when assessing PTD risk. Our results motivate future studies of pathways linking abuse and PTD.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 West Fee Rd. Rm 601B, East Lansing, MI, 48823, USA. cmargerisonzilko@epi.msu.edu.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Margerison-Zilko
authors.affiliation: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 West Fee Rd. Rm 601B, East Lansing, MI, 48823, USA.|Department of Public Health, Grand Valley State University, 545 Michigan St NE, Suite 300, Grand Rapids, MI, 49503, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Strutz
authors.affiliation: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 West Fee Rd. Rm 601B, East Lansing, MI, 48823, USA.
authors.forename: Yu
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 West Fee Rd. Rm 601B, East Lansing, MI, 48823, USA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Holzman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008824:Michigan / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology / Q000523:psychology*; D012189:Retrospective Studies; D012306:Risk; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires
keywords: Abuse; Life course; Preterm delivery; Stress