title: Social stress predicts preterm birth in twin pregnancies.
abstract: To investigate whether stress, anxiety and depression predict preterm birth in twin pregnancies.
  
  
  
  A prospective cohort study with a convenience sample of women pregnant with dichorionic, diamniotic twins. They were interviewed at 24-28 weeks using the Life Events and Difficulties Schedule and the Hospital Anxiety and Depression Scale. Corticotrophin-releasing hormone, ACTH and cortisol levels were assessed at 28 weeks. The main outcome was premature delivery; there were 42 preterm and 73 term births.
  
  
  
  Preterm births (<37 weeks) were predicted by higher levels of social stress: 24/42 (57.1%) of women labouring prematurely and 14/73 (19.2%) of those giving birth at term had experienced a severe life event and/or marked social difficulty in the preceding year (<0.001). In logistic regression controlling for age, anxiety and depression, the experience of a severe life event during the year preceding the interview (OR =15.6; 95%CI: 3.0 to 80.8) and a marked difficulty in a close relationship (OR = 17.8; 95%CI: 1.7 to 192) were the factors predicting preterm birth. Levels of CRH, cortisol and ACTH at 28 weeks were not associated with preterm birth. Of the women whose pregnancy lasted less than 34 weeks (early preterm birth) 15/16 had experienced a severe life event and/or marked social difficulty compared to a third (9/26) of those delivering at 34-36 weeks (late preterm birth) and 14/73 of women whose pregnancy reached term (p < .001).
  
  
  
  Experience of severe social stress predicts preterm birth in twin pregnancies.
authors.affiliation: a Department of Obstetrics , Liverpool Women's Hospital , Liverpool , UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Owen
authors.affiliation: a Department of Obstetrics , Liverpool Women's Hospital , Liverpool , UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: Wood
authors.affiliation: b Institute of Population Health, The University of Manchester , Manchester , UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
authors.affiliation: c Institute of Brain, Behaviour and Mental Health, The University of Manchester , Manchester , UK.
authors.forename: Francis
authors.initials: F
authors.lastname: Creed
authors.affiliation: d Centre for Women's Health Research, University of Liverpool, Liverpool Women's Hospital , Liverpool , UK.
authors.forename: James P
authors.initials: JP
authors.lastname: Neilson
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008016:Life Change Events; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D047928:Premature Birth / Q000175:diagnosis / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D013315:Stress, Psychological / Q000097:blood* / Q000453:epidemiology*
keywords: Cohort studies; life change events; maternal stress; multiple pregnancies; preterm birth