Psychosocial Stress and Preterm Birth: The Impact of Parity and Race
Objectives Studies examining risk factors for preterm birth (PTB) such as psychosocial stress are often focused on women with a history of PTB; however, most preterm babies are born to women with no history of preterm birth. Our objective was to determine if the relationship between psychosocial stress and PTB is altered by parity. Non-Hispanic black (NHB) women have increased psychosocial stress and PTB; therefore, we further aimed to determine if race alters the relationship between psychosocial stress, parity, and PTB. Methods We performed a secondary analysis of the Healthy Pregnancy, Healthy Baby Study comparing pregnant women who were primiparous (first pregnancy), multiparous with history of preterm birth, or multiparous with history of term birth. Perceived stress, perceived racism, interpersonal support, John Henryism and self-efficacy were measured using validated instruments. Logistic regression was used to model the effect of psychosocial stress on PTB stratified by parity and race. Results The analysis entire cohort included 1606 subjects, 426 were primiparous, 268 had a history of presterm birth, and 912 had a history of term birth. In women with a history of term birth, higher self-efficacy was associated with lower odds of spontaneous PTB, and this association was amplified in NHB women. In women with a history of spontaneous PTB, John Henryism Active Coping was associated with lower odds of spontaneous PTB in the index pregnancy. Conclusions for Practice The relationship between psychosocial stress and PTB may be mediated by parity and race.
KeywordsPsychosocial stress Preterm birth Parity Race
This research was supported by funding from the U.S. Environmental Protection Agency (RD-83329301-0).
- Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan, S. Oskamp (Eds.) The social psychology of health. Newbury Park, CA: Sage.Google Scholar
- Dole, N., Savitz, D. A., Siega-Riz, A. M., Hertz-Picciotto, I., McMahon, M. J., & Buekens, P. (2004). Psychosocial factors and preterm birth among African American and White women in central North Carolina. American Journal of Public Health, 94(8), 1358–1365.CrossRefPubMedCentralPubMedGoogle Scholar
- Grobman, W. A., Parker, C., Wadhwa, P. D., Willinger, M., Simhan, H., & Silver, B., … Eunice Kennedy Shriver National Institute of Child Health Human Development nuMoM2b Network, B. M. D. (2016). Racial/ethnic disparities in measures of self-reported psychosocial states and traits during pregnancy. American Journal of Perinatology. https://doi.org/10.1055/s-0036-1586510.PubMedCentralGoogle Scholar
- Guendelman, S., Kosa, J. L., Pearl, M., Graham, S., & Kharrazi, M. (2008). Exploring the relationship of second-trimester corticotropin releasing hormone, chronic stress and preterm delivery. The Journal of Maternal-Fetal & Neonatal Medicine, 21(11), 788–795. https://doi.org/10.1080/14767050802379031.CrossRefGoogle Scholar
- James, S. (1996). The John Henryism Scale for active coping. In: R. Jones (Ed.) Handbook of tests and measurements for Black populations. Hampton, VA: Cobb & Henry PublishersGoogle Scholar
- Jerusalem, M., Schwarzer, R. (1992). Self-efficacy as a resource factor in stress appraisal processes. In R. Schwarzer (Eds.) Self-efficacy: Thought control of action (pp. 195–213). Washington, DC: HemisphereGoogle Scholar
- Kazemier, B. M., Buijs, P. E., Mignini, L., Limpens, J., de Groot, C. J., Mol, B. W., & Ebm, C. (2014). Impact of obstetric history on the risk of spontaneous preterm birth in singleton and multiple pregnancies: A systematic review. BJOG, 121(10), 1197–1208. https://doi.org/10.1111/1471-0528.12896 (discussion 1209).CrossRefPubMedGoogle Scholar
- Khashan, A. S., McNamee, R., Abel, K. M., Mortensen, P. B., Kenny, L. C., Pedersen, M. G., … Baker, P. N. (2009). Rates of preterm birth following antenatal maternal exposure to severe life events: A population-based cohort study. Human Reproduction, 24(2), 429–437. https://doi.org/10.1093/humrep/den418.CrossRefGoogle Scholar
- Kramer, M. S., Lydon, J., Seguin, L., Goulet, L., Kahn, S. R., McNamara, H., … Platt, R. W. (2009). Stress pathways to spontaneous preterm birth: The role of stressors, psychological distress, and stress hormones. American Journal of Epidemiology, 169(11), 1319–1326. https://doi.org/10.1093/aje/kwp061.CrossRefGoogle Scholar
- March of Dimes 2017 Premature Birth Report Card. Retrieved from https://www.marchofdimes.org/mission/prematurity-reportcard.aspx.
- Mercer, B. M., Goldenberg, R. L., Moawad, A. H., Meis, P. J., Iams, J. D., Das, A. F., … McNellis, D. (1999). The preterm prediction study: Effect of gestational age and cause of preterm birth on subsequent obstetric outcome. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. American Journal of Obstetrics & Gynecology, 181(5 Pt 1), 1216–1221.CrossRefGoogle Scholar