Archives of Women's Mental Health

, Volume 17, Issue 6, pp 559–568 | Cite as

Cumulative psychosocial stress, coping resources, and preterm birth

  • Sheila W. McDonaldEmail author
  • Dawn Kingston
  • Hamideh Bayrampour
  • Siobhan M. Dolan
  • Suzanne C. Tough
Original Article


Preterm birth constitutes a significant international public health issue, with implications for child and family well-being. High levels of psychosocial stress and negative affect before and during pregnancy are contributing factors to shortened gestation and preterm birth. We developed a cumulative psychosocial stress variable and examined its association with early delivery controlling for known preterm birth risk factors and confounding environmental variables. We further examined this association among subgroups of women with different levels of coping resources. Utilizing the All Our Babies (AOB) study, an ongoing prospective pregnancy cohort study in Alberta, Canada (n = 3,021), multinomial logistic regression was adopted to examine the independent effect of cumulative psychosocial stress and preterm birth subgroups compared to term births. Stratified analyses according to categories of perceived social support and optimism were undertaken to examine differential effects among subgroups of women. Cumulative psychosocial stress was a statistically significant risk factor for late preterm birth (OR = 1.73; 95 % CI = 1.07, 2.81), but not for early preterm birth (OR = 2.44; 95 % CI = 0.95, 6.32), controlling for income, history of preterm birth, pregnancy complications, reproductive history, and smoking in pregnancy. Stratified analyses showed that cumulative psychosocial stress was a significant risk factor for preterm birth at <37 weeks gestation for women with low levels of social support (OR = 2.09; 95 % CI = 1.07, 4.07) or optimism (OR = 1.87; 95 % CI = 1.04, 3.37). Our analyses suggest that early vulnerability combined with current anxiety symptoms in pregnancy confers risk for preterm birth. Coping resources may mitigate the effect of cumulative psychosocial stress on the risk for early delivery.


Preterm birth Life course Anxiety Psychosocial stress 



We are extremely grateful to all the families who took part in this study and the whole All Our Babies team. Alberta Innovates Health Solutions Interdisciplinary Team Grant #200700595 provided funding for this cohort. Additional funding from the Alberta Children’s Hospital Foundation assisted with the analysis of data presented in this manuscript.

Ethical standards

This study was approved by the appropriate ethics committee and therefore was performed in accordance with the ethical stands laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Sheila W. McDonald
    • 1
    • 5
    Email author
  • Dawn Kingston
    • 2
  • Hamideh Bayrampour
    • 1
  • Siobhan M. Dolan
    • 3
  • Suzanne C. Tough
    • 1
    • 4
  1. 1.Department of PaediatricsUniversity of CalgaryCalgaryCanada
  2. 2.Faculty of NursingUniversity of AlbertaEdmontonCanada
  3. 3.Department of Obstetrics and Gynecology and Women’s HealthAlbert Einstein College of Medicine of Yeshiva UniversityBronxUSA
  4. 4.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada
  5. 5.Child Development CentreUniversity of CalgaryCalgaryCanada

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