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Stressors Across the Life-Course and Preterm Delivery: Evidence From a Pregnancy Cohort

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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.

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References

  • Behrman, R., & Butler, A. (2005). Preterm birth: Causes, consequences, and prevention. Washington, DC: National Academies Press.

    Google Scholar 

  • Blencowe, H., Cousens, S., Chou, D., Oestergaard, M., Say, L., Moller, A. B., et al. (2013). Born too soon: The global epidemiology of 15 million preterm births. Reproductive Health, 10(Suppl S2), 1.

    Google Scholar 

  • Blumenshine, P., Egerter, S., Barclay, C. J., Cubbin, C., & Braveman, P. A. (2010). Socioeconomic disparities in adverse birth outcomes: A systematic review. American Journal of Preventive Medicine, 39(3), 263–272.

    Article  PubMed  Google Scholar 

  • Bryant, A. S., Worjoloh, A., Caughey, A. B., & Washington, A. E. (2010). Racial/ethnic disparities in obstetric outcomes and care: Prevalence and determinants. American Journal of Obstetrics and Gynecology, 202(4), 335–343.

    Article  PubMed  PubMed Central  Google Scholar 

  • Challis, J. R. G. (2000). Mechanism of parturition and preterm labor. Obstetrical & Gynecological Survey, 55(10), 650–660.

    Article  Google Scholar 

  • Chen, M. J., Grobman, W. A., Gollan, J. K., & Borders, A. E. (2011). The use of psychosocial stress scales in preterm birth research. American Journal of Obstetrics and Gynecology, 205(5), 402–432.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cheng, T. L., Kotelchuck, M., & Guyer, B. (2012). Preconception women’s health and pediatrics: An opportunity to address infant mortality and family health. Academic Pediatric, 12(5), 357–359.

    Article  Google Scholar 

  • Christian, L. M. (2012). Psychoneuroimmunology in pregnancy: Immune pathways linking stress with maternal health, adverse birth outcomes, and fetal development. Neuroscience and Biobehavioral Reviews, 36(1), 350–361.

    Article  PubMed  Google Scholar 

  • Cohen, S., Kessler, R. C., & Gordon, L. U. (1995). Measuring stress: A guide for health and social scientists. New York: Oxford University Press.

    Google Scholar 

  • Collins, J. W., Rankin, K. M., & David, R. J. (2011). Low birth weight across generations: The effect of economic environment. Maternal and Child Health Journal, 15(4), 438–445.

    Article  PubMed  Google Scholar 

  • Culhane, J. F., & Goldenberg, R. L. (2011). Racial disparities in preterm birth. Seminars in Perinatology, 35(4), 234–239.

    Article  PubMed  Google Scholar 

  • Culhane, J. F., Rauh, V., McCollum, K. F., Hogan, V. K., Agnew, K., & Wadhwa, P. D. (2001). Maternal stress is associated with bacterial vaginosis in human pregnancy. Maternal and Child Health Journal, 5(2), 127–134.

    Article  CAS  PubMed  Google Scholar 

  • Dunkel Schetter, C. (2011). Psychological science on pregnancy: Stress processes, biopsychosocial models, and emerging research issues. Annual Review of Psychology, 62, 531–558.

    Article  PubMed  Google Scholar 

  • Gavin, A. R., Holzman, C., Siefert, K., & Tian, Y. (2009). Maternal depressive symptoms, depression, and psychiatric medication use in relation to risk of preterm delivery. Womens Health Issues, 19(5), 325–334.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gawade, P. L., Oeffinger, K. C., Sklar, C. A., Green, D. M., Krull, K. R., Chemaitilly, W., et al. (2015). Lifestyle, distress, and pregnancy outcomes in the Childhood Cancer Survivor Study cohort. American Journal of Obstetrics and Gynecology, 212(1), 47.e1–47.e10.

    Article  Google Scholar 

  • Goldenberg, R. L., Cliver, S. P., Mulvihill, F. X., Hickey, C. A., Hoffman, H. J., Klerman, L. V., et al. (1996). Medical, psychosocial, and behavioral risk factors do not explain the increased risk for low birth weight among black women. American Journal of Obstetrics and Gynecology, 175(5), 1317–1324.

    Article  CAS  PubMed  Google Scholar 

  • Goldenberg, R. L., Culhane, J. F., Iams, J. D., & Romero, R. (2008). Epidemiology and causes of preterm birth. Lancet, 371(9606), 75–84.

    Article  PubMed  Google Scholar 

  • Gonzalez, A., Jenkins, J. M., Steiner, M., & Fleming, A. S. (2009). The relation between early life adversity, cortisol awakening response and diurnal salivary cortisol levels in postpartum women. Psychoneuroendocrinology, 34(1), 76–86.

    Article  CAS  PubMed  Google Scholar 

  • Hardt, J., & Rutter, M. (2004). Validity of adult retrospective reports of adverse childhood experiences: Review of the evidence. Journal of Child Psychology and Psychiatry, 45(2), 260–273.

    Article  PubMed  Google Scholar 

  • Harville, E. W., Boynton-Jarrett, R., Power, C., & Hypponen, E. (2010). Childhood hardship, maternal smoking, and birth outcomes: A prospective cohort study. Archives of Pediatrics and Adolescent Medicine, 164(6), 533–539.

    Article  PubMed  PubMed Central  Google Scholar 

  • Harville, E. W., Hatch, M. C., & Zhang, J. (2005). Perceived life stress and bacterial vaginosis. J Womens Health (Larchmt), 14(7), 627–633.

    Article  Google Scholar 

  • Holzman, C., Bullen, B., Fisher, R., Paneth, N., & Reuss, L. (2001). Pregnancy outcomes and community health: The POUCH study of preterm delivery. Paediatric and Perinatal Epidemiology, 15(Suppl 2), 136–158.

    Article  PubMed  Google Scholar 

  • Holzman, C., Eyster, J., Tiedje, L. B., Roman, L. A., Seagull, E., & Rahbar, M. H. (2006). A life course perspective on depressive symptoms in mid-pregnancy. Maternal and Child Health Journal, 10(2), 127–138.

    Article  PubMed  Google Scholar 

  • Hummer, R. A., Biegler, M., De Turk, P. B., Forbes, D., Frisbie, W. P., Hong, Y., et al. (1999). Race, nativity, and infant mortality in the United States. Social Forces, 77(3), 1083–1117.

    Article  Google Scholar 

  • Khashan, A. S., McNamee, R., Abel, K. M., Mortensen, P. B., Kenny, L. C., Pedersen, M. G., et al. (2009). Rates of preterm birth following antenatal maternal exposure to severe life events: A population-based cohort study. Human Reproduction, 24(2), 429–437.

    Article  CAS  PubMed  Google Scholar 

  • Kramer, M. R., Hogue, C. J., Dunlop, A. L., & Menon, R. (2011). Preconceptional stress and racial disparities in preterm birth: An overview. Acta Obstetricia et Gynecologica Scandinavica, 90(12), 1307–1316.

    Article  PubMed  Google Scholar 

  • Laszlo, K. D., Li, J., Olsen, J., Vestergaard, M., Obel, C., & Cnattingius, S. (2016). Maternal bereavement and the risk of preterm delivery: The importance of gestational age and of the precursor of preterm birth. Psychological Medicine, 46(6), 1163–1173.

    Article  CAS  PubMed  Google Scholar 

  • Lhila, A., & Long, S. (2012). What is driving the black–white difference in low birthweight in the US? Health Economics, 21(3), 301–315.

    Article  PubMed  Google Scholar 

  • Love, C., David, R. J., Rankin, K. M., & Collins, J. W, Jr. (2010). Exploring weathering: Effects of lifelong economic environment and maternal age on low birth weight, small for gestational age, and preterm birth in African-American and white women. American Journal of Epidemiology, 172(2), 127–134.

    Article  PubMed  Google Scholar 

  • Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life-course perspective. Maternal and Child Health Journal, 7(1), 13–30.

    Article  PubMed  Google Scholar 

  • Martin, J. A., Hamilton, B. E., Ventura, S. J., Menacker, F., & Park, M. M. (2002). Births: Final data for 2000. National Vital Statistics Report, 50(5), 1–101.

    Google Scholar 

  • Maternal and Child Health Bureau. (2010). Rethinking MCH: The life course model as an organizing framework. Concept Paper. U.S. Department of Health and Human Services, Health Resources and Services Administration. http://mchb.hrsa.gov/lifecourse/rethinkingmchlifecourse.pdf. Accessed 5 May 2016.

  • McGrady, G. A., Sung, J. F., Rowley, D. L., & Hogue, C. J. (1992). Preterm delivery and low birth weight among first-born infants of black and white college graduates. American Journal of Epidemiology, 136(3), 266–276.

    Article  CAS  PubMed  Google Scholar 

  • Nerum, H., Halvorsen, L., Straume, B., Sorlie, T., & Oian, P. (2013). Different labour outcomes in primiparous women that have been subjected to childhood sexual abuse or rape in adulthood: A case-control study in a clinical cohort. BJOG: An International Journal of Obstetrics and Gynaecology, 120(4), 487–495.

    Article  CAS  Google Scholar 

  • Noll, J. G., Schulkin, J., Trickett, P. K., Susman, E. J., Breech, L., & Putnam, F. W. (2007). Differential pathways to preterm delivery for sexually abused and comparison women. Journal of Pediatric Psychology, 32(10), 1238–1248.

    Article  PubMed  Google Scholar 

  • Nuru-Jeter, A., Dominguez, T. P., Hammond, W. P., Lue, J., Skaff, M., Egerter, S., et al. (2009). “It’s the skin you’re in”: African-American women talk about their experiences of racism. An exploratory study to develop measures of racism for birth outcome studies. Maternal and Child Health Journal, 13, 29–39.

    Article  PubMed  Google Scholar 

  • Pallotto, E. K., & Kilbride, H. W. (2006). Perinatal outcome and later implications of intrauterine growth restriction. Clinical Obstetrics and Gynecology, 49(2), 257–269.

    Article  PubMed  Google Scholar 

  • Paul, K., Boutain, D., Manhart, L., & Hitti, J. (2008). Racial disparity in bacterial vaginosis: The role of socioeconomic status, psychosocial stress, and neighborhood characteristics, and possible implications for preterm birth. Social Science and Medicine, 67(5), 824–833.

    Article  PubMed  Google Scholar 

  • Pesonen, A. K., Raikkonen, K., Feldt, K., Heinonen, K., Osmond, C., Phillips, D. I., et al. (2010). Childhood separation experience predicts HPA axis hormonal responses in late adulthood: A natural experiment of World War II. Psychoneuroendocrinology, 35(5), 758–767.

    Article  CAS  PubMed  Google Scholar 

  • Precht, D. H., Andersen, P. K., & Olsen, J. (2007). Severe life events and impaired fetal growth: A nation-wide study with complete follow-up. Acta Obstetricia et Gynecologica Scandinavica, 86(3), 266–275.

    Article  PubMed  Google Scholar 

  • Richardson, L., Hussey, J. M., & Strutz, K. L. (2013). A life course perspective on maternal and child health. In J. Kotch (Ed.), Maternal and child health: Programs, problems, and policy in public health (3rd ed., pp. 65–85). Sudbury MA: Jones and Bartlett Publishers.

    Google Scholar 

  • Roberts, C. B., Vines, A. I., Kaufman, J. S., & James, S. A. (2008). Cross-sectional association between perceived discrimination and hypertension in African-American men and women: The Pitt County Study. American Journal of Epidemiology, 167(5), 624–632.

    Article  PubMed  Google Scholar 

  • Schei, B., Lukasse, M., Ryding, E. L., Campbell, J., Karro, H., Kristjansdottir, H., et al. (2014). A history of abuse and operative delivery–results from a European multi-country cohort study. PLoS ONE, 9(1), e87579.

    Article  PubMed  PubMed Central  Google Scholar 

  • Scheid, J. M., Holzman, C. B., Jones, N., Friderici, K. H., Nummy, K. A., Symonds, L. L., et al. (2007). Depressive symptoms in mid-pregnancy, lifetime stressors and the 5-HTTLPR genotype. Genes Brain and Behavior, 6(5), 453–464.

    Article  CAS  Google Scholar 

  • Seng, J. S., Low, L. K., Sperlich, M., Ronis, D. L., & Liberzon, I. (2011). Post-traumatic stress disorder, child abuse history, birthweight and gestational age: a prospective cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, 118(11), 1329–1339.

    Article  CAS  Google Scholar 

  • Strutz, K. L., Hogan, V. K., Siega-Riz, A. M., Suchindran, C. M., Halpern, C. T., & Hussey, J. M. (2014). Preconception stress, birth weight, and birth weight disparities among US women. American Journal of Public Health, 104(8), e125–e132.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thoits, P. A. (2010). Stress and health: Major findings and policy implications. Journal of Health and Social Behavior, 51(Suppl), S41–S53.

    Article  PubMed  Google Scholar 

  • Trabert, B., & Misra, D. P. (2007). Risk factors for bacterial vaginosis during pregnancy among African American women. American Journal of Obstetrics and Gynecology, 197(5), 477.e1.

    Article  Google Scholar 

  • Turner, R. J., Wheaton, B., & Lloyd, D. A. (1995). The epidemiology of social stress. Americal Sociological Review, 60, 104–125.

    Article  Google Scholar 

  • Wadhwa, P. D., Entringer, S., Buss, C., & Lu, M. C. (2011). The contribution of maternal stress to preterm birth: Issues and considerations. Clinics in Perinatology, 38(3), 351–384.

    Article  PubMed  PubMed Central  Google Scholar 

  • Williams, D. R., & Collins, C. (2001). Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports, 116(5), 404–416.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Witt, W. P., Cheng, E. R., Wisk, L. E., Litzelman, K., Chatterjee, D., Mandell, K., et al. (2014a). Maternal stressful life events prior to conception and the impact on infant birth weight in the United States. American Journal of Public Health, 104(Suppl 1), S81–S89.

    Article  PubMed  PubMed Central  Google Scholar 

  • Witt, W. P., Cheng, E. R., Wisk, L. E., Litzelman, K., Chatterjee, D., Mandell, K., et al. (2014b). Preterm birth in the United States: The impact of stressful life events prior to conception and maternal age. American Journal of Public Health, 104(Suppl 1), S73–S80.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yao, Y., Robinson, A. M., Zucchi, F. C., Robbins, J. C., Babenko, O., Kovalchuk, O., et al. (2014). Ancestral exposure to stress epigenetically programs preterm birth risk and adverse maternal and newborn outcomes. BMC Medicine, 12, 121.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors thank the POUCH Study community research study nurses for careful data collection and Bertha Bullen for her role in study logistics and data management. The POUCH Study was supported by the Perinatal Epidemiological Research Initiative Program Grant from the March of Dimes Foundation (Grants 20FY01-38 and 20FY04-37); the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Nursing Research (Grant R01HD34543); the Thrasher Research Foundation (Grant 02816-7); and the Centers for Disease Control and Prevention (Grant U01 DP000143-01). This analysis was also supported by the National Heart, Lung, and Blood Institute (Grant K01 HL128843).

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  1. Kelly L. Strutz

    Present address: Department of Public Health, Grand Valley State University, 545 Michigan St NE, Suite 300, Grand Rapids, MI, 49503, USA

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  1. Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 West Fee Rd. Rm 601B, East Lansing, MI, 48823, USA

    Claire E. Margerison-Zilko, Kelly L. Strutz, Yu Li & Claudia Holzman

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Correspondence to Claire E. Margerison-Zilko.

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Margerison-Zilko, C.E., Strutz, K.L., Li, Y. et al. Stressors Across the Life-Course and Preterm Delivery: Evidence From a Pregnancy Cohort. Matern Child Health J 21, 648–658 (2017). https://doi.org/10.1007/s10995-016-2151-5

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