The interaction between chronic stress and pregnancy: preterm birth from a biobehavioral perspective

Abstract

Women's health care providers are increasingly aware that chronic stressors--such as poverty, ongoing perceived stress and anxiety, intimate partner violence, and experiences of racism--are associated with an increased incidence of preterm birth in the United States. It is important to increase our understanding of the explanatory pathways involved in these associations. This article discusses the concepts of stress, chronic stress response, allostatic load, the physiology of labor initiation, and the pathophysiologic interactions that may contribute to the occurrence of chronic stress-related preterm birth. Implications for future research and interventions are explored.

Figure 1

Contributors to preterm birth. DM = diabetes mellitus; HTN = hypertension; PPROM = premature preterm rupture of membranes.

Figure 2

Heuristic model of the stress process. Adapted and reprinted from Cohen et al. by permission of Oxford University Press, Inc.

Figure 3

Proposed mechanism of labor induction at term. Reprinted with permission from Norwitz et al. Copyright© 1999 Massachusetts Medical Society. All rights reserved. CRH = corticotropin-releasing hormone; DHEAS = dehydroepiandrosterone sulfate; SROM = spontaneous rupture of membranes.

Figure 4

Biobehavioral pathway from chronic stress to preterm birth. CRH = corticotrophin-releasing hormone.