Psychoneuroimmunology in pregnancy: immune pathways linking stress with maternal health, adverse birth outcomes, and fetal development

Abstract

It is well-established that psychological stress promotes immune dysregulation in nonpregnant humans and animals. Stress promotes inflammation, impairs antibody responses to vaccination, slows wound healing, and suppresses cell-mediated immune function. Importantly, the immune system changes substantially to support healthy pregnancy, with attenuation of inflammatory responses and impairment of cell-mediated immunity. This adaptation is postulated to protect the fetus from rejection by the maternal immune system. Thus, stress-induced immune dysregulation during pregnancy has unique implications for both maternal and fetal health, particularly preterm birth. However, very limited research has examined stress-immune relationships in pregnancy. The application of psychoneuroimmunology research models to the perinatal period holds great promise for elucidating biological pathways by which stress may affect adverse pregnancy outcomes, maternal health, and fetal development.

Figure 1. Pathways Linking Stress, Immune Function, and Perinatal Health Outcomes

Greater exposure to objectively stressful events results in greater experience of subjective distress (A). This effect is moderated by coping resources, including social support (B). Psychological distress may affect immune function via health behaviors (C) and direct physiological pathways (D) via effects on neuroendocrine and the sympathetic nervous system. In turn, immune parameters may affect maternal health (e.g., preeclampia, susceptibility to infectious illness, wound healing), birth outcomes, and fetal development (E).