Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 30;18(3):e0282582.
doi: 10.1371/journal.pone.0282582. eCollection 2023.

Individual and collective contribution of antenatal psychosocial distress conditions and preterm birth in Pakistani women

Sharifa Lalani  1 , Shahirose Sadrudin Premji  2 , Kiran Shaikh  1 , Salima Sulaiman  3 , Ilona S Yim  4 , Ntonghanwah Forcheh  1 , Neelofur Babar  5 , Sidrah Nausheen  6 , Nicole Letourneau  7 ; Maternal-infant Global Health Team (MiGHT) Collaborators in Research
Affiliations

Individual and collective contribution of antenatal psychosocial distress conditions and preterm birth in Pakistani women

Sharifa Lalani et al. PLoS One. .

Abstract

Background: We determined whether dimensions of psychosocial distress during pregnancy individually and collectively predicted preterm birth (PTB) in Pakistani women as it may be misleading to extrapolate results from literature predominantly conducted in high-income countries.

Methods: This cohort study included 1603 women recruited from four Aga Khan Hospital for Women and Children in Sindh, Pakistan. The primary binary outcome of PTB (i.e., livebirth before 37 completed weeks' gestation) was regressed on self-reported symptoms of anxiety (Pregnancy-Related Anxiety (PRA) Scale and Spielberger State-Trait Anxiety Inventory Form Y-1), depression (Edinburgh Perinatal Depression Scale (EPDS)), and covariates such as chronic stress (Perceived Stress Scale) assessed with standardized question and scales with established language equivalency (Sindhi and Urdu).

Results: All 1603 births occurred between 24 and 43 completed weeks' gestation. PRA was a stronger predictor of PTB than other types of antenatal psychosocial distress conditions. Chronic stress had no effect on the strength of association between PRA and PTB and a slight but non-significant effect on depression. A planned pregnancy significantly lowered risk of PTB among women who experienced PRA. Aggregate antenatal psychosocial distress did not improve model prediction over PRA.

Conclusions: Like studies in high-income countries, PRA became a strong predictor of PTB when considering interactive effects of whether the current pregnancy was planned. Women's resilience and abilities to make sexual and reproductive health decisions are important to integrate in future research. Findings should be generalized with caution as socio-cultural context is a likely effect modifier. We did not consider protective/strength-oriented factors, such as resilience among women.

PubMed Disclaimer

Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: All authors except, NF, declare no conflict of interest. NF, Senior Biostatistician, was paid through the CIHR Project Grant and Startup Grant, Faculty of Health, York University. This does not alter our adherence to PLOS ONE policies on publication of this article. Data are available on reasonable request. Please contact Dr. Shahirose Sadrudin Premji (shahirose.premji@queensu.ca) for more information, collaborations, or data access inquiries. We do not have permission from the Pakistani participants to share individual level data. They have given informed consent on the basis that only aggregate date would be published. Hence, data are available on reasonable request as stated above and I have provided the contact information.

References

    1. World Health Organization. Preterm Birth; 2018. [Cited July 27, 20202]. Available from https://www.who.int/news-room/fact-sheets/detail/preterm-birth
    1. Walani SR. Global burden of preterm birth. Int J Gynecol Obstet. 2020; 150:31–33. doi: 10.1002/ijgo.13195 - DOI - PubMed
    1. Chawanpaiboon S, Vogel JP, Moller A-B, Lumbiganon P, Petzold M, Hogan D, et al.. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019; 7:e37–e46. doi: 10.1016/S2214-109X(18)30451-0 - DOI - PMC - PubMed
    1. Hanif A, Ashraf T, Waheed K, Sajid MR, Guler N, Pervaiz MK. 2017. Prevalence of preterm birth in Pakistan: a systematic review and meta-analysis. Ann King Edw Med Univ (Lahore Pakistan). 2017; 23:229–235.
    1. Pusdekar YV, Patel AB, Kurhe KG, Bhargav SR, Thorsten V, Garces A, et al.. Rates and risk factors for preterm birth and low birthweight in the global network sites in six low- and low middle-income countries. Reprod Health. 2020; 17:187. doi: 10.1186/s12978-020-01029-z - DOI - PMC - PubMed

Publication types

Grants and funding