McDonald Sheila W, Kingston Dawn, Bayrampour Hamideh, Dolan Siobhan M, Tough Suzanne C
Department of Paediatrics, University of Calgary, Calgary, AB, Canada,
Arch Womens Ment Health. 2014 Dec;17(6):559-68. doi: 10.1007/s00737-014-0436-5. Epub 2014 Jun 20.
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.
早产是一个重大的国际公共卫生问题，对儿童和家庭的幸福产生影响。孕期前后高水平的心理社会压力和负面影响是导致妊娠期缩短和早产的因素。我们开发了一个累积心理社会压力变量，并在控制已知早产风险因素和混杂环境变量的情况下，研究了其与早产的关联。我们还进一步研究了不同应对资源水平的女性亚组之间的这种关联。利用“我们所有的宝宝”（AOB）研究，这是加拿大艾伯塔省一项正在进行的前瞻性妊娠队列研究（n = 3021），采用多项逻辑回归来检验累积心理社会压力和早产亚组与足月产相比的独立效应。根据感知到的社会支持和乐观程度类别进行分层分析，以研究女性亚组之间的差异效应。在控制收入、早产史、妊娠并发症、生殖史和孕期吸烟的情况下，累积心理社会压力是晚期早产的一个具有统计学意义的风险因素（OR = 1.73；95%CI = 1.07，2.81），但不是早期早产的风险因素（OR = 2.44；95%CI = 0.95，6.32）。分层分析表明，对于社会支持水平低（OR = 2.09；95%CI = 1.07，4.07）或乐观程度低（OR = 1.87；95%CI = 1.04，3.37）的女性，累积心理社会压力是妊娠<37周早产的一个显著风险因素。我们的分析表明，早期易感性与孕期当前的焦虑症状相结合会增加早产风险。应对资源可能会减轻累积心理社会压力对早产风险的影响。
