Premji Shahirose Sadrudin, Lalani Sharifa, Ghani Farooq, Nausheen Sidrah, Forcheh Ntonghanwah, Omuse Geoffrey, Letourneau Nicole, Babar Neelofur, Sulaiman Salima, Wangira Musana, Ali Shahnaz Shahid, Islam Nazneen, Dosani Aliyah, Yim Ilona S
School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan.
Psychopathology. 2025;58(1):13-32. doi: 10.1159/000540579. Epub 2024 Sep 27.
The complex biopsychosocial pathways linking maternal mental health with preterm birth (PTB) are not well understood. This study aimed to explore allostatic load (AL) as a mediator and perceived chronic stress as a moderator in the pathway linking maternal mental health and PTB.
A cohort study of pregnant women (n = 1,567) recruited at clinic visits within 10-19 weeks of gestation was assessed for maternal mental health (i.e., pregnancy-related anxiety, state anxiety, depressive symptoms) and perceived chronic stress. Blood pressure and levels of cortisol, total cholesterol, C-reactive protein, and glycosylated hemoglobin were used to create a composite measure of AL.
AL had the most significant effect on PTB (odds ratio (OR) = 1.84, 95% CI = 1.26-12.67, p = 0.001), while systolic blood pressure emerged as the only significant individual marker using variable selection (OR = 22%, 95% CI = 1.06-1.40, p < 0.001) in multiple logistic regression analysis. A mediation analysis revealed that maternal mental health did not have a significant direct effect on PTB (p = 0.824), but its indirect effect mediated by AL was significant (z = 2.33, p < 0.020). Low and high levels of perceived chronic stress, relative to the mean, moderated this indirect effect (z = 3.66, p < 0.001).
AL has a significant direct influence on PTB and mediates the effect of maternal mental health on PTB; however, the indirect effect of AL is indistinguishable between women with higher or lower levels of perceived chronic stress than normal.
将孕产妇心理健康与早产（PTB）联系起来的复杂生物心理社会途径尚未得到充分理解。本研究旨在探讨在孕产妇心理健康与早产之间的途径中，应激负荷（AL）作为中介变量以及感知到的慢性应激作为调节变量的作用。
对1567名在妊娠10至19周期间到诊所就诊时招募的孕妇进行队列研究，评估其孕产妇心理健康（即与妊娠相关的焦虑、状态焦虑、抑郁症状）和感知到的慢性应激。使用血压、皮质醇、总胆固醇、C反应蛋白和糖化血红蛋白水平来创建应激负荷的综合测量指标。
应激负荷对早产的影响最为显著（优势比（OR）=1.84，95%置信区间（CI）=1.26 - 12.67，p = 0.001），而在多因素逻辑回归分析中，收缩压是唯一通过变量选择显示出显著作用的个体指标（OR = 22%，95% CI = 1.06 - 1.40，p < 0.001）。中介分析显示，孕产妇心理健康对早产没有显著的直接影响（p = 0.824），但其通过应激负荷介导的间接影响是显著的（z = 2.33，p < 0.020）。相对于均值，低水平和高水平的感知慢性应激调节了这种间接影响（z = 3.66，p < 0.001）。
应激负荷对早产有显著的直接影响，并介导了孕产妇心理健康对早产的影响；然而，在感知慢性应激水平高于或低于正常水平的女性中，应激负荷的间接影响没有差异。
