Mayne Gabriella, Ghidei Luwam, Buckley Ayisha, Perng Wei, Hurt K Joseph, Tracer David P
Department of Health & Behavioral Sciences, University of Colorado, Denver, CO, USA.
Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC 2820, USA.
Eur J Obstet Gynecol Reprod Biol X. 2025 Jun 8;27:100409. doi: 10.1016/j.eurox.2025.100409. eCollection 2025 Sep.
Spontaneous preterm birth (<37 weeks' gestation) is a leading cause of neonatal morbidity and mortality, with little global progress in prevention. Spontaneous preterm birth disproportionately affects communities marginalized by racism and socio-economic disadvantage. Maternal stress is a well-established risk factor for spontaneous preterm birth and is more prevalent in marginalized communities. Yet, maternal stress remains underutilized as a target for clinical intervention. In this review, we draw from ecological, evolutionary, and developmental (eco-evo-devo) biology, Black feminist theory, and reproductive justice to center the margins of those communities most burdened by both maternal stress and preterm birth. In doing so, we re-frame the importance of maternal stress mitigation in spontaneous preterm prevention. Through the lens of stress-induced developmental plasticity, environmental stressors may shorten gestation through evolutionarily conserved maternal-fetal-placental signaling pathways. Two features of this process are particularly relevant to clinical care: first, stress may impact gestational length in a dose-dependent manner; second, its effects may be reversible. Reducing maternal stress may be a highly feasible clinical opportunity to tangibly reduce spontaneous preterm birth and increase birth equity.
自发性早产（妊娠<37周）是新生儿发病和死亡的主要原因，全球在预防方面进展甚微。自发性早产对因种族主义和社会经济劣势而边缘化的社区影响尤为严重。母亲压力是自发性早产的一个公认风险因素，在边缘化社区更为普遍。然而，母亲压力作为临床干预目标仍未得到充分利用。在本综述中，我们借鉴生态、进化和发育（生态-进化-发育）生物学、黑人女性主义理论和生殖正义，将那些受母亲压力和早产负担最重的社区的边缘群体作为核心。这样做时，我们重新界定了减轻母亲压力在预防自发性早产中的重要性。从压力诱导的发育可塑性角度来看，环境压力源可能通过进化上保守的母婴-胎盘信号通路缩短妊娠期。这一过程的两个特征与临床护理特别相关：第一，压力可能以剂量依赖的方式影响妊娠期长度；第二，其影响可能是可逆的。减轻母亲压力可能是一个非常可行的临床机会，可以切实减少自发性早产并提高出生公平性。
