666 Perceived stress and spontaneous preterm birth in twin gestations

Abstract

Twins are at increased risk for both medically indicated and spontaneous preterm birth (sPTB). Stress affects a variety of biologic processes including inflammation and the immune response. Given that inflammatory and immune factors play a role in sPTB, our aim was to examine the association between maternal stress and sPTB in twin gestations. A prospective cohort study of women with twin gestations was conducted. Six previously validated questionnaires of stress, anxiety, depression, and trauma were administered at two time periods, 14-16 weeks and 24-26 weeks. Correlations were tested between measures from each time period and between each measure and gestational age (GA) at delivery. Time-to-event analysis was then conducted with birth as the outcome and GA as time. sPTB was defined as PTB following either PPROM or preterm labor. Cox proportional hazards regression models were performed using Efron’s method. 50 women were enrolled and included. Among the cohort, 33 (66%) women were nulliparous, 22 (44%) were non-white, and 1 (2%) was treated for mood disorders during the pregnancy. 33 (66%) delivered preterm, with a mean GA of 34 weeks, of whom 18 (54.5%) had sPTB. Questionnaire measures were similar between the two time periods. Overall, there were no clear correlations between measures of anxiety, depression and trauma and GA in the scatterplots; the Spearman correlation coefficient ranged from -0.31 to 0.36. Only perceived stress at 24-26 weeks correlated with an earlier GA at delivery among all PTB cases (r=-0.31; p=0.03), and those with sPTB (r=-0.39; p=0.02). In regression models, no measures were significantly associated with GA of delivery; the adjusted hazard ratio (HR) for perceived stress at 24-26 weeks was 1.05 (95% CI: 0.99-1.11) for PTB and 1.06 (95% CI: 0.99-1.14) for sPTB. Elevated perceived stress scores at 24-26 weeks’ gestation among women with twin gestations may be associated with sPTB . The utility of perceived stress as a marker for identifying women at increased risk for PTB deserves future study in a larger cohort.