Abstract

BackgroundMore than 1 in 10 infants are born prematurely worldwide, making preterm birth the leading cause of neonatal mortality and morbidity. Chronic maternal stress is increasingly recognized as one of the contributing risk factors for preterm birth, yet its specific role remains largely unknown. Examining the exposure to stressors over a mother’s life course might provide more perspective on the role of maternal stress in preterm birth. Our aim was therefore to retrospectively explore the associations between chronic, lifelong stressors and protective factors and spontaneous preterm birth.MethodsThis study was part of a large case–control study based in Edmonton, Canada, examining gene-environment interactions and preterm birth. Cases were mothers with a spontaneous singleton preterm birth (<37 weeks) without preterm premature rupture of membranes. Controls were mothers with an uncomplicated singleton term birth without a history of preterm birth. Sociodemographic and medical data were collected. A postpartum telephone questionnaire was administered to assess stressors across the lifespan. Both individual and contextual variables that could influence stress response systems were examined. Overall, 622 women were included, of which 223 subjects – 75 cases and 148 controls – completed the stress questionnaire. Univariate and multivariate logistic regression analyses were performed.ResultsMultivariate analysis showed that exposure to two or more adverse childhood experiences (ACEs) was associated with a two-fold risk of preterm birth, regardless of maternal age, smoking status, educational status, and history of miscarriage (adjusted OR, 2.09; 95 % CI, 1.10–3.98; P = 0.024). The adjusted odds ratio for the ACE score was 1.18 (95 % CI, 0.99–1.40), suggesting that for every increase in childhood adverse event endorsed, the risk of preterm birth increased by 18 %. Lifetime physical and emotional abuse was also associated with spontaneous preterm birth in our study population (adjusted OR, 1.30; 95 % CI, 1.02–1.65; P = 0.033).ConclusionsA strong relationship between ACEs and preterm birth was observed. It has been shown that two or more ACEs have a notable two-fold increase in the risk of spontaneous preterm birth. These data demonstrate that stressors throughout life can have a significant effect on pregnancy outcomes such as preterm birth.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0353-0) contains supplementary material, which is available to authorized users.

Highlights

  • More than 1 in 10 infants are born prematurely worldwide, making preterm birth the leading cause of neonatal mortality and morbidity

  • When examining the relationship between Adverse childhood experience (ACE) score and spontaneous preterm birth, we found that the proportion of women with preterm birth gradually increased with increasing number of ACEs

  • The adjusted odds ratios (OR) for ACE score was 1.18, suggesting that, for every increase in childhood adverse event endorsed, the risk of preterm birth increased by 18 %

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Summary

Introduction

More than 1 in 10 infants are born prematurely worldwide, making preterm birth the leading cause of neonatal mortality and morbidity. Chronic maternal stress is increasingly recognized as one of the contributing risk factors for preterm birth, yet its specific role remains largely unknown. Maternal stress is increasingly recognized as a variable in the etiology of spontaneous preterm birth. Significant antepartum and postpartum maternal stress can arise from multiple current circumstances or past sources across the lifespan; its specific contribution to the risk of preterm birth remains controversial. Women who experienced major and traumatic life events early in pregnancy were found to have an increased risk of preterm birth [9,10,11] these were only associated with preterm birth when they were perceived to be stressful [12]. Other stressors, including physical and emotional abuse or domestic violence prior to or during pregnancy [13,14,15,16], and distressed states, such as major depressive disorder and anxiety, are associated with the onset of preterm labour [6, 17]

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