Measures of maternal stress and mood in relation to preterm birth
Open accessAbstract
OBJECTIVE: To investigate the relationships between psychological and physiologic measures of stress, mood, and gestational age at delivery and preterm birth. METHODS: This prospective cohort study recruited healthy women in the early second trimester who were 18-45 years of age. Validated psychological measures of perceived stress, depressive symptoms, and anxiety were completed at 16, 22, 28, 34, and 40 weeks of gestation. Cortisol concentration was measured in maternal hair at 16, 28, and 40 weeks of gestation to approximate first-, second-, and third-trimester levels of physiologic stress. Statistical methods included: analyses of variance, t tests, χ, Pearson correlations, regression modeling, and mediation analysis as appropriate. Hair cortisol concentrations were natural log-transformed to normalize values. RESULTS: Eleven (12%) of the 90 included women had a spontaneous preterm birth or preterm premature rupture of membranes. Perceived stress at 16 weeks of gestation correlated with both second-trimester cortisol concentration (r=0.28, P=.007) and earlier gestational age at delivery (r=-0.30, P<.01). Gestational age at delivery was also negatively correlated with cortisol concentration in the second trimester (r=-0.25, P=.02) and second-trimester cortisol concentration was higher in preterm- (2.7 ± 0.4 log-transformed pg/mg) compared with term- (2.0 ± 0.7 log-transformed pg/mg, P<.001) delivered women. Using mediation statistics, the association between the psychological measure, the physiologic measure, and gestational age at delivery was mainly driven by increased physiologic stress (hair cortisol concentration) in the second trimester (difference in coefficients [standard error]=-0.05 [0.02]). CONCLUSION: Higher perceived stress in the second trimester is associated with both elevated second-trimester hair cortisol concentration and gestational age at delivery. Physiologic measure of stress in the second trimester appears most strongly associated with preterm birth. Identification and amelioration of early pregnancy stressors may attenuate physiologic stress and ultimately affect preterm birth.
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Formal prospective tests of biological mediation are rare among studies of adult stress effects on HPA activity and birth timing.
“Of studies assessing effects of stress in adulthood on HPA activity and birth timing, formal, prospective testing of biological mediation is rare (Hoffman et al., 2016; Mancuso et al., 2004).”
From Childhood stress and birth timing among African American women: cortisol as biological mediator (2017) · cites this paper as Hoffman et al., 2016
The study provides preliminary support for the accelerated placental clock theory, consistent with some but not all prior studies.
“We also provide preliminary support for the accelerated “placental clock” theory, which is consistent with some (Guendelman et al., 2008; Hobel et al., 1999; Hoffman et al., 2016; Mancuso et al., 2004; Moog et al., 2016), but not all (Himes and Simhan, 2011; Karakash et al., 2016; Kramer et al., 2009; Kramer et al., 2013; Noll et al., 2007; Owen et al., 2017), prior studies.”
From Childhood stress and birth timing among African American women: cortisol as biological mediator (2017) · cites this paper as Hoffman et al., 2016
In longitudinal studies, various HPA markers in the second and third trimesters have some predictive power for birth timing.
“In longitudinal studies, various HPA markers in the 2nd and 3rd trimesters provide some predictive power for birth timing (e.g., Hobel et al., 1999; Hoffman et al., 2016).”
From Childhood stress and birth timing among African American women: cortisol as biological mediator (2017) · cites this paper as Hoffman et al., 2016
Women with increased life event stress during the first trimester of pregnancy had 2.40 times the risk of preterm birth compared with women with average or below-average stress.
“in these studies, women with increased life event stress during the first trimester of pregnancy had 2.40 times the risk of PTB compared with women with average or below-average stress.80”
From The transition to parenthood in obstetrics: enhancing prenatal care for 2-generation impact (2022) · cites this paper as [78]
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Cites
A Global Measure of Perceived Stress
Cohen, S., Kamarck, T., & Mermelstein, R. (1983) · Journal of Health and Social Behavior · doi:10.2307/2136404 · Cited by 32,807 · see citing works
The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults
Radloff, L. S. (1991) · Journal of Youth and Adolescence · doi:10.1007/bf01537606 · Cited by 1,997 · see citing works
Estimating Mediated Effects in Prevention Studies
MacKinnon, D. P., & Dwyer, J. H. (1993) · Evaluation Review · doi:10.1177/0193841x9301700202 · Cited by 1,936 · see citing works
Social Class and Mental Illness: A Community Study
Hollingshead, A. B., & Redlich, F. C. (2007) · American Journal of Public Health · doi:10.2105/ajph.97.10.1756 · Cited by 1,845 · see citing works
Socioeconomic Disparities in Adverse Birth Outcomes
Blumenshine, P., Egerter, S. A., Barclay, C., Cubbin, C., & Braveman, P. (2010) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2010.05.012 · Cited by 853 · see citing works
Jackson, J. S., Knight, K. M., & Rafferty, J. A. (2010) · American Journal of Public Health · doi:10.2105/ajph.2008.143446 · Cited by 840 · see citing works
Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis
Robinson, D. P., & Klein, S. L. (2012) · Hormones and Behavior · doi:10.1016/j.yhbeh.2012.02.023 · Cited by 711 · see citing works
Davis, E. P., & Sandman, C. A. (2010) · Child Development · doi:10.1111/j.1467-8624.2009.01385.x · Cited by 704 · see citing works
Potential problems with the interpretation of hair analysis results
Wennig, R. (2000) · Forensic Science International · doi:10.1016/s0379-0738(99)00146-2 · Cited by 677 · see citing works
Maternal and Fetal Hypothalamic‐Pituitary‐Adrenal Axes During Pregnancy and Postpartum
MASTORAKOS, G., & ILIAS, I. (2003) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1290.016 · Cited by 621 · see citing works
More than skin deep: Stress neurobiology and mental health consequences of racial discrimination
Berger, M., & Sarnyai, Z. (2015) · Stress · doi:10.3109/10253890.2014.989204 · Cited by 606 · see citing works
The Contribution of Maternal Stress to Preterm Birth: Issues and Considerations
Wadhwa, P. D., Entringer, S., Buss, C., & Lu, M. C. (2011) · Clinics in Perinatology · doi:10.1016/j.clp.2011.06.007 · Cited by 486 · see citing works
Minireview: Hair cortisol: A novel biomarker of hypothalamic-pituitary-adrenocortical activity
Meyer, J. S., & Novak, M. A. (2012) · Endocrinology · doi:10.1210/en.2012-1226 · Cited by 457 · see citing works
Sandman, C. A., Glynn, L., Schetter, C. D., Wadhwa, P., Garite, T., Chicz-DeMet, A., & Hobel, C. (2006) · Peptides · doi:10.1016/j.peptides.2005.10.002 · Cited by 411 · see citing works
Glover, V. A. S. (2014) · Advances in neurobiology · doi:10.1007/978-1-4939-1372-5_13 · Cited by 398 · see citing works
Gozansky, W. S., Lynn, J. S., Laudenslager, M. L., & Kohrt, W. M. (2005) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2005.02349.x · Cited by 356 · see citing works
Self-citationD'Anna‐Hernandez, K., Ross, R. G., Natvig, C. L., & Laudenslager, M. L. (2011) · Physiology & Behavior · doi:10.1016/j.physbeh.2011.02.041 · Cited by 346 · see citing works
Self-citationMaternal Psychological Distress, Prenatal Cortisol, and Fetal Weight
Diego, M. A., Jones, N. A., Field, T., Hernandez-Reif, M., Schanberg, S., Kuhn, C., & Gonzalez-Garcia, A. (2006) · Psychosomatic Medicine · doi:10.1097/01.psy.0000238212.21598.7b · Cited by 302 · see citing works
Prenatal depression restricts fetal growth
Diego, M., Field, T. M., Hernandez‐Reif, M., Schanberg, S. M., Kuhn, C. M., & González-Quintero, V. H. (2008) · Early Human Development · doi:10.1016/j.earlhumdev.2008.07.002 · Cited by 277 · see citing works
New insights into the role of perinatal HPA-axis dysregulation in postpartum depression
Glynn, L. M., Davis, E. P., & Sandman, C. A. (2013) · Neuropeptides · doi:10.1016/j.npep.2013.10.007 · Cited by 268 · see citing works
Prenatal psychobiological predictors of anxiety risk in preadolescent children
Davis, E. P., & Sandman, C. A. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.12.016 · Cited by 254 · see citing works
Coussons‐Read, M. E., Lobel, M., Carey, J. C., Kreither, M., D'Anna‐Hernandez, K., Argys, L. M., Ross, R. G., Brandt, C., & Cole, S. (2012) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2012.02.009 · Cited by 245 · see citing works
Self-citationThe relationship between stress and hair cortisol in healthy pregnant women
Kalra, S., Einarson, A., Karaskov, T., Uum, S. H. M. V., & Koren, G. (2007) · Clinical and investigative medicine · doi:10.25011/cim.v30i2.986 · Cited by 238 · see citing works
Hair Cortisol as a Potential Biologic Marker of Chronic Stress in Hospitalized Neonates
Yamada, J., Stevens, B., de Silva, N., Gibbins, S., Beyene, J., Taddio, A., Newman, C. E., & Koren, G. (2007) · Neonatology · doi:10.1159/000100085 · Cited by 176 · see citing works
Murphy, V. E., & Clifton, V. L. (2003) · Placenta · doi:10.1016/s0143-4004(03)00103-6 · Cited by 155 · see citing works
Depressive Symptoms and Health-Related Quality of Life in Early Pregnancy
Nicholson, W. K., Setse, R. W., Hill‐Briggs, F., Cooper, L. A., Strobino, D. M., & Powe, N. R. (2006) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000204190.96352.05 · Cited by 151 · see citing works
The phenotype of spontaneous preterm birth: application of a clinical phenotyping tool
Manuck, T. A., Esplin, M. S., Biggio, J., Bukowski, R., Parry, S., Zhang, H., Huang, H., Varner, M. W., Andrews, W., Saade, G., et al. (2015) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2015.02.010 · Cited by 132 · see citing works
Braig, S., Grabher, F., Ntomchukwu, C., Reister, F., Stalder, T., Kirschbaum, C., Genuneit, J., & Rothenbacher, D. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.12.006 · Cited by 105 · see citing works
Vanaelst, B., Huybrechts, I., Bammann, K., Michels, N., Vriendt, T. D., Vyncke, K. E., Sioen, I., Iacoviello, L., Günther, K., Molnár, D., et al. (2012) · Psychophysiology · doi:10.1111/j.1469-8986.2012.01396.x · Cited by 101 · see citing works
Risk factors for postpartum depression in Japan
Tamaki, R., Murata, M., & Okano, T. (1997) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.1997.tb02368.x · Cited by 77 · see citing works
Maternal vascularisation of the human placenta: does the embryo develop in a hypoxic environment?
Burton, G. J., & Jaunaiux, E. (2001) · Gynécologie Obstétrique & Fertilité · doi:10.1016/s1297-9589(01)00179-5 · Cited by 74 · see citing works
Childhood abuse is associated with increased hair cortisol levels among urban pregnant women
Schreier, H. M. C., Enlow, M. B., Ritz, T., Gennings, C., & Wright, R. J. (2015) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2015-205541 · Cited by 74 · see citing works
Chemical processing and shampooing impact cortisol measured in human hair
Hoffman, M. C., Karban, L. V., Benitez, P., Goodteacher, A., & Laudenslager, M. L. (2014) · Clinical and investigative medicine · doi:10.25011/cim.v37i4.21731 · Cited by 71 · see citing works
Self-citationWosu, A. C., Gelaye, B., Valdimarsdóttir, U. A., Kirschbaum, C., Tobias Stalder, A., Shields, A. E., & Williams, M. A. (2014) · Annals of Epidemiology · doi:10.1016/j.annepidem.2014.11.022 · Cited by 60 · see citing works
August Hollingshead and Frederick Redlich: Poverty, Socioeconomic Status, and Mental Illness
Pols, H. (2007) · American Journal of Public Health · doi:10.2105/ajph.2007.117606 · Cited by 13 · see citing works
Yokokawa, A., Takasaka, T., Shibasaki, H., Kasuya, Y., Kawashima, S., Yamada, A., & Furuta, T. (2012) · Steroids · doi:10.1016/j.steroids.2012.07.008 · Cited by 8 · see citing works
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- [32]Sandman CA Glynn L Schetter CD Elevated maternal cortisol early in pregnancy predicts third trimester levels of placental corticotropin releasing hormone (CRH): priming the placental clock Peptides 2006 27 1457 63 16309788
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Self-citationEffects of yoga on anxiety and depression for high risk mothers on hospital bedrest
Gallagher, A., Kring, D., & Whitley, T. (2020) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2019.101079 · Cited by 41 · see citing works
Childhood stress and birth timing among African American women: cortisol as biological mediator
Gillespie, S. L., Christian, L. M., Alston, A. D., & Salsberry, P. J. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.06.009 · Cited by 38 · see citing works
The transition to parenthood in obstetrics: enhancing prenatal care for 2-generation impact
Monk, C., Dimidjian, S., Galinsky, E., Gregory, K. D., Hoffman, M. C., Howell, E. A., Miller, E. S., Osborne, C., Rogers, C. E., Saxbe, D. E., et al. (2022) · American Journal of Obstetrics & Gynecology MFM · doi:10.1016/j.ajogmf.2022.100678 · Cited by 19 · see citing works
Self-citationWang, R., Wang, J., Xu, S., Wang, L., Song, M., An, C., & Wang, X. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-01945-7 · Cited by 17 · see citing works
Pregnant Mexican American Biopsychosocial/Cultural risks for adverse infant outcomes
Ruiz, R. J., Newman, M., Suchting, R., Pasillas, R. M., Records, K., Stowe, R. P., & Moore, T. A. (2021) · Nursing Open · doi:10.1002/nop2.676 · Cited by 7 · see citing works
- Authors
- Hoffman, M. C., Mazzoni, S. E., Wagner, B. D., Laudenslager, M. L., & Ross, R. G.
- Affiliations
- National Institutes of Health (US)
- Venue
- Obstetrics & Gynecology
- Published
- 2016-03
- Volume
- 127
- Issue
- 3
- Pages
- 545-552
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC4764470
- OpenAlex
- W2259216925
- Cited by
- 168
- References
- 36
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 18 · 2023: 16 · 2022: 21 · 2021: 21 · 2020: 24 · 2019: 12 · 2018: 14 · 2017: 12 · 2016: 7
- FWCI
- 14.87
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR001082)
- National Institute of Mental Health (R01MH101295)
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (L30 HD074019, K12HD001271)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Keywords
- preterm birth, perceived stress, maternal mood, hair cortisol, physiological stress, gestational age at delivery, depressive symptoms, anxiety, second trimester, preterm premature rupture of membranes, mediation
- MeSH terms
- Adult, Affect, Female, Gestational Age, Hair, Humans, Hydrocortisone, Pregnancy, Pregnancy Trimesters, Prospective Studies, Stress, Physiological, Stress, Psychological, Premature Birth, Young Adult
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