Association between Maternal Psychosocial Stress during Pregnancy and Gestational Age in Puerto Rico

摘要

Preterm birth (PTB), the leading cause of infant morbidity and mortality worldwide, disproportionally impacts infants in Puerto Rico (PR). Psychosocial stress may be an important risk factor for PTB and hasn't been examined in PR. We examined associations between stress and gestational age continuously and PTB (<37 weeks gestation) using multiple dimensions of stress in order to optimally define exposure. Stress was measured using the Perceived Stress Scale (PSS), Life Experiences Survey (LES), Center for Epidemiologic Studies-Depression (CES-D), and ENRICHD Social Support Instrument (ESSI). We included 922 mother-infant pairs of the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Cohort, which examines environmental risk factors for PTB in the Northern Karst region of PR. Data on stress measures was collected during the 3rd trimester visit, except for LES, which was collected at the 2nd trimester. Responses on each scale were scored to create a continuous measure. Higher scores on each scale, except the ESSI, were indicative of increased stress. There were 93 PTBs in this analysis. Lower maternal education, unemployment, and public insurance were more common among women who delivered preterm and were associated with higher scores on all stress measures. Higher scores on the PSS (ß: 0.00; 95% CI (confidence interval): -0.02, 0.01), LES (ß: 0.01; 95% CI: -0.02, 0.04), ESSI (ß: 0.01; 95% CI: -0.02, 0.04), and CES-D scales (ß: -0.01; 95% CI: -0.02, 0.01) were not associated with gestational age or PTB. Although our findings show that stress as measured by these scales is not associated PTB, there are other facets of stress, such as anxiety and neighborhood perceptions, that were not captured in our scales but may be important. Our study indicates that stress in pregnancy is not a major risk factor for PTB in our population. Other environmental exposures, such as chemical exposures in pregnancy, will be investigated in this population in the future.