THE PRETERM PREDICTION STUDY - MATERNAL STRESS IS ASSOCIATED WITH SPONTANEOUS PRETERM BIRTH AT LESS-THAN 35 WEEKS GESTATION

OBJECTIVE: Our purpose was to determine whether various measures of po or psychosocial status in pregnancy are associated with spontaneous pr eterm birth, fetal growth restriction, or low birth weight. STUDY DESI GN: Anxiety, stress, self-esteem, mastery, and depression were assesse d at 25 to 29 weeks in 2593 gravid women by use of a 28-item Likert sc ale. Scores for each psychosocial subscale were determined, and an ove rall psychosocial score was calculated. Scores were divided into quart iles, and the lowest quartile scores were used to define poor psychoso cial status. The percent spontaneous preterm birth, low birth weight, and fetal growth restriction in women with low and high psychosocial s cores were compared. Logistic regression analyses provided the odds ra tios and 95% confidence intervals. RESULTS: Analyses revealed that str ess was significantly associated with spontaneous preterm birth and wi th low birth weight with odds ratios of 1.16, p = 0.003, and 1.08, p = 0.02, respectively, for each point on the scale. A low score on the c ombined scale or on any subscale other than stress did not predict spo ntaneous preterm birth, fetal growth restriction, or low birth weight. After multivariate adjustment was performed for psychosocial status, substance use, and demographic traits, black race was the only variabl e significantly associated with spontaneous preterm birth, fetal growt h restriction, and low birth weight; stress and low education were ass ociated with spontaneous preterm birth and low birth weight. CONCLUSIO N: Stress was associated with spontaneous preterm birth and low birth weight even after adjustment for maternal demographic and behavioral c haracteristics. Black race continues to be a significant predictor of spontaneous preterm birth, fetal growth restriction, and low birth wei ght even after adjustment for stress, substance use, and other demogra phic factors.