Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms

This review examines the associations between antenatal maternal stress and obstetric and infant outcomes using preterm delivery as the key outcome in dicator. This was done by means of a Medline search focusing predominantly on prospective, controlled studies which investigated both the associated e pidemiological factors and putative neuroendocrine mechanisms. There is evidence from a number of United States studies in economically de prived African American women for an association between perceived maternal life event (LE) stress and preterm delivery. The findings from the Europea n studies are conflicting, partly because they combine outcome measures ie. preterm delivery and low birth weight. However the three largest Scandinav ian epidemiological studies examining preterm delivery and controlling for confounders such as smoking, age and obstetric history, have confirmed this association. These studies taken together suggest that this may be a robus t finding not limited to socioeconomically deprived African American sample s and independent of other significant risk factors. Two small prospective studies examining the relationship between the hypoth alamic-pituitary-adrenal (HPA) axis, psychosocial status and premature deli very have reported a significant association between a set of adverse psych osocial factors on the one hand, and levels of adrenocorticcotrophic hormon e (ACTH), corticotrophin releasing hormone (CRH) and cortisol levels, and o n the other hand, a significant correlation between CRH levels and prematur e delivery Clearly these findings remain preliminary and indicate a complex relationship between perceived stress in pregnancy, the HPA axis and prema ture delivery The impact of antenatal maternal stress on infant temperament and psychopathology remains to be examined more fully in prospective contr olled trials.