Stressors Across the Life-Course and Preterm Delivery: Evidence From a Pregnancy Cohort

Objectives Growing evidence suggests that pre-conception stressors are associated with increased risk of preterm delivery (PTD). Our study assesses stressors in multiple domains at multiple points in the life course (i.e., childhood, adulthood, within 6 months of pregnancy) and their relation to PTD. We also examine heterogeneity of associations by race/ethnicity, PTD timing, and PTD clinical circumstance. Methods We assessed stressors retrospectively via mid-pregnancy questionnaires in the Pregnancy Outcomes and Community Health Study (1998-2004), a Michigan pregnancy cohort (n = 2559). Stressor domains included abuse/witnessing violence (hereafter "abuse"), loss, economic stress, and substance use. We used logistic and multinomial regression for the following outcomes: PTD (<37 weeks' gestation), PTD by timing (≤34 weeks, 35-36 weeks) and PTD by clinical circumstance (medically indicated, spontaneous). Covariates included race/ethnicity, education, parity, and marital status. Results Stressors in the previous 6 months were not associated with PTD. Experiencing abuse during both childhood and adulthood increased adjusted odds of PTD among women of white or other race/ethnicity only (aOR 1.6, 95 % CI 1.1, 2.5). Among all women, abuse in childhood increased odds of late PTD (aOR 1.5, 95 % CI 1.0, 2.2) while abuse in both childhood and adulthood non-significantly increased odds of early PTD (aOR 1.6, 95 % CI 0.9, 2.7). Sexual, but not physical, abuse in both childhood and adulthood increased odds of PTD (aOR 1.9, 95 % CI 1.0, 3.5). Conclusions Experiences of abuse-particularly sexual abuse-across the life-course may be important considerations when assessing PTD risk. Our results motivate future studies of pathways linking abuse and PTD.