Stress-induced developmental plasticity and spontaneous preterm birth: A justice-oriented eco-evo-devo review

Spontaneous preterm birth (<37 weeks' gestation) is a leading cause of neonatal morbidity and mortality, with little global progress in prevention. Spontaneous preterm birth disproportionately affects communities marginalized by racism and socio-economic disadvantage. Maternal stress is a well-established risk factor for spontaneous preterm birth and is more prevalent in marginalized communities. Yet, maternal stress remains underutilized as a target for clinical intervention. In this review, we draw from ecological, evolutionary, and developmental (eco-evo-devo) biology, Black feminist theory, and reproductive justice to center the margins of those communities most burdened by both maternal stress and preterm birth. In doing so, we re-frame the importance of maternal stress mitigation in spontaneous preterm prevention. Through the lens of stress-induced developmental plasticity, environmental stressors may shorten gestation through evolutionarily conserved maternal-fetal-placental signaling pathways. Two features of this process are particularly relevant to clinical care: first, stress may impact gestational length in a dose-dependent manner; second, its effects may be reversible. Reducing maternal stress may be a highly feasible clinical opportunity to tangibly reduce spontaneous preterm birth and increase birth equity.