Stress pathways to spontaneous preterm birth: The role of stressors, psychological distress, and stress hormones

Michael S. Kramer, John Lydon, Louise Séguin, Lise Goulet, Susan R. Kahn, Helen McNamara, Jacques Genest, Clément Dassa, Moy Fong Chen, Shakti Sharma, Michael J. Meaney, Steven Thomson, Stan Van Uum, Gideon Koren, Mourad Dahhou, Julie Lamoureux, Robert W. Platt

Research output: Contribution to journalArticlepeer-review

311 Scopus citations


The authors investigated a large number of stressors and measures of psychological distress in a multicenter, prospective cohort study of spontaneous preterm birth among 5,337 Montreal (Canada)-area women who delivered from October 1999 to April 2004. In addition, a nested case-control analysis (207 cases, 444 controls) was used to explore potential biologic pathways by analyzing maternal plasma corticotrophin-releasing hormone (CRH), placental histopathology, and (in a subset) maternal hair cortisol. Among the large number of stress and distress measures studied, only pregnancy-related anxiety was consistently and independently associated with spontaneous preterm birth (for values above the median, adjusted odds ratio = 1.8 (95% confidence interval: 1.3, 2.4)), with a dose-response relation across quartiles. The maternal plasma CRH concentration was significantly higher in cases than in controls in crude analyses but not after adjustment (for concentrations above the median, adjusted odds ratio = 1.1 (95% confidence interval: 0.8, 1.6)). In the subgroup (n = 117) of participants with a sufficient maternal hair sample, hair cortisol was positively associated with gestational age. Neither maternal plasma CRH, hair cortisol, nor placental histopathologic features of infection/inflammation, infarction, or maternal vasculopathy were significantly associated with pregnancy-related anxiety or any other stress or distress measure. The biologic pathways underlying stress-induced preterm birth remain poorly understood.

Original languageEnglish
Pages (from-to)1319-1326
Number of pages8
JournalAmerican Journal of Epidemiology
Issue number11
StatePublished - Jun 2009
Externally publishedYes


  • Anxiety
  • Corticotropin-releasing hormone
  • Hydrocortisone
  • Premature birth
  • Stress, physiological
  • Stress, psychological


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