Stressors Across the Life-Course and Preterm Delivery: Evidence From a Pregnancy Cohort
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Stressors Across the Life-Course and Preterm Delivery: Evidence From a Pregnancy Cohort Claire E. Margerison-Zilko1 • Kelly L. Strutz1,2 • Yu Li1 • Claudia Holzman1
Published online: 21 July 2016 Ó Springer Science+Business Media New York 2016
Abstract Objectives Growing evidence suggests that preconception 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 (B34 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-
& Claire E. Margerison-Zilko [email protected] 1
2
Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 West Fee Rd. Rm 601B, East Lansing, MI 48823, USA Present Address: Department of Public Health, Grand Valley State University, 545 Michigan St NE, Suite 300, Grand Rapids, MI 49503, USA
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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. Keywords Preterm delivery Stress Abuse Life course
Significance What is already known on this subject? Growing evidence suggests that exposure to pre-pregnancy stressors, such as death of a close relative, is associated with increased risks of low birth weight and preterm delivery (PTD). What this study adds? We examine associations between PTD and stressors in multiple domains and life course periods (childhood, adulthood, and around the time of pregnancy). We find that abuse—particularly sexual abuse—in both childhood and adulthood emerges as a risk factor for PTD, with abuse at multiple time points linked to earlier PTD. Findings are stronger among white compared to Af
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