Perceived stress may mediate the relationship between antenatal depressive symptoms and preterm birth: A pilot observational cohort study

Abstract

Background Screening for changes in pregnancy-related anxiety and depressive symptoms during pregnancy may further our understanding of the relationship between these two variables and preterm birth. Objectives To determine whether changes in pregnancy-related anxiety and depressive symptoms during pregnancy influence the risk of preterm birth among Pakistani women; explore whether perceived stress moderates or mediates this relationship, and examine the relationship between the various components of pregnancy-related anxiety and preterm birth. Methods A prospective cohort study design was used to recruit a diverse sample of 300 low-risk pregnant women from four centers of Aga Khan Hospital for Women and Children in Karachi, Pakistan. Changes in pregnancy-related anxiety and depressive symptoms during pregnancy were tested. Multiple logistic regression analysis was used to determine a predictive model for preterm birth. We then determined if the influence of perceived stress could moderate or mediate the effect of depressive symptoms on preterm birth. Results Changes in pregnancy-related anxiety (OR = 1.1, CI 0.97–1.17, p = 0.167) and depressive symptoms (OR = 0.9, CI 0.85–1.03, p = 0.179) were insignificant as predictors of preterm birth after adjusting for the effects of maternal education and family type. When perceived stress was added into the model, we found that changes in depressive symptoms became marginally significant after adjusting for covariates (OR = 0.9, CI 0.82–1.01, p = 0.082). After adjusting for the mediation effect of change in perceived stress, the effect of change in depressive symptoms on preterm birth were marginally significant after adjusting for covariates. Among six different dimensions of pregnancy-related anxiety, mother’s concerns about fetal health showed a trend towards being predictive of preterm birth (OR = 1.3, CI 0.97–1.72, p = 0.078). Conclusions There may be a relationship between perceived stress and antenatal depressive symptoms and preterm birth. This is the first study of its kind to be conducted in Pakistan. Further research is required to validate these results.

Is HbA1c associated with birth weight? A multivariable analysis of Pakistani pregnant women

“…Pregnant women who, at enrollment, were between 12‐ and 19‐weeks' gestational age (GA), were recruited from four sites 25 of Aga Khan University's Hospital for Women and Children in Pakistan ( N = 300), a private teaching hospital of the Aga Khan University system, an international network spanning five countries. Recruitment occurred across four sites to enhance sample diversity and study generalizability 26 .…”

“…Pregnant women were eligible if they spoke English or Urdu (Pakistan's national language). Women with a high‐risk pregnancy or pre‐pregnancy health problem affecting neuroendocrine function were excluded (see References 24–26). Participants with a very low birth weight infant (<1500 g) were excluded ( n = 4) because the inclusion of this data violated normality assumptions [When excluding these infants, the distribution of birth weight normalized (skewness = −0.26, kurtosis = 3.58, W = 0.99, p = 0.22)] and these infants are at greater risk of severe negative health outcomes and disease comorbidity 27 …”

“…This study used secondary data from a prospective longitudinal study in Pakistan [24][25][26] examining perinatal health and birth outcomes. Biopsychosocial data and medical records were collected from adult women at three times across pregnancy.…”

Individual and collective contribution of antenatal psychosocial distress conditions and preterm birth in Pakistani women

“…Studies from high-income countries examining the relationship between antenatal depression and preterm birth have shown inconsistent findings, with a minority of the studies [ 21 – 23 ] finding a statistically significant association with a small effect size [ 24 , 25 ]. Perceived stress during pregnancy, a proxy of chronic stress, is associated with depressive symptoms as well as preterm birth [ 26 – 29 ] and may moderate the relationship between antenatal depressive symptoms and preterm birth [ 30 ]. Although our pilot study of Pakistani women found that antenatal depression strongly predicted preterm birth (odds ratio (OR) 1.44), the degree to which antenatal anxiety predicts preterm birth in this population is unknown [ 31 ].…”

“…Our own systematic review and meta-analysis did not support this assertion but noted further reduction in heterogeneity when restricting the predictor variable to state anxiety (OR = 1.70, 95% CI: 1.33–2.18) and pregnancy-related anxiety (OR = 1.67, 95% CI: 1.35–2.07) [ 39 ], and explained the contradictory findings between two meta-analyses examining maternal anxiety in pregnancy and preterm birth [ 32 , 33 ]. In our pilot observational cohort study mother’s concerns regarding fetal wellbeing showed a trend of predicting preterm birth [ 30 ].…”