The Role of Body, Mind, and Environment in Preterm Birth: Mind the Gap

Abstract

Preterm birth continues to be a problem affecting low-, middle-, and high-income countries, with rates increasing in some areas despite ongoing efforts to reduce the incidence. This emphasizes the need for more effective interventions, particularly if we aim to achieve the broad health targets of the Sustainable Development Goals (SDGs) by 2030. The current focus on medically-oriented interventions such as reducing nonmedically-indicated induction of labor, cesarean birth, and multiple embryo transfers associated with assisted reproductive technologies, as well as the application of cervical cerclage and use of progesterone therapy, though important, are likely only partial solutions to the complex phenomenon of preterm birth. Preterm birth has multiple etiologies. The biologic mechanisms involved in preterm labor and how it may be triggered are not well understood. There is growing evidence to suggest some of these triggers may also be related to stress and environmental conditions. In this review, we focus on evidence concerning psychosocial (mind) and environmental factors (environment) as well as briefly review the evidence related to maternal and fetal factors (body) associated with the risk of preterm birth, with reference to some of the SDGs. We also assess emerging evidence regarding the interaction of the body, mind, and environment in relation to preterm birth, currently a gap in our knowledge, and how these interactions could impact clinical practice. Findings suggest that multidisciplinary expertise and approaches will be needed to develop effective interventions to address the complex etiologies of preterm birth, as opposed to single-risk-factor mitigation. Clinicians and researchers will play key roles in identifying many of these risk factors and shaping interventions that address this complex issue. Addressing the interlinkages between body, mind, and environment through the integration of research and clinical practice is critical to reducing the risk of preterm birth and contributing to the achievement of the SDGs.

Risk of being born preterm in offspring of survivors with childhood or adolescent central nervous system tumor in Sweden

“…One previous study examined paternal cancer history in relation to birth outcomes and did not observe a significantly elevated risk of PTB among offspring of male survivors with CNS tumor (RR = 1.31, 95% CI = 0.55–3.12), but the result should be interpreted with caution due to a small sample size ( n = 47) . Both physiological and psychological factors may potentially lead to a higher risk of PTB, including hormonal alterations, reproductive organ damage and prenatal depression or anxiety . A number of studies have indicated that survivors with CNS tumor suffered an elevated risk of depression, anxiety and other psychological problems, which was suggested to be associated with subsequent higher risk of PTB, in particular among female survivors .…”

Associations between unstable housing, obstetric outcomes, and perinatal health care utilization

“…Because in prior studies housing status has been associated with sociodemographic 26 and health factors 26 and access to care, 11 we included the following covariates for matching based on their previously reported associations with PTB: race/ethnicity, 4 maternal age, 4 parity, 27 prior PTB, 4 body mass index, 4,28 tobacco use during pregnancy, 4 alcohol 4,27 or drug abuse during pregnancy, 27 maternal hypertension, 27 maternal diabetes, 27 mental health conditions during pregnancy, 5,29,30 adequacy of prenatal care (using the Adequacy of Prenatal Care Utilization Index), 31,32 and maternal education. 27 We additionally matched on type of neonatal intensive care unit at the birth hospital.…”

Maternal health and birth outcomes in a South African birth cohort study

“…[15] Given the interactive nature of nutrition, physical health, and mental health for pregnant women, it is imperative to consider these factors in tandem when predicting birth outcomes. [16] Models that include sociodemographic, food insecurity, physical health, mental health, and substance use predictors of birth outcomes are needed to disentangle impacts on birth outcomes and to guide intervention efforts to improve maternal and infant health in LMICs. [17] The aim of this study was to comprehensively investigate maternal physical and mental health during pregnancy and the impact on birth outcomes in a South African birth cohort study, the Drakenstein Child Health Study (DCHS).…”