Predicting Preterm Birth: Quick Questionnaire Screens for Risk Factors and Protective Features

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Screening women before pregnancy or shortly after conception for factors that place them at increased risk for preterm or premature birth may help avoid adverse outcomes months and even years later.

The study explored factors that may raise or lower risk of premature births.

Anxiety, pain, fatigue, and poor self-rated health, for example, can increase the risk of a woman delivering a baby before gestational age 37 weeks, or preterm, a new study published May 20 in the American Journal of Perinatology reveals. The study also found that protective factors such as happiness and social support predict lower risk.

Preterm birth can have significant and long-lasting adverse developmental, health, and financial consequences.

“Identifying factors and potential mediators that predict, contribute to, or prevent preterm birth — and using this information to reduce risk — would be highly beneficial,” said senior author Firdaus S. Dhabhar, Ph.D., professor at Sylvester Comprehensive Cancer Center and in the Departments of Psychiatry and Behavioral Sciences, and Microbiology and Immunology at the University of Miami Miller School of Medicine.

The prospective cohort study builds on previous research showing that pregnancy-related anxiety, perceived stress, depression, and low support from a baby’s father can increase preterm birth risk.

Novel findings include firsts

The researchers also take things a step further with several novel findings.

“To our knowledge, our study is the first to also show that greater tiredness or fatigue, high frequency of pain experience, low self-rated health, low happiness, and low social support from parents and siblings are associated with increased risk of preterm birth,” Dr. Dhabhar said.

Importantly, the study used a practical rapid questionnaire, the DQAQ, developed by Dr. Dhabhar, that quantifies stress and psychosocial factors.

“The DQAQ could be a useful alternative for studies and investigators who do not have the time and resources to use traditional methods to quantify these factors, and/or don’t want to burden study participants with numerous questionnaires,” Dr. Dhabhar said.

The DQAQ is new, requires further validation and has the potential to streamline the study of stress and psychosocial factors in research and clinical conditions other than preterm birth.

Measuring relative risks

Along with co-first authors Martin Becker, Ph.D., and Jonathan Mayo, Ph.D., at the Stanford University School of Medicine, Dr. Dhabhar and a team of colleagues assessed the relative risk of preterm birth for each risk or protective factor, and supported their results using machine learning approaches.

They found, for example, that general anxiety increased the risk of preterm birth almost nine times, pain by nearly six-fold, and tiredness or fatigue by almost four times. A perceived risk of birth complications raised the risk by four-fold, and divorce increased risk by three times.

How women rated their past and current health also played a role. For example, women with a poor self-rating of her health over the previous three years had an almost three times greater risk. A poor current health rating was associated with two and a half times greater risk.

Timely research

“Stress and anxiety associated with the pandemic makes this research particularly timely, because the impacts of the pandemic have not only been physical morbidities and mortality, but also social and psychological stressors, such as personal isolation, loss of a loved one, loss of a job, etc. Such stressors may contribute to preterm birth and other pathological outcomes in pregnancy, as well as affect the outcomes of newborn infants, including their life course trajectories,” said co-author David K. Stevenson, M.D., Harold K. Faber Professor of Pediatrics, senior associate dean for maternal and child health, and co-director of the Maternal and Child Health Research Institute at the Stanford University School of Medicine.

The study also found that women who reported low happiness had a nine times greater relative risk of preterm birth, low levels of support from parents or siblings increased the risk by three and a half times, and low support from the baby’s father increased risk three-fold.

“The protective effect of factors such as happiness and social support is an exciting aspect of these findings, one that also gives hope,” Dr. Dhabhar said. “The results suggest that positive and nurturing aspects of humanity may be able to counter the harmful effects chronic stress, anxiety, and other negative factors. We’d like to expand our investigation of positive and protective factors in future studies. Our ultimate goal is to ameliorate or eliminate the effects of harmful factors and harness the effects of beneficial factors on health and healing.”

The study, “Deleterious and Protective Psychosocial and Chronic Stress Related Factors Predict Risk of Spontaneous Preterm Birth,” was supported by the March of Dimes Prematurity Research Center at Stanford University. Nisha K. Phogat, M.S., a research associate at the Miller School, is among the study’s authors.