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Poster Session 3

Category: Prematurity

Poster Session 3

(851) Breaking the Cycle of Preterm Birth: Prospective Cohort Study on Maternal Stress and Recurrent PTB

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Maayan Hagbi Bal, MD, MPH, Phd (she/her/hers)

OBGYN Resident PGY1
Icahn School of Medicine at Mount Sinai
Fair lawn, New Jersey, United States

Coauthor(s)

Eyal Sheiner, MD, PhD

Deichmann Lerner Full Professor of Obstetrics & Gynecology; Chairman of the Division of OBY&GYN
Soroka University Medical Center, Faculty of Health Sciences, Ben‑Gurion University of the Negev
beer sheva, HaDarom, Israel
Israel Yoles, MD

Obstetrician
Clalit Health Services, The Central District
Rishon Le Tzion, HaMerkaz, Israel
IS

Iris Shoam, MD

Ben-Gurion University of the Negev
Ben Gurion, HaDarom, Israel
Shimrit Yaniv Salem, MD

Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben-Gurion University
Beer sheva, HaDarom, Israel
NI

Noa Dina Israel-Tov

MPH
Ben-Gurion University of the Negev
Ben Gurion, HaDarom, Israel
Tamar Wainstock, PhD (she/her/hers)

Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev
Beer Sheva, HaDarom, Israel

Objective:

To investigate the association between prenatal maternal perceived stress, salivary cortisol, and the risk of recurrent preterm birth (rPTB).

Study Design:

This prospective cohort study was conducted at a tertiary medical center (IRB#0390-20-SOR). The study population included pregnant women with a history of spontaneous singleton preterm birth (PTB). Participants provided saliva samples and completed validated stress questionnaires twice during pregnancy. The incidence of rPTB was compared between women with high versus low cortisol levels and perceived stress, defined as greater than the 75^th percentile for the cortisol levels and the questionnaire score. Multivariable logistic regression models were used to assess the association between elevated stress markers and the risk of rPTB.

Results:

Among 245 women with a history of PTB included in the study, 55 (22.4%) experienced rPTB. No differences were observed between women with rPTB versus women without in terms of demographic, health, or lifestyle characteristics. No association was observed between cortisol levels, high perceived stress in the first trimester, and rPTB in either of the study groups (Figure 1). High perceived stress levels later in second/third trimesters, were associated with a higher incidence of rPTB compared to the first trimester (38.9% vs. 19.2%; p = 0.011, adj. OR = 2.44, 95% CI: 1.053–5.639; p = 0.038), after adjusting for maternal age, number of prior PTBs, and parity. Women with consistently high stress levels had the highest incidence of rPTB (40%), followed by women with increased stress in the second and third trimesters only (37.5%). Multivariable regression analyses identified consistently high stress (adj. OR = 3.82, 95% CI: 1.37–10.64; p = 0.010) and high stress in the second/third trimester of pregnancy (adj. OR = 3.18, 95% CI: 1.04–9.73; p = 0.042) as significant risk factors of rPTB (Table 1).

Conclusion:

High perceived stress levels during late pregnancy are significant risk factors for PTB. However, saliva cortisol was not statistically significant in relation to the risk of recurrence.