(558) Psychosocial stressors and preterm birth among individuals at risk for adverse pregnancy outcomes

Psychosocial stress has been linked with elevated risk for adverse pregnancy outcomes (APOs), but whether these stressors compound risk for pregnancies with other APO risk factors (high APO-risk) is unclear. We investigated whether mid‑pregnancy psychosocial stressors independently increased risk of preterm birth (PTB) for individuals with and without other APO risk factors.

Study Design:
The prospective Stress, Pregnancy and Health cohort collected self-reported stress measures in 2^nd and 3^rd trimesters and clinical outcomes from the medical record for a cohort of 605 singleton pregnancies. High APO-risk was defined by history of IUGR, antenatal bleeding, prior PTB, PPROM, or IUFD in a prior pregnancy, or past or current hypertensive disorders of pregnancy. Psychosocial factors included loneliness, depressive symptoms, financial hardship and food insecurity and were z‑scored for comparability. PTB was defined as delivery < 37 gestational weeks. Logistic regressions were conducted within each APO‑risk stratum, adjusting for maternal age, race, and ethnicity.

Results:
The 138 individuals with high APO-risk were more likely to identify as Black or Hispanic and have lower socioeconomic status. As expected, PTB occurred more frequently in the high APO-risk group versus the low-risk group (22.5% versus 6.0%). Among high‑risk pregnancies, each 1‑SD increase in loneliness (OR1.48, 95%CI 1.03–2.14), financial hardship (OR1.53, 1.06–2.21) and food insecurity (OR1.71, 1.20–2.43) was significantly associated with higher odds of PTB, while depressive symptoms were not. These associations were absent in low‑risk pregnancies.

Conclusion:
Elevated loneliness, financial strain, and food insecurity were independently associated with PTB in pregnancies with high APO-risk, compounding risk for adverse outcomes among those already more likely to experience them. Our results suggest that psychosocial stress screening and intervention in prenatal care, particularly for those with high APO-risk, may be a strategy to reduce risk for PTB.