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* Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048 and Jefferson Medical School, Philadelphia, PA 19107-5587
2 To whom correspondence should be addressed. E-mail: calvin.hobel{at}cshs.org.
Epidemiological evidence suggests that maternal psychosocial stress, strenuous physical activity and fasting are independent risk factors for preterm birth and low birth weight. Data from clinical studies consistently demonstrate that women in preterm labor have significantly elevated levels of corticotropin-releasing hormone compared with age-matched control subjects. Because production of corticotropin-releasing hormone appears to be stress sensitive, this neuropeptide may play a critical role in the physiological mediation among stressful experiences, work stress and fasting and risk of preterm birth. In addition to the direct effect of elevated corticotropin-releasing hormone on the initiation of labor, it may have an immunomodulatory effect such that women with high levels of corticotropin-releasing hormone may be more susceptible to infection or the pathological consequences of infection. We review the epidemiological data linking maternal stress, physical stain and fasting to preterm birth and low birth weight and review the plausible biological pathways through which these exposures may increase risk of preterm birth. The timing of these exposures is considered important. Future research and clinical programs addressing these exposures must consider assessments and interventions before pregnancy.
KEY WORDS: • preterm birth • psychosocial stress • social environment • corticotropin-releasing hormone (CRH) • perinatal infection
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