Allostatic load as a mediator and perceived chronic stress as a moderator in the association between maternal mental health and preterm birth: A prospective cohort study of pregnant women in Pakistan
Document Type
Article
Department
Obstetrics and Gynaecology; School of Nursing and Midwifery, Pakistan; Pathology and Microbiology; Pathology and Laboratory Medicine
Abstract
Introduction: The complex biopsychosocial pathways linking maternal mental health with preterm birth (PTB) are not well understood. This study aimed to explore allostatic load (AL) as a mediator and perceived chronic stress as a moderator in the pathway linking maternal mental health and PTB.
Methods: A cohort study of pregnant women (n = 1,567) recruited at clinic visits within 10-19 weeks of gestation was assessed for maternal mental health (i.e., pregnancy-related anxiety, state anxiety, depressive symptoms) and perceived chronic stress. Blood pressure and levels of cortisol, total cholesterol, C-reactive protein, and glycosylated hemoglobin were used to create a composite measure of AL.
Results: AL had the most significant effect on PTB (odds ratio (OR) = 1.84, 95% CI = 1.26-12.67, p = 0.001), while systolic blood pressure emerged as the only significant individual marker using variable selection (OR = 22%, 95% CI = 1.06-1.40, p < 0.001) in multiple logistic regression analysis. A mediation analysis revealed that maternal mental health did not have a significant direct effect on PTB (p = 0.824), but its indirect effect mediated by AL was significant (z = 2.33, p < 0.020). Low and high levels of perceived chronic stress, relative to the mean, moderated this indirect effect (z = 3.66, p < 0.001).
Conclusions: AL has a significant direct influence on PTB and mediates the effect of maternal mental health on PTB; however, the indirect effect of AL is indistinguishable between women with higher or lower levels of perceived chronic stress than normal.
Publication (Name of Journal)
Psychopathology
DOI
doi.org/10.1159/000540579
Recommended Citation
Premji, S. S.,
Lalani, S. B.,
Ghani, F.,
Nausheen, S.,
Omuse, G.,
Musana, W.,
Islam, N.,
Forcheh, N.,
Babar, N.,
Letourneau, N.,
Sulaiman, S.,
Ali, S. S.,
Dosani, A.,
Yim, I. S.
(2024). Allostatic load as a mediator and perceived chronic stress as a moderator in the association between maternal mental health and preterm birth: A prospective cohort study of pregnant women in Pakistan. Psychopathology, 1-20.
Available at:
https://ecommons.aku.edu/pakistan_fhs_son/555
Comments
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