• Sarahn Wheeler, Pamela Maxson, Tracy Truong, and Geeta Swamy.
• Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, DUMC Box 3967, Durham, NC, 27710, USA. sarahn.wheeler@duke.edu.
• Matern Child Health J. 2018 Oct 1; 22 (10): 1430-1435.

AbstractObjectives Studies examining risk factors for preterm birth (PTB) such as psychosocial stress are often focused on women with a history of PTB; however, most preterm babies are born to women with no history of preterm birth. Our objective was to determine if the relationship between psychosocial stress and PTB is altered by parity. Non-Hispanic black (NHB) women have increased psychosocial stress and PTB; therefore, we further aimed to determine if race alters the relationship between psychosocial stress, parity, and PTB. Methods We performed a secondary analysis of the Healthy Pregnancy, Healthy Baby Study comparing pregnant women who were primiparous (first pregnancy), multiparous with history of preterm birth, or multiparous with history of term birth. Perceived stress, perceived racism, interpersonal support, John Henryism and self-efficacy were measured using validated instruments. Logistic regression was used to model the effect of psychosocial stress on PTB stratified by parity and race. Results The analysis entire cohort included 1606 subjects, 426 were primiparous, 268 had a history of presterm birth, and 912 had a history of term birth. In women with a history of term birth, higher self-efficacy was associated with lower odds of spontaneous PTB, and this association was amplified in NHB women. In women with a history of spontaneous PTB, John Henryism Active Coping was associated with lower odds of spontaneous PTB in the index pregnancy. Conclusions for Practice The relationship between psychosocial stress and PTB may be mediated by parity and race.

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