A prospective cohort study on changes in psychosocial distress and preterm birth among pregnant Pakistani women

Changes in mental health during pregnancy may better predict preterm birth (PTB) as assessment at one time point are inconsistently associated with this outcome. Our prospective cohort study of 1225 pregnant Pakistani women determined whether (a) changes in psychosocial distress (i.e., pregnancy-related anxiety, state anxiety, depressive symptoms) between 10 and 19 and 22 to 29 weeks’ gestational age influenced the risk of PTB; and (b) social determinants of health and chronic stress influenced this relationship. The individual effect of changes in (a) pregnancy-related anxiety on PTB was significant only among women with low social support from family (OR = 0.85, 95 % CI 0.74–0.97, p = 0.017); and (b) depressive symptoms on PTB were significantly modified by education (p = 0.011), number of previous children (p = 0.028) and life-time interpersonal trauma (p = 0.073). The average aggregate change score was associated with PTB among women with low family support (OR = 0.79, 95 % CI 0.67–0.93, p = 0.005), after adjusting for confounders. The collective effect, assessed using multiple logistic regression, was not significant. Chronic stress did not alter any findings. An intersectional approach will enable exploration of the disparate burden of psychosocial distress during pregnancy on PTB.