Document Type : Original Article
Authors
1
Research Center for Psychiatry and Behavioral Science, Shiraz University of Medical Sciences, Shiraz, Iran;
2
Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran;
3
Department of Public Health, Khalkhal University of Medical Sciences, Khalkhal, Iran;
4
Maternal-fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
10.30476/ijcbnm.2026.108555.2903
Abstract
Background: Preterm birth (PTB) is one of the leading causes of newborn morbidity and mortality. This study aimed to investigate the differential associations of maternal psychological conditions— including anxiety, depression, stress, and their comorbidities—with PTB and its subtypes, including spontaneous preterm birth (SPTB) and medically indicated preterm birth (MPTB).
Methods: This longitudinal study included 566 third-trimester pregnant women referred to perinatal centers in Shiraz, Iran (January 2021–January 2022) who were followed till delivery. Maternal psychological conditions were assessed at ≥28 weeks using the 21-item DASS-21. Perinatal outcomes were recorded at delivery. Poisson regression, adjusted for confounders identified from univariate analyses (P<0.05), was applied and estimated associations were reported as adjusted relative risk with 95% confidence intervals (RRadj 95% CI). SPSS version 20 was used to analyze the data, and the significance level was set at P<0.05.
Results: Of the 566 participants, 181 (32.0%) had PTB, of which 111 (19.61%) were SPTB and 70 (12.40%) were MPTB; compared with term deliveries, single conditions showed no significant association with PTB, SPTB, and MPTB (P>0.05); however, all comorbid conditions demonstrated significantly elevated risks for PTB, SPTB, and MPTB. Depression and stress showed the strongest association (RRadj=2.34, P<0.001) with PTB, followed by stress and anxiety (RRadj=1.58, P=0.007), and anxiety and depression (RRadj=1.56, P< 0.001). Similar patterns were observed for SPTB (RRadj=2.45, P<0.001) and MPTB (RRadj=1.98, P=0.006), with depression and stress consistently demonstrating the highest risk across the two subtypes.
Conclusion: Comorbid maternal psychological conditions, particularly depression and stress, significantly increase the risk of PTB and its subtypes. Routine screening for comorbid conditions during pregnancy is essential for early intervention and prevention to improve maternal mental health policies and clinical interventions.
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