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Background. Studies have identified a trend towards suboptimal birth outcomes, including preterm birth (PTB), in women who experience psychological adversities (stress, depression, domestic violence, and low social support) during pregnancy. Objective. To evaluate the association of stress, depression, domestic violence, and low social support with PTB. Methods. This is a retrospective cohort study that used data of women assessed between February 2011 and February 2012. The primary outcome of the study was the occurrence of spontaneous PTB < 37 weeks of gestational age. The pregnant women included were evaluated at two different time points: prenatal (between 22 and 25 weeks) and at birth. Sociodemographic data, obstetric history, perceived stress, depression, violence, and social support were collected with a questionnaire and subsequently evaluated and analyzed. Univariate and multivariate log-binomial regression models were constructed to assess the effects of the variables collected on the presence of spontaneous PTB. The SAS 9.3 program was used for all analyses, assuming statistical significance at p < 0.05 and a power of the test of 80%. Results. A total of 1,370 women were included in the study. The prevalence of PTB was 9.1%. Log-binomial analysis revealed an association between the following characteristics and PTB: smoking (RR 1.64, 95% CI: 1.10-2.44), severe stress (RR 1.82, 95% CI: 1.21-2.73), three or more stressful life events (RR 1.65, 95% CI: 1.05-2.59), and being probably depressed (RR 1.49, 95% CI: 1.02-2.18). However, these associations did not remain significant after multivariate analysis. Conclusion. Evidence on the specific effects of depression, violence, anxiety, and stress on birth outcomes remains unclear and at times conflicting. Our results showed no association of the studied parameters with an increased risk of prematurity. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study was to assess the performance of a previously published algorithm for first-trimester prediction of spontaneous preterm birth (PTB) in a cohort of Brazilian women. Methods. This was a retrospective cohort study of women undergoing routine antenatal care. Maternal characteristics and medical history were obtained. The data were inserted in the Fetal Medicine Foundation (FMF) online calculator to estimate the individual risk of PTB. Univariate and multivariate logistic regression analyses were performed to determine the effects of maternal characteristics on the occurrence of PTB. A receiver-operating characteristics (ROC) curve was used to determine the detection rates and false-positive rates of the FMF algorithm in predicting PTB <34 weeks of gestation in our population. Results. In total, 1,323 women were included. Of those, 23 (1.7%) had a spontaneous PTB before 34 weeks of gestation, 87 (6.6%) had a preterm birth between 34 and 37 weeks, and 1,197 (91.7%) had a term delivery. Smoking and a previous history of recurrent PTB between 16 and 30 weeks of gestation without prior term pregnancy were significantly more common among women who delivered before 34 weeks of gestation compared to those who delivered at term were (39.1% vs. 12.0%, p=0.001 and 8.7% vs. 0%, p<0.001, respectively). Smoking and history of spontaneous PTB remained significantly associated with spontaneous PTB in the multivariate logistic regression analysis. Significant prediction of PTB <34 weeks of gestation was provided by the FMF algorithm (area under the ROC curve 0.67, 95% CI 0.56–0.78, p=0.005), but the detection rates for fixed false-positive rates of 10% and 20% were poor (26.1% and 34.8%, respectively). Conclusions. Maternal characteristics and history in the first trimester can significantly predict the occurrence of spontaneous delivery before 34 weeks of gestation. Although the predictive algorithm performed similarly to previously published data, the detection rates are poor and research on new biomarkers to improve its performance is needed. [ABSTRACT FROM AUTHOR]