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01.12.2014 | Ausgabe 10/2014 Open Access

Maternal and Child Health Journal 10/2014

Perinatal Distress in Women in Low- and Middle-Income Countries: Allostatic Load as a Framework to Examine the Effect of Perinatal Distress on Preterm Birth and Infant Health

Maternal and Child Health Journal > Ausgabe 10/2014
Shahirose Premji
Wichtige Hinweise
On behalf of MiGHT—Maternal Infant Global Health Team (Global collaborators in Research) [alphabetical order] Ms. Dorcas Akoya Amunga; Ms. Dorcus Asami Satia; Dr. Susan Dahinten; Dr. Farooq Ghani; Dr. Imtiaz Jehan; Dr. Zeenatkhanu Kanji; Mr. Adam King; Dr. Nicole Letourneau; Dr. Aliyah Mawji; Dr. Alliya Mohamed; Dr. Joseph Wangira Musana; Mrs. Mwasha Loveluck; Dr. Haider Ali Naqvi; Dr. Christopher T. Naugler; Ms. Christine Omukani Okoko; Dr. M. Sarah Rose; Dr. Pauline Samia; Ms. Kiran Shaikh; Ms. Salima Gulamani; Mr. Josephat Wambua; Ms. Saba Wasim; Dr. Ilona S. Yim.
An erratum to this article can be found at http://​dx.​doi.​org/​10.​1007/​s10995-014-1539-3.


In low- and middle-income countries (LMIC), determinants of women’s and children’s health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother–infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic–pituitary–adrenal axis, sympathetic, immune and cardiovascular systems, and behavioral responses resulting in pathophysiological effects. We suggest cultural–neutral composite measures of allostatic mediators (i.e., several biomarkers) of maternal perinatal distress as objective indicators of dysregulation in body systems in pregnant women in LMIC. Understanding causal links of maternal perinatal distress to preterm birth in women in LMIC should be a priority. The roles of allostasis and allostatic load are considered within the context of the health of pregnant women and fetuses/newborns in LMIC with emphasis on identifying objective indicators of the level of perinatal distress and protective factors or processes contributing to resilience while facing toxic stress. We propose a prospective study design with multiple measures across pregnancy and postpartum requiring complex statistical modeling. Building research capacity through partnering researchers in high-income countries and LMIC and reflecting on unique ethical challenges will be important to generating new knowledge in LMIC.

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