While its etiology is not fully elucidated, preterm birth represents a major public health concern as it is the leading cause of child mortality and morbidity. Stress is one of the most common perinatal conditions and may increase the risk of preterm birth. In this paper we aimed to investigate the association of maternal perceived stress and anxiety with length of gestation. We used harmonized data from five birth cohorts from Canada, France, and Norway. A total of 5297 pregnancies of singletons were included in the analysis of perceived stress and gestational duration, and 55,775 pregnancies for anxiety. Federated analyses were performed through the DataSHIELD platform using Cox regression models within intervals of gestational age. The models were fit for each cohort separately, and the cohort-specific results were combined using random effects study-level meta-analysis. Moderate and high levels of perceived stress during pregnancy were associated with a shorter length of gestation in the very/moderately preterm interval [moderate: hazard ratio (HR) 1.92 (95%CI 0.83, 4.48); high: 2.04 (95%CI 0.77, 5.37)], albeit not statistically significant. No association was found for the other intervals. Anxiety was associated with gestational duration in the very/moderately preterm interval [1.66 (95%CI 1.32, 2.08)], and in the early term interval [1.15 (95%CI 1.08, 1.23)]. Our findings suggest that perceived stress and anxiety are associated with an increased risk of earlier birth, but only in the earliest gestational ages. We also found an association in the early term period for anxiety, but the result was only driven by the largest cohort, which collected information the latest in pregnancy. This raised a potential issue of reverse causality as anxiety later in pregnancy could be due to concerns about early signs of a possible preterm birth.

虽然其病因尚未完全阐明，但早产是一个重大的公共卫生问题，因为它是儿童死亡和发病的主要原因。压力是最常见的围产期状况之一，可能会增加早产的风险。在本文中，我们旨在调查母亲感知的压力和焦虑与妊娠长度的关系。我们使用了来自加拿大、法国和挪威的五个出生队列的统一数据。共有 5297 例怀孕的单身人士被纳入感知压力和妊娠持续时间的分析，以及 55,775 例怀孕的焦虑情况。通过 DataSHIELD 平台使用 Cox 回归模型在胎龄区间内进行联合分析。这些模型分别适合每个队列，并使用随机效应研究水平荟萃分析来组合特定队列的结果。怀孕期间中度和高水平的感知压力与极/中度早产间隔期妊娠时间较短相关[中度：风险比 (HR) 1.92 (95% CI 0.83, 4.48)；高：2.04 (95%CI 0.77, 5.37)]，尽管没有统计学意义。没有发现其他时间间隔的关联。焦虑与极/中度早产间隔[1.66 (95%CI 1.32, 2.08)]和早产间隔[1.15 (95%CI 1.08, 1.23)]的妊娠持续时间相关。我们的研究结果表明，感知到的压力和焦虑与早产风险增加有关，但仅限于最早的孕龄。我们还发现妊娠早期与焦虑之间存在关联，但这一结果仅由最大的队列驱动，该队列收集了怀孕期间最新的信息。 这提出了一个潜在的反向因果关系问题，因为怀孕后期的焦虑可能是由于担心可能早产的早期迹象。