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their consequences for pregnancy outcomes, such as spontaneous preterm labor, spontaneous rupture of membranes, and fetal growth restriction.

  • Future studies on the association between stress and preterm birth should consider the unique forms of stress that specific racial and ethnic groups experience by using culturally valid measures in efforts to determine the optimal risk factors for specific subgroups of the population.

  • Studies on the association between racism and preterm birth warrant follow-up for replication and further clarification to understand the specific exposures and mechanisms that pose a risk.

  • Understudied topics that may be promising avenues for future research are the characteristics of daily activity and employment, as well as activity in the home and work contexts, including physical strain, occupational stress, and the effects of domestic violence during pregnancy.

  • Attention to the intendedness of pregnancy is warranted to determine whether it is a risk factor for preterm birth rather than other outcomes, such as intrauterine growth restriction, and the pathways to such outcomes.

  • Further research on personal resources, such as self-esteem, mastery, and control, may be warranted if it is conducted with a strong theoretical basis on the pathways to preterm birth. More generally, there is a need for theoretical models of the pathways from the presence of psychosocial conditions, including stress, social support, and other resilience factors, to preterm birth as a basis for ongoing observational research. These models should address the interrelationships of psychosocial conditions with biological and behavioral conditions by use of a multilevel approach.

  • A more integrative approach to understanding individual-level factors in prematurity is needed. This will require the use of both a longitudinal integration linking a woman’s life history to her vulnerability to preterm delivery and a contextual integration linking a woman’s individual biology, psychosocial processes, and behaviors to the multilevel, multiple determinants of preterm birth (Misra et al., 2003).

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