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BioMed Research International
Volume 2015, Article ID 450309, 12 pages
Review Article

Psychobiobehavioral Model for Preterm Birth in Pregnant Women in Low- and Middle-Income Countries

1Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
2Department of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6
3Alberta Children’s Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1
4O’Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, Canada T2N 4Z6
5Department of Psychology and Social Behavior, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
6School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, Canada T3E 6K6
7School of Nursing and Midwifery, Aga Khan University-East Africa, Opposite Aga Khan Primary School Plot (9/11), Colonel Muammar Gaddafi Road, P.O. Box 8842, Kampala, Uganda
8School of Nursing and Midwifery, Aga Khan University-Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
9Department of Obstetrics & Gynecology, Faculty of Health Sciences, Aga Khan University-Nairobi, 3rd Parklands Avenue off Limuru Road, P.O. Box 30270, Nairobi 00100, Kenya
10Department of Pediatrics, Aga Khan University-Nairobi, 2nd Parklands Avenue, East Tower Block, Room 505, Nairobi 00100, Kenya

Received 12 February 2015; Accepted 3 April 2015

Academic Editor: Igor Hudić

Copyright © 2015 Shahirose S. Premji et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in stress responses leading to PTB and explain the basis of this approach. We discuss ethical considerations for a psychosocial, biological, and behavioral screening tool to predict PTB from a LMI country perspective.