Stress and quality of life postpreterm birth during polycrises: prospective cohort study

Background: Preterm birth remains a leading cause of neonatal mortality globally and is worsened in crisis-affected countries like Lebanon. This study explored how social determinants of health relate to preterm birth and maternal postpartum outcomes, including quality of life (QoL), perceived stress, and social support. Objective: to explore the impact of the social environment in polycrises context on preterm birth, the association between preterm birth and maternal postpartum QoL, perceived stress, and social support. Study Design: A prospective cohort study was conducted in three Lebanese hospitals from September 2021 to December 2023. A total of 116 mother-infant pairs (78 full-term, 38 preterm) were recruited. Data on social determinants, perceived stress (PSS-10), social support (MSPSS), and QoL (WHOQOL-BREF) were collected at delivery and 4 to 6 months postpartum. Analyses included t tests, chi-square tests, and linear mixed models. Results: Mothers of preterm infants had significantly higher stress (PSS-10: 19.53 vs 15.29, P=.011) and lower QoL scores across physical (39.16 vs 57.4, P<.001), psychological (54.08 vs 66.91, P<.001), and social (58.53 vs 69.56, P=.007) domains at delivery. At 4 to 6 months postpartum, all mothers reported declines in social support (71.8 vs 67.3, P=.003), social QoL (69.4 vs 61.4, P=.005), and environmental QoL (70 vs 64.5, P=.012). Conclusion: This study highlights the impact of social support, stress, and QoL on preterm birth outcomes in a crisis-affected region. Mothers of preterm infants experienced higher stress and lower QoL at birth, suggesting the need for targeted interventions to support maternal mental health. Addressing these social determinants is needed for improving pregnancy outcomes, particularly in vulnerable populations facing multiple social and economic challenges.