Preterm delivery (PTD) is a leading cause of infant death, and surviving infants are at risk for poor health. Data from the Iowa Health in Pregnancy Study, a case-control study of maternal stress on risk of PTD and small for gestational age (SGA) deliveries were used to address three aims: 1) develop a method to correct for error in ultrasound measurement among suspected SGA infants, 2) estimate the association of occupational stress on risk of PTD, and 3) examine injury-related risk factors for PTD. Estimates of gestational age using ultrasound can be biased if the fetus is growth-restricted, yielding underestimates due to the small stature of the fetus. Multivariate linear regression modeling was used to estimate and correct for this bias among subjects with a suspected SGA infant who 1) began prenatal care in the first trimester, 2) reported a last menstrual period and 3) had an ultrasound examination between 7-21 weeks. To correct for this bias, an average of 1.5 weeks was added to the ultrasound gestational age. Following the correction, the proportion of PTD cases decreased from 29.1% to 26.5% while SGA cases increased from 23.7% to 31.3%. Using this PTD classification, occupational physical and psychosocial stressors were studied. Continuous employment over the first 20 weeks of pregnancy was associated with a 30% increased risk of PTD versus not working. Working women reporting highly repetitive tasks (aOR=1.47(1.10-1.98)) or inadequate breaks (aOR=1.67(1.03-2.73)) were at increased risk of PTD. Working women who reported high lifting in the home had double the risk of PTD. Over 5% of control subjects reported an injury during pregnancy, and injured women tended to be younger, unmarried, less educated, and have lower incomes. Women with injuries involving >1 body part (aOR=2.50(1.14-5.49)), or injuries to the abdomen and other regions of the body (OR=1.75(0.59-5.23)) were at increased risk of PTD. Our findings provide a statistical approach to assess and correct for underestimates of ultrasound gestational age in case-control studies of PTD and SGA. The analyses of occupational exposures and injury during pregnancy indicate the need for studies that incorporate specific and standardized assessments of these exposures.

Since fetal alcohol syndrome was first reported, studies have demonstrated a range of perinatal/developmental abnormalities that fall under the umbrella term fetal alcohol spectrum disorders. Of these, low birth weight in exposed children is among the most commonly observed and widely accepted. However, in the past, assertion of an association between prenatal alcohol exposure and preterm birth was controversial. Methodological difficulties may have contributed to failure to consistently detect such a relationship. However, new evidence suggests that pregnancy drinking may be a major contributor to extreme, but not mild prematurity. Extreme prematurity is a major cause of severe perinatal morbidity and mortality. If recent findings are confirmed, it suggests that extreme prematurity might be reduced by eliminating prenatal alcohol exposure.