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Prenatal Allostatic Load and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis

epidemiology
nursing
obstetrics-and-gynecology
psychology

Abstract

Background Allostatic load (AL) denotes the cumulative physiological dysregulation resulting from chronic stress exposure. This systematic review and meta-analysis aimed to evaluate the association between prenatal AL and adverse pregnancy outcomes (APOs), to synthesize current evidence to inform prenatal health strategies and potentially reduce the incidence of APOs.

Methodology This study systematically searched PubMed, Web of Science, Embase, PsycINFO, CNKI, Wanfang, VIP, and SinoMed databases for relevant studies examining prenatal AL and APOs published from September 1993 to 31 December 2025. Two researchers independently screened the literature, extracted data, and assessed the risk of bias using the Newcastle-Ottawa scale. Meta-analysis was performed using R software (version 4.4.3). The study protocol is registered in PROSPERO (CRD420251076952).

Results Nine original studies involving 9,170 pregnant women were included. High prenatal AL was associated with an increased risk of preterm birth (OR = 1.15, 95% CI: 1.03-1.28) and preeclampsia (OR = 2.31, 95% CI:1.42-3.76). There was no statistical association with low birth weight (OR = 1.10, 95% CI: 0.95-1.26) or small for gestational age infants (OR = 0.79, 95% CI:0.61-1.01). Subgroup analysis indicated that high AL during the second trimester (OR = 1.74, 95% CI: 1.08-2.80) and third trimester (OR = 4.83, 95% CI: 1.54-15.11) was particularly associated with preterm birth. Furthermore, the risk of preeclampsia appeared to escalate with advancing gestation in women with elevated AL.

Conclusions Elevated prenatal AL is associated with a higher risk of specific APOs, particularly preterm birth and preeclampsia. The second and third trimesters may represent critical windows for AL-related pathophysiology. Future studies should adopt longitudinal designs with repeated AL measurements across pregnancy to clarify temporal dynamics and elucidate underlying biological mechanisms.

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