{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:14:02Z","timestamp":1790241242458,"version":"4.1.0"},"reference-count":45,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Natural Science Foundation of China","award":["82473643"],"award-info":[{"award-number":["82473643"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Natural Science Foundation of China","award":["82574109"],"award-info":[{"award-number":["82574109"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Jiangsu Province Maternal and Child Health Research Project","award":["F202303"],"award-info":[{"award-number":["F202303"]}]},{"name":"Scientific Research Project of Jiangsu Provincial Health Commission","award":["K2024019"],"award-info":[{"award-number":["K2024019"]}],"id":[{"id":"https:\/\/ror.org\/03eqskn19","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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), and to synthesize current evidence to inform prenatal health strategies and potentially reduce the incidence of APOs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>This study systematically searched PubMed, Web of Science, Embase, PsycINFO, China National Knowledge Infrastructure, Wanfang, VIP China Science and Technology Journal Database, and SinoMed databases for relevant studies examining prenatal AL and APOs published from September 1993 to 22 June 2026. 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight original studies involving 8,795 pregnant women were included. High prenatal AL was associated with an increased risk of preterm birth (OR = 1.29, 95% CI [1.04\u20131.60]) and preeclampsia (OR = 2.31, 95% CI [1.42\u20133.76]). There was no statistically significant association with low birth weight (OR = 1.10, 95% CI [0.95\u20131.26]). Furthermore, exploratory subgroup analyses suggested that the gestational period and biomarker composition may influence these associations; however, high methodological heterogeneity limits direct clinical application.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated prenatal AL is associated with an increased risk of specific APOs, particularly preterm birth and preeclampsia. Future studies should adopt longitudinal designs with repeated AL measurements across pregnancy to clarify temporal dynamics and elucidate underlying biological mechanisms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.21756","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:52:53Z","timestamp":1790239973000},"page":"e21756","source":"Crossref","is-referenced-by-count":0,"title":["Prenatal allostatic load and adverse pregnancy outcomes: a systematic review and meta-analysis"],"prefix":"10.7717","volume":"14","author":[{"given":"Mengjie","family":"Zhao","sequence":"first","affiliation":[{"name":"Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanyue","family":"Zheng","sequence":"additional","affiliation":[{"name":"Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dengyan","family":"Qi","sequence":"additional","affiliation":[{"name":"Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuening","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Health Commission Key Laboratory of Contraceptives Vigilance and Fertility Surveillance,  Nanjing, China"},{"name":"Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment,  Nanjing, China"},{"name":"Jiangsu Health Development Research Center, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Ba","sequence":"additional","affiliation":[{"name":"National Health Commission Key Laboratory of Contraceptives Vigilance and Fertility Surveillance,  Nanjing, China"},{"name":"Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment,  Nanjing, China"},{"name":"Jiangsu Health Development Research Center, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bei","family":"Wang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Hong","sequence":"additional","affiliation":[{"name":"Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"issue":"5","key":"10.7717\/peerj.21756\/ref-1","doi-asserted-by":"publisher","first-page":"355","DOI":"10.5271\/sjweh.4236","article-title":"The effects of prenatal psychosocial work stress on adverse pregnancy outcomes: a comprehensive systematic review and meta-analysis","volume":"51","author":"Admas","year":"2025","journal-title":"Scandinavian Journal of Work, Environment & Health"},{"key":"10.7717\/peerj.21756\/ref-2","doi-asserted-by":"publisher","first-page":"104692","DOI":"10.1016\/j.phrs.2020.104692","article-title":"Pre-eclampsia: microbiota possibly playing a role","volume":"155","author":"Ahmadian","year":"2020","journal-title":"Pharmacological Research"},{"key":"10.7717\/peerj.21756\/ref-3","doi-asserted-by":"publisher","first-page":"2431","DOI":"10.3390\/healthcare12232431","article-title":"Prenatal maternal psychological stress (PMPS) and its effect on the maternal and neonatal outcome: a retrospective cohort study","volume":"12","author":"Aldinger","year":"2024","journal-title":"Healthcare"},{"key":"10.7717\/peerj.21756\/ref-4","doi-asserted-by":"publisher","first-page":"119922","DOI":"10.1016\/j.cca.2024.119922","article-title":"Preeclampsia: a comprehensive review","volume":"563","author":"Ali","year":"2024","journal-title":"Clinica Chimica Acta; International Journal of Clinical Chemistry"},{"key":"10.7717\/peerj.21756\/ref-5","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1097\/01.AOG.0000437382.03963.88","article-title":"Hypertension in pregnancy. 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