<p><strong>OBJECTIVE: </strong>To determine whether perceived stress is associated with preterm birth (PTB) and to investigate racial differences in stress and PTB.</p>

<p><strong>STUDY DESIGN: </strong>A secondary analysis of a prospective cohort study of 1911 women with singleton pregnancies examined responses to psychosocial stress questionnaires at 16-20 weeks of gestation.</p>

<p><strong>RESULTS: </strong>High perceived stress (19%) and PTB (10.8%) were prevalent in our sample (62% non-Hispanic Black). Women with PTB were more likely to be Black, have chronic hypertension (cHTN), pregestational diabetes, and higher BMI. Women with high perceived stress had more PTBs than those with lower stress (15.2% vs. 9.8%), and stress was associated with higher odds of PTB (aOR: 1.55, 95% CI: 1.09-2.19).</p>

<p><strong>CONCLUSION: </strong>The significant association between high perceived stress and PTB suggests that prenatal interventions to reduce maternal stress could improve the mental health of pregnant women and may result in reduced rates of PTB.</p>