Association between Maternal Stressors during Pregnancy and Adverse Perinatal Outcomes

Background: Maternal stressors during pregnancy are associated with an increased risk of congenital malformation. As little is known about the association between maternal stressors and other adverse perinatal outcomes, we examined these associations.

Methods: A retrospective cohort study of successive singleton birth outcomes in KPSC hospitals from 1991 through 2006 was performed using data from the Matched Perinatal Service System and Hospital Inpatient datasets. ICD-9 codes from hospitalizations during pregnancy and infant birth certificates were used to assess the associations between maternal stressors during pregnancy-1 and adverse perinatal outcomes in pregnancy-2. Maternal stressor is defined as a history of infertility, spontaneous and induced abortion, stillbirth, congenital anomalies, and neonatal death. Odds ratio (OR) and 95% confidence interval (CI) were used to quantify the associations after adjustment for confounders.

Results: Of the 37,299 women in these analyses, 1.5% experienced &ge 1 stressor in the first pregnancy. In the second pregnancy, women with a stressor in the first pregnancy were at increased risk of primary preeclampsia (OR 1.7, 95% CI 1.0-3.0), premature rupture of membranes (OR 2.7, 95% CI 1.4-4.9), chorioamnionitis (OR 3.3, 95% CI 1.9-5.4), primary cesarean delivery (OR 3.7, 95% CI 2.8-4.9), fetal distress (OR 2.0, 95% CI 1.2-3.3), intrauterine growth retardation (OR 3.9, 95% CI 2.1-7.3), and preterm birth (OR 2.3, 95% CI 1.5-3.5).

Conclusions: This study suggests that maternal stressors are significant contributors to adverse pregnancy outcomes. Clinicians should be aware of this when counseling at-risk women.