Association between maternal preconception and prenatal stress and the risk of spontaneous abortions

BACKGROUND: Prenatal stress has been shown to increase risk for adverse pregnancy outcomes. Between March, 2004 and December, 2008 the southern Israeli town of Sderot was a target of frequent rocket attacks, which have been shown to create anxiety and stress. The present study evaluated the association between exposure to life-threatening rocket attacks and the risk of spontaneous abortions (SA). METHODS: In a retrospective cohort study 1,345 pregnancies of women who resided in Sderot (Exposed Group) were compared to 2,143 pregnancies of women who lived in a town in the same region with a similar socioeconomic profile, which was outside the rocket attack range (Unexposed Group). Demographic and medical data was abstracted from patient records at Barzilai Medical Center, which provides tertiary obstetric care for the study population. Exposure information was obtained from official local authorities. Intensity of exposure was calculated as the weekly mean of rocket attack alarms for preconception and pregnancy periods. RESULTS: Women in the Exposed Group had higher rates of SA compared to those in the Unexposed Group (6.9% vs. 4.7%, P=0.005). Adjustment for marital status, gravidity and maternal age yielded OR = 1.59 (95% CI 1.17-2.2, P=0.003). Only women in the highest quintiles of exposure during preconception or pregnancy were at increased risk of SA, compared with unexposed women (adj.OR=2.5, 95% CI 1.6-4.0 and adj.OR=2.1, 95% CI 1.3-3.4, respectively). Same association was found regarding early or late SA. CONCLUSIONS: Preconception or pregnancy stress was associated with increased risk of SA.