Conceptualizations, measurement, and effects of prenatal maternal stress on birth outcomes

Abstract

This article analyzes the conceptual and methodological approaches which have been used to investigate effects of prenatal maternal stress on birth outcomes and highlights the major findings of this research. By viewing the most widely used operational definitions of prenatal stress in a broader theoretical framework, it can be seen that most studies have failed to conceptualize stress reliably. This, in addition to common methodological and design flaws which are described in the article, has produced equivocal findings about the role of stress in adverse birth outcomes such as preterm delivery and low birth weight. Recent studies using more powerful, multidimensional approaches to stress definition and measurement provide more definitive evidence and suggest some precise effects. Implications and strategies for future research are presented.

Measuring the ups and downs of pregnancy stress

“…The construct of stress is notoriously difficult to operationalize. Stress research during pregnancy has been hampered by the methodological issues common to stress studies in general 29,30 . These include the use of measurement tools in populations on which they were not validated, the role of appraisal in judging events, and imprecision in distinguishing the construct of stress from that of aspects of emotionality, particularly trait anxiety.…”

“…In particular, the number of children and/or previous pregnancies a woman has had may differentially affect physiological and psychosocial responses to the current pregnancy. Ascertaining the timing of stress exposure in relation to the start of pregnancy and stage of gestation provides further challenge in detecting significant associations 29 . A relatively unrecognized methodological issue in measuring stress during pregnancy is that pregnancy itself presents unique psychological and social challenges [31][32][33] ; thus failure to measure pregnancy-specific sources can underestimate maternal distress.…”

Prenatal stress and hemodynamics in pregnancy: a systematic review

“…Lobel and colleagues offer thorough reviews of prenatal stress research and the importance of utilizing a multidimensional approach to analyzing stress in pregnancy (Lobel, 1994;Lobel et al, 2008). Increased inclusion of such scales and greater attention to socioeconomic status and substance use in future interdisciplinary studies will provide researchers, clinicians, and patients with a more holistic understanding of the impact of maternal mental health on fetal well-being.…”

“I am the worst pregnant woman ever”: A mixed-method study of the nature of psychological distress during pregnancy

“…Furthermore, during pregnancy anxiety was reported to have a medium-to-large correlation with depressive symptoms (Lancaster, Flynn, Johnson, Marcus, & Davis, 2010). This review highlights the importance of using a clearly defined multidimensional approach in the operationalization of pregnancy-specific distress, encompassing both anxiety and perceived stress related to pregnancy, such as that proposed by Lobel (1994) which provides a definitive and inclusive approach to understanding pregnancyspecific distress and its precise effect. In a review (Alderdice, Lynn, & Lobel, 2012) on pregnancy-specific stress measures where 15 tools were identified and their psychometric properties examined, it was suggested that pregnancy-specific stress is: 1) associated, but not identical to general stress, and 2) pregnancy-specific stress was indeed predictive of PTB.…”

“…The multidimensional framework, defined by Lobel (1994) as pregnancy-specific distress, was used in five studies (Glynn et al, 2008;Lobel et al, 1992;Rini et al, 1999;Wadhwa et al, 1993). They were all assessed as low in bias and all provided evidence of a precise effect of the association between DAS and PTB.…”