Measuring Stress Before and During Pregnancy: A Review of Population-Based Studies of Obstetric Outcomes

Abstract

Objectives Mounting evidence from clinic and convenience samples suggests that stress is an important predictor of adverse obstetric outcomes. Using a proposed theoretical framework, this review identified and synthesized the population-based literature on the measurement of stress prior to and during pregnancy in relation to obstetric outcomes. Methods Population-based, peer-reviewed empirical articles that examined stress prior to or during pregnancy in relation to obstetric outcomes were identified in the PubMed and PsycInfo databases. Articles were evaluated to determine the domain(s) of stress (environmental, psychological, and/or biological), period(s) of stress (preconception and/or pregnancy), and strength of the association between stress and obstetric outcomes. Results Thirteen studies were evaluated. The identified studies were all conducted in developed countries. The majority of studies examined stress only during pregnancy (n=10); three examined stress during both the preconception and pregnancy periods (n=3). Most studies examined the environmental domain (e.g., life events) only (n=9), two studies examined the psychological domain only, and two studies examined both. No study incorporated a biological measure of stress. Environmental stressors before and during pregnancy were associated with worse obstetric outcomes, although some conflicting findings exist. Conclusions Few population-based studies have examined stress before or during pregnancy in relation to obstetric outcomes. Although considerable variation exists in the measurement of stress across studies, environmental stress increased the risk for poor obstetric outcomes. Additional work using a lifecourse approach is needed to fill the existing gaps in the literature and to develop a more comprehensive understanding of the mechanisms by which stress impacts obstetric outcomes.

Maternal Stressful Life Events Prior to Conception and the Impact on Infant Birth Weight in the United States

“…Previous research has focused on a relatively narrow time window preceding pregnancy (e.g., up to 17 months) and has found significant associations with poor birth outcomes. 15,35–37 Our findings, which examined a larger time window prior to pregnancy, suggest that the experience of stressful life events throughout a woman’s life span might exert lasting effects on her reproductive health and obstetric outcomes. Furthermore, the effect of events that occurred 1 year or more prior to conception had a stronger association with very LBW than did events that occurred within a year prior to conception.…”

Perceived stress and emotional social support among women who are denied or receive abortions in the United States: a prospective cohort study

“…Even though the elevation of stress among Turnaways was temporary, stress was elevated during a period that can have long term mental and physical health outcomes for mothers and children [17-20]. …”

Measuring lifetime stress exposure and protective factors in life course research on racial inequality and birth outcomes

“…allostatic load, health behaviors, cardiovascular disease) and are more common among Blacks and Latinos than among whites (Felitti et al, 1998; Shonkoff, Garner, The Committee on Psychological Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care and Second on Developmental and Behavioral Pediatrics, 2012). Yet, a recent review of population-based studies found only three studies linking pre-pregnancy stress and birth outcomes, with the longest preconception period being only 6 months (Witt, Litzelman, Cheng, Wakeel, & Barker, 2014). A short-preconception period is a common challenge in research on stress exposure and health.…”