284: Outcomes of maternal stress as evaluated by the perceived stress scale

Abstract

Stress during pregnancy, in particular during the first and second trimesters, leads to adverse pregnancy outcomes (APOs) including preterm birth and small for gestational age neonates. It is also highly correlated with perinatal depression, another risk factor for APOs. The Perceived Stress Scale (PSS) is common among various psychological and physiologic measures of stress. However, as stress is complex, data on the association of various stress measures with APOs has been inconsistent. This leads to challenges in identifying patients who may benefit from stress- reduction interventions in both clinical and research settings. The objective of this study was to evaluate the associations between the PSS, other measures of stress, and adverse pregnancy outcomes. Women were enrolled from perinatal clinics at a safety net hospital in Denver, Colorado at <16 weeks gestation and followed prospectively through delivery. Measures of stress included: the PSS, the Center for Epidemiologic Studies Depression Scale (CESD), and the State-Trait Anxiety Inventory (STAI), completed at 16, 22, 28, 34 and 40 weeks gestation. Physiologic measures of stress included hair corticosteroid concentrations representative of 1st, 2nd, and 3 rd trimester total corticosteroid production and both maternal and fetal heart rate variability (HRV) measures recorded at 28-32 weeks gestation in a sub-set of participants. Maternal sociodemographic data and birth data were also collected. Of 221 participants, the average PSS at 16 weeks was 23 ± 8, range 4-52. The PSS at 16 weeks was negatively correlated with: birthweight (r=-0.21, p=0.001), and gestational age at birth (r=-0.17, p=0.007) and positively correlated with: trait anxiety (r=0.59, p<0.0001) and both state anxiety (r=0.67, p<0.0001), and maternal depressive symptoms at 16 weeks (r=0.72, p<0.0001). No significant correlations were found between the PSS and maternal hair corticosteroids or maternal HRV measures. No correlation was noted between hair corticosteroids and HRV measures and APOs. The PSS is an important tool for assessing stress during pregnancy with elevated scores associated with adverse outcomes. It may be used to identify patients at higher risk of such outcomes in whom interventions to alleviate stress may be beneficial.