Abstract
Objective(s)We sought to prospectively study the association between antenatal emotional distress and gestational length at birth as well as preterm birth.Study DesignWe followed up 40,077 primiparous women in the Norwegian Mother and Child Cohort Study. Emotional distress was reported in a short form of the Hopkins Symptom Checklist-25 (SCL-5) at 17 and 30 weeks of gestation. Gestational length at birth, obtained from the Medical Birth Registry of Norway, was used as continuous (gestational length in days) and categorized (early preterm (22–31 weeks) and late preterm (32–36 weeks) versus term birth (≥37 weeks)) outcome, using linear and logistic regression analysis, respectively. Births were divided into spontaneous and provider-initiated.ResultsOf all women, 7.4% reported emotional distress at 17 weeks, 6.0% at 30 weeks and 5.1% had a preterm birth. All measurements of emotional distress at 30 weeks were significantly associated with a reduction of gestational length, in days, for provider-initiated births at term. Emotional distress at 30 weeks showed a reduced duration of pregnancy at birth of 2.40 days for provider-initiated births at term. An increase in emotional distress from 17 to 30 weeks was associated with a reduction of gestational length at birth of 2.13 days for provider-initiated births at term. Sustained high emotional distress was associated with a reduction of gestational length at birth of 2.82 days for provider-initiated births. Emotional distress did not increase the risk of either early or late preterm birth.ConclusionEmotional distress at 30 weeks, an increase in emotional distress from 17 to 30 weeks and sustained high levels of emotional distress were associated with a reduction in gestational length in days for provider-initiated term birth. We found no significant association between emotional distress and the risk of preterm birth.
Highlights
Preterm birth is a common but serious pregnancy complication [1,2]
All measurements of emotional distress at 30 weeks were significantly associated with a reduction of gestational length, in days, for provider-initiated births at term
An increase in emotional distress from 17 to 30 weeks was associated with a reduction of gestational length at birth of 2.13 days for provider-initiated births at term
Summary
Preterm birth (defined as birth before 37 weeks of gestation, WHO 1977) is a common but serious pregnancy complication [1,2]. Since the nineties a growing awareness that maternal antenatal stress may influence gestational length at birth and preterm birth in particular has led to a large number of studies, as the comprehensive review of Dunkel Schetter & Glynn indicates [5]. Other studies have assessed the association between preterm birth and emotional states such as pregnancy-related anxiety [9,10], general anxiety and depression [11], and various measures of psychosocial stress [12]. The influence of maternal psychological distress and stress hormones on the risk of preterm birth is not well defined, patterns are beginning to emerge [13]. Maternal inflammation and infection is one of the main causes of preterm birth [1,15], and the effects of chronic stress on the immune system are well known [16]. Behavioural responses to stress such as smoking and substance abuse may increase the risk of preterm birth [5]
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