Maternal life events and adverse pregnancy outcomes: lessons from the auvergne ectopic pregnancy registry

Abstract

Objective To investigate stressful maternal life events as candidate risk factors for ectopic pregnancy. Design Population-based registry study. Setting Auvergne ectopic pregnancy registry (France). Patient(s) Women (n = 641) registered between 1997 and 2000. Intervention(s) Standard treatment of ectopic pregnancy. Main outcome measure(s) Based on the Psychiatric Epidemiology Life Events Scale, we analyzed the nonresponse bias, the confounding effects of sociobehavioral factors associated with both life events and ectopic pregnancy, and the potential buffering effects of socio-cultural variables. A multivariate model was constructed to test the association between life events and ectopic pregnancy, adjusting for identified confounders and testing interactions. Result(s) The primary hypothesis that life events might be independent risk factors for ectopic pregnancy was not confirmed in this study, which nevertheless illustrated the numerous biases and measurement problems confronting association studies of life events with adverse pregnancy outcomes. Conclusion(s) Recommendations are made for future studies on life events and adverse pregnancy outcomes to avoid most selection, information, and confounding biases. Methodological improvements are needed for measurement of life events to develop measures that more closely consider the consequences of stress and the mechanisms of buffering.