Pattern of perceived stress and anxiety in pregnancy predicts preterm birth.

Laura M Glynn,Christine Dunkel Schetter,Curt A Sandman,Calvin J Hobel

doi:10.1037/0278-6133.27.1.43

Abstract

To determine whether the pattern of prenatal stress, as compared to prenatal stress assessed at a single gestational time point, predicts preterm delivery (PTD). Perceived stress and anxiety were assessed in 415 pregnant women at 18-20 and 30-32 weeks' gestation. Gestational length was determined by last menstrual period and confirmed by early pregnancy ultrasound. Births were categorized as preterm (< 37 weeks) or term. At neither assessment did levels of anxiety or perceived stress predict PTD. However, patterns of anxiety and stress were associated with gestational length. Although the majority of women who delivered at term exhibited declines in stress and anxiety, those who delivered preterm exhibited increases. The elevated risk for PTD associated with an increase in stress or anxiety persisted when adjusting statistically for obstetric risk, pregnancy-related anxiety, ethnicity, parity, and prenatal life events. These data suggest that the pattern of prenatal stress is an important predictor of PTD. More generally, the findings support the possibility that a decline in stress responses during pregnancy may help to protect mother and fetus from adverse influences associated with PTD.

Highlights

Three potential sources of stress—pregnancy anxiety, medical risk for preterm birth, and life events—were analyzed in conjunction with change in stress in the hierarchical logistic regression models used to predict preterm birth. These analyses were included to explore whether any association between changes in prenatal stress and preterm birth could be attributed to differences in pregnancy anxiety, the presence of medical conditions placing the woman at risk for a preterm birth, or to exposure to stressful life events
We explored whether the observed associations between changes in prenatal stress and preterm birth could be attributed to differences in pregnancy anxiety, to the presence of medical conditions placing the woman at risk for a preterm birth, or to exposure to stressful life events
Only change in perceived stress remained a statistically significant predictor (OR ϭ 2.26, 95% CI ϭ 1.02–5.01) and change in state anxiety was rendered not significant (OR ϭ 1.80, 95% CI ϭ 0.83–3.97). These are the first data to show that the pattern of change in prenatal stress during the course of gestation is an important predictor of the adverse outcome of preterm birth

Summary

Objective

To determine whether the pattern of prenatal stress, as compared to prenatal stress assessed at a single gestational time point, predicts preterm delivery (PTD). There is evidence that increased maternal stress during pregnancy is related to decreased gestational length and that pregnancy-associated changes in stress responses exist across a wide variety of species including humans. Given these findings, a step is to ask whether meaningful individual differences in stress responses during the prenatal period exist. We explored whether any changes in prenatal stress responses observed during gestation might be due to three potential sources of stress: pregnancy anxiety, the experience of a medically high risk pregnancy, or a range of stressful life events

Participants

Procedures

Results

Discussion

Change in anxietya