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Matern Child Health J (2014) 18:5263 DOI 10.1007/s10995-013-1233-x
Measuring Stress Before and During Pregnancy: A Review of Population-Based Studies of Obstetric Outcomes
Whitney P. Witt Kristin Litzelman
Erika R. Cheng Fathima Wakeel
Emily S. Barker
Published online: 28 February 2013 Springer Science+Business Media New York 2013
Abstract Mounting evidence from clinic and convenience samples suggests that stress is an important predictor of adverse obstetric outcomes.Usinga proposedtheoretical framework,this review identied and synthesized the population-based literature on the measurement of stress prior to and during pregnancy in relation to obstetric outcomes. Population-based, peer-reviewed empirical articles that examined stress prior to or during pregnancy in relation to obstetric outcomes were identied 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. Thirteen studies were evaluated. The identied 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 environmentaldomain(e.g.lifeevents)only(n = 9),twostudies
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 conicting ndings exist. 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 ll the existing gaps in the literature and to develop a more comprehensive understanding of the mechanisms by which stress impacts obstetric outcomes.
Keywords Maternal stress Stress measurement
Lifecourse Obstetric outcomes Population-based
Review
Introduction
Poor obstetric outcomes (e.g. low birthweight, pregnancy complications) are serious public health problems, accounting for over 40 % of all neonatal deaths and a substantial proportion of neurodevelopmental disabilities in the United States [13]. Mounting clinic-based evidence suggests that stress is an important risk factor for poor obstetric outcomes [413].
Theory suggests that stress is a process by which environmental demands tax or exceed the adaptive capacity of an organism, resulting in psychological and biological changes...