Associations of perceived prenatal stress and adverse pregnancy outcomes with perceived stress years after delivery

Abstract

Maternal stress is a risk factor for adverse pregnancy outcomes (APOs). This study evaluates the associations of prenatal stress and APOs with maternal stress years after pregnancy. The 10-item Perceived Stress Scale (PSS) (0-40 range) was completed in the first and third trimesters, and 2-7 years after delivery among a subsample (n = 4161) of nulliparous women enrolled at eight US medical centers between 2010 and 2013 in a prospective, observational cohort study. Demographics, medical history, and presence of APOs (gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preeclampsia (PE), and medically indicated or spontaneous preterm birth (miPTB, sPTB)) were obtained. The associations of prenatal PSS and the presence of APOs with PSS scores years after delivery were estimated using multivariable linear regression. Mean PSS scores were 12.5 (95% CI 12.3, 12.7) and 11.3 (95% CI 11.1, 11.5) in the first and third trimesters respectively and 14.9 (95% CI 14.7, 15.1) 2-7 years later, an average increase of 2.4 points (95% CI 2.2, 2.6) from the start of pregnancy. Regressing PSS scores after delivery on first-trimester PSS and PSS increase through pregnancy showed positive associations, with coefficients (95% CI) of 2.8 (2.7, 3.0) and 1.5 (1.3, 1.7) per 5-point change, respectively. Adding APO indicator variables separately showed higher PSS scores for women with HDP (0.7 [0.1, 1.3]), PE (1.3 [0.6, 2.1]), and miPTB (1.3 [0.2, 2.4]), but not those with GDM or sPTB. In this geographically and demographically diverse sample, prenatal stress and some APOs were positively associated with stress levels 2-7 years after pregnancy.ClinicalTrials.gov Registration number NCT02231398.

Keywords: Adverse pregnancy outcomes; Perceived stress; Preeclampsia (5); Prenatal maternal stress; Preterm birth.

Conflict of interest statement

Disclosure of potential conflicts of interests:

Author X has received speaker honorariums and consulting paid to Cedars-Sinai Medical Center from the American College of OB-GYN (lecture), Atlantic Health System (lecture), Abbott Diagnostics (lectures), American College of Cardiology (lectures), Cardio NAH Health Systems (lectures), Expert Exchanges (lectures), INOVA Health systems (lecture), George Washington University (lecture), Med Ed (lecture), Northwestern (young investigators grant review), Pri-Med (lectures), Oklahoma Chapter of American College of Cardiology (lecture), Renown Health System Reno (lectures), San Diego Heart Institute (lectures), Society of Vascular Medicine (lecture), St Francis Medical Center Hartford (lecture), University of Minnesota (lecture), USCF (lecture), University of Capetown (lecture), and University of Colorado (lecture). Author X has received honorarium and consulting from ACRWH (NIH advisory council), NIH-CASE (grant review study section), Springer International (book honorarium), Decision Support in Medicine LLC (book honorarium), and iRhythm (board director), and NHLBI subcontract to Research Triangle Institute (RTI) International. Author X has received personal research funding from WISE HFpEF, RWISE, Microvascular, Normal Control, FAMRI, Department of Defense, and California Institute for Precision Medicine. All other authors declare that there are no conflicts of interest.

Figures

Figure 1.

Conceptual Model Guiding our Research Questions.