Although there has been considerable accumulation of knowledge in psychosomatic obstetrics during the past few decades, the critical level of psychosocial stress above which sub-optimal pregnancy outcome can be said to occur remains indeterminate. Consequently, it is virtually impossible on the basis of psychosocial stress inventory for a prenatal care provider to accurately identify those women who are truly at the risk of stress-related poor pregnancy outcome.In our recent study of 185 primigravidas selected for their low baseline medical risk factors, the inability to cope (which we defined operationally as psychosocial distress and determined clinically from the participants' scores on the Hope Index Scale) was found to be highly predictive of pregnancy outcome with a positive predictive value of 0.8 1. The 3-year prospective study also suggests that lower socioeconomic status may not be a true risk factor in an otherwise low medical risk pregnancy.We conclude that in screening for the pregnant woman at risk, even in the absence of apparent biomedical risk factors, a determination of the ability or inability to cope is essential for an accurate prediction of pregnancy outcome. 0167-482X/84/$03.00 0 1984 Elsevier Science Publishers B.V. J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.

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