Pre-pregnancy stress reactivity and pregnancy outcome

Abstract

Summary Stress has been proposed as a cause of preterm birth (PTB) and small for gestational age (SGA), but stress does not have the same effects on all women. It may be that a woman’s reaction to stress relates to her pregnancy health, and previous studies indicate higher reactivity is associated with reduced birthweight and gestational age. The objective of the study was to examine the relationship between pre-pregnancy cardiovascular reactivity to stress and pregnancy outcome. The sample included 917 women in the Coronary Artery Risk Development in Young Adults (CARDIA) Study who had cardiovascular reactivity measured in 1987–1988 and at least one subsequent singleton live birth within an 18-year period. Cardiovascular reactivity was measured using a video game, star tracing, and cold pressor test. Gestational age and birthweight were based on the women’s self-report, with PTB defined as birth <37 weeks’ gestation and SGA as weight <10th percentile for gestational age. Linear and poisson regression and generalised estimating equations were used to model the relationship between reactivity to stress and birth outcomes with control for confounders. Few associations were seen between reactivity and pregnancy outcomes. Higher pre-pregnancy diastolic blood pressure (adjusted relative risk, 1.14, 95% confidence interval 0.98–1.34) and mean arterial pressure (MAP) reactivity (1.15, 0.98–1.36) were associated with risk of PTB at first pregnancy, while SGA was associated with lower SBP reactivity (0.76, 0.60–0.95). No associations were seen with other measures of reactivity. Contrary to hypothesis, the association between heart rate reactivity and preterm birth in first pregnancy was stronger in whites (aRRs 1.39, 1.03–1.88) than in blacks (1.00, 0.83–1.20; p for interaction=0.08). Similar results were found for mean arterial pressure. No strong associations were found between higher pre-pregnancy stress reactivity and SGA or PTB, and stress reactivity did not have a stronger association with birth outcomes in blacks than whites.

Physiological reactivity to psychological stress in human pregnancy: Current knowledge and future directions

“…Their results showed higher pre-pregnancy diastolic blood pressure and greater mean arterial pressure reactivity predicted greater likelihood of preterm birth at first pregnancy [94]. However, stress reactivity did not differentially predict risk of preterm birth in Blacks versus Whites.…”

Psychobiobehavioral Model for Preterm Birth in Pregnant Women in Low- and Middle-Income Countries

“…We proposed that the impact of stress on PTB involves intersects between acute and chronic stress (i.e., multidimensional nature of stress) and biological (i.e., biomarkers) and behavioral responses that establish differential pathways to PTB [ 25 , 45 ]. For instance, childhood adversity increases vulnerability to adverse psychological (e.g., depression), physical (e.g., diabetes), and pregnancy (e.g., PTB) health outcomes [ 56 – 58 ]. Consequently, our model draws from the adverse childhood experiences-international questionnaire (ACE-IQ) which is intended to measure chronic stress in early life in individuals irrespective of country of domicile [ 59 ].…”

Preterm Birth and Stressful Life Events

“…Social support interventions need to be guided by predictive models and more needs to be done to elucidate which components of interventions account for the largest variability in birth outcomes. Lastly, more work can be done to evaluate how physiologic responses to stressors might account for health disparities [245]. Progress in improving birth outcomes is undermined by growing health disparities between various sub-populations.…”