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Measuring Stress Before and During Pregnancy: A Review of Population-Based Studies of Obstetric Outcomes

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Abstract

Mounting evidence from clinic and convenience samples suggests that stress is an important predictor of adverse obstetric outcomes. Using a proposed theoretical framework, this review identified 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 identified 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 identified 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 environmental domain (e.g. life events) only (n = 9), two studies 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 conflicting findings 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 fill the existing gaps in the literature and to develop a more comprehensive understanding of the mechanisms by which stress impacts obstetric outcomes.

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Acknowledgments

This project has been funded in whole or in part with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services (Contract Nos HHSN275200503396C and HHSN275201100014C, National Children’s Study Wisconsin Study Center (PI: M. Durkin and S. Leuthner). The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Additional funding for this research was provided by a grant from the Health Disparities Research Scholars Program (FW; T32 HD049302; PI: G. Sarto). We would also like to thank the anonymous reviewers for their helpful comments and suggestions.

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Authors and Affiliations

  1. Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, 610 North Walnut Street, Office 503, Madison, WI, 53726, USA

    Whitney P. Witt

  2. Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, 610 North Walnut Street, Office 707, Madison, WI, 53726, USA

    Kristin Litzelman, Erika R. Cheng, Fathima Wakeel & Emily S. Barker

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  1. Whitney P. Witt
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Correspondence to Whitney P. Witt.

Appendix

Appendix

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Table 3 Additional information from the population-based studies listed in Table 2
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Witt, W.P., Litzelman, K., Cheng, E.R. et al. Measuring Stress Before and During Pregnancy: A Review of Population-Based Studies of Obstetric Outcomes. Matern Child Health J 18, 52–63 (2014). https://doi.org/10.1007/s10995-013-1233-x

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