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

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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.

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Abbreviations

APOs:

Adverse pregnancy outcomes

HDP:

Hypertensive disorders of pregnancy

GDM:

Gestational diabetes mellitus

GHTN:

Gestational hypertension

PE:

Preeclampsia

PTB:

Preterm birth

miPTB:

Medically indicated preterm birth

sPTB:

Spontaneous preterm birth

PSS:

Perceived Stress Scale

nuMoM2b:

Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be

HHS:

Heart Health Study

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Funding

This study is funded by cooperative agreement funding from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10-HL119991, U10-HL119989, U10-HL120034, U10-HL119990, U10-HL120006, U10-HL119992, U10-HL120019, U10-HL119993, and U10-HL120018. Supplemental funding for this analysis was provided by the National Institutes of Health Office of Behavioral and Social Sciences Research through U10-HL119992. In addition, support was provided by the National Institutes of Health National Center for Research Resources and National Center for Advancing Translational Sciences to Clinical and Translational Science Institutes at Indiana University (UL1TR001108), University of California, Irvine (UL1TR000153), and the National Center for Advancing Translational Sciences Grant UL1TR000124, the Barbra Streisand Women’s Cardiovascular Research and Education Program, and the Erika Glazer Women’s Heart Health Project, Cedars-Sinai Medical Center, Los Angeles, California.

Author information

Authors and Affiliations

  1. Departments of Psychiatry and Obstetrics and Gynecology, Columbia University, 630 West 168th Street, PH1540H, New York, NY, 10032, USA

    Catherine Monk

  2. Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Rachel S. Webster

  3. RTI International, Research Triangle Park, NC, USA

    Rebecca B. McNeil & Corette B. Parker

  4. Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA

    Janet M. Catov & Hyagriv N. Simhan

  5. Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA

    Philip Greenland

  6. Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    C. Noel Bairey Merz

  7. Department of Obstetrics and Gynecology, University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA

    Robert M. Silver

  8. Departments of Obstetrics and Gynecology and Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA

    Deborah B. Ehrenthal

  9. Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA

    Judith H. Chung

  10. Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN, USA

    David M. Haas

  11. Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA

    Brian M. Mercer & LuAnn Polito

  12. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA

    Samuel Parry

  13. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA

    Uma M. Reddy

  14. Department of Obstetrics and Gynecology, University of Texas Medical Branch, University of Texas, Galveston, TX, USA

    George R. Saade

  15. Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA

    William A. Grobman

Authors
  1. Catherine Monk
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  2. Rachel S. Webster
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  3. Rebecca B. McNeil
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  4. Corette B. Parker
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  5. Janet M. Catov
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  6. Philip Greenland
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  7. C. Noel Bairey Merz
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  8. Robert M. Silver
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  14. Samuel Parry
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  16. Uma M. Reddy
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  17. George R. Saade
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  18. William A. Grobman
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Consortia

for the NICHD nuMoM2b and NHLBI nuMoM2b Heart Health Study Networks

Corresponding author

Correspondence to Catherine Monk.

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Conflict of interest

Author C. Noel Bairey Merz 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 C. Noel Bairey Merz 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 C. Noel Bairey Merz has received personal research funding from WISE HFpEF, RWISE, Microvascular, Normal Control, FAMRI, Department of Defense, and California Institute for Precision Medicine. Authors Catherine Monk, Rachel S. Webster, Rebecca B. McNeil, Corette B. Parker, Janet M. Catov, Philip Greenland, Robert M. Silver, Hyagriv N. Simhan, Deborah B. Ehrenthal, Judith H. Chung, David M. Haas, Brian M. Mercer, Samuel Parry, LuAnn Polito, Uma M. Reddy, George R. Saade, William A. Grobman declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Study procedures were approved by each center’s institutional review board prior to initiation of the study and written informed consent was obtained from all individual participants included in this study.

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Monk, C., Webster, R.S., McNeil, R.B. et al. Associations of perceived prenatal stress and adverse pregnancy outcomes with perceived stress years after delivery. Arch Womens Ment Health 23, 361–369 (2020). https://doi.org/10.1007/s00737-019-00970-8

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