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Arch Womens Ment Health. 2019 Jun 29. doi: 10.1007/s00737-019-00970-8. [Epub ahead of print]

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

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Departments of Psychiatry and Obstetrics and Gynecology, Columbia University, 630 West 168th Street, PH1540H, New York, NY, 10032, USA.
Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
RTI International, Research Triangle Park, NC, USA.
Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Obstetrics and Gynecology, University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA.
Departments of Obstetrics and Gynecology and Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA.
Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN, USA.
Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA.
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
Department of Obstetrics and Gynecology, University of Texas Medical Branch, University of Texas, Galveston, TX, USA.
Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA.


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. Registration number NCT02231398.


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


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