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J Epidemiol Community Health. 2016 May;70(5):424-9. doi: 10.1136/jech-2015-206241. Epub 2015 Nov 19.

Severe stress following bereavement during pregnancy and risk of pregnancy loss: results from a population-based cohort study.

Author information

1
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
2
Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.
3
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark Department of Epidemiology, UCLA School of Public Health, Los Angeles, California, USA.

Abstract

BACKGROUND:

Previous findings on the association between stress during pregnancy and pregnancy loss are inconsistent. We aimed to estimate this association using a large prospective cohort.

METHODS:

This population-based study included all 1 303 660 clinically recognised pregnancies in Denmark between 1995 and 2008. We categorised women as exposed to severe stress if they lost a child, sibling or parent during pregnancy. Cox Proportional Hazards models were used to study the association between exposure and rate of fetal death, starting with the follow-up on the day of completion of week 4 of pregnancy. In an attempt to control for unknown potential confounders, we also designed a pregnancy-matched analysis in which each woman had her own baseline risk of pregnancy loss and controls therefore for genetic and time-stable environmental factors.

RESULTS:

A total of 146 031 pregnancies ended in clinically recognised fetal loss (11.2%) and a total of 10 808 (0.8%) women were categorised as exposed. The overall risk of pregnancy loss was similar in the exposed and unexposed (aHR=1.05, 95% CI 0.95 to 1.15). Results from the pregnancy-matched analysis (performed in 423 women) showed stronger and significant associations (aHR=1.83, 95% CI 1.49 to 2.25). All the analyses indicated a stronger effect of bereavement when the mother lost a child or when the death was unexpected.

CONCLUSIONS:

Our main results suggested no strong association between severe stress during pregnancy and risk of pregnancy loss. Results from the pregnancy-matched analyses considered information from a selected and small group of women for whom there may exist a stronger association between stress during pregnancy and pregnancy loss. The fact that an unexpected death or the loss of a child had a stronger effect in both analyses may indicate that severe stressful situations increase the risk of pregnancy loss.

KEYWORDS:

PREGNANCY; PSYCHOLOGICAL STRESS; REPRODUCTION

PMID:
26584858
DOI:
10.1136/jech-2015-206241
[Indexed for MEDLINE]

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