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Severe stress following bereavement during pregnancy and risk of pregnancy loss: results from a population-based cohort study
  1. Oleguer Plana-Ripoll1,
  2. Erik Parner2,
  3. Jørn Olsen1,3,
  4. Jiong Li1
  1. 1Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
  2. 2Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
  3. 3Department of Epidemiology, UCLA School of Public Health, Los Angeles, California, USA
  1. Correspondence to Oleguer Plana-Ripoll, Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark; opr{at}ph.au.dk

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.

  • PREGNANCY
  • REPRODUCTION
  • PSYCHOLOGICAL STRESS

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