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Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation

European Journal of Clinical Nutrition volume 57, pages 266–272 (2003)Cite this article

Abstract

Objectives: To evaluate: (1) the associations between maternal psychological stress, distress and low birth weight (LBW), prematurity and intrauterine growth retardation (IUGR); (2) the interactions between maternal stress, distress and smoking, alcohol and coffee intake; (3) the prevalences of stress and distress in pregnancy.

Design: Longitudinal cohort study.

Setting: Jundiaí city, São Paulo state, Brazil.

Subjects: A total of 865 pregnant women who attended antenatal care between September 1997 and August 2000.

Methods: Measures of stress and distress were obtained, by interview, three times in pregnancy: at a gestational age (GA) lower than 16 weeks, from 20 to 26 weeks and from 30 to 36 weeks. Stress was investigated by the perceived stress scale, PSS, and distress by both the general health questionnaire, GHQ, and the State Trait Anxiety inventories, STAI. The outcomes were: LBW (birth weight <2500 g), prematurity (gestational age (GA) at birth <37 weeks) and IUGR (birth weight for GA ≤10th percentile of William's curve). The associations between the outcomes and the psychological measures were assessed in multiple logistic regression models.

Results: Maternal distress was associated with LBW (RR=1.97, P=0.019) and prematurity (RR=2.32, P=0.015), respectively. There was an interaction between distress and smoking in the second interview (P=0.05). The prevalences of stress and distress in the different interviews of pregnancy varied from 22.1 to 52.9%.

Conclusions: The present study has confirmed that distress is associated with both birthweight and GA. Further research is needed to evaluate the effectiveness of psychological interventions that can improve maternal and foetal well-being.

Sponsorship: Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP (grant no. 1998/00321-0).

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Acknowledgements

We thank the pregnant women whose participation made this study possible, and the field workers Veranilce F Oliveira, Márcia R Souza, Sandra Vergílio, Rosemary F Ferreira, Janaina de Carvalho, Kátia K Valverde and Valéria Sttopa for their assistance. Scholarships from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) supported three of the field workers. The authors gratefully acknowledge Dr Ronaldo Moisés, Ms Vera M Saccheto, Dr Mauri Senise and Dr Gustavo Albuquerque from the Hospital Maternidade de Jundiaí; Dr Maria Emilia Ganito, Dr Alessandro D'Angieri, Dr Paulo Pontes, Dr Nelson O Maia, Dr Maria Emília R Miglioli and Dr Renato Tardelli from Hospital de Caridade São Vicente de Paulo; Dr Silvia Borgonovi, Dr Silvia Vilas Boas de Oliveira and Dr José Paulo May from Hospital Dr Paulo Sacramento; Dr Carim Chahine Yossef from Hospital Santa Rita de Cássia; Dr Jonas Zulpo, Dr Komei Samejima and Dr Cecília M Cordeiro from Casa de Saúde Dr Domingos Anastácio; Dr Rui Otanara and Dr Moacyr RF Paula from Centro Médico Pitangueiras; Dr Rubens A Dutra Alves and Dr Júlio C Lamarca Health Secretaries of Jundiaí, for allowing us to carry out our study in the hospitals and health centres of this city. Dr Laura C Rodrigues from the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine and Professor Andrew Tomkins from the Centre for International Child Health, University of London, are acknowledged for fruitful discussions concerning the analysis and results of the study.

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Author notes

  1. P H C Rondó: Guarantor: PHC Rondó.

  2. P H C Rondó, R F Ferreira, F Nogueira, M C N Ribeiro, H Lobert and R Artes: Contributors: PHCR designed the study protocol, secured funding, facilitated data collection, participated in the statistical analysis, interpreted data and did the main writing of the paper. RFF assisted in locating the study areas, coordinated all the data collection and participated in the interpretation of data. FN, HL and RA performed statistical data analysis, participated in the interpretation of the results and in discussion. MCNR participated in the interpretation of data and writing of the paper.

Authors and Affiliations

  1. Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil

    P H C Rondó, R F Ferreira & M C N Ribeiro

  2. Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil

    F Nogueira, H Lobert & R Artes

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Correspondence to P H C Rondó.

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Rondó, P., Ferreira, R., Nogueira, F. et al. Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation. Eur J Clin Nutr 57, 266–272 (2003). https://doi.org/10.1038/sj.ejcn.1601526

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