Life stressors, hypertensive disorders of pregnancy, and preterm birth

Abstract

Background

Stress-induced pregnancy complications are thought to represent a significant cause of maternal morbidity and mortality; little is known regarding types of stress most predictive of adverse outcomes.

Methods

We used Utah PRAMs 2012–2014 data to evaluate links between preconception life stressors and prevalence of hypertensive disorders of pregnancy (HDP) and pre-term labor (PTB) (births <37 weeks gestational age, and very PTB <33 weeks). We categorized 12 specific stressful events into 4 groups: partner, traumatic, financial, and emotional. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated controlling for important sociodemographic, lifestyle, and pregnancy history factors.

Results

4,378 mothers completed the survey. 26.6%, 12.2%, 32.2%, and 28.4% reported partner, traumatic, financial, and emotional-related stress. Reporting any of the 4-types of life stress was linked with increased prevalence of HDP (aPR: 1.46 [95% CI: 0.96, 2.22]) after adjusting for age, race/ethnicity, BMI, education, prior diagnosis of high blood pressure, and prior history of preterm labor. The strongest association was observed for financial stress (aPR: 1.50 [95% CI: 1.03, 2.18]). Financial stress was also associated with increased prevalence of very PTB (aPR: 1.61 [95% CI: 1.03, 2.51]) after adjustment.

Conclusion

Women reporting financial stress, including job loss, pay reduction, or difficulty paying bills, had increased prevalence of HDP and very PTB.

Keywords:

• Hypertensive disorders of pregnancy
• life stress
• pre-eclampsia
• prenatal stress
• premature birth
• pregnancy risk assessment and monitoring system (PRAMS)

Acknowledgments

Data were provided by the Utah Pregnancy Risk Assessment Monitoring System (PRAMS), a project of the Utah Department of Health (UDOH), the Office of Vital Records and Health Statistics of the UDOH, and the Center for Disease Control and Prevention (CDC) of the United States Health and Human Services Department. This report does not represent the official views of the CDC, Utah Department of Health, or the NIH.

Disclosure statement

All authors report no conflicts of interest.

Data availability

Data are available via a CDC PRAMs Application Form https://www.cdc.gov/prams/prams-data/researchers.htm