title: Psychosocial predictors of low birthweight: a prospective study.
abstract: OBJECTIVE
  To examine the role of psychosocial risk factors for low birthweight.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  Obstetric outpatient clinics of the University Hospital Vrije Universiteit, Amsterdam.
  
  
  METHODS
  Three hundred and ninety-six nulliparous women.
  
  
  METHODS
  Questionnaires on background variables, daily stressors, psychological and mental wellbeing, social support and work factors were completed by the women in the first, second and third trimester of pregnancy. Low birthweight for gestational age was defined at different cut off points: 1. < or = 10th customised birthweight centile (n = 69); 2. < or = 5th customised birthweight centile (n = 54); 3. < 3rd customised birthweight centile (n = 35); and 4. < or = the 10th Dutch birthweight centile (n = 40). Multivariate logistic regression was applied and the results were expressed in odds ratios and their 95% confidence intervals.
  
  
  RESULTS
  When the cut off level was defined < or = 5th and < 3rd customised centile, the number of daily stressors in the first trimester was a statistically significant risk factor (OR 1.04, 95% CI 1.01-1.07 and OR 1.04, 95% CI 1.01-1.08). No significant psychosocial risk factors could be identified when low birthweight for gestational age was defined < or = the 10th customised birthweight centile. When low birthweight for gestational age was defined < or = the 10th Dutch birthweight centile, number of hours housekeeping per week in the first trimester (OR 1.59, 95% CI 1.03-2.46), low subjective severity rating of daily stressors in the first trimester (OR 0.41, 95% CI 0.17-0.97) and depressive mood in the first trimester (OR 1.12, 95% CI 1.01-1.24) were statistically significant psychosocial risk factors after controlling for maternal weight and height, number of cigarettes smoked per day and educational level.
  
  
  CONCLUSIONS
  In the first trimester of pregnancy maternal psychosocial factors are associated with an increased risk of low birthweight. The specific psychosocial risk factors found were different when the definition of low birthweight was changed. Therefore, in this field of research, we suggest use of the most valid outcome measure for low birthweight, being the customised birthweight centiles.
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: K M
authors.initials: KM
authors.lastname: Paarlberg
authors.forename: A J
authors.initials: AJ
authors.lastname: Vingerhoets
authors.forename: J
authors.initials: J
authors.lastname: Passchier
authors.forename: G A
authors.initials: GA
authors.lastname: Dekker
authors.forename: A G
authors.initials: AG
authors.lastname: Heinen
authors.forename: H P
authors.initials: HP
authors.lastname: van Geijn
mesh_terms: D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000209:etiology; D004522:Educational Status; D005260:Female; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007398:Interpersonal Relations; D018811:Maternal Exposure; D009426:Netherlands / Q000453:epidemiology; D010298:Parity; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D012923:Social Class; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*