title: Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Jundiaí city, São Paulo state, Brazil.
  
  
  METHODS
  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 <or=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.
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil. phcrondo@usp.br
authors.forename: P H C
authors.initials: PH
authors.lastname: Rondó
authors.forename: R F
authors.initials: RF
authors.lastname: Ferreira
authors.forename: F
authors.initials: F
authors.lastname: Nogueira
authors.forename: M C N
authors.initials: MC
authors.lastname: Ribeiro
authors.forename: H
authors.initials: H
authors.lastname: Lobert
authors.forename: R
authors.initials: R
authors.lastname: Artes
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects; D003069:Coffee / Q000009:adverse effects; D005260:Female; D005317:Fetal Growth Retardation / Q000523:psychology*; D006801:Humans; D007230:Infant, Low Birth Weight / Q000523:psychology*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000523:psychology*; D008137:Longitudinal Studies; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013315:Stress, Psychological / Q000523:psychology*
chemical_list: D003069:Coffee