title: Does stress influence early pregnancy loss?
abstract: OBJECTIVE
  The purpose of this study is to examine the relationship between stress, cortisol level and the risk for spontaneous abortion and determine the influence of stress on health-related behaviors.
  
  
  METHODS
  Three hundred and twenty-six pregnant women presenting to the emergency department at the Hospital of the University of Pennsylvania from March 1999 through March 2000 were recruited and followed through 22 weeks gestation. Cases were women who experienced a spontaneous abortion and controls were women who maintained their pregnancy. Stress was measured by the Perceived Stress Scale (PSS), the Prenatal Social Environment Inventory (PSEI) and the Index of Spousal Abuse (ISA) prior to confirmation of spontaneous abortion. Blood samples were collected to measure cortisol and sex hormone levels. Urine samples were collected to assess cotinine, cocaine and marijuana use.
  
  
  RESULTS
  No relationship was found between psychosocial stress, as determined by the three stress scales or cortisol level, and the risk for spontaneous abortion. Women with high stress, as measured by the PSEI, were more likely to use cigarettes and marijuana during pregnancy. High psychosocial stress during early pregnancy was not related to spontaneous abortion but high stress was associated with substance use during pregnancy.
  
  
  CONCLUSIONS
  The influence of psychosocial stress on the risk of spontaneous abortion is unclear.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104, USA. dnelson@cceb.med.upenn.edu
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Nelson
authors.forename: Jeane Ann
authors.initials: JA
authors.lastname: Grisso
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Joffe
authors.forename: Colleen
authors.initials: C
authors.lastname: Brensinger
authors.forename: Leslie
authors.initials: L
authors.lastname: Shaw
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Datner
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008385:Marijuana Smoking; D011247:Pregnancy; D012307:Risk Factors; D012907:Smoking; D013315:Stress, Psychological / Q000097:blood; D014505:Urban Population