title: Maternal life events and adverse pregnancy outcomes: lessons from the Auvergne ectopic pregnancy registry.
abstract: OBJECTIVE
  To investigate stressful maternal life events as candidate risk factors for ectopic pregnancy.
  
  
  METHODS
  Population-based registry study.
  
  
  METHODS
  Auvergne ectopic pregnancy registry (France).
  
  
  METHODS
  Women (n = 641) registered between 1997 and 2000.
  
  
  METHODS
  Standard treatment of ectopic pregnancy.
  
  
  METHODS
  Based on the Psychiatric Epidemiology Life Events Scale, we analyzed the nonresponse bias, the confounding effects of sociobehavioral factors associated with both life events and ectopic pregnancy, and the potential buffering effects of socio-cultural variables. A multivariate model was constructed to test the association between life events and ectopic pregnancy, adjusting for identified confounders and testing interactions.
  
  
  RESULTS
  The primary hypothesis that life events might be independent risk factors for ectopic pregnancy was not confirmed in this study, which nevertheless illustrated the numerous biases and measurement problems confronting association studies of life events with adverse pregnancy outcomes.
  
  
  CONCLUSIONS
  Recommendations are made for future studies on life events and adverse pregnancy outcomes to avoid most selection, information, and confounding biases. Methodological improvements are needed for measurement of life events to develop measures that more closely consider the consequences of stress and the mechanisms of buffering.
authors.affiliation: INSERM Unité 569, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France. joel.coste@cch.ap-hop-paris.fr
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Jean
authors.initials: J
authors.lastname: Bouyer
authors.forename: Nadine
authors.initials: N
authors.lastname: Job-Spira
mesh_terms: D000328:Adult; D015982:Bias; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008016:Life Change Events; D017533:Marital Status; D015999:Multivariate Analysis; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000453:epidemiology / Q000523:psychology*; D012042:Registries; D012747:Sexual Partners / Q000523:psychology; D012907:Smoking; D012959:Socioeconomic Factors; D013315:Stress, Psychological