title: Is psychosocial stress in first ongoing pregnancies associated with pre-eclampsia and gestational hypertension?
abstract: OBJECTIVE
  Investigating the association of pre-eclampsia and gestational hypertension with psychosocial stress in the first half of pregnancy.
  
  
  METHODS
  Prospective community-based cohort study.
  
  
  METHODS
  Amsterdam, The Netherlands.
  
  
  METHODS
  Between January 2003 and March 2004, all pregnant Amsterdam women (n = 12 377) were invited to fill in a questionnaire with sociodemographic and psychosocial variables (response rate 67%). Only nulliparous women with a singleton pregnancy, who completed the questionnaire before 24 weeks, and delivered after 24 weeks, were included.
  
  
  METHODS
  A postpartum questionnaire was used to gather information on hypertension or proteinuria. If this questionnaire was not available, the national obstetric register was used for pregnancy outcome. Medical files were examined for women with hypertension and/or proteinuria to confirm the diagnosis of pre-eclampsia and gestational hypertension according to the International Society for the Study of Hypertension in Pregnancy guidelines. Psychosocial stress was defined as workstress (Work Experience and Appreciation Questionnaire partly based on the Job Content Instrument of Karasek et al.), anxiety (the State-Trait Anxiety Inventory), depression (Center for Epidemiological Studies Depression Scale) and pregnancy-related anxiety (PRAQ-R). The association of psychosocial stress with the incidence of pre-eclampsia and gestational hypertension was explored by multivariate analysis adjusted for sociodemographic and medical confounders.
  
  
  METHODS
  Incidence of pre-eclampsia and gestational hypertension.
  
  
  RESULTS
  A total of 3679 women were included. The incidence of pre-eclampsia and gestational hypertension was 3.5 and 4.4%, respectively. Workstress, anxiety, pregnancy-related anxiety or depression had no effect on the incidence of pre-eclampsia or gestational hypertension.
  
  
  CONCLUSIONS
  Psychosocial stress in the first half of pregnancy does not influence the incidence of pre-eclampsia and gestational hypertension in nulliparous women.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands. k.c.vollebregt@amc.uva.nl
authors.forename: K C
authors.initials: KC
authors.lastname: Vollebregt
authors.forename: M F
authors.initials: MF
authors.lastname: van der Wal
authors.forename: H
authors.initials: H
authors.lastname: Wolf
authors.forename: T G M
authors.initials: TG
authors.lastname: Vrijkotte
authors.forename: K
authors.initials: K
authors.lastname: Boer
authors.forename: G J
authors.initials: GJ
authors.lastname: Bonsel
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000523:psychology*; D009784:Occupational Diseases / Q000523:psychology*; D010298:Parity; D011225:Pre-Eclampsia / Q000523:psychology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D013315:Stress, Psychological / Q000209:etiology*