title: Psychological stress during pregnancy and stillbirth: prospective study.
abstract: OBJECTIVE
  To study the association between psychological stress during pregnancy and stillbirth.
  
  
  METHODS
  Prospective follow-up study.
  
  
  METHODS
  Aarhus University Hospital, Skejby, Denmark,1989-98.
  
  
  METHODS
  A total of 19 282 singleton pregnancies in women with valid information about psychological stress during pregnancy.
  
  
  METHODS
  Information about psychological stress during pregnancy was obtained from questionnaires and measured by the 12-item General Health Questionnaires (GHQ). A score was generated by the sum of all the answers, each contributing a value between 0 (low psychological stress) and 3 (high psychological stress). Women with an intermediate level of psychological stress (scores of 7-11) were considered the reference group. Scores of 0-6 were defined as a low level of psychological stress and scores of 12-36 as the highest level. The association between psychological stress and stillbirth was presented as relative risks with 95% CIs. Adjustment for potential confounding factors was carried out by logistic regression analyses.
  
  
  METHODS
  Stillbirth (delivery of a dead fetus at >28 weeks of gestation).
  
  
  RESULTS
  There were 66 stillbirths (3.4 per thousand) in the population studied. Compared with women with an intermediate level of psychological stress during pregnancy, women with a high level of stress had 80% increased risk of stillbirth (relative risk = 1.8; 95% CI 1.1-3.2). Adjustment for maternal age, parity, maternal pre-pregnancy body mass index, smoking habits, alcohol and caffeine intake during pregnancy, education and cohabitation failed to change the result. The results remained essentially unchanged after exclusion of preterm deliveries. Exclusion of women with complications during pregnancy such as diabetes, hypertension, vaginal bleeding, immunisation and imminent preterm delivery failed to change the results. Likewise, restriction to women's first pregnancy in the cohort did not change the results.
  
  
  CONCLUSIONS
  Psychological stress during pregnancy was associated with an increased risk of stillbirth.
authors.affiliation: Perinatal Epidemiology Research Unit, Department of Obstetrics and Paediatrics, Aarhus University Hospital, Aarhus N, Denmark. kirstenwisborg@dadlnet.dk
authors.forename: K
authors.initials: K
authors.lastname: Wisborg
authors.forename: A
authors.initials: A
authors.lastname: Barklin
authors.forename: M
authors.initials: M
authors.lastname: Hedegaard
authors.forename: T B
authors.initials: TB
authors.lastname: Henriksen
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*