title: Exposure to life-threatening stressful situations and the risk of preterm birth and low birth weight.
abstract: OBJECTIVE
  To evaluate the association between exposure to life-threatening rocket attacks and the risks of preterm birth (PTB) and low birth weight (LBW).
  
  
  METHODS
  The present retrospective cohort study compared the outcomes of 1851 births by women exposed to rocket attacks and 2979 births by unexposed women. The timing, frequency, and intensity of exposure were calculated for each trimester and for the entire pregnancy period. Demographic and medical data were abstracted from the patients' records.
  
  
  RESULTS
  The rates of PTB and LBW were higher among exposed than unexposed women (PTB: 9.1% versus 6.8%, P=0.004; LBW: 7.6% versus 5.8%, P=0.02). The rate of infants who were small for gestational age did not differ between the groups. After controlling for potential confounders, the risks for PTB and LBW remained significantly higher in the exposed group (PTB: adjusted odds ratio 1.3 [95% confidence interval, 1.1-1.7]; LBW: adjusted odds ratio 1.3 [95% confidence interval, 1.03-1.7]). There was no linear association between the intensity of exposure and the risk of PTB or LBW.
  
  
  CONCLUSIONS
  Maternal exposure to intermittent but repeated life-threatening rocket attacks for a prolonged period might be associated with increased risks of PTB and LBW.
authors: Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: wainstoc@post.bgu.ac.il.
authors: Tamar
authors: T
authors: Wainstock
authors: Department of Obstetrics and Gynecology, Barzilai Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashkelon, Israel.
authors: Eyal Y
authors: EY
authors: Anteby
authors: Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
authors: Saralee
authors: S
authors: Glasser
authors: Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Liat
authors: L
authors: Lerner-Geva
authors: Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Ilana
authors: I
authors: Shoham-Vardi
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007557:Israel / Q000453:epidemiology; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D023481:Terrorism / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult
keywords: Low birth weight; Prenatal stress; Preterm birth