title: The complex impact of five years of stress related to life-threatening events on pregnancy outcomes: a preliminary retrospective study.
abstract: OBJECTIVE
  To study the impact of chronic, life-threatening stressors in the form of daily missile attacks, for five consecutive years, on pregnancy outcomes.
  
  
  METHODS
  Charts of deliveries from two neighboring towns in the south of Israel, covering the years 2000 and 2003-2008, were reviewed retrospectively. One city had been exposed to missile attacks, while the other was not. For each year, 100 charts were chosen at random.
  
  
  RESULTS
  Significant association was found between exposure to stress and frequency of pregnancy complications (P=0.047) and premature membrane rupture (P=0.029). A more detailed analysis, based on dividing the stressful years into three distinct periods: early (2003-2004), intermediate (2005-2006) and late (2007-2008), revealed that preterm deliveries were significantly more frequent (P=0.044) during the intermediate period, as was premature membrane rupture during the late period (P=0.014).
  
  
  CONCLUSIONS
  Exposure to chronic life-threatening stress resulted in more pregnancy complications and in particular more premature membrane ruptures. The impact was most significant during the middle period of the 5-year-exposure to the stressor. Hence it seems that factors of duration and habituation may play a role in the impact of chronic, life-threatening stressors on pregnancy.
authors.affiliation: Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: mkeren@clalit.org.il.
authors.forename: M
authors.initials: M
authors.lastname: Keren
authors.affiliation: Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Keren
authors.affiliation: Barzilai Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Eden
authors.affiliation: Barzilai Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Tsangen
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Felsenstein Medical Research Center, Petah Tikva, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Weizman
authors.affiliation: Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Molecular Imaging and Neuropathology Division, Psychiatry Department, Columbia University, New York, NY, USA.
authors.forename: G
authors.initials: G
authors.lastname: Zalsman
mesh_terms: D000328:Adult; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology* / Q000523:psychology*; D006185:Habituation, Psychophysiologic; D006801:Humans; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008016:Life Change Events; D008297:Male; D008499:Medical Records; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000523:psychology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000523:psychology; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000150:complications*; D013997:Time Factors; D000067453:War Exposure / Q000009:adverse effects*
keywords: Chronic life-threatening stress; Differential impact; Pregnancy outcome