title: Spontaneous Pregnancy Loss in Denmark Following Economic Downturns.
abstract: An estimated 11%-20% of clinically recognized pregnancies result in spontaneous abortion. The literature finds elevated risk of spontaneous abortion among women who report adverse financial life events. This work suggests that, at the population level, national economic decline-an ambient and plausibly unexpected stressor-will precede an increase in spontaneous abortion. We tested this hypothesis using high-quality information on pregnancy and spontaneous loss for all women in Denmark. We applied time-series methods to monthly counts of clinically detected spontaneous abortions (n = 157,449) and the unemployment rate in Denmark beginning in January 1995 and ending in December 2009. Our statistical methods controlled for temporal patterns in spontaneous abortion (e.g., seasonality, trend) and changes in the population of pregnancies at risk of loss. Unexpected increases in the unemployment rate preceded by 1 month a rise in the number of spontaneous abortions (β = 33.19 losses/month, 95% confidence interval: 8.71, 57.67). An attendant analysis that used consumption of durable household goods as an indicator of financial insecurity supported the inference from our main test. Changes over time in elective abortions and in the cohort composition of high-risk pregnancies did not account for results. It appears that in Denmark, ambient stressors as common as increasing unemployment may precede a population-level increase in spontaneous abortion.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Bruckner
authors.forename: Laust H
authors.initials: LH
authors.lastname: Mortensen
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Catalano
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D003718:Denmark / Q000453:epidemiology; D057172:Economic Recession; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012042:Registries; D013315:Stress, Psychological / Q000150:complications* / Q000209:etiology; D014478:Unemployment / Q000706:statistics & numerical data*
keywords: economic recession; fetal mortality; psychological stress; spontaneous abortion