Wadhwa, PD, Sandman, CA, Porto, M, Dunkel-Schetter, C & Garite, TJ. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am. J. Obstet. Gynecol., 169, 858-865

Department of Obstetrics and Gynecology, University of California, Irvine.
American Journal of Obstetrics and Gynecology (Impact Factor: 4.7). 11/1993; 169(4):858-65. DOI: 10.1016/0002-9378(93)90016-C
Source: PubMed


The aim was to test a model of the influence of maternal prenatal psychosocial stress on birth outcomes after controlling for biomedical risk.
In a prospective study a sociodemographically homogeneous sample of 90 women was assessed during the third trimester with standard, reliable questionnaires that measured episodic and chronic stress, strain (response to stress), and pregnancy-related anxiety. Birth outcomes included infant birth weight, gestational age at birth, and intrapartum complications. Parity and biomedical (antepartum) risk was also coded. Bivariate and multivariate analyses were performed after controlling for the effects of biomedical risk factors.
Independent of biomedical risk, each unit increase of prenatal life event stress (from a possible sample range of 14.7 units) was associated with a 55.03 gm decrease in infant birth weight and with a significant increase in the likelihood of low birth weight (odds ratio 1.32), and each unit increase of prenatal pregnancy anxiety (from a possible sample range of 5 units) was associated with a 3-day decrease in gestational age at birth.
Independent of biomedical risk, maternal prenatal stress factors are significantly associated with infant birth weight and with gestational age at birth.

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    • "However the importance of screening for PrA is also evident with PrA consistently linked to negative outcomes for the unborn baby (i.e. preterm birth, low birth weight, difficult infant temperament, and negative affectivity; Blair et al., 2011; Wadhwa et al., 1993). These are all known to be detrimental to the infant's health, wellbeing and development (Dunkel-Schetter, 2011) and all potentially placing unborn children (of mother's with PrA) at risk if this anxiety is undetected. "
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    ABSTRACT: Depression in pregnancy is a serious health issue; however, anxiety in pregnancy, with a reported higher prevalence, may also be a serious issue. Anxiety symptoms in pregnancy can relate to several anxiety types, such as general anxiety, anxiety disorders, and pregnancy-related anxiety (PrA), anxiety characterised by pregnancy specific fears and worries. Awareness of these distinctions however, is not always widespread. Both general anxiety and PrA are associated with maternal negative outcomes (e.g. increased nausea) however; PrA is more often associated with negative outcomes for the child (e.g. preterm birth). Furthermore, PrA is potentially a risk factor for postnatal depression with assessment of PrA potentially affording important intervention opportunities. Currently several different instruments are used for PrA however their psychometric properties are unclear. To our knowledge a review of current instruments and their psychometric properties is lacking, this paper aims to fill that gap. Studies, which assessed PrA, published between 1983 and 2013 in peer-reviewed journals, were identified. Sixty studies were identified after applying inclusion/exclusion criteria, and classified as: pregnancy-related anxiety specific, scales for other constructs, sub scales of another instrument and general anxiety scales. Each scale׳s strengths and limitations were discussed. Our findings may be limited by restricting our review to peer-reviewed journals. This was done however as we sought to identify scales with good psychometric properties. Currently no scales are available for pregnancy-related anxiety with sound theoretical and psychometric properties. Clinically the need for such a scale is highlighted by the potential intervention opportunities this may afford. Future research should be directed towards the development of such a scale. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 05/2015; 176. DOI:10.1016/j.jad.2015.01.039 · 3.38 Impact Factor
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    • "Perceived stress during pregnancy is especially problematic because stress is associated with negative outcomes for both the pregnant woman and the baby, including low birthweight and premature birth; neonatal health issues, including impaired cognitive development; postpartum depression; and maternal-newborn attachment issues [17-20]. There is some evidence that women with unwanted pregnancies have higher perceived stress during pregnancy than women with wanted or mistimed pregnancies [21]. "
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    ABSTRACT: Background Examining women’s stress and social support following denial and receipt of abortion furthers understanding of the effects of unwanted childbearing and abortion on women’s well-being. This study investigated perceived stress and emotional social support over time among women who were denied wanted abortions and who received abortions, and compared outcomes between the groups. Methods The Turnaway Study is a prospective cohort study of women who sought abortions at 30 abortion facilities across the United States, and follows women via semiannual phone interviews for five years. Participants include 956 English or Spanish speaking women aged 15 and over who sought abortions between 2008 and 2010 and whose gestation in pregnancy fit one of three groups: women who presented up to three weeks beyond a facility’s gestational age limit and were denied an abortion; women presenting within two weeks below the limit who received an abortion; and women who received a first trimester abortion. The outcomes were modified versions of the Perceived Stress Scale and the Multidimensional Scale of Perceived Social Support. Longitudinal mixed effects models were used to assess differences in outcomes between study groups over 30 months. Results Women denied abortions initially had higher perceived stress than women receiving abortions near gestational age limits (1.0 unit difference on 0-16 scale, P = 0.003). Women receiving first-trimester abortions initially had lower perceived stress than women receiving abortions near gestational age limits (0.6 difference, P = 0.045). By six months, all groups’ levels of perceived stress were similar, and levels remained similar through 30 months. Emotional social support scores did not differ among women receiving abortions near gestational limits versus women denied abortions or women having first trimester abortions initially or over time. Conclusions Soon after being denied abortions, women experienced higher perceived stress than women who received abortions. The study found no longer-term differences in perceived stress or emotional social support between women who received versus were denied abortions.
    BMC Women's Health 06/2014; 14(1):76. DOI:10.1186/1472-6874-14-76 · 1.50 Impact Factor
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    • "pro-inflammatory cytokines and placental corticotrophin-releasing hormone (CRH) have been shown to be associated with shorter length of gestation [9,12,14,36–39] and reduced fetal growth [6] [14] [40]. It is possible that maternal positive affect may exert its beneficial effects on length of gestation by also impacting maternal–placental– fetal endocrine and immune physiology. "
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    ABSTRACT: The association between maternal psychological state during pregnancy and birth outcomes is well established. The focus of previous studies has been on the potentially detrimental consequences of maternal stress on pregnancy and birth outcomes, particularly shortened gestation and increased risk of preterm birth. Despite a growing literature linking positive affect with favorable health outcomes this construct has received little attention in the context of pregnancy. Therefore, in the current study, we tested the hypothesis that maternal positive affect during pregnancy is associated with beneficial consequences in terms of increased length of gestation and reduced risk of preterm birth above that of the absence of stress. In 169 pregnant women maternal positive affect and perceived stress were serially assessed at 15.2±0.9weeks (T1; mean±SD), 19.7±0.9weeks (T2) and 30.7±0.7weeks (T3) gestation. Pregnancy and birth outcomes were abstracted from the medical record. Higher maternal positive affect and a steeper increase in maternal positive affect over pregnancy were positively associated with length of gestation (p<.05) and reduced risk of preterm delivery (p<.01), whereas maternal perceived stress was not significantly associated with shorter length of gestation (p>.10). These findings suggest that maternal positive affect may be beneficial for outcomes related to the length gestation, and that this effect cannot be accounted for by the lower stress levels associated with higher positive affect. Interventions to increase maternal positive affect may be beneficial for fetal development.
    Journal of psychosomatic research 10/2013; 75(4):336-340. DOI:10.1016/j.jpsychores.2013.06.031 · 2.74 Impact Factor
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