NICHD: Stress increases stillbirth risk

A study supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of more than 2000 women shows that stressful life events increase the risk of stillbirth. The findings, published in The American Journal of Epidemiology, point to a need for ob/gyns to include counseling about stress in prenatal care.

Conducted by the multicenter Stillbirth Collaborative Research Network from March 2006 to September 2008, the population-based case-control study involved 5 US catchment areas. Researchers identified characteristics associated with racial/ethnic disparity and interpersonal and environmental stressors, including a list of 13 stressful life events. The event types were financial, emotional, traumatic, and partner-related and they included things such as loss of a job or having a loved one in the hospital in the year before giving birth.

Among women who reported experiencing all 4 types of stressful life events, the adjusted odds ratio for stillbirth was 2.22 (95% CI: 1.43, 3.46). The association was robust after control for the correlated variables of family income, marital status, and health insurance type, but there was no interaction between race/ethnicity and other variables. Overall, 83% of women who had a stillbirth and 75% of women who had a live birth reported a stressful life event.

Almost 20% of women with stillbirths and 10% of those with live births reported experiencing 5 or more stressful life events. Those who reported stressful events in 3 or 4 of the categories were at increased risk of stillbirth even after controlling for stillbirth risk factors such as sociodemographic characteristics and prior pregnancy history.  Black women reported more stressful life events than did white and Hispanic women, and non-Hispanic black women were more likely to report such events than were non-Hispanic white women and Hispanic women.

According to NICHD co-author Marian Willinger, PhD, acting chief of the Pregnancy and Perinatology Branch at NICDH, “This reinforces the need for healthcare providers to ask expectant mothers about what is going on in their lives, monitor stressful life events and to offer support as part of prenatal care.”