Stressful Life Events May Increase Risk of Stillbirth

Pregnant women who experienced certain stressful life events in the year preceding their delivery had an increased risk of having a stillbirth, a new study finds.¹
   
The study, based on data from more than 2000 US women, involved asking women about 13 significant life events (SLEs) within 24 hours of either a stillbirth or a live birth. The SLEs were categorized as emotional, financial, partner-related, or traumatic, and included questions about whether they had moved, had to deal with unemployment (self or partner), had been in a physical fight, or had experienced a death of someone very close to them.
   
Most participants reported an SLE within the past year; 83% of women who had a stillbirth and 75% of women who had a live birth reported an SLE. Nearly 20% of women who had a stillbirth and 10% of women who had a live birth reported having experienced 5 or more SLEs in the year preceding the delivery.
   
When 2 SLEs were reported, the risk of a stillbirth increased by approximately 40%, according to the analysis.¹ In addition, compared with women who reported no SLEs, those who reported 5 or more SLEs were nearly 2.5 times more likely to have a stillbirth. When women reported an SLE from all 4 categories, their risk of a stillbirth remained high-2.22 times more likely than that for women with no reported SLEs-even after additional control for correlated variables of family income, marital status, and health insurance type, reported the study authors. The SLEs most strongly correlated with stillbirth were being in a physical fight, which doubled the risk; hearing a partner say he or she did not want the pregnancy; and either herself or her partner spending any time in jail.
   
Non-Hispanic black women were more likely to report an SLE than non-Hispanic white women or Hispanic women. In addition, black women reported a greater number of SLEs than white or Hispanic women. The study authors suggested that this finding might help explain why black women have higher rates of stillbirth than other ethnic groups.¹
   
These findings reinforce the need for health care providers to ask pregnant patients specific questions about what is happening in their lives. General screening for intimate partner violence and depression is common at prenatal visits, but asking more detailed questions is needed to better document and monitor SLEs and offer specific support as part of prenatal care, suggested the study authors.¹

Pertinent Points:
- Pregnant women who experienced a stressful life event in the year before their delivery had an increased risk of having a stillbirth.
- About 21% of all women and 32% of non-Hispanic black women who experienced 3 or more stressful life events in the year before delivery had an increased risk of stillbirth of at least 50%.
- Effective ameliorative interventions could have a substantial impact on public health and the delivery of healthy babies.
 

References:

1. Hogue CJ, Parker CB, Willinger M, et al. A population-based case-control study of stillbirth: the relationship of significant life events to the racial disparity for African Americans. Am J Epidemiol. March 26, 2013. [Epub ahead of print]