Life event stress and the association with spontaneous abortion in gravid women at an urban emergency department

The association between psychological stress and miscarriage: A systematic review and meta-analysis

This systematic review and meta-analysis was designed to investigate whether maternal psychological stress and recent life events are associated with an increased risk of miscarriage. A literature search was conducted to identify studies reporting miscarriage in women with and without history of exposure to psychological stress (the only exposure considered). The search produced 1978 studies; 8 studies were suitable for analysis. A meta-analysis was performed using a random-effects model with effect sizes weighted by the sampling variance. The risk of miscarriage was significantly higher in women with a history of exposure to psychological stress (OR 1.42, 95% CI 1.19–1.70). These findings remained after controlling for study type (cohort and nested case-control study OR 1.33 95% CI 1.14–1.54), exposure types (work stress OR 1.27, 95% CI 1.10–1.47), types of controls included (live birth OR 2.82 95% CI: 1.64–4.86). We found no evidence that publication bias or study heterogeneity significantly influenced the results. Our finding provides the most robust evidence to date, that prior psychological stress is harmful to women in early pregnancy.

Stress and reproductive failure: past notions, present insights and future directions

PROBLEM

Maternal stress perception is frequently alleged as a cause of infertility, miscarriages, late pregnancy complications or impaired fetal development. The purpose of the present review is to critically assess the biological and epidemiological evidence that considers the plausibility of a stress link to human reproductive failure.

METHODS

All epidemiological studies published between 1980 and 2007 that tested the link between stress exposure and impaired reproductive success in humans were identified. Study outcomes were evaluated on the basis of how associations were predicted, tested and integrated with theories of etiology arising from recent scientific developments in the basic sciences. Further, published evidence arising from basic science research has been assessed in order to provide a mechanistic concept and biological evidence for the link between stress perception and reproductive success.

RESULTS

Biological evidence points to an immune-endocrine disequilibrium in response to stress and describes a hierarchy of biological mediators involved in a stress trigger to reproductive failure. Epidemiological evidence presents positive correlations between various pregnancy failure outcomes with pre-conception negative life events and elevated daily urinary cortisol. Strikingly, a relatively new conceptual approach integrating the two strands of evidence suggests the programming of stress susceptibility in mother and fetus via a so-called pregnancy stress syndrome.

CONCLUSIONS

An increasing specificity of knowledge is available about the types and impact of biological and social pathways involved in maternal stress responses. The present evidence is sufficient to warrant a reconsideration of conventional views on the etiology of reproductive failure. Physicians and patients will benefit from the adaptation of this integrated evidence to daily clinical practice.

Famine, social disruption, and involuntary fetal loss: evidence from Chinese survey data

Relying on half a million pregnancy histories collected from Chinese women in the late 1980s, we studied nearly a quarter century of self-reported miscarriages and stillbirths in China. Our results suggest that these two forms of involuntary fetal loss are affected not only by biological and demographic factors, such as the mother's age, pregnancy order, and pregnancy history, but also by the mother's social characteristics and the larger social environment. In this article, we focus on how two social and economic crises--the Great Leap Forward famine and the Cultural Revolution--resulted in elevated risks of miscarriage and stillbirth in the Chinese population.