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Second-trimester maternal distress increases the risk of small for gestational age

Published online by Cambridge University Press:  27 February 2014

A. S. Khashan ,
C. Everard ,
L. M. E. McCowan ,
G. Dekker ,
R. Moss-Morris ,
P. N. Baker ,
L. Poston ,
J. J. Walker  and
L. C. Kenny
A. S. Khashan*
Affiliation:
The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Ireland
C. Everard
Affiliation:
The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Ireland
L. M. E. McCowan
Affiliation:
Department of Obstetrics and Gynaecology, University of Auckland, New Zealand
G. Dekker
Affiliation:
Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, University of Adelaide, Australia
R. Moss-Morris
Affiliation:
Health Psychology Section, Department of Psychology, Institute of Psychiatry, King's College London, UK
P. N. Baker
Affiliation:
Gravida: National Centre for Growth and Development, Liggins Institute, University of Auckland, New Zealand
L. Poston
Affiliation:
Division of Women's Health, Women's Health Academic Centre, King's College London, UK
J. J. Walker
Affiliation:
Department of Obstetrics and Gynaecology, St James University Hospital, Leeds, UK
L. C. Kenny
Affiliation:
The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Ireland
*
* Address for correspondence: A. S. Khashan, Ph.D., Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Fifth Floor, University College Cork, Cork, Ireland. (Email: a.khashan@ucc.ie)
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Abstract

Background

The effect of prenatal distress on the risk of a small for gestational age (SGA) infant is uncertain. We have addressed the influences of prenatal stress, anxiety and depression on the risk of SGA. We also examined the effects of infant sex and timing of distress during pregnancy on any observed associations.

Method

The study population comprised 5606 healthy nulliparous pregnant women who participated in the international prospective Screening for Obstetric and Pregnancy Endpoints (SCOPE) study. Women completed the Perceived Stress Scale (PSS), the short form of the Spielberger State–Trait Anxiety Inventory (STAI) and the Edinburgh Postnatal Depression Scale (EPDS) at 15 ± 1 and 20 ± 1 weeks' gestation. SGA was defined as birthweight below the 10th customized percentile. Logistic regression was used for data analysis, adjusting for several potential confounders such as maternal age, body mass index (BMI), smoking, socio-economic status and physical exercise.

Results

The risk of SGA was increased in relation to mild [adjusted odds ratio (aOR) 1.35, 95% confidence interval (CI) 1.07–1.71], moderate (aOR 1.26, 95% CI 1.06–1.49), high (aOR 1.45, 95% CI 1.08–1.95) and very high stress scores (aOR 1.56, 95% CI 1.03–2.37); very high anxiety score (aOR 1.45, 95% CI 1.13–1.86); and very high depression score (aOR 1.14, 95% CI 1.05–1.24) at 20 ± 1 weeks' gestation. Sensitivity analyses showed that very high anxiety and very high depression increases the risk of SGA in males but not in females whereas stress increases the risk of SGA in both males and females.

Conclusions

These findings suggest that prenatal stress, anxiety and depression measured at 20 weeks' gestation increase the risk of SGA. The effects of maternal anxiety and depression on SGA were strongest in male infants.

Keywords

Estimated fetal weightprenatal anxietyprenatal depressionprenatal stresssmall for gestational age
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 13 , October 2014 , pp. 2799 - 2810
Copyright
Copyright © Cambridge University Press 2014 

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