Maternal Bereavement During Pregnancy and Risk of Stillbirth
Maternal Bereavement During Pregnancy and Risk of Stillbirth
Increasing evidence suggests that maternal stress during pregnancy may influence pregnancy outcomes. In a nationwide Swedish study including almost 3 million births taking place during 1973–2006, we investigated whether maternal bereavement during pregnancy is associated with stillbirth risk. Through individual record linkage between several population-based registers, we obtained information on demographic, health-related, and pregnancy-related factors and deaths of mothers' first-degree relatives. There were 11,071 stillbirths (3.8 per 1,000 births) in the cohort. After adjustment for potential confounders, infants of mothers who had lost any first-degree relative the year before or during pregnancy had an 18% higher risk of stillbirth than unexposed offspring (95% confidence interval (CI): 1.06, 1.31). Corresponding hazard ratios were 1.67 (95% CI: 1.18, 2.36) for maternal loss of an older child, 2.06 (95% CI: 1.44, 2.94) for loss of a sibling, and 1.07 (95% CI: 0.95, 1.21) for loss of a parent. The relationship between maternal bereavement and stillbirth did not vary by time of death or by whether the relative's death was expected or unexpected. Death of a close relative is one of the most severe sources of stress, and future studies need to investigate whether less severe but more common stressors also increase stillbirth risk.
Stillbirth represents one of the most painful events expecting couples may experience, and it is associated with intense long-term grief and psychological morbidity. Stillbirth rates vary greatly by region across the world, from 3.1 per 1,000 births in high-income countries to 28.3 per 1,000 in sub-Saharan Africa.
The etiology of stillbirth is complex and not well understood. An important proportion of stillbirths are associated with fetal growth restriction and impaired placental function, but in many cases no proximal cause can be identified. Better knowledge about risk factors and the mechanisms by which they are linked to stillbirth may facilitate identification of high-risk pregnancies and offer targets for intervention.
Increasing evidence suggests that maternal psychosocial stress during pregnancy may impair fetal growth. A limited number of studies, primarily case-control studies, also suggest that prenatal stress may be linked to preeclampsia and to placental abruption. Because fetal growth restriction, preeclampsia, and placental abruption increase the risk of stillbirth, an association between maternal stress during pregnancy and stillbirth is plausible. Nevertheless, to our knowledge, no study has investigated the role of antenatal stress in the etiology of stillbirth.
The death of a close relative, especially the death of a child, is considered one of the most severe sources of stress a person can experience, regardless of coping resources. Thus, if maternal stress during pregnancy is related to stillbirth, one would expect to find a higher risk of stillbirth among women who lost a relative shortly before or during pregnancy than among their unexposed counterparts.
We investigated whether maternal bereavement during pregnancy is associated with an increased risk of stillbirth in a large population-based cohort study.
Abstract and Introduction
Abstract
Increasing evidence suggests that maternal stress during pregnancy may influence pregnancy outcomes. In a nationwide Swedish study including almost 3 million births taking place during 1973–2006, we investigated whether maternal bereavement during pregnancy is associated with stillbirth risk. Through individual record linkage between several population-based registers, we obtained information on demographic, health-related, and pregnancy-related factors and deaths of mothers' first-degree relatives. There were 11,071 stillbirths (3.8 per 1,000 births) in the cohort. After adjustment for potential confounders, infants of mothers who had lost any first-degree relative the year before or during pregnancy had an 18% higher risk of stillbirth than unexposed offspring (95% confidence interval (CI): 1.06, 1.31). Corresponding hazard ratios were 1.67 (95% CI: 1.18, 2.36) for maternal loss of an older child, 2.06 (95% CI: 1.44, 2.94) for loss of a sibling, and 1.07 (95% CI: 0.95, 1.21) for loss of a parent. The relationship between maternal bereavement and stillbirth did not vary by time of death or by whether the relative's death was expected or unexpected. Death of a close relative is one of the most severe sources of stress, and future studies need to investigate whether less severe but more common stressors also increase stillbirth risk.
Introduction
Stillbirth represents one of the most painful events expecting couples may experience, and it is associated with intense long-term grief and psychological morbidity. Stillbirth rates vary greatly by region across the world, from 3.1 per 1,000 births in high-income countries to 28.3 per 1,000 in sub-Saharan Africa.
The etiology of stillbirth is complex and not well understood. An important proportion of stillbirths are associated with fetal growth restriction and impaired placental function, but in many cases no proximal cause can be identified. Better knowledge about risk factors and the mechanisms by which they are linked to stillbirth may facilitate identification of high-risk pregnancies and offer targets for intervention.
Increasing evidence suggests that maternal psychosocial stress during pregnancy may impair fetal growth. A limited number of studies, primarily case-control studies, also suggest that prenatal stress may be linked to preeclampsia and to placental abruption. Because fetal growth restriction, preeclampsia, and placental abruption increase the risk of stillbirth, an association between maternal stress during pregnancy and stillbirth is plausible. Nevertheless, to our knowledge, no study has investigated the role of antenatal stress in the etiology of stillbirth.
The death of a close relative, especially the death of a child, is considered one of the most severe sources of stress a person can experience, regardless of coping resources. Thus, if maternal stress during pregnancy is related to stillbirth, one would expect to find a higher risk of stillbirth among women who lost a relative shortly before or during pregnancy than among their unexposed counterparts.
We investigated whether maternal bereavement during pregnancy is associated with an increased risk of stillbirth in a large population-based cohort study.
