Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation

Abstract

Objectives: To evaluate: (1) the associations between maternal psychological stress, distress and low birth weight (LBW), prematurity and intrauterine growth retardation (IUGR); (2) the interactions between maternal stress, distress and smoking, alcohol and coffee intake; (3) the prevalences of stress and distress in pregnancy.

Design: Longitudinal cohort study.

Setting: Jundiaí city, São Paulo state, Brazil.

Subjects: A total of 865 pregnant women who attended antenatal care between September 1997 and August 2000.

Methods: Measures of stress and distress were obtained, by interview, three times in pregnancy: at a gestational age (GA) lower than 16 weeks, from 20 to 26 weeks and from 30 to 36 weeks. Stress was investigated by the perceived stress scale, PSS, and distress by both the general health questionnaire, GHQ, and the State Trait Anxiety inventories, STAI. The outcomes were: LBW (birth weight <2500 g), prematurity (gestational age (GA) at birth <37 weeks) and IUGR (birth weight for GA ≤10th percentile of William's curve). The associations between the outcomes and the psychological measures were assessed in multiple logistic regression models.

Results: Maternal distress was associated with LBW (RR=1.97, P=0.019) and prematurity (RR=2.32, P=0.015), respectively. There was an interaction between distress and smoking in the second interview (P=0.05). The prevalences of stress and distress in the different interviews of pregnancy varied from 22.1 to 52.9%.

Conclusions: The present study has confirmed that distress is associated with both birthweight and GA. Further research is needed to evaluate the effectiveness of psychological interventions that can improve maternal and foetal well-being.

Sponsorship: Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP (grant no. 1998/00321-0).

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1

References

  • Aarst, MCG & Vingerhoets, AJJM (1993). Psychosocial factors and intrauterine fetal growth—a prospective study. J. Psychosom. Obstet. Gynecol., 14, 249–258.

    Article  Google Scholar 

  • Anderson, DK, Rhees, RW & Fleming, DE (1985). Effects of prenatal stress on differentiation of the sexually dimorphic nucleus of the preoptic area (SDN-POA) of the rat brain. Brain Res., 332, 113–118.

    Article  CAS  Google Scholar 

  • Austin, MP & Leader, L (2000). Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms. Aust. NZ J. Obstet. Gynaecol., 40, 331–337.

    Article  CAS  Google Scholar 

  • Barlow, SM, Knight, AF & Sullivan, FM (1979). Prevention by diazepam of adverse effects of maternal restraint stress on postnatal development and learning in the rat. Teratology, 19, 105–110.

    Article  CAS  Google Scholar 

  • Beckhardt, S & Ward, IL (1983). Reproductive functioning in the prenatally stressed female rat. Dev. Psychobiol., 16, 111–118.

    Article  CAS  Google Scholar 

  • Branun, AM & Schoendorf, KC (2002). Changing patterns of low birth weight in the United States. Paediatr. Perinat. Epidemiol., 16, 8–15.

    Article  Google Scholar 

  • Brooke, OG, Anderson, HR, Bland, JM, Peacock, JL & Steward, CM (1989). Effects on birth weight of smoking, alcohol, caffeine, socioeconomic factors, and psychosocial stress. Br. Med. J., 298, 795–801.

    Article  CAS  Google Scholar 

  • Brownell, A & Shumaker, SA (1985). Where do we go from here: the policy implications of social support. J. Soc. Issues, 41, 111–121.

    Article  Google Scholar 

  • Buekens, P & Klebanoff, M (2001). Preterm birth research: from disillusion to the search for new mechanisms. Paediatr. Perinat. Epidemiol., 15, (Suppl 2) 159–161.

    Article  Google Scholar 

  • Calhoun, JB (1962). Population density and social pathology. Sci. Am., 206, 139–148.

    CAS  PubMed  Google Scholar 

  • Cameron, N (1984). The Measurement of Human Growth, 1st edn. London: Croom Helm

    Google Scholar 

  • Capurro, H, Konishezky, S, Fonseca, D & Caldeyro-Barcia, (1978). A simplified method for diagnosis of gestational age in the newborn infant. J. Pediatr., 93, 120–122.

    Article  CAS  Google Scholar 

  • Cohen, S, Kamarck, T & Mermelstein, R (1983). A global measure of perceived stress. J. Health. Soc. Behav., 24, 385–396.

    Article  CAS  Google Scholar 

  • Copper, RL, Goldenberg, RL, Das, A, Elder, N, Swain, M, Norman, G, Ramsey, R, Cotroneo, P, Collins, BA & Johnson, F et al (1996). The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than 35 weeks' gestation. Am. J. Obstet. Gynecol., 175, 1286–1292.

    Article  CAS  Google Scholar 

  • Edwards, CH, Cole, OJ, Oyemade, UJ, Knight, EM, Johnson, AA, Westney, OE, Laryea, H, West, W, Jones, S & Westney, LS (1994). Maternal stress and pregnancy outcomes in a prenatal clinic population. J. Nutr., 124, (Suppl 6) S1006–S1021.

    Google Scholar 

  • Faden, VB, Graubard, BI & Dufour, M (1997). The relationship of drinking and birth outcome in a US national sample of expectant mothers. Paediatr. Perinat. Epidemiol., 11, 167–180.

    Article  CAS  Google Scholar 

  • Floyd, RL, Rimer, BK, Giovino, GA, Mullen, PD & Sullivan, SE (1993). A review of smoking in pregnancy: effects on pregnancy outcomes and cessation efforts. Ann. Rev. Public Health, 14, 379–411.

    Article  CAS  Google Scholar 

  • Geber, WF (1966). Developmental effects of chronic maternal audiovisual stress on the rat fetus. J. Embriol. Exp. Morphol., 16, 1–16.

    CAS  Google Scholar 

  • Goldberg, DP (1972). The Detection of Psychiatric Illness by Questionnaire, London: Oxford University Press

    Google Scholar 

  • Grimstadt, H, Schei, B, Backe, B & Jacobsen, G (1999). Anxiety, physical abuse, and low birth weight. Scand. J. Public Health, 27, 296–300.

    Article  Google Scholar 

  • Hedegaard, M, Henriksen, TB, Sabroe, S & Secher, NJ (1993). Psychological distress in pregnancy and preterm delivery. Br. Med. J., 307, 234–238.

    Article  CAS  Google Scholar 

  • Hedegaard, M, Henriksen, TB, Scher, NJ, Hatch, MC & Sabroe, S (1996). Do stressful life events affect duration of gestation and risk of preterm delivery?. Epidemiology, 7, 339–345.

    Article  CAS  Google Scholar 

  • Henriksen, TB, Hedegaard, M & Secher, NJ (1994). The relation between psychosocial job strain, and preterm delivery and low birthweight for gestational age. Int. J. Epidemiol., 23, 764–774.

    Article  CAS  Google Scholar 

  • Hoffman, S & Hatch, C (1996). Stress, social support and pregnancy outcome: a reassessment based on recent research. Paediatr. Perinat. Epidemiol., 10, 380–405.

    Article  CAS  Google Scholar 

  • Horta, BL, Barros, FC, Halpern, R & Victora, C (1996). Baixo peso ao nascer em duas coortes de base populacional no Sul do Brasil. Cad Saúde Públ., 12, 27–31.

    Article  Google Scholar 

  • Istvan, J (1986). Stress, anxiety, and birth outcomes: a critical review of the evidence. Psychol. Bull., 100, 331–348.

    Article  CAS  Google Scholar 

  • Jacobsen, G, Schei, B & Hoffman, HJ (1997). Psychosocial factors and small-for-gestational-age infants among parous Scandinavian women. Acta Obstet. Gynecol. Scand., 76, (Suppl 165) S14–S18.

    Google Scholar 

  • Jelliffe, DB & Jelliffe, EFP (1989). Community Nutritional Assessment, with Special Reference to Less Technically Developed Countries, 2nd edn. London: Oxford University Press

    Google Scholar 

  • Kleinbaum, DG (1996). Logistic Regression—A Self-Learning Text, New York: Springer

    Google Scholar 

  • Kramer, MS (1987). Determinants of low birth weight: methodological assessment and meta-analysis. Bull. WHO, 65, 663–737.

    CAS  PubMed  Google Scholar 

  • Lawson, EJ (1994). The role of smoking in the lives of low-income pregnant adolescents: a field study. Adolescence, 29, 61–79.

    CAS  PubMed  Google Scholar 

  • Lederman, RP (1995). Relationship of anxiety, stress, and psychosocial development to reproductive health. Behav. Med., 21, 101–112.

    Article  CAS  Google Scholar 

  • Levin, JS & DeFrank, RS (1988). Maternal stress and pregnancy outcomes: a review of the psychosocial literature. J. Psychosom. Obstet. Gynecol., 9, 3–16.

    Article  Google Scholar 

  • Lwanga, SK & Lemeshow, S (1991). Sample Size Determination in Health Studies—a Practical Manual, Geneva: WHO

    Google Scholar 

  • Mari, JJ & Williams, P (1985). A comparison of the validity of two psychiatric screening questionnaires (GHQ-12 and SRQ-20) in Brazil, using relative operating characteristic (ROC) analysis. Psychol. Med., 15, 651–659.

    Article  CAS  Google Scholar 

  • McAnarney, ER & Stevens-Simons, C (1990). Maternal psychological stress/depression and low birth weight. Am. J. Dis. Child., 144, 789–792.

    Article  CAS  Google Scholar 

  • McCormick, MC, Gortmaker, SL & Sobol, AM (1990). Very low birth weight children: behavior problems and school difficulty in a national sample. J. Pediatr., 117, 687–693.

    Article  CAS  Google Scholar 

  • Nordentoft, M, Lou, HC, Hansen, D, Nim, J, Pryds, O, Rubin, P & Hemmingsen, R (1996). Intrauterine growth retardation and premature delivery: the influence of maternal smoking and psychological factors. Am. J. Public Health, 86, 347–354.

    Article  CAS  Google Scholar 

  • Omer, H (1986). Possible psychophysiologic mechanisms in premature labor. Psychosomatics, 27, 580–584.

    Article  CAS  Google Scholar 

  • Paarlberg, KM, Vingerhoets, AJJM, Passchier, J, Dekker, GA & Van Geijn, HP (1995). Psychosocial factors and pregnancy outcome: a review with emphasis on methodological issues. J. Psychosom. Res., 39, 563–595.

    Article  CAS  Google Scholar 

  • Paarlberg, KM, Vingerhoets, AJJM, Passchier, J, Dekker, GA, Heinen, AGJJ & van Geijn, HP (1999). Psychosocial predictors of low birthweight: a prospective study. Br. J. Obstet. Gynaecol., 106, 834–841.

    Article  CAS  Google Scholar 

  • Pagel, MD, Smilkstein, G, Regen, H & Montano, D (1990). Psychosocial influences on new born outcomes: a controlled prospective study. Soc. Sci. Med., 30, 597–604.

    Article  CAS  Google Scholar 

  • Paiva, AA (2000). Análise da relação entre os níveis de ferro de parturientes e recém-nascidos a termo, MPH thesis São Paulo: University of São Paulo

    Google Scholar 

  • Pinto, ML & Shetty, PS (1995). Influence of exercise-induced maternal stress on fetal outcome in Wistar rats: inter-generational effects. Br. J. Nutr., 73, 645–653.

    Article  CAS  Google Scholar 

  • Pritchard, CW & Teo, PYK (1994). Preterm birth, low birthweight and the stressfulness of the household role for pregnant women. Soc. Sci. Med., 38, 89–96.

    Article  CAS  Google Scholar 

  • Rondó, PHC, Rodrigues, LC & Tomkins, AM (1996). Coffee consumption and intrauterine growth retardation in Brazil. Eur. J. Clin. Nutr., 50, 705–709.

    PubMed  Google Scholar 

  • Rondó, PHC, Abbott, R, Rodrigues, LC & Tomkins, AM (1997). The influence of maternal nutritional factors on intrauterine growth retardation. Pediatr. Perinat. Epidemiol., 11, 152–166.

    Article  Google Scholar 

  • Sable, MR & Wilkinson, DS (2000). Impact of perceived stress, major life events and pregnancy attitudes on low birth weight. Fam. Plann. Perspect., 32, 288–294.

    Article  CAS  Google Scholar 

  • Smith, DJ, Joffe, JM & Heseltine, GFD (1975). Modification of prenatal stress effects in rats by adrenalectomy, dexamethasone, and chlorpromazine. Physiol. Behav., 15, 461–469.

    Article  CAS  Google Scholar 

  • Spielberger, CD, Gorsuch, RI & Lushene, RE (1970). STAI Manual for the State–Trait Anxiety Inventory, Palo Alto, CA: Consulting Psychologist Press

    Google Scholar 

  • Steer, RA, Scholl, TO, Hediger, MI & Fischer, RL (1992). Self-reported depression and negative pregnancy outcomes. J. Clin. Epidemiol., 45, 1093–1099.

    Article  CAS  Google Scholar 

  • Teixeira, JMA, Nicholas, MF & Glover, V (1999). Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. Br. Med. J., 318, 153–157.

    Article  CAS  Google Scholar 

  • Wadhwa, PD, Sandman, CA, Porto, M, Dunkel-Schetter, C & Garite, TJ (1993). The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am. J. Obstet. Gynecol., 169, 858–865.

    Article  CAS  Google Scholar 

  • WHO (1995). Physical status: the use and interpretation of anthropometry, Technical Report Series 854 Geneva: World Health Organization

  • WHO (1986). Young people's health—a challenge for society, Report of a WHO Study Group on Young People and ‘Health for all by the Year 2000’. Technical Report Series 731 Geneva: World Health Organization

  • Williams, RL, Creasy, RK, Cunningham, MD, Hawes, WE, Norris, FD & Tashiro, M (1982). Fetal growth and perinatal viability in California. Obstet. Gynecol., 59, 624–632.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the pregnant women whose participation made this study possible, and the field workers Veranilce F Oliveira, Márcia R Souza, Sandra Vergílio, Rosemary F Ferreira, Janaina de Carvalho, Kátia K Valverde and Valéria Sttopa for their assistance. Scholarships from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) supported three of the field workers. The authors gratefully acknowledge Dr Ronaldo Moisés, Ms Vera M Saccheto, Dr Mauri Senise and Dr Gustavo Albuquerque from the Hospital Maternidade de Jundiaí; Dr Maria Emilia Ganito, Dr Alessandro D'Angieri, Dr Paulo Pontes, Dr Nelson O Maia, Dr Maria Emília R Miglioli and Dr Renato Tardelli from Hospital de Caridade São Vicente de Paulo; Dr Silvia Borgonovi, Dr Silvia Vilas Boas de Oliveira and Dr José Paulo May from Hospital Dr Paulo Sacramento; Dr Carim Chahine Yossef from Hospital Santa Rita de Cássia; Dr Jonas Zulpo, Dr Komei Samejima and Dr Cecília M Cordeiro from Casa de Saúde Dr Domingos Anastácio; Dr Rui Otanara and Dr Moacyr RF Paula from Centro Médico Pitangueiras; Dr Rubens A Dutra Alves and Dr Júlio C Lamarca Health Secretaries of Jundiaí, for allowing us to carry out our study in the hospitals and health centres of this city. Dr Laura C Rodrigues from the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine and Professor Andrew Tomkins from the Centre for International Child Health, University of London, are acknowledged for fruitful discussions concerning the analysis and results of the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to P H C Rondó.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rondó, P., Ferreira, R., Nogueira, F. et al. Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation. Eur J Clin Nutr 57, 266–272 (2003). https://doi.org/10.1038/sj.ejcn.1601526

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601526

Keywords

  • stress
  • distress
  • pregnancy
  • low birth weight
  • prematurity
  • intrauterine growth retardation

This article is cited by

Search

Quick links