The Course Of Maternal Pregnancy-Specific Stress Across Pregnancy And Effects On Primary Pregnancy Outcomes:A Prospective Study

Objective To investigate the prevalence,trends of pregnancy-specific stress symptoms during the pregnancy,and explore the associations between pregnancy-specific stress and primary pregnancy outcomes.Methods Pregnant women building cards in the maternal and child health centers of Zhuhai city,Shanxi province,Haidian district in Beijing city,Jilin province and Shenzhen city before the first trimester(13 weeks)were recruited to participate in the prospective study.Women filled out questionnaires three times during pregnancy(at 13,24 and 37 gestations).Data on demographic characteristic(age,education,work status,and so forth),unwilling pregnancy,gravid,were collected.The Pregnancy Stress Rating Scale(PSRS)was used to assess the specific stress symptoms.The Self rating Anxiety Scale(SAS)was used to assess the pregnancy anxiety symptoms.The Edinburgh Postnatal Depression Scale(EPDS)was used to assess the pregnancy depression symptoms.A total of 1167 women participated in all three surveys and 1167 women delivered singletons live births.Repeated measures ANOVA,χ2 test and generalized estimating equations(GEE)was used to evaluate the trends of pregnancy-specific stress symptoms.The partial correlation analysis was used to analyze the relationship between pregnancy-specific stress and pregnancy anxiety or pregnancy depression.The relationships between pregnancy-specific stress and primary pregnancy outcomes were investigated by using logistic regression.Results The median score of the pregnancy-specific stress was 15.72±11.40,15.08±11.68,14.47±11.33 at the first,second,and third trimester,respectively.There was a significant difference among the three trimesters of pregnancy-specific stress(F=18.48,P<0.001).The first stressor of pregnancy-specific stress was coming from the concerning for the safety of the mothers themselves and their children.GEE analysis indicated that the pregnant women in Zhuhai(OR=1.71,95%CI 1.15-2.53),not satisfied with the living environment(OR=1.64,95%CI 1.25-2.14),depression in first trimester(OR=1.90,95%CI 1.36-2.67),anxiety in first trimester(OR=1.55,95%CI 1.09-2.20),depression in second trimester(OR=1.60,95%CI 1.08-2.36),anxiety in third trimester(OR=2.14,95%CI 1.45-3.17)significantly increased the risk of pregnancy-specific stress.The partial correlation analysis showed that pregnancy-specific stress had lower relationships with pregnancy anxiety or pregnancy depression during the pregnancy.Results of the logistic regression indicated that severe stress at the third trimester was the independent risk factor to postpartum depression(RR=1.48,95%CI 1.03-2.12),however,there was no relationships between pregnancy-specific stress and primary pregnancy outcomes.Conclusion Pregnancy-specific stress appeared a decreasing trend from the first to third trimester.Therefore,physicians should focus on the first trimester and fundamentally prevent it.Furthermore,since the severe pregnancy-specific stress was the independent risk factor to postpartum depression,more attention should be paid to those pregnant women who had severe pregnancy-specific stress.There were no relationships between pregnancy-specific stress and primary pregnancy outcomes and more research should be developed to confirm their relationships.