Association between life stress and serious perinatal complications.

The association between stressful life changes, social supports, and serious complications of pregnancy was measured in 513 women obtaining prenatal care in four rural family practices. Those women whose life change score (LCS) increased from the second to the third trimester had a significantly higher rate of poor outcomes (neonatal death, transfer to a neonatal intensive care unit, birthweight less than 2500 g or 5-minute Apgar score less than 7) than those whose LCS did not increase (9.2% vs 3.9%, P = .015). This effect of increasing stress was present even after controlling for demographic and standard obstetric risk factors. High life change scores at 20 weeks' gestation and 34 weeks' gestation were not individually associated with poor outcomes. Those with low social support did not have a statistically significant higher rate of complications, and social support did not buffer the adverse effects of increasing stress. This study shows that serious and clinically important complications of pregnancy are related to stressful life change independent of biomedical risk.