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Maternal bereavement and the risk of preterm delivery: the importance of gestational age and of the precursor of preterm birth

Published online by Cambridge University Press:  08 December 2015

K. D. László ,
J. Li ,
J. Olsen ,
M. Vestergaard ,
C. Obel  and
S. Cnattingius
K. D. László*
Affiliation:
Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
J. Li
Affiliation:
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
J. Olsen
Affiliation:
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA
M. Vestergaard
Affiliation:
Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
C. Obel
Affiliation:
Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark Research Program for Mental Child Health, Department of Public Health and Knowhow, AU Center Knowledge of Welfare and Health, Aarhus University, Aarhus, Denmark
S. Cnattingius
Affiliation:
Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
*
*Address for correspondence: Dr K. D. László, Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Eugeniahemmet T2, 17176 Stockholm, Sweden. (Email: [email protected])
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Abstract

Background

Maternal stress during pregnancy may increase the risk of preterm delivery (PD), but the associations between stress and subtypes of PD are not clear. We investigated maternal loss of a close relative and risks of very and moderately PD (<32 and 32–36 weeks, respectively) and spontaneous and medically indicated PD.

Method

We studied 4 940 764 live singleton births in Denmark (1978–2008) and Sweden (1973–2006). We retrieved information on death of women's family members (children, partner, siblings, parents), birth outcomes and maternal characteristics from nationwide registries.

Results

Overall, the death of a close family member the year before pregnancy or in the first 36 weeks of pregnancy was associated with a 7% increased risk of PD [95% confidence interval (CI) 1.04–1.10]. The highest hazard ratios (HR) for PD were found for death of an older child [HR (95% CI) 1.20 (1.10–1.31)] and for death of a partner [HR (95% CI) 1.31 (1.03–1.66)]. These losses were associated with higher risks of very preterm [HR (95% CI) 1.61 (1.29–2.01) and 2.07 (1.15–3.74), respectively] than of moderately preterm [HR (95% CI) 1.14 (1.03–1.26) and 1.22 (0.94–1.58), respectively] delivery. There were no substantial differences in the association between death of a child or partner and the risk of spontaneous v. medically indicated PD.

Conclusions

Death of a close family member the year before or during pregnancy was associated with an increased risk of PD, especially very PD. Possible mechanisms include both spontaneous and medically indicated preterm birth.

Keywords

Bereavementmedically indicated preterm deliverymoderately preterm deliverypreterm deliveryspontaneous preterm deliverystressvery preterm delivery
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 6 , April 2016 , pp. 1163 - 1173
Copyright
Copyright © Cambridge University Press 2015 

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