Psychological and social risk factors and pregnancy outcome: a prospective cohort study

BackgroundResearch suggests that besides somatic factors, psychological and social factors are associated with pregnancy outcomes. The objective of this study was to determine the independent effects of psychosocial risk factors on maternal blood pressure, gestational age at birth, birthweight and Apgar score. MethodsIn a prospective cohort study, Dutch women in the first half of pregnancy were recruited at a regional hospital, a university hospital and ten midwife practices. At inclusion, participants (before 20 weeks of gestation) filled in questionnaires on social and psychological factors. Obstetric data were extracted from patient records. Associations between risk factors and pregnancy outcomes were analysed with multivariable linear and logistic regression. Results598 Women were included in the study. 14 Women did not return questionnaires and 12 women stopped study participation before delivery. In multivariable regression analysis, primiparity, Odds Ratio [OR] = 3.4 (1.5, 7.5), obstetric and somatic history, OR = 3.5 (1.5, 7.9), and diastolic blood pressure at intake, OR = 1.1 (1.0, 1.1), were independently associated with preterm delivery. Smoking status, OR = 5.5 (2.3, 13), was independently associated with a newborn small for gestational age, and primiparity, OR = 6.9 (1.1, 45), with a low Apgar score. Diastolic blood pressure at intake, OR = 1.1 (1.07, 1.14), hypertension at intake, OR = 3.6 (1.1, 11), and negative affect, OR = 1.1 (1.02, 1.14), were independently associated with gestational hypertension. Negative affect was the only psychosocial risk factor independently associated with pregnancy outcome. ConclusionAlthough psychosocial factors are important in obstetric care, measurement of these factors in early pregnancy seems to have limited independent predictive value for adverse pregnancy outcome when medical and/or obstetric history and commonly applied physical measurements are already considered.