Stress and human reproductive failure: recommendations for future research
Prospective study design with multiple evaluation time points during pregnancy and a large number of patients (500 or more)
Development of measurable indices for pregnancy stress syndrome
Psychometric tools
Biological markers such as neurohormones (urinary cortisol, CRH), neuropeptides (substance P), sex/pregnancy-related hormones (progesterone, estradiol, βHCG)
Environmental risk assessment (noise, chemical exposure)
Indicators of increased susceptibility or resilience to a stress risk to pregnancy failure via hereditary, cultural/ethnic and gender factors
Genetic profile
Cultural/ethnic context of the study population
Consideration of risk subgroups combining variables suspected to confer high risk, for example
High stress perception with low social support, age over 30 years, low BMI, low progesterone and smoking