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. Author manuscript; available in PMC: 2015 Jan 1.
Published in final edited form as: Matern Child Health J. 2014 Jan;18(1):10.1007/s10995-013-1233-x. doi: 10.1007/s10995-013-1233-x

Table 2.

Characteristics of Measures Used to Assess Stress and the Strength of Association to Adverse Obstetric Outcomes among Population-Based Studies, by Specific Stress Domain (Studies from Year 2000-Present)

First Author (Year), Location Mode of Collection, Data Source Period/Domain Instrument Used Reliability and Validity Time Administered Outcome Adjusted OR or RR [95% CI]
Preconception Pregnancy
Khashan (2008), Denmark Objective measure, Danish National Registers E E E: Death or serious illness of a relative:

  1. in the 6 months prior to pregnancy

  2. during pregnancy

 NA NA SGA

  1. 1.13 [1.06–1.20]

  2. 1st trimester: 1.17 [1.07–1.29]; 2nd trimester 1.24 [1.13–1.36]; 3rd trimester: 1.22 [1.12–1.32]
Khashan (2009), Denmark Objective measure, Danish National Registers E E E: Death or serious illness of a relative:

  1. in the 6 months prior to pregnancy

  2. during pregnancy

 NA NA PTB

  1. 1.16 [1.08–1.23]

  2. 1st trimester: 1.03 [0.93–1.13]; 2nd trimester: 1.01 [0.91–1.11]
Precht (2007), Denmark Objective measure, Danish National Registers E E E: Death or serious illness in partners or children:

  1. up to 485 days before pregnancy;

  2. during pregnancy

 NA NA SGA

  1. 0–5 months before: 0.93 [0.78–1.11]; 6–11 months before: 1.17 [1.01–1.36]; 1 year-485 days before: 0.96 [0.81–1.14];

  2. 1st trimester: 1.03 [0.68–1.56]; 2nd trimester: 0.99 [0.68–1.45]; 3rd trimester: 1.18 [0.69–2.02]
Class (2011), Sweden Objective measure, linked Swedish population registries E E: Death of child’s father or first degree relative of the mother during pregnancy NA NA

  1. PTB

  2. LBW

  3. SGA

  1. 5 months gestation: 1.24 [1.02–1.50]; 6 months gestation: 1.23 [1.02–1.50];

  2. 5 months gestation: 1.37 [1.11–1.70]; 6 months gestation: 1.23 [1.02–1.50];

  3. 5 months gestation: 1.35 [1.07–1.72]
Eskenazi (2007), U.S. Objective measure, birth certificate data E E: Events of September 11th, 2001 (prevalence of PTB and LBW in the week of 9/11/01 versus the 3 weeks prior, and in the months after 9/11 compared to the same months in the preceding two years) NA NA

  1. PTB

  2. LBW

  1. No effect

  2. <1500g: NYC: 1.44 [0.97–2.15]; Upstate NY: 0.89 [0.54–1.46]

    1500–1999g: NYC: 1.67 [1.11–2.52]; Upstate NY: 1.42 [0.88, 2.29]

    2000–2499g: NYC: 0.83 [0.63–1.07; Upstate NY: 0.87 [0.66–1.16]
Lu (2004), U.S. Mailed SAQ, PRAMS E E: 13-item subset of Modified Life Events Inventory Cronbach’s alpha = 0.68 2–6 months after delivery PTB Emotional: 1.05 [0.94–1.18]; Financial: 1.05 [0.94–1.19]; Spousal: 1.04 [0.92–1.18]; Traumatic: 1.00 [0.87–1.16]
Nkansah-Amankra (2010), U.S. Mailed SAQ, PRAMS E E: 13-item subset of Modified Life Events Inventory Cronbach’s alpha = 0.68 2–6 months after delivery

  1. PTB

  2. LBW

  1. Emotional: 1.41 [1.35–1.48]; Financial: 0.96 [0.92–1.00]; Spousal: 0.89 [0.96–0.94]; Traumatic: 1.07 [1.03–1.12];

  2. Emotional: 1.31 [1.25–1.38]; Financial: 1.16 [1.10–1.22]; Spousal: 1.16 [1.11–1.22]; Traumatic: 1.14 [1.09–1.20]
Whitehead (2002), U.S. Mailed SAQ, PRAMS E E: 18-item subset of the Modified Life Events Inventory Unknown 2–6 months after delivery PTB 0.99 [0.97–1.02]a
1.05 [1.02–1.08]b
1.07 [1.01–1.13]c
1.03 [0.98–1.09]d
Zhu (2004), Denmark Telephone survey, DNBC E E: 2 questions associated with job strain (yes/no)e Unknown 11–25 weeks’ gestation (median 16 weeks)

  1. Fetal Loss

  2. Spontaneous Abortion

  3. Still Birth

 High job strain:

  1. 0.97 [0.69–1.36]

  2. 1.00 [0.68–1.46]

  3. 0.85 [0.40–1.82]
Pryor (2003), New Zealand Interviewer administered questionnaire P P: PSS Test-test reliability: 0.85 (2 days), 0.55 (6 weeks)
Internal consistency: 0.76		 Less than 1 week after delivery SGA Specific results not reported in paper
Tegthoff (2010), Denmark Computer-assisted interview, DNBC P P: 1 question (9 options) “Have you been stressed during pregnancy by..?”f Unknown 30 weeks’ gestation

  1. Length of gestation

  2. Body weight

  3. Body length

  4. Abdominal circumference

  5. Head circumference

 Adjusted Betas:

  1. −0.14 [−0.19–−0.10]

  2. 9.14 [4.99–13.28]

  3. 6.58 [2.39–10.77]

  4. 9.96 [5.77–14.16]

  5. 6.13 [1.95–10.30]
Ghosh (2010), U.S. Telephone survey, EPOS E, P E: Six major stressful life events
P: PSS-4		 E: Unknown
P: Cronbach’s alpha = 0.60		 3–6 months after delivery PTB E: 1 event: 0.89 [0.72–1.08]
E: 2–6 events: 0.78 [0.62–0.99]
P: Moderate stress: 1.06 [0.88–1.29]; P: High stress: 1.46 [1.11–1.92]
Sable (2000), U.S. Questionnaires (mailed and SAQ), face-to-face and phone interviews, MMIHS E, P E: 1 question (30 individual options; yes/no): “During your most recent pregnancy, did any of the following events occur to you?”g
P: 1 question (almost always, often, sometimes, almost never): “In general, how often did you feel stress during your recent pregnancy?”		 Unknown 0–3 months Postpartumh Very LBW E: Got back together with husband/partner: 1.37 [0.94–1.99];
E: Took out mortgage/loan: 0.54 [0.33–0.88];
E: Suffered major injury, accident, or illness: 1.70 [1.02–2.81];
E: Was in a physical fight: 1.63 [1.06–2.50];
E: Close family member died: 0.69 [0.50–0.96]
P: “Almost always”: 1.57 [1.21–2.05]

E=Environmental, P=Psychological, OR=Odds Ratio, RR=Relative Risk, CI=Confidence Interval, PTB=Preterm Birth, SAQ=Self-administered questionnaire, SGA=Small for Gestational Age, LBW=Low Birth Weight, U.S.=United States, NA=not applicable, EPOS=UCLA Environment and Pregnancy Outcomes Study, PRAMS=Pregnancy Risk Assessment Monitoring System, PSS= Perceived Stress Scale, DNBC=Danish National Birth Cohort, MMIHS=National Institute of Child Health and Human Development/Missouri Maternal and Infant Health Survey

a

Threshold model for each event in primiparas women, 1990–1993

b

Threshold model for each event over 2 events in primiparas women in 1994–1995

c

Threshold model for each event over 5 events in multiparas women, 1990–1993

d

Threshold model for each event over 5 events in multiparas women, 1994–1995

e

Do you have too many tasks at your work?” and “Do you have the opportunity to influence your tasks and working conditions?”

f

(1) Financial circumstances; (2) Housing conditions; (3) Work situation; (4) Relationship to partner; (5) Relations to family and friends; (6) Pregnancy; (7) Own health; (8) Illness among family or friends; or (9) Anything else

g

Living arrangements (moved to another residence, living conditions changed a lot, addition of person(s) to household, was homeless); Relationship issues (marriage, divorce, major change in number of arguments with husband/partner, separation from husband/partner, got back together with husband/partner, problems with parents or in-laws, sexual problems); Employment issues (laid off or fired from job, changed to a new job, change in responsibilities at work, trouble with your boss, husband/partner laid off or fired, husband/partner changed job); Violence and legal concerns (was a victim of a crime, was arrested, husband/partner was arrested, was involved in a physical fight); Illnesses and deaths (major personal injury, accident, or illness (excluding pregnancy complications), major change in health or behavior of a family member, death of husband/partner, death of a close family member, death of a close friend); Financial concerns (got into debt over your head, took out a mortgage or loan, loss of or major damage to personal property (car, home, other), unable to get the services you and family needed (AFDC, food stamps, WIC, Medicaid)).

h

In-hospital interviews completed after delivery; 3 mailed questionnaires attempts were made after birth of baby, with telephone follow-up and personal interviews for non-respondents.