Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
Am J Epidemiol. 2013 Feb 1;177(3):219-27. doi: 10.1093/aje/kws383. Epub 2013 Jan 7.
Increasing evidence suggests that maternal stress during pregnancy may influence pregnancy outcomes. In a nationwide Swedish study including almost 3 million births taking place during 1973-2006, we investigated whether maternal bereavement during pregnancy is associated with stillbirth risk. Through individual record linkage between several population-based registers, we obtained information on demographic, health-related, and pregnancy-related factors and deaths of mothers' first-degree relatives. There were 11,071 stillbirths (3.8 per 1,000 births) in the cohort. After adjustment for potential confounders, infants of mothers who had lost any first-degree relative the year before or during pregnancy had an 18% higher risk of stillbirth than unexposed offspring (95% confidence interval (CI): 1.06, 1.31). Corresponding hazard ratios were 1.67 (95% CI: 1.18, 2.36) for maternal loss of an older child, 2.06 (95% CI: 1.44, 2.94) for loss of a sibling, and 1.07 (95% CI: 0.95, 1.21) for loss of a parent. The relationship between maternal bereavement and stillbirth did not vary by time of death or by whether the relative's death was expected or unexpected. Death of a close relative is one of the most severe sources of stress, and future studies need to investigate whether less severe but more common stressors also increase stillbirth risk.
越来越多的证据表明，孕妇的压力可能会影响妊娠结局。在一项包括 1973 年至 2006 年期间近 300 万例分娩的全国性瑞典研究中，我们调查了孕妇在怀孕期间丧亲是否与死胎风险有关。通过几个基于人群的登记册之间的个体记录链接，我们获得了有关人口统计学、与健康相关和与妊娠相关的因素以及母亲一级亲属死亡的信息。该队列中有 11071 例死胎（每 1000 例分娩中有 3.8 例）。在校正了潜在的混杂因素后，与未暴露于丧亲的后代相比，母亲在怀孕前一年或怀孕期间失去任何一级亲属的婴儿死胎风险增加了 18%（95%置信区间：1.06，1.31）。相应的危险比为母亲失去年长子女的 1.67（95%置信区间：1.18，2.36），失去兄弟姐妹的 2.06（95%置信区间：1.44，2.94），失去父母的 1.07（95%置信区间：0.95，1.21）。母亲丧亲与死胎之间的关系不因死亡时间或亲属死亡是否可预见而有所不同。近亲死亡是最严重的压力源之一，未来的研究需要调查是否不那么严重但更常见的压力源也会增加死胎风险。
