Waterstone Clinic, Lotamore House, Tivoli, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Wilton Road, Cork, Ireland.
National Perinatal Epidemiology Centre, University College Cork, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2020 May;248:187-192. doi: 10.1016/j.ejogrb.2020.03.006. Epub 2020 Mar 6.
There is evidence to suggest that high perceived stress in early pregnancy is associated with increased rates of miscarriage. Our objective was to determine if psychological stressors have an impact on medically assisted reproduction (MAR) cycle outcomes including miscarriage rates.
A survey-based study of women recruited prior to commencing MAR treatment and followed prospectively for treatment outcome (negative/positive pregnancy test, miscarriage) during the study period 2013-2015. The survey focused on perceived stress, emotional well-being, maternal social support and outlook. The women were asked to grade their responses according to a specified scale.
320 women responded to the survey (response rate 64 %, 320/498). 290 (90 %, 290/320) women proceeded to MAR of which 58 % (n = 167/290) conceived. Analysis of stressful life events in the preceding 12 months, including job stress or serious financial problems did not reveal significance in terms of conception. A small number had experienced serious illness in the preceding 12 months which demonstrated significance in terms of not achieving pregnancy. Overall, there were high rates of emotional wellbeing, very high rates of maternal support and medium to low levels of perceived stress and this did not differ amongst those who conceived and failed to conceive. The data were further analysed according to livebirth and miscarriage (biochemical pregnancy and miscarriage). Analysis of stressful life events revealed a higher rate of miscarriage amongst those who reported a stressful/demanding job (p < 0.05). A number of women reported non-specified stressful life events and separation/divorce in higher numbers amongst the miscarriage group, reaching statistical significance, however the numbers are small thus limiting interpretation. Psychological factors had no impact on the risk of miscarriage amongst the group.
This study suggests that stressors do not impact greatly on conception rates from MAR but may negatively impact on miscarriage rates. Job-related stress, in particular, is associated with higher risk of miscarriage. This suggests that there may be a role for stress management in early pregnancy.
有证据表明，妊娠早期感知到的压力较高与流产率增加有关。我们的目的是确定心理压力是否会对医学辅助生殖（MAR）周期结果产生影响，包括流产率。
这是一项基于问卷调查的研究，在开始 MAR 治疗前招募了女性，并在 2013 年至 2015 年期间前瞻性地跟踪治疗结果（阴性/阳性妊娠试验、流产）。该调查侧重于感知压力、情绪健康、产妇社会支持和展望。女性被要求根据指定的量表对她们的反应进行评分。
320 名女性对调查做出了回应（回应率为 64%，320/498）。其中 290 名（90%，290/320）女性进行了 MAR，其中 58%（n=167/290）怀孕。分析前 12 个月的应激性生活事件，包括工作压力或严重的财务问题，在受孕方面没有发现显著差异。少数人在过去 12 个月中患有严重疾病，这在未能怀孕方面具有显著意义。总的来说，情绪健康水平较高，产妇支持率非常高，感知压力处于中低水平，而受孕和未受孕的女性之间没有差异。数据进一步根据活产和流产（生化妊娠和流产）进行分析。分析应激性生活事件显示，报告工作压力大/要求高的女性流产率更高（p<0.05）。一些女性报告了非特定的应激性生活事件，在流产组中离婚/分居的人数较多，达到了统计学意义，但数量较少，因此限制了解释。心理因素对该组的流产风险没有影响。
这项研究表明，压力源对 MAR 的受孕率影响不大，但可能对流产率产生负面影响。特别是与工作相关的压力与更高的流产风险相关。这表明在早期妊娠中可能需要进行压力管理。
