Severe stress following bereavement during pregnancy and risk of pregnancy loss: results from a population-based cohort study

J Epidemiol Community Health. 2016 May;70(5):424-9. doi: 10.1136/jech-2015-206241. Epub 2015 Nov 19.


Background: Previous findings on the association between stress during pregnancy and pregnancy loss are inconsistent. We aimed to estimate this association using a large prospective cohort.

Methods: This population-based study included all 1 303 660 clinically recognised pregnancies in Denmark between 1995 and 2008. We categorised women as exposed to severe stress if they lost a child, sibling or parent during pregnancy. Cox Proportional Hazards models were used to study the association between exposure and rate of fetal death, starting with the follow-up on the day of completion of week 4 of pregnancy. In an attempt to control for unknown potential confounders, we also designed a pregnancy-matched analysis in which each woman had her own baseline risk of pregnancy loss and controls therefore for genetic and time-stable environmental factors.

Results: A total of 146 031 pregnancies ended in clinically recognised fetal loss (11.2%) and a total of 10 808 (0.8%) women were categorised as exposed. The overall risk of pregnancy loss was similar in the exposed and unexposed (aHR=1.05, 95% CI 0.95 to 1.15). Results from the pregnancy-matched analysis (performed in 423 women) showed stronger and significant associations (aHR=1.83, 95% CI 1.49 to 2.25). All the analyses indicated a stronger effect of bereavement when the mother lost a child or when the death was unexpected.

Conclusions: Our main results suggested no strong association between severe stress during pregnancy and risk of pregnancy loss. Results from the pregnancy-matched analyses considered information from a selected and small group of women for whom there may exist a stronger association between stress during pregnancy and pregnancy loss. The fact that an unexpected death or the loss of a child had a stronger effect in both analyses may indicate that severe stressful situations increase the risk of pregnancy loss.


Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Legal / psychology*
  • Abortion, Spontaneous / epidemiology
  • Abortion, Spontaneous / psychology*
  • Adult
  • Bereavement*
  • Cohort Studies
  • Denmark / epidemiology
  • Female
  • Humans
  • Pregnancy
  • Proportional Hazards Models
  • Prospective Studies
  • Registries
  • Stress, Psychological / complications*
  • Young Adult