Abstract
Problem
Maternal stress perception is frequently alleged as a cause of infertility, miscarriages, late pregnancy complications or impaired fetal development. The purpose of the present review is to critically assess the biological and epidemiological evidence that considers the plausibility of a stress link to human reproductive failure.
Methods
All epidemiological studies published between 1980 and 2007 that tested the link between stress exposure and impaired reproductive success in humans were identified. Study outcomes were evaluated on the basis of how associations were predicted, tested and integrated with theories of etiology arising from recent scientific developments in the basic sciences. Further, published evidence arising from basic science research has been assessed in order to provide a mechanistic concept and biological evidence for the link between stress perception and reproductive success.
Results
Biological evidence points to an immune–endocrine disequilibrium in response to stress and describes a hierarchy of biological mediators involved in a stress trigger to reproductive failure. Epidemiological evidence presents positive correlations between various pregnancy failure outcomes with pre-conception negative life events and elevated daily urinary cortisol. Strikingly, a relatively new conceptual approach integrating the two strands of evidence suggests the programming of stress susceptibility in mother and fetus via a so-called pregnancy stress syndrome.
Conclusions
An increasing specificity of knowledge is available about the types and impact of biological and social pathways involved in maternal stress responses. The present evidence is sufficient to warrant a reconsideration of conventional views on the etiology of reproductive failure. Physicians and patients will benefit from the adaptation of this integrated evidence to daily clinical practice.
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Acknowledgements
Valuable assistance to KLK was provided by Dr. James Tansey, Assistant Professor and Chair of Business Ethics at the Sauder School of Business, UBC. The authors are grateful for the support provided by Mirjam Ruecke and Ronny Schwierzinski in performing a prospective cohort trial.
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Scientific evidence in synthesis supports the plausibility of a stress trigger to human reproductive failure; higher risk may be explained by pregnancy stress syndrome.
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Box 1
Stress and human reproductive failure: recommendations for future research | |
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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 |
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Nakamura, K., Sheps, S. & Clara Arck, P. Stress and reproductive failure: past notions, present insights and future directions. J Assist Reprod Genet 25, 47–62 (2008). https://doi.org/10.1007/s10815-008-9206-5
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DOI: https://doi.org/10.1007/s10815-008-9206-5