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Loss of a close family member the year before or during pregnancy and the risk of placental abruption: a cohort study from Denmark and Sweden

Published online by Cambridge University Press:  26 September 2013

K. D. László ,
C. V. Ananth ,
A. K. Wikström ,
T. Svensson ,
J. Li ,
J. Olsen ,
M. Vestergaard ,
C. Obel  and
S. Cnattingius
K. D. László*
Affiliation:
Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
C. V. Ananth
Affiliation:
Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, USA Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, USA
A. K. Wikström
Affiliation:
Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
T. Svensson
Affiliation:
Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
J. Li
Affiliation:
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
J. Olsen
Affiliation:
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark Department of Epidemiology, School of Public Health, University of California, Los Angeles, California, USA
M. Vestergaard
Affiliation:
Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
C. Obel
Affiliation:
Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark Research Program for Mental Child Health, Department of Public Health, Aarhus University and Institute of Handicap and Communication, The Central Region, Aarhus, Denmark
S. Cnattingius
Affiliation:
Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
*
*Address for correspondence: Dr K. D. László, Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Eugeniahemmet T2, 17176, Stockholm, Sweden. (Email: krisztina.laszlo@ki.se)
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Abstract

Background

Maternal stress during pregnancy is associated with a modestly increased risk of fetal growth restriction and pre-eclampsia. Since placental abruption shares similar pathophysiological mechanisms and risk factors with fetal growth restriction and pre-eclampsia, we hypothesized that maternal stress may be implicated in abruption risk. We investigated the association between maternal bereavement during pregnancy and placental abruption.

Method

We studied singleton births in Denmark (1978–2008) and Sweden (1973–2006) (n = 5 103 272). In nationwide registries, we obtained data on death of women's close family members (older children, siblings, parents, and partners), abruption and potential confounders.

Results

A total of 30 312 (6/1000) pregnancies in the cohort were diagnosed with placental abruption. Among normotensive women, death of a child the year before or during pregnancy was associated with a 54% increased odds of abruption [95% confidence interval (CI) 1.30–1.82]; the increased odds were restricted to women who lost a child the year before or during the first trimester in pregnancy. In the group with chronic hypertension, death of a child the year before or in the first trimester of pregnancy was associated with eight-fold increased odds of abruption (odds ratio 8.17, 95% CI 3.17–21.10). Death of other relatives was not associated with abruption risk.

Conclusions

Loss of a child the year before or in the first trimester of pregnancy was associated with an increased risk of abruption, especially among women with chronic hypertension. Studies are needed to investigate the effect of less severe, but more frequent, sources of stress on placental abruption risk.

Keywords

Bereavementcohort studyplacental abruptionstress
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 9 , July 2014 , pp. 1855 - 1866
Copyright
Copyright © Cambridge University Press 2013 

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