Psychosocial Stress and Its Relation to Obstetrical Complications
Authors: James Georgas, Eliza Giakoumaki, Nikos Georgoulias, Eugene Koumandakis, Dionysios Kaskarelis
Journal: Psychotherapy and Psychosomatics (1984)

A Greek adaptation of the Schedule of Recent Experience of Holmes and Rahe was employed to study the relationship of psychosocial stress to symptoms during pregnancy, obstetric complications, family planning and breast feeding. An initial experiment with 130 pregnant women in the third trimester indicated that psychosocial stress was not related to education, whether they were from Athens or the provinces, nor age. The second experiment with 103 mothers 3 or 4 days after delivery indicated that high psychosocial stress is related to increased symptom scores during pregnancy and to obstetric complications. Symptoms were not related to obstetric complications, nor were family planning nor breast feeding. Psychosocial stress was also related to family planning and also to whether or not the mother breast fed.The relationship between psychosocial stress, the occurrence of various symptoms during pregnancy, the occurrence of obstetric complications, family planning, and breast feeding intentions was assessed for 103 maternity patients at the Alexandra Maternity Hospital in Athens, Greece. A modified version of the Holmes and Rake Schedule of Recent Experience was used to measure the level of psychosocial stress. The modified instrument consisted of 48 stressogenic life events. Respondents were asked to identify the events they had experienced, to rate the level of stress induced by the event on a 0-100 scale, and to specify if the event occurred 0-6 months, 7-12 months, or 13-25 months prior to delivery. Respondents were also presented with a list of symptoms and asked to identify those they experienced during pregnancy, to rate the severity of the symptoms, and to identify the trimester in which they occurred. Subjective psychosocial stress scores and symptom scores were then calculated for each respondent. A gynecologist reviewed the delivery records of each woman and classified the delivery in respect to obstetric complications as either normal or abnormal. Respondents were also asked if the birth was the result of an unplanned or planned pregnancy and if they intended to breast feed their infant. Questionnaires were administered 3-4 days following delivery. Pearson product-moment correlation, analysis of variance, and chi-square techniques were used to analyze the data. The level of psychosocial stress experienced during the 6-month period prior to delivery was positively associated with the occurrence of obstetric complications; however, the level of stress experienced more than 6 months prior to delivery was not. The most common stressogenic events reported by women who had obstetric complications were 1) high anxiety about the health status of the fetus, 2) death of a loved one, 3) arguments with parents or spouse, 4) a sharp decline in income, and 5) job-related problems of spouse. The level of psychosocial stress was also positively related to occurrence of symptoms during pregnancy, and 25% of the variation in symptom scores was explained by differences in psychosocial stress levels. Symptom scores increased with each trimester of pregnancy, but were not associated with the occurrence of obstetric complications. Women who planned their pregnancies, in contrast to those who did not, had significantly lower psychosocial stress and symptom scores; however, the occurrence of obstetric complications was not significantly related to either planned or unplanned pregnancy. Similarly, women who intended to breast feed, compared with those who did not, had significantly lower psychoosocial stress and symptom scores, but breast feeding intention was not significantly related to the occurrence of obstetric complications. Women who planned to breast feed and women who planned their pregnancy tended to be younger than women who did not plan to breast feed and women who did not plan their pregnancy.