Stress, Anxiety, and Birth Outcomes: A Critical Review of the Evidence

Research exploring the relation of self-report assessments of life change and anxiety to birth outcomes is reviewed. Although there is evidence from infrahuman research that exposure to stressors during gestation can result in unfavorable reproductive outcomes, in humans both global categorizations of obstetric outcome and measures of neonatal status are found to be inconsistently related to indices of stress or anxiety. Such findings seem to result from both a consistent commitment by investigators to a conventional correlational approach focusing on the use of self-report instruments, and disregard for the impact of important sociodemographic and biomedical factors on obstetric risk. Alternatives to the methodological strategies used in these studies are discussed. Clearer findings could likely be provided by research adopting some of the controls and measurement techniques used in epidemiological analyses of the relation of psychosocial factors to illness.