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By The U.S. National Institute of Health


A study finds that women who experience stress during the first three weeks of pregnancy are three times more likely to have a miscarriage. "Try to benefit yourself from what you consider to be a positive environment. The less stress, the better," recommended lead investigator Pablo Nepomnaschy, research fellow at the National Institute of Environmental Health Sciences of the National Institutes of Health in Research Triangle Park, North Carolina.

His research team published their findings in this week's issue of Proceedings of the National Academy of Sciences. The NIH team followed 61 women during 12 months and collected urine samples from each woman three times a week to check for the pregnancy status and cortisol levels, a hormone associated with stress. "This study is special in that it includes data on cortisol," Nepomnaschy said, who added that they did this test in the early stages of pregnancy because "most miscarriages take place in the first three or four weeks of conception."

Of the 61 women, 22 remained pregnant. Nine completed the pregnancy and 13 suffered a miscarriage. The researchers found that the women with the higher cortisol levels during the first three weeks of pregnancy were 2.7 times more likely to experience a miscarriage.In general, a miscarriage occurred in 90 per cent of the pregnancies in which the women had higher cortisol levels and in 33 per cent of those with normal cortisol levels. Nepomnaschy said it is not clear why an increase in cortisol levels could increase the miscarriage risk, but he has a hypothesis: "The body could interpret [a higher cortisol level] as a deterioration in the condition, and it is possible that this could unleash the miscarriage mechanism."

The women in the study were all residents in a rural area of Guatemala. "This population is more homogeneous than any other population in the United States," Nepomnaschy said, in explaining that he tried to get a sample of women similar in terms of lifestyle, ethnicity and culture to dismiss other factors associated with miscarriage.

The women in the study had similar diets and activity levels, and all belonged to the same ethnic group. Another expert, Dr. Mary Stephenson, a gynecoobstetrician leading the Recurrent Pregnancy Loss Program at the University of Chicago, said, "it's an intriguing article. It is certainly necessary to conduct more research. But it is a potential mechanism through which a miscarriage could happen." Other studies have analyzed the relationship between cortisol and miscarriage, Stephenson pointed out. "The results have been contradictory. There are some animal studies that suggest that stress increases the risk of miscarriage. And doctors have suspected for a long time that stress does the same in humans."

About 15 per cent of known pregnancies end in miscarriage, according to the March of Dimes. Although Stephenson said the statistics usually include pregnancies that reach the 6th week. "When we count the ones that happen before the six weeks, up to half of the pregnancies ended in miscarriage," she noted. The best advice for women trying to get pregnant is to eliminate stress in their lives before conception, she noted. "I talk a lot about this with my patients," Stephenson said. "I recommend that prior to the pregnancy, they seriously analyze their lifestyle." And that includes getting enough hours of sleep, so that fatigue may not be a problem. "Fatigue is a type of stress," Stephenson emphasized.



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