Park, J., Porucznik, C. A., Christensen, K., Stanford, J. B., & Schliep, K. C. (2019). Daily perceived stress and time to pregnancy: A prospective cohort study of women trying to conceive. Psychoneuroendocrinology, 110, 104446. https://doi.org/10.1016/j.psyneuen.2019.104446
Park J, Porucznik CA, Christensen K, Stanford JB, Schliep KC. Daily perceived stress and time to pregnancy: A prospective cohort study of women trying to conceive. Psychoneuroendocrinology. 2019;110:104446. doi:10.1016/j.psyneuen.2019.104446
Park, J., et al. "Daily perceived stress and time to pregnancy: A prospective cohort study of women trying to conceive." Psychoneuroendocrinology, vol. 110, 2019, pp. 104446.
Daily stress was not tied to delayed pregnancy in proven-fertile women
Daily perceived stress was not linked to a longer time to pregnancy in 111 women of proven fertility. This cohort study followed daily diaries from a Utah trial, kept for up to 7 cycles. About 8 out of 10 of the 111 women got pregnant. Moderate and high stress showed no detectable difference from low stress.
Key Findings
Of the 111 women analyzed, 90 (81.1%) conceived and 76 (68.5%) had a live birth, over an average follow-up of 4.01 cycles.
Moderate versus low stress: adjusted fecundability odds ratio 1.37 (95% CI 0.71, 2.67). High versus low stress: 1.11 (95% CI 0.58, 2.14).
High versus low pre-ovulatory stress gave 1.79 (95% CI 0.90, 3.56). High versus low pre-implantation stress gave 1.08 (95% CI 0.56, 2.10).
Adding intercourse frequency during the fertile window to the model, or imputing missing stress values, did not appreciably change the estimates.
Interpretation
Moderate and high perceived stress showed no clear link to fecundability compared with low stress, whether stress was measured across the whole cycle or within the pre-ovulatory and pre-implantation windows. The authors note that stress was a secondary measure in this trial of time to pregnancy. The findings support larger studies of perceived stress and fecundability.
RRM Context
The trial behind this analysis randomized couples of proven fertility to Creighton Model instruction (n = 71) or general preconception counseling (n = 72). Women kept daily diaries and did daily urine LH tests. The records placed stress in set windows of each cycle. Adjusting for intent to conceive, tracked each cycle, had a substantial impact on the model, toward a stronger positive association.
Our editorial summary of this paper, not the article's abstract.
Abstract
Background
Prior studies among women with impaired fecundity have consistently demonstrated a positive association between daily perceived stress and the ability to conceive. However, the effects of daily stress on time to pregnancy (TTP) among women with proven fertility is not known.
Materials and Methods
One hundred and forty-three women ages 18-35, in a relationship of proven fertility, who desired to conceive were included in the analysis. Daily diaries recording perceived stress (scale 0-10) were completed for up to 7 menstrual cycles or until pregnancy. Cox proportional hazards regression models were used to estimate the association between time-varying perceived stress tertiles (high [>4.1-7.2], moderate [>2.7-4.1], and low [0.1-2.7]) and adjusted fecundability odds ratio (aFOR), 95% confidence intervals (CI), after taking into account age, parity, education, time-varying caffeine and alcohol intake, fertility awareness tracking, and cycle intent to conceive.
Results
Among the 111 participants who completed daily diaries, 90 (81.1%) conceived. Women reporting high or moderate stress, versus low stress, had no difference in probability of achieving pregnancy (aFOR: 1.11 [95% CI: 0.58, 2.14]; and aFOR: 1.37 [0.71, 2.67]), respectively. Additional adjustment for intercourse frequency during narrow fertile window, or narrowing exposure focus to pre-ovulatory or pre-implantation stress did not appreciably alter the estimates.
Conclusion
Daily perceived stress was not adversely associated with TTP among women with proven fertility. While a growing body of evidence supports adverse effects of more severe stressful life events on female reproductive function, moderate psychological stress, commonly referred to as eustress, among relatively healthy women with proven fertility does not appear to adversely impact TTP.
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