{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:19:36Z","timestamp":1780334376620,"version":"3.54.1"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T00:00:00Z","timestamp":1707091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Glob. Womens Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The epidemiologic literature on women's perceived stress in relation to perinatal outcomes has been inconclusive and does not consider the preconception window of exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether women's preconception perceived stress is related to live birth, gestational age, and birthweight in a cohort receiving fertility treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This observational study included women seeking fertility care at the Massachusetts General Hospital (2004\u20132019). During preconception, women provided information on their psychological stress using the short version of the validated Perceived Stress Scale 4 (PSS-4). We used regression models to evaluate the associations of stress with live birth (<jats:italic>N<\/jats:italic>\u2009=\u2009768 attempting to conceive) and perinatal outcomes (<jats:italic>N<\/jats:italic>\u2009=\u2009413 live births) while adjusting for confounders. Stratified analyses by mode of conception [natural, intrauterine insemination (IUI), and IVF (<jats:italic>in vitro<\/jats:italic>fertilization)] and selected socioeconomic factors (race, education, and income) were also conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Higher psychological stress was negatively associated with the overall probability of live birth (adjusted RR\u2009=\u20090.95, 95% CI: 0.92, 0.98), particularly among women conceiving using IVF. However, we found no association between women's psychological stress and gestational age and birth weight in the overall analyses and also stratified by mode of conception. Similarly, we observed no differences in women's psychological stress with any of the measured outcomes by socioeconomic factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>These results highlight the importance of considering the preconception window and mode of conception when evaluating the relationship between women's preconception stress and live birth.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fgwh.2024.1293255","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T04:48:15Z","timestamp":1707108495000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Women's preconception psychological stress and birth outcomes in a fertility clinic: the EARTH study"],"prefix":"10.3389","volume":"5","author":[{"given":"Lidia","family":"M\u00ednguez-Alarc\u00f3n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paige L.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Souter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer B.","family":"Ford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russ","family":"Hauser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge E.","family":"Chavarro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,2,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/S0140-6736(02)09417-5","article-title":"Female subfertility","volume":"360","author":"Evers","year":"2002","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1093\/humupd\/dmv016","article-title":"Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century","volume":"21","author":"Inhorn","year":"2015","journal-title":"Hum Reprod Update"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e1001356","DOI":"10.1371\/journal.pmed.1001356","article-title":"National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys","volume":"9","author":"Mascarenhas","year":"2012","journal-title":"PLoS Med"},{"key":"B4","first-page":"1","volume-title":"Pregnancy Rates for U.S. Women Continue to Drop","author":"Curtin","year":"2013"},{"key":"B5","first-page":"1","article-title":"Intended and unintended births in the United States: 1982\u20132010","volume":"55","author":"Mosher","year":"2012","journal-title":"Natl Health Stat Report"},{"key":"B6","year":""},{"key":"B7","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1016\/j.fertnstert.2013.10.005","article-title":"International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2005","volume":"101","author":"Zegers-Hochschild","year":"2014","journal-title":"Fertil Steril"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1093\/aje\/kwp281","article-title":"Estimation of the contribution of non-assisted reproductive technology ovulation stimulation fertility treatments to US singleton and multiple births","volume":"170","author":"Schieve","year":"2009","journal-title":"Am J Epidemiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1588","DOI":"10.1093\/humrep\/dew082","article-title":"International Committee for Monitoring Assisted Reproductive Technologies world report: Assisted Reproductive Technology 2008, 2009 and 2010","volume":"31","author":"Dyer","year":"2016","journal-title":"Hum Reprod"},{"key":"B10","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1093\/humupd\/8.2.141","article-title":"The variability of female reproductive ageing","volume":"8","author":"te Velde","year":"2002","journal-title":"Hum Reprod Update"},{"key":"B11","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1093\/humupd\/dml025","article-title":"Demographic effects of the introduction of steroid contraception in developed countries","volume":"12","author":"Leridon","year":"2006","journal-title":"Hum Reprod Update"},{"key":"B12","year":""},{"key":"B13","doi-asserted-by":"publisher","first-page":"41","DOI":"10.31887\/DCNS.2018.20.1\/klrooney","article-title":"The relationship between stress and infertility","volume":"20","author":"Rooney","year":"2018","journal-title":"Dialogues Clin Neurosci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1080\/0092623X.2014.958789","article-title":"The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: a systematic review","volume":"41","author":"Luk","year":"2015","journal-title":"J Sex Marital Ther"},{"key":"B15","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/S0015-0282(16)48316-0","article-title":"Psychological evaluation and support in a program of in vitro fertilization and embryo transfer","volume":"43","author":"Freeman","year":"1985","journal-title":"Fertil Steril"},{"key":"B16","doi-asserted-by":"crossref","first-page":"2264","DOI":"10.1093\/humrep\/deac172","article-title":"Prospectively assessed perceived stress associated with early pregnancy losses among women with history of pregnancy loss","volume":"37","author":"Schliep","year":"2022","journal-title":"Hum Reprod"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1038\/s41598-017-01792-3","article-title":"The association between psychological stress and miscarriage: a systematic review and meta-analysis","volume":"7","author":"Qu","year":"2017","journal-title":"Sci Rep"},{"key":"B18","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s12884-015-0775-x","article-title":"Effect of maternal stress during pregnancy on the risk for preterm birth","volume":"16","author":"Lilliecreutz","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"B19","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1515\/jpm-2012-0295","article-title":"Psychosocial stress in pregnancy and preterm birth: associations and mechanisms","volume":"41","author":"Shapiro","year":"2013","journal-title":"J Perinat Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1186\/s12884-019-2535-9","article-title":"Prenatal maternal stress and birth outcomes in rural Ghana: sex-specific associations","volume":"19","author":"Ae-Ngibise","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"B21","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1186\/s13104-019-4383-0","article-title":"Perceived stress and its associated factors among pregnant women in bale zone hospitals, Southeast Ethiopia: a cross-sectional study","volume":"12","author":"Engidaw","year":"2019","journal-title":"BMC Res Notes"},{"key":"B22","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1177\/109980040100300106","article-title":"Relationships of cortisol, perceived stress, genitourinary infections, and fetal fibronectin to gestational age at birth","volume":"3","author":"Ruiz","year":"2001","journal-title":"Biol Res Nurs"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1037\/hea0001017","article-title":"Impact of maternal prenatal psychological stress on birth weight","volume":"39","author":"M\u00e9lan\u00e7on","year":"2020","journal-title":"Health Psychol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1089\/jwh.2016.6118","article-title":"Prenatal perceived stress and adverse birth outcomes among Puerto Rican women","volume":"27","year":"2018","journal-title":"J Womens Health"},{"key":"B25","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1080\/14647273.2019.1709667","article-title":"Infertility and perceived stress: the role of identity concern in treatment-seeking men and women","volume":"25","author":"Grunberg","year":"2022","journal-title":"Hum Fertil"},{"key":"B26","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1001\/jama.2021.4788","article-title":"Diagnosis and management of infertility: a review","volume":"326","author":"Carson","year":"2021","journal-title":"JAMA"},{"key":"B27","doi-asserted-by":"publisher","first-page":"221","DOI":"10.4103\/jhrs.JHRS_39_17","article-title":"Infertility stress in couples undergoing intrauterine insemination and in vitro fertilization treatments","volume":"10","author":"Awtani","year":"2017","journal-title":"J Hum Reprod Sci"},{"key":"B28","doi-asserted-by":"publisher","first-page":"488","DOI":"10.2307\/1519795","article-title":"Status variations in stress exposure: implications for the interpretation of research on race, socioeconomic status, and gender","volume":"44","author":"Turner","year":"2003","journal-title":"J Health Soc Behav"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.1016\/S0277-9536(00)00084-8","article-title":"Social inequalities, stressors and self reported health status among African American and white women in the Detroit metropolitan area","volume":"51","author":"Schulz","year":"2000","journal-title":"Soc Sci Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1002\/smi.3095","article-title":"Socioeconomic status and psychological stress: examining intersection with race, sex and US geographic region in the REasons for Geographic and Racial Differences in Stroke study","volume":"38","author":"Cundiff","year":"2022","journal-title":"Stress Health"},{"key":"B31","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1007\/s40615-015-0110-2","article-title":"A comparison of birth outcomes among black, Hispanic, and black Hispanic women","volume":"2","author":"Bediako","year":"2015","journal-title":"J Racial Ethn Health Disparities"},{"key":"B32","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1111\/j.1365-3016.2011.01192.x","article-title":"The association between neighbourhoods and adverse birth outcomes: a systematic review and meta-analysis of multi-level studies","volume":"25","author":"Metcalfe","year":"2011","journal-title":"Paediatr Perinat Epidemiol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.reprotox.2016.07.012","article-title":"Dietary folate intake and modification of the association of urinary bisphenol A concentrations with in vitro fertilization outcomes among women from a fertility clinic","volume":"65","author":"Minguez-Alarcon","year":"2016","journal-title":"Reprod Toxicol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1177\/1359105313508346","article-title":"New, normative, English-sample data for the Short Form Perceived Stress Scale (PSS-4)","volume":"18","author":"Warttig","year":"2013","journal-title":"J Health Psychol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3389\/fpsyg.2018.00037","article-title":"Determining factors for stress perception assessed with the Perceived Stress Scale (PSS-4) in Spanish and other European samples","volume":"9","author":"Vallejo","year":"2018","journal-title":"Front Psychol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1002\/nur.20284","article-title":"Perceived stress in survivors of suicide: psychometric properties of the perceived stress scale","volume":"31","author":"Mitchell","year":"2008","journal-title":"Res Nurs Health"},{"key":"B37","first-page":"31","article-title":"Perceived stress in a probability sample of the United States","volume-title":"The Social Psychology of Health: Claremont Symposium on Applied Social Psychology","author":"Cohen","year":"1988"},{"key":"B38","first-page":"49","article-title":"Perceived stress scale, a tool to explore psychological stress in Mexican women","volume":"64","author":"Flores-Torres","year":"2021","journal-title":"Salud Publica Mex"},{"key":"B39","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.anr.2012.08.004","article-title":"Review of the psychometric evidence of the perceived stress scale","volume":"6","author":"Lee","year":"2012","journal-title":"Asian Nurs Res"},{"key":"B40","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1097\/01.AOG.0000454932.15177.be","article-title":"Committee opinion no 611: method for estimating due date","volume":"124","year":"2014","journal-title":"Obstet Gynecol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1016\/j.rbmo.2016.07.002","article-title":"Maternal physical and sedentary activities in relation to reproductive outcomes following IVF","volume":"33","author":"Gaskins","year":"2016","journal-title":"Reprod Biomed Online"},{"key":"B42","year":""},{"key":"B43","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1080\/00031305.1980.10483031","article-title":"Population marginal means in the linear model: an alternative to least square means","volume":"34","author":"Searle","year":"1980","journal-title":"Am Stat"},{"key":"B44","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1097\/GCO.0000000000000069","article-title":"The impact of lifestyle behaviors on infertility treatment outcome","volume":"26","author":"Rooney","year":"2014","journal-title":"Curr Opin Obstet Gynecol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/1477-7827-11-66","article-title":"Lifestyle factors and reproductive health: taking control of your fertility","volume":"11","author":"Sharma","year":"2013","journal-title":"Reprod Biol Endocrinol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"178","DOI":"10.2478\/s13382-012-0024-8","article-title":"Psychometric properties of the French versions of the Perceived Stress Scale","volume":"25","author":"Lesage","year":"2012","journal-title":"Int J Occup Med Environ Health"},{"key":"B47","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1186\/1471-2458-10-513","article-title":"Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke","volume":"10","author":"Leung","year":"2010","journal-title":"BMC Public Health"},{"key":"B48","doi-asserted-by":"publisher","first-page":"3783","DOI":"10.1038\/s41598-019-40539-0","article-title":"Association between dry eye disease and psychological stress among paramedical workers in Korea","volume":"9","author":"Hyon","year":"2019","journal-title":"Sci Rep"},{"key":"B49","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/j.8755-8920.2001.460201.x","article-title":"Stress and pregnancy loss: role of immune mediators, hormones and neurotransmitters","volume":"46","author":"Arck","year":"2001","journal-title":"Am J Reprod Immunol"},{"key":"B50","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1111\/j.1552-6909.2009.01034.x","article-title":"Are maternal cortisol levels related to preterm birth?","volume":"38","author":"Giurgescu","year":"2009","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"key":"B51","doi-asserted-by":"publisher","first-page":"101456","DOI":"10.1016\/j.pmedr.2021.101456","article-title":"Racial and ethnic disparities in birth outcomes: a decomposition analysis of contributing factors","volume":"23","author":"Su","year":"2021","journal-title":"Prev Med Rep"},{"key":"B52","doi-asserted-by":"publisher","first-page":"7","DOI":"10.2174\/1875318300801010007","article-title":"Biomarkers of psychological stress in health disparities research","volume":"1","author":"Djuric","year":"2008","journal-title":"Open Biomark J"}],"container-title":["Frontiers in Global Women's Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2024.1293255\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,10]],"date-time":"2024-11-10T03:16:28Z","timestamp":1731208588000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2024.1293255\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,5]]},"references-count":52,"alternative-id":["10.3389\/fgwh.2024.1293255"],"URL":"https:\/\/doi.org\/10.3389\/fgwh.2024.1293255","relation":{},"ISSN":["2673-5059"],"issn-type":[{"value":"2673-5059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,5]]},"article-number":"1293255"}}