Stress makes it more difficult to conceive, study suggests
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Women with a higher allostatic load — an indicator of chronic stress — experienced lower fecundability, according to data published in Acta Obstetricia et Gynecologica Scandinavica.
“To our knowledge, this is the first study to report this association among general pregnancy-attempting women from a cohort design,” Xiang Hong, PhD, who holds a postdoctoral position in the Key Laboratory of Environmental Medicine and Engineering of the Ministry of Education at Southeast University in Nanjing, China, and colleagues wrote. “Our results will help to provide scientific evidence to improve the prepregnancy health of women by developing appropriate management strategies.”
Identifying women attempting pregnancy
Hong and colleagues enrolled married couples trying to become pregnant who participated in the National Pre-conception Check-up Project in the Maternal and Child Center of the Gulou district of Nanjing between June 13, 2018, and May 30, 2020. Within these couples, the researchers identified 444 eligible women.
Participants completed a questionnaire on sociodemographic characteristics and pregnancy history and provided fasting blood samples. The researchers used the blood samples and other health indicators — which included systolic blood pressure, diastolic blood pressure, fasting plasma glucose, plasma cortisol, noradrenaline, interleukin-6, hypersensitive C-reactive protein, high density lipoprotein cholesterol and BMI — to determine allostatic load at baseline. Via telephone, they followed up with participants every 3 months for 1 year to determine whether they were pregnant or when their last menstrual cycle was.
Findings
The median allostatic load score was 1 on a scale of 0 to 6, with 33.8% of women having a score of 0 (group A), 35.1% scoring 1 or 2 (group B), 22.5% scoring 3 or 4 (group C) and 8.6% scoring 5 or 6 (group D).
Over 12 months of follow-up, the pregnancy rate was 55.4% in group A, 44.5% in group B, 50.9% in group C and 26.9% in group D. When adjusted for confounding factors, only group D had a statistically significant reduction of fecundability compared with group A (adjusted OR = 0.41; 95% CI, 0.21-0.83).
Hong and colleagues suggested that the connection between allostatic load and time to pregnancy may be related to the function of the hypothalamic-pituitary-adrenal axis, the suppression of the hypothalamic-pituitary-gonadal axis or a low sexual desire during times of stress.
“What we found provides a new idea for preconception counseling,” senior author Bei Wang, PhD, who is also affiliated with the Key Laboratory of Environmental Medicine and Engineering of the Ministry of Education, said in a press release. “But obviously, how to objectively assess the stress is a complex scientific question, and how to intervene and reduce the impact of chronic stress is a burning problem, which are all things we need to study further.”
References:
- Does stress make it more difficult to become pregnant? https://www.eurekalert.org/news-releases/965037. Published Sept. 21, 2022. Accessed Sept. 23, 2022.
- Hong X, et al. Acta Obstet Gynecol Scand. 2022;doi:10.1111/aogs.14443.
Perspective
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The review by Hong and colleagues demonstrated that women with a higher prepregnancy allostatic load did indeed have a longer time to conception than women with a lower allostatic load. The authors discuss why allostatic load reflects the emotional and psychological stressors that women trying to conceive are dealing with.
These findings would tend to confirm what most lay readers would believe: that stressors can make it harder for a couple to conceive. What many medical — and lay — readers might have more problems believing is that stressors directly affect such parameters as blood pressure, weight and hormonal levels.
I am not certain that the results of this study are applicable to a U.S. cohort. Most notably, the incidence of obesity in this population was miniscule: the average BMI was 20.9, with a 9% incidence of overweight and obesity. Obesity has a major influence in our population.
The other factor that was not investigated was frequency of intercourse. It would be very easy to believe that women (or a couple) with significant psychosocial stress would not be as sexually active as less stressed individuals. This could be a major confounding variable.
What I liked was that these women had all participated in a National Free Pre-Conception Check-up, an entity which would be welcomed in this country. Although strongly encouraged by ACOG, this visit often does not happen, but it could prevent many conception and pregnancy issues.
As a takeaway from this paper, encourage all women to get into as good physical and mental health state as you can to maximize your chances of getting pregnant.
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