April 11, 2013
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Stress from military action heightened risk for miscarriage

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Women living under constant threat of military attacks were significantly more likely to experience spontaneous abortions compared with women living under normal conditions, researchers from Ben Gurion University reported.

Rocket attacks targeting the southern Israeli town of Sderot are preceded by a loud warning alarm, sounded only seconds before the rockets hit the town. Between April 2001 and December 2008, over 1,000 alarms have been activated in Sderot. Since 2001, rocket attacks have resulted in 13 deaths and dozens wounded.

Ilana Shoham-Vardi, PhD, Tamar Wainstock, MMedSc, and colleagues followed the pregnancies of 1,345 women from Sderot who were exposed to constant life-threatening rocket fire and 2,143 women residing in Kiryat Gat, which is located out of missile range. The researchers obtained medical and demographic data from hospital records, and information about rocket attacks was obtained from official local databases. Exposure intensity was determined by calculating the number of alarms 6 months before each pregnancy and the mean amount of alarms during the pregnancy period.

Tamar Wainstock, MMedSc 

Tamar Wainstock

After controlling for risk factors such as age and medical conditions, Shoham-Vardi and colleagues found that women from Sderot had higher rates of spontaneous abortions compared with women from Kiryat Gat (6.9% vs. 4.7%; adjusted OR=1.59; 95% CI, 1.17-2.2).

From 2001 to 2008, the intensity of exposure varied, and some women had a mean weekly exposure of 31 alarms. However, results indicated that women who were pregnant during either high or low intensity exposure were at similar risk for spontaneous abortion, which suggests that the threat of an attack may be just as stressful as an actual attack.

One possible explanation for the higher prevalence of spontaneous abortions among women living in Sderot may be that the production of cortisol as a result of living the constant threat of rocket attacks may negatively impact pregnancy, according to the researchers.

“Not only high but also low levels of cortisol such as in posttraumatic stress disorder were found to be associated with high-risk pregnancies,” they wrote.

Shoham-Vardi and colleagues are now studying the impact of sustained stress on birth outcomes in the same population.

Disclosure: The researchers report no relevant financial disclosures.