Invited Commentary: Maternal Stress and Stillbirth--Another Piece of the Puzzle

Although numerous causes and risk factors for stillbirth have been described, there are many cases that remain unexplained. In addition, the relationship between various risk factors and potential etiologies remains uncertain. This has contributed to a plateau in stillbirth rates in developed countries. In this issue of the Journal, László et al. (Am J Epidemiol. 2013;177(3):219-227) present some of the first data clearly linking maternal stress and stillbirth. This is biologically plausible, since many of the bioactive mediators of stress contribute to the pathophysiology of stillbirth. Stress is an attractive potential risk factor for stillbirth, since in some cases it may be modified. However, it is important to be careful when counseling families about the relationship between stress and stillbirth so that they do not blame themselves for the event. These data should spur additional investigation into the link between stress and stillbirth, hopefully leading to fewer fetal deaths.