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Relation of outbursts of anger and the acute risk of placental abruption: A case‐crossover study
Author(s) -
Chahal Harpreet S.,
Gelaye Bizu,
Mostofsky Elizabeth,
Salazar Manuel S.,
Sanchez Sixto E.,
Ananth Cande V.,
Williams Michelle A.
Publication year - 2019
Publication title -
paediatric and perinatal epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 88
eISSN - 1365-3016
pISSN - 0269-5022
DOI - 10.1111/ppe.12591
Subject(s) - placental abruption , medicine , anger , obstetrics , confidence interval , preeclampsia , relative risk , anxiety , pregnancy , psychiatry , fetus , genetics , biology
Background Roughly, a fourth of all placental abruption cases have an acute aetiologic underpinning, but the causes of acute abruption are poorly understood. Studies indicate that symptoms of stress, depression, and anxiety during pregnancy may be associated with a higher risk of abruption. Objective We examined the rate of abruption in the 2 hours immediately following outbursts of anger. Methods In a multicentre case‐crossover study, we interviewed 663 women diagnosed with placental abruption admitted to one of the seven Peruvian hospitals between January 2013 and August 2015. We asked women about outbursts of anger before symptom onset and compared this with their usual frequency of anger during the week before abruption. Results The rate of abruption was 2.83‐fold (95% confidence interval [CI] 1.85, 4.33) higher in the 2 hours following an outburst of anger compared with other times. The rate ratio (RR) was lower for women who completed technical school or university (RR 1.38, 95% CI 0.52, 3.69) compared to women with secondary school education or less (RR 3.73, 95% CI 2.32, 5.99, P ‐homogeneity = .07). There was no evidence that the association between anger episodes and abruption varied by hypertensive disorders of pregnancy (ie preeclampsia/ eclampsia) or antepartum depressive symptoms. Conclusion There was a higher rate of abruption in the 2 hours following outbursts of anger compared with other times, providing potential clues to the aetiologic mechanisms of abruption of acute onset.