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CME Credit Offered
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Poster Session 3

(754) Pregnancy during wartime is associated with increased preterm rupture of membranes

Friday, January 31, 2025
10:30 AM – 12:30 PM  
Objective: Anxiety, depression, and stress during pregnancy negatively impact birth outcomes, including infant weight, head circumference, and APGAR scores. These effects are linked to physiological changes like catecholamine and cortisol secretion, leading to high blood pressure, maternal tachycardia, and increased risk of fetal growth restriction and preterm birth. The Iron Sword war, declared by Israel against Hamas, following the October 7, 2023 attack, has created tremendous psychological stress in the Israeli population. This study aims to assess the consequences of the Iron Sword war on obstetric outcomes related to stress and psychological distress, including preterm labor, premature rupture of membranes, preeclampsia, and preterm births.

Study Design:

A retrospective cohort analysis was conducted at a single university-affiliated medical center in Israel. The study included deliveries from October 7, 2023, to November 19, 2023, compared to deliveries during the same period in 2022. Univariate and regression analyses were used to adjust for confounders. Categorical variables were compared using χ² tests, and continuous variables were analyzed with the Mann-Whitney test. Significance was set at p< 0.05.

Results: Overall, 508 women in the study group were compared to 515 women in the control group. There was no difference in gestational age at delivery or neonatal birth weight. Women who delivered during the Iron Sword war experienced a nearly threefold increase in preterm rupture of membranes and 1.5 times more labor inductions, mainly due to rupture of membranes (14.8% vs. 6.3% and 51.4% vs. 34%, respectively, p< 0.001 for both).  Women during the war used more epidural anesthesia (62.4% vs. 48%, p< 0.001) .  Results remained significant after adjusting for maternal age, BMI, nulliparity, and fetus number. No other differences were noted in delivery mode or other perinatal outcomes.

Conclusion:

The prevalence of premature rupture of membranes increased significantly during the Iron Sword War, potentially linked to maternal stress and anxiety. Further studies are needed to evaluate these outcomes better.