Original article Maternal personality traits and risk of preterm birth and fetal growth restriction L. Chatzi a, *, K. Koutra a , M. Vassilaki a , A. Vardiampasis b , V. Georgiou a , A. Koutis a , C. Lionis a , P. Bitsios b , M. Kogevinas c,d a Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, Heraklion, 71003, Crete, Greece b Department of Psychiatry, Faculty of Medicine, University of Crete, Heraklion, Greece c Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain d National School of Public Health, Athens, Greece 1. Introduction Numerous studies have demonstrated associations between personality traits and a wide spectrum of medical conditions [29,38]. Personality traits are defined as ‘‘dimensions of individual differences in tendencies to show consistent patterns of thoughts, feelings and actions’’ [25]. In his classical treatise of personality, Eysenck has identified three key dimensions of personality [10]:  neuroticism, that is considered as a stable and relatively enduring trait, with a strong genetic component [22,32], representing a tendency to experience distress frequently [7,13,27,40]. It has long been linked to internalizing psychiatric conditions, such as anxiety and depression, and it accounts for much of the substantial comorbidity seen between these disorders [15,19,23];  extraversion, a personality construct, which includes positive emotionality, energy, sociability and assertiveness [6], and has been associated with resilience to mental illness [2,30];  psychoticism that describes characteristics of coldness, aggres- sion, and cruelty, which predisposes to impulsivity and antisocial behaviour [43]. Personality traits determine the appraisal of external stressors [23] and the nature, availability and efficiency of copying mechanisms [15], as well as the utilization of (personal and social) support systems [23]. There is a number of studies suggesting that maternal psychological stress is a significant and independent risk factor for a range of adverse reproductive outcomes such as preterm birth [8,9] and low birth weight [12,17], or both [34]. Also, despite some conflicting results, a recent meta-analysis [14] and a review [11] have shown that women with depression during pregnancy are at increased risk for preterm birth and low birth weight, although the magnitude of the effect varies as a function of depression measurement, country location, and socioeconomic status. These associations were suspected because: animal studies show that exposure to stressful environments during pregnancy is European Psychiatry 28 (2013) 213–218 A R T I C L E I N F O Article history: Received 14 June 2011 Received in revised form 26 October 2011 Accepted 11 November 2011 Available online 24 April 2012 Keywords: Personality Preterm birth Fetal growth restriction A B S T R A C T Background/Aims: Maternal personality may increase vulnerability to stress, which could lead to an unfavourable intrauterine environment to the fetus. We sought to investigate the impact of maternal personality traits on adverse birth outcomes such as preterm birth, and fetal growth restriction in the mother-child cohort study (RHEA Study) in Crete, Greece 2007–2009. Methods: Five hundred and eighty pregnant women participating in ‘‘Rhea’’ cohort study completed the Eysenck Personality Questionnaire-Revised (EPQ-R) at 28–32 weeks of gestation. Information on anthropometric measures at birth was obtained from the hospital delivery logs and medical records. Fetal growth restriction was based on a customized model, and multivariate logistic regression models were used adjusting for confounders. Results: A per unit increase in the EPQ Neuroticism scale increased the risk for fetal weight growth restriction by 9% [Odds Ratio (OR) = 1.09, 95 percent CI: 1.01, 1.19)], and for fetal head circumference growth restriction by 6% [OR = 1.06, 95 percent CI: 1.01, 1.18] after adjusting for maternal age, education, origin, marital status, working status, pre-pregnancy BMI, delivery type, parity, smoking, and alcohol intake during pregnancy. Conclusions: Maternal neuroticism, which predisposes to negative mood, may be a risk factor for fetal growth restriction. ß 2011 Elsevier Masson SAS. All rights reserved. Abbreviations: EPQ, Eysenck Personality Questionnaire; OR, Odds Ratio; CI, Confidence interval. * Corresponding author. Tel.: +30 6974595570; fax: +30 2810 394758. E-mail address: lchatzi@med.uoc.gr (L. Chatzi). Available online at www.sciencedirect.com 0924-9338/$ – see front matter ß 2011 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.eurpsy.2011.11.006