Stress during Pregnancy and Offspring Pediatric Disease: A National Cohort Study

By Tegethoff, Marion; Greene, Naomi et al. | Environmental Health Perspectives, November 2011 | Go to article overview

Stress during Pregnancy and Offspring Pediatric Disease: A National Cohort Study


Tegethoff, Marion, Greene, Naomi, Olsen, Jern, Schaffner, Emmanuel, Meinlschmidt, Gunther, Environmental Health Perspectives


BACKGROUND: Identifying risk factors for adverse health outcomes in children is important. The intrauterine environment plays a pivotal role for health and disease across life.

OBJECTIVES: We conducted a comprehensive study to determine whether common psychosocial stress during pregnancy is a risk factor for a wide spectrum of pediatric diseases in the offspring.

METHODS: The study was conducted using prospective data in a population-based sample of mothers with live singleton births (n = 66,203; 71.4% of those eligible) from the Danish National Birth Cohort. We estimated the association between maternal stress during pregnancy (classified based on two a priori--defined indicators of common stress forms, life stress and emotional stress) and offspring diseases during childhood (grouped into 16 categories of diagnoses from the International Classification of Diseases, 10th Revision, based on data from national registries), controlling for maternal stress after pregnancy.

RESULTS: Median age at end of follow-up was 6.2 (range, 3.6--8.9) years. Life stress (highest compared with lowest quartile) was associated with an increased risk of conditions originating in the perinatal period [odds ratio (OR) = 1.13; 95% confidence interval (CI): 1.06, 1.21] and congenital malformations (OR=1.17; CI: 1.06, 1.28) and of the first diagnosis of infection [hazard ratio (HR) = 1.28; CI: 1.17, 1.39], mental disorders (age 0-2.5 years: HR = 2.03; CI: 1.32, 3.14), and eye (age 0-2.5 years: HR = 1.27; CI: 1.06, 1.53), ear (HR = 1.36; CI: 1.23, 1.51), respiratory (HR = 1.27; CI; 1.19, 1.35), digestive (HR = 1.23; CI: 1.11, 1.37), skin (HR = 1.24; CI: 1.09, 1.43), musculoskeletal (HR = 1.15; CI: 1.01-1.30), and genitourinary diseases (HR = 1.25; CI; 1.08, 1.45). Emotional stress was associated with an increased risk for the first diagnosis of infection (HR = 1.09; CI: 1.01, 1.18) and a decreased risk for the first diagnosis of endocrine (HR = 0.81; CI; 0.67, 0.99), eye (HR = 0.84; CI; 0.71, 0.99), and circulatory diseases (age 0-3 years: HR = 0.63; CI: 0.42, 0.95).

CONCLUSIONS: Maternal life stress during pregnancy may be a common risk factor for impaired child health. The results suggest new approaches to reduce childhood diseases.

Key WORDS: antenatal stress, child health and development, intrauterine exposure, prenatal exposure delayed effects, prenatal programming, psychosocial stress. Environ Health Perspect 119:1647--1652 (2011). http://dx.doi.org/10.1289/ehp.1003253[Online 21 July 2011]

Early-life factors can predispose individuals to diseases over the life course (Gluckman et al. 2008). Followup studies have shown that fetal growth impairment is linked to an increased risk of morbidity and premature mortality (Barker et al. 1993; Forsen et al. 2000). However, fetal growth is probably only a crude indicator of complex developmental processes that are subject to genetic factors and various intrauterine exposures that may affect gene expression and influence disease susceptibility. Therefore, the effects of intrauterine exposures on postnatal outcomes should be studied more directly (Gillman 2002), and the National Institutes of Health and the World Health Organization (WHO) have advised that the role of maternal stress during pregnancy should be given high research priority (National Institutes of Health 2003; WHO 2006). Followup studies have raised concerns that offspring of mothers exposed to stress during pregnancy may have an increased risk of specific diseases such as malformations, asthma, and mental and behavioral disorders (Cookson et al. 2009; Hansen et al. 2000; O'Connor et al. 2002). However, a comprehensive study covering a larger spectrum of diseases is needed.

The purpose of this study was to assess the association between common psychosocial stress during pregnancy and the risk of a wide range of offspring diseases in a population-based birth cohort with prospective data linked with a national hospital register. …

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