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Maternal Lifetime Trauma and Birthweight: Effect Modification by In Utero Cortisol and Child Sex. J Pediatr 2018; 203:301-308. [PMID: 30197200 PMCID: PMC6398337 DOI: 10.1016/j.jpeds.2018.07.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/12/2018] [Accepted: 07/19/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate associations between maternal lifetime traumatic stress and offspring birthweight and examine modifying effects of third trimester cortisol and fetal sex. STUDY DESIGN Analyses included 314 mother-infant dyads from an ethnically mixed pregnancy cohort. Maternal lifetime trauma was reported via the Life Stressor Checklist-Revised. Fenton birthweight for gestational age z-scores (BWGA-z) were calculated. A 3-cm scalp-nearest maternal hair segment collected at birth was assayed to reflect cumulative third trimester cortisol secretion. Multivariable regression was used to investigate associations between maternal lifetime trauma and BWGA-z and examine 2- and 3-way interactions with cortisol and fetal sex. Because subjects with low or high cortisol levels could represent susceptible populations, varying coefficient models that relax the linearity assumption on cortisol level were used to assess the modification of maternal lifetime trauma associations with BWGA-z as a function of cortisol. RESULTS Women were primarily minorities (41% Hispanic, 26% black) with ≤12 years education (63%); 63% reported ≥1 traumatic event. Prenatal cortisol modified the association between maternal lifetime trauma and birthweight. Women with higher lifetime trauma and increased cortisol had significantly lower birthweight infants in males; among males exposed to the 90th percentile of cortisol, a 1-unit increase in trauma score was associated with a 0.19-unit decrease in BWGA-z (95% CI, -0.34 to -0.04). Associations among females were nonsignificant, regardless of cortisol level. CONCLUSIONS These findings underscore the need to consider complex interactions among maternal trauma, disrupted in utero cortisol production, and fetal sex to fully elucidate intergenerational effects of maternal lifetime trauma.
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Finken MJJ, van der Steen M, Smeets CCJ, Walenkamp MJE, de Bruin C, Hokken-Koelega ACS, Wit JM. Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications. Endocr Rev 2018; 39:851-894. [PMID: 29982551 DOI: 10.1210/er.2018-00083] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/21/2018] [Indexed: 12/25/2022]
Abstract
Children born small for gestational age (SGA), defined as a birth weight and/or length below -2 SD score (SDS), comprise a heterogeneous group. The causes of SGA are multifactorial and include maternal lifestyle and obstetric factors, placental dysfunction, and numerous fetal (epi)genetic abnormalities. Short-term consequences of SGA include increased risks of hypothermia, polycythemia, and hypoglycemia. Although most SGA infants show catch-up growth by 2 years of age, ∼10% remain short. Short children born SGA are amenable to GH treatment, which increases their adult height by on average 1.25 SD. Add-on treatment with a gonadotropin-releasing hormone agonist may be considered in early pubertal children with an expected adult height below -2.5 SDS. A small birth size increases the risk of later neurodevelopmental problems and cardiometabolic diseases. GH treatment does not pose an additional risk.
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Affiliation(s)
- Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, MB Amsterdam, Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Carolina C J Smeets
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Marie J E Walenkamp
- Department of Pediatrics, VU University Medical Center, MB Amsterdam, Netherlands
| | - Christiaan de Bruin
- Department of Pediatrics, Leiden University Medical Center, RC Leiden, Netherlands
| | - Anita C S Hokken-Koelega
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Jan M Wit
- Department of Pediatrics, Leiden University Medical Center, RC Leiden, Netherlands
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Prenatal stress and the development of psychopathology: Lifestyle behaviors as a fundamental part of the puzzle. Dev Psychopathol 2018; 30:1129-1144. [PMID: 30068418 DOI: 10.1017/s0954579418000494] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Maternal psychological stress, depression, and anxiety during pregnancy (prenatal stress; PNS) are thought to impact fetal development with long-term effects on offspring outcome. These effects would include physical and mental health, including psychopathology. Maternal sleep, diet, and exercise during pregnancy are lifestyle behaviors that are understudied and often solely included in PNS studies as confounders. However, there are indications that these lifestyle behaviors may actually constitute essential mediators between PNS and fetal programming processes. The goal of this theoretical review was to investigate this idea by looking at the evidence for associations between PNS and sleep, diet, and exercise, and by piecing together the information on potential underlying mechanisms and causal pathways through which these factors may affect the offspring. The analysis of the literature led to the conclusion that sleep, diet, and exercise during pregnancy, may have fundamental roles as mediators between PNS and maternal pregnancy physiology. By integrating these lifestyle behaviors into models of prenatal programming of development, a qualitatively higher and more comprehensive understanding of the prenatal origins of psychopathology can be obtained. The review finalizes by discussing some of the present challenges facing the field of PNS and offspring programming, and offering solutions for future research.
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Almeida J, Bécares L, Erbetta K, Bettegowda VR, Ahluwalia IB. Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress. Matern Child Health J 2018; 22:1154-1163. [PMID: 29442278 PMCID: PMC10998226 DOI: 10.1007/s10995-018-2500-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction Racial/ethnic inequities in low birth weight (LBW) and preterm birth (PTB) persist in the United States. Research has identified numerous risk factors for adverse birth outcomes; however, they do not fully explain the occurrence of, or inequalities in PTB/LBW. Stress has been proposed as one explanation for differences in LBW and PTB by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2013 for 21 states and one city (n = 15,915) we used Poisson regression to estimate the association between acute, financial and relationship stressors and LBW and PTB, and to examine the contribution of these stressors individually and simultaneously to racial/ethnic differences in LBW and PTB. Results Adjusting for age and race/ethnicity, acute (p < 0.001), financial (p < 0.001) and relationship (p < 0.05) stressors were associated with increased risk of LBW, but only acute (p < 0.05) and financial (p < 0.01) stress increased risk of PTB. Across all models, non-Hispanic blacks had higher risk of LBW and PTB relative to non-Hispanic whites (IRR 1.87, 95% CI 1.55, 2.27 and IRR 1.46, 95% CI 1.18, 1.79). Accounting for the effects of stressors attenuated the risk of LBW and PTB by 17 and 22% respectively, but did not fully explain the increased likelihood of LBW and PTB among non-Hispanic blacks. Discussion Results of this study demonstrate that stress may increase the risk of LBW and PTB. While stressors may contribute to racial/ethnic differences in LBW and PTB, they do not fully explain them. Mitigating stress during pregnancy may help promote healthier birth outcomes and reduce racial/ethnic inequities in LBW and PTB.
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Affiliation(s)
- Joanna Almeida
- Simmons School of Social Work, Simmons College, Boston, MA, USA.
| | | | - Kristin Erbetta
- Simmons School of Social Work, Simmons College, Boston, MA, USA
| | - Vani R Bettegowda
- Perinatal Data Center, March of Dimes Foundation, White Plains, NY, USA
| | - Indu B Ahluwalia
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control & Prevention, Atlanta, GA, USA
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Pakzad M, Dolatian M, Jahangiri Y, Nasiri M, Dargah FA. The Correlation between Islamic Lifestyle and Pregnancy-Specific Stress: A Cross-Sectional, Correlational Study. Open Access Maced J Med Sci 2018; 6:1163-1167. [PMID: 29983821 PMCID: PMC6026416 DOI: 10.3889/oamjms.2018.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 05/20/2018] [Accepted: 05/31/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Pregnancy is associated with great psychological, emotional and physical stress. In addition to undergoing hormonal changes, pregnant women experience a change in their attitude toward life and learn to re-assess their skills and lifestyle. Lifestyle, in general, and Islamic lifestyle, in particular, is concerned with the different psychological, social and physical aspects of the individual's life. AIM This study was conducted to evaluate the correlation between Islamic lifestyle and pregnancy-specific stress in pregnant women. MATERIAL AND METHODS This cross-sectional, correlational study was conducted on 300 pregnant women presenting to prenatal care clinics. Data were collected using a demographic, the Islamic lifestyle and the pregnancy-related stress questionnaires. RESULTS The results showed a statistically significant negative correlation (r = -0.284) between Islamic lifestyle and pregnancy-specific stress (P < 0.01). The stepwise regression showed that the mean score obtained in the pregnancy-related stress questionnaire decreased by 0.75 per year of marriage and by 0.14 per point in the Islamic lifestyle questionnaire. CONCLUSION There was a significant negative correlation between Islamic lifestyle and pregnancy-specific stress. Training mothers, raising their awareness and encouraging them to adopt an Islamic lifestyle may play a significant role in controlling pregnancy-specific stress.
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Affiliation(s)
- Mona Pakzad
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahrokh Dolatian
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yahia Jahangiri
- International Section of the Islamic Madhahib University, Tehran, Iran
| | - Malihe Nasiri
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Alidoust Dargah
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Coker ES, Gunier R, Huen K, Holland N, Eskenazi B. DNA methylation and socioeconomic status in a Mexican-American birth cohort. Clin Epigenetics 2018; 10:61. [PMID: 29760810 PMCID: PMC5941629 DOI: 10.1186/s13148-018-0494-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/25/2018] [Indexed: 11/25/2022] Open
Abstract
Background Maternal social environmental stressors during pregnancy are associated with adverse birth and child developmental outcomes, and epigenetics has been proposed as a possible mechanism for such relationships. Methods In a Mexican-American birth cohort of 241 maternal-infant pairs, cord blood samples were measured for repeat element DNA methylation (LINE-1 and Alu). Linear mixed effects regression was used to model associations between indicators of the social environment (low household income and education, neighborhood-level characteristics) and repeat element methylation. Results from a dietary questionnaire were also used to assess the interaction between maternal diet quality and the social environment on markers of repeat element DNA methylation. Results After adjusting for confounders, living in the most impoverished neighborhoods was associated with higher cord blood LINE-1 methylation (β = 0.78, 95%CI 0.06, 1.50, p = 0.03). No other neighborhood-, household-, or individual-level socioeconomic indicators were significantly associated with repeat element methylation. We observed a statistical trend showing that positive association between neighborhood poverty and LINE-1 methylation was strongest in cord blood of infants whose mothers reported better diet quality during pregnancy (pinteraction = 0.12). Conclusion Our findings indicate a small yet unexpected positive association between neighborhood-level poverty during pregnancy and methylation of repetitive element DNA in infant cord blood and that this association is possibly modified by diet quality during pregnancy. However, our null findings for other adverse SES indicators do not provide strong evidence for an adverse association between early-life socioeconomic environment and repeat element DNA methylation in infants.
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Affiliation(s)
- Eric S. Coker
- Center for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California, Berkeley, CA USA
- Berkeley, USA
| | - Robert Gunier
- Center for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California, Berkeley, CA USA
- Berkeley, USA
| | - Karen Huen
- Center for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California, Berkeley, CA USA
- Richmond, USA
| | - Nina Holland
- Center for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California, Berkeley, CA USA
- Richmond, USA
| | - Brenda Eskenazi
- Center for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California, Berkeley, CA USA
- Berkeley, USA
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Duffy AR, Schminkey DL, Groer MW, Shelton M, Dutra S. Comparison of Hair Cortisol Levels and Perceived Stress in Mothers Who Deliver at Preterm and Term. Biol Res Nurs 2018; 20:292-299. [PMID: 29490472 DOI: 10.1177/1099800418758952] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate relationships between hair cortisol levels and perceived stress in mothers who deliver preterm and term. We hypothesized that the rate of change in cortisol levels would be greater in the preterm delivery group. METHODS This preliminary study compared hair cortisol levels and Perceived Stress Scale (PSS) scores in predominately Caucasian mothers who delivered preterm ( n = 22) and term ( n = 30). We collected PSS and hair samples of ≥10 cm in length from mothers after delivery. Hair was segmented into three sections, and cortisol was measured using enzyme-linked immunosorbent assay. RESULTS The mean gestational age was 31.45 ( SD = 4.2) weeks for preterm deliveries and 39.45 ( SD = 1.1) for term. Cortisol differed significantly in the third trimester between mothers delivering term and preterm ( t = 2.16, df = 48, p = .04) and trended toward significance in the second trimester ( t = 1.88, df = 48, p = .06). PSS differed significantly between the two groups ( t = -2.96, df = 50, p = .05). Our data did not provide support for our hypothesis. CONCLUSION There appeared to be a blunted, flattened pattern of change in cortisol levels across gestation in the women who delivered preterm, suggesting diminished hypothalamic-pituitary-adrenal axis responsiveness in mechanisms that promote preterm labor. Future studies are needed to further evaluate best strategies for measuring the mechanisms of allostatic load during pregnancy along with the psychoneuroendocrine and immune triggers and placental responses that lead to premature birth.
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Affiliation(s)
- Allyson R Duffy
- 1 University of South Florida College of Nursing, Tampa, FL, USA
| | - Donna L Schminkey
- 2 University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Maureen W Groer
- 1 University of South Florida College of Nursing, Tampa, FL, USA
| | - Melissa Shelton
- 1 University of South Florida College of Nursing, Tampa, FL, USA.,3 Sarasota Memorial Health Care System, Sarasota, FL, USA
| | - Samia Dutra
- 1 University of South Florida College of Nursing, Tampa, FL, USA
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Haselow NJ, Stormer A, Pries A. Evidence-based evolution of an integrated nutrition-focused agriculture approach to address the underlying determinants of stunting. MATERNAL AND CHILD NUTRITION 2017; 12 Suppl 1:155-68. [PMID: 27187913 PMCID: PMC5084820 DOI: 10.1111/mcn.12260] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/11/2015] [Accepted: 11/11/2015] [Indexed: 11/30/2022]
Abstract
Despite progress in reducing hunger and malnutrition since the 1990s, many still suffer from undernutrition and food insecurity, particularly women and young children, resulting in preterm birth, low birthweight and stunting, among other conditions. Helen Keller International (HKI) has addressed malnutrition and household food insecurity through implementation of an Enhanced Homestead Food Production (EHFP) programme that increases year‐round availability and intake of diverse micronutrient‐rich foods and promotes optimal nutrition and hygiene practices among poor households. This paper reviews the evolution and impact of HKI's EHFP programme and identifies core components of the model that address the underlying determinants of stunting. To date, evaluations of EHFP have shown impact on food production, consumption by women and children and household food security. Sale of surplus produce has increased household income, and the use of a transformative gender approach has empowered women. EHFP has also realized nutrition improvements in many project sites. Results from a randomized control trial (RCT) in Baitadi district, Nepal showed a significant improvement in a range of practices known to impact child growth, although no impact on stunting. Additional non‐RCT evaluations in Kailali district of Nepal, demonstrated a 10.5% reduction in stunting and in the Chittagong Hill Tracts in Bangladesh, revealed an 18% decrease in stunting. Based on evidence, the EHFP has evolved into an integrated package that includes agriculture, nutrition, water/hygiene/sanitation, linkages to health care, women's empowerment, income generation and advocacy. Closing the stunting gap requires long‐term exposure to targeted multi‐sectoral solutions and rigorous evaluation to optimize impact.
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Affiliation(s)
- Nancy J Haselow
- Helen Keller International, Asia Pacific Regional Office, Phnom Penh, Cambodia
| | - Ame Stormer
- Helen Keller International, Asia Pacific Regional Office, Phnom Penh, Cambodia
| | - Alissa Pries
- Helen Keller International, Asia Pacific Regional Office, Phnom Penh, Cambodia
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Vinturache A, McKeating A, Daly N, Sheehan S, Turner M. Maternal body mass index and the prevalence of spontaneous and elective preterm deliveries in an Irish obstetric population: a retrospective cohort study. BMJ Open 2017; 7:e015258. [PMID: 29038176 PMCID: PMC5652568 DOI: 10.1136/bmjopen-2016-015258] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 07/19/2017] [Accepted: 08/17/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the association between maternal body mass index (BMI) and risk of spontaneous preterm delivery (sPTD) and elective preterm delivery (ePTD) in singleton and multiple pregnancies. DESIGN Retrospective cohort study. SETTING Electronic records of all deliveries from 2009 through 2013 in a tertiary university hospital were abstracted for demographic and obstetrical information. PARTICIPANTS A total of 38 528 deliveries were included. Participants with missing data were excluded from the study. BMI was calculated from the measurement of height and weight at the first prenatal visit and categorised. Sonographic confirmation of gestational age was standard. OUTCOME MEASURES Primary outcomes, sPTD and ePTD in singleton and multiple pregnancies, were evaluated by multinomial logistic regression analyses, stratified by parity, controlling for confounding variables. RESULTS Overall rate of PTD was 5.9%, from which 2.7% were sPTD and 3.2% ePTD. The rate of PTD was 50.4% in multiple pregnancies and 5.0% in singleton pregnancies. The risk of sPTD was increased in obese nulliparas (adjusted OR (aOR) 2.8, 95% CI 1.7 to 4.4) and underweight multiparas (aOR 2.2, 95% CI 1.3 to 3.8). The risk of ePTD was increased in underweight nulliparas (aOR 1.8; 95% CI 1.04 to 3.4) and severely obese multiparas (aOR 1.4, 95% CI 1.02 to 3.8).Severe obesity increased the risk of both sPTD (aOR 1.4; 95% CI 1.01 to 2.1) and ePTD (aOR 1.4; 95% CI 1.1 to 1.8) in singleton pregnancies. Obesity did not influence the rate of either sPTD or ePTD in multiple pregnancies. CONCLUSION Maternal obesity is an independent risk factor for PTD in singleton pregnancies but not in multiple pregnancies. Obesity and nulliparity increase the risk of sPTD, whereas obesity and multiparity increase the risk of ePTD.
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Affiliation(s)
- Angela Vinturache
- Centre for Human Reproduction, University College Dublin, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Aoife McKeating
- Centre for Human Reproduction, University College Dublin, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Niamh Daly
- Centre for Human Reproduction, University College Dublin, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Sharon Sheehan
- Centre for Human Reproduction, University College Dublin, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael Turner
- Centre for Human Reproduction, University College Dublin, Coombe Women and Infants University Hospital, Dublin, Ireland
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Chen PJ, Chou CC, Yang L, Tsai YL, Chang YC, Liaw JJ. Effects of Aromatherapy Massage on Pregnant Women's Stress and Immune Function: A Longitudinal, Prospective, Randomized Controlled Trial. J Altern Complement Med 2017; 23:778-786. [PMID: 28783372 DOI: 10.1089/acm.2016.0426] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This study's aims are to examine the effects of aromatherapy massage on women's stress and immune function during pregnancy. METHODS This longitudinal, prospective, randomized controlled trial recruited 52 healthy pregnant women from a prenatal clinic in Taipei using convenience sampling. The participants were randomly assigned to the intervention (n = 24) or control (n = 28) group using Clinstat block randomization. The intervention group received 70 min of aromatherapy massage with 2% lavender essential oil every other week (10 times in total) for 20 weeks; the control group received only routine prenatal care. In both groups, participants' salivary cortisol and immunoglobulin A (IgA) levels were collected before and after the intervention group received aromatherapy massage (every month from 16 to 36 weeks gestation) and were analyzed using enzyme-linked immunosorbent assay. RESULTS The pregnant women in the intervention group had lower salivary cortisol (p < 0.001) and higher IgA (p < 0.001) levels immediately after aromatherapy massage than those in the control group, which did not receive massage treatment. Comparing the long-term effects of aromatherapy massage on salivary IgA levels between groups at different times, the study found that the pretest salivary IgA levels at 32 (p = 0.002) and 36 (p < 0.001) weeks gestational age (GA) were significantly higher than the pretest IgA at 16 weeks GA (baseline). CONCLUSIONS This study presented evidence that aromatherapy massage could significantly decrease stress and enhance immune function in pregnant women. The findings can guide clinicians or midwives in providing aromatherapy massage to women throughout the pregnancy.
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Affiliation(s)
- Pao-Ju Chen
- 1 Graduate Institute of Medical Sciences , National Defense Medical Center, Taipei, Taiwan .,2 Department of Nursing, Hsin Sheng Junior College of Medical Care and Management , Taoyuan, Taiwan
| | - Cheng-Chen Chou
- 3 School of Nursing, Taipei Medical University , Taipei, Taiwan
| | - Luke Yang
- 4 Department of Social Welfare and Social Work, Hsuan Chuang University , Hsinchu, Taiwan
| | - Yu-Lun Tsai
- 5 School of Nursing, National Defense Medical Center , Taipei, Taiwan
| | - Yue-Cune Chang
- 6 Department of Mathematics, Tamkang University , New Taipei, Taiwan
| | - Jen-Jiuan Liaw
- 5 School of Nursing, National Defense Medical Center , Taipei, Taiwan
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Gestation-related psychosocial factors in women from Medellin, Colombia. ACTA ACUST UNITED AC 2017; 48:26-34. [PMID: 30651170 DOI: 10.1016/j.rcp.2017.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 04/27/2017] [Accepted: 06/05/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Perinatal stress and the impact generated by adverse conditions could affect fetal development negatively with long term and short term manifestations and could increase the risk of maternal depression. OBJECTIVE To determine the psychosocial risk factors present in women with high-obstetric risk and hospitalized in a high complexity institution. METHODS A cross-sectional study that included 112 pregnant or immediate postpartum women, who were evaluated using a scale designed by the researchers and the Edinburgh Postnatal Depression Scale. RESULTS Median age was 24 (RIC 9) years; 39.3% of the women were pregnant, and 65.9% had a gestational age of more than 28 weeks. The main reason for hospitalization was threat of preterm delivery in 39.2%. 52.4% planned the pregnancy and 22.3% had depressive symptoms compatible with depression. Suicidal ideas and suicide attempts were more prevalent in the first trimester (7.2% and 3.6%). DISCUSSION The high prevalence of depressive symptoms in the population studied coincides with what was reported in similar studies in Latin America. The fact that pregnancy does not protect against suicide was confirmed. CONCLUSIONS Psychosocial screening is recommended in every pregnant woman and women in immediate postpartum to detect symptoms and risk factors for depression.
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Chen PJ, Yang L, Chou CC, Li CC, Chang YC, Liaw JJ. Effects of prenatal yoga on women's stress and immune function across pregnancy: A randomized controlled trial. Complement Ther Med 2017; 31:109-117. [PMID: 28434463 DOI: 10.1016/j.ctim.2017.03.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/18/2016] [Accepted: 03/06/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The effects of prenatal yoga on biological indicators have not been widely studied. Thus, we compared changes in stress and immunity salivary biomarkers from 16 to 36 weeks' gestation between women receiving prenatal yoga and those receiving routine prenatal care. DESIGN For this longitudinal, prospective, randomized controlled trial, we recruited 94 healthy pregnant women at 16 weeks' gestation through convenience sampling from a prenatal clinic in Taipei. Participants were randomly assigned to intervention (n=48) or control (n=46) groups using Clinstat block randomization. INTERVENTION The 20-week intervention comprised two weekly 70-min yoga sessions led by a midwife certified as a yoga instructor; the control group received only routine prenatal care. MAIN OUTCOME MEASURES In both groups, participants' salivary cortisol and immunoglobulin A levels were collected before and after yoga every 4 weeks from 16 to 36 weeks' gestation. RESULTS The intervention group had lower salivary cortisol (p<0.001) and higher immunoglobulin A (p<0.001) levels immediately after yoga than the control group. Specifically, the intervention group had significantly higher long-term salivary immunoglobulin A levels than the control group (p=0.018), and infants born to women in the intervention group weighed more than those born to the control group (p<0.001). CONCLUSION Prenatal yoga significantly reduced pregnant women's stress and enhanced their immune function. Clinicians should learn the mechanisms of yoga and its effects on pregnant women. Our findings can guide clinicians to help pregnant women alleviate their stress and enhance their immune function.
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Affiliation(s)
- Pao-Ju Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, 11490, Taiwan, ROC; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, 32544, Taiwan, ROC.
| | - Luke Yang
- Department of Social Welfare, Hsuan Chuang University, Hsinchu, 30092, Taiwan, ROC.
| | - Cheng-Chen Chou
- School of Nursing, Taipei Medical University, Taipei, 110, Taiwan, ROC.
| | - Chia-Chi Li
- School of Nursing, National Defense Medical Center, Taipei, 11490, Taiwan, ROC.
| | - Yu-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei, 25137, Taiwan, ROC.
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei, 11490, Taiwan, ROC.
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Haghighi L, Nohesara S, Moradi Y, Rashidi M, Moridi M. Psychological Disorders in Women with Spontaneous Preterm Delivery. ACTA ACUST UNITED AC 2016. [DOI: 10.17795/semj39033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Andersson NW, Li Q, Mills CW, Ly J, Nomura Y, Chen J. Influence of prenatal maternal stress on umbilical cord blood cytokine levels. Arch Womens Ment Health 2016; 19:761-7. [PMID: 26846778 PMCID: PMC5032828 DOI: 10.1007/s00737-016-0607-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 01/09/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Prenatal maternal stress (PNMS) is known to influence fetal programming and development. Thus far, the effects of PNMS on the developing immune system have mainly been documented in animal studies. This study aimed to examine the association between PNMS and immune cytokine profiles in the umbilical cord blood of newborn human infants. METHODS PNMS, including perceived stress, numbers of stressful life events experiences (both partner and health related), and state and trait anxiety, was assessed with five questionnaires and interviews from 43 pregnant women during the second trimester. Seven key cytokines important for immune function, i.e., IL-12, IL-1β, IL-4, IL-5, IL-6, IL-8, and TNF-α, were analyzed in cord blood by bead-based ELISA method (Luminex 200). Logistic regression was used to estimate the associations of PNMS scores and cytokine levels. RESULTS Increased levels of IL-1β, IL-4, IL-5, IL-6, and IL-8 were significantly associated with at least one of the maternal stress assessments, while the levels of IL-12 and TNF-α were not significantly associated with any of the PNMS measurements examined. CONCLUSION These preliminary findings suggest that PNMS may influence cytokine levels in newborn infants, in particular Th2-related cytokines. This report supports previous findings in animal studies and could suggest that newborns born to mothers with elevated PNMS have a predisposition to immune-related disorders.
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Affiliation(s)
- Niklas W. Andersson
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark, Sydney Medical School, Faculty of Medicine, University of Sydney, Concord Hospital, Sydney, Australia, Department of Psychology, Queens College, the City University of New York (CUNY), Flushing, New York, USA
| | - Qian Li
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | | | - Jenny Ly
- Department of Psychology, Queens College, the City University of New York (CUNY), Flushing, New York, USA, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yoko Nomura
- Department of Psychology, Queens College, the City University of New York (CUNY), Flushing, New York, USA. .,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA. .,The Graduate Center, CUNY, New York, NY, USA. .,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jia Chen
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Preventing infant and child morbidity and mortality due to maternal depression. Best Pract Res Clin Obstet Gynaecol 2016; 36:156-168. [DOI: 10.1016/j.bpobgyn.2016.05.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/15/2016] [Indexed: 01/26/2023]
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Schwab FD, Zettler EK, Moh A, Schötzau A, Gross U, Günthert AR. Predictive factors for preterm delivery under rural conditions in post-tsunami Banda Aceh. J Perinat Med 2016; 44:511-5. [PMID: 25980381 DOI: 10.1515/jpm-2015-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/17/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the risk for preterm deliveries <37 week of gestation and associated prevalence of vaginal infection in a rural setting after the tsunami in Banda Aceh, Indonesia. METHODS Wet mount microscopy, vaginal pH and vaginal swabs for microbiological culture were collected in pregnant women during the 2nd trimester from February to June of 2005 in four temporary outpatient clinics and the patients were followed up until delivery. RESULTS One hundred and fifty-nine pregnant patients were screened. Sixty-two could be followed up until delivery. Thirty-nine (62.9%) delivered at term and 23 (37.1%) delivered prematurely. Significant risk factors for preterm delivery were a history of preterm delivery and group B streptococcus infection. Increased vaginal pH alone had no significant influence on preterm delivery, although there was a trend. CONCLUSION The rate of preterm delivery was high in this cohort. We suggest risk stratification for preterm delivery in rural conditions by performing a vaginal pH and wet mount microscopy. If either is suspect we suggest collecting a vaginal swab for microbiological culture for targeted treatment. Patients with a history of preterm delivery are at increased risk and should be monitored closely.
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Liou SR, Wang P, Cheng CY. Effects of prenatal maternal mental distress on birth outcomes. Women Birth 2016; 29:376-80. [PMID: 27079210 DOI: 10.1016/j.wombi.2016.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/18/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Adverse effects of maternal mental distress during pregnancy have been extensively investigated, but the impact of prenatal maternal mental distress at various time periods during pregnancy on birth outcomes is rarely discussed. By understanding the relationship between maternal mental distress and unfavourable birth outcomes throughout pregnancy, appropriate evidence-based preventative care or intervention may be adopted in a timely manner. AIM This study intended to investigate the effects of maternal stress, anxiety, and depressive symptoms across pregnancy on preterm birth and low birth weight. METHODS With a prospective longitudinal design, this study used the 10-item Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and Zung Self-reported Anxiety Scale to investigate 197 participants who, at greater than 24 gestational weeks, completed the self-administered questionnaires during regular checkups in a hospital in southern Taiwan. Descriptive statistics, Mann-Whitney U test/Kruskal-Wallis test, and hierarchical logistic regression were applied for data analysis. FINDINGS The study found that anxiety and depressive symptoms at 25-29 gestational weeks could predict preterm birth, and that anxiety at greater than 30 gestational weeks was able to predict low birthweight. However, stress was not able to predict any kind of negative birth outcomes. CONCLUSION Adverse birth outcomes were somewhat predictable by maternal mental distress; therefore, we suggested that prenatal visits incorporate psychological assessment for early detection and management to prevent possible adverse birth outcomes.
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Affiliation(s)
- Shwu-Ru Liou
- College of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan
| | - Panchalli Wang
- Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Taiwan
| | - Ching-Yu Cheng
- College of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan.
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Braig S, Grabher F, Ntomchukwu C, Reister F, Stalder T, Kirschbaum C, Rothenbacher D, Genuneit J. The Association of Hair Cortisol with Self-Reported Chronic Psychosocial Stress and Symptoms of Anxiety and Depression in Women Shortly after Delivery. Paediatr Perinat Epidemiol 2016; 30:97-104. [PMID: 26525484 DOI: 10.1111/ppe.12255] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Psychosocial stress during pregnancy including anxiety and depression is known to have adverse health effects on newborns. However, measuring these psychological constructs is complex with psychological, endocrinological, and physiological systems being affected. Hair cortisol concentrations (HCC), assumed to reflect long-term endocrine consequences of stress exposure, represent a promising instrument for epidemiological research. However, the association between HCC and questionnaire-based instruments is unclear. METHODS In the Ulm SPATZ Health Study, mothers were recruited shortly after delivery in the University Medical Centre Ulm, Germany between April 2012 and May 2013. HCC of 768 participants were determined in scalp-near 3 cm maternal hair segments, assumed to reflect cortisol exposure over the last trimester of pregnancy. Chronic stress, anxiety, and depressive symptomatology were self-reported in questionnaire-based instruments. Spearman correlation coefficients between HCC and these instruments as well as means of HCC in highly and low stressed subgroups were calculated. RESULTS HCC were not correlated with self-reported chronic stress, anxiety, or depressive symptomatology. Furthermore, the investigation of sub-populations did not reveal substantial differences of HCC across highly and low stressed women. CONCLUSIONS HCC were not found to correlate with self-reports of chronic stress, anxiety, or depressive symptomatology. Among other things, these findings could reflect problems with questionnaire-based assessments obtained shortly after delivery such as recall bias and/or suggest that associations between cortisol secretion and psychosocial stress are difficult to detect due to, e.g. a strong physiological increase of cortisol in the last trimester.
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Affiliation(s)
- Stefanie Braig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Felix Grabher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Clarissa Ntomchukwu
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Frank Reister
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | | | | | | | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Da Costa D, Zelkowitz P, Bailey K, Cruz R, Bernard JC, Dasgupta K, Lowensteyn I, Khalifé S. Results of a Needs Assessment to Guide the Development of a Website to Enhance Emotional Wellness and Healthy Behaviors During Pregnancy. J Perinat Educ 2016; 24:213-24. [PMID: 26834443 DOI: 10.1891/1058-1243.24.4.213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In preparation for developing a website to enhance emotional wellness and healthy lifestyle during the perinatal period, this study examined women's informational needs and barriers. Seventy-four women who were pregnant or had given birth completed an online survey inquiring about information needs and preferred sources related to psychosocial aspects and lifestyle behaviors. Information related to healthy diet choices and weight management, followed by exercise, was rated highly as a need. Information related to depression, stress, and anxiety was also rated as important. Health-care providers and the Internet were found to be preferred sources of information. Evidence-based websites can serve as a powerful low-cost educational resource to support and reinforce the health promotion advice received from their health-care providers.
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Varea C, Terán JM, Bernis C, Bogin B, González-González A. Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003-2012). Ann Hum Biol 2016; 43:169-82. [PMID: 26653704 DOI: 10.3109/03014460.2015.1131847] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is growing evidence of the impact of the current European economic crisis on health. In Spain, since 2008, there have been increasing levels of impoverishment and inequality, and important cuts in social services. AIM The objective is to evaluate the impact of the economic crisis on underweight at birth in Spain. METHOD Trends in underweight at birth were examined between 2003 and 2012. Underweight at birth is defined as a singleton, term neonatal weight lesser than -2 SD from the median weight at birth for each sex estimated by the WHO Standard Growth Reference. Using data from the Statistical Bulletin of Childbirth, 2 933 485 live births born to Spanish mothers have been analysed. Descriptive analysis, seasonal decomposition analysis and crude and adjusted logistic regression including individual maternal and foetal variables as well as exogenous economic indicators have been performed. RESULTS AND CONCLUSIONS Results demonstrate a significant increase in the prevalence of underweight at birth from 2008. All maternal-foetal categories were affected, including those showing the lowest prevalence before the crisis. In the full adjusted logistic regression, year-on-year GDP per capita remains predictive on underweight at birth risk. Previous trends in maternal socio-demographic profiles and a direct impact of the crisis are discussed to explain the trends described.
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Affiliation(s)
- Carlos Varea
- a Department of Biology, Faculty of Sciences , c/Darwin, 2, Madrid Autonomous University , Madrid , Spain
| | - José Manuel Terán
- a Department of Biology, Faculty of Sciences , c/Darwin, 2, Madrid Autonomous University , Madrid , Spain
| | - Cristina Bernis
- a Department of Biology, Faculty of Sciences , c/Darwin, 2, Madrid Autonomous University , Madrid , Spain
| | - Barry Bogin
- b School of Sport, Exercise and Health Sciences, Loughborough University , Loughborough , Leicestershire , UK , and
| | - Antonio González-González
- c Department of Obstetrics and Gynecology, Faculty of Medicine , c/ Arzobispo Morcillo, 4, Madrid Autonomous University , Madrid , Spain
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Andersson NW, Hansen MV, Larsen AD, Hougaard KS, Kolstad HA, Schlünssen V. Prenatal maternal stress and atopic diseases in the child: a systematic review of observational human studies. Allergy 2016; 71:15-26. [PMID: 26395995 PMCID: PMC5054838 DOI: 10.1111/all.12762] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND A growing number of studies suggest that maternal stress during pregnancy promotes atopic disorders in the offspring. This is the first systematic review to address prenatal maternal stress (PNMS) and the subsequent risk of atopy-related outcomes in the child. METHODS The review was performed in accordance to the PRISMA criteria. We searched and selected studies in PubMed, Scopus, Embase and PsychINFO until November 2014. RESULTS Sixteen (with 25 analyses) of 426 identified articles met the review criteria. Five main PNMS exposures (negative life events, anxiety/depression, bereavement, distress and job strain) and five main atopic outcomes (asthma, wheeze, atopic dermatitis, allergic rhinitis and IgE) were assessed across the studies. Overall, 21 of the 25 analyses suggested a positive association between PNMS and atopic outcomes. Of the 11 exposure-response analyses reported, six found statistically significant trends. CONCLUSION This systematic review suggests a relationship between maternal stress during pregnancy and atopic disorders in the child. However, the existing studies are of diverse quality. The wide definitions of often self-reported stress exposures imply a substantial risk for information bias and false-positive results. Research comparing objective and subjective measures of PNMS exposure as well as objective measures for atopic outcome is needed.
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Affiliation(s)
- N. W. Andersson
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
- Sydney Medical School Faculty of Medicine University of Sydney Concord Hospital Sydney NSW Australia
- Department of Organic Psychiatric Disorders and Emergency Ward Aarhus University Hospital Risskov, Aarhus Denmark
| | - M. V. Hansen
- Department of Organic Psychiatric Disorders and Emergency Ward Aarhus University Hospital Risskov, Aarhus Denmark
| | - A. D. Larsen
- The National Research Centre for the Working Environment Copenhagen Denmark
| | - K. S. Hougaard
- The National Research Centre for the Working Environment Copenhagen Denmark
| | - H. A. Kolstad
- Department of Occupational Medicine Danish Ramazzini Centre Aarhus University Hospital Aarhus Denmark
| | - V. Schlünssen
- The National Research Centre for the Working Environment Copenhagen Denmark
- Department of Occupational Medicine Danish Ramazzini Centre Aarhus University Hospital Aarhus Denmark
- Section for Environment, Occupation and Health Department of Public Health Danish Ramazzini Centre Aarhus University Aarhus Denmark
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Hux VJ, Catov JM, Roberts JM. Allostatic load in women with a history of low birth weight infants: the national health and nutrition examination survey. J Womens Health (Larchmt) 2015; 23:1039-45. [PMID: 25495368 DOI: 10.1089/jwh.2013.4572] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of our study was to determine whether women of reproductive age with history of low birth weight (LBW) deliveries have higher allostatic load (AL), a measure of the cumulative toll of chronic stress, than those with normal-weight deliveries. METHODS We used data from women ages 17-35 who responded to the National Health and Nutrition Examination Survey (NHANES) reproductive-health questionnaire, 1999-2006. Women reported history of LBW infants and those who were preterm. We classified preterm-LBW and term-LBW as surrogates for preterm birth (PTB) and small for gestational age (SGA), respectively. Normal weight included those without LBW infant history. We utilized nine biomarkers measured in NHANES to determine AL and used linear regression to compare unadjusted and adjusted means. RESULTS We identified 877 women divided among SGA (2%), PTB (10%), and normal groups (88%). The SGA group had higher unadjusted and adjusted AL scores than did the normal group (2.82 ± 0.35 vs. 1.92 ± 0.07, p=0.011); women in the PTB group had higher AL scores than did the referent in adjusted analyses (2.58 ± 0.21 vs. 1.92 ± 0.07, p=0.001). CONCLUSIONS Women with history of SGA or PTB had higher AL than did those with normal birth weight outcomes. This suggests a link between adverse pregnancy outcomes, chronic stress, and subclinical disease.
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Affiliation(s)
- Vanessa J Hux
- 1 School of Medicine, Vanderbilt University , Nashville, Tennessee
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Bussières EL, Tarabulsy GM, Pearson J, Tessier R, Forest JC, Giguère Y. Maternal prenatal stress and infant birth weight and gestational age: A meta-analysis of prospective studies. DEVELOPMENTAL REVIEW 2015. [DOI: 10.1016/j.dr.2015.04.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Barber CC, Starkey NJ. Predictors of anxiety among pregnant New Zealand women hospitalised for complications and a community comparison group. Midwifery 2015; 31:888-96. [PMID: 25987104 DOI: 10.1016/j.midw.2015.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 04/21/2015] [Accepted: 04/26/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE to investigate predictors of anxiety for women experiencing hospitalisation during pregnancy and a comparison group of pregnant women (with or without medical complications) in the community. DESIGN correlational, cross-sectional observational questionnaire study. SETTING regional antenatal inpatient unit and community-based settings in New Zealand in 2009 and 2010. PARTICIPANTS 118 pregnant women in hospital and 114 pregnant women in community. MEASUREMENTS AND FINDINGS women in hospital and community groups completed a battery of questionnaires on pregnancy and health history, life events, anxiety, optimism, coping, and relationship factors. Midwives caring for the women provided ratings of health status and psychological distress. Both groups of women had scores on state anxiety significantly above local norms; women in the hospital were significantly higher than those in the community on state anxiety and worry about their pregnancy. The groups did not differ on factors such as life events, optimism, and coping self-efficacy. Ratings of health and distress made by women and their midwives showed poor agreement. Predictors of acute anxiety differed across the groups: for hospitalised women, anxiety was predicted by their rating of their health and their dispositional optimism; for women in the community, anxiety was predicted by stressful life events, dispositional optimism, and coping self-efficacy. KEY CONCLUSIONS many women hospitalised during pregnancy are extremely anxious, and those most vulnerable are those who are less optimistic and see their health as poor. Health care professionals may not be aware of how anxious women are, and women and their hospital caregivers had poor agreement on ratings of the woman׳s health status. IMPLICATIONS FOR RESEARCH AND PRACTICE women hospitalised during pregnancy are at risk for high levels of anxiety. Midwives are well placed to help women by recognising their distress, supporting informed optimism, and guiding women toward realistic coping strategies and using existing social support networks. Research is needed on strategies for implementation and effectiveness of brief interventions to support women to manage anxiety and stress during pregnancy both in hospital and in the community.
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Affiliation(s)
- Carol Cornsweet Barber
- School of Psychology, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand.
| | - Nicola J Starkey
- School of Psychology, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand
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Moncayo R, Ortner K. Multifactorial determinants of cognition - Thyroid function is not the only one. BBA CLINICAL 2015; 3:289-98. [PMID: 26672993 PMCID: PMC4661586 DOI: 10.1016/j.bbacli.2015.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/11/2015] [Accepted: 04/14/2015] [Indexed: 12/31/2022]
Abstract
Background Since the 1960s hypothyroidism together with iodine deficiency have been considered to be a principal determinant of cognition development. Following iodine supplementation programs and improved treatment options for hypothyroidism this relation might not be valid in 2015. On the other hand neurosciences have added different inputs also related to cognition. Scope of review We will examine the characteristics of the original and current publications on thyroid function and cognition and also add some general determinants of intelligence and cognition. One central issue for us is the relation of stress to cognition knowing that both physical and psychological stress, are frequent elements in subjects with thyroid dysfunction. We have considered a special type of stress called pre-natal stress which can influence cognitive functions. Fear and anxiety can be intermingled requiring mechanisms of fear extinction. Major conclusions Recent studies have failed to show an influence of thyroid medication during pregnancy on intellectual development. Neuroscience offers a better explanation of cognition than hypothyroidism and iodine deficiency. Additional factors relevant to cognition are nutrition, infection, prenatal stress, and early life stress. In turn stress is related to low magnesium levels. Magnesium supplementation can correct both latent hypothyroidism and acquired mild cognitive deficits. General significance Cognition is a complex process that depends on many determinants and not only on thyroid function. Magnesium deficiency appears to be a basic mechanism for changes in thyroid function as well as of cognition. Untreated hypothyroidism, i.e. hypothyroxinemia, can influence IQ. Thyroxine administration to euthyroid pregnant women has no effect on cognition. The hippocampus and NMDA receptors play a central role in cognitive processes. Antenatal and early life stressors can influence cognition later in life. Stressors can lead to decreased levels of magnesium and demands supplementation.
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Affiliation(s)
- Roy Moncayo
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Karina Ortner
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
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Baskin R, Hill B, Jacka FN, O'Neil A, Skouteris H. The association between diet quality and mental health during the perinatal period. A systematic review. Appetite 2015; 91:41-7. [PMID: 25814192 DOI: 10.1016/j.appet.2015.03.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 03/09/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND While maternal nutrition during pregnancy is known to play a critical role in the health of both mother and offspring, the magnitude of this association has only recently been realized. Novel, epigenetic data suggest that maternal dietary intake has permanent phenotypic consequences for offspring, highlighting the potency of antenatal diet. To date, the relationship between poor antenatal diet and maternal mental health specifically, remains poorly understood. Therefore, we aimed to systematically review evidence that has examined associations between antenatal diet quality and the experience of depressive, anxiety and stress symptoms during the perinatal period. METHODS A search for peer-reviewed papers was conducted using Medline Complete, PsycINFO, CINAHL, Academic Search Premiere and Psychology and Behavioral Science Collection. RESULTS Nine studies (cohort = 4, cross-sectional = 5) published between 2005 and 2013 were eligible for inclusion in this review. A synthesis of findings revealed positive associations between poor quality and unhealthy diets and antenatal depressive and stress symptoms. Healthy diets were inversely associated with antenatal depressive and anxiety symptoms. Postnatal depressive symptoms demonstrated inconsistent results. CONCLUSIONS Given the paucity of research examining diet quality and mental health in women during the perinatal period, further sufficiently powered studies are urgently required to examine this association.
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Affiliation(s)
- Rachel Baskin
- School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, Vic. 3125, Australia
| | - Briony Hill
- School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, Vic. 3125, Australia
| | - Felice N Jacka
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, Vic. 3220, Australia; Centre for Adolescent Health, Murdoch Children's Research Centre, Flemington Road, Parkville, Vic. 3052, Australia; Department of Psychiatry, The University of Melbourne, Royal Melbourne Hospital, Vic. 3050, Australia; Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia
| | - Adrienne O'Neil
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, Vic. 3220, Australia; School of Public Health and Preventive Medicine, Alfred Hospital, 55 Commercial Road, Prahran, Vic. 3004, Australia
| | - Helen Skouteris
- School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, Vic. 3125, Australia.
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Kim E, Park H, Hong YC, Ha M, Kim Y, Lee BE, Ha EH. Effect of maternal job strain during pregnancy on infant neurodevelopment by gender at 6 and 12 months: Mothers and Children's Environmental Health (MOCEH) study. Ann Occup Environ Med 2015; 27:8. [PMID: 25866667 PMCID: PMC4392800 DOI: 10.1186/s40557-015-0059-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/25/2015] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Limited evidence is available regarding the association between prenatal job strain and infant neurodevelopment. Most studies used stress indicators other than job strain to explain the relationship between prenatal maternal stress and child development. The objective of this study was to investigate the association between maternal job strain during pregnancy and neurodevelopment in infancy. METHODS Mothers and Children's Environmental Health (MOCEH) study, an on-going prospective birth cohort study, has been conducted in South Korea since 2006. Job strain during pregnancy was measured using Korean version of Job Content Questionnaire (JCQ). Infant neurodevelopment was assessed using Korean Bayley Scale of Infant Development II (K-BSID-II) at 6 and 12 months of age. A total of 343 mother-child pairs that completed JCQ and K-BSID-II more than once were included. Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) defined in the K-BSID-II were used as outcome variables. RESULTS Compared to infants from mothers with low job strain, significant (p < 0.05) decreases in PDI were found in infants from mothers with active and passive job at 6 months of age. After stratification by infant sex, boys in the high strain group had a lower MDI score than boys in the low job strain group at 12 months. On the other hand, girls in the high strain and active groups had higher MDI scores than girls in the low job strain group at 12 months. PDI at 12 months also showed different results by sex. Boys in the high strain and passive job groups had lower PDI scores than boys in the low job strain group. However, such difference was not observed in girls. CONCLUSIONS The findings of this study suggest that prenatal job strain affects infant neurodevelopment in a gender-dependent manner.
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Affiliation(s)
- Eunjeong Kim
- Department of Preventive Medicine, Ewha Medical Research Center, Ewha Womans University, Seoul, South Korea
| | - HyeSook Park
- Department of Preventive Medicine, Ewha Medical Research Center, Ewha Womans University, Seoul, South Korea
| | - Yun-Chul Hong
- Department of Preventive Medicine, College of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Mina Ha
- Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, South Korea
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Bo-Eun Lee
- Environmental Health Research Division, National Institute of Environmental Research, Incheon, South Korea
| | - Eun-Hee Ha
- Department of Preventive Medicine, Ewha Medical Research Center, Ewha Womans University, Seoul, South Korea
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Green BB, Armstrong DA, Lesseur C, Paquette AG, Guerin DJ, Kwan LE, Marsit CJ. The Role of Placental 11-Beta Hydroxysteroid Dehydrogenase Type 1 and Type 2 Methylation on Gene Expression and Infant Birth Weight. Biol Reprod 2015; 92:149. [PMID: 25788665 DOI: 10.1095/biolreprod.115.128066] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/17/2015] [Indexed: 12/16/2022] Open
Abstract
Maternal stress has been linked to infant birth weight outcomes, which itself may be associated with health later in life. The placenta acts as a master regulator for the fetal environment, mediating intrauterine exposures to stress through the activity of genes regulating glucocorticoids, including the 11beta-hydroxysteroid dehydrogenase (HSD11B) type 1 and 2 genes, and so we hypothesized that variation in these genes will be associated with infant birth weight. We investigated DNA methylation levels at six sites across the two genes, as well as mRNA expression for each, and the relationship to infant birth weight. Logistic regressions correcting for potential confounding factors revealed a significant association between methylation at a single CpG site within HSD11B1 and being born large for gestational age. In addition, our analysis identified correlations between methylation and gene expression, including sex-specific transcriptional regulation of HSD11B2. Our work is one of the first comprehensive views of DNA methylation and expression in the placenta for both HSD11B types 1 and 2, linking epigenetic alterations with the regulation of fetal stress and birth weight outcomes.
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Affiliation(s)
- Benjamin B Green
- Departments of Pharmacology and Toxicology and of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - David A Armstrong
- Departments of Pharmacology and Toxicology and of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Corina Lesseur
- Departments of Pharmacology and Toxicology and of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Alison G Paquette
- Departments of Pharmacology and Toxicology and of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Dylan J Guerin
- Departments of Pharmacology and Toxicology and of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Lauren E Kwan
- Departments of Pharmacology and Toxicology and of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Carmen J Marsit
- Departments of Pharmacology and Toxicology and of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
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Wainstock T, Shoham-Vardi I, Glasser S, Anteby E, Lerner-Geva L. Fetal sex modifies effects of prenatal stress exposure and adverse birth outcomes. Stress 2015; 18:49-56. [PMID: 25319674 DOI: 10.3109/10253890.2014.974153] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Prenatal maternal stress is associated with pregnancy complications, poor fetal development and poor birth outcomes. Fetal sex has also been shown to affect the course of pregnancy and its outcomes. The aim of this study was to evaluate whether fetal sex modifies the association between continuous exposure to life-threatening rocket attack alarms and adverse pregnancy outcomes. A retrospective cohort study was conducted in which the exposed group was comprised of 1846 women exposed to rocket-attack alarms before and during pregnancy. The unexposed group, with similar sociodemographic characteristics, delivered during the same period of time at the same medical center, but resided out of rocket-attack range. Multivariable models for each gender separately, controlling for possible confounders, evaluated the risk associated with exposure for preterm births (PTB), low birthweight (LBW), small for gestational age and small head circumference (HC). In both univariable and multivariable analyses exposure status was a significant risk factor in female fetuses only: PTB (adj. OR = 1.43; 1.04-1.96), LBW (adj. OR = 1.41; 1.02-1.95) and HC < 31 cm (adj. OR = 1.78; 1.11-2.88). In addition, regarding all adverse outcomes, the male-to-female ratio was higher in the exposed group than in the unexposed group. The findings support the hypothesis that male and female fetuses respond differentially to chronic maternal stress.
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Affiliation(s)
- Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer-Sheva , Israel
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80
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Chen X, Velez JC, Barbosa C, Pepper M, Andrade A, Stoner L, De Vivo I, Gelaye B, Williams MA. Smoking and perceived stress in relation to short salivary telomere length among caregivers of children with disabilities. Stress 2015; 18:20-8. [PMID: 25256607 PMCID: PMC4344384 DOI: 10.3109/10253890.2014.969704] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Telomere length (TL), the length of repeated DNA sequence that forms protective caps at the end of chromosomes, has emerged as a novel biomarker of cell aging and oxidative stress. There is increasing research exploring the associations of smoking and perceived stress with TL, and the results are inconsistent. This study aimed to examine whether smoking and perceived stress were associated with shortened salivary TL among primary caregivers of children with disabilities. Using a quantitative polymerase chain reaction method, salivary TL was assessed among 89 caregivers aged 19-69 years (87% were women) who took care of disabled children in the Patagonia Region, Chile. Interviewer-administered questionnaires were used to collect information on sociodemographic and lifestyle factors. The 14-item Perceived Stress Scale was used to assess perceived stress. Mean relative TL was 0.92 (standard error = 0.03). Smokers had age-adjusted mean TL that was 0.07 units lower (β = -0.07, standard error = 0.03; p = 0.012) than non-smokers. Smokers were 2.17 times more likely to have shorter TL ( < 0.73, the lowest quartile of TL) than non-smokers (odds ratio = 3.17; 95% confidence interval = 1.05-9.52) with adjustment for age and perceived stress. Caregivers with higher perceived stress were 2.13 times more likely to have shorter TL (odds ratio = 3.13; 95% confidence interval = 1.03-9.55) than caregivers with lower perceived stress after adjustment for age and smoking. This study provides the first evidence of strong associations between smoking and perceived stress and shortened salivary TL among caregivers of children with disabilities. Larger studies with detailed information on smoking status are warranted to confirm our findings.
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Affiliation(s)
- Xiaoli Chen
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Corresponding author: Xiaoli Chen, MD, PhD, MPH, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Kresge 500, Boston, MA 02115, Phone: 617-432-0067, Fax: 617 566-7805,
| | - Juan Carlos Velez
- Centro de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Clarita Barbosa
- Centro de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Micah Pepper
- Centro de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Asterio Andrade
- Centro de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Lee Stoner
- School of Sport and Exercise, Massey University, Wellington, New Zealand
| | - Immaculata De Vivo
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115; Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, MA, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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McDonald SW, Kingston D, Bayrampour H, Dolan SM, Tough SC. Cumulative psychosocial stress, coping resources, and preterm birth. Arch Womens Ment Health 2014; 17:559-68. [PMID: 24948100 DOI: 10.1007/s00737-014-0436-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/11/2014] [Indexed: 01/27/2023]
Abstract
Preterm birth constitutes a significant international public health issue, with implications for child and family well-being. High levels of psychosocial stress and negative affect before and during pregnancy are contributing factors to shortened gestation and preterm birth. We developed a cumulative psychosocial stress variable and examined its association with early delivery controlling for known preterm birth risk factors and confounding environmental variables. We further examined this association among subgroups of women with different levels of coping resources. Utilizing the All Our Babies (AOB) study, an ongoing prospective pregnancy cohort study in Alberta, Canada (n = 3,021), multinomial logistic regression was adopted to examine the independent effect of cumulative psychosocial stress and preterm birth subgroups compared to term births. Stratified analyses according to categories of perceived social support and optimism were undertaken to examine differential effects among subgroups of women. Cumulative psychosocial stress was a statistically significant risk factor for late preterm birth (OR = 1.73; 95 % CI = 1.07, 2.81), but not for early preterm birth (OR = 2.44; 95 % CI = 0.95, 6.32), controlling for income, history of preterm birth, pregnancy complications, reproductive history, and smoking in pregnancy. Stratified analyses showed that cumulative psychosocial stress was a significant risk factor for preterm birth at <37 weeks gestation for women with low levels of social support (OR = 2.09; 95 % CI = 1.07, 4.07) or optimism (OR = 1.87; 95 % CI = 1.04, 3.37). Our analyses suggest that early vulnerability combined with current anxiety symptoms in pregnancy confers risk for preterm birth. Coping resources may mitigate the effect of cumulative psychosocial stress on the risk for early delivery.
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Affiliation(s)
- Sheila W McDonald
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada,
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Truijens SEM, Meems M, Kuppens SMI, Broeren MAC, Nabbe KCAM, Wijnen HA, Oei SG, van Son MJM, Pop VJM. The HAPPY study (Holistic Approach to Pregnancy and the first Postpartum Year): design of a large prospective cohort study. BMC Pregnancy Childbirth 2014; 14:312. [PMID: 25201155 PMCID: PMC4162933 DOI: 10.1186/1471-2393-14-312] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 09/03/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The HAPPY study is a large prospective longitudinal cohort study in which pregnant women (N ≈ 2,500) are followed during the entire pregnancy and the whole first year postpartum. The study collects a substantial amount of psychological and physiological data investigating all kinds of determinants that might interfere with general well-being during pregnancy and postpartum, with special attention to the effect of maternal mood, pregnancy-related somatic symptoms (including nausea and vomiting (NVP) and carpal tunnel syndrome (CTS) symptoms), thyroid function, and human chorionic gonadotropin (HCG) on pregnancy outcome of mother and foetus. METHODS/DESIGN During pregnancy, participants receive questionnaires at 12, 22 and 32 weeks of gestation. Apart from a previous obstetric history, demographic features, distress symptoms, and pregnancy-related somatic symptoms are assessed. Furthermore, obstetrical data of the obstetric record form and ultrasound data are collected during pregnancy. At 12 and 30 weeks, thyroid function is assessed by blood analysis of thyroid stimulating hormone (TSH), free thyroxine (FT4) and thyroid peroxidase antibodies (TPO-Ab), as well as HCG. Also, depression is assessed with special focus on the two key symptoms: depressed mood and anhedonia. After childbirth, cord blood, neonatal heel screening results and all obstetrical data with regard to start of labour, mode of delivery and complications are collected. Moreover, mothers receive questionnaires at one week, six weeks, four, eight, and twelve months postpartum, to investigate recovery after pregnancy and delivery, including postpartum mood changes, emotional distress, feeding and development of the newborn. DISCUSSION The key strength of this large prospective cohort study is the holistic (multifactorial) approach on perinatal well-being combined with a longitudinal design with measurements during all trimesters of pregnancy and the whole first year postpartum, taking into account two physiological possible markers of complaints and symptoms throughout gestation: thyroid function and HCG. The HAPPY study is among the first to investigate within one design physiological and psychological aspects of NVP and CTS symptoms during pregnancy. Finally, the concept of anhedonia and depressed mood as two distinct aspects of depression and its possible relation on obstetric outcome, breastfeeding, and postpartum well-being will be studied.
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Affiliation(s)
- Sophie EM Truijens
- />Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, De Run 4600 The Netherlands
| | - Margreet Meems
- />Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, Tilburg, P.O. BOX 90153, Tilburg, 5000 LE The Netherlands
| | - Simone MI Kuppens
- />Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, Eindhoven, The Netherlands
| | - Maarten AC Broeren
- />Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, De Run, 4600 The Netherlands
| | - Karin CAM Nabbe
- />Clinical Laboratory, Diagnostiek voor U, Stratumsedijk 28a, Eindhoven, The Netherlands
| | - Hennie A Wijnen
- />Department of Midwifery Science, Maastricht-ZUYD, Universiteitssingel 60, Maastricht, The Netherlands
| | - S Guid Oei
- />Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, De Run 4600 The Netherlands
| | - Maarten JM van Son
- />Department of Clinical and Health Psychology, Utrecht University, Padualaan, 14 Utrecht The Netherlands
| | - Victor JM Pop
- />Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, Tilburg, P.O. BOX 90153, Tilburg, 5000 LE The Netherlands
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83
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No associations of prenatal maternal psychosocial stress with fasting glucose metabolism in offspring at 5-6 years of age. J Dev Orig Health Dis 2014; 5:361-9. [PMID: 25081574 DOI: 10.1017/s2040174414000300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Highly prevalent maternal psychosocial complaints are accompanied by increases in glucocorticoid stress hormones, which may predispose the offspring for type 2 diabetes and cardiovascular disease later in adulthood. The aim of the current research is to study whether prenatal maternal psychosocial stress is associated with parameters of blood glucose metabolism in their children aged 5-6 years. The study design was a prospective birth cohort (the Amsterdam Born Children and their Development study, the Netherlands). Depressive symptoms, pregnancy-related anxiety, parenting daily hassles and job strain were recorded by questionnaire (gestational week 16). A cumulative score was also calculated. Possible sex differences in the associations were considered. The subjects were 1952 mother-child pairs. Outcome measures were fasting glucose (n=1952), C-peptide and insulin resistance (HOMA2-IR) (n=1478) in the children at the age of 5-6 years. The stress scales, single and cumulative, were not associated with glucose/C-peptide/insulin resistance (all P>0.05). We did not find evidence for sex differences. In conclusion, we did not find evidence for an association between psychosocial stress during early pregnancy and parameters of glucose metabolism in offspring at the age of 5-6 years. Differences emerging later in life or in response to a metabolic challenge should not be ruled out.
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84
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Painter RC, Roseboom TJ, de Rooij SR. Long-term effects of prenatal stress and glucocorticoid exposure. ACTA ACUST UNITED AC 2014; 96:315-24. [PMID: 24203920 DOI: 10.1002/bdrc.21021] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 11/07/2012] [Indexed: 12/13/2022]
Abstract
There is a growing body of evidence suggesting that events during prenatal life can have long-lasting effects on development and adult health. Stress during pregnancy is common and has been linked to increased incidence of a range of affective and behavioral outcomes in the offspring in later life and also some somatic outcomes. Glucocorticoids, and their actions on the fetus, which are regulated by placental 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), are hypothesized to mediate these effects. Animal studies have demonstrated long-term effects of stress and glucocorticoid administration on behavioral outcomes, as well as increased blood pressure, altered hypothalamic pituitary adrenal axis (HPA) function, and decreased glucose tolerance and brain size. In humans, licorice, which inhibits placental 11β-HSD2 when consumed during pregnancy, has been shown to increase the risk of behavioral problems linked to altered HPA activity. Synthetic glucocorticoids administered during pregnancy to improve fetal lung maturity in threatened preterm birth have been shown to reduce birth weight and head circumference, but have not been linked to gross changes in long-term health to date. It is important to consider the long-term consequences of stress, and medication that mimics stress, during pregnancy.
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Affiliation(s)
- Rebecca C Painter
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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85
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Poor marital support associate with anxiety and worries during pregnancy in Greek pregnant women. Midwifery 2014; 30:628-35. [DOI: 10.1016/j.midw.2013.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 10/08/2013] [Accepted: 10/13/2013] [Indexed: 01/21/2023]
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Impact of psychosocial risk factors on prenatal care delivery: a national provider survey. Matern Child Health J 2014; 18:2362-70. [PMID: 24740719 DOI: 10.1007/s10995-014-1476-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To evaluate providers' perspectives regarding the delivery of prenatal care to women with psychosocial risk factors. A random, national sample of 2,095 prenatal care providers (853 obstetricians and gynecologists (Ob/Gyns), 270 family medicine (FM) physicians and 972 midwives) completed a mailed survey. We measured respondents' practice and referral patterns regarding six psychosocial risk factors: adolescence (age ≤19), unstable housing, lack of paternal involvement and social support, late prenatal care (>13 weeks gestation), domestic violence and drug or alcohol use. Chi square and logistic regression analyses assessed the association between prenatal care provider characteristics and prenatal care utilization patterns. Approximately 60 % of Ob/Gyns, 48.4 % of midwives and 32.2 % of FM physicians referred patients with psychosocial risk factors to clinicians outside of their practice. In all three specialties, providers were more likely to increase prenatal care visits with alternative clinicians (social workers, nurses, psychologists/psychiatrists) compared to themselves for all six psychosocial risk factors. Drug or alcohol use and intimate partner violence were the risk factors that most often prompted an increase in utilization. In multivariate analyses, Ob/Gyns who recently completed clinical training were significantly more likely to increase prenatal care utilization with either themselves (OR 2.15; 95 % CI 1.14-4.05) or an alternative clinician (2.27; 1.00-4.67) for women with high psychosocial risk pregnancies. Prenatal care providers frequently involve alternative clinicians such as social workers, nurses and psychologists or psychiatrists in the delivery of prenatal care to women with psychosocial risk factors.
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87
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Barrios YV, Sanchez SE, Qiu C, Gelaye B, Williams MA. Risk of spontaneous preterm birth in relation to maternal experience of serious life events during pregnancy. Int J Womens Health 2014; 6:249-57. [PMID: 24591850 PMCID: PMC3938466 DOI: 10.2147/ijwh.s54269] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this study was to examine the risk of preterm birth (PTB) in relation to serious life events experienced during pregnancy in Peruvian women. Methods This case-control study included 479 PTB cases and 480 term controls. In-person interviews asked information regarding sociodemographics, medical and reproductive histories, and serious life events experienced during pregnancy. Multivariate logistic regression procedures were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results Compared with women who did not experience a serious life event during pregnancy, those who experienced the following life events had a more than two-fold increased odds of PTB: death of first-degree relative (adjusted OR 2.10; 95% CI 1.38–3.20), divorce or separation (adjusted OR 2.09; 95% CI 1.10–4.00), financial troubles (adjusted OR 2.70; 95% CI 1.85–3.94), or serious fight with partner (adjusted OR 2.40; 95% CI 1.78–3.17). Women who experienced any serious life events during pregnancy had higher odds (adjusted OR 2.29; 95% CI 1.65–3.18) of suffering spontaneous preterm labor and preterm premature rupture of membranes (adjusted OR 2.19; 95% CI 1.56–3.08), compared with women who did not experience any such events. Associations of similar directions and extent were observed for severity of PTB (ie, very, moderate, or late PTB). The magnitude of the associations increased as increased frequency of serious life events (Ptrend <0.001). Conclusion Experiencing serious life events during pregnancy was associated with increased odds of PTB among Peruvian women. Interventions aimed at assisting women experiencing serious life events may reduce the risk of PTB. Future studies should include objective measures of stress and stress response to understand better the biological underpinnings of these associations.
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Affiliation(s)
- Yasmin V Barrios
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Sixto E Sanchez
- Department of Obstetrics and Gynecology, Hospital Dos de Mayo, Lima, Peru ; Universidad Nacional Mayor de San Marco, Lima, Peru
| | - Chunfang Qiu
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Michelle A Williams
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Helbig A, Kaasen A, Malt UF, Haugen G. Maternal psychological distress and placental circulation in pregnancies after a previous offspring with congenital malformation. PLoS One 2014; 9:e86597. [PMID: 24475155 PMCID: PMC3903559 DOI: 10.1371/journal.pone.0086597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/13/2013] [Indexed: 12/20/2022] Open
Abstract
Introduction Antenatal maternal psychological distress may be associated with reduced placental circulation, which could lead to lower birthweight. Studies investigating this in humans show mixed results, which may be partially due to type, strength and timing of distress. In addition, the arterial vascular resistance measures often used as outcome measures do not detect smaller changes in placental volume blood flow. We aimed to investigate the effect of a specific stressor, with increased levels of stress early in pregnancy, on the fetoplacental volume blood flow in third trimester. Methods This was a prospective observational study of 74 pregnant women with a congenital malformation in a previous fetus or child. Psychological distress was assessed twice, around 16 and 30 weeks' gestation. Psychometric measures were the General Health Questionnaire-28 (subscales anxiety and depression), Edinburgh Postnatal Depression Scale, and Impact of Event Scale-22 (subscales intrusion, avoidance, and arousal). Placental circulation was examined at 30 weeks, using Doppler ultrasonography, primarily as fetoplacental volume blood flow in the umbilical vein, normalized for abdominal circumference; secondarily as vascular resistance measures, obtained from the umbilical and the uterine arteries. Results Maternal distress in second but not third trimester was associated with increased normalized fetoplacental blood flow (P-values 0.006 and 0.013 for score > mean for depression and intrusion, respectively). Post-hoc explorations suggested that a reduced birthweight/placental weight ratio may mediate this association. Psychological distress did not affect vascular resistance measures in the umbilical and uterine arteries, regardless of adjustment for confounders. Conclusions In pregnant women with a previous fetus or child with a congenital malformation, higher distress levels in second trimester were associated with third trimester fetoplacental blood flow that was higher than expected for the size of the fetus. The results do not support placental blood flow reduction as a pathway between maternal distress and reduced birthweight.
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Affiliation(s)
- Anne Helbig
- Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway ; Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Anne Kaasen
- Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway ; Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Ulrik Fredrik Malt
- Department of Neuropsychiatry and Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, University of Oslo, Norway
| | - Guttorm Haugen
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, University of Oslo, Norway
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Correlates of high perceived stress among pregnant Hispanic women in Western Massachusetts. Matern Child Health J 2014; 17:1138-50. [PMID: 23010861 DOI: 10.1007/s10995-012-1106-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Prenatal psychosocial stress has been associated with adverse pregnancy outcomes, even after controlling for known risk factors. This paper aims to evaluate correlates of high perceived stress among Hispanic women, a group with elevated rates of stress during pregnancy. We conducted this analysis among 1,426 pregnant Hispanic women using data from Proyecto Buena Salud, a prospective cohort study conducted in Western Massachusetts. Cohen's Perceived Stress Scale (PSS-14) validated in English and Spanish was administered in early (mean = 12.4 weeks gestation), mid (mean = 21.3 weeks gestation) and late (mean = 30.8 weeks gestation) pregnancy at which time bilingual interviewers collected data on socio-demographic, acculturation, behavioral, and psychosocial factors. High perceived stress was defined as a PSS score >30. Young maternal age (odds ratio (OR) = 0.6; 95 % confidence interval (CI) 0.4-0.9 for <19 vs. 19-23 years), pre-pregnancy consumption of alcohol (OR = 2.2; 95 % CI 1.4-3.5 for >12 drinks/month vs. none) and smoking (OR = 2.2; 95 % CI 1.3-3.7 for >10 cigarettes/day vs. none) were associated with high perceived stress during early pregnancy. Furthermore, higher annual household income (OR = 0.4; 95 % CI 0.1-0.9 for >$30,000 vs. <$15,000), greater number of adults in the household (OR = 1.8; 95 % CI 1.1-3.0 for ≥3 vs. 1) and language preference (OR = 0.6; 95 % CI 0.4-0.9 for Spanish vs. English) were associated with high stress during mid-pregnancy. Likewise, annual household income was inversely associated with high stress during late pregnancy. Our results have important implications for incorporation of routine screening for psychosocial stress during prenatal visits and implementation of psychosocial counseling services for women at high risk.
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90
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Tran TD, Tran T, Simpson JA, Tran HT, Nguyen TT, Hanieh S, Dwyer T, Biggs BA, Fisher J. Infant motor development in rural Vietnam and intrauterine exposures to anaemia, iron deficiency and common mental disorders: a prospective community-based study. BMC Pregnancy Childbirth 2014; 14:8. [PMID: 24401012 PMCID: PMC3890590 DOI: 10.1186/1471-2393-14-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 01/06/2014] [Indexed: 11/14/2022] Open
Abstract
Background Antenatal anaemia, iron deficiency and common mental disorders (CMD) are prevalent in low- and middle-income countries. The aim of this study was to examine the direct and indirect effects of antenatal exposures to these risks and infant motor development. Methods A cohort of women who were pregnant with a single foetus and between 12 and 20 weeks pregnant in 50 randomly-selected rural communes in Ha Nam province was recruited. Participants provided data twice during pregnancy (early and late gestation) and twice after giving birth (8 weeks and 6 months postpartum). The Edinburgh Postnatal Depression Scale was used at all four data collection waves to detect CMD (score ≥ 4). Maternal anaemia (Hb < 11 g/dL) and iron deficiency (ferritin < 15 ng/mL) were evaluated at early and late gestation. Infants’ motor development was assessed by the Bayley of Infant and Toddler Development Motor Scales (BSID-M) at the age of six months. Direct and indirect effects of the exposures on the outcome were examined with Path analysis. Results In total, 497 of 523 (97%) eligible pregnant women were recruited and 418 mother-infant pairs provided complete data and were included in the analyses. The prevalence of anaemia was 21.5% in early pregnancy and 24.4% in late pregnancy. There was 4.1% iron deficiency at early pregnancy and 48.2% at late pregnancy. Clinically significant symptoms of CMD were apparent among 40% women in early pregnancy and 28% in late pregnancy. There were direct adverse effects on infant BSID-M scores at 6 months of age due to antenatal anaemia in late pregnancy (an estimated mean reduction of 2.61 points, 95% Confidence Interval, CI, 0.57 to 4.65) and CMD in early pregnancy (7.13 points, 95% CI 3.13 to 11.13). Iron deficiency and anaemia in early pregnancy were indirectly related to the outcome via anaemia during late pregnancy. Conclusions Antenatal anaemia, iron deficiency, and CMD have a negative impact on subsequent infant motor development. These findings highlight the need to improve the quality of antenatal care when developing interventions for pregnant women that aim to optimise early childhood development in low- and middle-income countries.
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Affiliation(s)
- Thach D Tran
- Research and Training Centre for Community Development, 39/255 Vong Street, Hai Ba Trung District Hanoi, Vietnam.
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Meta-analytic findings of the relation between maternal prenatal stress and anxiety and child cognitive outcome. J Dev Behav Pediatr 2014; 35:38-43. [PMID: 24345757 DOI: 10.1097/dbp.0000000000000003] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Different studies have revealed mixed findings regarding the relation between maternal prenatal stress or anxiety (MPSA) and early child cognitive outcome. Different methodological considerations may be linked to the absence of clear support for this hypothesized link. The purpose of this article was to conduct a meta-analysis of this relation while considering the following as potential moderators: (1) pregnancy trimester during which MPSA was assessed, (2) type of MPSA assessment (life events, pregnancy related, subjective assessments), and (3) research design (retrospective or prospective). Other moderators were also examined: child age at assessment and the year of publication. METHOD Eleven studies were identified (N = 5903) that examined the relation between MPSA and early child cognitive outcome. RESULTS A small effect size of r = -.05 was found for this relation. The effect size varied across studies and was significantly moderated by the manner in which MPSA was operationalized (events, subjective assessment of stress or pregnancy-related stress or anxiety) and by whether MPSA assessment took place before or after infant birth. Greater relations to child cognitive outcome were found for postnatal event-based indicators of MPSA. CONCLUSION The relation between MPSA and child cognitive outcome seems to be present, but low. Moreover, it is affected by the specific choices made by researchers in the manner in which constructs are operationalized.
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92
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Krans EE, Davis MM, Palladino CL. Disparate patterns of prenatal care utilization stratified by medical and psychosocial risk. Matern Child Health J 2013; 17:639-45. [PMID: 22581379 DOI: 10.1007/s10995-012-1040-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To evaluate patterns of prenatal care utilization stratified by medical and psychosocial risk. A retrospective cohort of 786 pregnant women who subsequently delivered live births from 1999 to 2003 at the University of Michigan were classified into high medical, high psychosocial, high medical and high psychosocial (dual high risk) and low-risk pregnancies. Chi-square and logistic regression analyses assessed the association between risk and prenatal care utilization using the Kotelchuck Index. Of 786 pregnancies, 202 (25.7%) were high medical risk, 178 (22.7%) were high psychosocial risk, 227 (28.9%) were dual high risk and 179 (22.8%) were low-risk. Over 31% of dual high risk and 25% of high medical risk pregnancies received "adequate plus" prenatal care versus 10% of high psychosocial risk pregnancies. In multivariate analyses, adjusted for risk, race and insurance, high psychosocial risk pregnancies (OR = 1.69; 95% CI 1.06-2.72) were significantly more likely to receive inadequate prenatal care than care of greater intensity. Many high psychosocial risk pregnancies do not receive adequate prenatal care.
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Affiliation(s)
- Elizabeth E Krans
- Magee-Womens Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
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93
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Vaz JDS, Kac G, Emmett P, Davis JM, Golding J, Hibbeln JR. Dietary patterns, n-3 fatty acids intake from seafood and high levels of anxiety symptoms during pregnancy: findings from the Avon Longitudinal Study of Parents and Children. PLoS One 2013; 8:e67671. [PMID: 23874437 PMCID: PMC3710017 DOI: 10.1371/journal.pone.0067671] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/26/2013] [Indexed: 02/06/2023] Open
Abstract
Background Little is known about relationships between dietary patterns, n-3 polyunsaturated fatty acids (PUFA) intake and excessive anxiety during pregnancy. Objective To examine whether dietary patterns and n-3 PUFA intake from seafood are associated with high levels of anxiety during pregnancy. Design Pregnant women enrolled from 1991–1992 in ALSPAC (n 9,530). Dietary patterns were established from a food frequency questionnaire using principal component analysis. Total intake of n-3 PUFA (grams/week) from seafood was also examined. Symptoms of anxiety were measured at 32 weeks of gestation with the Crown-Crisp Experiential Index; scores ≥9 corresponding to the 85th percentile was defined as high anxiety symptoms. Multivariate logistic regression models were used to estimate the OR and 95% CI, adjusted by socioeconomic and lifestyle variables. Results Multivariate results showed that women in the highest tertile of the health-conscious (OR 0.77; 0.65–0.93) and the traditional (OR 0.84; 0.73–0.97) pattern scores were less likely to report high levels of anxiety symptoms. Women in the highest tertile of the vegetarian pattern score (OR 1.25; 1.08–1.44) were more likely to have high levels of anxiety, as well as those with no n-3 PUFA intake from seafood (OR 1.53; 1.25–1.87) when compared with those with intake of >1.5 grams/week. Conclusions The present study provides evidence of a relationship between dietary patterns, fish intake or n-3 PUFA intake from seafood and symptoms of anxiety in pregnancy, and suggests that dietary interventions could be used to reduce high anxiety symptoms during pregnancy.
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94
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Ficks CA, Lahey BB, Waldman ID. Does low birth weight share common genetic or environmental risk with childhood disruptive disorders? JOURNAL OF ABNORMAL PSYCHOLOGY 2013; 122:842-53. [PMID: 23834065 DOI: 10.1037/a0033079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although advances in neonatal care over the past century have resulted in increased rates of survival among at-risk births, including infants with low birth weight, we have much to learn about psychological outcomes in this population. In particular, despite growing evidence that low birth weight may be associated with an increased risk for Attention-Deficit/Hyperactive Disorder (ADHD) symptoms in childhood, few studies have examined birth weight as a risk factor for disruptive disorders that commonly co-occur with ADHD. In addition, the etiology of the relation between birth weight and these disorders is unknown. The current investigation aimed to better understand these associations in the context of potentially confounding genetic and environmental influences by examining phenotypic associations between birth weight and disruptive disorder symptoms both between families and within families in two independent twin samples (Sample 1: N = 1,676 individuals; Sample 2: N = 4,038 individuals). We found negative associations between birth weight and inattentive, hyperactive-impulsive, and broad externalizing symptoms in both samples. Nonetheless, the overall magnitude of these associations was very small, contributing to less than 1% of the variance in these symptom dimensions. Within-family associations between birth weight and disruptive disorder symptoms did not differ for monozygotic and dizygotic twin pairs, suggesting that nonshared environmental influences rather than common genetic influences are responsible for these associations. Overall, the consistent albeit weak associations between birth weight and disruptive disorder symptoms suggest that low birth weight may not represent a major risk factor in the development of these symptoms.
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95
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Kim D, Saada A. The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2296-335. [PMID: 23739649 PMCID: PMC3717738 DOI: 10.3390/ijerph10062296] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/26/2013] [Accepted: 05/16/2013] [Indexed: 11/17/2022]
Abstract
Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world.
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Affiliation(s)
- Daniel Kim
- Behavioural and Policy Sciences Department, RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, USA
- Department of Social and Behavioural Sciences, Ecole des Hautes Etudes en Santé Publique, Rennes 35043, France
| | - Adrianna Saada
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA 02115, USA; E-Mail:
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96
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Helbig A, Kaasen A, Malt UF, Haugen G. Does antenatal maternal psychological distress affect placental circulation in the third trimester? PLoS One 2013; 8:e57071. [PMID: 23437312 PMCID: PMC3577751 DOI: 10.1371/journal.pone.0057071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 01/17/2013] [Indexed: 11/27/2022] Open
Abstract
Introduction Some types of antenatal maternal psychological distress may be associated with reduced fetal growth and birthweight. A stress-mediated reduction in placental blood flow has been suggested as a mechanism. Previous studies have examined this using ultrasound-derived arterial resistance measures in the uterine (UtA) and umbilical (UA) arteries, with mixed conclusions. However, a reduction in placental volume blood flow may occur before changes in arterial resistance measures are seen. Fetoplacental volume blood flow can be quantified non-invasively in the umbilical vein (UV). Our objective was to study whether specific types of maternal psychological distress affect the placental circulation, using volume blood flow quantification in addition to arterial resistance measures. Methods This was a prospective observational study of 104 non-smoking pregnant women (gestational age 30 weeks) with uncomplicated obstetric histories. Psychological distress was measured by General Health Questionnaire-28 (subscales anxiety and depression) and Impact of Event Scale-22 (subscales intrusion, avoidance and arousal). UtA and UA resistance measures and UV volume blood flow normalized for fetal abdominal circumference, were obtained by Doppler ultrasound. Results IES intrusion scores above the mean were associated with a reduction in normalized UV volume blood flow (corresponding to –0.61 SD; P = 0.003). Adjusting for UA resistance increased the strength of this association (difference –0.66 SD; P<0.001). Other distress types were not associated with UV volume blood flow. Maternal distress was not associated with arterial resistance measures, despite adjustment for confounders. Conclusions Intrusive thoughts and emotional distress regarding the fetus were associated with reduced fetoplacental volume blood flow in third trimester. Uterine and umbilical artery resistance measures were not associated with maternal distress. Our findings support a decrease in fetoplacental blood flow as a possible pathway between maternal distress and reduced fetal growth.
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Affiliation(s)
- Anne Helbig
- Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway.
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97
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Krans EE, Davis MM, Schwarz EB. Psychosocial risk, prenatal counseling and maternal behavior: findings from PRAMS, 2004-2008. Am J Obstet Gynecol 2013; 208:141.e1-7. [PMID: 23159699 DOI: 10.1016/j.ajog.2012.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/28/2012] [Accepted: 11/14/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the impact of prenatal counseling regarding psychosocial risk factors on maternal behavior. STUDY DESIGN We analyzed data from 198,323 women participating in the Pregnancy Risk Assessment Monitoring System (PRAMS). The χ(2) and logistic regression analyses assessed the relationship between psychosocial risk, prenatal counseling and maternal behavior. RESULTS The odds of receiving risk-appropriate prenatal counseling were significantly greater for participants who used alcohol (odds ratio, 1.13; 95% confidence interval, 1.08-1.17) and tobacco (odds ratio, 2.02; 95% confidence interval, 1.91-2.13). After receiving counseling, women quit using alcohol (72.9% vs 27.1%; P < .01) and tobacco (79.9% vs 20.1%; P < .01) at a significantly greater rate and women with unintended pregnancies were more likely to use postpartum contraception (83.6% vs 16.4%; P < .01) than women who were not counseled. However, no significant differences were found in the rates of intimate partner violence during pregnancy (56.1% vs 43.9%; P = .09) between women who did and did not receive counseling. CONCLUSION Counseling regarding psychosocial risk factors during pregnancy may positively impact maternal behavior.
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98
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de Marco R, Pesce G, Girardi P, Marchetti P, Rava M, Ricci P, Marcon A. Foetal exposure to maternal stressful events increases the risk of having asthma and atopic diseases in childhood. Pediatr Allergy Immunol 2012; 23:724-9. [PMID: 22957808 DOI: 10.1111/j.1399-3038.2012.01346.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The natural history of asthma and atopic diseases begins in utero. Studies investigating the influence of foetal exposure to maternal stressful life events during pregnancy (SLEP) on asthma and atopic diseases are lacking. AIM To test whether the children of mothers who had experienced SLEP are at an increased risk for asthma, atopic eczema and allergic rhinitis. METHODS The association between maternal SLEP (at least one among: divorce, mourning or loss of the job) and the occurrence of asthma and atopic diseases in childhood was studied in a population (n = 3854) of children, aged 3-14 yrs, living in Northern Italy. The parents filled in a standardized questionnaire about the children's health and the events occurred to their mothers during pregnancy. RESULTS Three hundred and thirty-three (9%) of the mothers experienced SLEP. Their children had a statistically significantly higher lifetime prevalence of wheezing (31.6% vs. 23.1%), asthma (8.9% vs. 5.6%), allergic rhinitis (10.9% vs. 7.3%) and atopic eczema (29.7% vs. 21.1%) than those of mothers without SLEP. After adjusting for potential confounders, the foetal exposure to SLEP was positively associated with wheezing (OR: 1.41, 95% CI: 1.03-1.94), asthma (OR: 1.71, 95% CI: 1.02-2.89), allergic rhinitis (OR: 1.75, 95% CI: 1.08-2.84) and atopic eczema (OR: 1.53, 95% CI: 1.11-2.10). CONCLUSION The children of mothers who had experienced SLEP were at a moderately increased risk of having wheezing, asthma, eczema and allergic rhinitis during their childhood. Maternal stress during pregnancy might enhance the expression of asthma and atopic phenotypes in children.
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Affiliation(s)
- Roberto de Marco
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Italy.
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99
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Hompes T, Vrieze E, Fieuws S, Simons A, Jaspers L, Van Bussel J, Schops G, Gellens E, Van Bree R, Verhaeghe J, Spitz B, Demyttenaere K, Allegaert K, Van den Bergh B, Claes S. The influence of maternal cortisol and emotional state during pregnancy on fetal intrauterine growth. Pediatr Res 2012; 72:305-15. [PMID: 22669293 DOI: 10.1038/pr.2012.70] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND This exploratory study investigates the influence of maternal cortisol and emotional state during pregnancy on fetal intrauterine growth (IUG). We expected higher basal cortisol levels, or more depressive and anxious complaints during pregnancy, to be associated with slower IUG and lower birth weight. METHODS A total of 91 pregnant women were recruited from the antenatal clinic and were seen once each trimester. In addition to psychological assessments, a diurnal cortisol profile was derived from saliva samples. IUG was evaluated using ultrasound. RESULTS In mid-pregnancy (trimester (T)2), basal cortisol levels significantly predicted the variance of weight (proportion of variance in growth variable explained (PVE) = 11.6%) and body mass index (BMI) at birth (PVE = 6.8%). In late pregnancy (T3) emotional state, particularly depressive symptoms (BMI at birth: PVE = 6.9%; ponderal index (PI) at birth: PVE = 8.2%; head circumference at T3: PVE = 10.3%; head circumference at birth PVE = 9.1%) and attachment (BMI at birth: PVE = 6.9%; PI at birth: PVE = 7.2%) had an influence on growth. Analysis of growth between T2 and T3 showed that attachment and cortisol in T3 had an influence on the variation in increase in estimated fetal weight (PVE = 12.5-8.6%). CONCLUSION These data indicate basal cortisol levels were more important in T2 whereas emotional state was more important in T3.
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Affiliation(s)
- Titia Hompes
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium.
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100
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Loomans EM, van Dijk AE, Vrijkotte TGM, van Eijsden M, Stronks K, Gemke RJBJ, Van den Bergh BRH. Psychosocial stress during pregnancy is related to adverse birth outcomes: results from a large multi-ethnic community-based birth cohort. Eur J Public Health 2012; 23:485-91. [PMID: 22850187 DOI: 10.1093/eurpub/cks097] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prevalence rates of psychosocial stress during pregnancy are substantial. Evidence for associations between psychosocial stress and birth outcomes is inconsistent. This study aims to identify and characterize different clusters of pregnant women, each with a distinct pattern of psychosocial stress, and investigate whether birth outcomes differ between these clusters. METHODS Latent class analysis was performed on data of 7740 pregnant women (Amsterdam Born Children and their Development study). Included constructs were depressive symptoms, state anxiety, job strain, pregnancy-related anxiety and parenting stress. RESULTS Five clusters of women with distinct patterns of psychosocial stress were objectively identified. Babies born from women in the cluster characterized as 'high depression and high anxiety, moderate job strain' (12%) had a lower birth weight, and those in the 'high depression and high anxiety, not employed' cluster (15%) had an increased risk of pre-term birth. CONCLUSIONS Babies from pregnant women reporting both high levels of anxiety and depressive symptoms are at highest risk for adverse birth outcomes.
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Affiliation(s)
- Eva M Loomans
- Department of Psychology, Tilburg University, The Netherlands.
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