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Wagner E, Bień K, Łomża A, Grunwald A, Kimber-Trojnar Ż, Libera A, Leszczyńska-Gorzelak B. Stress of Prematurity in the Experience of the COVID-19 Pandemic-Current State of Knowledge. Life (Basel) 2023; 13:1757. [PMID: 37629614 PMCID: PMC10455823 DOI: 10.3390/life13081757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Stress is a process that triggers various physiological, hormonal and psychological mechanisms in response to a threat, which significantly affects the health of an individual. The COVID-19 pandemic introduced a lot of social changes that required constant adaptation to unfavorable conditions. The aim of the study was to assess the impact of stress related to this pandemic on pregnant women, mothers of premature infants and their families, and on obstetric complications, particularly preterm birth. A comprehensive literature review was performed using electronic databases such as Pubmed, Science Direct and Google Scholar. Keywords such as: "prematurity"; "pregnancy"; "stress"; "COVID-19" and various combinations of the above were used. Maternal stress and anxiety increase the levels of corticotropin-releasing hormone (CRH) in the placenta, which in turn affects the incidence of preterm birth and many other related maternal and neonatal complications. In addition, it was found that SARS-CoV-2 infection may increase the risk of this phenomenon. The COVID-19 pandemic has adversely affected preterm birth rates and the mental health of mothers of preterm infants, exacerbating their negative experience of having a premature baby. More research is needed to demonstrate the long-term effects of COVID-19 stress on prematurity.
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Affiliation(s)
| | | | | | | | - Żaneta Kimber-Trojnar
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (E.W.); (K.B.); (A.Ł.); (A.G.); (A.L.); (B.L.-G.)
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Pearson J, Fréchette-Boilard G, Baudry C, Matte-Gagné C, Bernier A, Lemelin JP, Tarabulsy GM. Prenatal maternal stress during the COVID-19 pandemic and birth outcomes: Is the newborn spared? Infant Behav Dev 2023; 72:101866. [PMID: 37506422 DOI: 10.1016/j.infbeh.2023.101866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
The COVID-19 pandemic has generated numerous stressors among the general population, but more specifically in pregnant women because of disruptions in prenatal care and delivery conditions. Studies suggest that prenatal maternal stress increased during the pandemic (Berthelot et al., 2020; Perzow et al., 2021; Tomfohr-Madsen et al., 2021). Considering what is known about the fetal programming potential of prenatal maternal stress, several researchers, early in the pandemic, raised concerns over the significant negative consequences that the pandemic context could have on birth outcomes. Studies comparing birth outcomes during versus before the pandemic suggest a marginal increase in birthweight and a significant decrease in preterm birth (Yang et al., 2022), but individual variations in prenatal maternal stress during the pandemic have received less attention. The objective of the present study is to examine the association between prenatal maternal stress during the COVID-19 pandemic and birth outcomes. During pregnancy, 195 expecting mothers reported on their general and pandemic-related stress. When their child was 6 months old, mothers completed a questionnaire collecting information on birth outcomes (gestational age, birthweight, head circumference and Apgar scores). Hierarchical linear regressions show that none of the maternal prenatal stress variables significantly predicted variations in birth outcomes. Potential pandemic-related protective factors (e.g., changes in life and hygiene habits, rest imposed by lockdowns) and the need to offer support to pregnant women are discussed.
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Riquelme-Gallego B, Martínez-Vázquez S, Caparros-Gonzalez RA. Pandemic-related stress in pregnant women during the first COVID-19 lockdown and neonatal development. J Reprod Infant Psychol 2023:1-16. [PMID: 37469194 DOI: 10.1080/02646838.2023.2237527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 06/26/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Maternal stress and psychopathology have a negative effect on mothers and neonates. Maternal stress may affect neonatal growth and development both physically and psychologically. PURPOSE To study the impact of pandemic-related pregnancy stress and maternal psychopathological symptoms during the COVID-19 lockdown in 2020 on neonatal development. METHODS A two-phase prospective study was carried out on a sample of 181 pregnant women ranged from 18 to 40 years old in Spain (Europe). Phase 1: Pandemic-related pregnancy stress (PREPS), Prenatal Distress Questionnaire (PDQ), Perceived Stress Scale (PSS) and the revised version of the Symptom Checklist-90 (SCL-90-R) were used to assess psychological symptoms during the lockdown. In the follow-up (Phase 2), obstetric, birth-related and anthropometric variables were collected from 81 pregnant women-neonates dyads. RESULTS Primiparous women showed higher psychopathological symptoms and higher levels of pandemic-related pregnancy stress than multiparous women. A multiple linear regression model showed that pandemic-related pregnancy stress could predict the length of neonate by adjusting for maternal age and gestational age, especially for primiparous women. IMPLICATIONS FOR RESEARCH Studies assessing neonates development should evaluate the long-term effect of the COVID-19 pandemic on neonates´ length. IMPLICATIONS FOR PRACTICE States the relation between pandemic-related pregnancy stress and neonatal development by being able to track the effects on neonates whose mothers had high levels of stress during the COVID-19 pandemic.
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Affiliation(s)
- Blanca Riquelme-Gallego
- Department of Nursing of the University of Granada, Ceuta Campus, Spain
- Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
| | | | - Rafael A Caparros-Gonzalez
- Department of Nursing of the University of Granada, Ceuta Campus, Spain
- Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
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Widen EM, Burns N, Kahn LG, Grewal J, Backlund G, Nichols AR, Rickman R, Foster S, Nhan-Chang CL, Zhang C, Wapner R, Wing DA, Owen J, Skupski DW, Ranzini AC, Newman R, Grobman W, Daniels MJ. Prenatal weight and regional body composition trajectories and neonatal body composition: The NICHD Foetal Growth Studies. Pediatr Obes 2023; 18:e12994. [PMID: 36605025 PMCID: PMC9924063 DOI: 10.1111/ijpo.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Gestational weight gain (GWG) and anthropometric trajectories may affect foetal programming and are potentially modifiable. OBJECTIVES To assess concomitant patterns of change in weight, circumferences and adiposity across gestation as an integrated prenatal exposure, and determine how they relate to neonatal body composition. METHODS Data are from a prospective cohort of singleton pregnancies (n = 2182) enrolled in United States perinatal centres, 2009-2013. Overall and by prepregnancy BMI group (overweight/obesity and healthy weight), joint latent trajectory models were fit with prenatal weight, mid-upper arm circumference (MUAC), triceps (TSF) and subscapular (SSF) skinfolds. Differences in neonatal body composition by trajectory class were assessed via weighted least squares. RESULTS Six trajectory patterns reflecting co-occurring changes in weight and MUAC, SSF and TSF across pregnancy were identified overall and by body mass index (BMI) group. Among people with a healthy weight BMI, some differences were observed for neonatal subcutaneous adipose tissue, and among individuals with overweight/obesity some differences in neonatal lean mass were found. Neonatal adiposity measures were higher among infants born to individuals with prepregnancy overweight/obesity. CONCLUSIONS Six integrated trajectory patterns of prenatal weight, subcutaneous adipose tissue and circumferences were observed that were minimally associated with neonatal body composition, suggesting a stronger influence of prepregnancy BMI.
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Affiliation(s)
- Elizabeth M Widen
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
- Department of Women's Health & Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Natalie Burns
- Department of Statistics, University of Florida, Gainesville, Florida, USA
| | - Linda G Kahn
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Jagteshwar Grewal
- Division of Population Health Research, Division of Intramural Research, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Grant Backlund
- Department of Statistics, University of Florida, Gainesville, Florida, USA
| | - Amy R Nichols
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Rachel Rickman
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Saralyn Foster
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Chia-Ling Nhan-Chang
- Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia, South Carolina, USA
| | - Cuilin Zhang
- Division of Population Health Research, Division of Intramural Research, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia, South Carolina, USA
| | - Deborah A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, University of California, Irvine, School of Medicine, Irvine, and Fountain Valley Regional Hospital and Medical Center, Fountain Valley, California, USA
| | - John Owen
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daniel W Skupski
- Department of Obstetrics and Gynecology, New York-Presbyterian Queens Hospital, Queens, New York, USA
| | - Angela C Ranzini
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, St Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Columbia, South Carolina, USA
| | - William Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University (WAG), New Rochelle, New York, USA
| | - Michael J Daniels
- Department of Statistics, University of Florida, Gainesville, Florida, USA
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Babineau V, Fonge YN, Miller ES, Grobman WA, Ferguson PL, Hunt KJ, Vena JE, Newman RB, Guille C, Tita ATN, Chandler-Laney PC, Lee S, Feng T, Scorza P, Takács L, Wapner RJ, Palomares KT, Skupski DW, Nageotte MP, Sciscione AC, Gilman S, Monk C. Associations of Maternal Prenatal Stress and Depressive Symptoms With Childhood Neurobehavioral Outcomes in the ECHO Cohort of the NICHD Fetal Growth Studies: Fetal Growth Velocity as a Potential Mediator. J Am Acad Child Adolesc Psychiatry 2022; 61:1155-1167. [PMID: 35367322 PMCID: PMC9427685 DOI: 10.1016/j.jaac.2022.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 01/27/2022] [Accepted: 03/21/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Maternal prenatal stress and mood symptoms are associated with risk for child psychopathology. Within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies (ECHO-FGS), a racially and ethnically diverse cohort, we studied associations between prenatal stress and depressive symptoms with child neurobehavior, and potential mediation by fetal growth velocity (FGV) in low-risk pregnancies. METHOD For 730 mother-child pairs, we had serial ultrasound measurements, self-reports of prenatal stress and depression, observations of child executive functions and motor skills from 4 to 8 years, and maternal reports of child psychiatric problems. We tested associations between prenatal stress and depressive symptoms with child neurobehavior in regression analyses, and associations with FGV in mixed effect models. Post hoc we tested severity of prenatal symptoms; FGV at 25th, 50th, and 75th percentiles; and moderation by biological sex and by race and ethnicity. RESULTS Prenatal stress and depressive symptoms were associated with child psychiatric problems, and prenatal depressive symptoms with decrements in executive functions and motor skills, especially in biological male children. Neither prenatal stress nor depressive symptoms were associated with FGV. CONCLUSION In one of the largest cohorts with observed child outcomes, and the first with broad representation of race and ethnicity in the United States, we found that prenatal stress and depressive symptoms were associated with greater reports of child psychiatric symptoms. Only prenatal depressive symptoms were associated with observed decrements in cognitive abilities, most significantly in biological male children. Stress during low-risk pregnancies may be less detrimental than theorized. There was no mediation by FGV. These findings support the need to attend to even small changes in prenatal distress, as these may have long-lasting implications.
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Affiliation(s)
| | - Yaneve N Fonge
- University of Pittsburgh Magee-Womens Hospital, Pennsylvania
| | - Emily S Miller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A Grobman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kelly J Hunt
- Medical University of South Carolina, Charleston
| | - John E Vena
- Medical University of South Carolina, Charleston
| | | | | | | | | | - Seonjoo Lee
- Columbia University, New York; New York State Psychiatric Institute, New York
| | | | | | | | | | | | | | | | | | - Stephen Gilman
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Effects of maternal exposure to acute stress on birth outcomes: a quasi-experiment study. J Dev Orig Health Dis 2021; 13:471-482. [PMID: 34937600 DOI: 10.1017/s2040174421000611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Numerous studies have shown associations between maternal stress and poor birth outcomes, but evidence is unclear for causal inference. Natural disasters provide an opportunity to study effects of quasi-randomized hardship with an accurate measure of onset and duration. In a population-based quasi-experimental study, we examined the effect of maternal exposure to the January 1998 Québec ice storm on birth outcomes by comparing pregnant mothers who lived in an area hard hit by the ice storm with those in two unaffected regions. In a total of 147,349 singleton births between 1995 and 2001, we used a difference-in-differences method to estimate the effects of the ice storm on gestational age at delivery (GA), preterm birth (PTB), weight-for-gestational-age z-scores (BWZ), large for gestational age (LGA), and small for gestational age (SGA). After adjusting for maternal and sociodemographic characteristics, there were no differences between the exposed and the unexposed mothers for birth outcomes. The estimated differences (exposed vs. unexposed) were 0.01 SDs (95% CI: -0.02, 0.05) for BWZ; 0.10% point (95% CI: -0.95%, 1.16%) for SGA; 0.25% point (95% CI: -0.78%, 1.28%) for LGA; -0.01 week (95% CI: -0.07, 0.05) for GA; and 0.16% point (95% CI: -0.66%, 0.97%) for PTB. Neither trimester-specific nor dose-response associations were observed. Overall, exposure to the 1998 Québec ice storm as a proxy for acute maternal stress in pregnancy was not associated with poor birth outcomes. Our results suggest that acute maternal hardship may not have a substantial effect on adverse birth outcomes.
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Elmetwally MA, Samy A, Eldesouky A, Lenis YY, Eldomany W. Uterine blood flow, fetal heart rate, gestational length, and fetal birth weight variability in response to maternal temperament in the goat. Anim Sci J 2021; 92:e13563. [PMID: 34013649 DOI: 10.1111/asj.13563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Abstract
This prospective study was designed to investigate the effects of maternal temperament on uterine blood flow, fetal heart rate, gestational length, and fetal birth weight in a goat experimental model. Based on the arena test, behavioral testing related to fear-eliciting stimulus, goats were divided into nervous (n = 13) and calm (n = 11) groups. After mating, the perfusion of maternal uterine arteries (UTAs) and its related Doppler parameters, blood flow volume (BFV), time-averaged mean velocity (TAMEANV), acceleration (Acce), and resistance impedance (S/D), were evaluated biweekly from week two until the end of pregnancy. Fetal heart rate (FHR) was investigated during the pregnancy in addition to the gestation length (GL) and fetal birth weight (FBW). The UTA-BFV and TAMEANV, as well as Acce and S/D, were influenced by maternal temperament (p < .05). The FHR showed no significant changes between experimental animals of different temperaments (p = .81). Both GL and FBW were increased in calm rather than nervous goats (p < .05). These results indicated that the maternal nervous (temperament) have negative impacts on uterine artery Doppler indices, fetal growth, and gestational length in a goat experimental model.
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Affiliation(s)
- Mohammed A Elmetwally
- Department of Theriogenology, Mansoura University, Mansoura, Egypt.,Institute of Reproductive Biology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Alaa Samy
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf Eldesouky
- Department of Theriogenology, Mansoura University, Mansoura, Egypt
| | - Yasser Y Lenis
- Division of Animal Science, University of Missouri, Columbia, Missouri, USA.,OHVRI, Health and Veterinary Innovative Research and Development, School of Veterinary Medicine, Faculty of Agrarian Science, Antioquia University, Medellín, Colombia.,Departamento de Ciencia Animal, Facultad de Ciencias Agropecuarias, Universidad Nacional de Colombia, Palmira, Colombia
| | - Wael Eldomany
- Department of Theriogenology, Mansoura University, Mansoura, Egypt
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Lim HA, Chua TE, Malhotra R, Allen JC, Teo I, Chern BSM, Tan KH, Chen H. Identifying trajectories of antenatal depression in women and their associations with gestational age and neonatal anthropometry: A prospective cohort study. Gen Hosp Psychiatry 2019; 61:26-33. [PMID: 31710855 DOI: 10.1016/j.genhosppsych.2019.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The present study sought to determine the longitudinal trajectories of antenatal depression and examine their associations with birth outcomes. METHOD 926 healthy women with uncomplicated singleton pregnancies within 14 weeks of gestation participated in this prospective cohort study. Women completed a sociodemographic and medical questionnaire and the locally-validated Edinburgh Postnatal Depression Scale (EPDS) in their first, second, and third trimesters, and prior to parturition. Gestational age and neonatal weight, length, and head circumference were recorded at birth. Group-based trajectory modelling characterized trajectories of antenatal depression. Analyses of covariance and covariate-adjusted linear regressions identified associations between trajectories and neonatal outcomes. RESULTS Four distinct non-fluctuating trajectories of depressive symptoms were identified, with 9% women suffering from probable clinical depression throughout the pregnancy. Women in this persistently-moderate depression trajectory delivered 2.48 days earlier than in other trajectories; a one-point increase in EPDS scores was associated with an adjusted reduction of 5.82 g in birthweight. CONCLUSIONS Although meaningful trajectories were identified, no clinically relevant associations between persistently-moderate depressive symptoms with neonatal outcomes were found. The stability of these trajectories, however, suggests the importance of screening for depressive symptoms early in pregnancy to identify women who may benefit from greater formal and informal support.
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Affiliation(s)
- Haikel A Lim
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - Tze-Ern Chua
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Rahul Malhotra
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - John C Allen
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - Irene Teo
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - Bernard S M Chern
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Kok Hian Tan
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Helen Chen
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
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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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Rendina DN, Blohowiak SE, Coe CL, Kling PJ. Maternal Perceived Stress during Pregnancy Increases Risk for Low Neonatal Iron at Delivery and Depletion of Storage Iron at One Year. J Pediatr 2018; 200:166-173.e2. [PMID: 29908648 PMCID: PMC6109609 DOI: 10.1016/j.jpeds.2018.04.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the impact of maternal stress during pregnancy on newborn iron and stage 1 iron deficiency at 1 year of age. STUDY DESIGN In total, 245 mothers and their newborn infants (52% male; 72% white) were recruited at the Meriter Hospital Birthing Center on the basis of known risk factors for iron deficiency. Umbilical cord blood hemoglobin and zinc protoporphyrin/heme (ZnPP/H) were determined to evaluate erythrocyte iron and plasma ferritin was determined to reflect storage iron. Mothers retrospectively reported stress experienced previously during pregnancy on a 25-item questionnaire. Blood was also was collected from 79 infants who were breastfed at 1 year of age. RESULTS Maternal recall of distress and health concerns during pregnancy correlated with cord blood ZnPP/H indices (r = 0.21, P < .01), even in the absence of major traumatic events. When concurrent with other known risks for iron deficiency, including maternal adiposity, socioeconomic status, and race, maternal stress had a summative effect, lowering cord blood iron. At 1 year, 24% of infants who were breastfed had moderate iron deficiency (plasma ferritin <12 µg/L). Higher cord blood ZnPP/H was predictive of this moderate iron deficiency (95% CI 0.26-1.47, P = .007). When coincident with maternal reports of gestational stress, the likelihood of low plasma ferritin at 1 year increased 36-fold in breastfed infants as compared with low-stress pregnancies (95% CI 1.33-6.83, P = .007). CONCLUSIONS Maternal recall of stress during pregnancy was associated with lower iron stores at birth. High cord blood ZnPP/H, reflecting low erythrocyte iron, was correlated with the likelihood of stage 1 iron deficiency at 1 year, when rapid growth can deplete storage iron in breastfed infants.
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Affiliation(s)
- Danielle N. Rendina
- Harlow Center for Biological Psychology, University of Wisconsin-Madison, Madison WI
| | - Sharon E. Blohowiak
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison WI,Department of Pediatrics, University of Wisconsin-Madison, Madison WI
| | - Christopher L. Coe
- Harlow Center for Biological Psychology, University of Wisconsin-Madison, Madison WI
| | - Pamela J. Kling
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison WI,Department of Pediatrics, University of Wisconsin-Madison, Madison WI
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Villar J, Cheikh Ismail L, Staines Urias E, Giuliani F, Ohuma EO, Victora CG, Papageorghiou AT, Altman DG, Garza C, Barros FC, Puglia F, Ochieng R, Jaffer YA, Noble JA, Bertino E, Purwar M, Pang R, Lambert A, Chumlea C, Stein A, Fernandes M, Bhutta ZA, Kennedy SH. The satisfactory growth and development at 2 years of age of the INTERGROWTH-21 st Fetal Growth Standards cohort support its appropriateness for constructing international standards. Am J Obstet Gynecol 2018; 218:S841-S854.e2. [PMID: 29273309 PMCID: PMC5807090 DOI: 10.1016/j.ajog.2017.11.564] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/30/2022]
Abstract
Background The World Health Organization recommends that human growth should be monitored with the use of international standards. However, in obstetric practice, we continue to monitor fetal growth using numerous local charts or equations that are based on different populations for each body structure. Consistent with World Health Organization recommendations, the INTERGROWTH-21st Project has produced the first set of international standards to date pregnancies; to monitor fetal growth, estimated fetal weight, Doppler measures, and brain structures; to measure uterine growth, maternal nutrition, newborn infant size, and body composition; and to assess the postnatal growth of preterm babies. All these standards are based on the same healthy pregnancy cohort. Recognizing the importance of demonstrating that, postnatally, this cohort still adhered to the World Health Organization prescriptive approach, we followed their growth and development to the key milestone of 2 years of age. Objective The purpose of this study was to determine whether the babies in the INTERGROWTH-21st Project maintained optimal growth and development in childhood. Study Design In the Infant Follow-up Study of the INTERGROWTH-21st Project, we evaluated postnatal growth, nutrition, morbidity, and motor development up to 2 years of age in the children who contributed data to the construction of the international fetal growth, newborn infant size and body composition at birth, and preterm postnatal growth standards. Clinical care, feeding practices, anthropometric measures, and assessment of morbidity were standardized across study sites and documented at 1 and 2 years of age. Weight, length, and head circumference age- and sex-specific z-scores and percentiles and motor development milestones were estimated with the use of the World Health Organization Child Growth Standards and World Health Organization milestone distributions, respectively. For the preterm infants, corrected age was used. Variance components analysis was used to estimate the percentage variability among individuals within a study site compared with that among study sites. Results There were 3711 eligible singleton live births; 3042 children (82%) were evaluated at 2 years of age. There were no substantive differences between the included group and the lost-to-follow up group. Infant mortality rate was 3 per 1000; neonatal mortality rate was 1.6 per 1000. At the 2-year visit, the children included in the INTERGROWTH-21st Fetal Growth Standards were at the 49th percentile for length, 50th percentile for head circumference, and 58th percentile for weight of the World Health Organization Child Growth Standards. Similar results were seen for the preterm subgroup that was included in the INTERGROWTH-21st Preterm Postnatal Growth Standards. The cohort overlapped between the 3rd and 97th percentiles of the World Health Organization motor development milestones. We estimated that the variance among study sites explains only 5.5% of the total variability in the length of the children between birth and 2 years of age, although the variance among individuals within a study site explains 42.9% (ie, 8 times the amount explained by the variation among sites). An increase of 8.9 cm in adult height over mean parental height is estimated to occur in the cohort from low-middle income countries, provided that children continue to have adequate health, environmental, and nutritional conditions. Conclusion The cohort enrolled in the INTERGROWTH-21st standards remained healthy with adequate growth and motor development up to 2 years of age, which supports its appropriateness for the construction of international fetal and preterm postnatal growth standards.
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Affiliation(s)
- José Villar
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
| | - Leila Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK; Clinical Nutrition and Dietetics Department, University of Sharjah, Sharjah, United Arab Emirates
| | - Eleonora Staines Urias
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Francesca Giuliani
- Azienda Ospedaliera OIRM Sant'Anna Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Eric O Ohuma
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cesar G Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotasl, Pelotas, Brazil
| | - Aris T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cutberto Garza
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Fernando C Barros
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotasl, Pelotas, Brazil; Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Fabien Puglia
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | | | - Yasmin A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman
| | - Julia A Noble
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Enrico Bertino
- Dipartimento di Scienze Pediatriche e dell' Adolescenza, SCDU Neonatologia, Universita di Torino, Torino, Italy
| | - Manorama Purwar
- Nagpur INTERGROWTH-21(st) Research Centre, Ketkar Hospital, Nagpur, India
| | - Ruyan Pang
- School of Public Health, Peking University, Beijing, China
| | - Ann Lambert
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Cameron Chumlea
- Lifespan Health Research Center, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Michelle Fernandes
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Stephen H Kennedy
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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