A Nationwide Study on the Risk of Autism After Prenatal Stress Exposure to Maternal Bereavement

Danish Epidemiology Science Centre, Department of Epidemiology, Institute of Public Health, University of Aarhus, Aarhus, Denmark.
PEDIATRICS (Impact Factor: 5.47). 05/2009; 123(4):1102-7. DOI: 10.1542/peds.2008-1734
Source: PubMed


Prenatal stress has been linked to several adverse neurobehavioral outcomes, which may share a common pathophysiology with autism. We aimed to examine whether prenatal stress exposure after maternal bereavement is associated with an increased risk of autism later in life.
We conducted a nationwide population-based cohort study of all 1492709 singletons in Denmark born from 1978 to 2003. A total of 37275 children were born to women who lost a close relative during pregnancy or up to 1 year before pregnancy. These children were included in the exposed group, and the remaining children were in the unexposed group. All children were followed up from birth until their death, migration, onset of autism, or the end of 2006. Information on autism was obtained from the Danish Psychiatric Central Register. We used Cox regression models to estimate hazard ratios in the exposed group compared with those in the unexposed group.
Maternal bereavement during the prenatal period was not associated with an increased risk of autism in the offspring. The hazard ratios did not differ by the nature of the exposure (maternal relationship to the deceased or cause of death). The hazard ratios were comparable between the 5 prenatal exposure periods under study (7-12 months before pregnancy, 0-6 months before pregnancy, first trimester, second trimester, and third trimester).
This is the first population-based cohort study to examine the effect of prenatal stress on autism in childhood. Our data do not support any strong association between prenatal stress after maternal bereavement and the risk of autism.

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    • "Much of the clinical evidence on the contribution of prenatal adverse events to the development of disease comes from birth cohort studies. Studies have linked maternal stressors including natural disasters, death of a family member, and reported levels of maternal anxiety or depression with an increased incidence of neurodevelopmental disorders including depression, anxiety, schizophrenia, and autism (Myhrman et al., 1996, van Os and Selten, 1998, Buka et al., 2000, Goldstein et al., 2000, Beversdorf et al., 2005, Khashan et al., 2008, Kinney et al., 2008a, Kinney et al., 2008b, Khashan and Kenny, 2009, Li et al., 2009), as well as impacting brain development and cognitive abilities (King and Laplante, 2005, King et al., 2009) in the offspring. In addition, the temporal specificity of maternal stress experience across pregnancy has been shown to be a factor in offspring disease risk (Huttunen and Niskanen, 1978). "
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    ABSTRACT: The prenatal and postnatal early-life periods are both dynamic and vulnerable windows for brain development. During these important neurodevelopmental phases, essential processes and structures are established. Exposure to adverse events that interfere with this critical sequence of events confers a high risk for the subsequent emergence of mental illness later in life. It is increasingly accepted that the gastrointestinal microbiota contributes substantially to shaping the development of the central nervous system. Conversely, several studies have shown that early-life events can also impact on this gut community. Due to the bidirectional communication between the gut and the brain, it is possible that aberrant situations affecting either organ in early life can impact on the other. Studies have now shown that deviations from the gold standard trajectory of gut microbiota establishment and development in early life can lead to not only disorders of the gastrointestinal tract but also complex metabolic and immune disorders. These are being extended to disorders of the central nervous system and understanding how the gut microbiome shapes brain and behavior during early life is an important new frontier in neuroscience.
    Neuroscience 10/2015; DOI:10.1016/j.neuroscience.2015.09.068 · 3.36 Impact Factor
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    • "As hypothesized, and consistent with some prior literature evidencing that autism spectrum traits (Ronald et al., 2011) and autismprevalence rates (Kinney et al., 2008a) increased with exposure to increasingly severe stress exposure, the current study found both objective hardship and subjective distress were associated with more severe autism-like traits, although most children scored in the subclinical range. Findings are not, however, consistent with two recent population studies (Li et al., 2009; Rai et al., 2012). This discrepancy may be attributable to differences in nature of stress exposure (e.g., sudden-onset of uniform natural disaster versus variable stressors with more diffuse onset). "
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    ABSTRACT: Research implicates prenatal maternal stress (PNMS) as a risk factor for neurodevelopmental disorders; however few studies report PNMS effects on autism risk in offspring. We examined, prospectively, the degree to which objective and subjective elements of PNMS explained variance in autism-like traits among offspring, and tested moderating effects of sex and PNMS timing in utero. Subjects were 89 (46F/43M) children who were in utero during the 1998 Quebec Ice Storm. Soon after the storm, mothers completed questionnaires on objective exposure and subjective distress, and completed the Autism Spectrum Screening Questionnaire (ASSQ) for their children at age 6½. ASSQ scores were higher among boys than girls. Greater objective and subjective PNMS predicted higher ASSQ independent of potential confounds. An objective-by-subjective interaction suggested that when subjective PNMS was high, objective PNMS had little effect; whereas when subjective PNMS was low, objective PNMS strongly affected ASSQ scores. A timing-by-objective stress interaction suggested objective stress significantly affected ASSQ in first-trimester exposed children, though less so with later exposure. The final regression explained 43% of variance in ASSQ scores; the main effect of sex and the sex-by-PNMS interactions were not significant. Findings may help elucidate neurodevelopmental origins of non-clinical autism-like traits from a dimensional perspective.
    Psychiatry Research 05/2014; 219(2). DOI:10.1016/j.psychres.2014.04.034 · 2.47 Impact Factor
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    • "Other studies have shown a reduction in cognitive performance [12] [18] associated with prenatal stress. Some studies have found an association between prenatal stress and increased risk of autism [21] [37], with exposure in mid-to late-gestation, although a large population study has failed to confirm the increased autism [38]. Two studies have found an increased risk of schizophrenia in adults born to mothers who experienced stress during pregnancy. "
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    ABSTRACT: Care for the emotional state of pregnant women remains a neglected aspect of obstetric medicine. Many prospective studies have shown that, if a mother is depressed, anxious, or stressed while pregnant, this increases the risk for her child having a wide range of adverse outcomes, including emotional problems, symptoms of attention deficit hyperactivity disorder, or impaired cognitive development. Although genetics and postnatal care clearly affect these outcomes, evidence for an additional prenatal causal component is substantial. Prenatal anxiety or depression may contribute 10-15% of the attributable load for emotional and behavioural outcomes. The Nurse Family Partnership remains the only intervention that starts in pregnancy and has been shown to have long-term benefits for the behaviour of the child. Several other interventions, however, are likely to be helpful. Depression, anxiety, and stress during pregnancy are frequently undetected by health professionals, and untreated. Programmes to help with this should eventually improve child outcome.
    Best practice & research. Clinical obstetrics & gynaecology 09/2013; 28(1). DOI:10.1016/j.bpobgyn.2013.08.017 · 1.92 Impact Factor
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