To study in a large-scale cohort with prospective data the associations of psychosocial adversities during pregnancy with length of gestation and offspring size at birth.
We defined a priori two types of psychosocial adversity during pregnancy: life stress (perceived burdens in major areas of life) and emotional symptoms (e.g. anxiety). Measures of offspring size at birth, including body weight, body length, abdominal and head circumference, were obtained from a national medical birth registry. We included in the analyses gestational age and offspring size at birth controlled for length of gestation; the latter was calculated by gestational-age-specific z scores (ZS) reported in 10(-3). We conducted multiple regression analyses adjusted for potential confounders to estimate the association between exposures and birth outcomes (n = 78017 pregnancies).
Life stress (per score increase by 1; range, 0-18) was associated with shorter length of gestation (days; B, -0.14; 95% confidence interval (CI), -0.19, -0.10), increased offspring body weight (ZS; B, 9.14; 95% CI, 4.99, 13.28), body length (ZS; B, 6.58; 95% CI, 2.39, 10.77), abdominal circumference (ZS; B, 9.96; 95% CI, 5.77, 14.16), and head circumference (ZS; B, 6.13; 95% CI, 1.95, 10.30). Emotional symptoms were associated with shorter length of gestation (days; B, -0.04; 95% CI, -0.07, -0.004) and decreased body length (ZS; B, -4.44; 95% CI, -7.57, -1.32) only.
Life stress and emotional symptoms both predicted a shorter length of gestation, while only life stress predicted an increased offspring size at birth controlled for length of gestation; yet, the associations were rather small. The fetoplacental-maternal unit may regulate fetal growth according to the type of psychosocial adversity and even increase fetal growth in response to maternal stress in major areas of life. This potentially reflects a basic principle of intrauterine human development in response to stress.
"The stage of change questions for physical activity and nutrition behaviour are adapted from Te Wai O Rona: Diabetes Prevention Strategy
, itself adapted from Prochaska
. Mental Health (stress, depression, anxiety) has been shown to affect birth weight and gestational age
. Therefore we chose to measure mental health with the widely-used WHO well being index
 and pregnancy specific worries with the Cambridge worry scale
[Show abstract][Hide abstract] ABSTRACT: Gestational diabetes mellitus (GDM) is an increasing problem world-wide. Lifestyle interventions and/or vitamin D supplementation might help prevent GDM in some women.Methods/design: Pregnant women at risk of GDM (BMI>=29 (kg/m2)) from 9 European countries will be invited to participate and consent obtained before 19+6 weeks of gestation. After giving informed consent, GDM will be excluded (based on IADPSG criteria: fasting glucose<5.1mmol; 1 hour glucose <10.0 mmol; 2 hour glucose <8.5mmol) and women will be randomized to one of the 8 intervention arms using a 2x(2x2) factorial design: ( 1) healthy eating (HE), 2) physical activity (PA), 3) HE+PA, 4) control, 5) HE+PA+vitamin D, 6) HE+PA+placebo, 7) vitamin D alone, 8) placebo alone), pre-stratified for each site. In total, 880 women will be included with 110 women allocated to each arm. Between entry and 35 weeks of gestation, women allocated to a lifestyle intervention will receive 5 face-to-face, and 4 telephone coaching sessions, based on the principles of motivational interviewing. The lifestyle intervention includes a discussion about the risks of GDM, a weight gain target <5kg and either 7 healthy eating 'messages' and/or 5 physical activity 'messages' depending on randomization. Fidelity is monitored by the use of a personal digital assistance (PDA) system. Participants randomized to the vitamin D intervention receive either 1600 IU vitamin D or placebo for daily intake until delivery. Data is collected at baseline measurement, at 24--28 weeks, 35--37 weeks of gestation and after delivery. Primary outcome measures are gestational weight gain, fasting glucose and insulin sensitivity, with a range of obstetric secondary outcome measures including birth weight.
DALI is a unique Europe-wide randomised controlled trial, which will gain insight into preventive measures against the development of GDM in overweight and obese women.Trial registration: ISRCTN70595832.
"Prenatal exposure to severe physical or mental stress may affect the development and life-long health of the offspring. Effects include reduced birthweight, shorter length of gestation, increased risk of metabolic, cardiac and psychiatric disease, and shortened lifespan (Barbosa, 2000; Reynolds et al., 2007; Seckl and Holmes, 2007; Xiong et al., 2008; Tamashiro and Moran, 2010; Tegethoff et al., 2010). The effect of severe maternal stress likely depends on the timing of exposure, as it may alter time-specific developmental processes (Glynn et al., 2001; Malaspina et al., 2008; Class et al., 2011; Torche, 2011). "
[Show abstract][Hide abstract] ABSTRACT: Previous research suggests that maternal exposure to acute stress has a negative impact on the duration of pregnancy, and that this effect may vary by the time of exposure. It has also been proposed that stress exposure reduces the ratio of male-to-female births. To date, no study has jointly examined both outcomes, although they may be strongly related. Using population-level data with no selectivity, we jointly study the sex-specific effect of stress on the duration of pregnancy and the observed sex ratio among pregnant women exposed to a major earthquake in Chile.
In a quasi-experimental design, women exposed to the earthquake in different months of gestation were compared with women pregnant 1 year earlier. Estimates from a comparison group of pregnant women living in areas not affected by the earthquake were also examined to rule out confounding trends. Regression models were used to measure the impact of earthquake exposure on gestational age and preterm birth by sex across month of gestation. A counterfactual simulation was implemented to assess the effect of the earthquake on the secondary sex ratio accounting for the differential impact of stress on gestational age by sex.
Earthquake exposure in Months 2 and 3 of gestation resulted in a significant decline in gestational age and increase in preterm delivery. Effects varied by sex, and were much larger for female than male pregnancies. Among females, the probability of preterm birth increased by 0.038 [95% confidence interval (CI): 0.005, 0.072] in Month 2 and by 0.039 (95% CI: 0.002, 0.075) in Month 3. Comparable increases for males were insignificant at the conventional P < 0.05 level. After accounting for the sex-specific impact on gestational age, a decline in the male-to-female ratio in Month 3 of exposure was detected [-0.058 (95% CI: -0.113, -0.003)].
Maternal exposure to an exogenous stressor early but not late in the pregnancy affects gestational age and the probability of preterm birth. This effect is much stronger in females than males. Stress exposure in early pregnancy may also contribute to a decline in the ratio of male-to-female live births in exposed cohorts.
Human Reproduction 12/2011; 27(2):558-67. DOI:10.1093/humrep/der390 · 4.57 Impact Factor
"We obtained information on maternal stress from a telephone interview taken around 30 weeks of gestation. We studied two a priori–defined types of stress— emotional stress and life stress—as used in previous studies (Sondergaard et al. 2003; Tegethoff et al. 2010a, 2010b). The separation of these two types of maternal stress is theoretically based on the well-described stressor specificity of biological responses, which may differentially affect the fetus (Pacak and Palkovits 2001; Richardson et al. 2006). "
[Show abstract][Hide abstract] ABSTRACT: Identifying risk factors for adverse health outcomes in children is important. The intrauterine environment plays a pivotal role for health and disease across life.
We conducted a comprehensive study to determine whether common psychosocial stress during pregnancy is a risk factor for a wide spectrum of pediatric diseases in the offspring.
The study was conducted using prospective data in a population-based sample of mothers with live singleton births (n = 66,203; 71.4% of those eligible) from the Danish National Birth Cohort. We estimated the association between maternal stress during pregnancy (classified based on two a priori-defined indicators of common stress forms, life stress and emotional stress) and offspring diseases during childhood (grouped into 16 categories of diagnoses from the International Classification of Diseases, 10th Revision, based on data from national registries), controlling for maternal stress after pregnancy.
Median age at end of follow-up was 6.2 (range, 3.6-8.9) years. Life stress (highest compared with lowest quartile) was associated with an increased risk of conditions originating in the perinatal period [odds ratio (OR) = 1.13; 95% confidence interval (CI): 1.06, 1.21] and congenital malformations (OR=1.17; CI: 1.06, 1.28) and of the first diagnosis of infection [hazard ratio (HR) = 1.28; CI: 1.17, 1.39], mental disorders (age 0-2.5 years: HR = 2.03; CI: 1.32, 3.14), and eye (age 0-4.5 years: HR = 1.27; CI: 1.06, 1.53), ear (HR = 1.36; CI: 1.23, 1.51), respiratory (HR = 1.27; CI; 1.19, 1.35), digestive (HR = 1.23; CI: 1.11, 1.37), skin (HR = 1.24; CI: 1.09, 1.43), musculoskeletal (HR = 1.15; CI: 1.01-1.30), and genitourinary diseases (HR = 1.25; CI; 1.08, 1.45). Emotional stress was associated with an increased risk for the first diagnosis of infection (HR = 1.09; CI: 1.01, 1.18) and a decreased risk for the first diagnosis of endocrine (HR = 0.81; CI; 0.67, 0.99), eye (HR = 0.84; CI; 0.71, 0.99), and circulatory diseases (age 0-3 years: HR = 0.63; CI: 0.42, 0.95).
Maternal life stress during pregnancy may be a common risk factor for impaired child health. The results suggest new approaches to reduce childhood diseases.
Environmental Health Perspectives 07/2011; 119(11):1647-52. DOI:10.1289/ehp.1003253 · 7.98 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.