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The Impact of Maternal Gestational Stress on Motor Development in Late Childhood and Adolescence: A Longitudinal Study

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The number and timing of stressors experienced during pregnancy were investigated using longitudinal data from the Western Australian Pregnancy (Raine) Study cohort (N = 2,900). Motor development data were collected at 10 (n = 1,622), 14 (n = 1,584), and 17 (n = 1,222) years using the McCarron Assessment of Neuromuscular Development. Linear mixed models were used to examine the effect of stress on motor development, accounting for repeated measures. Number of stressful events and mean Neuromuscular Development Index were negatively related (β = -1.197, p = .001). Stressful events experienced in late pregnancy were negatively related with offspring motor development (β = -0.0541, p = .050), while earlier stressful events had no significant impact.
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Original Article
Maternal hypertensive diseases negatively affect offspring
motor development
Tegan Grace
a,
, Max Bulsara
b
, Craig Pennell
c
, Beth Hands
b
a
School of Health Sciences, University of Notre Dame Australia, Australia
b
Institute for Health Research, University of Notre Dame Australia, Australia
c
School of Women’s and Infants’ Health, The University of Western Australia, Australia
article info
Article history:
Received 12 February 2014
Accepted 21 April 2014
Available online xxxx
Keywords:
Hypertension
Preeclampsia
Motor development
Raine Study
Adolescence
abstract
Objective: Hypertension in pregnancy and preeclampsia have been linked to poor out-
comes in cognitive, mental and psychomotor development; however, few longitudinal
studies have researched their effect on offspring motor development, particularly in late
childhood and adolescence. The purpose of this study was to determine if maternal hyper-
tensive diseases during pregnancy are a risk factor for compromised motor development at
10, 14, and 17 years.
Study design: Longitudinal cohort study using data from the Western Australian Pregnancy
Cohort Study (Raine).
Main outcome measure: Offspring (n= 2868) were classified by their maternal blood pres-
sure profiles during pregnancy: normotension (n= 2133), hypertension (n= 626) and pre-
eclampsia (n= 109). Offspring motor development, at 10, 14, and 17 years was measured
by the Neuromuscular Developmental Index (NDI) of the McCarron Assessment of Motor
Development (MAND).
Methods: Linear mixed models were used to compare outcomes between pregnancy
groups.
Results: Offspring from pregnancies complicated by preeclampsia had poorer motor out-
comes at all ages than offspring from either normotensive mothers (p60.001) or those
with hypertension (p= 0.002).
Conclusion: Hypertensive diseases during pregnancy, in particular preeclampsia, have long
term and possibly permanent consequences for motor development of offspring.
Ó2014 International Society for the Study of Hypertension in Pregnancy Published by
Elsevier B.V. All rights reserved.
Introduction
Hypertension in pregnancy, and preeclampsia have
been linked to poor outcomes in cognitive, mental and
psychomotor development; however, few longitudinal
studies have researched their effect on offspring motor
development, particularly in late childhood and adoles-
cence. It is already well established that fetal growth
restriction (FGR), premature birth, small for gestational
age (SGA) status, maternal stress, smoking and alcohol
consumption are risk factors for compromised motor
development in early [1–5] and late [6] childhood. Mater-
nal hypertensive diseases such as hypertension and pre-
eclampsia have been linked to SGA, FGR, prematurity [2]
http://dx.doi.org/10.1016/j.preghy.2014.04.003
2210-7789/Ó2014 International Society for the Study of Hypertension in Pregnancy Published by Elsevier B.V. All rights reserved.
Corresponding author. Address: School of Health Sciences, The
University of Notre Dame Australia, 19 Mouat Street, PO Box 1225,
Fremantle, WA 6959, Australia. Tel.: +61 8 9433 0206; fax: +61 8 9433
0210.
E-mail addresses: 20102122@my.nd.edu.au (T. Grace), max.bulsara@
nd.edu.au (M. Bulsara), craig.pennell@uwa.edu.au (C. Pennell), beth.
hands@nd.edu.au (B. Hands).
Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Pregnancy Hypertension: An International
Journal of Women’s Cardiovascular Health
journal homepage: www.elsevier.com/locate/preghy
Please cite this article in press as: Grace T et al. Maternal hypertensive diseases negatively affect offspring motor development. Preg Hyper:
An Int J Women’s Card Health (2014), http://dx.doi.org/10.1016/j.preghy.2014.04.003
and poorer cognitive development in early [7] and late
childhood [8].
A differential effect of hypertension and preeclampsia
has been reported in studies investigating mental health
and behavior, with hypertension linked to a higher risk of
negative outcomes, and preeclampsia associated with a
lower risk in some cases [9,10]. Other findings [11] have
indicated a possible reduction in the future risk of breast
cancer in female offspring born to mothers with
preeclampsia. Together these findings suggest different
pathways through which hypertension and preeclampsia
may influence mental health development, behavioral out-
comes and hormonal activity in the long term.
While preeclampsia may be associated with a positive
effect on mental health and behavioral outcomes, research
indicates that the impact is more likely to be negative for
physical development. Reduced heart size and heart func-
tion have been reported in five to eight year old children
born to mothers with preeclampsia [12] and delays in both
mental and psychomotor development were found in up to
76% of one year old infants born to mothers with severe
preeclampsia [13].
One possible mechanism that may explain the associa-
tion between maternal preeclampsia and offspring physi-
cal and motor outcomes may be a decrease in oxygen
delivery to the developing fetus via the placenta that is
seen in pregnancies complicated by preeclampsia [14].
Pitcher et al. [2] report that during the third trimester,
the most common time for preeclampsia to occur, the
developing fetal brain may be more vulnerable to hypoxic
and ischemic insults. During this time, the cerebellum (an
area responsible for some aspects of motor development
such as coordination, precision and accuracy of movement)
is rapidly developing and suboptimal maternal nutrition or
deficits in the delivery of nutrients via the placenta at this
time may result in developmental problems, particularly in
the motor domain [15,16]. In order to examine the effect of
hypertension and preeclampsia on motor development
and explore the theory of restricted placental blood flow
as a potential mechanism we used data from the Western
Australian Pregnancy Cohort (the Raine Study). This large
cohort has been followed longitudinally over twenty years
and provided the opportunity to examine the longer term
impact of hypertension and preeclampsia on motor devel-
opment and the potential role played by restricted placen-
tal blood flow through the use of Doppler flow velocity
waveform data.
The effects of various perinatal risk factors on motor
development have been previously reported in the Raine
cohort by Hands et al. [6] who found that hypertensive
diseases were linked to poorer outcomes in females at
10 years. The purpose of this study was to extend these
findings by using both cross sectional and linear mixed
models to identify the longer term consequences of
maternal hypertensive diseases on the motor develop-
ment of offspring as they matured from 10 to 14 and
17 years.
We predicted that the motor development of offspring
at 10, 14 and 17 years would be negatively affected by
the hypertensive status of the mother, with preeclampsia
in particular contributing to a poorer motor outcome.
Furthermore those mothers with preeclampsia were more
likely to have experienced restricted placental blood flow,
indicated by abnormal Doppler waveforms.
Method
Participants
Participants (n= 2900) were part of the Western Aus-
tralian Pregnancy Cohort (Raine Study) and were recruited
through the King Edward Memorial Hospital between 16
and 20 weeks gestation. The Raine Study is a randomized
control study, with women being allocated to either an
intensive ultrasound group or a regular ultrasound group
[17]. Women in the intensive group had ultrasound and
Doppler flow studies performed at approximately
18 weeks gestation, then again at 24, 28, 34 and 38 weeks
gestation. Women in the control group had one ultrasound
around 18 weeks and further scans only if requested by her
physician. Full cohort details and enrollment criteria have
previously been reported [17]. From the 2900 pregnancies,
2868 children were recruited for long-term follow-up.
Ultrasound and Doppler data were available for 1429 chil-
dren born to mothers in the intensive ultrasound group
and 1428 children born to those in the regular ultrasound
(control) group.
Original data collection was by questionnaire, under-
taken at enrollment with data obtained regarding maternal
health, SES and psychosocial characteristics. The second
data collection was administered at 34 weeks gestation.
Obstetric data were obtained from antenatal, postnatal,
and neonatal periods. Follow up data pertaining to motor
development reported in this paper were obtained from
the participants’ offspring at 10, 14, and 17 years.
Measures
Hypertension and preeclampsia
Maternal blood pressure and other physiological data
were recorded during antenatal visits in the first phase of
the study [17]. Hypertension and preeclampsia diagnoses
were confirmed by obstetricians and midwives after
reviewing medical records. Essential hypertension was
defined by a history of hypertension prior to pregnancy.
Gestational hypertension was defined as an increase in
systolic blood pressure P140 mmHg and/or an increase
in diastolic blood pressure P90 mmHg in women who
were normotensive previous to 24 weeks gestation [17].
Women with both essential (n= 72) and gestational
(n= 554) hypertension were included in the hypertension
group. Preeclampsia was defined as gestational hyperten-
sion with the addition of proteinuria (300 mg/24 h).
Women who had preeclampsia and gestational hyperten-
sion (n= 68) and preeclampsia superimposed on essential
hypertension (n= 41) were included in the preeclampsia
group. Three pregnancy groups were formed, indicating
whether the offspring was from a mother who had normo-
tension (N;n= 2132), hypertension (HT; n= 627), or
preeclampsia (PE; n= 109) based on the diagnostic criteria.
2T. Grace et al. / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health xxx (2014) xxx–xxx
Please cite this article in press as: Grace T et al. Maternal hypertensive diseases negatively affect offspring motor development. Preg Hyper:
An Int J Women’s Card Health (2014), http://dx.doi.org/10.1016/j.preghy.2014.04.003
The highest level of diagnoses was used to determine
groups, ensuring no data duplication.
Placental blood flow
Doppler flow velocity waveform study data were col-
lected using a spectrum analyzer and a D10 bi-directional
continuous wave Doppler system [18]. Using ultrasound
imaging and audible signals an umbilical artery and arcu-
ate artery within the placenta were located and waveforms
were obtained. A categorical variable was created to reflect
if the offspring were from pregnancies that had any abnor-
mal Doppler waveform (n= 205), no abnormal Doppler
waveform (n= 1223) or had no Doppler study completed
(n= 1428).
Child motor development
Motor development was assessed using the McCarron
Assessment of Neuromuscular Development (MAND) [19]
at 10 (n= 1622), 14 (n= 1584) and 17 (n= 1221) years.
The 10 item test comprises tasks designed to measure fine
and gross motor skills, and derive a composite score of
motor development, the Neuromuscular Development
Index (NDI). To calculate the NDI the score for each task is
converted to a scaled score (M= 10, SD = 3) using the age
appropriate table of norms. The total of the scaled scores
is then summed and converted to the NDI (M= 100,
SD = 15). A score of 685 is used to indicate the presence
of a minor motor disability [6,19]. McCarron [19] states that
the NDI can be thought of as a ‘motor quotient’ giving the
researcher an indication of where the child lies develop-
mentally compared to their peers of the same age.
The test–retest reliability coefficient of the MAND is
reported by McCarron [19] as 0.99 overall and is a reliable
measure of motor coordination in the Australian popula-
tion [20]. Further, a comparison of the MAND to two other
highly utilized motor coordination tests revealed it to be
superior in detecting motor development problems [21].
Control variables
Other variables known to influence motor development
[1–6] were included in all statistical models. These vari-
ables were gestational age, parity, percentage of expected
birth weight (a measure of whether growth potential has
been met), child’s sex, maternal age, maternal smoking sta-
tus, maternal alcohol intake, maternal stress and socio-
economic status as measured by the relative rating of
advantage and disadvantage [22].
Statistical analyses
Cross sectional analyses were accomplished using
chi-square tests, t-tests and univariate ANOVA models
(generalized linear model – GLM) with Bonferroni post
hoc correction to identify the maternal and child variables
that were related to motor development at 10, 14 and
17 years. No interactions were found between child’s sex
and hypertensive status or any of the control variables,
so results were not stratified by sex. The NDI scores at each
data collection for the offspring of mothers with normo-
tension, hypertension, and preeclampsia were then
compared using linear mixed models which account for
changes in motor development over time.
Results
Longitudinal motor development
Linear Mixed Models, adjusting for maternal age,
maternal stress, parity, gestational age, percentage of
expected birth weight, child’s sex, maternal alcohol and
smoking and SES revealed a group difference between off-
spring of mothers with preeclampsia, hypertension and
normotension (p60.001) over time. The mean NDI of
offspring in the preeclampsia group was lower than those
in the hypertension (p= 0.002) and normotension
(p60.001) groups (Fig. 1). While the mean NDI of each
group was within the range considered to be indicative
of normal motor development [19] the preeclampsia group
contained a higher percentage of individuals (46.8%) who
fell below the cutoff (685) used to determine motor dis-
ability [6,19] compared to the hypertension (27.9%) and
normotension (24.6%) groups (p60.001).
Doppler waveforms
Doppler waveform data were not significantly different
between pregnancy groups; however, those with pre-
eclampsia did have a larger percentage of abnormal Dopp-
ler waveforms (21.1%) than the hypertension (15.9%) or
normotension (13.5%) groups. Within the preeclampsia
group, those with abnormal Doppler waveforms (n= 12)
were found to have lower NDIs at all years than those with
hypertension, normotension or those with preeclampsia
with no abnormal placental blood flow (n= 45). Early onset
preeclampsia may be indicative of a more severe type of
preeclampsia, posing a greater health risk to mother and
offspring [23]. Previous findings reported differences in
85
87
89
91
93
95
97
99
101
103
105
PE HT N
Mean Group NDI
Pregnancy Group
*______________p=<0.001_______________*
*_____p=0.002______*
Fig. 1. Mean NDI of pregnancy groups based on Linear Mixed Model
adjusted for maternal age at conception, SES, maternal smoking and
alcohol intake, use of antihypertensive medication, parity, gestational
age, percentage of expected birth weight and child’s sex.
T. Grace et al. / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health xxx (2014) xxx–xxx 3
Please cite this article in press as: Grace T et al. Maternal hypertensive diseases negatively affect offspring motor development. Preg Hyper:
An Int J Women’s Card Health (2014), http://dx.doi.org/10.1016/j.preghy.2014.04.003
placental morphology between early (634 weeks gesta-
tion) and late (>34 weeks gestation) onset preeclampsia
[24] therefore we further examined the preeclampsia
group for restricted placental function. Of those with pre-
eclampsia and abnormal Doppler waveform (n= 12), 91%
had early onset preeclampsia. Of those with preeclampsia
and normal Doppler waveform (n= 41) only 41% had early
onset preeclampsia. Unfortunately the small numbers in
these groups did not support further statistical analyses.
Motor development at 10, 14 and 17 years
To examine the effect of hypertension and preeclampsia
on motor outcomes at 10, 14 and 17 years general linear
models were developed (Table 2). No significant interac-
tions between hypertensive status and any of the control
variables were found and were not included in the final
models. Offspring born to mothers with preeclampsia had
a significantly lower NDI at 10 (p= 0.041) and 14 years
(p= 0.002) than the other two groups. Although not signif-
icant, a lower NDI score was also evident at 17 years for the
preeclampsia group. Post hoc analyses at 10 years revealed
the differences between the preeclampsia group and the
hypertension (p= 0.031) and normotension (p= 0.012)
groups. At 14 years the group differences were found
between the preeclampsia group and the normotension
group (p= 0.007) and between the hypertension and nor-
motension groups (p= 0.006). In these cross sectional anal-
yses the presence of abnormal Doppler waveform did not
impact on motor development at any age.
The mean standard scores for the 10 individual tasks of
the MAND were lower in the preeclampsia group for all
tasks across the three follow up years, except the rod slide
at 17 years. These differences were significant for the jump
and beads on a rod tasks at 10, 14 and 17 years and for the
finger tapping, finger-nose-finger, and balancing on one
foot tasks in at least 2 of the 3 survey years.
Population characteristics
Mothers with preeclampsia had a significantly lower
socioeconomic status as measured by the relative rating
of advantage and disadvantage (p= 0.001) than either
hypertensive or normotensive mothers (Table 1). These
pregnancies also had significantly shorter gestational peri-
ods (p<0.001) than those with hypertension and normal
maternal blood pressure during pregnancy. Not surpris-
ingly, higher numbers of stressful events in later pregnancy
were reported in the preeclampsia group (p= 0.003). A
higher proportion of mothers with preeclampsia were
more likely to have previously given birth (p= 0.001) than
those with hypertension or normotension.
Discussion
Results supported our hypothesis, with offspring of
mothers who were diagnosed with preeclampsia during
pregnancy having lower motor competence at 10, 14, and
17 years than those from mothers who had either hyper-
tension or normal blood pressure during pregnancy
(Table 2). Furthermore there were a significantly higher
number of individuals who fell below the recommended
NDI cutoff score for motor dysfunction in the preeclampsia
group. When examined longitudinally, preeclampsia was a
greater risk factor than hypertension for persistent and
potentially permanent lower motor competence into late
adolescence (Fig. 1). The findings of this paper also support
and extend those of Hands et al. [6] who found that hyper-
tensive diseases impacted on motor development at
10 years, and Rep et al. [13] who reported psychomotor
delay in one year old infants born to mothers with severe
preeclampsia.
The MAND tasks that were performed significantly
worse by the preeclampsia group required underlying ele-
ments of postural control, proprioception and rhythm. For
example, the broad jump necessitates the timing and syn-
chronization of the leg and core muscles, the dynamic
extension of the leg muscles and the orientation of the
whole body in space. The finger-nose-finger and standing
on one foot tasks required a sound sense of the positioning
of relative body parts and balance, particularly when the
eyes were closed and proprioceptive feedback became
more important. Finger tapping required rhythm and con-
trol of small muscle groups, as well as postural control. It is
possible that poorer performance in these tasks may be
due to an interruption in the development and functioning
of the cerebellum and associated neurological pathways
caused by placental dysfunction. While the presence of
an abnormal Doppler waveform did not directly influence
motor outcome Egbor et al. [24] suggest that preeclampsia
is a heterogeneous condition, with reduced placental func-
tion being reported primarily in those diagnosed with early
onset (634 weeks gestation) preeclampsia. Exploration of
the pregnancies complicated by early and late onset pre-
eclampsia provided limited support for this theory, with
a trend toward those with early onset preeclampsia having
a higher percentage of abnormal Doppler waveforms and
lower NDIs than the late onset preeclampsia group. Moth-
ers with abnormal Doppler waveforms and preeclampsia
had a higher incidence of early-onset preeclampsia. While
the numbers in these groups were small the trend suggests
this may be indicative of a more severe form of the disease
[23,25] associated with restricted uteroplacental blood
flow [26]. Abnormal placental morphology including sig-
nificantly reduced intervillous space and terminal villi vol-
ume [24] may play a role in the long term deficit of motor
development seen in offspring with preeclampsia. Future
research comparing the impact of early and late onset pre-
eclampsia on motor development and the role of reduced
placental function will require a larger sample size to sup-
port these findings.
Mothers with preeclampsia had higher incidences of
other known risk factors that can effect development such
as a lower socioeconomic status, higher stress levels in
later pregnancy [27,28] and shorter gestational length
[3]. As no interactions were present in the models between
any of these previously identified risk factors and the
hypertensive status of the mothers preeclampsia emerged
as a risk factor for impaired motor development indepen-
dent of these factors.
4T. Grace et al. / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health xxx (2014) xxx–xxx
Please cite this article in press as: Grace T et al. Maternal hypertensive diseases negatively affect offspring motor development. Preg Hyper:
An Int J Women’s Card Health (2014), http://dx.doi.org/10.1016/j.preghy.2014.04.003
This study had several strengths. Firstly, the longitudi-
nal nature of the data and the large cohort allowed for a
robust statistical analysis of the impact of maternal hyper-
tension and preeclampsia on motor development using
linear mixed models. Such data are rare. Secondly, while
there is a growing body of evidence [29] indicating that
preeclampsia may be responsible for long term health
consequences in both mother and offspring there remains
a paucity of research into the long term effects of
hypertensive diseases on offspring motor development.
Furthermore while motor development has been studied
in infants, early, and late childhood, few studies have
sought to identify the early determinants of motor devel-
opment into adolescence. Finally, the measure of motor
development used in the current study, the MAND is a
reliable and accurate measure of motor development in
an Australian population and was administered by trained
personnel.
A challenge in using longitudinal data from the Raine
Cohort was the lack of motor development data collected
prior to the 10-year cohort review. This was unfortunate
as tracking of motor development in younger years may
have provided a picture of the changes in motor develop-
ment throughout early childhood as well as late childhood
and adolescence. While this was a limitation the high qual-
ity longitudinal data from late childhood to adolescence
provided a unique profile of motor development through-
out this often under researched time period.
Conclusion
Our findings indicate that hypertensive diseases during
pregnancy, in particular preeclampsia, have long term and
possibly permanent consequences that compromise motor
development of offspring into late adolescence. These find-
ings are unique as no previous studies have investigated
Table 1
Descriptive statistics of cohort according to the pregnancy group.
Continuous variables Normotension Hypertension Preeclampsia Group Diff
NM(sd) NM (sd) NM (sd)
Maternal age (yrs) 2133 27.57 (5.8) 626 27.62 (6.19) 109 27.30 (6.66) 0.872
% Expected birth wt 2111 97.44 (13.9) 623 97.40 (13.72) 109 96.45 (18.17) 0.775
Gestational age (wks) 2121 38.8 (2.30)
a
623 38.53 (2.10)
b
109 36.30 (3.46)
a,b
<0.001
Rating of adv dis 1448 1017 (90.5)
a
421 1019 (85.8)
b
70 978 (82.3)
a,b
0.001
Maternal stress
18 weeks 2132 1.19 (1.24) 626 1.28 (1.28) 109 1.02 (1.00) 0.088
34 weeks 1889 1.01 (1.18)
a
572 1.12 (1.16) 92 1.39 (1.39)
a
0.003
Categorical variables Nn (%) Nn %Nn (%)
Smoking 2127 626 109 109 0.001
None 1511 (71) 487 (77.8) 89 (81.7)
610/day 344 (16.2) 87 (13.9) 14 (12.8)
>10/day 272 (12.8) 52 (8.3) 6 (5.5)
Alcohol 2125 625 109 109 0.562
None 1146 (53.9) 351 (56.2) 62 (56.9)
Once a wk or less 845 (39.8) 246 (39.4) 41 (37.6)
Several times a wk 118 (5.6) 23 (3.7) 6 (5.5)
Daily 16 (0.8) 5 (0.8) 0 (0.0)
Sex 2133 626 109 109 0.331
Males 1067 (50.0) 292 (46.6) 54 (49.5)
Females 1066 (50.0) 334 (53.4) 55 (50.5)
Parity 2116 623 109 109 <0.001
0 962 (45.5) 342 (54.9) 64 (58.7)
1+ 1154 (54.5) 281 (45.1) 45 (41.3)
pvalues are for comparison between three groups according to ANOVA (continuous variables) and chi-squared analysis (categorical variables).
a
Difference between Normotension and Preeclampsia.
b
Difference between Hypertension and Preeclampsia.
Table 2
Mean NDI of offspring at 10, 14 and 17 years according to the pregnancy group.
NDI Normotension Hypertension Preeclampsia Group difference
M(sd) M(sd) M(sd)
10 yrs 98.40 (4.72)
a
97.66 (4.69)
b
92.32 (6.17)
a,b
0.041
14 yrs 102.37 (6.42)
a,c
98.41 (6.38)
c
92.90 (8.71)
a
0.002
17 yrs 97.28 (6.68) 98.22 (6.70) 92.19 (9.12) 0.268
Adjusted for maternal age at conception, SES, maternal stress, maternal smoking and alcohol intake, use of anti-hypertensive medication, gestation age,
parity, percentage of expected birth weight and child’s sex.
a
Difference between Nand PE.
b
Difference between HT and PE.
c
Difference between Nand HT.
T. Grace et al. / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health xxx (2014) xxx–xxx 5
Please cite this article in press as: Grace T et al. Maternal hypertensive diseases negatively affect offspring motor development. Preg Hyper:
An Int J Women’s Card Health (2014), http://dx.doi.org/10.1016/j.preghy.2014.04.003
the effect of hypertensive diseases during pregnancy on
motor development over such a long period of time. While
there are reports of the negative effects of hypertension
and preeclampsia on a range of developmental areas
[8,10,11,13] longitudinal motor outcomes have thus far
remained under researched. Health professionals should
be alerted to the risks for long term, possibly permanent
motor dysfunction in offspring born to mothers diagnosed
with preeclampsia, as early intervention may minimize
poorer long term motor outcomes.
Ethics Statement
Ethics clearance was obtained by the Human Research
Ethics Committee at the King Edward Memorial Hospital
and the Princess Margaret Hospital for Children, Perth,
Western Australia. Informed consent was obtained at
enrollment and at each follow up from parents and/or
guardians.
Funding
The authors have no support or funding to report.
Competing interests
The authors have declared that no competing interests
exist.
Acknowledgments
We would like to acknowledge the Raine Study partici-
pants and their families, the Raine Study Team for cohort
co-ordination and data collection, the NH&MRC (Sly et al.,
ID 211912, Stanley et al., ID 003209, Stanley et al., ID
353514) for their long term contribution in funding the
study over the last 20 years and the Telethon Institute for
Child Health Research for long term support of the study.
The following institutions have provided funding to the core
management of the Raine Study; The University of Western
Australia (UWA), the Telethon Institute for Child Health
Research, Raine Medical Research Foundation, UWA Faculty
of Medicine, Dentistry and Health Sciences, Women’s and
Infant’s Research Foundation and Curtin University.
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Please cite this article in press as: Grace T et al. Maternal hypertensive diseases negatively affect offspring motor development. Preg Hyper:
An Int J Women’s Card Health (2014), http://dx.doi.org/10.1016/j.preghy.2014.04.003
... decrements in executive functions, 4 and prenatal stress with compromised motor skills. 5 There are no prenatal programming studies to date that have examined both psychiatric outcomes and cognitive abilities within the same cohort, despite the fact that they are highly related. [6][7][8] Although integral to establishing associations between prenatal adversity and child neurobehavior, previous cohort studies are predominantly homogeneous in terms of race and ethnicity, most often rely on maternal report of child outcomes, and do not identify maternal prenatal mood effects prior to postpartum environmental influences. ...
... 15 Prenatal stress has been associated with delays in fine and gross motor skills from early childhood to adolescence, with greater delays among children whose mothers experience stress in late pregnancy. 5,16 Fine motor skills are associated with literacy and mathematics, whereas gross motor skills are associated with social and behavioral outcomes. 12 In infancy, there are data to suggest that biological male infants have greater delays in motor skills than biological female infants when exposed to prenatal depression. ...
... 18,19 Not yet conclusive, there are data to suggest that children exposed to prenatal stress continue to demonstrate delays in motor skills at 10, 14, and 17 years of age. 5 Decrements in executive functions and motor skills are strongly associated with childhood psychopathology, which highlights the possibility of shared etiological influences. [6][7][8] Deficits in executive functions are associated with general psychopathology, including anxiety, depression, oppositional defiant disorder, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). ...
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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 n=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 4-8 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 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 males. 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 US, 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 males. 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.
... p=.026, η2=.138). Further analysis of the interactive effect indicated that SEP improve the GMS score in EG that were gained in 1 month (t (34) =12.39, p=.001) and continued in 3 months (t (34) =16.63, p=.001); also, paired t-test indicated that the SEP had a more lasting effect in the EG (t (17) =4.25, p=.001) than CG (t (17) =1.41, p=.174). Using η2, the interaction between time and group accounted for about 14% of the total variability in the GMS score. ...
... p=.026, η2=.138). Further analysis of the interactive effect indicated that SEP improve the GMS score in EG that were gained in 1 month (t (34) =12.39, p=.001) and continued in 3 months (t (34) =16.63, p=.001); also, paired t-test indicated that the SEP had a more lasting effect in the EG (t (17) =4.25, p=.001) than CG (t (17) =1.41, p=.174). Using η2, the interaction between time and group accounted for about 14% of the total variability in the GMS score. ...
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This study was designed to determine whether the exercise program during pregnancy would be associated with motor, cognitive and social skills in infants at 1 and 3 months of age, based on standard developmental assessment tools. This study was a randomized controlled trial in which 40 healthy pregnant women were allocated 1:1 to an experimental or a control group. Eligible pregnant women in the experimental group performed 50 minutes structured exercise program, three times per week; those in control group just maintained usual activity and received standard clinical care. Baseline data of mothers were collected at enrolment and their infants were evaluated for gross and fine motor skills, developmental motor quotient, cognitive and social skills at ages of 1 and 3 months by Peabody Development Motor scale, and Ages and Stages Questionnaire. Thirty-six women completed the study. After birth, the significant differences were found for gross motor (p=.026) and personal-social skills (p=.001). Although there was no significant difference between the two groups in terms of fine motor skill (p=.214), developmental motor quotient (p=.149), problem solving skill (p=.207) and communication skill (p=.487), the skills in the infants of the experimental group increased compared to the control group. This trial suggests that exercise during pregnancy may provide an opportunity to develop the offspring's skills. Furthermore, maternal exercise also has long-lasting effects in the next months.
... Regarding the specific EI characteristics, with the exception of interpersonal skills, all other domains (intrapersonal, stress management, adaptability, general mood) had a significant correlation with total AHEMD. Previous studies have reported that lack of control and lack of care for negative emotions and the presence of stress and anxiety lead to disruptions in the quality and quantity of toy affordances [40], and subsequently with lesser growth of children's motor development [41][42][43][44][45]. It appears that mothers with higher EI, which includes sufficient knowledge of their own emotions, can independently control their emotions in a positive manner and with more optimism to improve the quality and quantity of their child's environment. ...
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Abstract: Background: Mothers are not only the axis of an ecological subsystem for their children but are also capable of creating a significant emotional and psychological environment through constant and direct interaction. This leads to interactions and emotional connections with the children, supportive behaviors, and a long-term commitment to their upbringing and development. Aims: This study examined the relationship between maternal emotional intelligence (EI) and demographics on the availability of motor affordances in the home environment that are conducive to their child’s motor development. Methods: Mothers (N = 451) and homes of children aged 18–42 months were assessed using the Persian version of Affordances in the Home Environment for Motor Development-Self-Report (AHEMD-SR) and the Bar-On Emotional Intelligence Questionnaire. In addition, mothers’physical activity (PA) experience and demographic data were collected. Results: Analyses indicated significant correlations between mothers’ education, level of PA, and income with EI and motor affordances. Conclusions: EI, PA experience, and select mother demographics were important to the availability of motor affordances in the home. One could also speculate, based on previous research, that such provision may affect the future motor development of the child. Future research should include a younger and more diverse population.
... Sex differences in the response to prenatal maternal hardship and other early life adverse experiences have been explored in detail [4,58]. For instance, prenatal maternal hardship puts males at higher risk to develop language and motor deficits associated with neurodevelopmental disorders as compared to females [59][60][61][62]. Here we report that boys at four years of age are at particular risk of impaired language development, poor attention, and externalizing problems when exposed to maternal objective hardship linked to the 2011 Queensland Flood. ...
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Background Exposure to adverse experiences during pregnancy, such as a natural disaster, can modify development of the child with potential long-term consequences. Elemental hair analysis may provide useful indicators of cellular homeostasis and child health. The present study investigated (1) if flood-induced prenatal maternal stress is associated with altered hair elemental profiles in 4-year-old children, and (2) if hair elemental profiles are associated with behavioural outcomes in children. Methods Participants were 75 children (39 boys; 36 girls) whose mothers were exposed to varying levels of stress due to a natural disaster (2011 Queensland Flood, Australia) during pregnancy. At 4 years of age, language development, attention and internalizing and externalizing problems were assessed and scalp hair was collected. Hair was analyzed by inductively coupled plasma mass spectrometry (ICP-MS) for 28 chemical elements. Results A significant curvilinear association was found between maternal objective hardship and copper levels in boys, as low and high maternal objective hardship levels were associated with the highest hair copper levels. Mediation analysis revealed that low levels of maternal objective hardship and high levels of copper were associated with lower vocabulary scores. Higher levels of maternal objective hardship were associated with higher magnesium levels, which in turn were associated with attention problems and aggression in boys. In girls, high and low maternal objective hardship levels were associated with high calcium/potassium ratios. Conclusion Elemental hair analysis may provide a sensitive biomonitoring tool for early identification of health risks in vulnerable children.
... Whereas it seems intuitive that most of those attributes could affect a child's motor development, at least indirectly, the volume of empirical studies is meagre. With that said, studies have shown that lack of control of mothers' negative emotions and the presence of stress and anxiety during and after pregnancy are associated with poor motor development in infants, children, and adolescents (Cao et al., 2014;Chuang et al., 2011;Cornish et al., 2005;Grace et al., 2016;Venkatesh et al., 2019). In another study, Crandall et al. (2015) showed that stress, anxiety, depression, and lack of control of these impulses after pregnancy have undesirable effects indirectly on a child's motor development. ...
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This study examined the relationship between the mother’s emotional intelligence (EI) and children’s motor development. Iranian preschool children (N = 148) in the range of 4-6 years were selected from daycare centers using a multi-stage cluster sampling. The BarOn Emotional Quotient Inventory and Bruininks-Oseretsky Test of Motor Proficiency 2 Short-Form were used to assess EI and child motor development. Results indicated a significant relationship between family income, mother’s education, mother’s EI, and child motor development. Structural equation modeling (SEM) revealed reliable goodness of fit for the relation between EI and motor development. Also, there was a statistically significant association between EI and motor development with an effect size of 45%, thus suggesting that the mother’s EI could predict motor development. Whereas all EI dimensions had some positive influence on the child’s motor development, interpersonal skills highlighted the overall impact. Among the four scales of motor proficiency, the highest effect of EI was with fine-motor skills (55%). Overall, and arguably the most profound finding was that higher EI scores were significantly associated with higher child motor skill scores. In conclusion, these findings support the notion that a mother’s EI could have a significant impact on a child’s motor development.
... Human foetus's affected by intrauterine growth retardation (IUGR) often demonstrate deficient skeletal muscle mass 60 . Stressful events during the later stage of pregnancy have been negatively linked with offspring motor development 61 . Behaviours causing physiological stress, such as smoking (by pregnant mothers), may also exposed offspring to a higher risk of IUGR and low birth weight 62 , as well as lower HGS 22 . ...
Article
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Natural disasters (NDs) experienced by women and their children during prenatal and infant growth may have long-lasting effects on offspring’s development. Handgrip strength (HGS) is one of the measures of muscular strength and an indicator of health status. This study compared HGS in children exposed to cyclone Aila in India during their prenatal and infant growth compared to a control group from a non-affected, adjacent area. The total sample involved 444 boys and 423 girls aged 7–9 years, categorised into 3 groups: prenatally exposed to Aila, exposed to Aila in infancy, and the control group, non-exposed to Aila. Results revealed that prenatally exposed children of both sexes had significantly lower HGS than the controls (at least, p < 0.001 in boys; p < 0.05 in girls). On the other hand, the postnatally exposed boys, but not the girls, showed lower HGS than the controls. A significant effect of a group factor (ND exposure) on HGS was observed even after controlling for confounding variables (age, height, BMI, birth weight, gestational age; at least, p < 0.05). Our findings indicate that prenatal or early postnatal experience of a ND may have association with impaired HGS in prepubertal children.
... During the antenatal period of motherhood, approximately 84% of mothers will experience stress which can stem from preexisting medical conditions but also from sociocultural experiences; stress typically lowers as the pregnancy progresses [1]. Prenatal maternal stress can have varied impacts on the mother and the offspring, such as obstetric complications [2], low birth weight [3,4], delayed child development [5,6], postpartum depression, as well as other mental health problems [7]. Maternal stress is highly correlated to depressive symptoms, anxiety, and sleep difficulties [8,9]. ...
Article
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Pregnant women face many physical and psychological changes during their pregnancy. It is known that stress, caused by many factors and life events such as the COVID-19 pandemic, can negatively impact the health of mothers and offspring. It is the first time social media, such as Twitter, are available and commonly used during a global pandemic; this allows access to a rich set of data. The objective of this study was to characterize the content of an international sample of tweets related to pregnancy and mental health during the first wave of COVID-19, from March to June 2020. Tweets were collected using GetOldTweets3. Sentiment analysis was performed using the VADER sentiment analysis tool, and a thematic analysis was performed. In total, 192 tweets were analyzed: 51 were from individuals, 37 from companies, 56 from non-profit organizations, and 48 from health professionals/researchers. Findings showed discrepancies between individual and non-individual tweets. Women expressed anxiety, depressive symptoms, sleeping problems, and distress related to isolation. Alarmingly, there was a discrepancy between distress expressed by women with isolation and sleep difficulties compared to support offered by non-individuals. Concrete efforts should be made to acknowledge these issues on Twitter while maintaining the current support offered.
... Data were collected at 18 and 34 weeks' gestation, at 18 gestational weeks, mothers were asked to record stressful life events experienced since confirmation of their pregnancy and at 34 gestational weeks they were asked about events in the preceding 4 months, to ensure that the same event was not reported twice. Separate continuous variables including the total number of maternal stressful life events reported at weeks 18 and 34 were created weighting each event equally (Grace et al., 2016a(Grace et al., , 2016bRobinson et al., 2011;Ronald et al., 2010;Whitehouse et al., 2010). ...
Article
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Background PCOS is the most common endocrine disorder in reproductive age women. The origins of PCOS are unknown but experimental and limited human evidence suggests that greater prenatal exposure to androgens may predispose to PCOS. Experimental evidence suggests that maternal stressors may affect reproductive function in the offspring via changes in prenatal androgen exposure. In this present study, we aim to investigate whether maternal stressful life events during pregnancy are associated with polycystic ovary morphology (PCOM) or polycystic ovary syndrome (PCOS) in adolescent offspring. Method In a large population-based pregnancy cohort study (The Raine Study) continuously followed from prenatal life through to adolescence we examined the association between maternal stressful life events during pregnancy in both early and late gestation, and subsequent circulating concentrations of ovarian and adrenal androgens, PCOM and PCOS in the normal menstrual cycle of offspring age 14–16 years. Maternal stressful life events were prospectively recorded during pregnancy at 18 and 34 weeks using a 10-point questionnaire. Female offspring (n = 223) completed a questionnaire about their menstrual cycles, underwent a clinical examination for hirsutism (Ferriman-Gallwey score) and transabdominal pelvic ultrasound examination to determine ovarian morphology according to standardized criteria for classification of PCOM. Plasma samples were obtained at day 2–6 of the normal menstrual cycle for measurement of androgens. PCOM was defined according to the international consensus definition, 2003 and the evidence-based guideline for the assessment and management of PCOS, 2018. PCOS was diagnosed according to Rotterdam criteria and National Institute of Health (NIH) criteria. Multivariate linear and logistic regression analyses were used to examine the associations between maternal stressful life event exposure and ovarian morphology (PCOM), circulating ovarian and adrenal androgens (clinical and biochemical hyperandrogenism (hirsutism)) and presence of PCOS. Results Of 223 recruited adolescent girls, 78 (35.9%) and 68 (31.3%) had PCOM by the 2003 and 2018 criteria respectively, while 66 (29.6%) and 37 (16.6%) had PCOS, using Rotterdam and NIH criteria, respectively. Most girls (141/223, 63.2%) were exposed to at least one stressful life event in early gestation and around half (121/223, 54.3%) were exposed to at least one stressful life event in late gestation. Maternal stressful life events in early gestation were associated with a statistically significant lower prevalence of PCOM when applying the 2003 criteria [adjusted odds ratio [aOR] and 95% confidence intervals (CI): 0.74 (95% CI: 0.55; 0.99)], and a similar association was detected when applying the 2018 PCOM criteria (aOR, 0.69, 95% CI: 0.50; 0.95)]. Maternal stressful life events in early gestation were also associated with lower circulating concentrations of testosterone (β = −0.05, 95% CI: −0.09; −0.004) and androstenedione (β = −0.05, 95% CI: −0.10; −0.002) in the offspring. No similar effects for PCOM or circulating androgens were detected in late gestation. No statistically significant associations between maternal stressful life events in early or late gestation with PCOS (neither Rotterdam nor NIH criteria) in adolescence were detected. The prospective collection of maternal stressful life events during both early and late gestation and direct measurement of PCOM, PCOS and circulating androgens in adolescence and key co-variates implies minimal possibility of recall, information bias and selection bias. Conclusion Maternal exposure to stressful life events in early gestation is associated with significantly reduced circulating ovarian and adrenal androgen concentrations in adolescence (testosterone and androstenedione), and an indication of fewer cases of polycystic ovary morphology (PCOM) defined by the 2003 international consensus definition and by the 2018 international evidence-based guideline, but has no effect on polycystic ovary syndrome (PCOS), diagnosed using either Rotterdam or NIH criteria.
... The response to each of each items in the questionnaire was recorded as "yes/no" once, in accordance with previous studies to maximize recall [21]. Separate continuous variables including the total number of maternal stressful life event reported at weeks 18 and 34 were created weighting each event equally [22][23][24][25][26][27]. A categorical (yes/no) variable was also developed for each gestational time point. ...
Article
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Background Experimental studies suggest that prenatal stress affects reproductive function in female offspring, but human evidence is sparse and inconsistent. In this present study, we aim to investigate whether maternal psychological stress, quantified as stressful life events during pregnancy, affect reproductive function in the female offspring. Method In a large population-based pregnancy cohort study (The Raine Study) continuously followed from prenatal life through to adolescence we examined the association between the number of maternal stressful life events in both early and late gestation and subsequent ovarian and uterine function in 228 female adolescent offspring. Mothers prospectively reported stressful life events during pregnancy at 18 and 34 weeks using a standardized 10-point questionnaire. Female offspring (n = 228) age 14–16 years underwent gynecological examination including transabdominal abdominal ultrasound (TAUS) to measure uterine volume and ovarian AFC. Plasma samples on day 2–6 of the spontaneous menstrual cycle measured circulating AMH and inhibin B. Multivariate linear regression analysis was used to examine the associations between maternal stressful life events and reproductive function in female offspring. Adolescents taking hormonal contraception were excluded. Results Most adolescents (145/228, 64%) were exposed to at least one stressful life event in early gestation and around half (125/228, 55%) were exposed to at least one in later gestation. Exposure to one or more maternal stressful life events in late gestation was associated with a greater uterine volume (β = 0.13, 95% CI 0.04; 0.23) and higher ovarian AFC (β = 0.19, 95% CI 0.02; 0.35) at age 14–16 years. No associations between maternal stressful events in late gestation and reproductive function were identified. No associations between stressful life events in early or late gestation and circulating AMH or Inhibin B were observed. Conclusion Maternal psychological stress in late, but not early gestation was associated with a significantly greater uterine volume and ovarian antral follicle count (AFC) in adolescent offspring but did not affect ovarian production of antimullerian hormone (AMH) or Inhibin B. These findings suggest that female reproductive function is influenced by prenatal exposure to stress.
Article
STUDY QUESTION Is there an association between prenatal exposure to stressful life events and age at menarche, and does childhood BMI mediate this association? SUMMARY ANSWER Girls exposed to prenatal stress had a slightly earlier age at menarche, but this association did not show a dose-response effect and was not mediated by childhood offspring BMI. WHAT IS ALREADY KNOWN Prenatal stress may impact on reproductive function in females including age at menarche, but human data are very limited. High childhood BMI is known to be associated with earlier age at menarche. Only one small study has measured the association between maternal stress and age at menarche and reported that childhood BMI mediated the association between maternal stress and earlier age at menarche. However, neither maternal stress nor age at menarche was prospectively recorded and the study was limited to 31 mother–daughter pairs. STUDY DESIGN, SIZE, DURATION The Raine Study is a large prospective population-based pregnancy cohort study (n = 1414 mother–daughter pairs) continuously followed from prenatal life through to adolescence. In the present study, we examined the association between exposure to maternal stressful life events during early, late and total gestation and age at menarche in offspring using 753 mother–daughter pairs with complete case information. PARTICIPANTS/MATERIALS, SETTING, METHODS Mothers prospectively reported stressful life events during pregnancy at 18 and 34 weeks using a standardized 10-point questionnaire. Exact date of menarche was assessed using a purpose-designed questionnaire at 8, 10, 14 and 17 years of age. Complete information on exposure, outcome and confounding variables was obtained from 753 mothers–daughter pairs. Multivariate linear regression complete case analysis was used to examine associations between maternal stressful life event exposure and age at menarche. Potential selection bias was evaluated using multiple imputations (50 datasets). The mediating effects of offspring childhood BMI (ages 5, 8, or 10 years) on these associations were measured in separate sub-analyses. MAIN RESULTS AND ROLE OF CHANCE Most (580/753, 77%) daughters were exposed to at least one prenatal stressful life event. Exposure to maternal stressful life events during the entire pregnancy was associated with a non-linear earlier age at menarche. Exposure to one, two, or more psychological stressful events was associated with a 3.5 and 1.7-month earlier onset of puberty, respectively when compared to the reference group with no exposure maternal stressful life events. The estimates from multiple imputation with 50 datasets were comparable with complete case analysis confirming the existence of an underlying effect. No separate significant effects were observed for exposure during early or late gestation. The association between prenatal stressful events and age at menarche was not mediated by childhood BMI in the offspring. LIMITATIONS, REASONS FOR CAUTION Stressful life events may have affected pregnant women in different ways and self-perceived maternal stress severity may have provided a more precise estimate of gestational psychological stress. The observed non-linear U-shape of the association between maternal psychological stress and age at menarche did not reflect a dose-response. This suggests that the first exposure to prenatal stress exerts a greater effect on fetal reproductive development. A potential mechanism is via dramatic initial activation of the hypothalamic–pituitary–adrenal (HPA) axis following the first stressful life event which is greater than that observed following subsequent exposure to two or more maternal stressful life events. Whilst we adjusted for a priori chosen confounders, we cannot exclude residual confounding or confounding by factors we did not include. Maternal age at menarche was not available so the effects of familial history/genetics could not be assessed. There was a large loss due to the number of girls with no information on date of menarche and missing confounder information implying risk of selection bias and multiple imputation analyses did not fully exclude this risk (similar direction but slightly weaker estimate magnitude). WIDER IMPLICATIONS OF THE FINDINGS Menarche is a sentinel reproductive event and earlier age at menarche carries implications for psychological, social and reproductive health and for long-term risk of common non-communicable diseases. Understanding the factors regulating age at menarche has extensive health implications. This is the first population-based cohort study in humans to demonstrate that prenatal psychological stress might directly modify age at menarche. STUDY FUNDING/COMPETING INTEREST(S) Dr. Bräuner and Trine Koch’s salaries were supported by Doctor Sofus Carl Emil Friis and spouse Olga Doris Friis foundation, The Danish Cancer Society (Kræftens Bekæmpelse, RP15468, R204-A12636, Denmark) and The Danish Health Foundation (Helsefonden, F-22181-23, Denmark). Martha Hickey was funded by NHMRC Practitioner Fellowships. The funding bodies played no role in the design, collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. Dr. Hart has received personal fees in his function as the Medical Director of Fertility Specialists of Western Australia and received educational sponsorship grants from MSD, Merck-Serono and from Ferring Pharmaceuticals. Dr Hart has also received personal fees from Shareholders in Western IVF outside the submitted work. TRIAL REGISTRATION NUMBER NA.
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This paper reports the follow-up at age 15 of a group of children who were diagnosed at age 5 as having delayed motor development. The group of children who were clumsy and the control group still differed in motor performance 10 years later: 46% of the members of the early motor delay group were classified as different from the control group on motor and perceptual tasks. The remainder made up an intermediate group that could not be clearly distinguished from the other groups. Adolescents with stable motor problems had fewer social hobbies and pastimes and had lower academic ambitions for their future than the controls, although the lower academic ambitions also reflect their lower academic achievements. The adolescents who were clumsy believed they were less physically and scholastically competent than the controls. However, they did not have poor opinions of their social acceptance or self-worth. The intermediate group, although they showed motor delay at age 5, had good school performance and high ambitions and engaged in social sports at age 15.
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The investigation explored 12 adults' past experiences of physical awkwardness. Hermeneutic phenomenology, a descriptive and interpretative methodology, uncovered feelings and meanings associated with childhood reminiscences of physical awkwardness, from 18 semi-structured interviews. Findings focus upon four themes, namely: "failing and falling," "hurt and humiliation," "worrying and wondering," and seeking ways of "avoiding awkwardness" in the future. A heightened awareness of the subjective lived experience of those who are awkward in physical activity and sport situations would alert teachers, coaches, and others of the potential emotional and social consequences associated with it and the need to address the problem of physical awkwardness, in particular, during early growth, maturation, skill development, and learning.
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There is good evidence that symptoms of anxiety and depression are more common during pregnancy than in the postnatal period. In addition, pregnancy is a period during which stresses between partners and domestic violence may be elevated. Recent research suggests that the stresses and strains that women experience in pregnancy can have long-term adverse effects on the fetus and the child. Stress/anxiety during pregnancy can double the risk of a range of emotional, behavioural and cognitive problems. There is a wide variation in outcome among exposed children; current research seeks to clarify the interaction between prenatal stress/anxiety, genetic vulnerabilities and postnatal risk exposures and protective factors. Although such research is important, it is clear that there are immediate practical applications of the findings so far. There needs to be appropriate prenatal screening and intervention. It should be possible to significantly reduce the incidence of child neurodevelopmental disorder.
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Preeclampsia, the leading cause of maternal and perinatal morbidity and mortality, has been recently considered not only a pregnancy disease but also a risk factor for developing diseases later in life. Preeclampsia is becoming a disease of interest to internists and not just obstetricians. Women who have had preeclampsia seem to be at higher risk of premature death, mortality from ischemic heart disease, cardiovascular diseases including ischemic heart disease and hypertension, fatal and non-fatal stroke, venous thromboembolism, renal failure, type 2 diabetes mellitus, hypothyroidism, and cognitive defects, although they appear surprisingly protected from cancer. Furthermore, having had preeclampsia is a problem not only for the mother's future health, but it also affects the offspring's adult health. Children born from preeclamptic pregnancies are more prone to hypertension, insulin resistance and diabetes mellitus, neurological problems, stroke, and mental disorders along their life. Whether preeclampsia is a risk factor for disease later in life or it creates long-term organ damage is an intriguing question. This review analyzes recent epidemiological evidence of the long-term outcomes of preeclampsia and the background mechanisms of this phenomenon. Understanding the etiological background may provide guidance for the prevention and follow-up of women who experience preeclampsia. Copyright © 2012 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.
Article
There is growing evidence that maternal prenatal stress may be hazardous to infant health. Changes in maternal hormonal and immune function as a result of stress may adversely affect the immune function and neurodevelopment of the fetus. Prenatal stress in the mother may produce lasting effects on the (1) infant's health status, (2) development and function of the infant's immune system, and (3) neurocognitive development of the infant. This article provides a synthesis of current human and animal literature on the effects of maternal prenatal stress on the developing fetus and the infant, with the resulting model evolving out of the framework of psychoneuroimmunology. The intent of the authors is an integrative review. The authors examined the following research question: What effect does maternal prenatal stress have on infants' immune development and neurodevelopment? All relevant studies were reviewed with no exclusion criteria. Major databases (CINAHL, MEDLINE, PsychINFO) were searched using a combination of the following key words: prenatal stress, cytokines, thymus, and infant neurodevelopment.