Association of Maternal Stress and Social Support During Pregnancy With Growth Marks in Children’s Primary Tooth Enamel

Rebecca V Mountain,Olivia R Pickett,Yiwen Zhu,Jill M Goldstein,Alexandre A Lussier,Felicitas B Bidlack,Erin C Dunn,Joshua L Roffman

doi:10.1001/jamanetworkopen.2021.29129

Rebecca V Mountain, Olivia R Pickett + Show 6 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2021.29129

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Abstract

Exposure to maternal psychosocial stressors during the prenatal and perinatal periods can have major long-term mental health consequences for children. However, valid and inexpensive biomarkers are currently unavailable to identify children who have been exposed to psychosocial stress and the buffers of stress exposure. To assess whether a growth mark in tooth enamel, the neonatal line, is associated with exposure to prenatal and perinatal maternal psychosocial factors. This prospective cohort study used exfoliated primary canine teeth and epidemiological survey data from 70 children enrolled in the Avon Longitudinal Study of Parents and Children, a birth cohort based in Bristol, England. Exfoliated teeth were collected from children at 5 to 7 years of age. Data were collected from January 1, 1991, to December 31, 1998, and were analyzed from January 1, 2019, to August 10, 2021. Four types of prenatal and perinatal maternal psychosocial factors were studied: stressful life events, psychopathological history, neighborhood disadvantage, and social support. Data were collected from mailed-in questionnaires completed during and shortly after pregnancy. Neonatal line width measured within 3 portions of the tooth crown (the cuspal, middle, and innermost third) in exfoliated primary canines. A total of 70 children (34 of 70 [48.7%] male; 63 of 67 [94.0%] White) were studied. Most children were born full term (57 [83.8%]) and to mothers of typical child-bearing age (60 [88.2%]). Neonatal lines were wider in the canines of children born to mothers who self-reported severe lifetime depression (β = 3.35; 95% CI, 1.48-5.23; P = .001), any lifetime psychiatric problems (β = 2.66; 95% CI, 0.92-4.41; P = .003), or elevated anxiety or depressive symptoms at 32 weeks' gestation (β = 2.29; 95% CI, 0.38-4.20; P = .02). By contrast, neonatal lines were narrower in children born to mothers who self-reported high social support shortly after birth (β = -2.04; 95% CI, -3.70 to -0.38; P = .02). The magnitude of these associations was large, up to 1.2 SD unit differences, and persisted after adjusting for other risk factors. In this cohort study, neonatal line width was associated with exposure to maternal perinatal psychosocial factors. Replication and validation of these findings can further evaluate teeth as possible new biomarkers.

Highlights

Children’s exposure to prenatal and perinatal maternal psychosocial stressors, such as psychopathological symptoms,[1-3] stressful life events,[4,5] and neighborhood disadvantage,[6,7] can impact brain health across the life course
Neonatal lines were wider in the canines of children born to mothers who self-reported severe lifetime depression (β = 3.35; 95% CI, 1.48-5.23; P = .001), any lifetime psychiatric problems (β = 2.66; 95% CI, 0.92-4.41; P = .003), or elevated anxiety or depressive symptoms at 32 weeks’ gestation (β = 2.29; 95% CI, 0.38-4.20; P = .02)
Neonatal lines were narrower in children born to mothers who self-reported high social support shortly after birth (β = −2.04; 95% CI, −3.70 to −0.38; P = .02)

Summary

Introduction

Children’s exposure to prenatal and perinatal maternal psychosocial stressors, such as psychopathological symptoms,[1-3] stressful life events,[4,5] and neighborhood disadvantage,[6,7] can impact brain health across the life course. Increased maternal social support[15] is a known protective factor, associated with reduced inflammation in offspring during the first year of life,[16] and fewer internalizing and externalizing symptoms across development.[17]. These empirical findings are consistent with the developmental origins of health and disease and prenatal programming hypotheses, which propose that the intrauterine environment shapes development and risk of disease across the life course.[2,18-21]. These findings underscore the importance of characterizing maternal stressors and social support to better understand their associations with pediatric mental health.[22]. There is a need for novel measurement tools that can objectively, as well as inexpensively and noninvasively, provide information (beyond self-reports) about children’s exposure to prenatal maternal stress and social support

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