Abstract
BackgroundIn developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana.MethodsLeveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined.ResultsIn all children, high prenatal maternal stress was associated with reduced birth length (β = − 0.91, p = 0.04; p-value for trend = 0.04). Among girls, moderate and high prenatal maternal stress was associated with reduced birth weight (β = − 0.16, p = 0.02; β = − 0.18, p = 0.04 respectively; p-value for trend = 0.04) and head circumference (β = − 0.66, p = 0.05; β = − 1.02, p = 0.01 respectively; p-value for trend = 0.01). In girls, high prenatal stress increased odds of any adverse birth outcome (OR 2.41, 95% CI 1.01-5.75; p for interaction = 0.04). Sex-specific analyses did not demonstrate significant effects in boys.ConclusionsAll infants, but especially girls, were vulnerable to effects of prenatal maternal stress on birth outcomes. Understanding risk factors for impaired fetal growth may help develop preventative public health strategies.Trial registrationNCT01335490 (prospective registration).Date of Registration: April 14, 2011.Status of Registration: Completed.
Highlights
In developed countries, prenatal maternal stress has been associated with poor fetal growth, this has not been evaluated in rural sub-Saharan Africa
The importance of fetal growth extends beyond perinatal mortality-- the Developmental Origins of Health and Disease (DOHaD) theory posits that fetal growth predicts disease risk across the life course, including cardiovascular risk and cognitive decline [5,6,7]
Only one prospective study has examined the associations between prenatal maternal stress, with a focus on childhood trauma and lifetime posttraumatic stress disorder, and infant birth outcomes in a peri-urban sub-Saharan Africa and found that increased maternal trauma adversely impacted fetal growth [11]
Summary
Prenatal maternal stress has been associated with poor fetal growth, this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. In higher-income countries, maternal psychosocial stress during or prior to pregnancy has been associated with low birth weight, prematurity, intrauterine growth retardation and other negative birth outcomes [8,9,10]. Only one prospective study has examined the associations between prenatal maternal stress, with a focus on childhood trauma and lifetime posttraumatic stress disorder, and infant birth outcomes in a peri-urban sub-Saharan Africa and found that increased maternal trauma adversely impacted fetal growth [11]. While mechanisms are not well delineated, stress-associated disruption in key regulatory systems in the pregnant woman, including hypothalamic-pituitary-adrenal (HPA) axis, autonomic nervous system (ANS), and immune functioning may lead to altered fetal development and enhanced vulnerability to low birth weight
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