Maternal Bereavement Research Articles

Intergenerational Clustering of Under-Five Mortality: A Cohort Perspective in Low- and Middle-Income Countries

A burgeoning demographic literature documents the exceedingly high rates at which contemporary cohorts of women across the Global South experience the death of their children—even amid historic declines in child mortality. Yet, the patterning of maternal bereavement remains underinvestigated, as does the extent to which it replicates across generations of the same family. To that end, we ask: Are the surviving daughters of bereaved mothers more likely to eventually experience maternal bereavement? How does the intergenerational clustering of maternal bereavement vary across countries and cohorts? To answer these questions, we make use of Demographic and Health Survey Program data from 50 low- and middle-income countries, encompassing data on 1.05 million women and their mothers spanning three decadal birth cohorts. Descriptive results demonstrate that maternal bereavement is increasingly patterned intergenerationally across cohorts, with most women experiencing the same fate as their mothers. Multivariable hazard models further show that, on average, women whose mothers were maternally bereaved have significantly increased odds of losing a child themselves. In most countries, the association is stable across cohorts; however, in select countries, the risk associated with having a bereaved mother is shrinking among more recent birth cohorts.

Reducing childhood mortality extends mothers’ lives

During the twentieth century, childhood mortality was dramatically reduced globally, falling by more than 90% in the United States and much of Europe. Total fertility also fell, with the combined result that many parents who otherwise would have experienced the loss of a child were spared the trauma and negative health consequences that accompany such a loss. Here I use mathematical modeling to argue that the reduction in the frequency of child death that occurred in the twentieth century indirectly led to a substantial reduction in female mortality, resulting in an extension of female lifespan. I estimate that the reduction in maternal bereavement in the US during the twentieth century indirectly increased mean female lifespan after age 15 by approximately 1 year. I discuss implications for our understanding of the persistence of the sex gap in longevity and approaches to improving maternal health outcomes in countries that still face high levels of childhood mortality.

The Intergenerational Transmission of Health Disadvantage: Can Education Disrupt It?

In low-income countries, intergenerational processes can culminate in the replication of extreme forms of health disadvantage between mothers and adult daughters, including experiencing a young child's death. The preventable nature of most child deaths raises questions of whether social resources can protect women from enduring this adversity like their mothers. This study examined whether education-widely touted as a vehicle for social mobility in resource-poor countries-disrupts the intergenerational cycle of maternal bereavement. We estimated multilevel discrete-time survival models of women's hazard of child loss using Demographic and Health Survey Program data (N = 195,744 women in 345 subnational regions in 32 African countries). Women's educational attainment minimizes the salience of their mothers' bereavement history for their own probability of child loss; however, mothers' background becomes irrelevant only among women with ≥10 years of schooling. Education's neutralizing influence is most prominent in the highest mortality-burdened communities.

Maternal experienced bereavement and offspring mental health in early adulthood: the role of modifiable parental factors.

It is estimated that 78% of children experience the death of a close friend or family member by 16 years of age, yet longitudinal research examining the mental health outcomes of wider experiences of bereavement is scarce. We conducted a longitudinal investigation of the association between maternal experienced bereavement before the age of 11 years and offspring depressive and anxiety disorders at age 18 and examined moderation of this association by modifiable parental factors. We analysed data from the Avon Longitudinal Study of Parents and Children, a UK-based birth cohort, including 9,088 child participants with data available on bereavement. Bereavement was measured via maternal report at eight timepoints until children were 11 years. Offspring depressive and anxiety-related disorders were self-reported at 18 years old using the Clinical Interview Schedule-Revised (CIS-R). The potential moderating roles of maternal anxiety, maternal depression, parental monitoring, positive parenting and negative parenting practices were examined. Maternal experienced bereavement was not associated with depression or anxiety-related disorders in early adulthood among offspring. In addition, no support was found for negative parenting practices, parental monitoring or maternal anxiety and depression as moderators of the relationship between maternal experienced bereavement and offspring mental health problems at 18 years old. Findings in relation to the moderating role of positive parenting practices were inconsistent. Findings suggest that a large number of children are exposed to maternal experienced bereavement. We found no evidence that maternal experienced bereavement during childhood increases the risk for offspring psychiatric disorders in early adulthood. Several methodological considerations prudent to bereavement research are discussed.

Prenatal Exposure to Severe Stress and the Risk of Heart Failure Up to Middle-Age

BackgroundPrenatal stress is a potential risk factor for cardiovascular disease, but its association with heart failure (HF) is unknown. ObjectivesThe purpose of this study was to investigate whether prenatal stress, defined as maternal bereavement, was associated with HF risk up to middle-age. MethodsThis cohort study included 6,758,560 live singleton births from the Danish (1973-2016) and the Swedish (1973-2014) Medical Birth Registers. The authors retrieved information on death of the mothers’ close family members (partner, older children, parents, and siblings) and offspring’s HF (up to 2016 in Denmark and 2020 in Sweden) from nationwide registers. They estimated HRs and 95% CIs for HF in the offspring according to maternal bereavement. ResultsDuring up to 48 years of follow-up, 4,812 offspring (0.07%) had a diagnosis of HF. Maternal loss of any close family member was not associated with HF in the offspring (adjusted HR: 1.04; 95% CI: 0.88-1.23). However, the most severe forms of bereavement, ie, death of a partner or an older child (adjusted HR: 1.47; 95% CI: 1.06-2.04) and unnatural death of a relative (adjusted HR: 2.77; 95% CI: 1.49-5.17), were associated with increased risks of HF. Congenital heart disease and preterm birth contributed substantially to the association of maternal loss of a partner or older child with HF risk in the offspring. ConclusionsMaternal loss of a partner or older child and loss of a close relative caused by unnatural causes the year before or during pregnancy were associated with increased risk of HF in offspring.

Prenatal Exposure to Severe Stress and Risks of Ischemic Heart Disease and Stroke in Offspring

Prenatal stress is associated with increased risks of several cardiovascular risk factors later in life. However, knowledge regarding the role of prenatal stress in the development of ischemic heart disease (IHD) and stroke is very limited. To examine prenatal stress, defined as maternal bereavement, and risks of IHD and stroke in the offspring. A cohort study was conducted using data from Danish and Swedish registries. Live singleton births during calendar years 1973-2016 in Denmark (followed up until December 31, 2016) and during calendar years 1973-2014 in Sweden (followed up until December 31, 2021) were included in the analysis. Maternal loss of a close family member (partner, older children, parents, or siblings) the year before or during the pregnancy. Diagnoses of IHD and stroke. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for IHD and stroke in the offspring according to maternal bereavement. The study included 6 758 560 births (39.4% from Denmark; 51.4% boys). During the median follow-up of 24.6 (IQR, 13.9-35.1) years, 8664 offspring (0.1%) were diagnosed with IHD and 13 094 with stroke (0.2%). Overall, maternal bereavement the year before or during pregnancy was not associated with IHD (adjusted HR [AHR], 0.98; 95% CI, 0.85-1.13) or stroke (AHR, 1.04; 95% CI, 0.94-1.16) in offspring. Similarly, no associations were observed when exposure was classified by the mother's relationship to the deceased individual, ie, loss of older child or partner (HR, 0.85; 95% CI, 0.64-1.14 for IHD and 0.98; 95% CI, 0.77-1.25 for stroke) or loss of parent or sibling (HR, 1.03; 95% CI, 0.87-1.21 for IHD and 1.06; 95% CI, 0.94-1.19 for stroke). However, associations between loss in the third trimester and IHD (AHR, 1.50; 95% CI, 1.06-2.13), and loss due to cardiovascular disease and stroke (AHR, 1.22; 95% CI, 1.03-1.44) were identified when exposure was classified by time of loss or the relative's cause of death. The findings of this study provide little support for the hypothesis that prenatal stress is associated with risks of IHD and stroke in the first 5 decades of life. However, the association observed between stress in the third trimester and IHD warrants further investigation.

Mothering against motherhood: doula work, xenohospitality and the idea of the momrade

Today, a new vein of queer Marxist-feminist family-abolitionist theorising is reviving contemporary feminists’ willingness to imagine, politically, what women's liberationists in the 1970s called ‘mothering against motherhood’. Concurrently, the jokey portmanteau ‘momrade’, i.e. mom + comrade, has circulated persistently in the twenty-first century on online forums maintained by communities of mothers and/or leftists. This article asks: what if, in the name of abolishing the family, we took the joke entirely seriously? What makes a ‘mom’ a ‘momrade’, or vice versa? In what ways does the work of reproduction, conceivably, actively participate in class struggles, producing new worlds (and un-producing others)? How do the collective arts of mothering unmake selves? And how does the verb ‘to mother’ work to abolish the present state of things? The chosen point of departure for exploring these questions is the concept of xenohospitality; a term I borrow from Helen Hester – one of the authors of the Xenofeminist Manifesto – who defines it as openness to the alien, a definition I link closely to ‘comradeliness’. Further, the meaning of the term ‘family abolition’, here, is aptly summed up by the formula ‘xenofam ≥ biofam’; to abolish the family is not to destroy relationships of care and nurturance, but on the contrary, to expand and proliferate them. Reflecting on the conditions of possibility for such universally xenofamilial – that is to say, comradely – kin relations, this article implicitly argues for utopia(nism) in feminist kinship studies. It grounds this utopianism, however, in first-hand experiences of informal ‘death doula’ labour. The labour of mothering one's mother is offered as a potential practice of un-mothering oneself and others. In fact, the argument pivots on these auto-ethnographic observations about maternal bereavement, because the event of the author's mother's death interrupted and intruded upon the feminist theorising involved.

Prenatal Maternal Bereavement and Its Association With Intellectual Disability in the Offspring.

This study aimed to examine the association of a mother's loss of a close relative before or during pregnancy with intellectual disability (ID) in the offspring. We performed a nationwide population-based cohort study based on Danish national registries. All live-born singletons born in Denmark during the 1978-2016 period (n = 2,216,601) were followed up starting from birth to 38 years of age. Log-linear Poisson regression was used to estimate the association between maternal bereavement (the death of an older child, a partner, or a parent 1 year before or during pregnancy) and the risk of ID in the offspring. Maternal bereavement during or before pregnancy was associated with an increased risk of ID (incidence rate ratio [IRR] = 1.15; 95% confidence interval [CI] = 1.04-1.28). The risk of ID was increased by 27% when maternal bereavement occurred during pregnancy (IRR = 1.27; 95% CI = 1.08-1.49). When stratifying on the child's sex, we also observed an increased risk of ID associated with maternal bereavement during pregnancy both for male (IRR = 1.25; 95% CI = 1.02-1.53) and for female (IRR = 1.31; 95% CI = 1.02-1.69), respectively. The IRRs for unnatural death of a relative were also elevated (IRR = 1.22; 95% CI = 0.91-1.64) in general, although the difference was not statistically significant. Our findings suggest that prenatal stress due to maternal loss of a close relative may increase the risk of offspring's ID of both sexes, in particular when the loss happened during pregnancy.

Global burden of maternal bereavement: indicators of the cumulative prevalence of child loss

BackgroundWe provide country-level estimates of the cumulative prevalence of mothers bereaved by a child’s death in 170 countries and territories.MethodsWe generate indicators of the cumulative prevalence of mothers who have...

Daughters’ experiences of maternal bereavement during adolescence: A scoping review

ABSTRACT The purpose of the scoping review was to synthesize peer-reviewed literature of daughters’ experiences of maternal bereavement. The search was conducted across eight databases and included peer-reviewed, qualitative research that reported on daughters’ experiences of the death of their mother. The review identified 21 studies. Experiences included recurrent grief including secondary losses, difficulties establishing and maintaining relationships, and intrapersonal and daily lifestyle changes. Implications for maternal loss during adolescence, and recommendations for those supporting women whose mothers have passed away have been provided. Further research is needed to identify the experiences of loss at different developmental stages.

Bonded from Brokenness: A Collaborative Autoethnography on Maternal Bereavement

The purpose of this study is to explore the experience of maternal bereavement. As scholar practitioners the authors offer their personal narratives to bring awareness to the multifaceted aspects of grieving the death of a child. Using collaborative autoethnography as the study’s methodology enabled the authors to explore their connection to the sociocultural context of maternal grief. Data collection consisted of a dialogue process that took place electronically through the course of asynchronous messages. Data analysis revealed three interrelated themes: transformation, constructing meaning, and creative ways of knowing. The findings are examined in light of literature regarding maternal bereavement and the expressing of grief through writing. The study concludes with a discussion on implications and recommendations for bereaved mothers and those who serve this population.

Maternal life and work stressors during pregnancy and asthma in offspring.

BackgroundMaternal stressors during pregnancy are potential risk factors for asthma in offspring. However, previous studies have been limited by the use of self-reported data focusing on stressors either in private life or at work. This study examined the association between maternal stressors both in private life and at work during pregnancy and asthma in offspring.MethodsIn the Danish National Birth Cohort, 75 156 live-born singletons born during 1996–2002 were identified. Maternal information on job title were available around weeks 12–16 of gestation. Data on maternal bereavement, life-threatening illness, suicide attempt and alcohol or drug abuse of a close relative and offspring childhood asthma (3–10 years of age) were obtained from Danish nationwide registers. Maternal psychosocial work stressors (job control, psychological job demands, emotional job demands, work-related violence and threats of work-related violence) were estimated by the use of job-exposure matrices. The association between maternal stress and childhood asthma was analysed in Cox models adjusted for maternal age, comorbidity and parity.ResultsNeither private-life nor work stressors were related to onset of asthma in offspring. Separate analyses by parental atopy or onset of asthma in offspring supported the main findings.ConclusionsThis study does not support an elevated risk of childhood asthma related to exposure to stress during pregnancy.

Maternal Bereavement the Year Before or During Pregnancy and Total and Cause-Specific Infant Mortality: A Cohort Study From Denmark and Sweden.

We analyzed the associations between maternal bereavement the year before or during pregnancy and total and cause-specific infant mortality (IM). We studied live singleton births from the Danish (1978-2008) and Swedish Medical Birth Registers (1973-2006; N = 5,114,246). Information on maternal sociodemographic, pregnancy-related, and health-related factors, and death of family members was obtained from nationwide registers. Among children of mothers with register links to family members and without the considered IM risk factors, 110,993 (2.76%) were exposed and 15,199 (0.4%) died in infancy. Death of an older child the year before or during pregnancy was associated with an increased IM risk (adjusted odds ratio [aOR; 95% confidence intervals {CIs}] = 2.05 [1.44-2.92]). Losing an older child the year before pregnancy or during pregnancy was associated with risks of prematurity-related IM (aOR [95% CI] = 2.61 [1.44-4.72] and 3.08 [1.70-5.57]) and with infant death in term-born children due to causes other than sudden infant death syndrome, congenital malformations, or asphyxia (aOR [95% CI] = 3.31 [1.58-6.96] and 5.10 [1.27-20.43]). Losing an older child during pregnancy was also associated with increased risks of sudden infant death syndrome (aOR [95% CI] = 5.41 [1.34-21.83]). Death of a partner during pregnancy was associated with IM (aOR [95% CI] = 1.83 [1.01-3.32]). The number of events was small and CIs were wide in some subanalyses, and caution is needed when interpreting our results. Severe prenatal stress may increase the risk of several types of IM. Whether less severe but more common maternal stressors shortly before or during pregnancy also increase IM risk warrants further investigation.

Educational attainment in offspring bereaved by sudden parental death from external causes: a national cohort study from birth and throughout adulthood

PurposePrevious research has linked loss of a parent during childhood to reduced educational aspirations, school performance, and educational attainment later in life. The potential effect of maternal and paternal bereavement on attainment at all educational levels is, however, unknown. The present study aimed to investigate the potential influence of parental death by external causes on completion of compulsory education, high school, vocational education, and University or College education.MethodsThe study was based on data from three national longitudinal registers in Norway. The study population comprised 373,104 individuals born between January 1st 1970 and December 31st 1994. Information concerning deceased parents’ cause and date of death and offspring’s education and sociodemographic data were retrieved. Data were analysed with Cox regression.ResultsChildren who had experienced parental death by external causes had a significantly reduced hazard ratio (HR) of completing all educational levels compared to children who did not have such experiences. The largest effects were evident for completion of high school (HR 0.68, 95% CI 0.65–0.71) and University or College education (HR 0.75, 95% CI 0.70–0.80). No differences were evident for different causes of death, genders of deceased or ages at bereavement, and generally no significant interactions between gender of the bereaved offspring and predictor variables were evident for completion of all educational levels.ConclusionParental death by external causes has vast and long-lasting impacts on offspring’s educational attainment at all levels. Health care interventions aimed at supporting bereaved children and adolescents should focus on challenges related to educational progress.

Telling the Untellable: Negotiating Maternal Bereavement in Sophie Daull's Camille, mon envolée (2015)

Sophie Daull's Camille, mon envolée (2015) is an autobiographical depiction of the sudden and traumatic loss of an only daughter (Camille) due to an undetected fatal bacterial infection. It is recounted uniquely from the maternal point of view and directly addresses the daughter throughout. It concerns an incredibly recent bereavement as the writing of the text, the author tells us, commences just one week after the daughter's death. Camille, mon envolée is a markedly intimate and brutally honest account of a mother who is an active witness to and, one could argue, participant in her daughter's agonizing death scene. The text captures the sense of powerlessness that is experienced by the mother, the incomprehensibility of the loss, the self-blame, and, finally, the coming to terms with it and the learning to live on, not without guilt, however. It also offers insight into maternal motivation for writing such a text, ranging from a quest for understanding and an outlet for grief, to a desire to preserve the daughter's memory. Furthermore, through close examination of the physical, psychological and social impact of the death of a child on mother figure subjectivity, Camille mon envolée successfully traces out for the reader the very specific characteristics of maternal bereavement and its overwhelmingly embodied nature. Finally, the text represents an engagement on the part of the grieving mother with what has been termed 'scriptotherapy' in a bid to negotiate this trauma and find a means, not only of remembering the daughter, but also of surviving the tragedy. In this respect, Camille, mon envolée is a text of resistance, where the unthinkable is confronted and the untellable bravely told.

Maternal bereavement shortly before or during pregnancy and risk of postpartum psychotic illness: a population-based study from Denmark and Sweden.

Purpose: Postpartum psychosis is a rare but severe complication following childbirth, with unknown etiology. This study investigated whether the death of a close family member — a source of severe stress — the year before or during pregnancy was associated with an increased risk of psychotic illness in the postpartum period among women without and with a history of psychiatric disorder.Methods: We studied live births in Denmark during 1978–2008 and births in Sweden during 1973–2006 (n=5,246,978). Information on death of women’s relatives and partners and sociodemographic, health-, and pregnancy-related factors was obtained through linkage with nationwide registries.Results: The death of a close relative the year before or during pregnancy was not associated with psychotic illness during the first 90 days postpartum among women without (adjusted HR 1.02, 95% CI 0.76–1.37) or with a history of psychiatric disorder (HR 0.96, 95% CI 0.74–1.25). Similarly, there was no association between bereavement and risk of postpartum psychosis according to the timing of the loss (the year before or during pregnancy), the relative’s cause of death (natural or unnatural), or the woman’s relationship to the deceased (parent/sibling or partner/older child).Conclusions: Death of a close relative, one of the most severe sources of stress, before or during pregnancy was not associated with postpartum psychosis. Therefore, these data do not support the hypothesis that severely stressful life events, such as bereavement around the time of pregnancy, are associated with postpartum psychosis.

Prenatal exposure to maternal bereavement and offspring psoriasis: a Danish nationwide cohort study.

Prenatal stress may alter immune competence of the fetus. Limited data exist on the role of antenatal stress in psoriasis development. To investigate whether prenatal exposure to maternal bereavement increases the risk of offspring psoriasis. This register-based cohort study included 1 811 917 live singletons born from 1978 to 2008 in Denmark. The children were assigned to the bereaved group if their mothers lost a child, partner/spouse, parent or sibling during pregnancy or up to 12 months before pregnancy. Follow-up started at the date of birth and ended at the date of first hospital treatment for psoriasis or a prescription redeemed for topical vitamin D derivatives (often used to treat psoriasis), emigration, death or 31 December 2010, whichever came first. We evaluated the hazard ratio (HR) of psoriasis in bereaved children using Cox proportional hazards regressions, compared with the nonbereaved group. During 28 million person-years of follow-up, 7956 children were hospitalized or prescribed medications for psoriasis. By the age of 30 years, 1·54% [95% confidence interval (CI) 1·25-1·90%] of children from the bereaved group were diagnosed with psoriasis, compared with 1·34% (95% CI 1·30-1·38%) of nonbereaved children. Overall, prenatal exposure to maternal bereavement was not associated with risk of psoriasis in general (HR 1·05, 95% CI 0·91-1·20). However, children born to mothers who lost a partner/spouse or an older child had an increased risk of psoriasis (HR 1·33, 95% CI 1·02-1·73). Prenatal exposure to the most stressful life event may contribute to the development and/or exacerbation of psoriasis.

Reproductive function in the sons of women who experienced stress due to bereavement before and during pregnancy: a nationwide population-based cohort study

To estimate the association between prenatal exposure to maternal stress and reproductive disorders in Danish men, where prenatal stress exposure was defined as the mother's loss of a close relative during pregnancy or in the 12months before conception. Population-based cohort study. Not applicable. All males born in Denmark between 1973 and 2008 (n = 1,217,576) and observed for up to 39years. None. Male reproductive function, defined using a composite outcome including congenital malformations of genital organs, testicular cancer, diagnosis of male infertility, or assisted conception use due to male factor infertility. In total, 28,986 men (2.4%) had been exposed to prenatal stress, and 62,929 (5.2%) experienced the composite outcome during the follow-up period. Prenatal exposure to stress was associated with an elevated risk of reproductive problems (hazard ratio [HR] 1.09; 95% CI, 1.04-1.15). The association was stronger when the exposure occurred during the first trimester of pregnancy, and for congenital malformations of genital organs. When focusing on infertility alone, we saw no evidence of increased risk (HR 0.90; 95% CI, 0.77-1.06). In addition, the probability of marrying a woman was lower for exposed men (HR 0.93; 95% CI, 0.89-0.98). Prenatal stress in the form of the mother's bereavement during the first trimester of pregnancy is associated with a higher risk of reproductive disorders from congenital malformations of the genital organs in the male offspring. The lack of an association between maternal bereavement and later infertility in the exposed male offspring may be due in part to the men's lower probability of attempting to have children.

Prenatal maternal bereavement and mortality in the first decades of life: a nationwide cohort study from Denmark and Sweden.

The loss of a close relative is one of the most stressful life events. In pregnancy, this experience has been associated with a higher risk of fetal death and under-five mortality, but little is known about potential effects on long-term mortality in offspring. We examined the association between prenatal maternal bereavement and mortality in a cohort of 5.3 million children followed until up to 37 years of age. The population-based cohort study included 5253508 live singleton births in Denmark (1973-2004) and Sweden (1973-2006). Children born to mothers who lost a child, spouse, sibling, or parent during or 1 year before pregnancy were categorized as exposed. Prenatal maternal bereavement was associated with a 10% increased all-cause mortality risk in offspring [mortality rate ratio (MRR) 1.10, 95% confidence interval (CI) 1.03-1.18]. The association was the most pronounced for children of mothers who lost a child/spouse (MRR 1.28, 95% CI 1.14-1.44) and was stronger during the first 10 years of life. Prenatal maternal bereavement may have stronger effects on natural causes of death in offspring, including infectious/parasitic disease (MRR 1.86, 95% CI 1.07-3.23), endocrine/nutritional/metabolic diseases (MRR 3.23, 95% CI 2.02-5.17), diseases of nervous system (MRR 3.36, 95% CI 2.47-4.58), and congenital malformations (MRR 1.39, 95% CI 1.08-1.80). No excess mortality risk in offspring was observed for unnatural causes of death. Prenatal maternal bereavement was associated with an increased long-term mortality risk in offspring, particularly for selected natural causes of diseases and medical conditions. Our results support the fetal programming hypothesis that prenatal stress may contribute to ill health from physical diseases later in life.

Maternal Antenatal Bereavement and Neural Tube Defect in Live-Born Offspring: A Cohort Study.

BackgroundMaternal emotional stress during pregnancy has previously been associated with congenital neural malformations, but most studies are based on data collected retrospectively. The objective of our study was to investigate associations between antenatal maternal bereavement due to death of a close relative and neural tube defects (NTDs) in the offspring.MethodsWe performed a register-based cohort study including all live-born children (N = 1,734,190) from 1978–2008. Exposure was bereavement due to loss of a close relative from one year before conception to the end of the first trimester of pregnancy. The outcome was NTDs in the offspring according to the International Classification of Disease. We used multivariate logistic regression to estimate prevalence odds ratios (ORs).ResultsA total of 2% children were born to mothers who lost a close relative prenatally. During 30 years of follow-up, 1,115 children were diagnosed with any NTDs: spina bifida (n = 889), anencephaly (n = 85) and encephalocele (n = 164). And 23 children were diagnosed with two types of NTDs. Overall, when comparing bereaved mothers to non-bereaved mothers, no significant increased prevalence of NTDs in the offspring was seen (OR = 0.84; 95% confidence interval: 0.52–1.33).ConclusionOverall maternal bereavement in the antenatal period was not related to NTDs in liveborn offspring.