Prenatal Stressful Life Events Research Articles

Reproductive Development And Related Effects Of Phthalate Diesters In Males And Modification By Maternal Stress

We propose to expand the concept of endocrine disruption to include non-chemical exposures (psychosocial stress, hyperthermia and malnutrition) that may also interfere with the body's endocrine system and produce adverse health effects. For example, in rodents prenatal stress disrupts the normal surge of testosterone in the developing male and may also act as an androgen on the developing female. Here we present data from two multi-center pregnancy cohort studies in which we examined psychosocial stress in relation to androgen sensitive, sexually dimorphic endpoints. In the first of these studies (The Study for Future Families (SFF); 2000-2002), participants were asked about the occurrence of major stressful life events during pregnancy. We measure anogenital distance (AGD), a sexually dimorphic index of prenatal androgen exposure, in the resulting infants (mean age 16 months). After adjustment for age and body size, females born to couples reporting high stress had significantly longer (i.e. more masculine) AGD than females born to couples reporting low stress (p=0.015). When these children were 4-7 their mothers were asked to complete the Preschool Activities Inventory (PSAI), a standardized questionnaire that measures sexually dimorphic play behavior. We found that girls, but not boys, with a history of more prenatal stressful life events had significantly more masculine scores than those with fewer life events (β=3.48, p=0.006). More recently, in The Infant Development and the Environment Study (TIDES) women were enrolled in four US cities in their first trimester in 2010-2012 and AGD measured in their infants at birth. Phthalate metabolite concentrations were measured in first trimester urine samples and women reported on major stressful life events during pregnancy. We saw a significant inverse association between first trimester exposure to DEHP and AGD in males (sum DEHP metabolites β=-1.26, p=0.029, N=366). While we did not see a direct effect of stress on AGD in this second study, we saw strong evidence that maternal stress modified the phthalate-AGD association. When stratifying by number of stressful life events, this association was stronger in those with low stress (sum DEHP metabolites β=-1.78, p=0.004) but absent in those reporting high stress (β=1.62, p=0.242). Together these preliminary data suggest that prenatal stressful life events may exert androgenic action and modify the effects of prenatal exposure to antiandrogens on genital and neurodevelopment.

Sex-specific and time-dependent effects of prenatal stress on the early behavioral symptoms of ADHD: a longitudinal study in China.

There is increasing evidence that prenatal stressful life events (SLEs) may be a potential risk factor for attention-deficit hyperactivity disorder (ADHD), but the sex-specific and time-dependent effects of prenatal stress on ADHD are less clear. In this prospective longitudinal study, data on prenatal SLEs during different stages of gestation and indicators of buffers against stress, including maternal social support and avoidance coping, were obtained from 1765 pregnant women at 32 weeks of gestation. The behavioral symptoms of ADHD in children aged 48-54 months were evaluated by reports from the parents. There were 226 children (12.8%) above the clinically significant cutoff for ADHD. After adjusting for potential confounders, boys whose mother experienced severe SLEs in the second trimester had a significantly increased risk (OR = 2.41, 95% CI: 1.03-5.66) of developing ADHD symptoms compared with boys whose mothers did not experience severe SLEs at this time. However, no significantly increased risk of ADHD symptoms was observed in girls born to mothers experienced prenatal severe SLEs. Additionally, significant interaction effects of prenatal SLEs, social support and coping style on ADHD symptoms were found in males. Boys whose mothers experienced severe SLEs during the second trimester accompanied by a higher score for avoidance coping (OR = 3.31, 95% CI: 1.13-9.70) or a lower score for social support (OR = 4.39, 95% CI: 1.05-18.31) were likely to be at a higher risk for ADHD symptoms. The epidemiological evidence in this prospective follow-up study suggests that the effect of prenatal SLEs on ADHD symptoms in offspring may depend on the timing of prenatal stress and may vary according to the sex of the offspring.

Exposure to stressful life events during pregnancy predicts psychotic experiences via behaviour problems in childhood

BackgroundExposure to stressful life events during pregnancy has been associated with later schizophrenia in offspring. We explore how prenatal stress and neurodevelopmental abnormalities in childhood associate to increase the risk of later psychotic experiences. MethodsParticipants from the Mater University Study of Pregnancy (MUSP), an Australian based, pre-birth cohort study were examined for lifetime DSM-IV positive psychotic experiences at 21 years by a semi-structured interview (n = 2227). Structural equation modelling suggested psychotic experiences were best represented with a bifactor model including a general psychosis factor and two group factors. We tested for an association between prenatal stressful life events with the psychotic experiences, and examined for potential moderation and mediation by behaviour problems and cognitive ability in childhood. ResultsPrenatal stressful life events predicted psychotic experiences indirectly via behaviour problems at child age five years, and this relationship was not confounded by maternal stressful life events at child age five. We found no statistical evidence for an interaction between prenatal stressful life events and behaviour problems or cognitive ability. ConclusionThe measurable effect of prenatal stressful life events on later psychotic experiences in offspring manifested as behaviour problems by age 5. By identifying early abnormal behavioural development as an intermediary, this finding further confirms the role of prenatal stress to later psychotic disorders.

Prenatal stress and limbic-prefrontal white matter microstructure in children aged 6–9 years: a preliminary diffusion tensor imaging study

Objectives. Maternal prenatal stress is associated with elevated risk of adverse behavioural outcomes in offspring. This association may involve developmental disruption to limbic-prefrontal white matter circuitry, of which the uncinate fasciculus is the major tract. One potential candidate for modulating brain development is maternal prenatal stress. We provide the first prospective study of prenatal stress and white matter microstructure in children. Methods. A total of 22 healthy children (mean age 7 years) of mothers recruited in pregnancy underwent diffusion tensor magnetic resonance imaging. We examined correlations between prenatal stressful life events and white matter microstructural organisation indices (fractional anisotropy (FA) and perpendicular diffusivity (Dperp)) of the uncinate fasciculus and a “control” tract. Results. Maternal prenatal stressful life events were correlated positively with right uncinate fasciculus FA, and negatively with right uncinate fasciculus Dperp in their child, with a similar trend with left uncinate fasciculus Dperp. Prenatal stress was not associated with control tract properties; sociodemographic/obstetric variables were not associated with FA/Dperp of either tract. Conclusions. Variation in maternal prenatal stress may be associated with differences in the development of white matter within brain networks underlying child social behaviour.

Time-specific effect of prenatal stressful life events on gestational weight gain

ObjectiveTo investigate the time-specific effect of maternal exposure to prenatal stressful life events (SLEs) on gestational weight gain (GWG) and to determine whether pre-pregnancy body mass index (BMI) modifies the effect. MethodsBetween March and November 2008, data were collected from 1800 pregnant women who received prenatal check-ups in Hefei, China, after 32 completed weeks of gestation. Participants completed a structured interview on demographic characteristics and a checklist of SLEs during different stages of pregnancy. GWG during pregnancy was determined by self-reported pre-pregnancy weight and measured weight at delivery. ResultsThere was a significant dose–response relationship between prenatal SLEs in the first, but not the second or third, trimester and GWG. For each 1-unit increase in SLEs during the first trimester, there was a reduction in GWG of approximately 0.497kg (95% confidence interval, 0.176–0.817kg). After stratification by pre-pregnancy BMI, a significant negative association between SLEs in the first trimester and GWG was observed among women with pre-pregnancy normal (β=−0.796; 95% CI, −1.291 to −0.301) and low (β=−1.066; 95% CI, −2.180 to −0.048) weight. ConclusionThe effect of prenatal SLEs on GWG depends on the timing of maternal exposure to stress and varies according to pre-pregnancy BMI.

Prenatal stressful life events predict child cognitive outcomes

Introduction: There is growing evidence that prenatal maternal stress is associated with poorer behavioural [1] and cognitive [2] development in the child. What has not been established is whether this is because antenatal stress has a direct effect on the fetus. Animal models indicate that prenatal stress can have a long-term effect on the neuroendocrine stress response in the offspring, specifically the HPA axis [3], although other possible mechanisms include genetic predisposition or postnatal effects mediated by parenting. What is also unclear is the nature of the antenatal stress that is most harmful for child outcomes. We are conducting a study aiming to examine the association between maternal antenatal and postnatal stress and infant cognitive and behavioural development, and to explore possible mediating hormonal mechanisms. Here we present infant outcomes in relation to maternal stress during pregnancy and in the postnatal period. Methods: Women were originally recruited from an amniocentesis clinic, after obtaining written consent. Mothers completed a 26-item questionnaire relating to antenatal and postnatal stressful life events [4]. A trained developmental researcher administered the Bayley Scales of Infant Development (Second Edition) assessing mental (MDI) and motor (PDI) development. The study was approved by the local research ethics committee and is funded by the March of Dimes. Results: Seventy women returned for assessments when their child was about 18 months old ([mean±S.D.] 17.4± 1.1 months). English was the first language in the family and the children (32 girls and 36 boys) were all born at full term (>37 weeks; [mean±S.D.] 39.49±1.26 weeks) and had no clinical problems. Two mothers and babies were excluded because of insufficient English. There was a significant correlation between the total number of stressful life events in the antenatal period and infant MDI [Spearman's correlation (rs)=−0.43, p<0.0001]; the association with PDI was in the same direction but weaker and non-significant (rs =−0.19, n=68). A bivariate analysis showed that the mean±S.D. MDI scores of the children whose mother had experienced three or more life events during pregnancy was 85.8±8.2 (n=15), compared with 98.7±9.0 (n=53) for those children whose mother had experienced under 3 (p<0.0001). In contrast, the association between the total number of postnatal life events and MDI and PDI were non-significant (rs=−.12 and −.02, respectively). In a multivariate analysis including both antenatal and postnatal stressful life event scores, maternal education, antenatal maternal smoking, alcohol and street drug consumption, parity, infant gestational age at birth, infant sex, and infant birthweight for gestational age, the association between antenatal life events and child MDI remained significant (B=−3.19; S.E.= 0.71; β=−0.55; p<0.0001), although birthweight for gestational age also emerged as a significant inverse predictor (B=−2.51; S.E.=2.27; β=−0.12; p=0.05). However, while antenatal life events alone explained 22% of the observed variance in child MDI scores, birthweight for gestational age explained only 6% of the variance. Stressful life events indicative of a strained relationship between the mother and her partner (“you were separated/ divorced”, “you had a serious argument with your partner” and “your partner was emotionally cruel to you”) accounted for 40% of the variance in infant MDI due to life events. Discussion: This study adds evidence to support the hypothesis that stressful life events during pregnancy have a lasting and clinically relevant effect on the cognitive outcome for the child. It supports the concept that intrauterine influences affect behavioural and mental development, independent of postnatal factors. Although birthweight for gestational age emerged as a significant predictor of child MDI scores, the relationship is weak. The data presented here represents half of the final cohort, and future analyses with a fuller cohort will help to clarify this finding. The mediators responsible for the effect of antenatal events are as yet unknown.

Prenatal maternal stress is associated with delivery analgesia and unplanned cesareans

We tested the hypothesis that women with greater prenatal maternal stress (PNMS) would be more likely to receive intravenous opiates and epidural for delivery, and thereby increase the likelihood of unplanned cesarean delivery. PNMS was assessed during early, mid, and late pregnancy using psychometrically sound instruments in structured interviews with women receiving prenatal care at a public university clinic. Medical records were abstracted for analgesia during delivery, fetal heart tracing (FHT) abnormalities, and method of delivery. Only subjects attempting vaginal delivery (N = 298) were included. Using structural equation modeling, a PNMS variable was constructed from five indicators: pregnancy-specific distress, number of prenatal stressful life events, distress from life events, state anxiety, and perceived stress. After controlling for medical predictors of analgesia receipt and surgical delivery, women with higher PNMS were more likely to receive analgesia, and those who received analgesia were more likely to deliver surgically. Analgesia was also associated with FHT abnormalities, which in turn was associated with surgical delivery (all p's < 0.05). Women who received both an epidural and meperidine were most likely to have a cesarean delivery; 29% of this group delivered surgically. Results indicate that PNMS contributes to higher likelihood of unplanned cesarean delivery through its association with delivery analgesia.

Psychometric Properties of the Resilience Inventory for Pregnant Mexican Women

Resilience has been related to mental health during perinatal period. However, to our knowledge, there are no instruments of resilience that have been validated in this population. The purpose of this study was to examine the psychometric properties of the Resilience Inventory in a sample of Mexican pregnant women. A sample of 280 women was evaluated using the Resilience Inventory, Patient Health Questionnaire and a stressful life events questionnaire. The reliability coefficient of Resilience Inventory was 0.88 for the complete scale. Exploratory factor analysis resulted in a three-factor structure of resilience (personal competence, religiosity and positive attitude) for pregnant women. Concurrent validity was supported by negative correlations with prenatal depressive symptoms and stressful life events. The Resilience Inventory could be a potentially a valid and reliable measure. It is necessary to continue exploring the role of resilience in the perinatal period and identify the factors that shape it.

Psychometric Properties of the Resilience Inventory for Pregnant Mexican Women

Resilience has been related to mental health during perinatal period. However, to our knowledge, there are no instruments of resilience that have been validated in this population. The purpose of this study was to examine the psychometric properties of the Resilience Inventory in a sample of Mexican pregnant women. A sample of 280 women was evaluated using the Resilience Inventory, Patient Health Questionnaire and a stressful life events questionnaire. The reliability coefficient of Resilience Inventory was 0.88 for the complete scale. Exploratory factor analysis resulted in a three-factor structure of resilience (personal competence, religiosity and positive attitude) for pregnant women. Concurrent validity was supported by negative correlations with prenatal depressive symptoms and stressful life events. The Resilience Inventory could be a potentially a valid and reliable measure. It is necessary to continue exploring the role of resilience in the perinatal period and identify the factors that shape it.