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Reduced Infant Birthweight Consequent Upon Maternal Exposure to Severe Life Events

From the Centre for Women's Mental Health Research (A.S.K., K.M.A., R.T.W.), University of Manchester, Manchester, UK; Biostatistics Group (R.M.), University of Manchester, Manchester, UK; Maternal and Fetal Health Research Group (A.S.K., L.C.K., P.N.B.), University of Manchester, Manchester, UK; National Centre for Register-Based Research (M.G.P., P.B.M.), University of Aarhus, Aarhus, Denmark; Department of Obstetrics and Gynaecology (L.C.K.), University College Cork, Cork University Maternity Hospital, Cork, Ireland.

Address correspondence and reprint requests to Ali Khashan, Centre for Women's Mental Health Research, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK. E-mail: ali.khashan{at}postgrad.manchester.ac.uk

Objective: To investigate the association between maternal exposure to severe life events and fetal growth (birthweight and small for gestational age). Stress has been associated with adverse pregnancy outcome.

Methods: Mothers of 1.38 million singleton live births in Denmark between January 1, 1979 and December 31, 2002 were linked to information on their spouses, parents, siblings, and older children. Exposure was defined as death or serious illness in a relative during pregnancy or in the 6 months before conception. Linear regression was used to examine the effect of exposure on birthweight. Log-linear binomial regression was used to assess the effect of exposure on small for gestational age.

Results: Death of a relative during pregnancy or in the 6 months before conception reduced birthweight by 27 g (adjusted estimate –27 g, 95% Confidence Interval (CI) = –33, –22). There was a significant association between maternal exposure to death of a relative and risk of a baby weighing below the 10th percentile (adjusted relative risk (RR) = 1.17, 95% CI = 1.13, 1.22) and 5th percentile (adjusted RR = 1.22, 95% CI = 1.15, 1.29).

Conclusions: Mothers exposed to severe life events before conception or during pregnancy have babies with significantly lower birthweight. If this association is causal, the potential mechanisms of stress-related effects on birthweight include changes in lifestyle due to the exposure and stress-related dysregulation of the hypothalamic-pituitary-adrenal axis during pregnancy.

Key Words: stress • pregnancy • birthweight • small for gestational age • severe life events

Abbreviations: IUGR = intrauterine growth restriction; CVA = cerebrovascular accident; AMI = acute myocardial infarction; SGA = small for gestational age; VSGA = very small for gestational age; GHQ = general health questionnaire; SES = socioeconomic status.