Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-14T05:21:31.362Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  20 October 2016

Y. Yu ,
S. Cnattingius ,
J. Olsen ,
E. T. Parner ,
M. Vestergaard ,
Z. Liew ,
N. Zhao  and
J. Li
Y. Yu*
Affiliation:
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
S. Cnattingius
Affiliation:
Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
J. Olsen
Affiliation:
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
E. T. Parner
Affiliation:
Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
M. Vestergaard
Affiliation:
Department of Public Health, Research Unit for General Practice and Section for General Medical Practice, Aarhus University, Aarhus, Denmark
Z. Liew
Affiliation:
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
N. Zhao
Affiliation:
Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
J. Li
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
*
*Address for correspondence: Y. Yu, MSc, Section for Epidemiology, Department of Public Health, Aarhus University, Artholins Alle 2, DK 8000 Aarhus C, Denmark. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

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.

Method

The population-based cohort study included 5 253 508 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.

Results

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.

Conclusion

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.

Keywords

Bereavementdisease programmingmortalitypregnancystress
Type
Review Article
Information
Psychological Medicine , Volume 47 , Issue 3 , February 2017 , pp. 389 - 400
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexander, GR, Kogan, M, Martin, J, Papiernik, E (1998). What are the fetal growth patterns of singletons, twins, and triplets in the United States? Clinical Obstetrics and Gynecology 41, 115–125.CrossRefGoogle ScholarPubMed
Alexander, GR, Salihu, HM (2005). Perinatal outcomes of singleton and multiple births in the United States. In Multiple Pregnancy: Epidemiology, Gestation, and Perinatal Outcome, pp. 3–9. CRC Press: Boca Raton, FL.CrossRefGoogle Scholar
Barker, DJ, Eriksson, JG, Forsen, T, Osmond, C (2002). Fetal origins of adult disease: strength of effects and biological basis. International Journal of Epidemiology 31, 1235–1239.CrossRefGoogle ScholarPubMed
Class, QA, Khashan, AS, Lichtenstein, P, Langstrom, N, D'Onofrio, BM (2013). Maternal stress and infant mortality: the importance of the preconception period. Psychological Science 24, 1309–1316.CrossRefGoogle ScholarPubMed
Class, QA, Mortensen, PB, Henriksen, TB, Dalman, C, D'Onofrio, BM, Khashan, AS (2015). Preconception maternal bereavement and infant and childhood mortality: a Danish population-based study. Psychosomatic Medicine 77, 863–869.CrossRefGoogle ScholarPubMed
Cottrell, EC, Seckl, JR (2009). Prenatal stress, glucocorticoids and the programming of adult disease. Frontiers in Behavioral Neuroscience 3, 1–9.CrossRefGoogle ScholarPubMed
Donovan, SJ, Susser, E (2011). Commentary: advent of sibling designs. International Journal of Epidemiology 40, 345–349.CrossRefGoogle ScholarPubMed
Drake, AJ, Tang, JI, Nyirenda, MJ (2007). Mechanisms underlying the role of glucocorticoids in the early life programming of adult disease. Clinical Science 113, 219–232.CrossRefGoogle ScholarPubMed
Eurostat (1998). European shortlist causes of death (http://ec.europa.eu/eurostat/ramon/documents/cod_1998/cod_1998_pdf.zip). Accessed 17 November 2015.Google Scholar
Fowden, AL, Sibley, C, Reik, W, Constancia, M (2006). Imprinted genes, placental development and fetal growth. Hormone Research 65 (Suppl. 3), 50–58.CrossRefGoogle ScholarPubMed
Gitau, R, Cameron, A, Fisk, NM, Glover, V (1998). Fetal exposure to maternal cortisol. Lancet 352, 707–708.CrossRefGoogle ScholarPubMed
Glover, V (2015). Prenatal stress and its effects on the fetus and the child: possible underlying biological mechanisms. In Perinatal Programming of Neurodevelopment (ed. M. C. Antonelli), pp. 269–283. Springer: New York.CrossRefGoogle Scholar
Gluckman, PD, Hanson, MA, Cooper, C, Thornburg, KL (2008). Effect of in utero and early-life conditions on adult health and disease. New England Journal of Medicine 359, 61–73.CrossRefGoogle ScholarPubMed
Guldin, MB, Li, J, Pedersen, HS, Obel, C, Agerbo, E, Gissler, M, Cnattingius, S, Olsen, J, Vestergaard, M (2015). Incidence of suicide among persons who had a parent who died during their childhood: a population-based cohort study. JAMA Psychiatry 72, 1227–1234.CrossRefGoogle ScholarPubMed
Hansen, D, Lou, HC, Olsen, J (2000). Serious life events and congenital malformations: a national study with complete follow-up. Lancet 356, 875–880.CrossRefGoogle ScholarPubMed
Heron, M (2013). Deaths: leading causes for 2010. National vital Statistics Reports 62, 1–97.Google ScholarPubMed
Kapoor, A, Dunn, E, Kostaki, A, Andrews, MH, Matthews, SG (2006). Fetal programming of hypothalamo-pituitary-adrenal function: prenatal stress and glucocorticoids. Journal of Physiology 572, 31–44.CrossRefGoogle ScholarPubMed
Kapoor, A, Kostaki, A, Janus, C, Matthews, SG (2009). The effects of prenatal stress on learning in adult offspring is dependent on the timing of the stressor. Behavioural Brain Research 197, 144–149.CrossRefGoogle ScholarPubMed
Khashan, AS, Abel, KM, McNamee, R, Pedersen, MG, Webb, RT, Baker, PN, Kenny, LC, Mortensen, PB (2008). Higher risk of offspring schizophrenia following antenatal maternal exposure to severe adverse life events. Archives of General Psychiatry 65, 146–152.CrossRefGoogle ScholarPubMed
Khashan, AS, McNamee, R, Abel, KM, Mortensen, PB, Kenny, LC, Pedersen, MG, Webb, RT, Baker, PN (2009). Rates of preterm birth following antenatal maternal exposure to severe life events: a population-based cohort study. Human Reproduction 24, 429–437.CrossRefGoogle ScholarPubMed
Krozowski, Z (1999). The 11beta-hydroxysteroid dehydrogenases: functions and physiological effects. Molecular and Cellular Endocrinology 151, 121–127.CrossRefGoogle ScholarPubMed
Laszlo, KD, Li, J, Olsen, J, Vestergaard, M, Obel, C, Cnattingius, S (2016). Maternal bereavement and the risk of preterm delivery: the importance of gestational age and of the precursor of preterm birth. Psychological Medicine 46, 1163–1173.CrossRefGoogle ScholarPubMed
Laszlo, KD, Svensson, T, Li, J, Obel, C, Vestergaard, M, Olsen, J, Cnattingius, S (2013). Maternal bereavement during pregnancy and the risk of stillbirth: a nationwide cohort study in Sweden. American Journal of Epidemiology 177, 219–227.CrossRefGoogle ScholarPubMed
Li, J, Laursen, TM, Precht, DH, Olsen, J, Mortensen, PB (2005). Hospitalization for mental illness among parents after the death of a child. New England Journal of Medicine 352, 1190–1196.CrossRefGoogle ScholarPubMed
Li, J, Olsen, J, Vestergaard, M, Obel, C (2010). Attention-deficit/hyperactivity disorder in the offspring following prenatal maternal bereavement: a nationwide follow-up study in Denmark. European Child and Adolescent Psychiatry 19, 747–753.CrossRefGoogle ScholarPubMed
Li, J, Olsen, J, Vestergaard, M, Obel, C, Kristensen, JK, Virk, J (2012). Prenatal exposure to bereavement and type-2 diabetes: a Danish longitudinal population based study. PLoS ONE 7, e43508.CrossRefGoogle Scholar
Li, J, Precht, DH, Mortensen, PB, Olsen, J (2003). Mortality in parents after death of a child in Denmark: a nationwide follow-up study. Lancet 361, 363–367.CrossRefGoogle Scholar
Li, J, Vestergaard, M, Cnattingius, S, Gissler, M, Bech, BH, Obel, C, Olsen, J (2014). Mortality after parental death in childhood: a nationwide cohort study from three nordic countries. PLoS Medicine 11, e1001679.CrossRefGoogle ScholarPubMed
Li, J, Vestergaard, M, Obel, C, Cnattingus, S, Gissler, M, Olsen, J (2011). Cohort profile: the nordic perinatal bereavement cohort. International Journal of Epidemiology 40, 1161–1167.CrossRefGoogle ScholarPubMed
Li, J, Yang, H, Guldin, MB, Vedsted, P, Vestergaard, M (2015). Increased utilisation of primary healthcare in persons exposed to severe stress in prenatal life: a national population-based study in Denmark. BMJ Open 5, e005657.CrossRefGoogle ScholarPubMed
Marinescu, IP, Foarfa, MC, Pirlog, MC, Turculeanu, A (2014). Prenatal depression and stress – risk factors for placental pathology and spontaneous abortion. Romanian Journal of Morphology and Embryology 55, 1155–1160.Google ScholarPubMed
Mulder, EJ, Robles de Medina, PG, Huizink, AC, Van den Bergh, BR, Buitelaar, JK, Visser, GH (2002). Prenatal maternal stress: effects on pregnancy and the (unborn) child. Early Human Development 70, 3–14.CrossRefGoogle ScholarPubMed
Nielsen, NM, Hansen, AV, Simonsen, J, Hviid, A (2011). Prenatal stress and risk of infectious diseases in offspring. American Journal of Epidemiology 173, 990–997.CrossRefGoogle ScholarPubMed
Office for National Statistics (2012). Statistical bulletin: live births, stillbirths and infant deaths, babies born in 2009 in England and Wales (http://www.ons.gov.uk/ons/dcp171778_266305.pdf). Accessed 17 November 2015.Google Scholar
Patin, V, Lordi, B, Vincent, A, Thoumas, JL, Vaudry, H, Caston, J (2002). Effects of prenatal stress on maternal behavior in the rat. Developmental Brain Research 139, 1–8.CrossRefGoogle ScholarPubMed
Plana-Ripoll, O, Liu, X, Momen, NC, Parner, E, Olsen, J, Li, J (2016). Prenatal exposure to maternal stress following bereavement and cardiovascular disease: a nationwide population-based and sibling-matched cohort study. European Journal of Preventive Cardiology 23, 1018–1028.CrossRefGoogle ScholarPubMed
Skodol, AE, Shrout, PE (1989). Use of DSM-III axis-IV in clinical practice: rating etiologically significant stressors. American Journal of Psychiatry 146, 61–66.Google ScholarPubMed
Stroebe, M, Schut, H, Stroebe, W (2007). Health outcomes of bereavement. Lancet 370, 1960–1973.CrossRefGoogle ScholarPubMed
Virk, J, Li, J, Lauritsen, J, Olsen, J (2013). Risk of childhood injuries after prenatal exposure to maternal bereavement: a danish national cohort study. BMJ Open 3, e002357.CrossRefGoogle ScholarPubMed
Wadhwa, PD (2005). Psychoneuroendocrine processes in human pregnancy influence fetal development and health. Psychoneuroendocrinology 30, 724–743.CrossRefGoogle ScholarPubMed
Wainstock, T, Lerner-Geva, L, Glasser, S, Shoham-Vardi, I, Anteby, EY (2013). Prenatal stress and risk of spontaneous abortion. Psychosomatic Medicine 75, 228–235.CrossRefGoogle ScholarPubMed
Welberg, LA, Seckl, JR (2001). Prenatal stress, glucocorticoids and the programming of the brain. Journal of Neuroendocrinology 13, 113–128.CrossRefGoogle ScholarPubMed
Wisborg, K, Barklin, A, Hedegaard, M, Henriksen, TB (2008). Psychological stress during pregnancy and stillbirth: prospective study. British Journal of Obstetrics and Gynaecology 115, 882–885.CrossRefGoogle ScholarPubMed
Wolfe, I, Macfarlane, A, Donkin, A, Marmot, M, Viner, R (2014). Why children die: death in infants, children, and young people in the UK – Part A. Royal College of Paediatrics and Child Health (http://www.rcpch.ac.uk/sites/default/files/page/Death%20in%20infants,%20children%20and%20young%20people%20in%20the%20UK.pdf). Accessed 17 November 2015.Google Scholar
Yu, Y, Qin, G, Cnattingius, S, Gissler, M, Olsen, J, Zhao, N, Li, J (2016). Mortality in children aged 0–9 years: a nationwide cohort study from three nordic countries. PLoS ONE 11, e0146669.CrossRefGoogle Scholar
Zhu, JL, Olsen, J, Sorensen, HT, Li, J, Nohr, EA, Obel, C, Vestergaard, M, Olsen, MS (2013). Prenatal maternal bereavement and congenital heart defects in offspring: a registry-based study. Pediatrics 131, e1225–e1230.CrossRefGoogle ScholarPubMed
Supplementary material: File

Yu supplementary material

Figure S1 and Table S1

Download Yu supplementary material(File)
File 71.4 KB