Second-trimester maternal distress increases the risk of small for gestational age

TY - JOUR

T1 - Second-trimester maternal distress increases the risk of small for gestational age

AU - Khashan, A. S.

AU - Everard, C.

AU - McCowan, L. M. E.

AU - Dekker, G.

AU - Moss-Morris, R.

AU - Baker, P. N.

AU - Poston, L.

AU - Walker, J. J.

AU - Kenny, L. C.

AU - SCOPE Consortium

PY - 2014/10

Y1 - 2014/10

N2 - Background. The effect of prenatal distress on the risk of a small for gestational age (SGA) infant is uncertain. We have addressed the influences of prenatal stress, anxiety and depression on the risk of SGA. We also examined the effects of infant sex and timing of distress during pregnancy on any observed associations.Method. The study population comprised 5606 healthy nulliparous pregnant women who participated in the international prospective Screening for Obstetric and Pregnancy Endpoints (SCOPE) study. Women completed the Perceived Stress Scale (PSS), the short form of the Spielberger State-Trait Anxiety Inventory (STAI) and the Edinburgh Postnatal Depression Scale (EPDS) at 15 +/- 1 and 20 +/- 1 weeks' gestation. SGA was defined as birthweight below the 10th customized percentile. Logistic regression was used for data analysis, adjusting for several potential confounders such as maternal age, body mass index (BMI), smoking, socio-economic status and physical exercise.Results. The risk of SGA was increased in relation to mild [adjusted odds ratio (aOR) 1.35, 95% confidence interval (CI) 1.07-1.71], moderate (aOR 1.26, 95% CI 1.06-1.49), high (aOR 1.45, 95% CI 1.08-1.95) and very high stress scores (aOR 1.56, 95% CI 1.03-2.37); very high anxiety score (aOR 1.45, 95% CI 1.13-1.86); and very high depression score (aOR 1.14, 95% CI 1.05-1.24) at 20 +/- 1 weeks' gestation. Sensitivity analyses showed that very high anxiety and very high depression increases the risk of SGA in males but not in females whereas stress increases the risk of SGA in both males and females.Conclusions. These findings suggest that prenatal stress, anxiety and depression measured at 20 weeks' gestation increase the risk of SGA. The effects of maternal anxiety and depression on SGA were strongest in male infants.

AB - Background. The effect of prenatal distress on the risk of a small for gestational age (SGA) infant is uncertain. We have addressed the influences of prenatal stress, anxiety and depression on the risk of SGA. We also examined the effects of infant sex and timing of distress during pregnancy on any observed associations.Method. The study population comprised 5606 healthy nulliparous pregnant women who participated in the international prospective Screening for Obstetric and Pregnancy Endpoints (SCOPE) study. Women completed the Perceived Stress Scale (PSS), the short form of the Spielberger State-Trait Anxiety Inventory (STAI) and the Edinburgh Postnatal Depression Scale (EPDS) at 15 +/- 1 and 20 +/- 1 weeks' gestation. SGA was defined as birthweight below the 10th customized percentile. Logistic regression was used for data analysis, adjusting for several potential confounders such as maternal age, body mass index (BMI), smoking, socio-economic status and physical exercise.Results. The risk of SGA was increased in relation to mild [adjusted odds ratio (aOR) 1.35, 95% confidence interval (CI) 1.07-1.71], moderate (aOR 1.26, 95% CI 1.06-1.49), high (aOR 1.45, 95% CI 1.08-1.95) and very high stress scores (aOR 1.56, 95% CI 1.03-2.37); very high anxiety score (aOR 1.45, 95% CI 1.13-1.86); and very high depression score (aOR 1.14, 95% CI 1.05-1.24) at 20 +/- 1 weeks' gestation. Sensitivity analyses showed that very high anxiety and very high depression increases the risk of SGA in males but not in females whereas stress increases the risk of SGA in both males and females.Conclusions. These findings suggest that prenatal stress, anxiety and depression measured at 20 weeks' gestation increase the risk of SGA. The effects of maternal anxiety and depression on SGA were strongest in male infants.

KW - Estimated fetal weight

KW - prenatal anxiety

KW - prenatal depression

KW - prenatal stress

KW - small for gestational age

KW - INTERNATIONAL PROSPECTIVE COHORT

KW - PITUITARY-ADRENAL-FUNCTION

KW - POPULATION-BASED COHORT

KW - SEVERE LIFE EVENTS

KW - LOW-BIRTH-WEIGHT

KW - PRENATAL STRESS

KW - 11-BETA-HYDROXYSTEROID DEHYDROGENASE

KW - PSYCHOLOGICAL DISTRESS

KW - FETAL WEIGHT

KW - PREGNANCY

U2 - 10.1017/S0033291714000300

DO - 10.1017/S0033291714000300

M3 - Article

SN - 0033-2917

VL - 44

SP - 2799

EP - 2810

JO - Psychological Medicine

JF - Psychological Medicine

IS - 13

ER -