Kenneth Ayuurebobi Ae-Ngibise1,2, Blair J Wylie3, Ellen Boamah-Kaali1, Darby W Jack4, Felix Boakye Oppong1, Steven N Chillrud5, Stephaney Gyaase1, Seyram Kaali1, Oscar Agyei1, Patrick L Kinney6, Mohammed Mujtaba1, Rosalind J Wright7,8, Kwaku Poku Asante1, Alison G Lee9. 1. Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana. 2. School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia. 3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 4. Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA. 5. Lamont-Doherty Earth Observatory at Columbia University, Palisades, NY, USA. 6. Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA. 7. Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 8. Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 9. Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA. Alison.Lee@mssm.edu.
Abstract
BACKGROUND: In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. METHODS: Leveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined. RESULTS: In all children, high prenatal maternal stress was associated with reduced birth length (β = - 0.91, p = 0.04; p-value for trend = 0.04). Among girls, moderate and high prenatal maternal stress was associated with reduced birth weight (β = - 0.16, p = 0.02; β = - 0.18, p = 0.04 respectively; p-value for trend = 0.04) and head circumference (β = - 0.66, p = 0.05; β = - 1.02, p = 0.01 respectively; p-value for trend = 0.01). In girls, high prenatal stress increased odds of any adverse birth outcome (OR 2.41, 95% CI 1.01-5.75; p for interaction = 0.04). Sex-specific analyses did not demonstrate significant effects in boys. CONCLUSIONS: All infants, but especially girls, were vulnerable to effects of prenatal maternal stress on birth outcomes. Understanding risk factors for impaired fetal growth may help develop preventative public health strategies. TRIAL REGISTRATION: NCT01335490 (prospective registration). Date of Registration: April 14, 2011. Status of Registration: Completed.
BACKGROUND: In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. METHODS: Leveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined. RESULTS: In all children, high prenatal maternal stress was associated with reduced birth length (β = - 0.91, p = 0.04; p-value for trend = 0.04). Among girls, moderate and high prenatal maternal stress was associated with reduced birth weight (β = - 0.16, p = 0.02; β = - 0.18, p = 0.04 respectively; p-value for trend = 0.04) and head circumference (β = - 0.66, p = 0.05; β = - 1.02, p = 0.01 respectively; p-value for trend = 0.01). In girls, high prenatal stress increased odds of any adverse birth outcome (OR 2.41, 95% CI 1.01-5.75; p for interaction = 0.04). Sex-specific analyses did not demonstrate significant effects in boys. CONCLUSIONS: All infants, but especially girls, were vulnerable to effects of prenatal maternal stress on birth outcomes. Understanding risk factors for impaired fetal growth may help develop preventative public health strategies. TRIAL REGISTRATION: NCT01335490 (prospective registration). Date of Registration: April 14, 2011. Status of Registration: Completed.
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