Alexa A Freedman1,2, Gregory E Miller3,4, Lauren S Keenan-Devlin5, Britney P Smart6, Janedelie Romero6, Ann Borders5,7,8, Linda M Ernst9. 1. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, NorthShore University HealthSystem, Evanston, IL, USA. alexa.freedman@northwestern.edu. 2. Institute for Policy Research, Northwestern University, 1801 Maple Ave, Evanston, IL, 60201, USA. alexa.freedman@northwestern.edu. 3. Institute for Policy Research, Northwestern University, 1801 Maple Ave, Evanston, IL, 60201, USA. 4. Department of Psychology, Northwestern University, Evanston, IL, USA. 5. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, Evanston, IL, USA. 6. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, NorthShore University HealthSystem, Evanston, IL, USA. 7. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 8. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 9. Department of Pathology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL, USA.
Abstract
INTRODUCTION: Women exposed to stressful events during pregnancy are thought to be at increased risk of adverse birth outcomes. However, studies investigating stressful events are often unable to control for important confounders, such as behavioral and genetic characteristics, or to isolate the impact of the stressor from other secondary effects. We used a discordant-sibling design, which provides stronger inferences about causality, to examine whether a widespread stressor with limited impact on day-to-day life (John F. Kennedy assassination) resulted in an increased risk of adverse birth outcomes. METHODS: Data were obtained from the Collaborative Perinatal Project, a prospective, multi-site cohort study conducted in the US from 1959 to 1965. Our analysis was restricted to singleton live births ≥24 weeks born before the assassination (n = 24,406) or in utero at the time (n = 5833). We also evaluated associations within siblings discordant for exposure (n = 1144). We used survival analysis to evaluate associations between exposure and preterm birth and marginal models to evaluate associations with birthweight and placental pathology. RESULTS: First trimester exposure was associated with preterm birth (hazard ratio (HR): 1.17; 95% CI: 1.05, 1.31). In the discordant-sibling model, the point estimate was similar (HR: 1.22; 95% CI: 0.36, 4.06). Third trimester exposure was associated with increased odds of fetal acute inflammation in the placenta (odds ratio (OR): 1.34, 95% CI: 1.05, 1.71). CONCLUSIONS FOR PRACTICE: First trimester exposure to an acute stressor was associated with preterm birth. We did not observe increased odds of placental pathology with first trimester exposure; however, stress may increase preterm birth risk through chronic placental inflammation, which was not evaluated in this sample.
INTRODUCTION: Women exposed to stressful events during pregnancy are thought to be at increased risk of adverse birth outcomes. However, studies investigating stressful events are often unable to control for important confounders, such as behavioral and genetic characteristics, or to isolate the impact of the stressor from other secondary effects. We used a discordant-sibling design, which provides stronger inferences about causality, to examine whether a widespread stressor with limited impact on day-to-day life (John F. Kennedy assassination) resulted in an increased risk of adverse birth outcomes. METHODS: Data were obtained from the Collaborative Perinatal Project, a prospective, multi-site cohort study conducted in the US from 1959 to 1965. Our analysis was restricted to singleton live births ≥24 weeks born before the assassination (n = 24,406) or in utero at the time (n = 5833). We also evaluated associations within siblings discordant for exposure (n = 1144). We used survival analysis to evaluate associations between exposure and preterm birth and marginal models to evaluate associations with birthweight and placental pathology. RESULTS: First trimester exposure was associated with preterm birth (hazard ratio (HR): 1.17; 95% CI: 1.05, 1.31). In the discordant-sibling model, the point estimate was similar (HR: 1.22; 95% CI: 0.36, 4.06). Third trimester exposure was associated with increased odds of fetal acute inflammation in the placenta (odds ratio (OR): 1.34, 95% CI: 1.05, 1.71). CONCLUSIONS FOR PRACTICE: First trimester exposure to an acute stressor was associated with preterm birth. We did not observe increased odds of placental pathology with first trimester exposure; however, stress may increase preterm birth risk through chronic placental inflammation, which was not evaluated in this sample.
Authors: Katherine A Ahrens; Carol Louik; Stephen Kerr; Allen A Mitchell; Martha M Werler Journal: Paediatr Perinat Epidemiol Date: 2014-10-21 Impact factor: 3.980
Authors: T Yee Khong; Eoghan E Mooney; Ilana Ariel; Nathalie C M Balmus; Theonia K Boyd; Marie-Anne Brundler; Hayley Derricott; Margaret J Evans; Ona M Faye-Petersen; John E Gillan; Alex E P Heazell; Debra S Heller; Suzanne M Jacques; Sarah Keating; Peter Kelehan; Ann Maes; Eileen M McKay; Terry K Morgan; Peter G J Nikkels; W Tony Parks; Raymond W Redline; Irene Scheimberg; Mirthe H Schoots; Neil J Sebire; Albert Timmer; Gitta Turowski; J Patrick van der Voorn; Ineke van Lijnschoten; Sanne J Gordijn Journal: Arch Pathol Lab Med Date: 2016-05-25 Impact factor: 5.534
Authors: Stefanie N Hinkle; Paul S Albert; Pauline Mendola; Lindsey A Sjaarda; Edwina Yeung; Nansi S Boghossian; S Katherine Laughon Journal: Paediatr Perinat Epidemiol Date: 2013-12-09 Impact factor: 3.980
Authors: Marius Lahti-Pulkkinen; Melissa Jane Cudmore; Eva Haeussner; Christoph Schmitz; Anu-Katriina Pesonen; Esa Hämäläinen; Pia M Villa; Susanna Mehtälä; Eero Kajantie; Hannele Laivuori; Rebecca M Reynolds; Hans-Georg Frank; Katri Räikkönen Journal: Sci Rep Date: 2018-01-15 Impact factor: 4.379