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- Title
Prenatal Exposure to Severe Stress and Risks of Ischemic Heart Disease and Stroke in Offspring.
- Authors
Yang, Fen; Janszky, Imre; Roos, Nathalie; Li, Jing; László, Krisztina D.
- Abstract
Key Points: Question: Is prenatal stress associated with increased risks of ischemic heart disease (IHD) and stroke in the offspring? Findings: In this cohort study including 6.8 million participants from Denmark and Sweden, no association between maternal stress during pregnancy, defined as loss of a close relative, and the offspring's risk of IHD and stroke up to middle-age was observed. However, maternal bereavement in the third trimester was associated with an increased risk of IHD. Meaning: The findings of this study suggest that severe maternal stress during pregnancy is not associated with IHD and stroke risk up to middle-age in the offspring. Importance: Prenatal stress is associated with increased risks of several cardiovascular risk factors later in life. However, knowledge regarding the role of prenatal stress in the development of ischemic heart disease (IHD) and stroke is very limited. Objective: To examine prenatal stress, defined as maternal bereavement, and risks of IHD and stroke in the offspring. Design, Setting, and Participants: A cohort study was conducted using data from Danish and Swedish registries. Live singleton births during calendar years 1973-2016 in Denmark (followed up until December 31, 2016) and during calendar years 1973-2014 in Sweden (followed up until December 31, 2021) were included in the analysis. Exposure: Maternal loss of a close family member (partner, older children, parents, or siblings) the year before or during the pregnancy. Main Outcome and Measures: Diagnoses of IHD and stroke. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for IHD and stroke in the offspring according to maternal bereavement. Results: The study included 6 758 560 births (39.4% from Denmark; 51.4% boys). During the median follow-up of 24.6 (IQR, 13.9-35.1) years, 8664 offspring (0.1%) were diagnosed with IHD and 13 094 with stroke (0.2%). Overall, maternal bereavement the year before or during pregnancy was not associated with IHD (adjusted HR [AHR], 0.98; 95% CI, 0.85-1.13) or stroke (AHR, 1.04; 95% CI, 0.94-1.16) in offspring. Similarly, no associations were observed when exposure was classified by the mother's relationship to the deceased individual, ie, loss of older child or partner (HR, 0.85; 95% CI, 0.64-1.14 for IHD and 0.98; 95% CI, 0.77-1.25 for stroke) or loss of parent or sibling (HR, 1.03; 95% CI, 0.87-1.21 for IHD and 1.06; 95% CI, 0.94-1.19 for stroke). However, associations between loss in the third trimester and IHD (AHR, 1.50; 95% CI, 1.06-2.13), and loss due to cardiovascular disease and stroke (AHR, 1.22; 95% CI, 1.03-1.44) were identified when exposure was classified by time of loss or the relative's cause of death. Conclusions and Relevance: The findings of this study provide little support for the hypothesis that prenatal stress is associated with risks of IHD and stroke in the first 5 decades of life. However, the association observed between stress in the third trimester and IHD warrants further investigation. This cohort study examines the risk of ischemic heart disease and stroke in adults who were exposed to prenatal stress when their mothers experienced the death of a close family member.
- Subjects
SWEDEN; DENMARK; REPORTING of diseases; CAUSES of death; STROKE; CONFIDENCE intervals; MYOCARDIAL ischemia; THIRD trimester of pregnancy; CARDIOVASCULAR diseases; PREGNANT women; PRENATAL exposure delayed effects; RISK assessment; SEVERITY of illness index; DESCRIPTIVE statistics; DATA analysis software; BEREAVEMENT; PSYCHOLOGICAL stress; LONGITUDINAL method; PROPORTIONAL hazards models; DISEASE risk factors; DISEASE complications; CHILDREN; ADULTS; MIDDLE age; PREGNANCY
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2349463
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.49463