Early prenatal food supplementation ameliorates the negative association of maternal stress with birth size in a randomised trial

Abstract

Low birth weight increases the risk of infant mortality, morbidity, and poor development. Maternal nutrition and stress influence birth size, but their combined effect is not known. We hypothesized that an early invitation time to start a prenatal food supplementation program could reduce the negative influence of prenatal maternal stress on birth size, and that effect would differ by infant sex. A cohort of 1041 pregnant women, who had delivered an infant, June 2003-March 2004, was sampled from among 3267 in the randomized controlled trial, Maternal Infant Nutritional Interventions Matlab, conducted in Matlab, Bangladesh. At 8 wk gestation, women were randomly assigned an invitation to start food supplements (2.5 MJ/d; 6 d/wk) either early (~9 wk gestation; early-invitation group) or at usual start time for the governmental program (~20 wk gestation; usual-invitation group). Morning concentration of cortisol was measured from 1 saliva sample/woman at 28-32 wk gestation to assess stress. Birth size measurements for 90% of infants were collected within 4 d of birth. In a general linear model, there was an interaction between invitation time to start the food supplementation program and cortisol with birth weight, length, and head circumference of male infants, but not female infants. Among the usual-invitation group only, male infants whose mothers had higher prenatal cortisol weighed less than those whose mothers had lower prenatal cortisol. Prenatal food supplementation programs that begin first trimester may support greater birth size of male infants despite high maternal stress where low birth weight is a public health concern.

Sex Differences in Vulnerability to Prenatal Stress: a Review of the Recent Literature

“…Edwards et al ( N  = 196) evaluated the association between prenatal maternal depression and a global measure of neonatal health problems (e.g., prematurity, low Apgar scores, low birth weight), with no evidence of sex-dependent associations [73]. Within the context of a randomized controlled trial ( N = 1041), Frith et al found that maternal prenatal salivary cortisol concentration was negatively associated with infant birth weight and head circumference only among male children whose mothers were randomized to the usual care condition [56]. Kaitz et al ( N  = 212) reported significant interactions between maternal third trimester anxiety and child sex in predicting both third trimester fetal weight and birth weight.…”

Experiencing Lifetime Domestic Violence: Associations with Mental Health and Stress among Pregnant Women in Rural Bangladesh: The MINIMat Randomized Trial

“…Each participant was visited in her home by a field worker between 7–8 am (approximately 30 min to 1 h post awakening) for the collection of one salivary sample. The timing of cortisol collection in this population has been validated as a representative measure of morning cortisol [33]. Each participants was given a cylindrical cotton swab, chewed on it for 30–45 s or until it was fully saturated, and placed it in a test tube with cap.…”

“…The limited research of DV and cortisol among non-pregnant and pregnant women is contradictory, however, as the experience of DV has been associated with higher levels of morning cortisol [14], or no change in levels of morning cortisol with higher levels of evening cortisol [12,15]. While effects of these adaptations are not fully known, an altered level of cortisol can disturb women’s neural, neuroendocrine and immune functions, making them more susceptible to metabolic diseases, immune disorders [16,17], and poor birth outcomes [18,19]. …”

Adolescent pregnancy and nutrition: a subgroup analysis from the Mamachiponde study in Malawi

“…In order to meet the nutrient demands of pregnancy, it is ideal that women have optimal nutrition and health before becoming pregnant . Unfortunately, many pregnant adolescents in developing countries have inadequate nutrient reserves, placing them at increased risk of fetal growth restriction, preterm birth, and other adverse neonatal and maternal outcomes .…”