Modeling Prenatal Adversity/Advantage: Effects on Birth Weight

Abstract

ImportanceHow maternal experiences of adversity/advantage during pregnancy impact the developing fetus remains unclear.ObjectiveUsing prospective data about experiences of adversity/advantage and other factors known to impact fetal developmental, we explored how these risk and protective factors relate to each other and impact infant birth weight by gestational age.DesignA prospective study that collected data on of forms of social advantage/disadvantage, and psychological factors from pregnant women during each trimester of pregnancy that accounted for maternal medical and nutritional status. We aimed to determine the differential impact of social advantage/disadvantage and adversity and psychological factors on infant birthweight accounting for gestational age. Structural Equation Modeling (SEM) was used to investigate the relationship of these forms of adversity as latent constructs on infant outcome. The follow-up of children is ongoing as a part of the Early Life Adversity Biological Embedding and Risk for Developmental Precursors of Mental Disorders (eLABE). Data collection was conducted from 2017-2020.SettingAn academic medical center.ParticipantsPregnant women who were participants in a study of preterm birth within the Prematurity Research Center at Washington University in St. Louis with negative drug screens (other than cannabis) and without known pregnancy complications or known fetal congenital problems, were invited for participation. N=395 mothers were included in the analysis and N=268 eligible subjects declined participation. N=399 singleton offspring were included.Main Outcome(s) and Measure(s)Birthweight accounting for gestational age.ResultsThe study included N=395 pregnant women and their N=399 singleton offspring. The Social Advantage latent factor significantly predicted the residual birthweight after accounting for gestational age (p=.006) representing a 2.57% increase in residual gestational age-adjusted birthweight for each one standard deviation increase in the Social Advantage. The only other significant predictor was pre-pregnancy BMI (p=.019) which was associated with increased birthweight by gestational age while the Psychosocial Stress factor was no longer significant when other factors were accounted for.Conclusions and RelevanceFindings elucidate the significant effects of social adversity on the developing fetus and underscore the need to protect pregnant women in this risk group.Key PointsQuestion: What are the differential effects of social adversity/advantage and psychosocial stress during pregnancy on fetal development evidenced by birthweight?Findings: Psychosocial adversity/advantage significantly impacted birthweight after accounting for other salient risk factors including maternal physical health.Meaning: Resources and interventions for pregnant women experiencing social adversity should become a public health priority for the protection of the developing fetus.

Prenatal Exposure to Early Life Adversity and Neonatal Brain Volumes at Birth

“…Second, this study did not assess other environmental exposures such as lead and air pollution, which may be linked with both poverty and aberrant brain development in offspring. Third, as described in Luby et al, 37 we did not investigate the role of race in this analysis due to the co-linearity between race and social disadvantage. This sample reflects the clear link between racial disparities and social disadvantage in the United States and provides justification for including a measure of racial discrimination.…”

“…In this longitudinal, observational, multi-wave, multi-method NIMH-funded collaborative study, a cohort of pregnant women who participated in a large-scale study of preterm birth within the March of Dimes Prematurity Research Center at Washington University in St. Louis were recruited from 2017-2020. Women from the parent study were invited to participate in this investigation (see Luby, et al for cohort details) 37 with the following exclusion criteria: multiple gestations, diagnosed infections known to cause congenital disease (e.g., toxoplasmosis), and/or alcohol or drug use (excluding tobacco and marijuana). Participating mothers completed assessments during each trimester of pregnancy and at delivery.…”

“…As described in Luby et al, confirmatory factor analysis was used to derive two composite measures of Maternal Social Advantage and Maternal Psychological Stress. 37 The following datapoints were used to estimate Social Advantage: household Income to Needs Ratio (I/R) 38 in each trimester, national Area Deprivation Index (ADI) percentiles, 39 Healthy Eating Index (HEI), 40 highest level of educational attainment, and health insurance status. Race was highly correlated with Social Advantage, offering no additional improvement to the model after other variables (including racial discrimination) were accounted for and, thus, it was not included in the latent Advantage composite.…”

Association of Prenatal Exposure to Early-Life Adversity With Neonatal Brain Volumes at Birth

“…In this longitudinal, observational, multiwave, multimethod collaboration, a cohort of pregnant women who participated in a large-scale study of preterm birth 44 within the Washington University in St Louis March of Dimes Prematurity Research Center were recruited from September 1, 2017, to February 28, 2020. Women from the parent study (n = 663) were invited to participate in this investigation (see Luby et al 45 for cohort details) with the following exclusion criteria: multiple gestation, infections known to cause congenital disease (eg, syphilis), and/or alcohol or drug use other than tobacco and marijuana. A total of 395 eligible participating mothers completed assessments during each trimester of pregnancy and at delivery.…”

“…Confirmatory factor analysis was used to derive 2 latent maternal social disadvantage and maternal psychosocial stress constructs. 45 The following maternal measures were included in the social disadvantage construct: health insurance status (grouped by private insurance or public or no insurance), highest educational level, income-to-needs ratio 47 in each trimester, national Area Deprivation Index percentile at birth, 48 and Healthy Eating Index. 49 The following maternal psychological measures were included in the psychosocial stress construct: Perceived Stress Scale 50 and Edinburgh Postnatal Depression Scale (EPDS) 51 in each trimester, Stress and Adversity Inventory, 52 and Everyday Discrimination Scale (eMethods in the Supplement ).…”