Stress during Pregnancy and Offspring Pediatric Disease: A National Cohort Study

Tegethoff, Marion; Greene, Naomi; Olsen, Jørn; Schaffner, Emmanuel; Meinlschmidt, Gunther

doi:10.1289/ehp.1003253

Cited by 112 publications

(102 citation statements)

References 80 publications

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“…Although all people are exposed to some degree of stress, as one moves lower on the SES ladder, exposure to chronic, toxic stress increases (43). Both animal and human studies link greater stress experienced by the mother during pregnancy with slower offspring growth, impaired immune functioning, damage to brain structure and functioning, and a range of pediatric illnesses (31,33,(44)(45)(46).…”

Section: Causality and Its Discontentsmentioning

confidence: 99%

Rigor, vigor, and the study of health disparities

Adler

Bush²,

Pantell

2012

Proc. Natl. Acad. Sci. U.S.A.

104

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Health disparities research spans multiple fields and methods and documents strong links between social disadvantage and poor health. Associations between socioeconomic status (SES) and health are often taken as evidence for the causal impact of SES on health, but alternative explanations, including the impact of health on SES, are plausible. Studies showing the influence of parents' SES on their children's health provide evidence for a causal pathway from SES to health, but have limitations. Health disparities researchers face tradeoffs between "rigor" and "vigor" in designing studies that demonstrate how social disadvantage becomes biologically embedded and results in poorer health. Rigorous designs aim to maximize precision in the measurement of SES and health outcomes through methods that provide the greatest control over temporal ordering and causal direction. To achieve precision, many studies use a single SES predictor and single disease. However, doing so oversimplifies the multifaceted, entwined nature of social disadvantage and may overestimate the impact of that one variable and underestimate the true impact of social disadvantage on health. In addition, SES effects on overall health and functioning are likely to be greater than effects on any one disease. Vigorous designs aim to capture this complexity and maximize ecological validity through more complete assessment of social disadvantage and health status, but may provide less-compelling evidence of causality. Newer approaches to both measurement and analysis may enable enhanced vigor as well as rigor. Incorporating both rigor and vigor into studies will provide a fuller understanding of the causes of health disparities.methodology | social determinants of health | cumulative risk G ood health and longevity are unequally distributed in populations. Although some unavoidable variations in health emanate from individual differences in vulnerability to disease, others are linked to membership in socially disadvantaged groups. The latter are unjust and have been the focus of considerable research and policy (1). Research on these health disparities has demonstrated consistent graded associations between various components of socioeconomic status (SES) and a wide range of health indicators; at each step up the social ladder, whether indexed by higher income, education, and/or occupational level, rates of morbidity and mortality decrease (2). The prevailing understanding of this relationship is that SES is a "fundamental cause" of health status (3), which operates through physical and/or psychosocial resources that are more readily available as SES increases, and hardships and adverse exposures that are more intense and frequent as SES decreases.Evidence for the SES-health gradient comes primarily from cross-sectional data linking contemporaneous measures of SES in adulthood with prevalence of disease, poor health, or mortality. Smaller literatures have established associations between socioeconomic conditions in childhood and childhood health, and betwe...

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Section: Causality and Its Discontentsmentioning

confidence: 99%

Rigor, vigor, and the study of health disparities

Adler

Bush²,

Pantell

2012

Proc. Natl. Acad. Sci. U.S.A.

104

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“…64 However, comorbidities may well be mediators of the observed associations, meaning that, in this case, comorbidities are only triggered by asthma, and adjusting for mediators bears the risk of underestimation. The same is true for psychosocial factors during pregnancy that have been shown to be associated with a wide range of offspring diseases, 26 and that may either trigger or be triggered by asthma. 65 Our findings have clinical and public health relevance, as asthma is a common serious medical problem to complicate pregnancy, with approximately up to 8% of pregnant women affected.…”

mentioning

confidence: 93%

Asthma During Pregnancy and Clinical Outcomes in Offspring: A National Cohort Study

Tegethoff¹,

Olsen

Schaffner

et al. 2013

Pediatrics

Self Cite

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WHAT'S KNOWN ON THIS SUBJECT: Asthma is a common medical complication during pregnancy that is associated with an increased risk of adverse obstetric outcomes. WHAT THIS STUDY ADDS:This study adds knowledge on potential long-term consequences of maternal asthma during pregnancy for offspring health, demonstrating that maternal asthma during pregnancy is linked to a wide spectrum of offspring diseases during childhood. abstract BACKGROUND AND OBJECTIVE: Maternal asthma is a common pregnancy complication, with adverse short-term effects for the offspring. The objective was to determine whether asthma during pregnancy is a risk factor of offspring diseases. METHODS:We studied pregnant women from the Danish National Birth Cohort (births: 1996Cohort (births: -2002; prospective data) giving birth to live singletons (n = 66 712 mother-child pairs), with 4145 (6.2%) women suffering from asthma during pregnancy. We estimated the associations between asthma during pregnancy and offspring diseases (International Classification of Diseases, 10th Revision diagnoses from national registries), controlling for potential confounders and validating findings by secondary analyses. RESULTS:Offspring median age at end of follow-up was 6.2 (3.6-8.9) years. Asthma was associated with an increased offspring risk of infectious and parasitic diseases (hazard ratio [HR] 1.34; 95% confidence interval [CI] 1.23-1.46), diseases of the nervous system (HR 1.43; CI 1.18-1.73), ear (HR 1.33; CI 1.19-1.48), respiratory system (HR 1.43; CI 1.34-1.52), and skin (HR 1.39; CI 1.20-1.60), and potentially (not confirmed in secondary analyses) of endocrine and metabolic disorders (HR 1.26; CI 1.02-1.55), diseases of the digestive system (HR 1.17; CI 1.04-1.32), and malformations (odds ratio 1.13; CI 1.01-1.26), but not of neoplasms, mental disorders, or diseases of the blood and immune system, circulatory system, musculoskeletal system, and genitourinary system. CONCLUSIONS:To the best of our knowledge, this is the first comprehensive study of the associations between asthma during pregnancy and a wide spectrum of offspring diseases. In line with previous data on selected outcomes, asthma during pregnancy may be a risk factor for numerous offspring diseases, suggesting that careful monitoring of women with asthma during pregnancy and their offspring is important. Dr Tegethoff conceptualized and designed the study, carried out the statistical analyses, interpreted data, drafted the initial manuscript, critically reviewed the manuscript, and obtained funding; Dr Olsen acquired data, interpreted data, critically reviewed the manuscript, and obtained funding; Mr Schaffner carried out the statistical analyses, interpreted data, and critically reviewed the manuscript; Dr Meinlschmidt conceptualized and designed the study, carried out the statistical analyses, interpreted data, critically reviewed the manuscript, and obtained funding; and all authors approved the final manuscript as submitted. Asthma is a frequently occurring medical condition in pregnancy, ...

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“…Stress may be a mediator through which parents transmit adverse effects to their children, in both conflict and non-conflict settings. In a large population-based cohort study, maternal stress during pregnancy was associated with a number of outcomes in children, including risk of infection and mental disorders [86]. Stress arising from childhood separation from parents during World War II was linked to longterm impairment in offspring social mobility and socioeconomic position [87].…”

Section: Intergenerational Associationsmentioning

confidence: 99%

Emotional Abuse Towards Children by Schoolteachers in Aden Governorate, Yemen: A Cross-Sectional Study

2015

Childhood Adversity and Developmental Effects

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Background: The short-and medium-term effects of conflict on population health are reasonably well documented. Less considered are its consequences across generations and potential harms to the health of children yet to be born. Discussion: Looking first at the nature and effects of exposures during conflict, and then at the potential routes through which harm may propagate within families, we consider the intergenerational effects of four features of conflict: violence, challenges to mental health, infection and malnutrition. Conflict-driven harms are transmitted through a complex permissive environment that includes biological, cultural and economic factors, and feedback loops between sources of harm and weaknesses in individual and societal resilience to them. We discuss the multiplicative effects of ongoing conflict when hostilities are prolonged. Summary: We summarize many instances in which the effects of war can propagate across generations. We hope that the evidence laid out in the article will stimulate research and -more importantly -contribute to the discussion of the costs of war; particularly in the longer-term in post-conflict situations in which interventions need to be sustained and adapted over many years.

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Stress during Pregnancy and Offspring Pediatric Disease: A National Cohort Study

Cited by 112 publications

References 80 publications

Rigor, vigor, and the study of health disparities

Rigor, vigor, and the study of health disparities

Asthma During Pregnancy and Clinical Outcomes in Offspring: A National Cohort Study

Emotional Abuse Towards Children by Schoolteachers in Aden Governorate, Yemen: A Cross-Sectional Study

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