title: Offspring psychopathology following preconception, prenatal and postnatal maternal bereavement stress.
abstract: BACKGROUND
  Preconception, prenatal and postnatal maternal stress is associated with increased offspring psychopathology, but findings are inconsistent and need replication. We estimated associations between maternal bereavement stress and offspring autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, suicide attempt and completed suicide.
  
  
  METHODS
  Using Swedish registers, we conducted the largest population-based study to date examining associations between stress exposure in 738,144 offspring born 1992-2000 for childhood outcomes and 2,155,221 offspring born 1973-1997 for adult outcomes with follow-up to 2009. Maternal stress was defined as death of a first-degree relative during (a) the 6 months before conception, (b) pregnancy or (c) the first two postnatal years. Cox proportional survival analyses were used to obtain hazard ratios (HRs) in unadjusted and adjusted analyses.
  
  
  RESULTS
  Marginal increased risk of bipolar disorder and schizophrenia following preconception bereavement stress was not significant. Third-trimester prenatal stress increased the risk of ASD [adjusted HR (aHR) 1.58, 95% confidence interval (CI) 1.15-2.17] and ADHD (aHR 1.31, 95% CI 1.04-1.66). First postnatal year stress increased the risk of offspring suicide attempt (aHR 1.13, 95% CI 1.02-1.25) and completed suicide (aHR 1.51, 95% CI 1.08-2.11). Bereavement stress during the second postnatal year increased the risk of ASD (aHR 1.30, 95% CI 1.09-1.55).
  
  
  CONCLUSIONS
  Further research is needed regarding associations between preconception stress and psychopathological outcomes. Prenatal bereavement stress increases the risk of offspring ASD and ADHD. Postnatal bereavement stress moderately increases the risk of offspring suicide attempt, completed suicide and ASD. Smaller previous studies may have overestimated associations between early stress and psychopathological outcomes.
authors.affiliation: Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
authors.forename: Q A
authors.initials: QA
authors.lastname: Class
authors.forename: K M
authors.initials: KM
authors.lastname: Abel
authors.forename: A S
authors.initials: AS
authors.lastname: Khashan
authors.forename: M E
authors.initials: ME
authors.lastname: Rickert
authors.forename: C
authors.initials: C
authors.lastname: Dalman
authors.forename: H
authors.initials: H
authors.lastname: Larsson
authors.forename: C M
authors.initials: CM
authors.lastname: Hultman
authors.forename: N
authors.initials: N
authors.lastname: Långström
authors.forename: P
authors.initials: P
authors.lastname: Lichtenstein
authors.forename: B M
authors.initials: BM
authors.lastname: D'Onofrio
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology; D001601:Bereavement; D001714:Bipolar Disorder / Q000453:epidemiology; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D018811:Maternal Exposure / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology*; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult