Examining the link between women's exposure to stressful life events prior to conception and infant and toddler health: the role of birth weight.
BACKGROUND
The life course perspective suggests a pathway may exist among maternal exposure to stressful life events prior to conception (PSLEs), infant birth weight and subsequent offspring health, whereby PSLEs are part of a 'chains-of-risk' that set children on a certain health pathway. No prior study has examined the link between PSLEs and offspring health in a nationally representative sample of US mothers and their children. We used longitudinal, nationally representative data to evaluate the relation between maternal exposure to PSLEs and subsequent measures of infant and toddler health, taking both maternal and obstetric characteristics into account.


METHODS
We examined 6900 mother-child dyads participating in 2 waves of the nationally representative Early Childhood Longitudinal Study-Birth Cohort (n=6900). Infant and toddler health outcomes assessed at 9 and 24 months included overall health status, special healthcare needs and severe health conditions. Adjusted path analyses examined associations between PSLEs, birth weight and child health outcomes.


RESULTS
In adjusted analyses, PSLEs increased the risk for very low birth weight (VLBW, <1500 g), which, in turn, predicted poor health at both 9 and 24 months of age. Path analyses demonstrated that PSLEs had small indirect effects on children's subsequent health that operated through VLBW.


CONCLUSIONS
Our analysis suggests a chains-of-risk model in which women's exposure to PSLEs increases the risk for giving birth to a VLBW infant, which, in turn, adversely affects infant and toddler health. Addressing women's preconception health may have important downstream benefits for their children, although more research is needed to replicate these findings.
Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Erika R
ER
Cheng
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Hyojun
H
Park
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
Lauren E
LE
Wisk
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Kara C
KC
Mandell
Public Health Programs, College of Health Professions, Ferris State University, Big Rapids, Michigan, USA.
Fathima
F
Wakeel
National Cancer Institute, Bethesda, Maryland, USA.
Kristin
K
Litzelman
Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
Debanjana
D
Chatterjee
Truven Health Analytics, Durham, North Carolina, USA.
Whitney P
WP
Witt
D000328:Adult; D001724:Birth Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D019102:Infant, Very Low Birth Weight; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications*
BIRTH WEIGHT; CHILD HEALTH; Life course epidemiology; MATERNAL HEALTH; PSYCHOSOCIAL FACTORS