Study: Infant health is influenced by mothers' prenatal fears

reference

Beijers R, Jansen J, Riksen-Walraven M, de Weerth C. Maternal prenatal anxiety and stress predict infant illness and health problems.Pediatrics. 2010;126(2):e401-409.

design

Prospective cohort study.

Participant

174 mothers with normal pregnancies and term deliveries in the Netherlands completed questionnaires during their third trimester to quantify stress and anxiety and provided saliva samples to assess cortisol levels. The subjects were then surveyed monthly during the infants' first year of life to determine the frequency of illnesses and the use of antibiotics.

Key findings

Adjustments were made for confounders including maternal smoking and alcohol consumption, duration of breastfeeding, and daycare attendance, among others. The results suggest that maternal stress and anxiety are positive predictors of infant illness and antibiotic use in the first year of life. In particular, the results show a connection between increased maternal stress and anxiety as well as respiratory, skin and general diseases as well as the use of antibiotics, but not digestive diseases. There was also a link between higher evening cortisol levels or flattened daytime cortisol rhythms and an increased incidence of infant illness.

Effects on practice

A number of studies have previously shown that maternal stress has a negative impact on infant temperament and cognitive development; However, this is the first study to examine the impact of prenatal maternal stress on the incidence of infant illness.^1,2,3Evidence from this and previous studies suggests that the effects of elevated cortisol and maternal stress and anxiety have the greatest influence on postnatal outcomes in the third trimester.⁴In fact, it has been reported that women exposed to natural disasters in the second and third trimesters (such as Hurricanes Andrew and Katrina in the United States) had an increased risk of fetal distress compared to women exposed in the first trimester.^5.6

Stress is known to activate beta-adrenergic receptors, which can affect various aspects of cognitive function.⁷A study by Connors et al. from 2008 suggests that overstimulation of beta-adrenergic receptors by stress or medications such as terbutaline (given to prevent premature labor) is associated with an increased risk of autism.^8.9By linking this to increased infant illnesses, this study may also indicate a link between the influence of maternal stress on the intrauterine environment and immune deficiency in neurodevelopmental disorders such as autism.¹⁰

Factors such as social and cultural norms, paternal social support and involvement, guidance and support from health care providers, education, and work environment contribute to a woman's decision to breastfeed.

Factors such as social and cultural norms, paternal social support and involvement, guidance and support from health care providers, education, and work environment contribute to a woman's decision to breastfeed. It then seems reasonable that these factors also influence the mother's stress and anxiety.^11,12,13Although researchers adjusted for breastfeeding, it should still be considered that mothers who report higher levels of prenatal stress and anxiety may also be less likely to breastfeed. The positive impact of breastfeeding on the developing immune system is well known and its protective effects should not be overlooked; It may not reduce the frequency of illnesses, but it may potentially reduce their severity.¹⁴Breastfeeding should continue to be encouraged, especially among mothers with higher levels of stress and anxiety.

This study highlights the importance of managing stress and anxiety in pregnant patients. Both self-assessment questionnaires and cortisol levels were found to be predictive of infant illness and antibiotic use. Therefore, it is definitely worth considering both parameters as tools for monitoring this population in practice, potentially saving time during the interview to assess the mother's stress level and her support resources. Early detection and intervention by the doctor can certainly help reduce the mother's stress and anxiety and thereby reduce illness in infants and the use of antibiotics.

Further research is certainly needed to both confirm the results of this particular study and to determine the therapeutic implications of how reducing maternal stress and anxiety in the third trimester may impact infant health.