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Prenatal maternal bereavement and mortality in the first decades of life: a nationwide cohort study from Denmark and Sweden

Published online by Cambridge University Press:  20 October 2016

Y. Yu ,
S. Cnattingius ,
J. Olsen ,
E. T. Parner ,
M. Vestergaard ,
Z. Liew ,
N. Zhao  and
J. Li
Y. Yu*
Affiliation:
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
S. Cnattingius
Affiliation:
Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
J. Olsen
Affiliation:
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
E. T. Parner
Affiliation:
Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
M. Vestergaard
Affiliation:
Department of Public Health, Research Unit for General Practice and Section for General Medical Practice, Aarhus University, Aarhus, Denmark
Z. Liew
Affiliation:
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
N. Zhao
Affiliation:
Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
J. Li
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
*
*Address for correspondence: Y. Yu, MSc, Section for Epidemiology, Department of Public Health, Aarhus University, Artholins Alle 2, DK 8000 Aarhus C, Denmark. (Email: yoyu@ph.au.dk)
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Abstract

Background

The loss of a close relative is one of the most stressful life events. In pregnancy, this experience has been associated with a higher risk of fetal death and under-five mortality, but little is known about potential effects on long-term mortality in offspring. We examined the association between prenatal maternal bereavement and mortality in a cohort of 5.3 million children followed until up to 37 years of age.

Method

The population-based cohort study included 5 253 508 live singleton births in Denmark (1973–2004) and Sweden (1973–2006). Children born to mothers who lost a child, spouse, sibling, or parent during or 1 year before pregnancy were categorized as exposed.

Results

Prenatal maternal bereavement was associated with a 10% increased all-cause mortality risk in offspring [mortality rate ratio (MRR) 1.10, 95% confidence interval (CI) 1.03–1.18]. The association was the most pronounced for children of mothers who lost a child/spouse (MRR 1.28, 95% CI 1.14–1.44) and was stronger during the first 10 years of life. Prenatal maternal bereavement may have stronger effects on natural causes of death in offspring, including infectious/parasitic disease (MRR 1.86, 95% CI 1.07–3.23), endocrine/nutritional/metabolic diseases (MRR 3.23, 95% CI 2.02–5.17), diseases of nervous system (MRR 3.36, 95% CI 2.47–4.58), and congenital malformations (MRR 1.39, 95% CI 1.08–1.80). No excess mortality risk in offspring was observed for unnatural causes of death.

Conclusion

Prenatal maternal bereavement was associated with an increased long-term mortality risk in offspring, particularly for selected natural causes of diseases and medical conditions. Our results support the fetal programming hypothesis that prenatal stress may contribute to ill health from physical diseases later in life.

Keywords

Bereavementdisease programmingmortalitypregnancystress
Type
Review Article
Information
Psychological Medicine , Volume 47 , Issue 3 , February 2017 , pp. 389 - 400
Copyright
Copyright © Cambridge University Press 2016 

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