Offspring psychopathology following preconception, prenatal and postnatal maternal bereavement stress

Q. A. Class, K. M. Abel, A. S. Khashan, M. E. Rickert, C. Dalman, H. Larsson, C. M. Hultman, N. Långström, P. Lichtenstein, B. M. D'Onofrio

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    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. Method Using Swedish registers, we conducted the largest population-based study to date examining associations between stress exposure in 738Â 144 offspring born 1992-2000 for childhood outcomes and 2Â 155Â 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. © 2013 Cambridge University Press.
    Original languageEnglish
    Pages (from-to)71-84
    Number of pages13
    JournalPsychological Medicine
    Issue number1
    Publication statusPublished - 1 Jan 2014


    • Attention deficit hyperactivity disorder
    • autism
    • postnatal
    • preconception
    • prenatal
    • psychiatric
    • psychopathology
    • schizophrenia
    • stress
    • suicide


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