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Examining the link between women's exposure to stressful life events prior to conception and infant and toddler health: the role of birth weight
  1. Erika R Cheng1,
  2. Hyojun Park2,
  3. Lauren E Wisk3,
  4. Kara C Mandell2,
  5. Fathima Wakeel4,
  6. Kristin Litzelman5,
  7. Debanjana Chatterjee6,
  8. Whitney P Witt7
  1. 1Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
  2. 2Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  3. 3Division of Adolescent/Young Adult Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
  4. 4Public Health Programs, College of Health Professions, Ferris State University, Big Rapids, Michigan, USA
  5. 5National Cancer Institute, Bethesda, Maryland, USA
  6. 6Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
  7. 7Truven Health Analytics, Durham, North Carolina, USA
  1. Correspondence to Dr Whitney P Witt, Center for Maternal and Child Health Research, Truven Health Analytics, 4819 Emperor Boulevard, Suite 125, Durham, NC 27703, USA; whitney.witt{at}


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.

  • Life course epidemiology

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