Maternal stress before and during pregnancy and subsequent infertility in daughters: a nationwide population-based cohort study

Abstract STUDY QUESTION Is maternal stress following the death of a close relative before or during pregnancy associated with the risk of infertility in daughters? SUMMARY ANSWER Compared with unexposed women, women whose mothers had experienced bereavement stress during, or in the year before, preg...

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Bibliographic Details
Published in:Human reproduction (Oxford) 2016-02, Vol.31 (2), p.454-462
Main Authors: Plana-Ripoll, O., Li, J., Kesmodel, U.S., Olsen, J., Parner, E., Basso, O.
Format: Article
Language:English
Subjects:
Adult
Bereavement
Cohort Studies
Denmark
Female
Humans
Infertility, Female - etiology
Mothers
Nuclear Family
Pregnancy
Pregnancy Trimester, First
Prenatal Exposure Delayed Effects
Proportional Hazards Models
Risk Factors
Stress, Psychological - complications
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Summary:Abstract STUDY QUESTION Is maternal stress following the death of a close relative before or during pregnancy associated with the risk of infertility in daughters? SUMMARY ANSWER Compared with unexposed women, women whose mothers had experienced bereavement stress during, or in the year before, pregnancy had a similar risk of infertility overall, but those exposed to maternal bereavement during the first trimester had a higher risk of infertility. WHAT IS KNOWN ALREADY Animal studies have shown that prenatal maternal stress results in reduced offspring fertility. In humans, there is evidence that girls who have been prenatally exposed to stress have a more masculine behaviour and a slight delay in having their first child. STUDY DESIGN, SIZE AND DURATION This population-based cohort study, included 660 099 females born in Denmark between 1 January 1973 and 31 December 1993 to mothers of Danish origin and with at least one living relative in the exposure window, and followed the women through 31 December 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS Overall, 13 334 women (2.0%) were considered prenatally exposed to stress because their mother had lost a spouse/partner, a child, a parent, or a sibling during pregnancy or in the year before conception. Infertility was defined as any record of infertility treatment or diagnosis of female infertility. We considered the date of onset as the date of the first appearance of any such record. The association between exposure and outcome was examined using hazard ratios (HR) with 95% confidence intervals (CI). MAIN RESULTS AND THE ROLE OF CHANCE Based on our definition, 40 052 (6.5%) women were infertile in the follow-up period (median age at the end of follow-up: 26.7 years, maximum age: 39 years). Overall, prenatal exposure to maternal stress was not associated with risk of infertility (adjusted HR = 1.04 [CI: 0.95–1.14]). However, women prenatally exposed during the first trimester had a higher estimated risk (adjusted HR = 1.40 [CI: 1.05–1.86]). These findings were consistent in subgroups defined by the relationship of the mother to the deceased and in several sensitivity analyses, including a sibling-matched analysis, and in analyses restricted to women who were married or cohabitating with a man, or to women born at term. LIMITATIONS, REASONS FOR CAUTION We did not have a direct measure of stress, but bereavement due to death of a close relative is likely to be very stressful. We based the timing of exposure o
ISSN:0268-1161
1460-2350
DOI:10.1093/humrep/dev309