Prenatal Anxiety Linked to Infant Illnesses and Early Life Antibiotic Use

From MedscapeCME Clinical Briefs

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

August 2, 2010 — Maternal prenatal anxiety and stress are associated with infant illnesses and antibiotic use early in life, according to the results of a study reported online July 19 in Pediatrics.

"Evidence from both animals and humans suggests that maternal prenatal anxiety and stress can have adverse consequences on the offspring's development," write Roseriet Beijers, MSc, from the Behavioural Science Institute in Nijmegen, the Netherlands, and colleagues. "Animal models also show that prenatal stress has programming effects on the physical health of the offspring, such as immune functioning. In human studies, however, physical health outcomes are often restricted to birth complications; studies on the effects of acquiring illnesses are scarce."

The goal of the study was to determine whether maternal prenatal anxiety and stress are related to more infant illnesses and antibiotic use during the first year of life. The study sample consisted of 174 mothers with normal pregnancies and term deliveries who completed third-trimester questionnaires on general and pregnancy-specific anxiety and stress and who were tested for circadian cortisol levels in saliva.

Of the offspring, 71 were firstborns and 91 were boys. Monthly interviews of the mother during the infant's first year of life allowed collection of data concerning infant illnesses and antibiotic use.

Even after adjustment for many relevant confounders, prenatal anxiety and stress predicted considerable variance in infant illnesses and antibiotic use (9.3% for respiratory tract disease, 10.7% for general disease, 8.9% for skin diseases, and 7.6% for antibiotic use), based on hierarchic multiple regressions. In contrast, prenatal anxiety and stress were not associated with digestive tract illnesses.

Limitations of this study include poor generalizability because nearly all mothers were highly educated, lived together with their partner, had healthy pregnancies, and reported relatively mild or moderate prenatal stress. In addition, this study examined prenatal anxiety and stress only during late gestation, and infant health data were based on maternal report.

"This study is 1 of the first to link maternal prenatal anxiety and stress to infant illnesses and antibiotic use early in life," the study authors write. "As such, it provides a starting point for future research in larger and clinical samples. Follow-up studies are necessary to determine whether the effects of prenatal anxiety and stress on infant susceptibility to illnesses are transient, persistent, or even progressive."

The Netherlands Organization for Scientific Research supported this study. The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online July 19, 2010. Abstract
Clinical Context

Different animal models have reported that prenatal stress has programming effects on the physical health of the offspring such as growth and immune functioning. In the same way, maternal stress and anxiety during pregnancy can affect the development of the offspring. Maternal stress can be reflected in diurnal cortisol levels such as higher evening cortisol levels and flattened diurnal rhythms.

This is a prospective study of healthy pregnant women to determine the association between maternal stress and anxiety as measured by questionnaires and by salivary cortisol and infant health in the first year.