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Severe maternal grief associated with increased risk of heart failure in offspring

By Denise Doherty - 01st Mar 2024


Reference: March 2024 | Issue 3 | Vol 10 | Page 48


Babies born to mothers who experience profound grief during pregnancy may be vulnerable to heart failure (HF), new research suggests. Prenatal stress is a potential risk factor for later manifestation of cardiovascular disease (CVD) in offspring, however, its association with HF has been poorly researched to date.

The study, which was recently published in the Journal of the American College of Cardiology: Heart Failure, found thatmaternal loss of a partner or child shortly before or during pregnancy was associated with an increased risk of HF up to middle-age in the child.

The researchers theorise that maternal stress shortly before or during pregnancy may lead to an adverse intrauterine environment, which may, in turn, increase the risk of adverse pregnancy outcomes, as well as worsen the cardiovascular risk profile for offspring later in life. For the purposes of the study, prenatal stress was defined as maternal bereavement.

“The death of a close relative is considered by several classification systems of sources of stress as one of the most adverse life events. It is often regarded as an objective source of stress that is likely to be perceived as stressful and that requires readjustments by most individuals, irrespective of their coping resources,” said senior author Dr Fen Yang, Department of Global Public Health at the Karolinska Institutet, Stockholm, Sweden.

“We thus hypothesised that if prenatal stress is involved in the causation of HF diagnosis up to middle-age, we may expect to observe an association between the death of a close family member – in particular, in cases of losses of a spouse or child or in the case of unexpected losses – and the risk of HF up to middle-age.”

The study cohort included 6,758,560 live singleton births from the Danish (1973-2016) and the Swedish (1973-2014) Medical Birth Registers. Investigators gathered information on death of the mothers’ close family members (partner, older children, parents, and siblings) and offspring’s HF from the nationwide registers. Median follow up time was 24.2 years.

Within the study cohort, 167,192 study participants experienced prenatal stress due to maternal bereavement in the year prior to or during pregnancy. Mothers in the exposed group were more likely to be older, married, smokers, and have a family history of CVD compared to mothers in the unexposed group.

During the follow up period, 4,812 offspring were diagnosed with HF. More severe forms of maternal loss, including loss of a partner or older child, were associated with a HF diagnosis. However, the loss of other close family members in the year before or during pregnancy was not associated with an increased risk of HF in the offspring, except in the case of unnatural death of the family members. There was no substantial difference in the risk of HF when the exposure was categorised by time of bereavement event in relation to pregnancy.

“We found that only the most severe forms of maternal bereavement were associated with the offspring’s risk of HF up to middle-age. Whether mental health or other types of stress, for example financial difficulties, work and marital stress, or other adverse life events could influence the risk of HF, not only at a young age, but also in older ages than we could study in the current cohort, would need to be determined in future studies,” added senior author Prof Krisztina László, Department of Global Public Health at the Karolinska Institutet, Stockholm, Sweden.

Study limitations include the failure to identify some milder forms of HF, the inability to rule out the possibility of residual confounding due to unmeasured genetic and familial lifestyle, and health-related factors. The researchers also did not have information regarding the mother’s participation in psychotherapy or other interventions for bereaved individuals.

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