Death of partner, older child during pregnancy tied to HF incidence in maternal offspring
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Key takeaways:
- Severe prenatal stress was associated with increased risk for heart failure in offspring during the first 5 decades of life.
- Congenital heart disease and preterm birth contributed to the association.
Women who experienced the death of a partner or older child during or around the time of pregnancy were more likely to have offspring who developed HF by midlife, Danish and Swedish register data show.
“Maternal severe stress, ie, experiencing the death of a partner or child and the unnatural death of a close family member during pregnancy, may increase the risk for HF in their children up to middle age,” Fen Yang, MD, PhD, a postdoctoral researcher in the department of global public health at the Karolinska Institutet in Stockholm, told Healio. “If our findings are confirmed by further studies, early lifestyle-related counselling, effective preventive measures and targeted intervention may be implemented among individuals at risk to reduce their risk for developing HF in later life.”
Yang and colleagues analyzed data from 6,758,560 live singleton births from the Danish (1973-2016) and the Swedish (1973-2014) medical birth registers. Researchers retrieved information on death of the mothers’ close family members, defined as a partner, older children, parents and siblings, and also assessed incidence of offspring’s HF (up to 2016 in Denmark and 2020 in Sweden) from nationwide registers. They estimated the odds of offspring developing HF according to maternal bereavement.
The findings were published in JACC: Heart Failure.
According to nationwide registers, 2.5% of women experienced prenatal stress caused by maternal bereavement the year before or during pregnancy. During up to 48 years of follow-up, 0.07% of offspring were diagnosed with HF.
Researchers found that maternal loss of any close family member was not associated with HF in the offspring (adjusted HR = 1.04; 95% CI, 0.88-1.23). However, the most severe forms of bereavement, such as death of a partner or an older child (aHR = 1.47; 95% CI, 1.06-2.04) and unnatural death of a relative (aHR = 2.77; 95% CI, 1.49-5.17) were associated with increased risks for HF.
Researchers also found that congenital heart disease and preterm birth mediated a substantial part of the association between maternal loss of a partner or older child and the offspring’s risk for HF.
“Maternal stress may induce a suboptimal intrauterine environment through the prolonged activation of the hypothalamic-pituitary-adrenal axis and of the autonomic nervous system, leading to adverse changes in mental health, lifestyle, proinflammatory and cardiometabolic activity,” the researchers wrote. “Such intrauterine insults may program the development of the fetal heart, including structural and functional changes that may increase the risk of HF later in life. Because fetal cardiac development primarily occurs during the first trimester of pregnancy, we expected that exposure to stress in the year before pregnancy or during the first trimester of pregnancy would have a stronger association with HF than stress in later trimesters. However, our study did not reveal differences in the studied associations when we categorized exposure by its timing.”
The researchers wrote that the findings, if confirmed by further studies, suggest early screening and prevention may be implemented among individuals prenatally exposed to very severe stress to try to reduce their risk of HF later in life.
“Future studies may investigate whether more frequent but less severe sources of prenatal stress, for example financial difficulties, work and marital stress or other adverse life events, could also be involved in the development of HF, not only at a young age, but also at older ages than we could study in the current cohort,” Yang told Healio.
For more information:
Fen Yang, MD, can be reached at fen.yang@ki.se; X (Twitter): @fenyang880606.
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