Preconception Maternal Bereavement and Infant and Childhood Mortality: A Danish Population-Based Study.
Preconception Maternal Bereavement and Infant and Childhood Mortality: A Danish Population-Based Study.
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DOI：
10.1097/psy.0000000000000229
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发表时间：
2015-10
影响因子：
3.3
通讯作者：
Khashan AS
中科院分区：
文献类型：
--
作者：
Class QA;Mortensen PB;Henriksen TB;Dalman C;DʼOnofrio BM;Khashan AS
孕前母亲的丧亲可能与婴儿死亡风险增加有关，尽管之前报道的这些发现尚未得到重复。我们试图检验这种关联是否可以复制，并探讨风险是否会延续到童年时期。使用 1979-2009 年出生的丹麦人口样本（N=1,865,454），我们预测了孕前（怀孕前 6-0 个月）和产前（受孕和出生之间）期间产妇丧亲后的新生儿（0-28 天）、新生儿后婴儿（29-364 天）和幼儿期（1-5 岁）死亡率。产妇丧亲被定义为母亲的一级亲属死亡。使用逻辑和对数线性泊松回归进行分析，并根据后代、母亲和父亲的社会人口统计和健康因素进行调整。我们确定了 6,541 名 (0.004%) 新生儿、3,538 名 (0.002%) 新生儿和 2,132 名 (0.001%) 1 至 5 岁儿童死亡。调整协变量后，孕前期间的丧亲之痛与新生儿几率增加（调整后比值比[aOR] = 1.87，95% CI：1.53-2.30）和新生儿后婴儿死亡率（aOR=1.52，95% CI：1.15-2.02）增加相关。相关性具有时间特异性（仅限怀孕前 6 个月），并且在敏感性分析中保持一致。产前时期的丧亲之痛并不总是与后代死亡风险增加相关，但这可能反映了相对较低的统计功效。结果支持并扩展了之前的研究结果，即孕前期间的丧亲之痛与后代早期死亡率增加的几率增加有关。怀孕前一段时间可能是一个敏感期，具有潜在的病因学意义和对后代死亡率的影响。
Preconception maternal bereavement may be associated with an increased risk for infant mortality, though these previously reported findings have not been replicated. We sought to examine if the association could be replicated and explore if risk extended into childhood. Using a Danish population-based sample of offspring born 1979–2009 (N=1,865,454), we predicted neonatal (0–28 days), post-neonatal infant (29–364 days), and early childhood (1–5 years) mortality following maternal bereavement in the preconception (6–0 months before pregnancy) and prenatal (between conception and birth) periods. Maternal bereavement was defined as death of a first degree relative of the mother. Analyses were conducted using logistic and log-linear Poisson regression that were adjusted for offspring, mother, and father sociodemographic and health factors. We identified 6,541 (0.004%) neonates, 3,538 (0.002%) post-neonates, and 2,132 (0.001%) children between the ages of 1 to 5 years who died. After adjusting for covariates, bereavement during the preconception period was associated with an increased odds of neonatal (adjusted odds ratio [aOR] = 1.87, 95% CI: 1.53–2.30) and post-neonatal infant mortality (aOR=1.52, 95% CI: 1.15–2.02). Associations were timing-specific (6 months prior to pregnancy only) and consistent across sensitivity analyses. Bereavement during the prenatal period was not consistently associated with increased risk of offspring mortality, however this may reflect relatively low statistical power. Results support and extend previous findings linking bereavement during the preconception period with increased odds of early offspring mortality. The period immediately prior to pregnancy may be a sensitive period with potential etiological implications and ramifications for offspring mortality.