Stress during pregnancy quotes,pregnancy leave in california 2016,pregnancy test tells how many weeks you are,why cant i get pregnant whats wrong with me 4sh - New On 2016

ERRORCouldn't use this database:indiavision_com_-_ivnewsPlease contact admin about this err. Chronic stress, like poverty, affects a woman’s pregnancy both physically and emotionally, as she doesn’t have access to good pre-conception healthcare, consistent prenatal care, good nutrition and social support.
Most studies haven’t found a consistent and definite link between “normal” stress and complications with pregnancy.
But one research team at the University of Los Angeles (UCLA), which focuses specifically on the effects of stress on pregnancy, has found psychosocial stress and daily hassles to be associated with prematurity and low birth weight, particularly in African-American women. On the other hand, if a woman feels low levels of fear and anxiety about pregnancy and the art of birthing, then it will be hard for her to come to a place of trust and relaxation about the birth, which in severe cases may lead to postpartum depression, anxiety and post-traumatic stress. There are many ways to practice good emotional prenatal care and exquisite self-care by addressing fears and anxieties during pregnancy! If your fears and anxiety interfere with your everyday life, such as a conflict in major areas of your life (relationships at home, friendships at work and in the quality of work), it is a sign that you should obtain professional help. Another flag that you should seek professional help is if you have significant life stressors, including a current or past history of a mental health diagnosis, if you are introducing a baby into a complex, high-conflict, blended family, or if you have suffered past sexual, physical or emotional abuse issues, which are being triggered by the emotional and physical changes of pregnancy.
Parenting is both joyful and challenging; learning some stress reduction habits during pregnancy is a good way to a lifelong habit of self-care! Even before a woman becomes pregnant, her stress physiology may predict a lower-birth weight of baby -- less than 2.5 kg, said a new study.
The findings revealed that the mother's stress physiology before she even conceives is also important. Researchers claim this study first evidence that shows maternal cortisol -- a hormone the body releases in response to stressful events -- patterns before conception influence the weight of the baby. The study, published in the journal Health Psychology, analysed 142 women, which looked at how chronic stress affects new parents and their babies in which they provided daily saliva samples. But when cortisol levels are elevated beyond that range, the effects can be both immediate -- because elevated cortisol levels reduce blood flow to the foetus -- and longer-lasting -- influencing the child's response to stress later in life, Schetter explained.
They have a higher-than-normal risk for infant mortality developmental and for health abnormalities throughout their lives, including cardiovascular and metabolic disorders. Women planning a pregnancy should take into account the possible effects of everyday stress and begin planning for a healthy first pregnancy well in advance, Schetter added.
I made this WEBSITE to be able to share and provide women some of the most useful and helpful knowledge concerning all about pregnancy, healthy diet plans, Nutrition, morning sickness remedies, signs and symptoms, pregnancy problems and so many things that may guide you right before you plan a pregnancy through your labor. A child entering the world, whether it’s your first or third, is a huge occasion that will impact upon every area of your life, so it’s no wonder you feel a little stressed at times.
A mother’s health and well-being will always affect the baby during the child’s gestational period. This is not to say though that cortisol is bad for the pregnancy as cortisol is found to have a role in a child’s brain and lung development. Experiencing stress during pregnancy is not totally dangerous, but it cannot be avoided as well.
In the first stages of pregnancy, the body secretes cortisol to act as a suppressant to the mother’s immune system to prevent them from attacking the child in its foetal stages.
Cortisol can even influence the timing of the birth of the child; too much cortisol can cause a miscarriage which is why it is important that pregnant women avoid stressful situations. The presence of stressors can be considered a permanent fixture and as mentioned earlier, stress is not necessarily harmful to the infant and the mother. A larger support group is better in keeping the mother feel encouraged and empowered as she and her baby continues to develop. Objectives: We conducted a comprehensive study to determine whether common psychosocial stress during pregnancy is a risk factor for a wide spectrum of pediatric diseases in the offspring.
Conclusions: Maternal life stress during pregnancy may be a common risk factor for impaired child health. The work for this manuscript was performed at the University of Basel, Basel, Switzerland, and at the University of California Los Angeles, Los Angeles, California, USA. Early-life factors can predispose individuals to diseases over the life course (Gluckman et al. The purpose of this study was to assess the association between common psychosocial stress during pregnancy and the risk of a wide range of offspring diseases in a population-based birth cohort with prospective data linked with a national hospital register.
For conditions that may have onset after the perinatal period (diagnostic categories 1–14) and for “any disease,” we estimated the associations of maternal life stress and emotional stress during pregnancy with the risk of the offspring for the first diagnosis of a disease within each major diagnostic category by conducting separate Cox proportional hazards regression models for each of the diagnostic categories.
We calculated all standard errors using the clustered sandwich estimator to correct for possible dependence between health outcomes in infants born to the same mother (n = 3,029). To obtain less-confounded estimates, we adjusted for potential predictors of child health, selected a priori, including socioeconomic status (Gissler et al. Maternal emotional stress during pregnancy was associated with an increased risk for the first diagnosis of infectious and parasitic diseases and a decreased risk for the first diagnosis of endocrine and metabolic disorders, diseases of the eye, and the circulatory system (up to 3 years of age).
When we repeated the adjusted analyses using only the first pregnancy of each woman in the cohort and when we repeated the adjusted analyses controlling for smoking, hypertension, and gestational diabetes, or for birth weight and length of gestation, the estimates were of similar magnitude as those presented in Tables 3 and 4 (data not shown). In this large population-based cohort study, maternal life stress during pregnancy was associated with an increased risk of a wide range of diseases during childhood. Our study has important strengths, including prospective data collection for 66,203 mother–child pairs and linkage to a comprehensive medical registry with complete information on hospital discharge diagnoses.
Our findings on maternal life stress during pregnancy corroborate and extend the results of previous studies (Hansen et al.
The decreased risk of certain diseases predicted by maternal emotional stress during pregnancy is in line with some previous evidence on beneficial effects of maternal stress on offspring development and brain maturation (DiPietro et al. The observed association between maternal stress during pregnancy and child health may represent long-term consequences of subtle adaptations in multiple organ systems to the intrauterine environment (Bateson et al.
As yet, we cannot exclude the possibility that associations between stress during pregnancy and child diseases are mediated by maternal behavioral factors, such as stress-related changes in lifestyle, or health-related factors.
The observed associations between maternal stress during pregnancy and offspring health may have implications for public health and health care policy: First, further investment in the reduction of life stress during pregnancy may be an important opportunity to improve child health. This study suggests that maternal life stress during pregnancy may be a common risk factor for a wide range of diseases in the offspring; however, we found almost no evidence for adverse health consequences of maternal emotional stress during pregnancy. EHP is now using Editorial Manager for manuscript submissions. All user accounts have been transferred to Editorial Manager—just log into Editorial Manager and reset your password.
DisclaimerPublication of articles in EHP does not mean that the National Institute of Environmental Health Sciences (NIEHS) condones, endorses, approves, or recommends the use of any products, services, materials, methodology, or policies stated therein.
Therefore, physically, poverty is a risk factor for prematurity and low birth weight, which can be devastating.
But in general, these studies analyze small groups of pregnant women and aren’t consistent with their methods.
In addition, they have found that pregnant women that experience anxiety concerning the impending birth and the health of their children are consistently at risk for preterm birth.
Antenatal childbirth classes provide factual information and also proven complementary mindbody techniques to improve confidence, address fears and promote relaxation. Kathy specializes in helping women and their families with the emotions of birth, pregnancy, postpartum and in the adjustment to parenthood. It suggests that a woman's health and life circumstances before her pregnancy, especially chronic stress, matter greatly. This way you’re keeping your immune system strong and fight some unwanted diseases and complications. If you don’t take a pregnancy test in a timely manner, you might run into complications caused by unhealthy habits. Swimming is a great exercise that will help you stay active throughout your entire pregnancy because it helps get those aches and pains out and help you relax. Take this information to heart to keep your body, and your baby, healthy during this nine month period of your life.
Make sure you are getting the most important pregnancy information you need and you can trust. The infant inside the womb is affected from the food the mother intakes; to the situation she faces every day. Lack of cortisol during the last trimester of the pregnancy might give birth to a child with respiratory problems. Over time, cortisol helps to regulate the blood flow between the foetus and the placenta; it also helps the organs to mature. A pregnant woman’s partner is the best person to provide the support and love she needs to feel. By keeping herself surrounded by people who are calm and supportive, a mother will reflect their persona and feel empowered by their presence. We estimated the association between maternal stress during pregnancy (classified based on two a priori–defined indicators of common stress forms, life stress and emotional stress) and offspring diseases during childhood (grouped into 16 categories of diagnoses from the International Classification of Diseases, 10th Revision, based on data from national registries), controlling for maternal stress after pregnancy.
The Danish National Birth Cohort was established by the Danish Epidemiology Science Centre, Department of Epidemiology, Institute of Public Health, University of Aarhus, Aarhus, Denmark. The decision to give an overview of a broad range of diseases accounts for the large body of evidence linking maternal adversities with changes in numerous physiological systems in the offspring (Entringer et al. This study is based on prospective data from the Danish National Birth Cohort, including births between 1996 and 2003 (Olsen et al. We obtained information on maternal stress from a telephone interview taken around 30 weeks of gestation.
Information on children’s diseases was derived from the Danish National Hospital Register (Copenhagen, Denmark), which contains information on all inpatients and outpatients in Danish hospitals and provides reporting of diagnoses, the validity of which has been demonstrated for several diseases (Andersen et al. We used the Wilcoxon signed-rank test to compare the score reflecting maternal stress during pregnancy with the score reflecting maternal stress after pregnancy for each stress type. Data on timing of competing events, such as deaths and emigration, were not available in this data source, but these events are uncommon in Denmark (WHO 2005).
Moreover, to control for previous reproductive experiences and their possible effect on exposures (Olsen 2008), we repeated all analyses including only the first pregnancy of each woman in the cohort. We addressed loss to follow-up and missing data by restricting analyses to mother–child pairs with complete data on stress. After adjustment, maternal life stress during pregnancy was associated with an increased disease risk in 11 of 16 diagnostic categories, including an increased risk for the first diagnosis of infectious and parasitic diseases, mental and behavioral disorders (up to 2.5 years of age), diseases of the eye, ear, respiratory system, digestive system, skin, musculoskeletal and genitourinary systems, and of any disease (Table 3).


However, a significantly reduced risk of diseases of the eye and the circulatory system was seen only in offspring of highly stressed mothers. These findings are in line with data from animal models indicating changes in different physiological systems after maternal stress during pregnancy (Fowden et al. Although associations were of low to moderate strength, our results have broad relevance for the general population, because our definition of maternal stress focuses on everyday occurrences (rather than rare disasters or severe life events), and we focused on the whole range of illnesses, including very common diseases, which suggests that a substantial part of the population may be adversely affected by maternal stress. Adjusting for maternal smoking during pregnancy, hypertension, and diabetes did not alter associations between maternal stress during pregnancy and child health. Second, our findings encourage consideration of preventive strategies for infants of mothers who were highly stressed during pregnancy.
Future studies should a) focus on the underlying mechanisms of these relationships, b) analyze the associations between selected forms of maternal stress during pregnancy and specific offspring diseases, including more detailed information on disease characteristics and information from further health registries, and c) identify modifiable determinants within this context to improve preventive approaches and interventions.
Prenatal psychosocial stress exposure is associated with insulin resistance in young adults.
These CEHN summaries discuss the potential policy implications of current children’s environmental health research. Conclusions and opinions are those of the individual authors and advertisers only and do not reflect the policies or views of the NIEHS. Long-term stress during pregnancy can eventually surface as postpartum depression and anxiety. Just eight weeks of practicing mindful and aware relaxation methods promotes emotional wellness and builds an emotional bank account of tranquility. You must also to learn those things you must to avoid when trying to conceive to be aware of those things that may harm your entire pregnancy. In some instances, you will see the baby being born prematurely due to extreme levels of stress.
She can provide wisdom and support during pregnancy, and she can help with natural delivery if you wish. This website will help you keep track and keep both eyes with your pregnancy from 1 week till birth and even before conceiving , including in which size your baby today and how your belly and body is changing. In order to prevent negative impact on the baby, women must be careful not to experience too much stress during pregnancy. Normal levels of cortisol in the body are not harmful to a child, but too much will endanger the infant. The amount of cortisol level and the time it is released in a pregnant woman’s body is what affects the child’s health.
It is ideal that mothers stay relaxed or return to a relaxed mindset after a stressful situation.
Most pregnant women feel a range of emotions such as insecurity due to the changes their body is experiencing so having their partners with them helps them to feel beautiful and comfortable with their body. Mothers may be the ones who physically carry and have to give birth to the child, but it doesn’t mean that they have to carry the burden alone.
The Danish National Research Foundation established the Danish Epidemiology Science Centre, which initiated and created the Danish National Birth Cohort.
Validation of the stress scores was undertaken, in part, with data from the National Centre of Competence in Research, Swiss Etiological Study of Adjustment and Mental Health (sesam), funded by Swiss National Science Foundation project 51A240–104890.
Follow-up studies have shown that fetal growth impairment is linked to an increased risk of morbidity and premature mortality (Barker et al. We studied two a priori–defined types of stress—emotional stress and life stress—as used in previous studies (Sondergaard et al.
In each Cox proportional hazards regression model, data on all children without a diagnosis in the respective category were censored at the end of follow-up (31 December 2006).
For those with missing information on a particular covariate, we included an additional “missing” category for the respective variable. Sample characteristics are provided in Table 2 (for additional information on the sample characteristics according to the stress categories, see Supplemental Material, Table 2). Maternal life stress during pregnancy was associated with an increased risk of conditions originating in the perinatal period and of congenital malformations (Table 4). However, the prenatal life stress–associated risk for the first onset of mental disorders within the first 2.5 years of life decreased markedly [4th quartile vs.
We adjusted for several potential confounders, but our results still may be biased by residual or uncontrolled confounding by factors such as chemical exposures. However, some of these associations were seen only in offspring of highly stressed mothers, with marginal statistical significance.
The potential biological mechanisms underlying such developmental plasticity, including epigenetic processes (Gluckman et al. Maternal nutrition is another candidate mediator, because stress is related to quality of nutrition (Torres and Nowson 2007), and a relationship between nutrition during pregnancy and a range of offspring diseases has been well documented (Symonds et al. Increased fat mass and cardiac septal hypertrophy in newborn infants of mothers with well-controlled diabetes during pregnancy. The relation of small head circumference and thinness at birth to death from cardiovascular disease in adult life. Physical and mental health outcomes of prenatal maternal stress in human and animal studies: a review of recent evidence.
Blunted HPA axis responsiveness to stress in atopic patients is associated with the acuity and severeness of allergic inflammation. Psychosocial stress increases inflammatory markers and alters cytokine production across pregnancy. Interplay between inflammation, immune system and neuronal pathways: effect on gastrointestinal motility.
Maternal psychological distress during pregnancy in relation to child development at age two. Case-control study of parental age, parity and socioeconomic level in relation to childhood cancers.
Maternal and perinatal outcome in nulliparous women complicated with pregnancy hypertension. Boys have more health problems in childhood than girls: follow-up of the 1987 Finnish birth cohort.
Social class differences in health until the age of seven years among the Finnish 1987 birth cohort.
Possible role of cortisol and dehydroepiandrosterone in human development and psychopathology.
Serious life events and congenital malformations: a national study with complete follow-up. Maternal age-specific rates of numerical chromosome abnormalities with special reference to trisomy. Fetal programming of hypothalamic-pituitary-adrenal (HPA) axis function and behavior by synthetic glucocorticoids. Higher risk of offspring schizophrenia following antenatal maternal exposure to severe adverse life events. Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress, and stress hormones. Non-stress-related factors associated with maternal corticotrophin-releasing hormone (CRH) concentration. Stress during pregnancy affects general intellectual and language functioning in human toddlers.
Are maternal psychosocial factors associated with cord immunoglobulin E in addition to family atopic history and mother immunoglobulin E? Conceptualizations, measurement, and effects of prenatal maternal stress on birth outcomes. Fetal heart rate reactivity differs by women’s psychiatric status: An early marker for developmental risk? Stressor specificity of central neuroendocrine responses: implications for stress-related disorders. Programming of the stress response: a fundamental mechanism underlying the long-term effects of the fetal environment?
Inflammation, sanitation, and consternation: Loss of contact with coevolved, tolerogenic microorganisms and the pathophysiology and treatment of major depression. Exposure to repetitive versus varied stress during prenatal development generates two distinct anxiogenic and neuroendocrine profiles in adulthood.
Role of the pro-inflammatory cytokines tumor necrosis factor-alpha, interleukin-1 beta, interleukin-6 and interleukin-8 in the pathogenesis of the otitis media with effusion. A population-based Danish data resource with possible high validity in pharmacoepidemiological research.
Long-term effects of nutritional programming of the embryo and fetus: mechanisms and critical windows. Maternal psychosocial adversity during pregnancy is associated with length of gestation and offspring size at birth: evidence from a population-based cohort study.
Maternal psychosocial stress during pregnancy and placenta weight: evidence from a national cohort study.
Effects of intrauterine exposure to synthetic glucocorticoids on fetal, newborn, and infant hypothalamic-pituitary-adrenal axis function in humans: a systematic review. High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds. High antenatal maternal anxiety is related to impulsivity during performance on cognitive tasks in 14- and 15-year-olds. Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. The Danish National Hospital Register is a valuable study base for epidemiologic research in febrile seizures. Influence of parental gender and self-reported health and illness on parent-reported child health. But because each woman has her own individual level of tolerance for stress, it is unknown exactly how much stress is a causative factor for postpartum mood disorders.


You can also decide what to ask your doctor and find out the answers to anything that you are wondering about your possible pregnancy. But you still have to have regular check-up and consultation to your doctor to be able to learn and be aware when will you expect you baby.
The baby depends on the mother while the mother depends on her family and loved ones to provide the support she need as she undergoes pregnancy. When a pregnant woman is in a prolonged and repeated stress environment, elevated cortisol in her body will increase the risk of miscarriage. The amount of cortisol levels that are released by the body is affected by the stage of pregnancy the woman is currently experiencing. The mere act of saying encouraging words can help alleviate the feelings of stress during pregnancy so make sure that you give pregnant woman all the support you can give. Participants gave written informed consent, and the Danish National Committee for Biomedical Research Ethics, Copenhagen, approved the study on behalf of all committees in the country. 2001), maternal age (Hassold and Chiu 1985), self-reported general maternal health (Waters et al.
To our knowledge, this is the first comprehensive study of the relationship between maternal stress during pregnancy and a wide spectrum of offspring diseases during childhood. Temporal sequence, consistency of findings across a variety of categories, and evidence of a dose–response relationship support the possibility of a causal link (Grimes and Schulz 2002).
Hence, it is too early to conclude whether common forms of maternal emotional stress during pregnancy have the potential to protect certain organ systems against disease.
2009) and changes at the molecular, cellular, and organ level in the offspring, provide new ideas to the fetal origin of chronic disease concept (Fowden et al.
Induction of cytokine release and modulation of susceptibility to infection by cytokine exposure. The reason behind why women should not suppose to change a cats litter boxes when pregnant is because of toxoplasmosis.
We will also help you have a healthy, calm and happy pregnancy with our pregnancy-safe workouts and diet meal plans. About 50% of all general practitioners in the country took part in the recruitment, and 60% of the invited women participated.
We tested the proportional hazards assumption by visually checking Schoenfeld residuals and the test of Grambsch and Therneau.
We controlled for potential bias by maternal stress after pregnancy, which might increase the likelihood that a mother would seek to have her child hospitalized. Moreover, alcohol consumption during pregnancy has been associated with birth defects (O’Leary et al. Cats can be a host for this and the infection can pass to the fetus which can lead to stillbirth, it may be passed to the growing baby and result in stillbirth or miscarriage, as well as other abnormalities. You'll learn how to write a birth plan, and we'll tell you what to expect when it times to give birth.
However, fetal growth is probably only a crude indicator of complex developmental processes that are subject to genetic factors and various intrauterine exposures that may affect gene expression and influence disease susceptibility.
Of these, we considered as eligible all pregnancies with live singleton births (see “Results”). The separation of these two types of maternal stress is theoretically based on the well-described stressor specificity of biological responses, which may differentially affect the fetus (Pacak and Palkovits 2001; Richardson et al. If the assumption was not met, we stratified the data by age (Table 3) based on the Schoenfeld residuals to ensure that the proportional hazards assumption was met.
Cumulative lifetime incidences of all diagnostic categories are shown according to quartile of prenatal life or emotional stress in Supplemental Material, Figure 2. In addition, it is unlikely that maternal stress would influence hospital treatment, because in the Danish health care system, 99% of the population must be referred for elective hospital treatment by a general practitioner, and both referrals and hospital treatment are free of charge for patients (Strandberg-Larsen et al.
2004), our data provide evidence for an increased risk of mental disorders during the first 2.5 years of life in offspring of mothers reporting high life stress during pregnancy compared with mothers reporting low life stress. If you find this articles helpful, kindly subscribe and you can also share the content to everyone!
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Therefore, the effects of intrauterine exposures on postnatal outcomes should be studied more directly (Gillman 2002), and the National Institutes of Health and the World Health Organization (WHO) have advised that the role of maternal stress during pregnancy should be given high research priority (National Institutes of Health 2003; WHO 2006). All hospital diagnoses, based on the Danish version of the International Classification of Diseases, 10th Revision (ICD-10) (Danish National Board of Health 1993), were divided into major diagnostic categories (dichotomous) selected a priori according to chapters 1–14 and 16 and 17 of the ICD-10, which cover all relevant diagnoses during childhood.
For conditions originating in the perinatal period and for malformations, we used separate logistic regression models to estimates associations with maternal life stress and emotional stress. Moreover, for explorative purposes, we repeated the analyses, controlling for self-reported hypertension during pregnancy (Fatemeh et al. However, we cannot rule out the possibility that this result was biased by reverse causation between offspring disease and postnatal life stress.
2001), indicating that alcohol may mediate associations between maternal stress and child health. Follow-up studies have raised concerns that offspring of mothers exposed to stress during pregnancy may have an increased risk of specific diseases such as malformations, asthma, and mental and behavioral disorders (Cookson et al. Virtually all available studies investigating maternal stress have used one of these two types of stress measures (Beydoun and Saftlas 2008; Lobel 1994). Moreover, we controlled for potential bias by reverse causation between child disease and maternal stress after pregnancy. In the present study, emotional stress during pregnancy was associated with an increased risk of infectious diseases only, whereas previous studies observed associations between emotional problems during pregnancy and other outcomes, including malformations, asthma, and mental disorders (Cookson et al. Specifically, in relation to maternal stress during pregnancy, numerous subclinical alterations in physiology, including changes in immune, brain, cardiovascular, autonomic, endocrine, and metabolic function, have been described, such as changes in fetal heart rate, insulin resistance, increased concentrations of immunoglobulin E in cord blood and changes in hypothalamic–pituitary–adrenal (HPA) axis function (Entringer et al.
We tested for trends using log-rank–based trend tests of the survivor function stratifying for the other covariates or by repeating logistic regressions with the stress categories modeled as a continuous ordinal variable.
2011), and maternal smoking during pregnancy (Shea and Steiner 2008) as potential mediators (categorized as yes, no, or unknown). One limitation is that we did not have data on the timing of the maternal stress exposure during pregnancy, which may play a role in the relationship between stress and long-term health, given that each organ system has a specific critical period in which it is most susceptible to intrauterine perturbations (Hansen et al. Emotional stress and life stress were each assessed by nine questions, each covering the time period since the beginning of pregnancy. In addition, we repeated the analyses, controlling for birth weight and length of gestation (Gillman 2002) (continuous) as potential mediators. Answers (no = 0, a little = 1, a lot = 2) were added up into a score for each stress type (range, 0–18). We extended the model by adjusting for postnatal exposure to maternal stress assessed, according to the method described for maternal stress during pregnancy, at 6 months postpartum, covering the time since parturition.
However, life stress and emotional stress generally reflect chronic states of adversity (McEwen and Stellar 1993). Items were selected from the Symptom Check List-90 (Derogatis 1977) and The General Health Questionnaire (Goldberg 1972) to cover frequent symptoms of anxiety and depression. High maternal stress may be a consequence rather than a cause of offspring disease within the first 6 months of life (Fowlie and McHaffie 2004).
Of all eligible mother–child pairs, 72% participated in the relevant interviews, and 99% of these were included in our analyses. Discrepancies among studies may partly reflect differences in disease outcome or emotional stress classifications.
Life stress was assessed using an inventory based on the major categories of the Life Events Questionnaire (Norbeck 1984) on whether the women felt burdened in major areas of life such as work, housing, and human relations (for detailed description of items, see Table 1). Therefore, we repeated the analyses after excluding all cases having their first diagnosis within the first 7 months of life.
Given the low loss to follow-up, the high percentage of complete data, and linkage to the Danish National Hospital Register, we think measurable selection bias is unlikely. For example, we classified outcomes based on clinical diagnoses (instead of subclinical dysfunction) in the offspring, and defined emotional stress across the entire range rather than focusing on more severe psychopathology, as in Schneid-Kofman et al. Indeed, changes in HPA axis activity have been associated not only with maternal stress during pregnancy (Kapoor et al.
We addressed up to two missing answers per stress type by using person-specific mean substitution.
Therefore, the observed associations between stress during pregnancy and offspring health should not be generalized to children born extremely preterm (< 30 weeks of gestation). Moreover, discrepancies between findings may be explained by differential mutual control for life stress and emotional stress and by differential control for maternal stress after pregnancy. In the analyses, we included life stress and emotional stress as categorical independent variables, with the limits between the categories defined by cutoffs as close as possible to the quartiles of the distributions of the respective stress scores (Table 2). To account for overlap, the analysis of the associations between life stress and child diseases was adjusted for emotional stress, and vice versa.
However, although the HPA axis has long been proposed as a causal link between early adversity and lifelong disease risk (Phillips 2007), it also has been suggested that HPA-related hormones may be noncausal markers of other causal mechanisms (Kramer et al. There also is some evidence that maternal stress affects placental HSD11B2, which in turn regulates the bioavailability of glucocorticoids in fetal organs (Harris and Seckl 2011).
Elevated stress levels across pregnancy have also been associated with changes in production of pro-inflammatory cytokines in the offspring (Coussons-Read et al. Dysregulation of cytokine production has been associated with certain mental disorders (Conti and Fulcheri 2010; Raison et al.
Other mechanisms, such as catecholamines (Harris and Seckl 2011), intrauterine artery resistance, and intrauterine perception and learning (Kinsella and Monk 2009), also may be involved in offspring disease programming.



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