School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Biol Psychiatry. 2018 Jan 15;83(2):100-108. doi: 10.1016/j.biopsych.2017.07.010. Epub 2017 Jul 27.
It has been suggested that prenatal maternal stress may increase the risk of childhood externalizing disorders, yet no large cohort study has investigated this association across a large range of acute stressors. Our objective was to estimate the association between prenatal stressful events and risk of offspring conduct disorder and hyperactivity.
We used data from 10,184 mother-offspring pairs from the United Kingdom-based Avon Longitudinal Study of Parents and Children. Mothers self-reported 42 prenatal stressful life events at 18 weeks' gestation. Symptoms of conduct disorder and hyperactivity in their offspring were measured at 6, 9, 11, 13, and 16 years of age using the Strengths and Difficulties Questionnaire. The primary outcome was membership in high-symptom trajectories of 1) conduct disorder and 2) hyperactivity throughout childhood, identified using latent class growth modeling. Multinomial logistic regression models estimated the association between prenatal stress and both conduct disorder and hyperactivity, after adjusting for sex, parental education, low birth weight, preterm birth, parental social class, maternal smoking and drinking, maternal mental health, offspring stressful life events, and offspring depressive and anxious symptoms.
Those exposed to the highest quartile of prenatal stress were more likely to belong to the high symptom trajectory for hyperactivity (B = 0.46, p < .05) and conduct disorder (B = 0.88, p < .01), respectively. Prenatal stress further demonstrated a positive, dose-response relationship with symptoms of externalizing disorders at independent time points.
The findings suggest that prenatal stressful events may be an independent risk factor for offspring externalizing symptoms, regardless of maternal mental health and offspring internalizing.
有人认为产前母体应激可能会增加儿童外化障碍的风险，但还没有大型队列研究在大范围急性应激源的情况下调查这种关联。我们的目的是估计产前应激事件与后代品行障碍和多动的风险之间的关联。
我们使用了来自英国阿冯纵向父母与子女研究的 10184 对母子数据。母亲在妊娠 18 周时自我报告了 42 种产前应激生活事件。在 6、9、11、13 和 16 岁时，使用《长处与困难问卷》测量了后代品行障碍和多动的症状。主要结果是识别出儿童期整个阶段（1）品行障碍和（2）多动的高症状轨迹的成员，使用潜在类别增长模型。在调整性别、父母教育程度、低出生体重、早产、父母社会阶层、母亲吸烟和饮酒、母亲心理健康、后代应激性生活事件以及后代抑郁和焦虑症状后，多变量逻辑回归模型估计了产前应激与品行障碍和多动之间的关联。
那些暴露于产前应激最高四分位数的人更有可能属于多动（B=0.46，p<0.05）和品行障碍（B=0.88，p<0.01）的高症状轨迹。产前应激与外化障碍的症状在独立时间点进一步表现出正相关，呈剂量反应关系。
这些发现表明，产前应激事件可能是后代外化症状的独立危险因素，而与母亲心理健康和后代内化无关。
