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Published in: BMC Public Health 1/2009

Open Access 01-12-2009 | Research article

Does acute maternal stress in pregnancy affect infant health outcomes? Examination of a large cohort of infants born after the terrorist attacks of September 11, 2001

Authors: Skye M Endara, Margaret AK Ryan, Carter J Sevick, Ava Marie S Conlin, Caroline A Macera, Tyler C Smith

Published in: BMC Public Health | Issue 1/2009

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Abstract

Background

Infants in utero during the terrorist attacks of September 11, 2001 may have been negatively affected by maternal stress. Studies to date have produced contradictory results.

Methods

Data for this retrospective cohort study were obtained from the Department of Defense Birth and Infant Health Registry and included up to 164,743 infants born to active-duty military families. Infants were considered exposed if they were in utero on September 11, 2001, while the referent group included infants gestating in the same period in the preceding and following year (2000 and 2002). We investigated the association of this acute stress during pregnancy with the infant health outcomes of male:female sex ratio, birth defects, preterm birth, and growth deficiencies in utero and in infancy.

Results

No difference in sex ratio was observed between infants in utero in the first trimester of pregnancy on September 11, 2001 and infants in the referent population. Examination of the relationship between first-trimester exposure and birth defects also revealed no significant associations. In adjusted multivariable models, neither preterm birth nor growth deficiencies were significantly associated with the maternal exposure to the stress of September 11 during pregnancy.

Conclusion

The findings from this large population-based study suggest that women who were pregnant during the terrorist attacks of September 11, 2001 had no increased risk of adverse infant health outcomes.
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Metadata
Title
Does acute maternal stress in pregnancy affect infant health outcomes? Examination of a large cohort of infants born after the terrorist attacks of September 11, 2001
Authors
Skye M Endara
Margaret AK Ryan
Carter J Sevick
Ava Marie S Conlin
Caroline A Macera
Tyler C Smith
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2009
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-9-252

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