Increased utilisation of primary healthcare in persons exposed to severe stress in prenatal life: a national population-based study in Denmark

BMJ Open. 2015 Jan 8;5(1):e005657. doi: 10.1136/bmjopen-2014-005657.


Objective: Recent studies have suggested that stress in a pregnant mother may affect the future health of the unborn child negatively. An excellent proxy for health problems is the use of healthcare resources. Using nationwide data, we examined whether persons born to mothers who lost a close relative during pregnancy have more contacts to general practice.

Design: Population-based cohort study.

Setting: Denmark.

Participants: We included all children born in Denmark from 1973 to 2002 (N=2 032 528). Exposure of prenatal stress was defined as maternal bereavement by the death of a close relative during the antenatal period. The outcome of interest was contact with general practice between 2003 and 2009 when the participants were between 1 and 35 years of age. Poisson regression was used to assess the association between exposure and outcome.

Outcome measures: Contacts to general practitioner.

Results: Overall, persons exposed to prenatal stress had 2% more GP contacts than those not exposed, primarily due to increased utilisation of healthcare services during late adolescence and early adulthood. The exposed persons born to mothers who had lost a spouse had a higher risk (relative risk (RR) 1.12, 95% CI 1.10 to 1.14) and so did those born to mothers who had lost a close relative due to unexpected death (RR 1.06, 95% CI 1.05 to 1.06). Exposed persons had more contacts to general practice in daytime and more psychometric tests, talk therapies and C reactive protein tests than unexposed persons.

Conclusions: Prenatal stress following maternal bereavement was associated with a slightly increased utilisation of primary healthcare, mainly due to increased healthcare needs related to mental health and infections. Understanding how stress during pregnancy influences the future health of the child is an important aspect of prenatal care.

Keywords: bereavement; cohort; general practice; prenatal stress; primary health care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bereavement*
  • Cohort Studies
  • Denmark
  • Female
  • Humans
  • Male
  • Mothers / psychology*
  • Pregnancy
  • Prenatal Exposure Delayed Effects / psychology*
  • Primary Health Care / statistics & numerical data*
  • Risk Factors
  • Stress, Psychological / psychology*