Maternal Stress During Pregnancy Predicts Infant Infectious and Noninfectious Illness

J Pediatr. 2021 Jan:228:117-125.e2. doi: 10.1016/j.jpeds.2020.08.041. Epub 2020 Aug 19.


Objectives: To examine the association between prenatal stress and infant physical health in the first year of life within an understudied, racially and ethnically diverse, highly stressed community sample. We expected that greater stress exposure would predict higher rates of infant illness.

Study design: Low-income, racially/ethnically diverse, overweight women with low medical risk pregnancies were recruited (2011-2014) during pregnancy. Pregnancy Stressful Life Events were assessed retrospectively (mean, 11.88 months postpartum). Perceived stress was assessed twice during pregnancy (at a mean of 17.4 weeks and again at a mean of 25.6 weeks) and at 6 months postpartum. Women with live births (n = 202) were invited; 162 consented to the offspring study. Medical records from pediatric clinics and emergency departments for 148 infants were abstracted for counts of total infectious illnesses, total noninfectious illness, and diversity of illnesses over the first year of life.

Results: The final analytic sample included 109 women (mean age, 28.08 years) and their infants. In covariate-adjusted negative binomial models, maternal perceptions of stress across pregnancy were positively associated with infant illness. Each 1-point increase in average stress was associated with a 38% increase in incidence of infant infections (Incidence rate ratio, 1.38; 95% CI, 1.01-1.88; P < .05), a 73% increase in noninfectious illness (IRR, 1.73; 95% CI, 1.34-2.23; P < .05), and a 53% increase in illness diversity (IRR, 1.53; 95% CI, 1.25, 1.88; P < .01); effect sizes were larger for perceived stress later in pregnancy. Stressful life events count and postnatal stress were not uniquely associated with illness.

Conclusions: In line with recommendations from the American Academy of Pediatrics to screen for maternal perinatal depression, screening and support for stress reduction during pregnancy may benefit both maternal and child health.

Keywords: HPA axis; atopy; developmental origins of health and disease; fetal programming; illness; immune system; infant; infectious illness; maternal stress; prenatal programming.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Humans
  • Incidence
  • Infant, Newborn
  • Infant, Newborn, Diseases / epidemiology
  • Infant, Newborn, Diseases / etiology*
  • Infections / epidemiology
  • Infections / etiology*
  • Middle Aged
  • Postpartum Period*
  • Pregnancy
  • Pregnancy Complications / psychology*
  • Retrospective Studies
  • Stress, Psychological / complications*
  • Stress, Psychological / psychology
  • United States / epidemiology
  • Young Adult