Maternal Bereavement the Year Before or During Pregnancy and Total and Cause-Specific Infant Mortality: A Cohort Study From Denmark and Sweden

• Published in: Psychosomatic medicine 2020-07, Vol.82 (6), p.577-585
• Main Authors: László, Krisztina D., Johansson, Stefan, Miao, Maohua, Li, Jiong, Olsen, Jørn, Yuan, Wei, Cnattingius, Sven
• Format: Article
• Language: English
• Subjects: Asphyxia; Bereavement; Births; Child mortality; Children; Cohort analysis; Congenital defects; Death & dying; Families & family life; Grief; Health risk assessment; Health status; Infancy; Infant mortality; Infants; Maternal and infant welfare; Maternal characteristics; Medicin och hälsovetenskap; Medicine; Mothers; Older children; Pregnancy; Prenatal care; Prenatal experience; Relatives; Risk factors; SIDS; Sociodemographics; Stress; Sudden death; Sudden infant death syndrome
• ISSN: 0033-3174; 1534-7796; 1534-7796
• DOI: 10.1097/PSY.0000000000000822

We analyzed associations between maternal bereavement the year before or during pregnancy and total and cause-specific infant mortality (IM). We studied live singleton births from the Danish (1978-2008) and Swedish Medical Birth Registers (1973-2006) (N=5,114,246). Information on maternal sociodemographic, pregnancy- and health-related factors and death of family members were obtained from nationwide registers. Among children of mothers with register links to family members and without the considered IM risk factors, 110,993 (2.76%) were exposed and 15,199 (0.4%) died in infancy. Death of an older child the year before or during pregnancy was associated with an increased IM risk [adjusted odds ratio (aOR), 95% confidence intervals (CI): 2.05 (1.44-2.92)]. Losing an older child the year before pregnancy or during pregnancy were associated with risks of prematurity-related IM [aOR (95% CI): 2.61 (1.44-4.72) and 3.08 (1.70-5.57)], and with infant death in term born children due to other causes than sudden infant death syndrome (SIDS), congenital malformations or asphyxia [aOR (95% CI): 3.31 (1.58-6.96) and 5.10 (1.27-20.43)]. Losing an older child during pregnancy was also associated with increased risks of SIDS [aOR (95% CI): 5.41 (1.34-21.83)]. Death of a partner during pregnancy was associated with IM [aOR 1.83 (1.01-3.32)]. The number of events were small and CIs wide in some sub-analyses and caution is needed when interpreting our results. Severe prenatal stress may increase the risk of several types of IM. Whether less severe, but more common maternal stressors shortly before or during pregnancy also increase IM risk warrants further investigation.