In the first study of its kind, researchers from the Icahn School of Medicine at Mount Sinai have found significantly lower birth weights in male infants--an average decrease of 38 grams, or approximately 1.3 ounces--born to women who had been exposed to trauma at some point in their lives and who secreted higher levels of cortisol, a hormone related to stress, in late pregnancy.
The study will be published online on Tuesday, September 18, at 12:01 am EDT in The Journal of Pediatrics.
Only women who had both a history of trauma and higher levels of cortisol secretion experienced lower birth weights; trauma alone was not sufficient. The association was also only seen among male babies. This is consistent with other data that shows that male fetuses are more susceptible to effects of maternal stress on intrauterine growth.
The Programming of Intergenerational Stress Mechanisms (PRISM) study provided data for the research. Information was gathered from 314 pregnant women receiving prenatal care and their children. The women provided information on their medical history and exposure to traumatic and stressful events using the Life Stressor Checklist-Revised (LSC-R), a commonly used tool to measure lifetime exposure to stressful events particularly relevant to women. At delivery, the subjects provided hair samples which were used to measure cortisol. Birth weight and sex of the infant were recorded.
While the mechanisms remain unclear, trauma-related stress, even when occurring long before the woman becomes pregnant, can have lasting effects on regulatory systems involved in her day-to-day response to stress, including processes related to cortisol production. Not everyone who experiences trauma develops disruption in their biological stress response systems but if they do, there can be health implications for both the woman and her child. Therefore, knowing about a pregnant woman's history of trauma together with stress hormone levels may identify at-risk pregnancies that may be complicated by low birth weight.
"Our study highlights that experiences prior to pregnancy can shape the health of subsequent generations through altered fetal development and pregnancy outcomes," said the study's senior author, Rosalind Wright, MD, MPH, Dean for Translational Biomedical Sciences at the Icahn School of Medicine at Mount Sinai. "Given the disproportionate exposure to stressors among racial minorities and women of lower socioeconomic status, there are important implications for understanding intergenerational perpetuation of health disparities and for understanding how to intervene."
Size at birth is a determinant of lifelong function, health, and disease. Minority women and those of disadvantaged socio-economic status are more likely to have low-birthweight infants. Chronic lifetime stress contributes to this risk.
"Identifying a prior history of trauma and providing interventions, for example treatment for associated mood disturbances, could lead to improved perinatal outcomes that have lifelong implications for health of mother and baby," said the study's first author, Julie Flom, MD, MPH, fellow in the Department of Allergy and Immunology at Icahn School of Medicine at Mount Sinai.
Other institutions involved in this study include the Harvard T.H.Chan School of Public Health, University of Cincinnati College of Medicine, Boston Children's Hospital, and Harvard Medical School.
This study was supported by grants from the National Institute of Health.
About Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system encompassing seven hospital campuses, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The System includes approximately 6,600 primary and specialty care physicians; 10 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 13 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat, while Mount Sinai Beth Israel, Mount Sinai St. Luke's and Mount Sinai West are ranked regionally. For more information, visit http://www.mountsinai.org/, or find Mount Sinai on Facebook, Twitter and YouTube.
The Journal of Pediatrics