Associations between maternal stress during pregnancy and offspring obesity risk later in life—A systematic literature review

Abstract

Exposure to prenatal stress is linked to health consequences in the offspring. The objective of this systematic review was to synthesize and critically appraise primary human studies that have examined the association between prenatal exposure to psychosocial stress, or adverse life events, stress hormones, and later risk of developing obesity. We searched Medline, Embase, ScienceDirect, WorldCat, and OpenGrey up to January 2019 to identify relevant literature. We critically appraised the identified studies, assessed their quality, and summarized their findings. From a total of 5930 search results and references of studies that authors considered pertinent, we identified 15 relevant studies among which three were of high quality and the rest were medium-quality studies. We found direct association between exposure to stress in fetal life and different measures of obesity in the offspring in eight studies.The direct association was usually observed in studies that involved measurement of stress among mothers exposed to natural disasters. Due to lack of adequate and comparable data from the included studies, we did not conduct a meta-analysis. We concluded that there may be direct association between prenatal stress and later obesity, but further research with more comparable sources of stressors is recommended.BMI, life events, obesity, prenatal stress 1 | BACKGROUND The rising burden of overweight and obesity in all age groups across most parts of the world is a major global health challenge 1 . The health risks of obesity are well accepted in scientific communities 2-4 .Children with obesity are likely to also be overweight or obese in adulthood and the consequent health risks increase with age 5-8 . The morbidities related to obesity also have large economic consequences 9 . Thus, there is a public health urgency to identify preventable causes to intervene against obesity.Excessive intake of energy dense foods and low levels of physical activity are two major factors that contribute to obesity 10,11 . In addition, several studies have established clear associations between maternal exposure to an adverse external environment such as famine or undernutrition during pregnancy, and various short-and long-term Abbreviations: BMI, body mass index; CRH, corticotropin-releasing hormone; DXA, dualenergy X-ray absorptiometry; DNBC, Danish National Birth Cohort; FMI, fat mass index; HPA axis, hypothalamic-pituitary-adrenocortical axis; MOOSE, meta-analyses and systematic reviews of observational studies; PNMS, prenatal maternal stress; PROSPERO, international prospective register of ongoing systematic reviews; SS, subscapular thickness; TR, triceps thickness; WHtR, waist-to-height ratio.

Relationships between Prenatal Distress and Infant Body Mass Index in the First Year of Life in a Lower-Middle Income Country

“…For example, studies in Brazil (upper-middle income) showed that greater perceived stress during pregnancy predicted lower BMI Z-scores at ages 5–8 [ 6 ]. This is in contrast to many studies from high-income countries, which tend to show increased obesity risk following prenatal stress exposure [ 2 ]. More detailed studies in LMICs might highlight pathways to improve maternal and child health in these settings.…”

“…Research in the developmental origins of health and disease demonstrates that a stressful prenatal environment has long-term implications for physical growth and cardiometabolic outcomes such as obesity and diabetes. This likely reflects the effects of maternal stress hormones on developing fetal systems and epigenetic changes in fetal tissues that might have lifelong effects [ 1 , 2 ]. Prenatal stress exposure might affect the developing hypothalamic pituitary adrenal axis and thereby affect growth and cardiometabolic outcomes across childhood, adolescence, and adulthood [ 1 ].…”

“…Second, most studies on prenatal stress and physical growth, body composition, or obesity are from high-income countries [ 2 ]. Results might differ in low- and middle-income countries (LMICs).…”

“…However, they also point to complexities that warrant further study. For example, prenatal stress likely interacts with prenatal diet [ 1 , 7 ], but few studies combine analyses of these factors [ 2 , 7 ]. Furthermore, some studies indicate non-linear relationships between prenatal stress and child outcomes [ 8 , 9 ], but most focus on adverse effects of prenatal stress, with little discussion of potential curvilinear relationships.…”

The Role of Prenatal Melatonin in the Regulation of Childhood Obesity

“…It should also be noted that it is not only recognized prenatal medical conditions, such as IUGR and gestational diabetes, that increase offspring obesity. A number of studies show a variety of prenatal stressors to also have such impacts on human offspring [104]. The effects of different stressors is partly mediated by an increase in corticotropin-releasing hormone in the hypothalamus and amygdala, which then acts on mucosal mast cells to increase tumor necrosis factor α (TNFα), which then increases gut permeability and contributes to gut dysbiosis [105].…”