MedicalResearch.com Interview with:
Julie Flom, MD MPH
Division of Allergy & Immunology
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study?
Response: Women who are minorities and of lower socioeconomic have particularly high rates of exposure to chronic ongoing adversity such as poverty as well as traumatic stressors in their lifetime and are also more likely to have low birthweight infants. Not all women exposed to chronic adversity or trauma transfer this risk to the next generation – it is primarily when the trauma results in changes in her bodies’ ability to handle ongoing stress that the developing child can be impacted.
Our group undertook a study to investigate whether women with increased exposure to traumatic stressors over her lifetime were at higher risk of having low birthweight infants and also whether effects of trauma would only be evident among women who produced higher levels of cortisol, the major stress response hormone, while pregnant.
MedicalResearch.com: What are the main findings?
Response: We did not find a direct association between higher lifetime trauma and lower birthweight. It was only among women who secreted higher levels of cortisol during pregnancy that higher lifetime trauma was significantly associated with lower birthweight infants. Interestingly, this was only observed in male babies, which is consistent with other research showing that male fetuses are more susceptible to impacts of stress on fetal growth. Among male babies exposed to higher maternal cortisol levels, for every additional traumatic event reported by mothers, there was an average decrease in birthweight of 88 grams.
MedicalResearch.com: What should readers take away from your report?
Response: Stressful experiences adding up over a woman’s lifetime may be important for infant outcomes than more acute stress occurring during pregnancy. We know there is a disproportionately higher exposure to stressors among racial minorities and women of lower socioeconomic status, and this study supports that health disparities can be perpetuated between generations. There are interventions to improve mental health outcomes and our hope is that identifying women with a prior history of trauma, prior to or during pregnancy, and intervening, may lead to improved outcomes not only for the mother but also for the baby.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need to further elucidate underlying biological changes in the stress response system that underlie effects of lifetime trauma exposure on fetal growth. Ultimately, we would like to understand how to best identify those at elevated risk of adverse pregnancy outcomes and to develop effective interventions to improve intergenerational health outcomes and early biological signatures can help us reach that. At the same time, it is imperative that we better understand the underlying biological mechanisms that contribute to resilience – specifically, programming of the maternal stress response that enables some fetuses to be protected against the impact of maternal lifetime trauma exposure.
Julie D. Flom, Yueh-Hsiu Mathilda Chiu, Hsiao-Hsien Leon Hsu, Katrina L. Devick, Kelly J. Brunst, Rebecca Campbell, Michelle Bosquet Enlow, Brent A. Coull, Rosalind J. Wright. Maternal Lifetime Trauma and Birthweight: Effect Modification by In Utero Cortisol and Child Sex. The Journal of Pediatrics, 2018; DOI: 10.1016/j.jpeds.2018.07.069
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