Maternal life stress events in pregnancy link to children's school achievement at age 10 years.

OBJECTIVE: To test the hypothesis that maternal antenatal exposure to life stress events is associated with lower achievement in literacy and numeracy at age 10 years, with sex differences in this link. STUDY DESIGN: The Western Australian Pregnancy Cohort Study recruited 2900 women at 18 weeks' pregnancy, and 2868 children were followed up at birth and postnatally. At age 10 years, information on 1038 children was linked to their literacy and numeracy test scores. Multivariate regression models were used to test the foregoing hypotheses, adjusting for important confounders. RESULTS: In girls, maternal antenatal exposure to 4 or more maternal life stress events or death of the mother's friend and/or relative was associated with lower reading scores. In contrast, exposure to 3 or more life stress events or to a pregnancy or financial problem was associated with higher reading scores in boys. Furthermore, maternal exposure to 4 or more life stress events was associated with higher mathematic scores and a residential move was linked to higher writing scores in boys. CONCLUSION: Maternal antenatal exposure to life stress events has differing effects on the school performance of male and female offspring. Further research is needed to explore the reasons for this sex difference.

The long-term effects of breastfeeding on child and adolescent mental health: a pregnancy cohort study followed for 14 years.

OBJECTIVES: To determine whether there was an independent effect of breastfeeding on child and adolescent mental health. STUDY DESIGN: The Western Australian Pregnancy Cohort (Raine) Study recruited 2900 pregnant women and followed the live births for 14 years. Mental health status was assessed by the Child Behaviour Checklist (CBCL) at 2, 6, 8, 10, and 14 years. Maternal pregnancy, postnatal, and infant factors were tested in multivariable random effects models and generalized estimating equations to examine the effects of breastfeeding duration on mental health morbidity. RESULTS: Breastfeeding for less than 6 months compared with 6 months or longer was an independent predictor of mental health problems through childhood and into adolescence. This relationship was supported by the random effects models (increase in total CBCL score: 1.45; 95% confidence interval 0.59, 2.30) and generalized estimating equation models (odds ratio for CBCL morbidity: 1.33; 95% confidence interval 1.09, 1.62) showing increased behavioral problems with shorter breastfeeding duration. CONCLUSION: A shorter duration of breastfeeding may be a predictor of adverse mental health outcomes throughout the developmental trajectory of childhood and early adolescence.

Hypertensive diseases of pregnancy and the development of behavioral problems in childhood and adolescence: the Western Australian Pregnancy Cohort Study.

OBJECTIVE: To examine whether maternal gestational hypertension and preeclampsia are associated with behavioral problems in offspring throughout childhood and early adolescence. STUDY DESIGN: We conducted a prospective cohort study of 2804 women in the Western Australian Pregnancy Cohort Study and their children observed at age 2, 5, 8, 10, and 14 years. The Child Behavior Checklist (CBCL) was used to measure problem child behavior with continuous z-scores and clinical cutoff points. Control variables included known biomedical, sociodemographic, and psychological factors. RESULTS: After adjustment, with general linear model analyses children of women with gestational hypertension were shown to be more likely to have higher CBCL z-scores, indicative of poorer behavior, from 8 years on, with the largest difference seen at 14 years. Children of mothers with preeclampsia were more likely to have lower CBCL z-scores, indicative of pro-social behaviors. The multivariable logistic regression analysis showed that gestational hypertension was predictive of clinically significant CBCL T-scores from age 8 to 14 years. This association was significant for externalizing behavior, such as delinquent and aggressive behavior, and for internalizing behavior at age 14 years. Unexpectedly, preeclampsia reduced internalizing morbidity at ages 5 and 8 years. CONCLUSIONS: The opposing effect on child and adolescent behavior of gestational hypertension and preeclampsia warrants further attention.

The association of maternal overweight and obesity with breastfeeding duration.

OBJECTIVE: To determine whether maternal prepregnancy overweight or obesity has an independent effect on breastfeeding duration. STUDY DESIGN: A prospective birth cohort study of 1803 live-born children and their mothers ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth, Australia, were followed until 3 years of age. Unconditional logistic, Cox regression, and Kaplan Meier analyses were used to model the association between maternal prepregnancy overweight and obesity and the duration of predominant or any breastfeeding allowing for adjustment of confounders (infant factors: gender, birth weight, gestational age, age solids introduced, and older siblings; maternal factors: smoking, education, age, race, marital status, pregnancy and birth complications, cesarean section, and socioeconomic status). RESULTS: Overweight and obese women were more likely to have discontinued breastfeeding at any time before 6 months than normal weight women (P < .0005) following adjustment for potential confounders. CONCLUSION: We have shown that prepregnancy body mass index is associated with reduced breastfeeding duration, and that mothers who are overweight or obese before pregnancy tend to breastfeed their infants for a shorter duration than normal weight mothers independent of maternal socioeconomic and demographic characteristics.