Severe grief for a close family member experienced by a woman shortly before or during pregnancy was found to be associated with a later diagnosis of heart failure (HF) in a child through middle age, according to a study published on Feb. 21 in JACC: Heart Failure.

Fen Yang, MD, MSc, et al., examined 6,758,560 live births in Denmark and Sweden from 1973 to 2016 using nationwide registries. Exposure to prenatal stress was defined as maternal loss of a close family member (older child, partner, sibling or parent) in the year before or during pregnancy. Pregnancy loss was not included in the definition. If there were several losses during the exposure period, researchers counted the first loss as the date of exposure. Exposure was also categorized by: 1) the mother's relationship to the deceased; 2) the deceased family member's cause of death (natural or unnatural as defined by the International Classification of Diseases); and 3) time of loss (year before pregnancy, first, second or third trimester of pregnancy).

In the study cohort, 167,192 study participants experienced prenatal stress due to maternal bereavement in the year prior to or during pregnancy. Mothers in the exposed group were more likely to be older, married, smokers and have a family history of cardiovascular disease compared to mothers in the unexposed group.

Over the median follow-up of 24.2 years, 4,812 children were diagnosed with HF.

Yang, et al., found that the severest forms of maternal loss – the death of a partner or older child or the unnatural death of another family member – were associated with a HF diagnosis. However, other losses of less severity, like the natural death of another family member, were not associated with risk of HF. The time of bereavement – whether it was in the year before or during pregnancy – also showed no substantial difference in outcome.

The authors outline how others might build on their work. "Whether mental health or other types of stress, for example financial difficulties, work and marital stress or other adverse life events could influence the risk of [HF], not only at a young age, but also in older ages than we could study in the current cohort would need to be determined in future studies," said Krisztina László, PhD, senior author of the study.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: ACC International, Pregnancy, Heart Failure