Abstract
The etiology of pediatric abdominal disorders is poorly understood, and the relationship with maternal mental health is understudied. We sought to determine the association between maternal psychiatric disorders and abdominal conditions in childhood. We performed a retrospective cohort study of 1,080,518 newborns in Quebec, Canada, between 2006 and 2020. We identified maternal mental disorders before or during pregnancy and computed the incidence of abdominal disorders in offspring before 1 year of age. Outcomes included Hirschsprung disease; hypertrophic pyloric stenosis; and esophageal, intestinal, and biliary atresia. We calculated adjusted risk ratios (RR) with 95% confidence intervals (CI) for the association of maternal mental disorders with these pediatric abdominal disorders. Among 51,371 children exposed to maternal mental disorders, 200 children had an abdominal condition, for a rate of 38.9 cases per 10,000 children (95% CI 33.6–44.3) compared with 27.7 per 10,000 for children who were unexposed to maternal mental disorders (95% CI 26.7–28.7). Compared with no mental disorder, maternal mental disorders were associated with hypertrophic pyloric stenosis (RR 1.39, 95% CI 1.16–1.68). Associations were stronger for severe mental disorders and were more marked for depression and stress and anxiety disorders. Maternal mental disorders are associated with the risk of hypertrophic pyloric stenosis in offspring. The origin of hypertrophic pyloric stenosis may relate to maternal mental disorders that were present during pregnancy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The data that support the findings of this study are available upon request from the Quebec Ministry of Health and Social Services, following standard access procedures for confidential data.
Code availability
Statistical code is available from the authors upon request.
References
Alwan S, Reefhuis J, Rasmussen SA et al (2007) Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med 356:2684–2692. https://doi.org/10.1056/NEJMoa066584
Auger N, Bilodeau-Bertrand M, Tith RM, Arbour L (2019) Bariatric surgery and the risk of congenital anomalies in subsequent pregnancies. Am J Clin Nutr 110:1168–1174. https://doi.org/10.1093/ajcn/nqz195
Caton AR, Druschel CM, McNutt LA (2004) The epidemiology of extrahepatic biliary atresia in New York State, 1983–98. Paediatr Perinat Epidemiol 18:97–105. https://doi.org/10.1111/j.1365-3016.2003.00536.x
Coran AG, Caldamone A, Adzick NS et al (eds) (2012) Coran pediatric surgery, 7th edn. Philadelphia: Saunders
Davit-Spraul A, Baussan C, Hermeziu B et al (2008) CFC1 gene involvement in biliary atresia with polysplenia syndrome. J Pediatr Gastroenterol Nutr 46:111–112. https://doi.org/10.1097/01.mpg.0000304465.60788.f4
DeSocio JE (2018) Epigenetics, maternal prenatal psychosocial stress, and infant mental health. Arch Psychiatr Nurs 32:901–906. https://doi.org/10.1016/j.apnu.2018.09.001
Felix JF, de Jong EM, Torfs CP et al (2009) Genetic and environmental factors in the etiology of esophageal atresia and/or tracheoesophageal fistula: an overview of the current concepts. Birth Defects Res Part A Clin Mol Teratol 85:747–754. https://doi.org/10.1002/bdra.20592
Galea R, Said E (2018) Infantile hypertrophic pyloric stenosis: an epidemiological review. Neonatal Netw 37:197–204. https://doi.org/10.1891/0730-0832.37.4.197
Given JE, Loane M, Garne E et al (2017) Gastroschisis in Europe—a case-malformed-control study of medication and maternal illness during pregnancy as risk factors. Paediatr Perinat Epidemiol 31:549–559. https://doi.org/10.1111/ppe.12401
Grote NK, Bridge JA, Gavin AR et al (2010) A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 67:1012–1024. https://doi.org/10.1001/archgenpsychiatry.2010.111
Harris BS, Bishop KC, Kemeny HR et al (2017) Risk factors for birth defects. Obstet Gynecol Surv 72:123–135. https://doi.org/10.1097/OGX.0000000000000405
Iqbal MM, Sohhan T, Mahmud SZ (2001) The effects of lithium, valproic acid, and carbamazepine during pregnancy and lactation. J Toxicol Clin Toxicol 39:381–392. https://doi.org/10.1081/clt-100105159
Krogh C, Fischer TK, Skotte L et al (2010) Familial aggregation and heritability of pyloric stenosis. JAMA 303:2393–2399. https://doi.org/10.1001/jama.2010.784
Lodha AK, Satodia P, Whyte H (2005) Fetal alcohol syndrome and pyloric stenosis: alcohol induced or an association? J Perinat Med 33:262–263. https://doi.org/10.1515/JPM.2005.049
LöfGranström A, Svenningsson A, Hagel E et al (2016) Maternal risk factors and perinatal characteristics for Hirschsprung disease. Pediatrics 138:e20154608. https://doi.org/10.1542/peds.2015-4608
Lorent K, Gong W, Koo KA et al (2015) Identification of a plant isoflavonoid that causes biliary atresia. SciTransl Med 7:286ra67. https://doi.org/10.1126/scitranslmed.aaa1652
MacMahon B (2006) The continuing enigma of pyloric stenosis of infancy: a review. Epidemiology 17:195–201. https://doi.org/10.1097/01.ede.0000192032.83843.c9
McAteer JP, Ledbetter DJ, Goldin AB (2013) Role of bottle feeding in the etiology of hypertrophic pyloric stenosis. JAMA Pediatr 167:1143–1149. https://doi.org/10.1001/jamapediatrics.2013.2857
Mei-Dan E, Ray JG, Vigod SN (2015) Perinatal outcomes among women with bipolar disorder: a population-based cohort study. Am J Obstet Gynecol 212:367.e1–8. https://doi.org/10.1016/j.ajog.2014.10.020
Ministry of Health and Social Services (2017) Med-echo system normative framework—maintenance and use of data for the study of hospital clientele. Quebec: Government of Quebec
Oddsberg J, Jia C, Nilsson E et al (2008) Influence of maternal parity, age, and ethnicity on risk of esophageal atresia in the infant in a population-based study. J Pediatr Surg 43:1660–1665. https://doi.org/10.1016/j.jpedsurg.2007.11.021
Panteli C (2009) New insights into the pathogenesis of infantile pyloric stenosis. Pediatr Surg Int 25:1043–1052. https://doi.org/10.1007/s00383-009-2484-x
Prince MK, Ayers D (2020) Substance use in pregnancy. In: StatPearls. Treasure Island: StatPearls Publishing
Sadler T (2012) Langman’s Medical Embryology, 12th edn. Philadelphia: Lippincott Williams & Wilkins
Skarsgard ED, Meaney C, Bassil K et al (2015) Maternal risk factors for gastroschisis in Canada. Birth Defects Res A Clin Mol Teratol 103:111–118. https://doi.org/10.1002/bdra.23349
Svenningsson A, Svensson T, Akre O, Nordenskjöld A (2014) Maternal and pregnancy characteristics and risk of infantile hypertrophic pyloric stenosis. J Pediatr Surg 49:1226–1231. https://doi.org/10.1016/j.jpedsurg.2014.01.053
Thomas EG, Higgins C, Westgate M-N et al (2018) Malformations surveillance: comparison between findings at birth and age 1 year. Birth Defects Research 110:142–147. https://doi.org/10.1002/bdr2.1096
Vermes G, László D, Czeizel AE, Ács N (2016) Maternal factors in the origin of infantile hypertrophic pyloric stenosis: a population-based case-control study. Congenit Anom (Kyoto) 56:65–72. https://doi.org/10.1111/cga.12134
Vermes G, Mátrai Á, Czeizel AE, Ács N (2015) Maternal factors in the origin of isolated oesophageal atresia: a population-based case-control study. Birth Defects Res Part A Clin Mol Teratol 103:804–813. https://doi.org/10.1002/bdra.23383
Vesga-Lopez O, Blanco C, Keyes K et al (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65:805–815. https://doi.org/10.1001/archpsyc.65.7.805
Werler MM, Guéry E, Waller DK, Parker SE (2018) Gastroschisis and cumulative stressor exposures. Epidemiology 29:721–728. https://doi.org/10.1097/EDE.0000000000000860
Werler MM, Sheehan JE, Mitchell AA (2002) Maternal medication use and risks of gastroschisis and small intestinal atresia. Am J Epidemiol 155:26–31. https://doi.org/10.1093/aje/155.1.26
Wogelius P, Nørgaard M, Gislum M et al (2006) Maternal use of selective serotonin reuptake inhibitors and risk of congenital malformations. Epidemiology 17:701–704. https://doi.org/10.1097/01.ede.0000239581.76793.ae
Funding
This study was supported by the Canadian Institutes of Health Research [PJT-162300] and the Fonds de recherche du Québec-Santé [34695]. The sponsors were not involved in study design; the collection, analysis, and interpretation of data; writing of the report; and the decision to submit the article for publication.
Author information
Authors and Affiliations
Contributions
AL-N, GL, and NA conceived and designed the study. GL analyzed the data with input from NA. AL-N and NP helped interpret the results. The first draft of the manuscript was written by AL-N and NP. GL and NA critically revised it for important intellectual content. All authors read and approved the final version of the manuscript.
Corresponding author
Ethics declarations
Ethical approval
For this type of study, formal consent is not required.
Informed consent to participate and publish
Data used in this study were de-identified, and informed consent was not required.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Le-Nguyen, A., Piché, N., Lee, G.E. et al. Maternal mental disorders and risk of pathological abdominal conditions in children. Arch Womens Ment Health 24, 925–932 (2021). https://doi.org/10.1007/s00737-021-01126-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-021-01126-3