Maternal Prenatal Psychosocial Stress in Relation to Maternal and Neonatal Anemia

Background: Maternal prenatal psychosocial stress and iron deficiency are both common, and each may affect fetal iron stores and subsequent offspring neurodevelopment. The extent to which psychosocial stress affects maternal iron status and maternal-fetal iron regulation is not known. Objectives: To assess 1) associations of prenatal stress and mental health with maternal anemia and neonatal hemoglobin (Hb), and 2) the extent to which prenatal stressors modify maternal anemia–neonatal Hb associations. Methods: Observational data from participants enrolled in a randomized prenatal care trial were used. Prenatal distress, perceived stress, life stressors, and depression symptoms were assessed with validated questionnaires in the second (T2) and third trimesters (T3). T2 and T3 anemia (Hb <10.5 and 11 g/dL, respectively) and neonatal Hb were abstracted from participants’ electronic health records. Adjusted log Poisson and linear regression models were fit. Effect measure modification was examined with stratified regression models and product terms. Results: Hb was available for 1263 participants in T2, 1707 in T3, and 427 neonates <7 d old. Anemia prevalence was 27% in T2 and 51% in T3. Prenatal stressors were associated with higher rates of T3 but not T2 anemia: in models adjusted for the other stress exposures and covariates, T3 anemia was associated with perceived stress [prevalence ratio (PR): 1.02; 95% confidence interval (CI): 1.00,1.04] and 1–2 and ≥3 life stressors compared with none (PR:1.12; 95% CI 1.02, 1.26 and PR:1.2; 95% CI 1.02,1.41). Infants of mothers with T2 anemia had lower neonatal Hb (median: 16.6 g/dL, IQR: 15.3–18.5 compared with 17.2, 15.8–18.8; P = 0.077). Prenatal stressors were not associated with neonatal Hb, nor did they modify the relationship between maternal anemia and neonatal Hb. Conclusions: In this sample, maternal T3 anemia was sensitive to maternal stressors, whereas T2 anemia and neonatal Hb were not. Highly stress-exposed pregnancies may require additional monitoring and intervention for anemia to protect maternal and infant health.