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PLoS One. 2016 Sep 29;11(9):e0163355. doi: 10.1371/journal.pone.0163355. eCollection 2016.

Maternal Antenatal Bereavement and Neural Tube Defect in Live-Born Offspring: A Cohort Study.

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Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark.
Research Unit for Obstetrics and Gynecology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States of America.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.



Maternal emotional stress during pregnancy has previously been associated with congenital neural malformations, but most studies are based on data collected retrospectively. The objective of our study was to investigate associations between antenatal maternal bereavement due to death of a close relative and neural tube defects (NTDs) in the offspring.


We performed a register-based cohort study including all live-born children (N = 1,734,190) from 1978-2008. Exposure was bereavement due to loss of a close relative from one year before conception to the end of the first trimester of pregnancy. The outcome was NTDs in the offspring according to the International Classification of Disease. We used multivariate logistic regression to estimate prevalence odds ratios (ORs).


A total of 2% children were born to mothers who lost a close relative prenatally. During 30 years of follow-up, 1,115 children were diagnosed with any NTDs: spina bifida (n = 889), anencephaly (n = 85) and encephalocele (n = 164). And 23 children were diagnosed with two types of NTDs. Overall, when comparing bereaved mothers to non-bereaved mothers, no significant increased prevalence of NTDs in the offspring was seen (OR = 0.84; 95% confidence interval: 0.52-1.33).


Overall maternal bereavement in the antenatal period was not related to NTDs in liveborn offspring.

Conflict of interest statement

The authors have declared that no competing interests exist.

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