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The Evidence Base: Predictors of Infant Health

The Evidence Base: Predictors of Infant Health

Prenatal care is key to preventing pregnancy complications and identifying intimate partner violence.1,2,3 “Inadequate” prenatal care is associated with an increased risk of preterm delivery compared with women receiving “adequate” care.4 “Adequate” care significantly reduces risk for premature birth, low birth weight, and small-for-gestational-age status in drug-exposed infants.5 Late entry to prenatal care has been associated with increased risk for neonatal death, infant death, and cumulative death within the first year of life.6

Maternal stress, anxiety, and depression during pregnancy has been linked to adverse birth and developmental outcomes, including: preterm delivery and low birth weight;7,8,9 difficult and reactive infant behavior;10,11 poorer physical outcomes such as the development of Celiac Disease and asthma.12,13

Postpartum depression is associated with less infant weight gain, increased infant physical health concerns, and increased infant night awakenings. Postpartum depression has also been linked to a lack of appropriate mother-child engagement, poorer developmental outcomes, and insecure attachment in the infant.14,15 In addition, low maternal responsiveness and sensitivity is significantly associated with the development of insecure attachment in infants.16,17,18

Breastfeeding confers significant benefits to premature babies including host protection and improved developmental outcomes compared to premature babies given formula.19 Breastfeeding is strongly linked with a reduction in sudden infant death syndrome (SIDS) with one meta-analysis concluding that a history of breastfeeding is associated with a 36 percent reduction in the risk of SIDS compared to infants without a history of breastfeeding.20,21 Finally, breastfeeding is associated with a reduction in risk for a variety of physical conditions, including diarrhea in infants, acute otitis media,22 gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, and childhood leukemia.23

Safe sleep practices decrease the likelihood of SIDS, the risk of infant breathing problems, overheating, and issues with the infant cardiovascular system.24 Prone or side sleep positions (as opposed to supine) are linked with these negative outcomes. Additional independent risk factors that contribute the risk of SIDS include: sleeping on a soft surface, maternal smoking during pregnancy, overheating, late or no prenatal care, young maternal age, preterm birth and/or low birth weight, and male gender.25

For CFRP's full Evidence Base Series, go to Publications > The Evidence-Base Series.
  • Citations
    1.	Stulberg, D. B., Cain, L., Hasham Dahlquist, I., & Lauderdale, D. S. (2017). Pre‐pregnancy and Early Prenatal Care are Associated with Lower Risk of Ectopic Pregnancy Complications in the Medicaid Population: 2004–08. Paediatric and perinatal epidemiology, 31(1), 4-10.
2.	Schrag, S. J., Arnold, K. E., Mohle-Boetani, J. C., Lynfield, R., Zell, E. R., Stefonek, K., ... & Schuchat, A. (2003). Prenatal screening for infectious diseases and opportunities for prevention. Obstetrics & Gynecology, 102(4), 753-760.
3.	Fletcher, T. R., Clements, A. D., & Bailey, B. (2016). Identifying intimate partner violence during pregnancy in prenatal care settings. International Journal of Health Sciences Education, 3(1), 3.
4.	Krueger PM, Scholl TO. Adequacy of prenatal care and pregnancy outcome. J Am Osteopath Assoc. 2000;(100):485–92.
5.	El-Mohandes, A., A.A. Herman, M. Nabil El-Khorazaty, P.S. Katta, D. White, L. Grylack. Prenatal care reduces the impact of illicit drug use on perinatal outcomes. J Perinatol, 23 (2003), pp. 354–360.
6.	Pilliod, R., Savitsky, L., Allen, A., Eriksen, J. K., & Caughey, A. (2015). 214: Late entrants to prenatal care: a predictor of infant mortality?. American Journal of Obstetrics & Gynecology, 212(1), S120-S121.
7.	Endnotes
8.	Dole, N., Savitz, D. A., Hertz-Picciotto, I., Siega-Riz, A. M., McMahon, M. J., & Buekens, P. (2003). Maternal stress and preterm birth. American Journal of Epidemiology, 157, 14 –24.
9.	Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A Meta-analysis of Depression During Pregnancy and the Risk of Preterm Birth, Low Birth Weight, and Intrauterine Growth Restriction. Arch Gen Psychiatry. 2010;67(10):1012-1024. doi:10.1001/archgenpsychiatry.2010.111
10.	Weinstock, M. (2001). Alterations induced by gestational stress in brain morphology and behaviour of the offspring. Progress in neurobiology, 65(5), 427-451.
11.	Davis, E.P., Snidman, N., Wadhwa, P.D., Glynn, L.M.,Schetter, C.D., & Sandman, C.A. (2004). Prenatalmaternal anxiety and depression predict negativebehavioral reactivity in infancy. Infancy, 6, 319–331.
12.	Huizink, A. C., De Medina, P. G. R., Mulder, E. J., Visser, G. H., & Buitelaar, J. K. (2002). Psychological measures of prenatal stress as predictors of infant temperament. Journal of the American Academy of Child & Adolescent Psychiatry, 41(9), 1078-1085. 
13.	Ludvigsson JF, Ludvigsson J. Stressful life events, social support and confidence in the pregnant woman and risk of celiac disease in the offspring. Scand J Gastroenterol. 2003;38(5):516 –521
14.	Cookson H, Granell R, Joinson C, BenShlomo Y, Henderson AJ. Mothers’ anxiety during pregnancy is associated with asthma in their children. J Allergy Clin Immunol. 2009;123(4):847– 853
15.	Gress-Smith J, Luecken LJ, Lemery-Chalfant K, Howe R. 2012. Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Matern. Child Health J. 16:887–93 
16.	Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behavior and Development, 33(1), 1-6.
17.	Cerezo, M. A., Pons-Salvador, G., & Trenado, R. M. (2008). Mother–infant interaction and children’s socio-emotional development with high-and low-risk mothers. Infant Behavior and Development, 31(4), 578-589.
18.	NICHD Early Child Care Research Network. (1997). The effects of infant child care on infant-mother attachment security: Results of the NICHD Study of Early Child Care. Child development, 860-879.
19.	Lee, G., McCreary, L., Breitmayer, B., Kim, M. J., & Yang, S. (2013). Promoting mother–infant interaction and infant mental health in low‐income Korean families: Attachment‐based cognitive behavioral approach. Journal for Specialists in Pediatric Nursing, 18(4), 265-276.
20.	Gartner, L. M., Morton, J., Lawrence, R. A., Naylor, A. J., O'Hare, D., Schanler, R. J., & Eidelman, A. I. (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496-506.
21.	Ip S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Evidence report/technology assessment No. 153
22.	Chen, A., & Rogan, W. J. (2004). Breastfeeding and the risk of postneonatal death in the United States. Pediatrics, 113(5), e435-e439.
23.	Scariati, P., Grummer-Strawn, L., & Fein, S. (1997). A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics 99.  
24.	Ip S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Evidence report/technology assessment No. 153
25.	Task Force on Sudden Infant Death Syndrome. (2011). SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment.
26.	Ibid.
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