Prenatal stress is a potential risk factor for cardiovascular disease, but its association with heart failure (HF) is unknown. The purpose of this study was to investigate whether prenatal stress, defined as maternal bereavement, was associated with HF risk up to middle-age. This cohort study included 6,758,560 live singleton births from the Danish (1973-2016) and the Swedish (1973-2014) Medical Birth Registers. The authors retrieved information on death of the mothers’ close family members (partner, older children, parents, and siblings) and offspring’s HF (up to 2016 in Denmark and 2020 in Sweden) from nationwide registers. They estimated HRs and 95% CIs for HF in the offspring according to maternal bereavement. During up to 48 years of follow-up, 4,812 offspring (0.07%) had a diagnosis of HF. Maternal loss of any close family member was not associated with HF in the offspring (adjusted HR: 1.04; 95% CI: 0.88-1.23). However, the most severe forms of bereavement, ie, death of a partner or an older child (adjusted HR: 1.47; 95% CI: 1.06-2.04) and unnatural death of a relative (adjusted HR: 2.77; 95% CI: 1.49-5.17), were associated with increased risks of HF. Congenital heart disease and preterm birth contributed substantially to the association of maternal loss of a partner or older child with HF risk in the offspring. Maternal loss of a partner or older child and loss of a close relative caused by unnatural causes the year before or during pregnancy were associated with increased risk of HF in offspring.

中文翻译：

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产前承受严重压力和中年之前发生心力衰竭的风险

产前应激是心血管疾病的潜在危险因素，但其与心力衰竭（HF）的关系尚不清楚。本研究的目的是调查产前压力（定义为产妇丧亲）是否与中年期间的心力衰竭风险相关。这项队列研究包括丹麦（1973-2016）和瑞典（1973-2014）医学出生登记处的 6,758,560 名活产单胎婴儿。作者从全国登记册中检索了有关母亲近亲（伴侣、年长的孩子、父母和兄弟姐妹）死亡和后代心衰的信息（丹麦截至 2016 年，瑞典截至 2020 年）。他们根据母亲的丧亲经历估计了后代心力衰竭的 HR 和 95% CI。在长达 48 年的随访中，4,812 名后代 (0.07%) 被诊断为心力衰竭。母亲失去任何近亲与后代的心力衰竭无关（调整后的 HR：1.04；95% CI：0.88-1.23）。然而，最严重的丧亲形式，即伴侣或年长子女的死亡（调整后 HR：1.47；95% CI：1.06-2.04）和亲属非正常死亡（调整后 HR：2.77；95% CI：1.49） -5.17），与心力衰竭风险增加相关。先天性心脏病和早产在很大程度上导致母亲失去伴侣或年长的孩子与后代的心力衰竭风险之间存在关联。母亲在怀孕前一年或怀孕期间因非自然原因失去伴侣或年龄较大的孩子以及近亲死亡与后代心力衰竭的风险增加有关。