Associations between maternal stressful life events experiences and risk of neural tube defects in offspring: a systematic review and meta-analysis

Abstract

Objectives

Multiple factors associated with neural tube defects (NTDs) risk have been identified, yet there is little evidence on the possible effects of maternal stressful life events. In this study, we aimed to investigate the association between stressful life events during the periconceptional period and risk of NTDs in offspring.

Methods

Relevant literature was searched in PubMed, Springer Link, ScienceDirect, and Cochrane Library up to July 2023. The pooled odds ratio (OR) and 95% confidence interval (CI) of NTDs risk with maternal stressful life events were estimated using a random effects model. Publication bias was assessed using Egger’s regression asymmetry test and Begg’s rank correlation test with Begg’s funnel plot.

Results

Analysis results showed that mothers who experienced stressful life events during the periconceptional period were at greater risk of having NTDs offspring (OR: 1.37, 95% CI: 1.08–1.73) than those who did not. In subgroup analysis, the pooled OR was 1.37 (1.13–1.67) and 1.73 (0.36–8.32) for with and without adjusting for folic acid supplementation in each included study, while was 1.37 (1.13–1.67) and 1.64 (0.39–6.88) for exposure time of three months preconception until three months post conception and one year preconception until three months post conception, respectively.

Conclusions

This study suggests that maternal stressful life events during the periconceptional period are significantly associated with higher NTDs risk in offspring. Tailored approaches for evaluating the risk and policy of NTDs among women of childbearing age should emphasize individual stressful experiences before and during early pregnancy.

Keywords:

• Neural tube defects
• pregnant
• stressful life events
• meta-analysis
• association

Acknowledgements

This work was supported by grants from the Quzhou Competitive/Instructive Science and Technology Project (2022K77, 2021097) of the Bureau of Science and Technology.

Author contributions

Meng Wang designed the study and prepared the manuscript. Meng Wang collected and analyzed the data with Xian Chen Jiang, Zhi Juan Gan, and Shi Ming Lai. Professors Jin Na Wang and Bing Dong Zhan provided advice and directions on both the study design and preparation of the manuscript. All authors have read and approved the final submitted version.

Disclosure statement

The authors declare no conflicts of interest.

Data availability statement

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by grants from the Quzhou Competitive/Instructive Science and Technology Project (2022K77, 2021097) of the Bureau of Science and Technology.