Sunday, May 12, 2013

Mother's Day Special: 13+ Things Science Has To Tell Us About the First "VIP" in Our Lives

Tell me that's not you! (img. Geeks.Pirillo.com)
While the risk of birth has decreased by 99% in the course of the 20th century, from approximately 850 maternal deaths per 100,000 live births in 1900 to 7.5 in 1982, it is - at least in the US - stagnating ever since (2002 data from the CDC; cf. Chang. 2002). This does not just mean that the Healthy People 2000 objective for maternal mortality of no more than 3.3 maternal deaths per 100,000 live births was not achieved during the twentieth century; it does also mean that your mother - irrespective of your and her age risked her life for you, the very moment you were born. And I am pretty sure that regardless of whether she's had the chance to do just that again, she'd be willing to sacrifice her life, if that would save yours. This alone would be worth cherishing what she has done and hopefully is and will be doing for you on at least one day of the year!

Now, science is a pretty impersonal business and using questionnaires and score-boards to quantify emotions is probably not the appropriate thing to do on Mother's Day. Against that background I have broadened the scoop of today's SuppVersity Mother's Day Special to "all things mother and child" and compiled a potpourri of the very latest and selected older studies on the physical and psychological bond between mother an child and the burdens and rewards of motherhood.
  • Married mothers receive the greatest social support, but mothers don't complain (Flowers. 1996) -- As a 1996 paper in the Journal of Divorce & Remarriage reports that the social support in the lives of single, divorced, and married mothers differs significantly.

    According to the qualitative and quantitative measures Anita F. Flowers and her colleagues evaluated, the social support network which was defined as the number of people available to the mother for social support and her own perception of the quantity and quality of social support, married mothers differed significantly from single and divorced mothers in both qualitative and quantitative measures of support.
    "Married mothers appeared to fare best, reporting larger social support networks and more perceived support, as well as less depression and anxiety." (Flowers. 1996)
    But single and divorced mothers don't complain: All reported similar patterns of emotional support. The patterns of instrumental support, however, varied significantly between married and single mother and those who were divorced, with the latter reporting that they receiving significantly less instrumental support than than the former.

    Contrary to the emotional support, which correlated "moderately" with the rates of depression among all mothers, the instrumental support was not significantly correlated with either depression, anxiety, or adjustment to parenthood and lend support to the initially raised notion that the words "Mom, I love you! Thanks for all you're doing for me" are worth more than all the toasters, vacuum cleaners and flowers you may have bought for your mothers in the past ;-)
  • A History of Mother's Day: The first celebrations in honor of mothers were held in the spring time in ancient Greece. In the course of the festivities, the Greeks paid tribute to Rhea, the Mother of the Gods. Later, during the 17th century, England honored mothers on "Mothering Sunday," celebrated on the fourth Sunday of Lent. In the United States, Julia Ward Howe is said to have suggested the idea of Mother's Day in 1872. Howe, who wrote the words to the Battle Hymn of the Republic, saw Mother's Day as being dedicated to peace. It is yet Anna Jarvis of Philadelphia who is officially credited with turning this day into an "official" holiday. 
    What children write in their letters on Mother's Day changes with age (Weisz. 1980) -- According to an analysis of the Mother's Day letters from 249  children,  aged  7-17 "references to being granted autonomy and control declined with age"; an observation the scientists interpreted as a sign of a developing understanding for the intent underlying parental behavior.
    "She  cooks  the  best  chili  and  she  kisses me every  day on  the  nose."  (April, age 7)
    The same maturation process is probably behind the decline in references to the way mother provide food and physical support to the authors of the analyzed Mother's Day letters.
    "She  teaches  me right from wrong, even though it may hurt.  She very heart warming when your down  in  the  blues  [sic]."  (Bill, age  15)
    The references to just  "being there", on the other hand are consistent with person-perception literature "on age increases  in  the use of abstract, covert, and psychological  categories." 
  • Iodine is an indispensable nutrient for mothers-to-be and the developing brain of their kids (Hynes. 2013) -- Even a mild iodine deficiency during pregnancy is associated with reduced educational outcomes in the offspring.
    "These associations remained significant after adjustment for a range of biological factors (maternal age at birth of child, gestational length at time of birth, gestational age at time of urinary iodine collection, birth weight, and sex). Differences in spelling remained significant after further adjustment for socioeconomic factors (maternal occupation and education)." (Hynes. 2013)
    The data Hynes et al. evaluated was based on the results of a 9-year follow-up of the Gestational Iodine Cohort. According to the detailed analysis, kids that had been born to mother who had urine iodine concentrations (UIC) that were lower than 150µg/l  scored 10.0% worse on spelling, 7.6% worse on grammar, and 5.7% in English-literacy performance tests compared with children whose mothers' UICs were =150 µg/L.
    While Crohn's disease, just as a leaky gut and other intestinal disturbances appear to contribute to overall inflammation and consequent visceral fat gain (learn more), Crohn's does not influence the mortality rate of the patients offspring.
  • Children born to mothers with Crohn's disease don't have a higher mortality rates (Zugna. 2013) -- While you may get the impression that each and every minimal impairment of maternal health will have highly detrimental effects on the offspring, the effects of Crohn's disease are at least not life-threatening: With 60 deaths per 100,000 person-years in children of mothers with CD, vs. 54 in controls, "[p]arental CD does not seem to influence mortality rate in offspring, which suggests that neither genetic influences of CD nor intrauterine conditions have adverse effects on offspring mortality rate."
  • Children born to vaccinated mothers have higher risk of being infected with measles and, possibly, rubella (Waajenborg. 2013) -- What may sound counter-intuitive is actually a pretty logical reaction to the modifying effects of vaccination on the original immune defenses.

    Compared to mothers who had not been vaccinated, the "estimated duration of protection by maternal antibodies" among infants in the general population was short: 3.3 months for measles, 2.7 months for mumps, 3.9 months for rubella, and 3.4 months for varicella and thus on average 2 months less than for women from orthodox and unvaccinated communities in the Netherlands.
  • Relationship to parents changes with age, but other factors have a greater influence (Kaufman. 1998) -- Gayle Kaufman and Peter Uhlenberg from the The University Of North Carolina At Chapel Hill analyzed the "Effects of Life Course Transitions on the Quality of Relationships between Adult Children and Their Parents" in an eponymous paper from 1998 and observed, that approximately one fifth of relation ships deteriorated with time.
    Figure 1: OLS regression of relationship quality with parent at national survey of families and households (Kaufman. 1998)
    A larger baseline effect on the benefial (positive) or negative (negative values) of the mother-son/daughter and father-son/daughter relationship was yet observed the number of siblings and at first maybe surprisingly and not necessarily statistically significant the (partial-) employment status of the parents (see figure 1). Furthermore divorce and declines in parental health lead to deteriorating child-parent relationships and the mother-daughter relationship was significantly better in African American women than in any other ethnicity (0.422 vs. 0.172-0.173 in hispanic and others).
  • Mothers who return to work early are more likely to develop depression (Chatterji. 2013) -- According to the results of a recent study from the University of Albany. Specifically,...
    "Among mothers of 6-month-old infants, maternal work hours are positively associated with depressive symptoms and parenting stress and negatively associated with self-rated overall health." (Chatterji. 2013)
    As you would expect, this does yet not have negative effects on the mothers' "quality of parenting" - that's how mothers operate: Everything for the kids, nothing for themselves and that's why we are celebrating their day today ;-)
  • Kids' inappropriate food intake is mainly a function of "maladaptive parenting practices in mothers" (Moens. 2013) -- I know it's not fair to blame mothers for the obesity of their children, I can hardly think of any mother who does not want only the very best for her kids. Nevertheless, the net outcome of what mothers do and don't do at the dinner table can contribute to children's eating- and weightproblems.

    In a pertinent study, researchers from the
    Department of Developmental, Personality and Social Psychology at the Ghent University. The scientists invited 36 mothers with two children (4-12 y) of which 10 sibling-pairs were discordant for weight status (healthy weight - overweight) to the lab and observed the maternal response and controlling behavior during the meal. Their results showed that the mothers' authariation / permissive behavior had direct influence on the amount the children ate. In particular, ...
    • authoritarian behavior control on part of the mother and higher food intakes (0.51)
    • permissive behavior control on part of the mother and lower food intake (0.52)
    • authoritarian behavior control on part of the mother and less restraint eating (0.66)
    • permissive behavior control on part of the mother and higher dietary restraint (0.65)
    showed statistically significant correlations (corresponding values in brackets). In other words: The harder the mothers pushed, the more the children ate and the less controlled were their eating habits.
  • Although ketogenic diets may not be 100% save for pregnant women, many of the fatty staple foods of ketogenic dieters are abundant in choline, a nutrient 25% of the women from high and almost all women from low income countries are deficient. Potential consequences? Birth defects, hampered brain development & more (cf. Zeisel. 2013; learn more about choline)
    Ketogenic diets ain't for mother's to be (Sussmann. 2013) -- Preliminary evidence from rodent studies would suggest that the consumption of a ketogenic diet during pregnancy could result in organ dysfunction and behavioral changes in postnatal life.
    • larger body size early in pregnancy,
    • smaller brain size,
    • smaller body volume later in pregnancy
    • reduced heart sizes
    • smaller thymus
    • enlarged spines, thalamus and midbrain
    I guess most of you will yet be lucky enough to have been born before the keto-hype, anyway. In case you are planning to have a baby though, I personally would not recommend you rely on the stupid saying "mice are no little men".
  • Breast-feeding is heart-healthy for mothers (Groer. 2013) -- While you have read numerous times about the superior health effects of breast feeding on the health of your offspring, there is more an more evidence that breastfeeding is also important for the mother's health. While it is obvious that it helps them shed pregnancy weight, a recent from the University of South Florida Colleges of Nursing and Medicine clearly suggests that breastfeading is also good for the heart of the mothers.

    Even after adjustment for BMI, the systolic blood pressure (SBP) and heart rate decline in the postpartum period was significantly greater in breastfeeding women compared to matched controls in the who were feeding formula (p<0.05). Other covariates, the scientists evaluated, e.g. family income, stress, marital status, and ethnicity were" not significantly associated with these variables over time." The latter did however influence the stress levels, which were likewise lower in the breast feeding women, but highly depended on the aforementioned confounding factors.
  • Children born to better educated mothers have lower risks of depression (Park. 2013) -- While it has long been known that "early-life low socioeconomic position (SEP) increases the risk of adult major depression", the role of maternal eduction is often a better predictor of the offspring's physiological and psychological well-being.

    Scientific support for this hitherto non-validated hypothesis comes from a group of researchers who conducted a longitudinal analysis of data from the Canadian National Population Health Survey from 1994/1995 to 2006/2007. In the corresponding paper that's about to be published in an upcoming issue of Social Psychiatry and Psychiatric Epidemiology the authors report that children who are born to mothers with less than secondary school education had a +104% risk of major depressive episodes (MDE) compared to those whose mothers had more education.

    Paternal education, on the other hand, was not associated with MDE, at all. Even more astounding is yet that neither adult income, student status, psychosocial stress, and selected common early-life adversities did not influence the association between major depressive episodes and the estimate for maternal education. 
  • Transfer of H. pylori from mother to child could be one of the downsides of natural child-birth (Siavoshi. 2013) -- While recent studies did eventually lend credible support to the notion that the bacterial composition of children who are born by Caesarian appear to be less favorable (Turroni. 2012) and could partly explain the higher incidence of type I diabetes (Stene. 2013), a recent study from the University College of Sciences at the  University of Tehran, suggests that natural (=vaginal) child birth entails a greater risk of early colonization with H. pylori.
    Certain lactobacillus strains can help eridacte H. pylori infections (learn more)
    "A significant correlation was found between the occurrence of H.pylori genes in vaginal yeasts and that in neonates' oral yeasts, occurrence of H.pylori genes in mothers' vaginal yeasts or neonates' oral yeasts, and UBT+ [urea breath test] results in mothers." (Siavoshi. 2013)
    Currently, there is yet a paucicity of evidence suggesting that the higher risk of H.pylori infection entails any future health risks. Nevertheless, a 2009 study from the Peking University Third Hospital is not the only study reporting greater rates of gastric cancer in areas with higher H. pylori prevalence among children in their early teens (Zhang. 2009).  
  • "Can you sooth your baby, when he/she is crying"?  (Radesky. 2013) As innocuous as the question may sound, it could be the most important question for a doctor to ask the mother of newborn child. After all, the latest data from a Boston Medical Center and Boston University study clearly shows that inconsolable infant crying quadruples the risk of postpartum depression.

    Thus, 5 to 6 weeks postpartum, more than 20 minutes of inconsolable crying per day have more detrimental effects on a mother's psyche than the dreaded infant colics (+100% risk in postpartum depression).
  • Well-known / celebrity older mums: Cherie Blair (baby at 45), Madonna (baby at 41), Sarah Brown (wife of Gordon Brown - baby at 40 and 42), J K Rowling (baby at 37 and 39), Emma Thompson (baby at 40), Liz Hurley (baby at 36), Susan Sarandon (baby at 46), Mimi Rogers (baby at 45), Iman (baby at 44), Jerry Hall (baby at 41), Annette Bening (baby at 41), Brooke Shields (baby at 37 and 40),  Geena Davis (baby at 46), Courtney Cox Arquette (baby at almost 40), Helen Hunt (baby at 40), Helen Fielding (baby at 46 and 48), Lowri Turner (baby at 42), Meera Syal (baby at 43), Holly Hunter (twins at 47), Sarah Jessica Parker (baby at 37), Elle Macpherson (baby at 39), Anna Nichol Smith (baby at 38), Salma Hayek (baby at 41), Nicole Kidman (baby at 41), Gwen Stefani (baby at 38), Lisa Marie Presley (twins at 40), Gillian Anderson (baby at 40), Dannii Minogue (baby at 38), Celine Dion (twins at 42), Mariah Carey (baby at 41), complete list at pregnancyover35.
    A mother's age at birth is a significant risk factor for type I diabetes in the offspring (Flood. 1982; Bingley. 2000) -- While the risk for children of older mothers to be born with type I diabetes appears to be particularly pronounced for (late) first-borns, Flood et al. observed in 1982, already, that it type I diabetes was also ore prevalent in late-birth-order siblings.

    According to a study by Bingley et al., the risk of type I diabetes increases by 25% (95% confidence interval 17% to 34%) for each five year band of maternal age, so that maternal age at delivery of 45 years or more was associated with a relative risk increase of +211% compared with a maternal age of less than 20 years.
    Figure 2: Women by Number of Children Ever Born (US data from the CDC based on stats from 2010)
    The study from the University of Bristol did yet also reveal that paternal age was also associated with a +9% increase for each five year increase in paternal age. Similar to Flood et al. Bingley et al. did also observe a trend for decreasing diabetes risk, for children who came late in the birth order compared to children who were firts-borns to parents in the same age (-15% risk reduction per child born.

That's it for Mother's Day: Now that you even had a serving of Mother's day gossip, I hope that all of you have something to talk about at the afternoon coffee party at your mother's or your mother-in-law's Mother's Day table. And before I do forget to mention that all the best to all the mother's out there, you are the bests! All of you ;-)

References:
    • Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, Syverson CJ. Pregnancy-related mortality surveillance--United States, 1991--1999. MMWR Surveill Summ. 2003 Feb 21;52(2):1-8.  
    • Chatterji P, Markowitz S, Brooks-Gunn J. Effects of early maternal employment on maternal health and well-being. J Popul Econ. 2013 Jan 1;26(1):285-301. 
    • Flood TM, Brink SJ, Gleason RE. Increased incidence of type I diabetes in children of older mothers. Diabetes Care. 1982 Nov-Dec;5(6):571-3.
    • Flowers AF, Schneider HG, Ludtke HA. Social Support and Adjustment in Mothers with Young Children, Journal of Divorce & Remarriage. 1996. 25:3-4, 69-84
    • Groer MW, Jevitt CM, Sahebzamani F, Beckstead JW, Keefe DL. Breastfeeding status and maternal cardiovascular variables across the postpartum. J Womens Health (Larchmt). 2013 May;22(5):453-9. 
    • Hynes KL, Otahal P, Hay I, Burgess JR. Mild Iodine Deficiency During Pregnancy Is Associated With Reduced Educational Outcomes in the Offspring: 9-Year Follow-up of the Gestational Iodine Cohort. J Clin Endocrinol Metab. 2013 May;98(5):1954-62. 
    • Kaufman G, Uhlenberg P. Effects of Life Course Transitions on the Quality of Relationships between Adult Children and Their Parents. Journal of Marriage and Family. 1998; 60(4): 924-938. 
    • Moens E, Braet C, Vandewalle J. Observation of parental functioning at mealtime using a sibling design. Appetite. 2013 Apr 30.  
    • Park AL, Fuhrer R, Quesnel-Vallée A. Parents' education and the risk of major depression in early adulthood. Soc Psychiatry Psychiatr Epidemiol. 2013 May 10. 
    • Radesky JS, Zuckerman B, Silverstein M, Rivara FP, Barr M, Taylor JA, Lengua LJ, Barr RG. Inconsolable Infant Crying and Maternal Postpartum Depressive Symptoms. Pediatrics. 2013 May 6. 
    • Siavoshi F, Taghikhani A, Malekzadeh R, Sarrafnejad A, Kashanian M, Jamal AS, Saniee P, Sadeghi S, Sharifi AH. The Role of Mother's Oral and Vaginal Yeasts in Transmission of Helicobacter Pylori to Neonates. Arch Iran Med. 2013 May;16(5):288-94. 
    • Sussman D, van Eede M, Wong MD, Adamson SL, Henkelman M. Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse. BMC Pregnancy Childbirth. 2013 May 8;13(1):109. 
    • Stene LC, Gale EA. The prenatal environment and type 1 diabetes. Diabetologia. 2013 May 10.
    • Turroni F, Peano C, Pass DA, Foroni E, Severgnini M, Claesson MJ, Kerr C, Hourihane J, Murray D, Fuligni F, Gueimonde M, Margolles A, De Bellis G, O'Toole PW, van Sinderen D, Marchesi JR, Ventura M. Diversity of bifidobacteria within the infant gut microbiota. PLoS One. 2012;7(5):e36957.
    • Waaijenborg S, Hahné SJ, Mollema L, Smits GP, Berbers GA, van der Klis FR, de Melker HE, Wallinga J. Waning of Maternal Antibodies Against Measles, Mumps, Rubella, and Varicella in Communities With Contrasting Vaccination Coverage. J Infect Dis. 2013 May 8. 
    • Weisz JR. Autonomy, Control, and Other Reasons Why "Mom Is the Greatest": A Content Analysis of Children's Mother's Day Letters. Child Development. 1980; 51(3): 801-807 .
    • Zeisel SH. Nutrition in pregnancy: the argument for including a source of choline. Int J Womens Health. 2013 Apr 22;5:193-9. doi: 10.2147/IJWH.S36610. Print 2013.
    • Zhang DH, Zhou LY, Lin SR, Ding SG, Huang YH, Gu F, Zhang L, Li Y, Cui RL, Meng LM, Yan XE, Zhang J. Recent changes in the prevalence of Helicobacter pylori infection among children and adults in high- or low-incidence regions of gastric cancer in China. Chin Med J (Engl). 2009 Aug 5;122(15):1759-63.
    • Zugna D, Richiardi L, Stephansson O, Cnattingius S, Ludvigsson JF. Mortality Rate in Children Born to Mothers and Fathers With Celiac Disease: A Nationwide Cohort Study. Am J Epidemiol. 2013 Apr 25.