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Frigerio A, Nazzari S. Antenatal maternal anxiety, maternal sensitivity and toddlers' behavioral problems: An investigation of possible pathways. Early Hum Dev 2021; 157:105364. [PMID: 33813323 DOI: 10.1016/j.earlhumdev.2021.105364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/14/2021] [Accepted: 03/20/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND While evidence exists of an association between maternal antenatal anxiety and offspring's behavioral outcomes, the role played by maternal care in explaining this link has been poorly investigated. AIM The current study aimed to investigate the mediating/moderating role of maternal sensitivity in the association between maternal antenatal trait anxiety and toddlers' behavioral problems and temperament, taking also into account potential confounders. Analyses were also replicated for maternal antenatal state anxiety and depression. METHODS Ninety women filled in the State-Trait Anxiety Questionnaire and the Edinburgh Postnatal Depression Scale to assess anxiety/depressive symptoms during the third trimester of pregnancy (34-36 weeks of gestation) and 14 months post-partum. They also filled in the Child Behavior Checklist and the Infant Behavior Questionnaire to evaluate their 14-month-olds' behavioral problems and negative affectivity, respectively. Maternal sensitivity was assessed through the Emotional Availability Scales. RESULTS Maternal antenatal trait anxiety was associated with internalizing, but not externalizing, problems. Interestingly, maternal sensitivity moderated the association between antenatal trait anxiety and externalizing problems. Conversely, antenatal maternal depression was significantly associated with toddlers' negative affectivity. CONCLUSIONS Our findings contribute to shed light on the association between maternal antenatal anxiety and child behaviors, as well as on the role played by parenting in moderating this link, with promising implications for targeted interventions.
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Affiliation(s)
- Alessandra Frigerio
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy.
| | - Sarah Nazzari
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
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Naurin E, Markstedt E, Stolle D, Enström D, Wallin A, Andreasson I, Attebo B, Eriksson O, Martinsson K, Elden H, Linden K, Sengpiel V. Pregnant under the pressure of a pandemic: a large-scale longitudinal survey before and during the COVID-19 outbreak. Eur J Public Health 2021; 31:7-13. [PMID: 33231625 PMCID: PMC7717243 DOI: 10.1093/eurpub/ckaa223] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND One of the groups that is most vulnerable to the COVID-19 pandemic is pregnant women. They cannot choose to refrain from care; they and their children are at risk of severe complications related to the virus; and they lose comfort and support as clinics prohibit their partners and as societal restrictions demand isolation from friends and relatives. It is urgent to study how this group is faring during the pandemic and we focus here on their health-related worries. METHODS A longitudinal survey at a Swedish hospital starting 6 months before (16 September 2019) and continuing during the COVID-19 outbreak (until 25 August 2020). A total of 6941 pregnant women and partners of diverse social backgrounds were recruited. Ninety-six percent of birth-giving women in the city take early ultrasounds where recruitment took place. Sixty-two percent of the women with an appointment and fifty-one percent of all partners gave consent to participate. RESULTS Pregnant women experienced dramatically increased worries for their own health, as well as for their partner's and their child's health in the beginning of the pandemic. The worries remained at higher than usual levels throughout the pandemic. Similar, but less dramatic changes were seen among partners. CONCLUSIONS There is a need for heightened awareness of pregnant women's and partners' health-related worries as a consequence of the COVID-19 pandemic. Related feelings, such as anxiety, have been linked to adverse pregnancy outcome and might have long-term effects. The healthcare system needs to prepare for follow-up visits with these families.
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Affiliation(s)
- Elin Naurin
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Elias Markstedt
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden.,Society, Opinion and Media Institute, University of Gothenburg, Gothenburg, Sweden
| | - Dietlind Stolle
- Department of Political Science, McGill University, Montreal, Canada
| | - Daniel Enström
- Society, Opinion and Media Institute, University of Gothenburg, Gothenburg, Sweden
| | - Anton Wallin
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Andreasson
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Birgitta Attebo
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Ottilia Eriksson
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Klara Martinsson
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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53
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Takegata M, Matsunaga A, Ohashi Y, Toizumi M, Yoshida LM, Kitamura T. Prenatal and Intrapartum Factors Associated With Infant Temperament: A Systematic Review. Front Psychiatry 2021; 12:609020. [PMID: 33897486 PMCID: PMC8060501 DOI: 10.3389/fpsyt.2021.609020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Temperament involves individual variations in behavioural tendencies of emotional responses and reactions to stimuli after birth. Because 'foetal programming' is a strong hypothesis in developing temperament, prenatal and intrapartum factors may be significant determinants of infant temperament. This systematic literature review aims to elucidate the evidence of prenatal and intrapartum predictors, including genetic, biological, environmental, socio-demographic, psychological, and obstetric factors of parents and their child. Methods: Relevant articles were searched using MEDLINE, PubMed, and SCOPUS. The inclusion criteria were (a) original research article, (b) written in English, (c) assessed the temperament of infants 12 months old or younger as an outcome variable, and (d) investigated prenatal and intrapartum factorial variables of infant temperament. Following the PRISMA guideline, the articles found in the three databases were screened and selected according to the inclusion and exclusion criteria before the final review. Results: Finally, 35 articles were reviewed. This systematic review identified a variety of prenatal and intrapartum factors that were significantly associated with infant temperament: (1) genetic and biological factors: certain genotypes, maternal cortisol and ACTH, and CRHs, (2) environmental factors: substance use such as tobacco, alcohol, and illegal drugs, (3) socio-demographic factor: lower-income, (4) psychological factors: depression or anxiety, eating disorders, personality types of mothers, and domestic violence, and (5) obstetric factors: foetal growth (birth weight), hypertension in mothers, nausea (emesis), and preterm birth. Conclusion: The findings support gene-environment interaction and biological mechanisms for developing infant temperament, suggesting the importance of ensuring a safe and comfortable environment for pregnant mothers, unborn infants, and families during pregnancy and delivery.
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Affiliation(s)
- Mizuki Takegata
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Kitamura Institute of Mental Health Tokyo, Tokyo, Japan
| | - Asami Matsunaga
- Kitamura Institute of Mental Health Tokyo, Tokyo, Japan.,Kitamura KOKORO Clinic Mental Health, Tokyo, Japan.,Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yukiko Ohashi
- Faculty of Nursing, Josai International University, Togane, Japan
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Lay Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Toshinori Kitamura
- Kitamura Institute of Mental Health Tokyo, Tokyo, Japan.,Kitamura KOKORO Clinic Mental Health, Tokyo, Japan.,T. and F. Kitamura Foundation for Studies and Skill Advancement in Mental Health, Tokyo, Japan.,Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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54
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Yu J, Ghassabian A, Chen Z, Goldstein RB, Hornig M, Buka SL, Goldstein JM, Gilman SE. Maternal Immune activity during pregnancy and socioeconomic disparities in children's self-regulation. Brain Behav Immun 2020; 90:346-352. [PMID: 32919039 PMCID: PMC7544646 DOI: 10.1016/j.bbi.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 12/31/2022] Open
Abstract
Maternal immune activity during pregnancy has been associated with risk for psychiatric disorders in offspring, but less is known about its implications for children's emotional and behavioral development. This study examined whether concentrations of five cytokines assayed from prenatal serum were associated with socioeconomic status (SES) and racial disparities in their offspring's self-regulation abilities. Participants included 1628 women in the Collaborative Perinatal Project (CPP). Seven behavioral items conceptually related to self-regulation were rated by CPP psychologists when children were 4 years old. Concentrations of interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor (TNF)-α, and IL-10 were assessed. Covariates included child sex and mother's age, psychiatric disorders, and medical conditions during pregnancy. There were significant SES differences in child self-regulation, with higher SES children scoring higher on self-regulation (β = 0.18, 95% CI [0.11, 0.25]), but no racial differences. The concentration of IL-8 in maternal serum was associated with higher child self-regulation, β = 0.09, 95% CI [0.02, 0.16]. In mediation analyses, variation in maternal IL-8 contributed to the association between family SES and child self-regulation (β = 0.02, 95% CI [0.003, 0.030]), explaining about one-tenth of the SES disparities. This study suggests pregnancy as an early sensitive period and maternal immune activity as an important context for child development.
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Affiliation(s)
- Jing Yu
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD 20817, United States.
| | - Akhgar Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University, 403 East 34th St., New York, NY 10016, United States
| | - Zhen Chen
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD 20817, United States
| | - Risë B Goldstein
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD 20817, United States
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St. NY, NY 10032, United States
| | - Stephen L Buka
- Department of Epidemiology, School of Public Health, Brown University, 21 South Main Street, Providence, RI 02912, United States
| | - Jill M Goldstein
- Departments of Psychiatry and Medicine, Harvard Medical School, and Department of Psychiatry and Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Stephen E Gilman
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD 20817, United States; Department of Mental Health, Bloomberg School of Public Health, John Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, United States
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55
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Schaal NK, Marca-Ghaemmaghami PL, Preis H, Mahaffey B, Lobel M, Amiel Castro R. The German version of the pandemic-related pregnancy stress scale: A validation study. Eur J Obstet Gynecol Reprod Biol 2020; 256:40-45. [PMID: 33166796 DOI: 10.1016/j.ejogrb.2020.10.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The consequences of the COVID-19 pandemic may lead to exceptional stress in pregnant women. In order to evaluate stress levels of pregnant woman in this difficult time, the Pandemic-Related Pregnancy Scale (PREPS) was introduced in the US. The present study introduces and validates the German version of the PREPS. STUDY DESIGN In total, 1364 German-speaking pregnant women from Germany and Switzerland took part in this online cohort study and completed the PREPS as well as gave information on sociodemographic, obstetric and other psychological factors. RESULTS A confirmatory factor analysis of the PREPS showed very good psychometric values and confirmed the structure of the original questionnaire. The PREPS comprises three dimensions: Infection Stress (5 items), Preparedness Stress (7 items) and Positive Appraisal (3 items). Furthermore, correlations between the PREPS and other psychological factors such as Pregnancy Specific Stress and Fear of Childbirth highlight convergent validity. The sensitivity of the questionnaire was demonstrated by its associations with several obstetric and COVID-19 related factors. CONCLUSION The German PREPS showed good psychometric properties and is a useful instrument for future studies which aim to investigate the impact of pandemic-related stress on birth outcomes and postpartum factors.
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Affiliation(s)
- Nora K Schaal
- Institute of Experimental Psychology, Heinrich-Heine-University, Duesseldorf, Germany.
| | - Pearl La Marca-Ghaemmaghami
- Psychology Research and Counselling Institute for Sexuality, Marriage, and Family, International Academy for Human Sciences and Culture, Walenstadt, Switzerland
| | - Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA; Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Brittain Mahaffey
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Rita Amiel Castro
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
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56
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Forte Camarneiro AP, de Miranda Justo JMR. Emotional states and psychopathological symptoms in couples during pregnancy and post-partum. J Reprod Infant Psychol 2020; 40:384-398. [PMID: 32877260 DOI: 10.1080/02646838.2020.1814226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIMS Comparing depression, anxiety, stress and psychopathological symptomatology in: pregnancy vs. post-partum in men and in women, marital partners' (men vs. women) in pregnancy and in post-partum. BACKGROUND During perinatal period, couples undergo emotional changes and psychopathological symptoms. METHODS Descriptive-correlational-longitudinal study. Participants: Couples (n = 67; men and women = 134) interviewed in pregnancy and at 8 months post-partum. Women are younger and more educated than men. For 65.7% of couples, this was the first pregnancy. INSTRUMENTS Sociodemographic and Clinical Questionnaire; Depression Anxiety and Stress Scale-42; Brief Symptoms Inventory. RESULTS In pregnancy, women's scores were significantly higher than men's in anxiety and somatization. In post-natal period, women presented significantly higher scores in somatization. Between pre- and post-natal periods, women's scores (stress, obsessions-compulsions, interpersonal sensitivity, depression, hostility, paranoid ideation, psychoticism, global severity index, positive symptoms distress index) rose significantly. Men's positive symptoms distress index rose significantly. CONCLUSIONS In pregnancy, women show less stress and less psychopathological symptoms than in post-natal period. During pregnancy women are more anxious and somatise more than men. After birth, they keep somatising more. Also, in perinatal period, women's changes are more salient. The association of conjugality and motherhood-fatherhood development should be deepened in future investigation.
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Lehtola SJ, Tuulari JJ, Scheinin NM, Karlsson L, Parkkola R, Merisaari H, Lewis JD, Fonov VS, Louis Collins D, Evans A, Saunavaara J, Hashempour N, Lähdesmäki T, Acosta H, Karlsson H. Newborn amygdalar volumes are associated with maternal prenatal psychological distress in a sex-dependent way. Neuroimage Clin 2020; 28:102380. [PMID: 32805677 PMCID: PMC7453059 DOI: 10.1016/j.nicl.2020.102380] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/20/2022]
Abstract
Maternal psychological distress during pregnancy (PPD)1 has been associated with changes in offspring amygdalar and hippocampal volumes. Studies on child amygdalae suggest that sex moderates the vulnerability of fetal brains to prenatal stress. However, this has not yet been observed in these structures in newborns. Newborn studies are crucial, as they minimize the confounding influence of postnatal life. We investigated the effects of maternal prenatal psychological symptoms on newborn amygdalar and hippocampal volumes and their interactions with newborn sex in 123 newborns aged 2-5 weeks (69 males, 54 females). Based on earlier studies, we anticipated small, but statistically significant effects of PPD on the volumes of these structures. Maternal psychological distress was measured at gestational weeks (GW)2 14, 24 and 34 using Symptom Checklist-90 (SCL-90, anxiety scale)3 and Edinburgh Postnatal Depression Scale (EPDS)4 questionnaires. Newborn sex was found to moderate the relationship between maternal distress symptoms at GW 24 and the volumes of left and right amygdala. This relationship was negative and significant only in males. No significant main effect or sex-based moderation was found for hippocampal volumes. This newborn study provides evidence for a sex-dependent influence of maternal psychiatric symptoms on amygdalar structural development. This association may be relevant to later psychopathology.
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Affiliation(s)
- Satu J Lehtola
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine University of Turku, Turku, Finland.
| | - Jetro J Tuulari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine University of Turku, Turku, Finland; Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland; Turku Collegium for Science and Medicine, University of Turku, Turku, Finland; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine University of Turku, Turku, Finland; Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine University of Turku, Turku, Finland; Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland; Center for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Harri Merisaari
- Department of Future Technologies, University of Turku, Turku, Finland
| | - John D Lewis
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Vladimir S Fonov
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - D Louis Collins
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Alan Evans
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Niloofar Hashempour
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine University of Turku, Turku, Finland
| | - Tuire Lähdesmäki
- Department of Pediatric Neurology, University of Turku and Turku University Hospital, Turku, Finland
| | - Henriette Acosta
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine University of Turku, Turku, Finland; Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland; Center for Population Health Research, University of Turku and Turku University Hospital, Finland
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Erickson NL, Neumann AA, Hancock GR, Gartstein MA. Baby preparation and worry scale (Baby-PAWS): Instrument development and psychometric evaluation. Early Hum Dev 2020; 147:105080. [PMID: 32485400 DOI: 10.1016/j.earlhumdev.2020.105080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/02/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Baby Preparation and Worry Scale (Baby-PAWS) addresses expectant mothers' anticipatory worries regarding the transition to parenthood, focusing on practical concerns (i.e., ability to care for the infant, securing childcare, personal wellbeing, and partner involvement). AIMS The present study describes measurement development, psychometric evaluation, and predictive and concurrent validity of Baby-PAWS, administered during pregnancy. STUDY DESIGN We used a repeated-measures design, with anonymous self-report obtained during the 3rd trimester of pregnancy and at 2 months postpartum. SUBJECTS Healthy pregnant women (N = 276) completed Baby-PAWS and measures of depression, general anxiety, and pregnancy-specific anxiety. Demographic, pregnancy, and birth-related information (e.g., complications, gestational age) was also obtained. At postpartum follow-up, the majority (n = 154) met inclusion criteria and provided data on themselves and their infants. OUTCOME MEASURES Prenatally, we examined correlations between Baby-PAWS and established measures of general anxiety, pregnancy-specific anxiety, and depression. Postnatally, Baby-PAWS scores were used to predict maternal depression, anxiety, and infant temperament. RESULTS AND CONCLUSIONS Two factor-analytic techniques indicated a three-factor structure, with internal consistency for all three components and the overall scale. We labeled the three factors: Self and Partner Worry, Non-parental Childcare Worry, and Baby Caregiving Worry, based on item content. Higher Baby-PAWS scores were associated with greater anxiety and depression in the third trimester. Predictive links with postpartum anxiety/depression symptoms and infant temperament were observed for the overall Baby-PAWS score and Self and Partner Worry factor. Although this instrument requires further evaluation, it offers promising utility in research and clinical settings.
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Affiliation(s)
- Nora L Erickson
- Hennepin Healthcare Research Institute, 701 Park Ave, Suite PP7.700, Minneapolis, MN 55415, United States of America.
| | - Alyssa A Neumann
- Washington State University, P.O. Box 644820, Pullman, WA 99164-4820, United States of America.
| | - Gregory R Hancock
- University of Maryland, 1230 Benjamin Building, 3942 Campus Drive, College Park, MD 20742-1115, United States of America.
| | - Maria A Gartstein
- Washington State University, P.O. Box 644820, Pullman, WA 99164-4820, United States of America.
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Reflective parenting home visiting program: A longitudinal study on the effects upon depression, anxiety and parenting stress in first-time mothers. Heliyon 2020; 6:e04292. [PMID: 32671248 PMCID: PMC7339064 DOI: 10.1016/j.heliyon.2020.e04292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/06/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022] Open
Abstract
Objective Our study aimed to investigate the effects of a reflective parenting home visiting program in first time-mothers at risk for depression, anxiety, and parenting stress, from three to 12 months after their child's birth. Study design The sample was composed by 77 first-time mothers and their healthy babies (53% boys and 47% girls). Mothers filled out the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory, and the Parenting Stress Index-SF at 3, 6 and 12 months of the child. Thirty-six mothers were assigned to the experimental group and received the reflective parenting home-visiting program, the other 36 constituted the control group. Results Analyses showed a significant higher reduction in the level of depression, anxiety and parenting stress among mothers belonging to the experimental group, compared to the control group. Conclusion Our findings confirm the benefits of reflective parenting home visiting programs and underline the need to constantly evaluate the levels of depression, anxiety and parenting stress throughout the perinatal period to target effective prevention programs to foster early mother-child attachment bond.
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Eide KT, Morken NH, Bærøe K. Tensions and interplay: A qualitative study of access to patient-centered birth counseling of maternal cesarean requests in Norway. Midwifery 2020; 88:102764. [PMID: 32534254 DOI: 10.1016/j.midw.2020.102764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/10/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to explore women's access to patient-centered counseling for concerns initiating cesarean requests in absence of obstetric indications in pregnancy, and to identify tensions, barriers and facilitators affecting such care. DESIGN, SETTING AND INFORMANTS This qualitative study (June 2016 to August 2017) obtained data through semi-structured in-depth interviews with 17 women requesting planned C-section during birth counseling at a university hospital in Norway and focus group discussions with 20 caregivers (9 midwives and 11 obstetricians) employed at the same hospital. Analysis was carried out by systematic text condensation, a method for thematic analysis in medical research, presented within the frames of Levesque and colleagues' conceptual framework of access to patient-centered care. FINDINGS The analysis revealed that there were considerable tensions in care seeking and provision of counseling for maternal requests for C-section. There was a prominent culture of vaginal delivery among caregivers and women. The appropriateness of CS on maternal request was debated and caregivers revealed diverging attitudes and practices when agreement with women was not reached. Women's views on their entitlement to choose were divided, but the majority of women did not support complete maternal choice. Midwife-led counseling were highly appreciated among woman as well as obstetricians. IMPLICATIONS FOR PRACTICE Tensions and barriers in care seeking and provision of counseling for women requesting C-section for non-obstetric reasons, call for standardized counseling in order for equal and adequate care to be provided across health care institutions and providers. Dialogue-based decision-making and midwife-led care may improve satisfaction of care, enhance spontaneous vaginal deliveries and avoid future conflicts.
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Affiliation(s)
- Kristiane Tislevoll Eide
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway.
| | - Nils-Halvdan Morken
- Department of Clinical Science, University of Bergen, Bergen, Jonas Lies veg 87, 5021 Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Jonas Lies veg 87, 5021 Bergen, Norway.
| | - Kristine Bærøe
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway.
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Matvienko-Sikar K, Flannery C, Redsell S, Hayes C, Kearney PM, Huizink A. Effects of interventions for women and their partners to reduce or prevent stress and anxiety: A systematic review. Women Birth 2020; 34:e97-e117. [PMID: 32107141 DOI: 10.1016/j.wombi.2020.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/09/2020] [Accepted: 02/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The period from conception to two years postpartum (the first 1000 days) represents a normative transitional period, which can be potentially stressful for some parents. Parental stress and anxiety adversely impacts psychological and physical health for parents and children. AIM The aim of this review is to systematically examine effects of interventions for women and their partners to reduce or prevent stress and/or anxiety during the first 1000 days. METHODS MEDLINE, Embase, CINAHL, PsychINFO, and Maternity and Infant Care were searched from inception to March 2019. Randomised controlled trials examining intervention effects on parental stress and/or anxiety during first 1000 days were eligible for inclusion. Data were independently extracted by two reviewers and narratively synthesised. FINDINGS Fifteen interventions, reported in 16 studies, met inclusion criteria (n=1911 participants). Overall, findings were inconsistent and the majority of trials demonstrated high risk of bias. Interventions were predominantly delivered to women during pregnancy and only two studies included fathers. There was some evidence that adapting interventions to the pre and postnatal periods provided benefits for stress and anxiety reduction, however there was limited evidence for individual intervention types or approaches. CONCLUSIONS There is currently inconsistent evidence of what interventions are most effective for women during the first 1000 days and there is insufficient evidence for any interventions for male partners during this period. There is a clear need for rigorous development and examination of interventions developed specifically to reduce or prevent stress and/or anxiety across the first 1000 days.
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Affiliation(s)
| | | | - Sarah Redsell
- School of Medicine, University of Nottingham, United Kingdom
| | | | | | - Anja Huizink
- Department of Clinical, Neuro- and Developmental Psychology, VU University Amsterdam, Amsterdam, The Netherlands
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Matvienko-Sikar K, Cooney J, Flannery C, Murphy J, Khashan A, Huizink A. Maternal stress in the first 1000 days and risk of childhood obesity: a systematic review. J Reprod Infant Psychol 2020; 39:180-204. [PMID: 32046507 DOI: 10.1080/02646838.2020.1724917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: Maternal stress is associated with adverse child outcomes. Conception to 2-years postpartum (the first 1000 days) is a developmentally sensitive period for stress exposure. The role of maternal stress in the first 1000 days on child obesity risk is unclear. This review systematically examines the relationship between maternal stress across the first 1000 days and child obesity risk. Methods: The Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, and Maternity and Infant Care were searched from inception to June 2018. Eligible studies included women who experienced maternal stress in the first 1000 days; an included a measure of maternal stress and of child anthropometrics. Results: Sixteen studies met inclusion criteria, the majority of these examined prenatal stress exposure. Inconsistent effects were observed for psychological and physiological stress responses, on child weight outcomes. Environmental stress exposures, including natural disaster and bereavement, were more consistently associated with increased obesity risk. Conclusion: This review does not provide support for the effects of psychological or physiological maternal stress on child weight outcomes; there is some evidence of associations between environmental stress exposures and greater childhood adiposity. Variation in conceptualisation and measurement of stress, timing of stress exposure, and limited examination of stress-related behaviours were noted.
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Affiliation(s)
| | - Jennifer Cooney
- School of Applied Psychology, University College Cork , Cork, Ireland
| | - Caragh Flannery
- School of Public Health, University College Cork , Cork, Ireland
| | - Jennifer Murphy
- School of Public Health, University College Cork , Cork, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork , Cork, Ireland.,Irish Centre for Fetal and Neonatal Transnational Research (INFANT) Centre, Cork University Maternity Hospital , Cork, Ireland
| | - Anja Huizink
- Department of Clinical, Neuro- and Developmental Psychology, VU University Amsterdam , Amsterdam, The Netherlands
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Maria A, Nissilä I, Shekhar S, Kotilahti K, Tuulari JJ, Hirvi P, Huotilainen M, Heiskala J, Karlsson L, Karlsson H. Relationship between maternal pregnancy-related anxiety and infant brain responses to emotional speech - a pilot study. J Affect Disord 2020; 262:62-70. [PMID: 31710930 DOI: 10.1016/j.jad.2019.10.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/09/2019] [Accepted: 10/28/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Maternal pregnancy-related anxiety (PRA) is reportedly related to neurodevelopmental outcomes of infants. However, the relationship between maternal PRA and the processing of emotions in the infant brain has not been extensively studied with neuroimaging. The objective of the present pilot study is to investigate the relationship between maternal PRA and infant hemodynamic responses to emotional speech at two months of age. METHODS The study sample included 19 mother-infant dyads from a general sample of a population of Caucasian mothers. Self-reported Pregnancy-Related Anxiety Questionnaire (PRAQ-R2) data was collected from mothers during pregnancy at gestational weeks (gwks) 24 (N = 19) and 34 (N = 18). When their infants were two months old, the infants' brains functional responses to emotional speech in the left fronto-temporoparietal cortex were recorded using diffuse optical tomography (DOT). RESULTS Maternal PRAQ-R2 scores at gwk 24 correlated negatively with the total hemoglobin (HbT) responses to sad speech on both sides of the temporoparietal junction (Spearman's rank correlation coefficient ρ = -0.87). The correlation was significantly greater at gwk 24 than gwk 34 (ρ = -0.42). LIMITATIONS The field of view of the measurement did not include the right hemisphere or parts of the frontal cortex. The sample size is moderate and the mothers were relatively highly educated, thus there may be some differences between the study sample and the general population. CONCLUSIONS Maternal pregnancy-related anxiety may affect child brain emotion processing development. Further research is needed to understand the functional and developmental significance of the findings.
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Affiliation(s)
- Ambika Maria
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
| | - Ilkka Nissilä
- Aalto University, Department of Neuroscience and Biomedical Engineering, Finland.
| | - Shashank Shekhar
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Mississippi Medical Center, Department of Neurology, MS, USA
| | - Kalle Kotilahti
- Aalto University, Department of Neuroscience and Biomedical Engineering, Finland
| | - Jetro J Tuulari
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; The Turku Collegium for Science and Medicine (TCSM); University of Oxford, Department of Psychiatry, Oxford, United Kingdom; University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
| | - Pauliina Hirvi
- Aalto University, Department of Neuroscience and Biomedical Engineering, Finland; Aalto University, Department of Mathematics and Systems Analysis, Finland
| | - Minna Huotilainen
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Helsinki, Faculty of Educational Sciences, CICERO Learning, Finland
| | - Juha Heiskala
- Helsinki University Central Hospital, Department of Clinical Neurophysiology, Finland
| | - Linnea Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Turku and Turku University Hospital, Department of Child Psychiatry, Turku, Finland
| | - Hasse Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
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Mudra S, Göbel A, Barkmann C, Goletzke J, Hecher K, Schulte-Markwort M, Diemert A, Arck P. The longitudinal course of pregnancy-related anxiety in parous and nulliparous women and its association with symptoms of social and generalized anxiety. J Affect Disord 2020; 260:111-118. [PMID: 31494362 DOI: 10.1016/j.jad.2019.08.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/26/2019] [Accepted: 08/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is evidence that pregnancy-related anxiety (PrA) has a negative impact on birth outcomes and infant development. However, little is known about worrisome levels and individual trajectories of PrA dimensions across pregnancy and their predictive factors, particularly the association of PrA with symptoms of social phobia (SP) and generalized anxiety disorder (GAD). METHODS A sample of 180 pregnant women was assessed three times during pregnancy with the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2). Linear mixed model analyses were used to investigate the course of different PrA dimensions across pregnancy, and to relate PrA to symptoms of social and generalized anxiety. Additionally, distinct developmental patterns of PrA were explored by latent class growth analyses. RESULTS While the PrA total score remained stable, the different dimensions of PrA varied significantly over time. After controlling for obstetric and sociodemographic factors as well as depression, perceived social support and self-efficacy, symptoms of SP significantly predicted higher levels of fear of childbirth, child-related worries and concerns about mother´s appearance. Symptoms of GAD predicted higher child-related worries. Moreover, two distinct groups of women with either consistently higher or lower PrA scores were identified. LIMITATIONS Our results are limited due to the use of self-report questionnaires and would benefit from a larger sample size and replication in high-risk samples. CONCLUSION Our study suggests that a longitudinal and differentiated investigation of specific forms of prenatal anxiety may improve our understanding of women at high risk for PrA and promote the development of individualized forms of interventions initiated during pregnancy.
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Affiliation(s)
- Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janina Goletzke
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Arck
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Göbel A, Arck P, Hecher K, Schulte-Markwort M, Diemert A, Mudra S. Manifestation and Associated Factors of Pregnancy-Related Worries in Expectant Fathers. Front Psychiatry 2020; 11:575845. [PMID: 33362598 PMCID: PMC7759496 DOI: 10.3389/fpsyt.2020.575845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background: During the last decades, fathers have increasingly participated in prenatal care, birth preparation classes, and childbirth. However, comparably little is known about the prenatal emotional well-being of fathers, particularly content and extent of broader paternal concerns that may arise during pregnancy beyond those focusing on childbirth. Thus, the aims of this study were to investigate the manifestation of paternal pregnancy-related worries in a population-based sample and to identify relevant associated factors. Materials and Methods: As part of a longitudinal pregnancy cohort at the University Medical Center Hamburg-Eppendorf, Germany, N = 129 expectant fathers were assessed once during pregnancy. Pregnancy-related worries centering around medical procedures, childbirth, health of the baby, as well as socioeconomic aspects were assessed with the Cambridge Worry Scale (CWS). Additionally, paternal socioeconomic background and maternal obstetrical history, symptoms of generalized anxiety and depression, and level of hostility were investigated, as well as perceived social support. The cross-sectional data were analyzed based on multiple regression analyses. Results: The level of reported worries was overall low. Some fathers reported major worries for individual aspects like the health of a significant other (10.9%) and the baby (10.1%), as well as the current financial (6.2%) and employment situation (8.5%). Pregnancy-related worries were negatively associated with household income and positively associated with anxious and depressive symptoms and low perceived social support. Associations varied for specific pregnancy-related worries. Limitations: Due to the cross-sectional data examined in this study, a causal interpretation of the results is not possible. The sample was rather homogeneous regarding its socioeconomic background. More research needs to be done in larger, more heterogeneous samples. Conclusion: Though overall worries were rather low in this sample, specific major worries could be identified. Hence, addressing those fathers reporting major worries regarding specific aspects already in prenatal care might support their psychosocial adjustment. Fathers with little income, those with elevated levels of general anxious and depressive symptoms, and those with less social support reported higher pregnancy-related worries. Our results indicate the relevance of concerns beyond health- and birth-related aspects that could be relevant for fathers. Measurements developed specifically for expectant fathers are needed to properly capture their perspective already during pregnancy.
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Affiliation(s)
- Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Arck
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Specific relations of dimensional anxiety and manifest anxiety disorders during pregnancy with difficult early infant temperament: a longitudinal cohort study. Arch Womens Ment Health 2020; 23:535-546. [PMID: 31927695 PMCID: PMC7369131 DOI: 10.1007/s00737-019-01015-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023]
Abstract
Anxiety in the antenatal period is a common experience, associated with adverse consequences for mother and child. Specific types of prenatal anxiety may have unique associations with infant temperament. This study examines the prospective relationships between general prenatal anxiety, fear of childbirth, and specific prenatal anxiety disorders and early infant temperament 8 weeks postpartum. Data were derived from the Akershus Birth Cohort (ABC), a longitudinal cohort study which targeted all women scheduled to give birth at Akershus University Hospital, Norway. Psychometric measures pertained to general prenatal anxiety (Hopkins Symptom Checklist), fear of childbirth (Wijma delivery expectancy questionnaire), screening for manifest prenatal anxiety disorders based on questions from the mini-international neuropsychiatric interview, and difficult infant temperament (Infant Characteristics Questionnaire). The sample for the present study included 2206 women. General prenatal anxiety, fear of childbirth, agoraphobia, generalized anxiety disorder, and specific phobia presented unique significant prospective contributions to difficult infant temperament 8 weeks postpartum. Separate hierarchical regression models indicated that general prenatal anxiety and fear of childbirth provided the strongest unique contributions. Considering the burden on mothers and the potential long-term effects on child development, the findings of this study highlight the importance of screening women for different types of prenatal anxiety in routine obstetric care. Clinical awareness of the condition and its consequences is warranted. Due to the complexity of infant temperament as a construct with various influences, future research should consider mechanisms and influential factors pertaining to the relationship between prenatal anxiety and infant temperament.
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Abstract
Early Life Stress Stress and daily hassles are a normal part of day-to day-life. The amount of control that is experienced strongly contributes to resilience and coping. Children very frequently do not experience control over the stressors within their lives. Starting from pregnancy, they are subjected - via the maternal endocrine system - to a variety of stressors ranging from normal stress regarding the transition to parenthood to maternal abuse or torture. This article collects research of the last two decades regarding the influence of stress on the developing brain. Both, animal and human studies will shed light on the effect of pre- and postnatal stress demonstrating an influence of early life stressors reaching far into adulthood. A direct influence of stress on multiple developmental characteristics has been postulated and shown. The results of this review will underline the necessity of early life programs focusing stress reduction and resilience in children and their parents. Also, a need for programs targeting stress reduction in pregnancy will be demonstrated and emphasized.
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68
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Letourneau N, Leung B, Ntanda H, Dewey D, Deane AJ, Giesbrecht GF. Maternal and paternal perinatal depressive symptoms associate with 2- and 3-year-old children's behaviour: findings from the APrON longitudinal study. BMC Pediatr 2019; 19:435. [PMID: 31722682 PMCID: PMC6852959 DOI: 10.1186/s12887-019-1775-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 10/07/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Prenatal and postnatal depressive symptoms are common in expectant and new mothers and fathers. This study examined the association between four patterns of probable perinatal depression (mother depressed, father depressed, both depressed, neither depressed) in co-parenting mothers and fathers and their children's internalizing and externalizing behaviours at 24 and 36 months of age. The influence of sociodemographic, risk and protective factors was also examined. METHODS Depressive symptoms were measured during pregnancy and at 3 months postpartum and children's behaviour was assessed at 24 and 36 months of age. Families (n = 634) provided data on their children's internalizing (i.e. emotionally reactive, anxious/depressed, somatic complaints, withdrawn and total) and externalizing (i.e. attention problems, aggression and total) behaviour. Marginal models were employed to determine the relationship between children's behaviour over the two time points and the four patterns of probable parental depression. Sociodemographic variables as well as risk (stress) and protective (social support) factors were included in these models. RESULTS In the perinatal period 19.40% (n = 123) of mothers scored as probably depressed and 10.57% (n = 67) of fathers. In 6.31% (n = 40) of the participating families, both parents scored as probably depressed and in 63.72% (n = 404) neither parent scored as depressed. For children's emotionally reactive, withdrawn and total internalizing behaviours, both mothers' probable depression and mothers and fathers' co-occurring probable depression predicted higher scores, while for children's aggressive behaviour, attention problems, and total externalizing behaviours, only mothers' probable depression predicted higher scores, controlling for sociodemographic, risk and protective factors. CONCLUSIONS While probable perinatal depression in mothers predicted 2 and 3 year-old children's behavioural problems, co-occurrence of depression in mothers and fathers had an increased association with internalizing behavioural problems, after considering sociodemographic, risk and protective factors. Health care providers are encouraged to consider the whole family in preventing and treating perinatal depression.
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Affiliation(s)
- Nicole Letourneau
- Faculty of Nursing and Cumming School of Medicine, Departments of Pediatrics, Psychiatry, & Community Health Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada. .,Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, T2N 1N4, Canada.
| | - Brenda Leung
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Henry Ntanda
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Deborah Dewey
- Cumming School of Medicine, Departments of Pediatrics & Community Health Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Andrea J Deane
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Gerald F Giesbrecht
- Cumming School of Medicine, Departments of Pediatrics, Psychology, & Community Health Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada
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Erickson NL, Hancock GR, Oberlander TF, Brain U, Grunau RE, Gartstein MA. Prenatal SSRI antidepressant use and maternal internalizing symptoms during pregnancy and postpartum: Exploring effects on infant temperament trajectories for boys and girls. J Affect Disord 2019; 258:179-194. [PMID: 31437600 DOI: 10.1016/j.jad.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The severity and treatment of depression/anxiety during pregnancy and postpartum has important implications for maternal and child well-being. Yet, little is known about prenatal SSRI use and early child socioemotional development. This study explores effects of prenatal SSRI exposure, and pre- and postnatal internalizing symptoms on trajectories of infant temperament, identifying potential differences for boys and girls. METHODS Using latent growth models, sex differences in infant temperament trajectories from 3- to 10-months were examined in relation to prenatal and postpartum internalizing symptoms and prenatal SSRI exposure among 185 mother-infant dyads. RESULTS For girls, prenatal internalizing symptoms were associated with greater initial distress to limitations, and lower duration of orienting, smiling/laughter, and soothability. Postnatal symptoms predicted slower decreases in girls' duration of orienting. SSRI exposure predicted decreases in distress to limitations and slower increases in smiling and laughter. For boys, maternal internalizing symptoms did not generally affect temperament profiles. SSRI exposure was associated with higher initial activity level and slower declines in distress to limitations. LIMITATIONS Only parent-report indicators of infant temperament across 10 months of infancy were provided. Maternal internalizing symptoms were measured at discrete times during pregnancy and postpartum, with no analysis of changes in symptoms across time. CONCLUSIONS Prenatal SSRI treatment, and both prenatal and postpartum internalizing symptoms, exert unique effects on infant temperament. Overall, the present study suggests sex-dependent fetal programming effects that should be further evaluated in future research. Results have implications for perinatal mental health treatment and perceived impacts on child socioemotional development.
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Affiliation(s)
- Nora L Erickson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, United States.
| | - Gregory R Hancock
- Department of Measurement, Statistics & Evaluation, University of Maryland, College Park, MD, United States
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Ursula Brain
- Department of Pediatrics, University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Maria A Gartstein
- Department of Psychology, Washington State University, Pullman, WA, United States
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Hakanen H, Flykt M, Sinervä E, Nolvi S, Kataja EL, Pelto J, Karlsson H, Karlsson L, Korja R. How maternal pre- and postnatal symptoms of depression and anxiety affect early mother-infant interaction? J Affect Disord 2019; 257:83-90. [PMID: 31299408 DOI: 10.1016/j.jad.2019.06.048] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/17/2019] [Accepted: 06/30/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Maternal pre- and postnatal psychological distress, such as anxiety and depression, may negatively affect mother-infant interaction quality. However, more information is needed on the role of specific types and timings of pre- and postnatal distress symptoms on mother-infant interaction. Research on the role of maternal anxiety is especially scarce. METHODS We examined whether maternal pregnancy- related anxiety (gestational weeks 24 and 34), general anxiety or depressive symptoms (gw 14, 24 and 34 and at the infant age of 3 and 6 months) associate with the quality of mother-infant interaction when the child is eight months old. Maternal symptoms (N = 190) were measured with EPDS, SCL-90 anxiety subscale and PRAQ-R2. Mother-infant interaction was measured with the Emotional Availability Scales (EAS). RESULTS After controlling for background factors, general anxiety at the 3rd pregnancy trimester was associated with higher maternal intrusiveness in EAS. Depressive symptoms at 6 months postpartum associated with lower maternal structuring behavior and with the child's lower involvement of the mother. LIMITATIONS A very small number of mothers with severe symptoms of depression and anxiety. CONCLUSIONS Prenatal anxiety and postnatal depressive symptoms may each have unique effects on the different areas of mother-infant interaction, suggesting the need to develop more targeted interventions for mothers with different symptom profiles and timings. Prenatally anxious mothers could potentially benefit from early interventions decreasing stress and anxiety symptoms and specifically promoting their ability to read infant cues appropriately. Infants of postnatally depressed mothers may need interventions where both members of the dyad receive help.
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Affiliation(s)
- Hetti Hakanen
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Turku, Department of Psychology, Turku, Finland.
| | - Marjo Flykt
- University of Tampere, The Department of Psychology, Finland; Department of Human Development and Family Studies, Colorado State University, USA
| | - Eija Sinervä
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
| | - Saara Nolvi
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Medical Psychology, Berlin, Germany
| | - Eeva-Leena Kataja
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Turku, Department of Psychology, Turku, Finland
| | - Juho Pelto
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
| | - Hasse Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
| | - Linnea Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Turku and Turku University Hospital, Institute of Clinical Medicine, Department of Child Psychiatry, Turku, Finland
| | - Riikka Korja
- University of Turku, Department of Psychology, Turku, Finland; University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
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Perinatal maternal mental health and infant socio-emotional development: A growth curve analysis using the MPEWS cohort. Infant Behav Dev 2019; 57:101336. [PMID: 31404801 DOI: 10.1016/j.infbeh.2019.101336] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 12/17/2022]
Abstract
Pregnancy and the early post partum period are widely understood as a critical period for the infant's emotional development and the earliest influence shaping social interaction. The present study aims to understand the potential influence of both antenatal and postnatal maternal anxiety and depressive symptoms on socio-emotional outcomes in offspring aged 12 months. The study used longitudinal data from a prospective cohort study on Australian pregnant women and their children. Data were available for 282 mothers and their children. Maternal depressive and anxiety symptoms were measured in early pregnancy, trimester three of pregnancy, six and 12 months postpartum. Social and emotional development in children was measured using the Brief Infant and Toddler Social Emotional Assessment (BITSEA) at 12 months. Using growth curve analysis of 4 waves of repeated measurement to examine intercept and slope, we found that both initial maternal depression and anxiety symptom levels, and the growth of these symptoms over time, predicted more problems with children's social and emotional development. In the final model anxiety accounted for 19% of the variance in child socio-emotional problems and depression 23% of variance. The results emphasise the importance of perinatal maternal mental health as a potential risk factor for child development. This carries important implications for policy development, such as the need to build early identification and early intervention models in to the current clinical practice for perinatal care, specifically, to develop targeted screening, assessment and interventions to address maternal mental health issues for at-risk parents during pregnancy, and continuing monitoring of young children whose mothers have experienced perinatal mental health difficulties.
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Acosta H, Tuulari JJ, Scheinin NM, Hashempour N, Rajasilta O, Lavonius TI, Pelto J, Saunavaara V, Parkkola R, Lähdesmäki T, Karlsson L, Karlsson H. Maternal Pregnancy-Related Anxiety Is Associated With Sexually Dimorphic Alterations in Amygdala Volume in 4-Year-Old Children. Front Behav Neurosci 2019; 13:175. [PMID: 31447658 PMCID: PMC6691065 DOI: 10.3389/fnbeh.2019.00175] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/15/2019] [Indexed: 12/03/2022] Open
Abstract
Prenatal stress is associated with child behavioral outcomes increasing susceptibility for psychiatric disorders in later life. Altered fetal brain development might partly mediate this association, as some studies suggest. With this study, we investigated the relation between prenatal stress, child's brain structure and behavioral problems. The association between self-reported maternal pregnancy-related anxiety (PRAQ-R2 questionnaire, second and third trimester) and brain gray matter volume was probed in 27 4-year-old children (13 female). Voxel based morphometry was applied with an age-matched template in SPM for the whole-brain analyses, and amygdala volume was assessed with manual segmentation. Possible pre- and postnatal confounders, such as maternal depression and anxiety among others, were controlled for. Child behavioral problems were assessed with the Strength and Difficulties Questionnaire by maternal report. We found a significant interaction effect of pregnancy-related anxiety and child's sex on child's amygdala volume, i.e., higher pregnancy-related anxiety in the second trimester was related to significantly greater left relative amygdala volume in girls compared to boys. Further exploratory analyses yielded that both maternal pregnancy-related anxiety and child's amygdala volume are related to child emotional and behavioral difficulties: While higher pregnancy-related anxiety was associated with more emotional symptoms, peer relationship problems and overall child difficulties, greater left amygdala volume was related to less of these child difficulties and might partly mediate sex-specific associations between pregnancy-related anxiety and child behavioral difficulties. Our data suggest that maternal prenatal distress leads to sexually dimorphic structural changes in the offspring's limbic system and that these changes are also linked to behavioral difficulties. Our results provide further support for the notion that prenatal stress impacts child development.
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Affiliation(s)
- Henriette Acosta
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Jetro J. Tuulari
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
- Turku Collegium for Science and Medicine, University of Turku, Turku, Finland
| | - Noora M. Scheinin
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Niloofar Hashempour
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Olli Rajasilta
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Tuomas I. Lavonius
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Juho Pelto
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Virva Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Tuire Lähdesmäki
- Department of Pediatric Neurology, Turku University Hospital, University of Turku, Turku, Finland
| | - Linnea Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Hasse Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
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73
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Mudra S, Göbel A, Barthel D, Hecher K, Schulte-Markwort M, Goletzke J, Arck P, Diemert A. Psychometric properties of the German version of the pregnancy-related anxiety questionnaire-revised 2 (PRAQ-R2) in the third trimester of pregnancy. BMC Pregnancy Childbirth 2019; 19:242. [PMID: 31296168 PMCID: PMC6625049 DOI: 10.1186/s12884-019-2368-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Pregnancy-related anxiety (PrA) has been identified as a construct distinct from general stress and anxiety with a negative impact on birth and child outcomes. Validated instruments with good psychometric properties to assess pregnancy-related anxiety in German-speaking expectant mothers are still lacking. The Pregnancy-Related Anxiety Questionnaire revised for its use independent of parity (PRAQ-R2) assesses fear of giving birth (FoGB), worries of bearing a physically or mentally handicapped child (WaHC) and concerns about own appearance (CoA). The aim of this study was to investigate the psychometric properties of the PRAQ-R2 in a German sample of pregnant women in their third pregnancy trimester. Methods The PRAQ-R2 and several questionnaires measuring different forms of anxiety as well as depressive symptoms and perceived general self-efficacy were administered cross-sectionally in a sample of nulliparous and parous women (N = 360) in the third trimester of pregnancy. Results Reliability was satisfactory to excellent for the PRAQ-R2 total scale (Cronbach’s α = .85) and the subscales (α = .77 to .90). Confirmatory and exploratory factor analysis confirmed the three-factorial structure of the instrument. The three factors together explained 68% of variance. Construct validity was confirmed by positive low- to moderate-sized correlations of the PRAQ-R2 total score and the subscales with measurements of anxiety and depression and by negative low correlations with general self-efficacy. Conclusions The German version of the PRAQ-R2 is a valid and feasible measurement for pregnancy-related anxiety for research and clinical practice.
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Affiliation(s)
- S Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - A Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - D Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - M Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - J Goletzke
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - P Arck
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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74
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McLean MA, Cobham VE, Simcock G, Kildea S, King S. Toddler Temperament Mediates the Effect of Prenatal Maternal Stress on Childhood Anxiety Symptomatology: The QF2011 Queensland Flood Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111998. [PMID: 31195616 PMCID: PMC6603961 DOI: 10.3390/ijerph16111998] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/27/2022]
Abstract
It is not known whether alterations to temperamental characteristics associated with prenatal maternal stress (PNMS) exposure account for the development of childhood anxiety symptomatology (internalizing behaviors and anxiety symptoms). The QF2011 Queensland flood study examined whether (1) toddler temperamental characteristics explained the association between PNMS exposure and childhood anxiety symptomatology; and (2) whether effects were dependent upon child sex or the timing of gestational exposure to PNMS. We investigated the effects of various aspects of flood-related stress in pregnancy (objective hardship, cognitive appraisal, subjective distress) on maternal report of 16-month toddler temperament (attentional control, shy-inhibition, negative reactivity), 4-year maternal-reported childhood anxiety symptomatology (internalizing and anxiety symptoms; N = 104), and teacher reports of internalizing behaviors (N = 77). Severity of maternal objective hardship during pregnancy and shy-inhibited behaviors were uniquely associated with 4-year child anxiety symptoms. Mediation analyses found that higher levels of 16-month negative reactivity accounted, in part, for the relationship between increased maternal objective flood-related hardship and greater internalizing behaviors (maternal but not teacher report). Neither child sex nor gestational timing of exposure moderated the hypothesized mediations. Our findings highlight several pathways through which varying aspects of disaster-related PNMS may influence early childhood anxiety symptomatology.
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Affiliation(s)
- Mia A McLean
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Vanessa E Cobham
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Gabrielle Simcock
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of Sunshine Coast, Sippy Downs, QLD 4556, Australia.
| | - Sue Kildea
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Suzanne King
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health University Institute, Verdun, QC H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada.
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75
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Hicks LM, Swales DA, Garcia SE, Driver C, Davis EP. Does Prenatal Maternal Distress Contribute to Sex Differences in Child Psychopathology? Curr Psychiatry Rep 2019; 21:7. [PMID: 30729361 DOI: 10.1007/s11920-019-0992-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Prenatal maternal psychological distress is an established risk factor for the development of psychopathology in offspring. The purpose of this review is to evaluate whether sex differences in fetal responses to maternal distress contribute to sex differences in subsequent psychopathology. RECENT FINDINGS Male and female fetuses respond differently to stress signals. We review recent evidence that demonstrates a sex-specific pattern of association between prenatal maternal distress and pathways associated with risk for psychopathology including offspring hypothalamic pituitary adrenocortical (HPA) axis regulation, brain development, and negative emotionality. Prenatal maternal distress exerts sex-specific consequences on the fetus. These differences may contribute to the well-established sex differences in psychopathology and in particular to greater female vulnerability to develop internalizing problems.
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Affiliation(s)
- Laurel M Hicks
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Danielle A Swales
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Sarah E Garcia
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Camille Driver
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA. .,Department of Psychiatry and Human Behavior, University of California Irvine, One University Drive, Orange, CA, 92866, USA.
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76
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Karlsson L, Tolvanen M, Scheinin NM, Uusitupa HM, Korja R, Ekholm E, Tuulari JJ, Pajulo M, Huotilainen M, Paunio T, Karlsson H. Cohort Profile: The FinnBrain Birth Cohort Study (FinnBrain). Int J Epidemiol 2019; 47:15-16j. [PMID: 29025073 DOI: 10.1093/ije/dyx173] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 12/29/2022] Open
Affiliation(s)
- Linnea Karlsson
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Child Psychiatry
| | - Mimmi Tolvanen
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Community Dentistry
| | - Noora M Scheinin
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Psychiatry
| | - Henna-Maria Uusitupa
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study
| | - Riikka Korja
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Psychology, University of Turku
| | - Eeva Ekholm
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jetro J Tuulari
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study
| | - Marjukka Pajulo
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Child Psychiatry
| | - Minna Huotilainen
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,University of Helsinki, Cognitive Brain Research Unit and CICERO Learning Network, Helsinki, Finland
| | - Tiina Paunio
- National Institute for Health and Welfare, the Genomics and Biomarkers Unit, Helsinki, Finland.,University of Helsinki and Helsinki University Hospital, Department of Psychiatry, Helsinki, Finland
| | - Hasse Karlsson
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Psychiatry
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77
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Korja R, Nolvi S, Kataja EL, Scheinin N, Junttila N, Lahtinen H, Saarni S, Karlsson L, Karlsson H. The courses of maternal and paternal depressive and anxiety symptoms during the prenatal period in the FinnBrain Birth Cohort study. PLoS One 2018; 13:e0207856. [PMID: 30557345 PMCID: PMC6296666 DOI: 10.1371/journal.pone.0207856] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 11/07/2018] [Indexed: 01/09/2023] Open
Abstract
Maternal prenatal symptoms of depression and anxiety have been suggested to impose differential effects on later offspring development, depending on their characteristics, such as timing, intensity and persistence. Paternal symptoms have been less investigated. While knowledge on these trajectory characteristics is essential for improved comprehension of prenatal stress, prospective studies including both expecting parents have been scarce. We aim at identifying and comparing the trajectories of prenatal depressive and anxiety symptoms in both parents in a pregnancy cohort design. The sample included 3202 mothers and 2076 fathers who were recruited to the FinnBrain Birth Cohort study (www.finnbrain.fi). Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and general anxiety by the anxiety scale of the Symptom Checklist -90 (SCL-90) repeatedly at 14, 24, and 34 gestational weeks. Five differential depressive and four anxiety symptom trajectories were identified across pregnancy both in mothers and in fathers. The trajectories of consistently low depressive or anxiety symptoms were associated with higher educational level in both parents, and with nulliparity and non-smoking during pregnancy in mothers. Parents with consistently high or increasing levels of symptoms had more often prenatal SSRI medication. The congruences between elevated depressive and anxiety symptoms at any point in pregnancy, as well as parental trajectories within families were low. However, in this population-based sample, the self-reported symptom levels of both parents were generally very low. Variance in timing and persistence of parent-reported prenatal depressive and anxiety symptoms is potentially important, while symptom trajectories are very similar in mothers and fathers. These differential symptom trajectories and the significance of their correlates should be acknowledged when studying prenatal stress exposures and the related outcomes in children.
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Affiliation(s)
- Riikka Korja
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku, Department of Psychology, Turku, Finland
| | - Saara Nolvi
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
| | - Eeva-Leena Kataja
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku, Department of Psychology, Turku, Finland
| | - Noora Scheinin
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
| | - Niina Junttila
- University of Turku, Department of Teacher Education, Turku, Finland
| | - Henna Lahtinen
- University of Turku, Department of Psychology, Turku, Finland
| | - Suoma Saarni
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
- Helsinki University Hospital, Department of Psychiatry, Helsinki, Finland
| | - Linnea Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku and Turku University Hospital, Institute of Clinical Medicine, Department of Child Psychiatry, Turku, Finland
| | - Hasse Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
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78
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Fuller A, Messito MJ, Mendelsohn AL, Oyeku SO, Gross RS. Prenatal Material Hardships and Infant Regulatory Capacity at 10 Months Old in Low-Income Hispanic Mother-Infant Pairs. Acad Pediatr 2018; 18:897-904. [PMID: 29729425 PMCID: PMC6214792 DOI: 10.1016/j.acap.2018.04.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/22/2018] [Accepted: 04/28/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Prenatal maternal stresses have been associated with infant temperament patterns linked to later behavioral difficulties. Material hardships, defined as inability to meet basic needs, are important prenatal stressors. Our objective was to determine the associations between prenatal material hardships and infant temperament at 10 months. METHODS This was a longitudinal study of mother-infant pairs in a randomized controlled trial of a primary care-based early obesity prevention program (Starting Early). Independent variables representing material hardship were: housing disrepair, food insecurity, difficulty paying bills, and neighborhood stress (neighborhood safety). Dependent variables representing infant temperament were assessed using questions from 3 subscales of the Infant Behavior Questionnaire: orienting/regulatory capacity, negative affect, and surgency/extraversion. We used linear regression to investigate associations between individual and cumulative hardships and each temperament domain, adjusting for confounders, and testing for depression as a moderator. RESULTS Four hundred twelve mother-infant pairs completed 10-month assessments. Thirty-two percent reported food insecurity, 26% difficulty paying bills, 35% housing disrepair, and 9% neighborhood stress. In adjusted analyses, food insecurity was associated with lower orienting/regulatory capacity scores (β = -0.25; 95% confidence interval [CI], -0.47 to -0.04), as were neighborhood stress (β = -0.50; 95% CI, -0.83 to -0.16) and experiencing 3 to 4 hardships (compared with none; β = -0.54; 95% CI, -0.83 to -0.21). For neighborhood stress, the association was stronger among infants of mothers with prenatal depressive symptoms (interaction term P = .06). CONCLUSION Prenatal material hardships were associated with lower orienting/regulatory capacity. These findings support the need for further research exploring how temperament relates to child behavior, and for policies to reduce prenatal material hardships.
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Affiliation(s)
- Anne Fuller
- Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY.
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, Bellevue Hospital Center, New York, NY
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University School of Medicine, Bellevue Hospital Center, New York, NY
| | - Suzette O Oyeku
- Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Rachel S Gross
- Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY; Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, Bellevue Hospital Center, New York, NY
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79
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Göbel A, Stuhrmann LY, Harder S, Schulte-Markwort M, Mudra S. The association between maternal-fetal bonding and prenatal anxiety: An explanatory analysis and systematic review. J Affect Disord 2018; 239:313-327. [PMID: 30031251 DOI: 10.1016/j.jad.2018.07.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/23/2018] [Accepted: 07/08/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The prenatal period can be associated with an increase in distress and anxiety. Research indicates that impaired mental well-being influences the development of prenatal maternal-fetal bonding, which manifests in representations, emotions and behaviors. However, the impact of prenatal anxieties on maternal-fetal bonding is still not fully understood, partly due to heterogeneity in the conceptualization and the measurement of both constructs. The aims of this review were to identify studies assessing the relation between both constructs and to investigate direction and size of effects for different types of prenatal anxiety and conceptualizations of maternal-fetal bonding. METHODS A systematic search was carried out on January 7, 2017, and updated on October 23, 2017, based on four electronic databases and a targeted reference search. Of the 3845 identified publications, K = 31 studies fit the eligibility criteria. RESULTS While components of maternal-fetal bonding centering around pregnancy or maternal role were not affected, the quality of perceived emotional proximity to the child, as assessed by the Maternal Antenatal Attachment Scale, was impaired by anxieties across studies. Associations were overall negative and of low to moderate size. LIMITATIONS Studies focusing on high-risk subpopulations were excluded. Included studies mostly assessed samples from Western societies, which limits the generalizability of results to non-Western cultures. CONCLUSION The quality of perceived emotional proximity to the fetus was consistently impaired by anxiety. Nevertheless, varying effect sizes indicate a more complex association that is influenced by underlying confounders. Multivariate analyses are needed to improve the understanding of the interacting factors that influence maternal-fetal bonding.
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Affiliation(s)
- Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany.
| | - Lydia Yao Stuhrmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
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80
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Systematic review on maternal depression versus anxiety in relation to excessive infant crying: it is all about the timing. Arch Womens Ment Health 2018; 21:15-30. [PMID: 28900745 DOI: 10.1007/s00737-017-0771-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/14/2017] [Indexed: 10/24/2022]
Abstract
Different types of studies suggest a link between maternal depression/anxiety and excessive infant crying (EC). However, comparability is hampered due to different designs, definitions and measurements. This systematic review investigates the specific role of maternal depression and anxiety considering them as preceding, concurrent and subsequent conditions of EC. A computerised literature search was conducted in January 2017 using Medline, PubMed, PsycINFO and Web of Science. After screening n = 399 records for inclusion/exclusion criteria, n = 33 records based on n = 30 projects were eligible for systematic qualitative data synthesis. All studies on maternal depression/anxiety and EC within the first 3 years of life were included. Included studies investigated predominantly maternal depression (25/30) and secondly maternal anxiety (17/30). Significant positive results were found in the majority of studies for maternal depression (21/25) as well as for maternal anxiety (12/17) in relation to EC. In-depth analyses further revealed that concurrent and subsequent maternal depression was robustly related with EC, whilst preceding maternal depression was not. In contrast, preceding and concurrent (but not subsequent) maternal anxiety was consistently related to subsequent EC. Maternal depression is more likely a correlate or even a consequence of EC, whereas anxiety is rather a temporally preceding condition and thus a potential risk factor or risk marker for both subsequent EC and associated maternal depression. Interventions for EC should address concurrent maternal depression, whilst preventive approaches might target preceding maternal anxiety as early as prior to or during pregnancy.
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