Maternal pregnancy-specific anxiety is associated with child executive function at 6-9 years age

Association of Financial Worry and Material Financial Risk with Short-Term Ambulatory Healthcare Utilization in a Sample of Subsidized Exchange Patients

BACKGROUND

Financial burden can affect healthcare utilization. Few studies have assessed the short-term associations between material (debt, trouble paying rent) and psychological (worry or distress about affording future healthcare) financial risks, and subsequent outpatient and emergency healthcare use. Worry was defined as concerns about affording future healthcare.

OBJECTIVE

Examine whether worry about affording healthcare is associated with healthcare utilization when controlling for material risk and general anxiety DESIGN: Longitudinal observational study PARTICIPANTS: Kaiser Permanente members with exchange-based federally subsidized health insurance (n = 450, 45% response rate) MAIN MEASURES: Survey measures of financial risks (material difficulty paying for medical care and worry about affording healthcare) and general anxiety. Healthcare use (primary care, urgent care, emergency department, and outpatient specialty visits) in the 6 months following survey completion.

KEY RESULTS

Emergency department and primary care visits were not associated with material risk, worry about affording care, or general anxiety in individual and pooled analyses (all 95% confidence intervals (CI) for relative risk (RR) included 1). Although no individual predictor was associated with urgent care use (all 95% CIs for RR included 1), worry about affording prescriptions (relative risk (RR) = 2.01; 95% CI 1.14, 3.55) and general anxiety (RR = 0.38; 95% CI 0.15, 0.95) were significant when included in the same model, suggesting the two confounded each other. Worry about affording healthcare services was associated with fewer specialty care visits (RR = 0.40; 95% CI 0.25, 0.64) even when controlling for material risk and general anxiety, although general anxiety was also associated with more specialty care visits (RR = 1.98; 95% CI, 1.23, 3.18).

CONCLUSIONS

Screening for both general anxiety and financial worry may assist with specialty care utilization. Identifying these concerns may provide more opportunities to assist patients. Future research should examine interventions to reduce worry about cost of care.

Perceived stress may mediate the relationship between antenatal depressive symptoms and preterm birth: A pilot observational cohort study

Background

Screening for changes in pregnancy-related anxiety and depressive symptoms during pregnancy may further our understanding of the relationship between these two variables and preterm birth.

Objectives

To determine whether changes in pregnancy-related anxiety and depressive symptoms during pregnancy influence the risk of preterm birth among Pakistani women; explore whether perceived stress moderates or mediates this relationship, and examine the relationship between the various components of pregnancy-related anxiety and preterm birth.

Methods

A prospective cohort study design was used to recruit a diverse sample of 300 low-risk pregnant women from four centers of Aga Khan Hospital for Women and Children in Karachi, Pakistan. Changes in pregnancy-related anxiety and depressive symptoms during pregnancy were tested. Multiple logistic regression analysis was used to determine a predictive model for preterm birth. We then determined if the influence of perceived stress could moderate or mediate the effect of depressive symptoms on preterm birth.

Results

Changes in pregnancy-related anxiety (OR = 1.1, CI 0.97–1.17, p = 0.167) and depressive symptoms (OR = 0.9, CI 0.85–1.03, p = 0.179) were insignificant as predictors of preterm birth after adjusting for the effects of maternal education and family type. When perceived stress was added into the model, we found that changes in depressive symptoms became marginally significant after adjusting for covariates (OR = 0.9, CI 0.82–1.01, p = 0.082). After adjusting for the mediation effect of change in perceived stress, the effect of change in depressive symptoms on preterm birth were marginally significant after adjusting for covariates. Among six different dimensions of pregnancy-related anxiety, mother’s concerns about fetal health showed a trend towards being predictive of preterm birth (OR = 1.3, CI 0.97–1.72, p = 0.078).

Conclusions

There may be a relationship between perceived stress and antenatal depressive symptoms and preterm birth. This is the first study of its kind to be conducted in Pakistan. Further research is required to validate these results.

Exploring the relationship between maternal prenatal stress and brain structure in premature neonates

BACKGROUND

Exposure to maternal stress in utero is associated with a range of adverse outcomes. We previously observed an association between maternal stress and white matter microstructure in a sample of infants born prematurely. In this study, we aimed to investigate the relationship between maternal trait anxiety, stressful life events and brain volumes.

METHODS

221 infants (114 males, 107 females) born prematurely (median gestational age = 30.43 weeks [range 23.57-32.86]) underwent magnetic resonance imaging around term-equivalent age (mean = 42.20 weeks, SD = 1.60). Brain volumes were extracted for the following regions of interest: frontal lobe, temporal lobe, amygdala, hippocampus, thalamus and normalized to total brain volume. Multiple linear regressions were conducted to investigate the relationship between maternal anxiety/stress and brain volumes, controlling for gestational age at birth, postmenstrual age at scan, socioeconomic status, sex, days on total parenteral nutrition. Additional exploratory Tensor Based Morphometry analyses were performed to obtain voxel-wise brain volume changes from Jacobian determinant maps.

RESULTS AND CONCLUSION

In this large prospective study, we did not find evidence of a relationship between maternal prenatal stress or trait anxiety and brain volumes. This was the case for both the main analysis using a region-of-interest approach, and for the exploratory analysis using Jacobian determinant maps. We discuss these results in the context of conflicting evidence from previous studies and highlight the need for further research on premature infants, particularly including term-born controls.

Cohort profile: Understanding Pregnancy Signals and Infant Development (UPSIDE): a pregnancy cohort study on prenatal exposure mechanisms for child health

PURPOSE

Extensive research suggests that maternal prenatal distress is reliably related to perinatal and child health outcomes-which may persist into adulthood. However, basic questions remain regarding mechanisms involved. To better understand these mechanisms, we developed the Understanding Pregnancy Signals and Infant Development (UPSIDE) cohort study, which has several distinguishing features, including repeated assessments across trimesters, analysis of multiple biological pathways of interest, and incorporation of placental structure and function as mediators of child health outcomes.

PARTICIPANTS

Women with normal risk pregnancies were recruited at <14 weeks gestation. Study visits occurred in each trimester and included extensive psychological, sociodemographic, health behaviour and biospecimen collection. Placenta and cord blood were collected at birth. Child visits (ongoing) occur at birth and 1, 6, 12, 24, 36 and 48 months of age and use standard anthropometric, clinical, behavioural, biological and neuroimaging methods to assess child physical and neurodevelopment.

FINDINGS TO DATE

We recruited 326 pregnancies; 294 (90%) were retained through birth. Success rates for prenatal biospecimen collection were high across all trimesters (96%-99% for blood, 94%-97% for urine, 96%-99% for saliva, 96% of placentas, 88% for cord blood and 93% for buccal swab). Ninety-four per cent of eligible babies (n=277) participated in a birth examination; postnatal visits are ongoing.

FUTURE PLANS

The current phase of the study follows children through age 4 to examine child neurodevelopment and physical development. In addition, the cohort participates in the National Institutes of Health's Environmental influences on Child Health Outcomes programme, a national study of 50 000 families examining early environmental influences on perinatal outcomes, neurodevelopment, obesity and airway disease. Future research will leverage the rich repository of biological samples and clinical data to expand research on the mechanisms of child health outcomes in relation to environmental chemical exposures, genetics and the microbiome.

Mental health of pregnant and postpartum women in response to the COVID-19 pandemic

Background

The COVID-19 pandemic has been uniquely challenging for pregnant and postpartum women. Uncontrollable stress amplifies risk for maternal depression and anxiety, which are linked to adverse mother and child outcomes. This study examined change in internalizing symptoms from before to during the COVID-19 pandemic among pregnant and postpartum women longitudinally, and investigated moderation by loneliness and other contextual risk factors.

Methods

135 women (M_age = 31.81; 26% Latina, 55% non-Hispanic White, 11% Black; 39% low-income) enrolled in an existing prospective study completed self-report questionnaires including the EPDS and STAI-short form during early pregnancy, prior to COVID-19, and during COVID-19.

Results

Depressive symptoms were higher during COVID-19 compared to pre-COVID-19 and just as high as during early pregnancy. Anxiety symptoms were higher during COVID-19 compared to both pre-COVID-19 and early pregnancy. Higher loneliness was associated with increased depressive symptoms during COVID-19. Greater COVID-19 specific adversity was linked to greater increases in internalizing symptoms during COVID-19. Lower income-to-needs-ratio most strongly predicted symptoms during early pregnancy.

Limitations

The present study is longitudinal, but the correlational nature of the data precludes causal conclusions regarding the effect of the pandemic on mental health.

Conclusion

Longitudinal analyses suggest the COVID-19 pandemic resulted in increased internalizing symptoms among diverse pregnant and postpartum women. Interpersonal and contextual factors exacerbate risk and the impact of the pandemic on women's mental health. Identifying mothers at-risk for depression and anxiety may increase treatment utilization, mitigate fetal and infant exposure to maternal depression and anxiety, and help prevent adverse child outcomes.

Maternal Prenatal Mood, Pregnancy-Specific Worries, and Early Child Psychopathology: Findings From the DREAM BIG Consortium

OBJECTIVE

Few studies have attempted to identify how distinct dimensions of maternal prenatal affective symptoms relate to offspring psychopathology. We defined latent dimensions of women's prenatal affective symptoms and pregnancy-specific worries to examine their association with early offspring psychopathology in three prenatal cohorts.

METHOD

Data were used from three cohorts of the DREAM-BIG consortium: Avon Longitudinal Study of Parents and Children (ALSPAC [N = 12,515]), Generation R (N = 6,803), and the Canadian prenatal cohort Maternal Adversity, Vulnerability, and Neurodevelopment (MAVAN [N = 578]). Maternal prenatal affective symptoms and pregnancy-specific worries were assessed using different measures in each cohort. Through confirmatory factor analyses, we determined whether comparable latent dimensions of prenatal maternal affective symptoms existed across the cohorts. We used structural equation models to examine cohort-specific associations between these dimensions and offspring psychopathology at 4 to 8 years of age (general psychopathology, specific internalizing and externalizing previously derived using confirmatory factor analyses). Cohort-based estimates were meta-analyzed using inverse variance-weighing.

RESULTS

Four prenatal maternal factors were similar in all cohorts: a general affective symptoms factor and three specific factors-an anxiety/depression factor, a somatic factor, and a pregnancy-specific worries factor. In meta-analyses, both the general affective symptoms factor and pregnancy-specific worries factor were independently associated with offspring general psychopathology. The general affective symptoms factor was further associated with offspring specific internalizing problems. There were no associations with specific externalizing problems.

CONCLUSION

These replicated findings of independent and adverse effects for prenatal general affective symptoms and pregnancy-specific worries on child mental health support the need for specific interventions in pregnancy.

A Unifying Theory for Autism: The Pathogenetic Triad as a Theoretical Framework

This paper presents a unifying theory for autism by applying the framework of a pathogenetic triad to the scientific literature. It proposes a deconstruction of autism into three contributing features (an autistic personality dimension, cognitive compensation, and neuropathological risk factors), and delineates how they interact to cause a maladaptive behavioral phenotype that may require a clinical diagnosis. The autistic personality represents a common core condition, which induces a set of behavioral issues when pronounced. These issues are compensated for by cognitive mechanisms, allowing the individual to remain adaptive and functional. Risk factors, both exogenous and endogenous ones, show pathophysiological convergence through their negative effects on neurodevelopment. This secondarily affects cognitive compensation, which disinhibits a maladaptive behavioral phenotype. The triad is operationalized and methods for quantification are presented. With respect to the breadth of findings in the literature that it can incorporate, it is the most comprehensive model yet for autism. Its main implications are that (1) it presents the broader autism phenotype as a non-pathological core personality domain, which is shared across the population and uncoupled from associated features such as low cognitive ability and immune dysfunction, (2) it proposes that common genetic variants underly the personality domain, and that rare variants act as risk factors through negative effects on neurodevelopment, (3) it outlines a common pathophysiological mechanism, through inhibition of neurodevelopment and cognitive dysfunction, by which a wide range of endogenous and exogenous risk factors lead to autism, and (4) it suggests that contributing risk factors, and findings of immune and autonomic dysfunction are clinically ascertained rather than part of the core autism construct.

A theoretical model of financial burden after cancer diagnosis

Current models of financial burden after cancer do not adequately define types of financial burden, moderators or causes. We propose a new theoretical model to address these gaps. This model delineates the components of financial burden as material and psychological as well as healthcare-specific (affording treatment) versus general (affording necessities). Psychological financial burden is further divided into worry about future costs and rumination about past and current financial burden. The model hypothesizes costs and employment changes as causes, and moderators include precancer socioeconomic status and post-diagnosis factors. The model outlines outcomes affected by financial burden, including depression and mortality. Theoretically derived measures of financial burden, interventions and policy changes to address the causes of financial burden in cancer are needed.

Mental health of Urban Mothers (MUM) study: a multicentre randomised controlled trial, study protocol

INTRODUCTION

Mental health disorders are common during pregnancy and the postnatal period and can have serious adverse effects on women and their children. The consequences for global mental health due to COVID-19 are likely to be significant and may have a long-term impact on the global burden of disease. Besides physical vulnerability, pregnant women are at increased risk of mental health problems such as anxiety, depression and post-traumatic stress disorder due to the consequences of social distancing. It can result in altered healthcare routines, less support from the family and friends, and in some cases, partners not being allowed to be present during prenatal visits, labour and delivery. Higher than expected, rates of perinatal anxiety and depression have been already reported during the pandemic. Pregnant women may also feel insecure and worried about the effects of COVID-19 on their unborn child if they get infected during pregnancy. Today, young urban women are used to using internet services frequently and efficiently. Therefore, providing mental health support to pregnant women via internet may be effective in ameliorating their anxiety/depression, reducing the risk of serious mental health disorders, and lead to improved maternal and perinatal outcomes.

OVERARCHING AIM

Our aim is to explore the effectiveness of a web-based psychosocial peer-to-peer support intervention in reducing the risk and severity of perinatal mental health disorders and preventing adverse pregnancy outcomes among pregnant women living in metropolitan urban settings.

METHODS AND ANALYSIS

We plan to conduct a multicentre prospective randomised controlled trial, Mental health of Urban Mothers trial. Pregnant women living in large metropolitan cities will be recruited using internet-based application through non-profit organisations' websites. The women who consent will be randomised to receive a web-based peer-to-peer support intervention or usual care. Data will be analysed to identify the effects of intervention on Edinburgh Postnatal Depression Score and Generalised Anxiety Disorder 7 scores as well as pregnancy outcomes. The impact of COVID-19 pandemic on maternal stress will be assesed using Impact Event Scale-R. Any differences in outcomes between cities will be addressed in subgroup analyses.

ETHICS AND DISSEMINATION

The study will be conducted according to the principles of Good Clinical Practice and will follow the ethical principles of the Declaration of Helsinki. The study protocol has been approved by the ethical review board of Chinese University of Hong Kong (IRB number 2019-8170) and Shanghai Center for Women's and Children's Health (international review board (IRB) number 2020-F001-12). The results will be disseminated at national and international scientific conferences, published in peer-reviewed medical journals and spread to the public through social media, news outlets and podcasts.

TRIAL REGISTRATION NUMBER

NCT04363177; Trial sponsor Karolinska Institute, CLINTEC, Stockholm, Sweden.

Perinatal Maternal Anxiety and Depressive Symptoms and Child Executive Function and Attention at Two-years of Age

The objective was to investigate whether perinatal maternal anxiety and depressive symptoms predicted child attention and executive function (EF). Mothers (N = 614) reported pregnancy and three-months postnatal anxiety and depressive symptoms. Attention and EF were measured at two-years-of-age. Covariates were demographics, alcohol use, mood disorder history, and pregnancy factors. Higher prenatal anxiety, b(SE) =.020(.005), p<.001, and postnatal depressive symptoms, b(SE) =.009(.004), p=.04, predicted poorer child attention. A prenatal-by-postnatal depressive symptom interaction emerged, b(SE) = -.005(.003), p=.04: When pregnancy depressive symptoms were low, higher postnatal symptoms predicted poorer attention. No distress variables predicted EF, p's>.22. Perinatal distress timing, kind, and change were important for child attention.

Influence of Maternal Stress during Pregnancy on Child’s Neurodevelopment

(1) Background: High stress levels during pregnancy can affect the organogenesis and the foetus’ central nervous system maturation. The objective of this study was to determine whether a relationship between maternal stress during pregnancy and alterations in child neurodevelopment exists; (2) Methods: A bibliographical review was carried out following PRISMA Methodology and using Scopus, Web of Science and Cinahl databases. The research questions were made using PEO methodology (Participants, Exposition, Outcomes). Moreover, article quality was measured using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies; (3) Results: 22 articles that fit the inclusion criteria were selected. Different elements altered because of maternal stress during pregnancy could side with alterations in different areas of the neurodevelopment, such as cognitive development, motor development, behaviour, temperament, memory and learning abilities; (4) Conclusions: Although maternal stress can have an influence on children’s neurodevelopment, it is still unknown which are the specific elements related to this stress that can modify it negatively. Furthermore, future studies should evaluate whether a sex-specific association exists.

The impact of maternal perinatal depression on exposure to reading and screen time for their infants: pilot findings from the MPEWS Study

OBJECTIVE

To explore the association between maternal depression and the screen and reading time experienced by their infants.

METHODS

This study utilises data on 158 women and infants, collected within the Mercy Pregnancy and Emotional Wellbeing Study. Women less than 20 weeks gestation were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Six months postpartum they completed questionnaires about themselves, their infant and early parenting practices.

RESULTS

Children of women with a past diagnosis of depression were exposed to fewer days of 15-minute reading time per week compared to the children of women with no diagnosis. While the current depression group showed a lower average reading time, this difference was not statistically significant. There were no significant differences in infant screen time between groups.

CONCLUSIONS

A maternal past diagnosis of depression is correlated with decreased reading time in infants. This may present a practical point for screening and intervention or suggest a causal pathway for poorer outcomes in children of those with depression.

Maternal Anxiety and Depression during Late Pregnancy and Newborn Brain White Matter Development

BACKGROUND AND PURPOSE

Anxiety and depression during pregnancy have been associated with an increased risk of adverse neurodevelopmental outcomes in offspring. We aimed to study the in utero effects of maternal anxiety and depression on early brain development.

MATERIALS AND METHODS

Pregnant women were recruited at ∼36 weeks of gestation for this prospective study. They were assessed for anxiety symptoms by the State-Trait Anxiety Inventory and for depression symptoms by the Beck Depression Inventory, 2nd Edition. After delivery, infant underwent an MR imaging examination of the brain without sedation, including DTI, for evaluation of white matter (WM) development. Infant fractional anisotropy values, a putative marker of WM integrity, were correlated with the mothers' State-Trait Anxiety Inventory and Beck Depression Inventory scores by using both tract-based spatial statistics and ROI methods.

RESULTS

Thirty-four infants were included in this study. Both maternal State-Anxiety and Trait-Anxiety scores negatively correlated (P < .05, corrected) with fractional anisotropy values in widespread brain WM regions; Beck Depression Inventory scores also negatively correlated (P < .05) with fractional anisotropy values in one cluster in the brain. Further ROI analyses confirmed significant negative correlations between average fractional anisotropy values in ROIs including left and right prefrontal WM, left and right middle frontal gyrus WM, and the fornix, and State-Anxiety (R values, -0.47 to -0.67; P values, .008 to <.001), Trait-Anxiety (R, -0.37 to -0.59; P, .04 to <.001), and Beck Depression Inventory (R values, -0.36 to -0.55; P, .05 to .002) scores.

CONCLUSIONS

Higher maternal anxiety and depression symptom scores during late pregnancy were associated with lower estimated infant brain WM development, which indicated in utero influences of maternal mental health during pregnancy on the developing brain.

A lifespan developmental science perspective on trauma experiences in refugee situations

Developmental science theory and empirical research on refugee situations requires an updated approach to the study of trauma as a multi-systemic and multilevel phenomenon. We present a theoretical framework that integrates developmental science approaches to highlight critical threats to development in situations of violent displacement. Given the complexities of displacement (causes, trajectories, and living circumstances once displaced), this theoretical model highlights the utility of an approach that recognizes the person-age-context fit in which displaced individuals live their lives and how both trauma and ongoing major disruption to daily life affects outcomes. In so doing, we aim to broaden understanding for future trauma and intervention research as well as practice with those who experience potentially traumatic events and severe disruption to their social ecology at different points in the lifespan.

Newborn amygdalar volumes are associated with maternal prenatal psychological distress in a sex-dependent way

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.

Maternal prenatal anxiety trajectories and infant developmental outcomes in one-year-old offspring

A longitudinal study of a sample of women and their offspring from two urban areas (N = 233) was conducted to test whether maternal prenatal anxiety trajectories from early to late pregnancy are associated with 12-month infant developmental outcomes, independent of maternal postpartum anxiety symptoms, prenatal and postpartum depressive symptoms, parity, birth outcomes and maternal education. Three types of maternal anxiety trajectories over the course of pregnancy were identified and labeled increasing, decreasing, and stable-low. Only increasing maternal prenatal anxiety was associated with 12-month infant outcomes, specifically lower Bayley-III scores on receptive language and gross motor skills. Maternal anxiety measured at each individual timepoint in pregnancy was not associated with infant Bayley-III outcomes, highlighting the importance of examining trajectories of maternal affect.

Perinatal complications and executive dysfunction in early-onset schizophrenia

BACKGROUND

The present study examined the association between perinatal obstetric complications and executive dysfunction in early-onset schizophrenia (EOS), compared to healthy controls. Higher incidences of obstetric complications and more severe executive dysfunctions characterize EOS. Research shows extensive brain maturation in newborns, suggesting them to be particularly vulnerable for perinatal insults. Executive function is mainly mediated by the prefrontal cortex, an area that matures last during pregnancy. Thus, exposure to perinatal complications may influence executive dysfunction in EOS.

METHODS

The participants were 19 EOS patients and 54 healthy controls. Executive function was assessed with the D-KEFS Color Word Interference Test and the Wisconsin Card Sorting Test. Information on perinatal obstetric complications and Apgar 5-min scores were obtained from the Norwegian Medical Birth Registry. Associations between perinatal conditions and executive function were studied using stepwise regression analyses.

RESULTS

Perinatal complications, and especially shorter gestational lengths, were significantly associated with significant executive dysfunctions in EOS. Perinatal complications did not affect executive function among healthy controls. A significant relationship between lower Apgar 5-min scores and executive dysfunction was found among both EOS patients and healthy controls.

CONCLUSIONS

Exposure to perinatal complications, and particularly a shorter gestational length, was associated with increased executive dysfunction in EOS. Exposed healthy controls did not exhibit similar executive difficulties, suggesting that the EOS patients seemed especially vulnerable for executive deficits due to perinatal insults. The findings indicate that EOS youths learn more slowly and experience more difficulty with problem-solving, which carry important implications for clinical practice. Lower Apgar 5-min scores were associated with executive dysfunction in both groups. Low Apgar score at 5 min may therefore be an important early indicator of executive difficulties among adolescents, independent of diagnosis.

Maternal antenatal anxiety and electrophysiological functioning amongst a sub-set of preschoolers participating in the GUSTO cohort

BACKGROUND

Antenatal maternal anxiety is a risk for offspring psychological and cognitive difficulties. The preschool years represent an important time for brain development, and so may be a window for intervention. However, electrophysiological investigations of maternal anxiety and preschoolers' brain functioning are lacking. We ask whether anxiety symptoms predict neurophysiology, and consider timing specificity (26-weeks antenatal or 24-months postnatal), form of insult (anxiety symptoms, per se, or also depression symptoms), and offspring gender.

METHODS

The sample consisted of a subset of 71 mothers and their 3 year old children taking part in the prospective birth cohort, GUSTO. Mothers provided antenatal (26 weeks) and postnatal (2 years) anxiety and depressive symptomatology data, respectively via the "State Trait Anxiety Questionnaire" and the "Edinburgh Postpartum Depression Scale." Offspring provided electrophysiological data, obtained while they indicated the emotional expression of actors whose facial expressions remained consistent throughout a pre-switch block, but were reversed at "post-switch."

RESULTS

Three electrophysiological components linked to different information processing stages were identified. The two earliest occurring components (i.e., the N1 and P2) differed across blocks. During post-switch, both were significantly predicted by maternal anxiety, after controlling for pre-switch neurophysiology. Similar results were observed with depression. Antenatal mental health remained a significant predictor after controlling for postnatal mental health.

CONCLUSION

In combination with past work, these findings suggest the importance of reducing symptoms in women prior to and during pregnancy, and offering support to offspring early in development.

Relationship between maternal pregnancy-related anxiety and infant brain responses to emotional speech - a pilot study

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.

Pregnancy anxiety in expectant mothers predicts offspring negative affect: The moderating role of acculturation

BACKGROUND

Pregnancy anxiety predicts adverse developmental outcomes in offspring from infancy through late childhood, but studies have not examined associations with outcomes in early childhood, nor clarified ethnic or cultural variations in these processes.

AIMS

(1) To examine differences in pregnancy anxiety and related concerns between non-Hispanic White women, Latina women who prefer to speak in English, and Latinas who prefer Spanish; (2) To test prospective associations between pregnancy anxiety and child negative affect and moderation by ethnicity and language preference, used as a proxy for acculturation.

STUDY DESIGN AND METHODS

This longitudinal study included 95 women (40 Non-Hispanic Whites, 31 Spanish-preference Latinas, and 24 English-preference Latinas). Language preference was provided at study entry. Pregnancy anxiety was assessed in the second and third trimesters of pregnancy with two standardized measures. Mothers reported child negative affect at age 4.

RESULTS

Spanish-preference Latinas had significantly more pregnancy-related anxiety about their health and safety in childbirth and concerning the medical system compared to English-preference Latinas and non-Hispanic White women. Adjusting for covariates, pregnancy anxiety in the second trimester, though not the third trimester, predicted significantly higher child negative affect in the full sample. A significant moderation effect indicated that the association was strongest among the lower acculturated Latinas, i.e., those who preferred Spanish.

CONCLUSION

These results document higher risk for offspring associated with pregnancy anxiety in the second trimester especially among less acculturated Latina women, and suggest the need for culturally-sensitive screening tools and interventions to improve outcomes for Latina mothers and their children.

The effectiveness and characteristics of pregnancy yoga interventions: a systematic review protocol

Background: The purpose of this review is to systematically examine the reported clinical effectiveness of pregnancy yoga.  The review will use the FITT (frequency, intensity, time/duration and type) principle of physical activity to characterise the different types of yoga interventions that have been evaluated in the included studies.  Studies will be categorised as effectiveness or efficacy studies and this continuum of efficacy versus effectiveness will be incorporated into the full review.  Methods/design: The following electronic databases will be searched using a detailed search strategy: MEDLINE, PsycINFO, EMBASE, CINAHL, WHOLiS, AMED, ScieLo, ASSIA and Web of Science. Randomised control trials and quasi-experimental studies examining pregnancy yoga and reporting on effect will be included. Titles, abstracts and full articles will be screened by two investigators independently to identify eligible studies.  The Cochrane Collaboration's Risk of Bias Assessment tool will be used to assess study quality.  Quality of the evidence will be evaluated using the GRADE criteria. A standardised data extraction form will be used to extract data. Effect sizes will be estimated using mean differences for continuous outcomes, and relative risks for dichotomous outcome. Where possible, pooling of effect estimates will be done using a random effect model.  The outcomes of interest are quality of life, stress, anxiety, depression, mode of birth, labour duration and pain management in labour. Discussion: This review will synthesise the best available evidence on the effectiveness of yoga during pregnancy and provide valuable high-quality information for clinicians and health policymakers. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant conference proceedings. The review will make recommendations for the appropriate volume, intensity and type of pregnancy yoga for maximum effect and may have implications for policy and practice relating to pregnancy yoga as an intervention.   Registration: PROSPERO, CRD42019119916.  Registered on 11th January 2019.

Manifestation and Associated Factors of Pregnancy-Related Worries in Expectant Fathers

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.

The longitudinal course of pregnancy-related anxiety in parous and nulliparous women and its association with symptoms of social and generalized anxiety

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.

Maternal environmental risk factors and the development of internalizing and externalizing problems in childhood: The complex role of genetic factors

The development of problem behavior in children is associated with exposure to environmental factors, including the maternal environment. Both are influenced by genetic factors, which may also be correlated, that is, environmental risk and problem behavior in children might be influenced by partly the same genetic factors. In addition, environmental and genetic factors could interact with each other increasing the risk of problem behavior in children. To date, limited research investigated these mechanisms in a genome-wide approach. Therefore, the goal of this study was to investigate the association between genetic risk for psychiatric and related traits, as indicated by polygenetic risk scores (PRSs), exposure to previously identified maternal risk factors, and problem behavior in a sample of 1,154 children from the Amsterdam Born Children and their Development study at ages 5-6 and 11-12 years old. The PRSs were derived from genome-wide association studies (GWASs) on schizophrenia, major depressive disorder, neuroticism, and wellbeing. Regression analysis showed that the PRSs were associated with exposure to multiple environmental risk factors, suggesting passive gene-environment correlation. In addition, the PRS based on the schizophrenia GWAS was associated with externalizing behavior problems in children at age 5-6. We did not find any association with problem behavior for the other PRSs. Our results indicate that genetic predispositions for psychiatric disorders and wellbeing are associated with early environmental risk factors for children's problem behavior.

Assessing Worry About Affording Healthcare in a General Population Sample

This study adapted a measure on worry about affording healthcare. The financial costs of healthcare are increasingly being shifted to patients. Financial burden from healthcare costs can be material (such as bankruptcy) or psychological. Psychological distress can be either worry about affording future care or distress due to material consequences and, despite evidence from clinical psychology that differentiates these types of emotional symptoms, this distinction has largely been ignored for financial burden in healthcare. We adapted a worry about affording healthcare scale for use in the general population (n = 398) to facilitate comparisons between disease groups and across countries. Participants completed a survey through an online platform. The worry about affording healthcare measure showed good reliability and validity through associations with quality of life (QOL) and measures of other types of financial burden. Worry about affording healthcare was also associated with cost-related non-adherence to medical care. Future research on patient QOL should consider worry about affording healthcare.

The effectiveness and characteristics of pregnancy yoga interventions: a systematic review protocol

Background: The purpose of the proposed review is to systematically examine the clinical effectiveness of pregnancy yoga.  The review will use the FITT (frequency, intensity, time/duration and type) principle of physical activity to characterise the different types of yoga interventions that have been evaluated in the included studies.   Methods/design: The following electronic databases will be searched using a detailed search strategy: MEDLINE, PsycINFO, EMBASE, CINAHL, WHOLiS, AMED, ScieLo, ASSIA and Web of Science. Randomised control trials and quasi-experimental studies examining pregnancy yoga will be included. Titles, abstracts and full articles will be screened by two investigators independently to identify eligible studies.  The Cochrane Collaboration's Risk of Bias Assessment tool will be used to assess study quality.  Quality of the evidence will be evaluated using the GRADE criteria. A standardised data extraction form will be used to extract data. Effect sizes will be estimated using mean differences for continuous outcomes, and relative risks for dichotomous outcome. Where possible, pooling of effect estimates will be done using a random effect model. Discussion: This review will synthesise the best available evidence on the effectiveness of yoga during pregnancy and provide valuable high-quality information for clinicians and health policymakers. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant conference proceedings. The review will make recommendations for the appropriate volume, intensity and type of pregnancy yoga for maximum effect and may have implications for policy and practice relating to pregnancy yoga as an intervention.   Registration: PROSPERO, CRD42019119916.  Registered on 11th January 2019.

Prenatal Maternal Stress and the Cascade of Risk to Schizophrenia Spectrum Disorders in Offspring

PURPOSE OF REVIEW

Disruptions in fetal development (via genetic and environmental pathways) have been consistently associated with risk for schizophrenia in a variety of studies. Although multiple obstetric complications (OCs) have been linked to schizophrenia, this review will discuss emerging evidence supporting the role of prenatal maternal stress (PNMS) in the etiology of schizophrenia spectrum disorders (SSD). In addition, findings linking PNMS to intermediate phenotypes of the disorder, such as OCs and premorbid cognitive, behavioral, and motor deficits, will be reviewed. Maternal immune and endocrine dysregulation will also be explored as potential mechanisms by which PNMS confers risk for SSD.

RECENT FINDINGS

PNMS has been linked to offspring SSD; however, findings are mixed due to inconsistent and retrospective assessments of PNMS and lack of specificity about SSD outcomes. PNMS is also associated with various intermediate phenotypes of SSD (e.g., prenatal infection/inflammation, decreased fetal growth, hypoxia-related OCs). Recent studies continue to elucidate the impact of PNMS while considering the moderating roles of fetal sex and stress timing, but it is still unclear which aspects of PNMS (e.g., type, timing) confer risk for SSD specifically. PNMS increases risk for SSD, but only in a small portion of fetuses exposed to PNMS. Fetal sex, genetics, and other environmental factors, as well as additional pre- and postnatal insults, likely contribute to the PNMS-SSD association. Longitudinal birth cohort studies are needed to prospectively illuminate the mechanisms that account for the variability in outcomes following PNMS.

Translating basic research knowledge on the biological embedding of early-life stress into novel approaches for the developmental programming of lifelong health

This review integrates scientific knowledge obtained over the past few decades on the biological mechanisms that contribute to the profound association between exposure to early adversity, including childhood trauma and prenatal stress, and the lifelong elevated risk to develop a broad range of diseases. We further discuss insights into gene-environment interactions moderating the association between early adversity and disease manifestation and we discuss the role of epigenetic and other molecular processes in the biological embedding of early adversity. Based on these findings, we propose potential mechanisms that may contribute to the intergenerational transmission of risk related to early adversity from the mother to the fetus. Finally, we argue that basic research knowledge on the biological embedding of early adversity must now be translated into novel intervention strategies that are mechanism-driven and sensitive to developmental timing. Indeed, to date, there are no diagnostic biomarkers of risk or mechanism-informed interventions that we can offer to victims of early adversity in order to efficiently prevent or reverse adverse health outcomes. Such translational efforts can be expected to have significant impact on both clinical practice and the public health system, and will promote precision medicine in pediatrics and across the lifespan.

Prenatal Risk Predicts Preschooler Executive Function: A Cascade Model

Little research has considered whether prenatal experience contributes to executive function (EF) development above and beyond postnatal experience. This study tests direct, mediated, and moderated associations between prenatal risk factors and preschool EF and IQ in a longitudinal sample of 1,292 children from the Family Life Project. A composite of prenatal risk factors (i.e., low birth weight, prematurity, maternal emotional problems, maternal prepregnancy obesity, and obstetric complications) significantly predicted EF and IQ at age 3, above quality of the postnatal environment. This relationship was indirect, mediated through infant general cognitive abilities. Quality of the postnatal home and child-care environments did not moderate the cascade model. These findings highlight the role of prenatal experience as a contributor to individual differences in cognitive development.

Associations of first trimester co-use of tobacco and Cannabis with prenatal immune response and psychosocial well-being

PURPOSE

This study aims to describe the association of first trimester co-use of tobacco and cannabis with maternal immune response and psychosocial well-being, relative to tobacco use only.

METHODS

A preliminary midpoint analysis included 138 pregnant women with biologically verified tobacco use, 38 of whom (28%) also tested positive for recent cannabis use. Maternal perceived stress (Perceived Stress Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and serum immune markers (IL-1β, IL-2, IL-6, IL-8, IL-10, TNFα, CRP, MMP8), were collected, although cytokine data were only available for 122 women.

RESULTS

Participant average age was 29.1 years, approximately half had a high school education or less, and half were unemployed. Compared to tobacco only users, co-users were more likely to be non-White, younger and more economically disadvantaged. In the adjusted linear regression models, TNF-α levels were significantly lower among co-users relative to tobacco only users, after adjusting for age, race/ethnicity, body mass index and tobacco use group (tobacco cigarettes, electronic nicotine delivery devices [ENDS] or both). TNF-α was the only immune marker found to be significant in this analysis. Measured stress levels (M = 5.9, SD = 3.3; potential range 0-16) and depression scores (M = 7.8, SD = 5.8; potential range 0-30) were low across all participants and did not differ as a function of co-use.

CONCLUSION

Preliminary results suggest women co-using during the first trimester exhibit decreased pro-inflammatory immune responsivity on one out of eight markers. Further research is needed to determine the impact of this immune modulation on fetal health outcomes and the unique contribution of cannabis.

Association of Financial Burden With Self-Rated and Mental Health in Older Adults With Cancer

Objective: Financial problems in cancer survivors are associated with distress and reduced quality of life. Most studies have been cross-sectional, and a longitudinal study is needed to guide clinical interventions. Method: We used data from two surveys of the National Health and Aging Trends Study (NHATS). Participants (n = 307) reported whether they experienced six indicators of financial burden. The Patient Health Questionnaire 4 assessed depressive symptoms and general anxiety. Cross-lagged panel analyses assessed whether financial burden predicted distress and health or vice versa. Results: In the total sample, financial burden at the first survey predicted depressive symptoms (p < .01), general anxiety (p < .01), and self-rated health (p < .01) at the second survey. Depressive symptoms, general anxiety, and self-rated health at the first survey did not predict later financial burden (ps > .05). Discussion: Results suggest financial problems predict later distress and poor health. This study highlights the need to address financial burden in cancer survivors.

The Interplay Between Nutrition and Stress in Pregnancy: Implications for Fetal Programming of Brain Development

Growing evidence supports an important role for the intrauterine environment in shaping fetal development and subsequent child health and disease risk. The fetal brain is particularly plastic, whereby even subtle changes in structure and function produced by in utero conditions can have long-term implications. Based on the consideration that conditions related to energy substrate and likelihood of survival to reproductive age are particularly salient drivers of fetal programming, maternal nutrition and stress represent the most commonly, but independently, studied factors in this context. However, the effects of maternal nutrition and stress are context dependent and may be moderated by one another. Studies examining the effects of the bidirectional nutrition-stress interplay in pregnancy on fetal programming of brain development are beginning to emerge in the literature. This review incorporates all currently available animal and human studies of this interplay and provides a synthesis and critical discussion of findings. Nine of the 10 studies included here assessed nutrition-stress interactions and offspring neurodevelopmental or brain development outcomes. Despite significant heterogeneity in study design and methodology, two broad patterns of results emerge to suggest that the effects of prenatal stress on various aspects of brain development may be mitigated by 1) higher fat diets or increased intake and/or status of specific dietary fats and 2) higher dietary intake or supplementation of targeted nutrients. The limitations of these studies are discussed, and recommendations are provided for future research to expand on this important area of fetal programming of brain development.

Elective caesarean section on maternal request prior to 39 gestational weeks and childhood psychopathology: a birth cohort study in China

BACKGROUND

The recommendation of non-indicated caesarean section (CS) after 39 gestational weeks has been announced based on evidence of maternal and infant physiological effects. The potential psychological risks have not been acknowledged. This study aims to investigate emotional and behavioral problems in pre-school children born with elective CS (ECS) on maternal request prior to 39 weeks.

METHODS

Pregnant women within 12 gestational weeks between November 2008 and October 2010 were invited to participate in the China-Anhui Birth Cohort Study (C-ABCS). They were asked to complete a self-administered questionnaire respectively in 1st and 3rd trimester of pregnancy to collect basic maternal characteristics. Pregnant complications and delivery modes were abstracted from medical notes. Their singleton live births were followed up at preschool age. Strengths and Difficulties Questionnaires (SDQ) were completed by parents to assess children's emotional and behavioral problems. A total of 3319 mother-child pairs were put into the final analysis. Descriptive analysis and binary logistic regression analysis were used to assess the impact of delivery modes on abnormalities in SDQ dimensions at various gestational ages.

RESULTS

The prevalence of ECS on maternal request prior to 39 weeks, at 39-40 weeks, and after 41 weeks was 16.6, 23.7 and 15.9%, respectively. Compared with those born vaginally, children born with ECS on maternal request were more likely to have total difficult problems (RR 1.519, 95% confidence interval 1.077 to 2.142). ECS on maternal request was the independent predictor of emotional problems (3.479, 1.676 to 7.222) and total difficult problems (2.172, 1.175 to 4.016) in children born prior to 39 gestational weeks.

CONCLUSION

Children delivered by ECS on maternal request have an increased risk to have emotional and behavioral problems prior to 39 gestational weeks at preschool age. The potential psychological implication prior to 39 weeks has been added to the roster of impacts of ECS on maternal request. Further research is needed to probe the potential biological mechanisms.

Sex differences and the neurobiology of affective disorders

Observations of the disproportionate incidence of depression in women compared with men have long preceded the recent explosion of interest in sex differences. Nonetheless, the source and implications of this epidemiologic sex difference remain unclear, as does the practical significance of the multitude of sex differences that have been reported in brain structure and function. In this article, we attempt to provide a framework for thinking about how sex and reproductive hormones (particularly estradiol as an example) might contribute to affective illness. After briefly reviewing some observed sex differences in depression, we discuss how sex might alter brain function through hormonal effects (both organizational (programmed) and activational (acute)), sex chromosome effects, and the interaction of sex with the environment. We next review sex differences in the brain at the structural, cellular, and network levels. We then focus on how sex and reproductive hormones regulate systems implicated in the pathophysiology of depression, including neuroplasticity, genetic and neural networks, the stress axis, and immune function. Finally, we suggest several models that might explain a sex-dependent differential regulation of affect and susceptibility to affective illness. As a disclaimer, the studies cited in this review are not intended to be comprehensive but rather serve as examples of the multitude of levels at which sex and reproductive hormones regulate brain structure and function. As such and despite our current ignorance regarding both the ontogeny of affective illness and the impact of sex on that ontogeny, sex differences may provide a lens through which we may better view the mechanisms underlying affective regulation and dysfunction.

What is learned from Mindfulness Based Childbirth and Parenting Education? - Participants' experiences

BACKGROUND

In the search for effective interventions aiming to prevent perinatal stress, depression and anxiety, we are evaluating a Mindfulness Based Childbirth and Parenting (MBCP) Program. In this study we explore the participants' experiences of the program.

METHOD

This is a descriptive qualitative study with influences of phenomenology. The participants were expectant couples who participated in the program and the pregnant women had an increased risk of perinatal stress, anxiety and depression. Ten mothers and six fathers were interviewed in depth, at four to six months postpartum. Thematic analysis of the transcripts was conducted.

RESULTS

The participants' descriptions show a variety in how motivated they were and how much value they ascribed to MBCP. Those who experienced that they benefitted from the intervention described that they did so at an intra-personal level-with deeper self-knowledge and self-compassion; and on an inter-personal level-being helpful in relationships. Furthermore, they perceived that what they had learned from MBCP was helpful during childbirth and early parenting.

CONCLUSION

Our findings demonstrate that most of the parents experienced MBCP as a valuable preparation for the challenges they met when they went through the life-changing events of becoming parents. The phenomenon of participating in the intervention, integrating the teachings and embodying mindfulness seems to develop inner resources that foster the development of wisdom.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02441595, May 4, 2015.

Neonatal outcomes in pregnant women with untreated and treated panic disorder

OBJECTIVE

The objective of the present study was to compare neonatal outcomes including gestational age, birth weight and hospitalization of newborns of pregnant women with treated with antidepressants and untreated panic disorder.

METHODS

The study sample included 146 pregnant women (44 patients with panic disorder treated with antidepressants, 52 patients with untreated panic disorder, and 50 healthy controls). Panic disorder was diagnosed by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

RESULTS

The highest proportions of preterm birth (28.8%), low birth weight (34.6%) and requirement of neonatal care (25.0%) were observed in infants of untreated patients. Pharmacotherapy group and control subjects had similar neonatal outcomes. Compared with infants of healthy subjects and the pharmacotherapy group, infants of untreated patients had significantly lower birth weight and gestational age at delivery. In addition, newborns of untreated patients had higher rate of hospitalization at the neonatal care unit.

CONCLUSION

Our results suggest that treatment with pharmacotherapy of panic disorder during pregnancy may have beneficial effects on the risk of negative neonatal outcomes due to maternal panic disorder in the infants.

Children's stress regulation mediates the association between prenatal maternal mood and child executive functions for boys, but not girls

Prenatal exposure to maternal mood disturbances shapes children's cognitive development reflected in the critical construct of executive functions (EFs). Little is known, however, about underlying mechanisms. By examining cortisol responses in both everyday and lab challenge settings, we tested whether the child/offspring hypothalamic-pituitary-adrenal axis mediates effects of prenatal maternal mood on child EFs at age 6. In 107 Canadian children born to women with a wide range of anxious and depressive symptoms during pregnancy, we found that in boys but not girls, depressed and/or anxious prenatal maternal mood is associated with heightened diurnal cortisol levels in everyday settings, as well as heightened cortisol reactivity to a lab challenge and that this heightened reactivity was associated with poorer EFs. Among boys we also observed that cortisol reactivity but not diurnal cortisol mediated the association between depressed and/or anxious prenatal maternal mood and EFs. Depressed and/or anxious prenatal maternal mood was related to child EFs for both girls and boys. To our knowledge, this is the first study to demonstrate a mediating role for child stress regulation in the association between prenatal maternal stress-related mood disturbances and child EFs, providing evidence of a mechanism contributing to fetal programming of cognition.

Prenatal stress and models explaining risk for psychopathology revisited: Generic vulnerability and divergent pathways

The present review revisits three hypothesized models that potentially could explain how prenatal maternal stress influences fetal development, birth outcomes, and subsequent developmental psychopathology. These models were mostly based on animal models, and new evidence for these models from human studies is evaluated. Furthermore, divergent trajectories from prenatal exposure to adversities to offspring affected outcomes are reviewed, including the comparison of studies on prenatal maternal stress with research on maternal substance use and maternal malnutrition during pregnancy. Finally, new directions in research on the mechanism underlying prenatal stress effects on human offspring is summarized. While it is concluded that there is abundant evidence for the negative associations between prenatal maternal stress and offspring behavioral, brain, and psychopathological outcomes in humans, there is no consistent evidence for specific mechanisms or specific outcomes in relation to stress exposure in utero. Rather, principles of multifinality and equifinality best describe the consequences for the offspring, suggesting a generic vulnerability and different pathways from prenatal adversities to developmental psychopathology, which complicates the search for underlying mechanisms. New and promising directions for research are provided to get a better understanding of how prenatal stress gets under the skin to affect fetal development.

Placental FKBP51 mediates a link between second trimester maternal anxiety and birthweight in female infants

Prenatal distress is associated with adverse outcomes in affected offspring. Alterations in placental glucocorticoid signalling and subsequent foetal overexposure to glucocorticoids have been implicated as an underlying mechanism. Infant sex is emerging as an important factor in disease susceptibility. This study aimed to examine the effects of maternal distress across pregnancy on birth outcomes and placental glucocorticoid genes in a sex-dependent manner. Participants completed psychological distress questionnaires throughout pregnancy. Placental HSD11B2, NR3C1 and FKBP51 were analysed by real time PCR and cortisol was measured in new-born hair. Second trimester stress was negatively correlated with birthweight in males and positively correlated with placental NR3C1 mRNA in females. Second trimester anxiety was negatively correlated with birthweight and placental FKBP51 mRNA in females. In mediation analysis, placental FKBP51 mRNA expression was found to mediate the link between prenatal anxiety and birthweight. New-born cortisol was negatively correlated with second trimester anxiety and positively correlated with female placental FKBP51 mRNA levels. Again, FKBP51 mRNA was found to mediate the link between anxiety and new-born cortisol. These results highlight a role for FKBP51 in the placental response to prenatal distress in females. The precise role that placental FKBP51 has in foetal and infant development has not been extensively studied and warrants further investigations.

Risk factors for antenatal anxiety: A systematic review of the literature

BACKGROUND

Given the prevalence of antenatal anxiety and its consistent associations with adverse pregnancy and child outcomes, early detection and management of anxiety are essential.

OBJECTIVE

The aim was to identify risk factors for anxiety among pregnant women by systematically reviewing original research.

METHODS

Cross-sectional, case-control and cohort studies that examined associations between antenatal anxiety and at least one potential risk factor prospectively or retrospectively and measured anxiety independent from other mental health conditions were included. Studies rated strong/moderate in methodological quality appraisal were used to synthesise the evidence.

RESULTS

Factors associated with greater risk of anxiety included previous pregnancy loss, medical complications, childhood abuse, intimate partner violence, denial/acceptance coping styles, personality traits, inadequate social support, history of mental health problems, high perceived stress and adverse life events.

CONCLUSIONS

Several risk factors identified in this review are detectable in routine prenatal care visits (e.g. previous pregnancy loss, pregnancy complications), potentially modifiable (e.g. coping styles, social support, partner factors) and can be identified prior to pregnancy (e.g. psychosocial factors), underlining the significance of pre-conception mental health screening.

Risk factors of new onset anxiety and anxiety exacerbation in the perinatal period: A systematic review and meta-analysis

BACKGROUND

Even though more than 20% of women meet diagnostic criteria for an anxiety disorder during the perinatal period, very little is known about the predictors of these problems. As a result, we systematically reviewed the literature on risk factors for new onset anxiety and maternal anxiety exacerbation in the perinatal period.

METHODS

PubMed, MEDLINE, PsycINFO, CINAHL, Ovid, ProQuest Portal, and Web of Science were searched for studies assessing risk factors for the development of new onset anxiety or anxiety worsening in women during pregnancy and the postpartum period.

RESULTS

11,759 citations were identified, with 11 studies meeting eligibility criteria. New onset anxiety was assessed in 7 studies, anxiety worsening in 3, and 1 assessed both. Lower educational attainment, living with extended family members, multiparity, a family history of psychiatric disorders, hyperemesis gravidarum, comorbid sleep disorders, and prenatal oxytocin exposure were risk factors for new onset perinatal anxiety, while presence of comorbid psychiatric disorders and prenatal oxytocin were risk factors for anxiety worsening.

LIMITATIONS

Studies not explicitly stating whether participants had pre-existing anxiety disorders were excluded. As a result, meta-analysis was not possible for several risk factors.

CONCLUSIONS

Risk factors for new onset anxiety and anxiety worsening during the perinatal period include psychological, social, and biological exposures. Given the lack of studies differentiating women with and without pre-existing anxiety disorders, additional research is required in order to determine whether these factors differ from the non-puerperal population, as well as from each other.

Do mothers who are anxious during pregnancy have inattentive children?

BACKGROUND

Maternal somatic anxiety during pregnancy may affect neural foetal development via corticoid pathways. Using a large epidemiological cohort, this study explores the relationship between maternal somatic anxiety in pregnancy and child scores on the Test of Everyday Attention in Children (TEA-Ch).

METHODS

Linear regression was used to analyse the association of maternal somatic anxiety during pregnancy and performance of children on three subtests of the TEA-Ch at age 8.5 years that assess selective attention (Sky Search), sustained attention (Sky Search Dual Test) and attentional control (Opposite Worlds).

RESULTS

Children with complete data on each subtest were included in the analysis, comprising 4,198 children for the Sky Search subtest, 3,845 for the Sky Search Dual Test and 4,202 for the Opposite Worlds subtest. No association was found between exposure to maternal somatic anxiety and child's performance in any of the TEA-Ch subtests either before or after adjusting for confounders. The results did not change when stratifying by gender.

LIMITATIONS

Selective attrition, lack of sensitivity of tests and lack of adjustment for the postnatal environment are possible limitations to this study.

CONCLUSIONS

We found no evidence of an association between exposure to maternal somatic anxiety in pregnancy and TEA-Ch scores. These results suggest that anxiety during pregnancy does not affect the development of children's attentional skills measured by TEA-Ch.

Parent depressive symptoms and offspring executive functioning

Introduction: Previous research has found mixed results when assessing the association between a parent's history of depressive symptoms and a child's abilities on measures of executive functioning. The purpose of this study was to replicate and expand upon these findings by evaluating the influence of a parent's depressive symptoms on a young person's executive functioning. Method: As part of a larger study, 135 children (54.8% female, aged 8-12) and one biological parent completed diagnostic screening interviews. Children then completed a brief executive functioning battery. Symptoms endorsed under the past major depressive episode module of the MINI International Neuropsychiatric Interview was used to measure depressive symptoms of parents. Results: While controlling for parent alcohol status and age, gender, intelligence, and current depressive symptoms of the child, linear regression models revealed that the parent's depressive symptoms significantly predicted deficits in Letter-Number Sequencing [b = -0.15 (0.07), p < .05] and Motor Speed [b = -0.17 (0.05), p < .005] on the Delis-Kaplan Executive Function System (D-KEFS) Trails Test. Parent depressive symptoms had no relationship with inhibition on the D-KEFS Color-Word Interference Test [b = -0.04 (0.14), p = .74] or the Verbal Working Memory subtest of the Stanford-Binet [b = 0.14 (0.12) p = .43]. Greater depressive symptoms in parents were associated with fewer perseverative errors on the Wisconsin Card Sorting Task (WCST) [b = 0.73 (0.32), p < .05]. Conclusion: In sum, a parent's depressive symptomatology was differentially associated with a young person's neurocognitive abilities. Clinical implications were discussed.

Maternal programming: Application of a developmental psychopathology perspective

The fetal phase of life has long been recognized as a sensitive period of development. Here we posit that pregnancy represents a simultaneous sensitive period for the adult female with broad and persisting consequences for her health and development, including risk for psychopathology. In this review, we examine the transition to motherhood through the lens of developmental psychopathology. Specifically, we summarize the typical and atypical changes in brain and behavior that characterize the perinatal period. We highlight how the exceptional neuroplasticity exhibited by women during this life phase may account for increased vulnerability for psychopathology. Further, we discuss several modes of signaling that are available to the fetus to affect maternal phenotypes (hormones, motor activity, and gene transfer) and also illustrate how evolutionary perspectives can help explain how and why fetal functions may contribute to maternal psychopathology. The developmental psychopathology perspective has spurred advances in understanding risk and resilience for mental health in many domains. As such, it is surprising that this major epoch in the female life span has yet to benefit fully from similar applications.