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Arranz Betegón Á, García M, Parés S, Montenegro G, Feixas G, Padilla N, Camacho A, Goberna J, Botet F, Gratacós E. A Program Aimed at Reducing Anxiety in Pregnant Women Diagnosed With a Small-for-Gestational-Age Fetus: Evaluative Findings From a Spanish Study. J Perinat Neonatal Nurs 2017; 31:225-235. [PMID: 28737543 DOI: 10.1097/jpn.0000000000000270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to evaluate the effect of anxiety-reducing techniques including music therapy, sophrology, and creative visualization in pregnant women with a fetus diagnosed as small for gestational age and improved fetal and neonatal weight. This was a quasi-experimental study with a nonrandomized clinical trial design. We compared 2 groups of pregnant women with a fetus diagnosed as small for gestational age with no abnormalities on Doppler studies. The control group (n = 93) received standard care, and the intervention group (n = 65), in addition to standard care, underwent a program of 6 sessions led by a midwife or nurse who taught anxiety-reduction techniques. The State-Trait Anxiety Inventory (STAI) including trait and state subscales were completed by both groups at the start of the study, and only the STAI-State subscale was completed again at the end of the study. Comparisons between the 2 groups regarding fetal weight and centile and maternal STAI scores were performed using the t test and the χ test. There were no significant differences in the STAI-Trait scores between the 2 groups. There were statistically significant differences in the intervention group's STAI-State score percentiles between the start and the end of the study, being lower at the end of the study (P < .001). There were significant differences between the 2 groups in fetal weight trajectory on the basis of fetal weight: the intervention group had a larger weight gain (P < .005). The program designed to reduce anxiety in pregnant women was effective at reducing anxiety in the women in the intervention group, leading to a favorable fetal weight trajectory in this group.
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Affiliation(s)
- Ángela Arranz Betegón
- BCNatal (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Barcelona, Spain (Drs Arranz Betegón, Botet, and Gratacós and Mss García, Parés, Montenegro, Feixas, and Camacho); Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden (Dr Padilla); Department of Public Health, Mental Health and Perinatal Nursing, University of Barcelona, Barcelona, Spain (Dr Goberna); and IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain (Drs Botet and Gratacós)
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102
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Lahti M, Savolainen K, Tuovinen S, Pesonen AK, Lahti J, Heinonen K, Hämäläinen E, Laivuori H, Villa PM, Reynolds RM, Kajantie E, Räikkönen K. Maternal Depressive Symptoms During and After Pregnancy and Psychiatric Problems in Children. J Am Acad Child Adolesc Psychiatry 2017; 56:30-39.e7. [PMID: 27993226 DOI: 10.1016/j.jaac.2016.10.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 09/11/2016] [Accepted: 10/18/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Maternal depressive symptoms during pregnancy are associated with increased risk of psychiatric problems in children. A more precise understanding of the timing of the symptoms during pregnancy and their independence of other prenatal and postnatal factors in predicting child psychopathology risk is needed. We examined whether maternal depressive symptoms during pregnancy predict child psychiatric problems, whether these associations are trimester- or gestational-week-specific and/or independent of pregnancy disorders, and whether maternal depressive symptoms after pregnancy mediate or add to the prenatal effects. METHOD The study sample comprised 2,296 women and their children born in Finland between 2006-2010, participating in the prospective pregnancy cohort study Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction (PREDO) and followed up from 1.9 to 5.9 years of age. The women completed the Center for Epidemiologic Studies Depression Scale biweekly between gestational weeks+days 12+0/13+6 and 38+0/39+6 or delivery. In the follow-up, they completed the Beck Depression Inventory-II and Child Behavior Checklist 1½-5. RESULTS Maternal depressive symptoms during pregnancy predicted significantly higher internalizing (0.28 SD unit per SD unit increase [95% CI = 0.24-0.32]), externalizing (0.26 [0.23-0.30]), and total problems (0.31 [0.27-0.35]) in children. These associations were nonspecific to gestational week and hence pregnancy trimester, independent of pregnancy disorders, and independent of, although partially mediated by, maternal depressive symptoms after pregnancy. Psychiatric problems were greatest in children whose mothers reported clinically significant depressive symptoms across pregnancy trimesters and during and after pregnancy. CONCLUSION Maternal depressive symptoms during pregnancy predict increased psychiatric problems in young children. Preventive interventions from early pregnancy onward may benefit offspring mental health.
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Affiliation(s)
- Marius Lahti
- Institute of Behavioural Sciences, University of Helsinki, Finland; Queen's Medical Research Institute, University of Edinburgh, UK.
| | - Katri Savolainen
- Institute of Behavioural Sciences, University of Helsinki, Finland
| | - Soile Tuovinen
- Institute of Behavioural Sciences, University of Helsinki, Finland
| | | | - Jari Lahti
- Institute of Behavioural Sciences, University of Helsinki, Finland; Helsinki Collegium for Advanced Studies, University of Helsinki, Finland
| | - Kati Heinonen
- Institute of Behavioural Sciences, University of Helsinki, Finland
| | - Esa Hämäläinen
- Helsinki University Hospital and University of Helsinki, Finland
| | - Hannele Laivuori
- Helsinki University Hospital and University of Helsinki, Finland; Institute for Molecular Medicine Finland, University of Helsinki, Finland
| | - Pia M Villa
- Helsinki University Hospital and University of Helsinki, Finland
| | | | - Eero Kajantie
- Helsinki University Hospital and University of Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland and Oulu University Hospital and University of Oulu, Finland
| | - Katri Räikkönen
- Institute of Behavioural Sciences, University of Helsinki, Finland
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103
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Fontein-Kuipers Y, van Limbeek E, Ausems M, de Vries R, Nieuwenhuijze M. Responding to maternal distress: from needs assessment to effective intervention. Int J Public Health 2016; 62:441-452. [PMID: 27812724 DOI: 10.1007/s00038-016-0910-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/16/2016] [Accepted: 10/18/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To perform a needs assessment of maternal distress to plan the development of an intervention for the prevention and reduction of antenatal maternal distress. METHODS We searched PubMed, OVID and EBSCO and applied the PRECEDE logic model to select the data. Experts in the field validated the findings. RESULTS We identified 45 studies. Maternal distress was associated with diminished maternal and child's quality of life. Aetiological factors of maternal distress included past and present circumstances related to obstetric factors and to a woman's context of living, coping behaviour, and support mechanisms. Lacking knowledge of coping with (maternal) distress was identified as a predisposing factor. Reinforcing factors were relaxation, partner support, counselling experiences and positive interaction with the midwife. Enabling factors were the availability of a support network. CONCLUSIONS When planning the development of an antenatal intervention for maternal distress, it is advisable to focus on assessment of antenatal emotional wellbeing, the context of the woman's past and present circumstances, her coping behaviour and her environment. The identified predisposing factors, enabling and reinforcing factors should also be taken into consideration.
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Affiliation(s)
- Yvonne Fontein-Kuipers
- Midwifery Education and Studies Maastricht-ZUYD, Research Department Midwifery Science, PO Box 1256, 6201 BG, Maastricht, The Netherlands.
| | - Evelien van Limbeek
- Midwifery Education and Studies Maastricht-ZUYD, Research Department Midwifery Science, PO Box 1256, 6201 BG, Maastricht, The Netherlands
| | - Marlein Ausems
- Midwifery Education and Studies Maastricht-ZUYD, Research Department Midwifery Science, PO Box 1256, 6201 BG, Maastricht, The Netherlands
| | - Raymond de Vries
- Midwifery Education and Studies Maastricht-ZUYD, Research Department Midwifery Science, PO Box 1256, 6201 BG, Maastricht, The Netherlands.,Maastricht University Medical Centre/CAPHRI, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 300 North Ingalis Street, Rm 7C27, Ann Arbor, MI, 48109-5429, USA
| | - Marianne Nieuwenhuijze
- Midwifery Education and Studies Maastricht-ZUYD, Research Department Midwifery Science, PO Box 1256, 6201 BG, Maastricht, The Netherlands
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104
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Pastor V, Antonelli MC, Pallarés ME. Unravelling the Link Between Prenatal Stress, Dopamine and Substance Use Disorder. Neurotox Res 2016; 31:169-186. [DOI: 10.1007/s12640-016-9674-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 12/21/2022]
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105
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Andersson NW, Li Q, Mills CW, Ly J, Nomura Y, Chen J. Influence of prenatal maternal stress on umbilical cord blood cytokine levels. Arch Womens Ment Health 2016; 19:761-7. [PMID: 26846778 PMCID: PMC5032828 DOI: 10.1007/s00737-016-0607-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 01/09/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Prenatal maternal stress (PNMS) is known to influence fetal programming and development. Thus far, the effects of PNMS on the developing immune system have mainly been documented in animal studies. This study aimed to examine the association between PNMS and immune cytokine profiles in the umbilical cord blood of newborn human infants. METHODS PNMS, including perceived stress, numbers of stressful life events experiences (both partner and health related), and state and trait anxiety, was assessed with five questionnaires and interviews from 43 pregnant women during the second trimester. Seven key cytokines important for immune function, i.e., IL-12, IL-1β, IL-4, IL-5, IL-6, IL-8, and TNF-α, were analyzed in cord blood by bead-based ELISA method (Luminex 200). Logistic regression was used to estimate the associations of PNMS scores and cytokine levels. RESULTS Increased levels of IL-1β, IL-4, IL-5, IL-6, and IL-8 were significantly associated with at least one of the maternal stress assessments, while the levels of IL-12 and TNF-α were not significantly associated with any of the PNMS measurements examined. CONCLUSION These preliminary findings suggest that PNMS may influence cytokine levels in newborn infants, in particular Th2-related cytokines. This report supports previous findings in animal studies and could suggest that newborns born to mothers with elevated PNMS have a predisposition to immune-related disorders.
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Affiliation(s)
- Niklas W. Andersson
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark, Sydney Medical School, Faculty of Medicine, University of Sydney, Concord Hospital, Sydney, Australia, Department of Psychology, Queens College, the City University of New York (CUNY), Flushing, New York, USA
| | - Qian Li
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | | | - Jenny Ly
- Department of Psychology, Queens College, the City University of New York (CUNY), Flushing, New York, USA, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yoko Nomura
- Department of Psychology, Queens College, the City University of New York (CUNY), Flushing, New York, USA. .,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA. .,The Graduate Center, CUNY, New York, NY, USA. .,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jia Chen
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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106
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Fontein-Kuipers YJ, Ausems M, de Vries R, Nieuwenhuijze MJ. The effect of Wazzup Mama?! An antenatal intervention to prevent or reduce maternal distress in pregnancy. Arch Womens Ment Health 2016; 19:779-88. [PMID: 26965708 DOI: 10.1007/s00737-016-0614-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
We evaluated the effect of the intervention WazzUp Mama?! on antenatal maternal distress in a non-randomized pre-post study including healthy women in 17 Dutch midwifery practices. The control group (n = 215) received antenatal care-as-usual. The experimental group (n = 218) received the intervention. Data were collected at the first and third trimester of pregnancy. Maternal distress (MD) was measured with the Edinburgh Depression Scale (EDS), State-Trait Anxiety Inventory (STAI), and Pregnancy-Related Anxiety Questionnaire (PRAQ). We used multivariate repeated-measure analysis to examine the across time changes and ANCOVA was used to examine the differences between the two groups. In the control group, mean EDS, STAI, and MD scores significantly increased from first to third trimester of pregnancy, mean PRAQ scores increased, but not significantly, the proportion of scores above cut-off level of EDS, STAI, and PRAQ significantly increased from first to third trimester, and the proportion of MD scores above cut-off level increased, but not significantly. Within the experimental group, the mean STAI, PRAQ, and MD scores significantly decreased from first to third trimester, the EDS mean scores decreased but not significantly, proportions of scores above cut-off level for PRAQ and MD significantly decreased from first to third trimester of pregnancy, the proportions of EDS and STAI scores above cut-off level decreased but not significantly. There was a moderate significant positive effect of WazzUP Mama?! on the MD scores (F(1.43) = 27.05, p < 0.001, d = 0.5). The results provide support for the effectiveness of the intervention WazzUp Mama?!
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Affiliation(s)
- Yvonne J Fontein-Kuipers
- Midwifery Education & Studies Maastricht-ZUYD, Research Centre for Midwifery Science, PO Box 1256, 6201, Maastricht, The Netherlands.
| | - Marlein Ausems
- Midwifery Education & Studies Maastricht-ZUYD, Research Centre for Midwifery Science, PO Box 1256, 6201, Maastricht, The Netherlands
| | - Raymond de Vries
- Midwifery Education & Studies Maastricht-ZUYD, Research Centre for Midwifery Science, PO Box 1256, 6201, Maastricht, The Netherlands.,Maastricht University Medical Centre/CAPHRI, PO Box 6202, AZ, Maastricht, The Netherlands.,Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 300 North Ingalis Street, Rm 7C27, Ann Arbor, MI, 48109-5429, USA
| | - Marianne J Nieuwenhuijze
- Midwifery Education & Studies Maastricht-ZUYD, Research Centre for Midwifery Science, PO Box 1256, 6201, Maastricht, The Netherlands
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107
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Barcelona de Mendoza V, Harville E, Theall K, Buekens P, Chasan-Taber L. Effects of acculturation on prenatal anxiety among Latina women. Arch Womens Ment Health 2016; 19:635-44. [PMID: 26790686 PMCID: PMC4956601 DOI: 10.1007/s00737-016-0605-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 01/09/2016] [Indexed: 12/16/2022]
Abstract
Anxiety in pregnancy has been associated with adverse birth outcomes. Relatively few studies have investigated how acculturation affects mental health in pregnancy among Latinas. The goal of this study was to determine if acculturation was associated with anxiety over the course of pregnancy in a sample of predominantly Puerto Rican women. Women were recruited in pregnancy for participation in Proyecto Buena Salud, a prospective cohort study of Latina women (n = 1412). Acculturation was measured via the Psychological Acculturation Scale (PAS), language preference and generation in the USA. Anxiety was measured using the State-Trait Anxiety Instrument. Linear and logistic multivariable regressions were used to investigate associations. After adjustment, women with bicultural identification had significantly lower trait anxiety scores in early pregnancy (β = -3.62, SE = 1.1, p < 0.001) than low acculturated women. Women with higher levels of acculturation as indicated by English-language preference (β = 1.41, SE = 0.7, p = 0.04) and second or third generation in the USA had significantly higher trait anxiety scores in early pregnancy (β = 1.83, SE = 0.6, p < 0.01). Bicultural psychological acculturation was associated with lower trait anxiety in early pregnancy, while English-language preference and higher generation in the USA were associated with higher trait anxiety in early pregnancy.
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Affiliation(s)
- Veronica Barcelona de Mendoza
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA.
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA.
| | - Emily Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
| | - Katherine Theall
- Department of Global Community Health and Behavioral Science, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts School of Public Health and Health Sciences, 405 Arnold House, 715 N Pleasant Street, Amherst, MA, 01003, USA
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108
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Suto M, Isogai E, Mizutani F, Kakee N, Misago C, Takehara K. Prevalence and Factors Associated With Postpartum Depression in Fathers: A Regional, Longitudinal Study in Japan. Res Nurs Health 2016; 39:253-62. [DOI: 10.1002/nur.21728] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Maiko Suto
- Graduate School of International and Cultural Studies; Tsuda College; Tokyo Japan
| | - Emi Isogai
- Public Health Nurse; Nishio City Health Center; Aichi Japan
| | | | - Naoko Kakee
- Division of Bioethics; National Center for Child Health and Development; Tokyo Japan
| | - Chizuru Misago
- Department of International and Cultural Studies; Tsuda College; Tokyo Japan
| | - Kenji Takehara
- Department of Health Policy; National Center for Child Health and Development; 10-1 Okura 2-chome Setagaya Tokyo 157-8535 Japan
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109
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Unternaehrer E, Bolten M, Nast I, Staehli S, Meyer AH, Dempster E, Hellhammer DH, Lieb R, Meinlschmidt G. Maternal adversities during pregnancy and cord blood oxytocin receptor (OXTR) DNA methylation. Soc Cogn Affect Neurosci 2016; 11:1460-70. [PMID: 27107296 DOI: 10.1093/scan/nsw051] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 04/10/2016] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to investigate whether maternal adversities and cortisol levels during pregnancy predict cord blood DNA methylation of the oxytocin receptor (OXTR). We collected cord blood of 39 babies born to mothers participating in a cross-sectional study (N = 100) conducted in Basel, Switzerland (2007-10). Mothers completed the Inventory of Life Events (second trimester: T2), the Edinburgh Postnatal Depression Scale (EPDS, third trimester: T3), the Trier Inventory of Chronic Stress (TICS-K, 1-3 weeks postpartum) and provided saliva samples (T2, T3) for maternal cortisol profiles, as computed by the area under the curve with respect to ground (AUCg) or increase (AUCi) for the cortisol awakening response (CAR) and for diurnal cortisol profiles (DAY). OXTR DNA methylation was quantified using Sequenom EpiTYPER. The number of stressful life events (P = 0.032), EPDS score (P = 0.007) and cortisol AUCgs at T2 (CAR: P = 0.020; DAY: P = 0.024) were negatively associated with OXTR DNA methylation. Our findings suggest that distinct prenatal adversities predict decreased DNA methylation in a gene that is relevant for childbirth, maternal behavior and wellbeing of mother and offspring. If a reduced OXTR methylation increases OXTR expression, our findings could suggest an epigenetic adaptation to an adverse early environment.
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Affiliation(s)
- Eva Unternaehrer
- University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, 4055 Basel, Switzerland University of Basel, National Centre of Competence in Research (NCCR) Swiss Etiological Study of Adjustment and Mental Health (sesam), 4055 Basel, Switzerland Douglas Mental Health University Institute, McGill University, 6875 La Salle Boulevard, Montreal, QC H4H 1R3, Canada
| | - Margarete Bolten
- University of Basel, Child and Adolescent Psychiatric Hospital, 4058 Basel, Switzerland Ludwig-Maximilians-University Munich, Department of Psychology, 80802 Munich, Germany
| | - Irina Nast
- University of Basel, National Centre of Competence in Research (NCCR) Swiss Etiological Study of Adjustment and Mental Health (sesam), 4055 Basel, Switzerland Zurich University of Applied Sciences, School of Health Professions, 8401 Winterthur, Switzerland
| | - Simon Staehli
- University of Trier, Institute of Psychobiology, 54296 Trier, Germany
| | - Andrea H Meyer
- University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, 4055 Basel, Switzerland
| | - Emma Dempster
- University of Exeter Medical School, Exeter EX1 2LU, UK
| | | | - Roselind Lieb
- University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, 4055 Basel, Switzerland University of Basel, National Centre of Competence in Research (NCCR) Swiss Etiological Study of Adjustment and Mental Health (sesam), 4055 Basel, Switzerland
| | - Gunther Meinlschmidt
- University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, 4055 Basel, Switzerland University of Basel, National Centre of Competence in Research (NCCR) Swiss Etiological Study of Adjustment and Mental Health (sesam), 4055 Basel, Switzerland Ruhr-University Bochum, Faculty of Medicine, Universitaetsstrasse 150, 44801 Bochum, Germany
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110
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Braig S, Grabher F, Ntomchukwu C, Reister F, Stalder T, Kirschbaum C, Rothenbacher D, Genuneit J. The Association of Hair Cortisol with Self-Reported Chronic Psychosocial Stress and Symptoms of Anxiety and Depression in Women Shortly after Delivery. Paediatr Perinat Epidemiol 2016; 30:97-104. [PMID: 26525484 DOI: 10.1111/ppe.12255] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Psychosocial stress during pregnancy including anxiety and depression is known to have adverse health effects on newborns. However, measuring these psychological constructs is complex with psychological, endocrinological, and physiological systems being affected. Hair cortisol concentrations (HCC), assumed to reflect long-term endocrine consequences of stress exposure, represent a promising instrument for epidemiological research. However, the association between HCC and questionnaire-based instruments is unclear. METHODS In the Ulm SPATZ Health Study, mothers were recruited shortly after delivery in the University Medical Centre Ulm, Germany between April 2012 and May 2013. HCC of 768 participants were determined in scalp-near 3 cm maternal hair segments, assumed to reflect cortisol exposure over the last trimester of pregnancy. Chronic stress, anxiety, and depressive symptomatology were self-reported in questionnaire-based instruments. Spearman correlation coefficients between HCC and these instruments as well as means of HCC in highly and low stressed subgroups were calculated. RESULTS HCC were not correlated with self-reported chronic stress, anxiety, or depressive symptomatology. Furthermore, the investigation of sub-populations did not reveal substantial differences of HCC across highly and low stressed women. CONCLUSIONS HCC were not found to correlate with self-reports of chronic stress, anxiety, or depressive symptomatology. Among other things, these findings could reflect problems with questionnaire-based assessments obtained shortly after delivery such as recall bias and/or suggest that associations between cortisol secretion and psychosocial stress are difficult to detect due to, e.g. a strong physiological increase of cortisol in the last trimester.
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Affiliation(s)
- Stefanie Braig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Felix Grabher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Clarissa Ntomchukwu
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Frank Reister
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | | | | | | | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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111
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Rouleau CR, Tomfohr-Madsen LM, Campbell TS, Letourneau N, O'Beirne M, Giesbrecht GF. The role of maternal cardiac vagal control in the association between depressive symptoms and gestational hypertension. Biol Psychol 2016; 117:32-42. [PMID: 26868182 DOI: 10.1016/j.biopsycho.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 01/20/2023]
Abstract
Reduced cardiac vagal control, indexed by relatively lower high-frequency heart rate variability (HF-HRV), is implicated in depressed mood and hypertensive disorders among non-pregnant adults whereas research in pregnancy is limited. This study examined whether maternal HF-HRV during pregnancy mediates the association between depressed mood and gestational hypertension. Depressive symptoms (Edinburgh Depression Scale) and HF-HRV were measured during early (M=14.9 weeks) and late (M=32.4 weeks) pregnancy in 287 women. Gestational hypertension was determined by chart review. Depressive symptoms were associated with less HF-HRV (b=-0.02, p=.001). There was an indirect effect of depressed mood on gestational hypertension through late pregnancy HF-HRV (b=0.04, 95% CI 0.0038, 0.1028) after accounting for heart rate. These findings suggest cardiac vagal control is a possible pathway through which prenatal depressed mood is associated with gestational hypertension, though causal ordering remains uncertain.
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Affiliation(s)
- Codie R Rouleau
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Lianne M Tomfohr-Madsen
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Nicole Letourneau
- Alberta Children's Hospital Research Institute for Child and Maternal Health, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Paediatrics, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada
| | - Maeve O'Beirne
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Gerald F Giesbrecht
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute for Child and Maternal Health, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Paediatrics, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada.
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112
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Andersson NW, Hansen MV, Larsen AD, Hougaard KS, Kolstad HA, Schlünssen V. Prenatal maternal stress and atopic diseases in the child: a systematic review of observational human studies. Allergy 2016; 71:15-26. [PMID: 26395995 PMCID: PMC5054838 DOI: 10.1111/all.12762] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND A growing number of studies suggest that maternal stress during pregnancy promotes atopic disorders in the offspring. This is the first systematic review to address prenatal maternal stress (PNMS) and the subsequent risk of atopy-related outcomes in the child. METHODS The review was performed in accordance to the PRISMA criteria. We searched and selected studies in PubMed, Scopus, Embase and PsychINFO until November 2014. RESULTS Sixteen (with 25 analyses) of 426 identified articles met the review criteria. Five main PNMS exposures (negative life events, anxiety/depression, bereavement, distress and job strain) and five main atopic outcomes (asthma, wheeze, atopic dermatitis, allergic rhinitis and IgE) were assessed across the studies. Overall, 21 of the 25 analyses suggested a positive association between PNMS and atopic outcomes. Of the 11 exposure-response analyses reported, six found statistically significant trends. CONCLUSION This systematic review suggests a relationship between maternal stress during pregnancy and atopic disorders in the child. However, the existing studies are of diverse quality. The wide definitions of often self-reported stress exposures imply a substantial risk for information bias and false-positive results. Research comparing objective and subjective measures of PNMS exposure as well as objective measures for atopic outcome is needed.
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Affiliation(s)
- N. W. Andersson
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
- Sydney Medical School Faculty of Medicine University of Sydney Concord Hospital Sydney NSW Australia
- Department of Organic Psychiatric Disorders and Emergency Ward Aarhus University Hospital Risskov, Aarhus Denmark
| | - M. V. Hansen
- Department of Organic Psychiatric Disorders and Emergency Ward Aarhus University Hospital Risskov, Aarhus Denmark
| | - A. D. Larsen
- The National Research Centre for the Working Environment Copenhagen Denmark
| | - K. S. Hougaard
- The National Research Centre for the Working Environment Copenhagen Denmark
| | - H. A. Kolstad
- Department of Occupational Medicine Danish Ramazzini Centre Aarhus University Hospital Aarhus Denmark
| | - V. Schlünssen
- The National Research Centre for the Working Environment Copenhagen Denmark
- Department of Occupational Medicine Danish Ramazzini Centre Aarhus University Hospital Aarhus Denmark
- Section for Environment, Occupation and Health Department of Public Health Danish Ramazzini Centre Aarhus University Aarhus Denmark
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113
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Thibeau S, D'Apolito K, Minnick AF, Dietrich MS, Kane B, Cooley S, Groer M. Relationships of Maternal Stress with Milk Immune Components in African American Mothers of Healthy Term Infants. Breastfeed Med 2016; 11:6-14. [PMID: 26701800 PMCID: PMC4742984 DOI: 10.1089/bfm.2015.0117] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In the United States, African American infants experience the highest mortality, and their mothers report the lowest breastfeeding rates. Science reports decreased infant mortality among breastfed infants and suggests that milk immune component (MIC) levels are associated with maternal stressors. Little is known about these relationships among African Americans; therefore the aim was to explore the relationships of African American mothers' stressors and MICs 1-14 days postdelivery. MATERIALS AND METHODS Mothers meeting eligibility requirements were approached for consent 48-72 hours postdelivery of a healthy term infant and given instructions to collect milk (Days 3, 9, and 14) and saliva (Day 9), as well as complete three Perceived Stress Scale questionnaires (Days 3, 9, and 14) and a survey of pregnancy stressors experiences. Pearson correlations and linear regressions were performed to assess the relationships of maternal stressors with MICs. RESULTS There was at least one statistically significant correlation of a maternal stressor with nine of the 10 MICs (effect sizes ranging from r = 0.22 to 0.38) on Days 3 and 9. Of all MICs, epidermal growth factor had the most associations with maternal stress indicators. No mediational relationship of cortisol with MICs was observed. CONCLUSIONS Many of the MIC changes observed could potentially impact the health of term and preterm infants. Further research is warranted.
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Affiliation(s)
- Shelley Thibeau
- 1 Center for Nursing Research , Ochsner Health System, New Orleans, Louisiana
| | - Karen D'Apolito
- 2 Vanderbilt University School of Nursing , Nashville, Tennessee
| | - Ann F Minnick
- 2 Vanderbilt University School of Nursing , Nashville, Tennessee
| | - Mary S Dietrich
- 2 Vanderbilt University School of Nursing , Nashville, Tennessee.,3 Department of Biostatistics, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Bradley Kane
- 4 Bio-behavioral Lab, University of South Florida College of Nursing , Tampa, Florida
| | - Shaun Cooley
- 4 Bio-behavioral Lab, University of South Florida College of Nursing , Tampa, Florida
| | - Maureen Groer
- 4 Bio-behavioral Lab, University of South Florida College of Nursing , Tampa, Florida
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114
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Staneva A, Morawska A, Bogossian F, Wittkowski A. Pregnancy-specific distress: the role of maternal sense of coherence and antenatal mothering orientations. J Ment Health 2015; 25:387-394. [PMID: 26652295 DOI: 10.3109/09638237.2015.1101425] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Maternal mental health during pregnancy has been identified as a key factor in the future physiological, emotional and social development of both the mother and her baby. Yet little is known about the factors that contribute to increased levels of pregnancy-specific distress. The present study investigated the role of two psychosocial and personality-based constructs, namely women's sense of coherence (SoC) and their mothering orientations, on their pregnancy-specific distress. DESIGN During their second trimester of pregnancy, 293 Australian and New Zealand women participated in an online study. Hierarchical multiple regression analysis was used to determine the unique contribution of women's SoC (Sense of Coherence Scale, SoC 13) and their antenatal mothering orientation (Antenatal Mothering Orientation Measure-Revised, AMOM-R) to pregnancy-specific distress (Revised Prenatal Distress Questionnaire, NuPDQ). RESULTS Low SoC was the best determinant of women's pregnancy-specific distress, accounting for over 45% of the variance (β = -0.33, p < 0.001, 95% CI [-0.43, -0.23]). A Regulator mothering orientation was correlated with distress but did not have a unique contribution in the final model. CONCLUSIONS This study further highlights the importance of better understanding women's perceptions of emotional health and their mothering role while taking into consideration their wider social context.
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Affiliation(s)
| | - Alina Morawska
- a The School of Psychology, The University of Queensland , Australia
| | - Fiona Bogossian
- b The School of Nursing, Midwifery and Social Work, The University of Queensland , Brisbane , Australia , and
| | - Anja Wittkowski
- c Department of Psychology, Division of Clinical Psychology , University of Manchester , Manchester , UK
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115
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Su Q, Zhang H, Zhang Y, Zhang H, Ding D, Zeng J, Zhu Z, Li H. Maternal Stress in Gestation: Birth Outcomes and Stress-Related Hormone Response of the Neonates. Pediatr Neonatol 2015; 56:376-81. [PMID: 26363772 DOI: 10.1016/j.pedneo.2015.02.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/24/2015] [Accepted: 02/24/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Relatively few studies have been made on neurobehavioral outcomes of prenatal maternal stress during the newborn period, and little research has focused on umbilical cord stress hormones including cortisol, adrenocorticotropic hormone (ACTH), norepinephrine, and epinephrine. Our objective was to investigate the effects of prenatal maternal life stressors on neonatal birth outcomes, neurobehavioral development, and stress-related hormones levels. METHODS Participants were 142 mothers and their infants; 71 were selected as the prenatal life stressor exposed group and 71 as the control group matched on maternal age, gestational week, delivery type, socioeconomic and education status, and newborns' sex. Maternal life stressors during pregnancy were determined using the Life Events Scale for Pregnant Women. Neonatal neurobehavioral development was assessed with the Neonatal Behavioral Neurological Assessment. Umbilical cord plasma stress-related hormones, including ACTH, cortisol, norepinephrine, and epinephrine were measured using an enzyme-linked immunosorbent assay. RESULTS In the prenatal life stressors exposed group, newborns had significantly lower birth weight, smaller head circumference (p < 0.01, p < 0.01, respectively). Scores of Neonatal Behavioral Neurological Assessment were significantly reduced (p < 0.001). Cord plasma ACTH, norepinephrine, and epinephrine levels were significantly increased (p < 0.001), but cortisol levels were reduced (p < 0.001). CONCLUSION Prenatal maternal stress may negatively affect fetal birth outcomes, neurobehavioral development and affect neonates' cord plasma ACTH, cortisol, norepinephrine, and epinephrine.
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Affiliation(s)
- Qian Su
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huifang Zhang
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Division of Neonatology, Xi'an Children's Hospital, Xi'an, Shaanxi, China
| | - Yanyan Zhang
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Department of Neonatology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Huiping Zhang
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ding Ding
- Division of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Junan Zeng
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Department of Neonatology, Child and Maternity Healthy Hospital of Shaanxi Province, Xi'an, Shaanxi, China
| | - Zhongliang Zhu
- Shaanxi Province Biomedicine Key Laboratory, College of Life Sciences Northwest University, Xi'an, Shaanxi, China; Department of Pharmacology, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hui Li
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Chiang MC. Effects of Maternal Stress During Pregnancy on Birth Outcome and Stress-related Hormones. Pediatr Neonatol 2015; 56:365-6. [PMID: 26427344 DOI: 10.1016/j.pedneo.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ming-Chou Chiang
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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117
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Clark CAC, Espy KA, Wakschlag L. Developmental pathways from prenatal tobacco and stress exposure to behavioral disinhibition. Neurotoxicol Teratol 2015; 53:64-74. [PMID: 26628107 DOI: 10.1016/j.ntt.2015.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 11/04/2015] [Accepted: 11/23/2015] [Indexed: 12/25/2022]
Abstract
Prenatal tobacco exposure (PTE) and prenatal stress exposure (PSE) both have been linked to externalizing behavior, although their effects generally have been considered in isolation. Here, we aimed to characterize the joint or interactive roles of PTE and PSE in early developmental pathways to behavioral disinhibition, a profile of cognitive and behavioral under-control that presages severe externalizing behavior. As part of a prospective, longitudinal study, 296 children were assessed at a mean age of 5 years. Exposures were assessed via repeated interviews across the prenatal period and bioassays of cotinine were obtained. Behavioral disinhibition was assessed using temperament measures in infancy, performance-based executive control tasks and measures of disruptive and inattentive behavior. PSE was associated with a higher probability of difficult temperament in infancy. Each exposure independently predicted poorer executive control at age 5 years. Difficult temperament and executive control difficulties in turn predicted elevated levels of disruptive behavior, although links from PTE and PSE to parent-reported attention problems were less robust. Children who experienced these prenatal exposures in conjunction with higher postnatal stress exposure showed the lowest executive control and highest levels of disruptive behavior. Findings highlight the compounding adverse impact of PTE and PSE on children's behavioral trajectories. Given their high concordance, prenatal health campaigns should target these exposures in tandem.
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Affiliation(s)
- C A C Clark
- Department of Psychology, University of Arizona, United States
| | - K A Espy
- Department of Psychology, University of Arizona, United States; Developmental Cognitive Neuroscience Laboratory, University of Nebraska-Lincoln, United States
| | - L Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Policy Research, Northwestern University, United States
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Van Parys AS, Deschepper E, Michielsen K, Galle A, Roelens K, Temmerman M, Verstraelen H. Intimate partner violence and psychosocial health, a cross-sectional study in a pregnant population. BMC Pregnancy Childbirth 2015; 15:278. [PMID: 26554901 PMCID: PMC4641387 DOI: 10.1186/s12884-015-0710-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this paper is to explore whether IPV 12 months before and/or during pregnancy is associated with poor psychosocial health. METHODS From June 2010 to October 2012, a cross-sectional study was conducted in 11 antenatal care clinics in Belgium. Consenting pregnant women were asked to complete a questionnaire on socio-demographics, psychosocial health and violence in a separate room. Overall, 2586 women were invited to participate and we were able to use data from 1894 women (73.2%) for analysis. Ethical clearance was obtained in all participating hospitals. RESULTS We found a significant correlation between IPV and poor psychosocial health: within the group of women who reported IPV, 53.2% (n = 118) had poor psychosocial health, as compared to 21% (n = 286) in the group of women who did not report IPV (P < 0.001). Lower psychosocial health scores were associated with increased odds of reporting IPV (aOR 1.55; 95% CI 1.39-1.72), with adjustments made for the language in which the questionnaire was filled out, civil/marital status, education and age. In other words, a decrease of 10 points on the psychosocial health scale (total of 140) increased the odds of reporting IPV by 55 %. When accounting for the 6 psychosocial health subscales, the analysis revealed that all subscales (depression, anxiety, self-esteem, mastery, worry and stress) are strongly correlated to reporting IPV. However, when accounting for all subscales simultaneously in a logistic regression model, only depression (aOR 0.87; 95 % CI 0.84-0.91) and stress (aOR 0.85; 95 % CI 0.77-095) remained significantly associated with IPV. The association between overall psychosocial health and IPV remained significant after adjusting for socio-demographic status. CONCLUSION Our research corroborated that IPV and psychosocial health are strongly associated. Due to the limitations of our study design, we believe that future research is needed to deepen understanding of the multitude of factors involved in the complex interactions between IPV and psychosocial health.
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Affiliation(s)
- An-Sofie Van Parys
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Ellen Deschepper
- Department of Public Health, Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Kristien Michielsen
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Anna Galle
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Kristien Roelens
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Hans Verstraelen
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Brotnow L, Reiss D, Stover CS, Ganiban J, Leve LD, Neiderhiser JM, Shaw DS, Stevens HE. Expectant Mothers Maximizing Opportunities: Maternal Characteristics Moderate Multifactorial Prenatal Stress in the Prediction of Birth Weight in a Sample of Children Adopted at Birth. PLoS One 2015; 10:e0141881. [PMID: 26544958 PMCID: PMC4636431 DOI: 10.1371/journal.pone.0141881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/22/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mothers' stress in pregnancy is considered an environmental risk factor in child development. Multiple stressors may combine to increase risk, and maternal personal characteristics may offset the effects of stress. This study aimed to test the effect of 1) multifactorial prenatal stress, integrating objective "stressors" and subjective "distress" and 2) the moderating effects of maternal characteristics (perceived social support, self-esteem and specific personality traits) on infant birthweight. METHOD Hierarchical regression modeling was used to examine cross-sectional data on 403 birth mothers and their newborns from an adoption study. RESULTS Distress during pregnancy showed a statistically significant association with birthweight (R2 = 0.032, F(2, 398) = 6.782, p = .001). The hierarchical regression model revealed an almost two-fold increase in variance of birthweight predicted by stressors as compared with distress measures (R2Δ = 0.049, F(4, 394) = 5.339, p < .001). Further, maternal characteristics moderated this association (R2Δ = 0.031, F(4, 389) = 3.413, p = .009). Specifically, the expected benefit to birthweight as a function of higher SES was observed only for mothers with lower levels of harm-avoidance and higher levels of perceived social support. Importantly, the results were not better explained by prematurity, pregnancy complications, exposure to drugs, alcohol or environmental toxins. CONCLUSIONS The findings support multidimensional theoretical models of prenatal stress. Although both objective stressors and subjectively measured distress predict birthweight, they should be considered distinct and cumulative components of stress. This study further highlights that jointly considering risk factors and protective factors in pregnancy improves the ability to predict birthweight.
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Affiliation(s)
- Line Brotnow
- Dept of Psychiatry, University of Iowa College of Medicine, Iowa City, IA, United States of America
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States of America
| | - David Reiss
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States of America
| | - Carla S. Stover
- Dept. of Mental Health Law & Policy, University of South Florida, Tampa, FL, United States of America
| | - Jody Ganiban
- Dept. of Psychology, George Washington University, Washington DC, United States of America
| | - Leslie D. Leve
- Dept. of Counseling Psychology & Human Services, University of Oregon, Eugene, OR, United States of America
| | - Jenae M. Neiderhiser
- Dept. of Psychology, Penn State University, University Park, PA, United States of America
| | - Daniel S. Shaw
- Dept. of Psychology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Hanna E. Stevens
- Dept of Psychiatry, University of Iowa College of Medicine, Iowa City, IA, United States of America
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States of America
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120
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van de Loo KFE, van Gelder MMHJ, Roukema J, Roeleveld N, Merkus PJFM, Verhaak CM. Prenatal maternal psychological stress and childhood asthma and wheezing: a meta-analysis. Eur Respir J 2015; 47:133-46. [PMID: 26541526 DOI: 10.1183/13993003.00299-2015] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 08/17/2015] [Indexed: 02/07/2023]
Abstract
The aim of this study was to systematically review and meta-analyse observational studies on prenatal maternal psychological stress and the subsequent development of asthma and wheezing in early childhood.All available published literature from 1960 until November 2013 was systematically searched through electronic databases (PubMed, Embase, PsycInfo and Web of Science). All observational studies assessing associations between any form of prenatal maternal psychological stress and respiratory morbidity in the child were included. Data extraction, quality assessment and meta-analyses were performed.The overall meta-analysis included 10 studies and showed that the prevalence of wheezing, asthma and other respiratory symptoms is higher in children of mothers who were exposed to or experienced some form of psychological stress during pregnancy than in mothers who did not (pooled OR 1.56 (95% CI 1.36-1.80)). Comparable results were observed in subgroup analyses of stress exposure, perceived stress, asthma and wheezing.This study demonstrates that prenatal maternal psychological stress is associated with respiratory morbidity, including asthma and wheezing in the child. Future studies examining the early origins of asthma and wheezing need to account for the impact of prenatal maternal stress.
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Affiliation(s)
- Kim F E van de Loo
- Dept of Medical Psychology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - Jolt Roukema
- Dept of Pediatric Pulmonology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Dept for Health Evidence, Radboud Institute for Health Sciences, Nijmegen, The Netherlands Dept of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter J F M Merkus
- Dept of Pediatric Pulmonology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands Both authors contributed equally
| | - Christianne M Verhaak
- Dept of Medical Psychology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands Both authors contributed equally
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Braeken M, Jones A, Otte R, Widjaja D, Van Huffel S, Monsieur G, van Oirschot C, Van den Bergh B. Anxious women do not show the expected decrease in cardiovascular stress responsiveness as pregnancy advances. Biol Psychol 2015; 111:83-9. [DOI: 10.1016/j.biopsycho.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
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Fontein-Kuipers Y, Ausems M, Budé L, Van Limbeek E, De Vries R, Nieuwenhuijze M. Factors influencing maternal distress among Dutch women with a healthy pregnancy. Women Birth 2015; 28:e36-43. [DOI: 10.1016/j.wombi.2015.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 02/05/2015] [Accepted: 02/11/2015] [Indexed: 01/19/2023]
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123
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Reynolds RM, Pesonen AK, O'Reilly JR, Tuovinen S, Lahti M, Kajantie E, Villa PM, Laivuori H, Hämäläinen E, Seckl JR, Räikkönen K. Maternal depressive symptoms throughout pregnancy are associated with increased placental glucocorticoid sensitivity. Psychol Med 2015; 45:2023-2030. [PMID: 25628053 DOI: 10.1017/s003329171400316x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Maternal prenatal depression predicts post-partum depression and increases risk of prematurity and low birth weight. These effects may be mediated by altered placental function. We hypothesized that placental function would be influenced by the gestational week of experiencing depressive symptoms and aimed to examine associations between maternal depressive symptoms during pregnancy and placental expression of genes involved in glucocorticoid and serotonin transfer between mother and fetus. METHOD We studied women participating in a prospective pregnancy cohort: the Prediction and Prevention of Preeclampsia (PREDO) Study, Helsinki, Finland. Maternal depressive symptoms were assessed at 2-week intervals throughout pregnancy in 56 healthy women with singleton, term pregnancies. Messenger ribonucleic acid (mRNA) levels of glucocorticoid (GR) and mineralocorticoid (MR) receptors and serotonin transporter (SLC6A4), 11β-hydroxysteroid dehydrogenase type 1 (HSD1) and 2 (HSD2) were quantified in placental biopsies. RESULTS In adjusted analyses women who reported higher depressive symptoms across the whole pregnancy had higher mRNA levels of GR [effect size 0.31 s.d. units, 95% confidence interval (CI) 0.01-0.60, p = 0.042] and MR (effect size 0.34 s.d. units, 95% CI 0.01-0.68, p = 0.047). These effects were significant for symptoms experienced in the third trimester of pregnancy for GR; findings for MR were also significant for symptoms experienced in the second trimester. GR and MR mRNA levels increased linearly by having the trimester-specific depressive symptoms scores 0, 1 or 2-3 times above the clinical cut-off for depression (p = 0.003, p = 0.049, respectively, and p = 0.004, p = 0.15 in adjusted analyses). CONCLUSIONS Our findings offer potential gestational-age-specific mechanisms linking maternal depressive symptoms during pregnancy via placental biology. Future studies will test whether these also link with adverse offspring outcomes.
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Affiliation(s)
- R M Reynolds
- Endocrinology Unit,University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute,47 Little France Crescent,Edinburgh,UK
| | - A-K Pesonen
- Institute of Behavioral Sciences, University of Helsinki,00014 University of Helsinki,Helsinki,Finland
| | - J R O'Reilly
- Endocrinology Unit,University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute,47 Little France Crescent,Edinburgh,UK
| | - S Tuovinen
- Institute of Behavioral Sciences, University of Helsinki,00014 University of Helsinki,Helsinki,Finland
| | - M Lahti
- Institute of Behavioral Sciences, University of Helsinki,00014 University of Helsinki,Helsinki,Finland
| | - E Kajantie
- National Institute for Health and Welfare,00271 Helsinki,Finland
| | - P M Villa
- Department of Obstetrics and Gynaecology,University of Helsinki and Helsinki University Central Hospital,Helsinki,Finland
| | - H Laivuori
- Haartman Institute, Medical Genetics, University of Helsinki,00014 University of Helsinki,Helsinki,Finland
| | - E Hämäläinen
- HUSLAB and Department of Clinical Chemistry,Helsinki University Central Hospital,00014 University of Helsinki,Helsinki,Finland
| | - J R Seckl
- Endocrinology Unit,University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute,47 Little France Crescent,Edinburgh,UK
| | - K Räikkönen
- Institute of Behavioral Sciences, University of Helsinki,00014 University of Helsinki,Helsinki,Finland
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Abstract
High levels of stress during pregnancy are associated with a number of adverse psychological and physiological outcomes for mother and child. These effects seem to be transmitted in part by one of the major stress-responsive systems, namely the hypothalamic-pituitary-adrenal (HPA) axis, which includes the hormone cortisol. However, as inconsistent study results indicate, methodology poses a substantial challenge to the investigation of stress during pregnancy. For example, although measures of maternal psychological stress and stress hormones are independently related to adverse pregnancy outcome, they seldom have been found to correlate with one another directly. Repeated measurement of psychological and biological responses to acute standardized stress challenges appears to reveal stronger associations. This article reviews the literature on experienced stress and stress hormones in pregnant women and presents studies that used standardized stress challenges (e.g., the Trier Social Stress Test, the cortisol response to morning awakening) to examine maternal stress reactivity more systematically. This review also takes a look at the few studies that examined the protective effects of psychological and psychosocial resources or stress interventions on experienced stress and stress hormones in pregnant women. Overall, results indicate that baseline stress hormone levels advance incrementally during gestation, presumably to prepare mother and fetus for delivery, while responses to acute stress appear to be increasingly attenuated. Moreover, the acute maternal stress response seems to be predictive of neonatal birth outcome and maternal well-being postpartum. Preliminary findings also suggest that much can be done toward coping with stress during pregnancy. Further research and a closer collaboration between science and clinical practice are required.
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Affiliation(s)
| | - Ulrike Ehlert
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Switzerland
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Ribeiro LA, Zachrisson HD, Gustavson K, Schjølberg S. Maternal distress during pregnancy and language development in preschool age: A population-based cohort study. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2015. [DOI: 10.1080/17405629.2015.1050373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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The role of body image in prenatal and postpartum depression: a critical review of the literature. Arch Womens Ment Health 2015; 18:409-21. [PMID: 25895137 PMCID: PMC4810003 DOI: 10.1007/s00737-015-0525-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 03/29/2015] [Indexed: 10/23/2022]
Abstract
Maternal depression increases risk of adverse perinatal outcomes, and recent evidence suggests that body image may play an important role in depression. This systematic review identifies studies of body image and perinatal depression with the goal of elucidating the complex role that body image plays in prenatal and postpartum depression, improving measurement, and informing next steps in research. We conducted a literature search of the PubMed database (1996-2014) for English language studies of (1) depression, (2) body image, and (3) pregnancy or postpartum. In total, 19 studies matched these criteria. Cross-sectional studies consistently found a positive association between body image dissatisfaction and perinatal depression. Prospective cohort studies found that body image dissatisfaction predicted incident prenatal and postpartum depression; findings were consistent across different aspects of body image and various pregnancy and postpartum time periods. Prospective studies that examined the reverse association found that depression influenced the onset of some aspects of body image dissatisfaction during pregnancy, but few evaluated the postpartum onset of body image dissatisfaction. The majority of studies found that body image dissatisfaction is consistently but weakly associated with the onset of prenatal and postpartum depression. Findings were less consistent for the association between perinatal depression and subsequent body image dissatisfaction. While published studies provide a foundation for understanding these issues, methodologically rigorous studies that capture the perinatal variation in depression and body image via instruments validated in pregnant women, consistently adjust for important confounders, and include ethnically diverse populations will further elucidate this association.
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Brunton RJ, Dryer R, Saliba A, Kohlhoff J. Pregnancy anxiety: A systematic review of current scales. J Affect Disord 2015; 176:24-34. [PMID: 25687280 DOI: 10.1016/j.jad.2015.01.039] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression in pregnancy is a serious health issue; however, anxiety in pregnancy, with a reported higher prevalence, may also be a serious issue. Anxiety symptoms in pregnancy can relate to several anxiety types, such as general anxiety, anxiety disorders, and pregnancy-related anxiety (PrA), anxiety characterised by pregnancy specific fears and worries. Awareness of these distinctions however, is not always widespread. Both general anxiety and PrA are associated with maternal negative outcomes (e.g. increased nausea) however; PrA is more often associated with negative outcomes for the child (e.g. preterm birth). Furthermore, PrA is potentially a risk factor for postnatal depression with assessment of PrA potentially affording important intervention opportunities. Currently several different instruments are used for PrA however their psychometric properties are unclear. To our knowledge a review of current instruments and their psychometric properties is lacking, this paper aims to fill that gap. METHODS Studies, which assessed PrA, published between 1983 and 2013 in peer-reviewed journals, were identified. RESULTS Sixty studies were identified after applying inclusion/exclusion criteria, and classified as: pregnancy-related anxiety specific, scales for other constructs, sub scales of another instrument and general anxiety scales. Each scale's strengths and limitations were discussed. LIMITATIONS Our findings may be limited by restricting our review to peer-reviewed journals. This was done however as we sought to identify scales with good psychometric properties. CONCLUSIONS Currently no scales are available for pregnancy-related anxiety with sound theoretical and psychometric properties. Clinically the need for such a scale is highlighted by the potential intervention opportunities this may afford. Future research should be directed towards the development of such a scale.
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Affiliation(s)
- Robyn J Brunton
- School of Psychology, Charles Sturt University, Bathurst, NSW 2795, Australia.
| | - Rachel Dryer
- School of Psychology, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Anthony Saliba
- School of Psychology, Charles Sturt University, Bathurst, NSW 2795, Australia
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Roos A, Geerts L, Koen N, Faure SC, Vythilingum B, Stein DJ. Psychosocial predictors of fetoplacental blood flow during pregnancy. Compr Psychiatry 2015; 57:125-31. [PMID: 25481236 DOI: 10.1016/j.comppsych.2014.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although a number of studies have found significant associations between maternal psychological distress, anxiety and changes in fetoplacental blood flow, findings remain inconsistent. A recent pilot study by our group highlighted some of these inconsistencies. In the current study, we expanded this pilot analysis to include psychological distress, anxiety and a range of antenatal variables, with the aim of identifying predictors of fetoplacental blood flow. METHODS Healthy pregnant women (n=148) underwent Doppler flow studies on uterine, umbilical and fetal arteries; as well as assessments of distress, anxiety and other antenatal variables (e.g. perceived social support, resilience, nicotine and alcohol use) in each trimester. RESULTS Stepwise regression analyses found that state anxiety was associated with lower mid-cerebral artery pulsatility index at trimester 3. LIMITATIONS Subjects were recruited from selected midwife obstetric units in the same health district, so the generalizability of our results may be limited. While most subjects received Doppler assessment at trimesters 2 and 3, only approximately half of our sample was assessed at trimester 1. CONCLUSION The finding that anxiety is associated with increased blood flow to the fetal brain during trimester 3 of pregnancy, coincide with previous work. The findings emphasize a growing appreciation of the potential importance of psychological well-being during pregnancy for infant development. However, as associations were small and variable, further research using multivariate models to determine the precise mechanisms underlying these associations would be warranted.
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Affiliation(s)
- A Roos
- SU/UCT MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa.
| | - L Geerts
- Department of Obstetrics & Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa
| | - N Koen
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - S C Faure
- SU/UCT MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa
| | - B Vythilingum
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - D J Stein
- SU/UCT MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, J-Block Groote Schuur Hospital, Observatory, Cape Town, South Africa
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Ehlert U, La Marca-Ghaemmaghami P. Lohnt sich die Exploration von pränatalem Stress für die Therapieindikation? VERHALTENSTHERAPIE 2014. [DOI: 10.1159/000369186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Auerbach MV, Lobel M, Cannella DT. Psychosocial correlates of health-promoting and health-impairing behaviors in pregnancy. J Psychosom Obstet Gynaecol 2014; 35:76-83. [PMID: 25078858 DOI: 10.3109/0167482x.2014.943179] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Behaviors during pregnancy including eating, exercise, cigarette smoking, and other substance use affect the health of a pregnant woman and her fetus. However, little is known about what influences pregnant women to engage in these health behaviors. Based upon relevant theory, we hypothesized that because health-promoting behaviors require continuous efforts that may depend upon a reliable, stable set of resources, intrapersonal traits, namely self-esteem and optimism, would be associated with the practice of health-promoting behaviors during pregnancy. In addition, we hypothesized that variables reactive to the more immediate context, pregnancy-specific stress and perceived control over pregnancy, would be associated with the practice of health-impairing behaviors. We distinguished health-promoting and health-impairing behaviors in a diverse sample of 165 pregnant women and investigated whether such behaviors are associated with distinct psychosocial factors. Results supported study hypotheses and provide evidence that even after controlling for maternal age, income, body mass index, and gestation, a stable, self-relevant disposition, self-esteem, is associated with the practice of health-promoting behaviors in pregnancy whereas pregnancy-specific stress, a situationally-evoked factor, is associated with the practice of health-impairing prenatal behaviors. Perceived control over pregnancy, which may reflect stable disposition and situational perceptions, was associated with health-promoting and health-impairing behaviors.
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Affiliation(s)
- Melissa V Auerbach
- Department of Psychology, Stony Brook University , Stony Brook, NY , USA
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Ertel KA, Silveira ML, Pekow PS, Dole N, Markenson G, Chasan-Taber L. Prepregnancy body mass index, gestational weight gain, and elevated depressive symptoms in a Hispanic cohort. Health Psychol 2014; 34:274-8. [PMID: 25110848 DOI: 10.1037/hea0000137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Our objective was to assess the associations among prepregnancy Body Mass Index (BMI), gestational weight gain (GWG), and elevated depressive symptoms across pregnancy. METHODS We evaluated these associations among 1,090 participants in Proyecto Buena Salud, a prospective cohort study of Hispanic (predominantly Puerto Rican) women in Western Massachusetts. BMI and GWG were self-reported; GWG was classified according to the 2009 Institute of Medicine guidelines. Depressive symptoms were assessed in early, mid-, and late pregnancy using the 10-item Edinburgh Postnatal Depression Scale (EPDS). We defined elevated depressive symptoms as EPDS scores ≥13 and ≥15. RESULTS In multivariable, longitudinal modeling, overweight (25.0 to <30 kg/m2) women had an odds ratio of 0.53 (95% CI [0.31, 0.90]) for EPDS scores ≥13 and 0.51 (95% CI [0.28, 0.91]) for EPDS scores ≥15 compared to normal weight women. We did not observe an association between GWG or an interaction between BMI and GWG, in predicting elevated depressive symptoms. CONCLUSIONS Our findings provide preliminary support for an association of prepregnancy overweight status and lower depressive symptoms across pregnancy in Hispanic women. Future research should focus on potential social and cultural differences in perceptions of weight and weight gain in the perinatal period and how these influence psychological health.
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Affiliation(s)
- Karen A Ertel
- Division of Biostatistics and Epidemiology, Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts
| | - Marushka L Silveira
- Division of Biostatistics and Epidemiology, Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts
| | - Penelope S Pekow
- Division of Biostatistics and Epidemiology, Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts
| | - Nancy Dole
- Carolina Population Center, University of North Carolina
| | | | - Lisa Chasan-Taber
- Division of Biostatistics and Epidemiology, Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts
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Ulrich F, Petermann F. Zur Bedeutung von sozialer Unterstützung während der Schwangerschaft. PSYCHOLOGISCHE RUNDSCHAU 2014. [DOI: 10.1026/0033-3042/a000197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Eine wachsende Zahl an Studien dokumentiert die negativen Auswirkungen von mütterlichen psychosozialen Stressoren (z. B. mütterliche Depression) und gesundheitsrelevanten Verhaltensweisen (z. B. Nikotin- und Alkoholkonsum) während der Schwangerschaft auf den Geburtsausgang. Jedoch werden mütterliche Ressourcen in diesem Kontext noch unzureichend berücksichtigt. Das Ziel ist es daher, die Bedeutung sozialer Unterstützung als frühe Ressource im Schwangerschaftsverlauf und zum Zeitpunkt der Geburt im Hinblick auf das Gesundheitsverhalten der Schwangeren und im Hinblick auf Geburtsmaße zu untersuchen. Die Datenbanken Web of Science und PubMed wurden entsprechend nach deutsch- und englischsprachigen Beiträgen für den Zeitraum 2003 bis 2013 durchsucht. 23 Studien erfüllten die Auswahlkriterien. Die Ergebnisse verdeutlichen, dass die Befundlage sehr inkonsistent ist, was teilweise auf die unterschiedlichen Definitionen sozialer Unterstützung und die Nutzung verschiedener Erhebungsinstrumente zurückzuführen ist. Des Weiteren fehlt es an Studien zur Bedeutung sozialer Unterstützung im Kontext mütterlicher psychosozialer Stressoren und Geburtsmaßen. Es bedarf weiterer Studien an Risiko- und Allgemeinpopulationen, die auf der Basis eines fundierten Rahmenkonzeptes mögliche Effekte der sozialen Unterstützung differenziert analysieren können.
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Mina TH, Reynolds RM. Mechanisms linking in utero stress to altered offspring behaviour. Curr Top Behav Neurosci 2014; 18:93-122. [PMID: 24577734 DOI: 10.1007/7854_2014_291] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Development in utero is recognised as a determinant of health in later life, a concept known as early life 'programming'. Several studies in humans have now shown a link between in utero stressors of maternal stress, anxiety and depression and adverse behavioural outcomes for the offspring including poorer cognitive function and behavioural and emotional problems. These behaviours are observed from the very early neonatal period and appear to persist through to adulthood. Underlying mechanisms are not known but overexposure of the developing foetus to glucocorticoids has been proposed. Dysregulation of the maternal and offspring hypothalamic-pituitary-adrenal (HPA) axis has been proposed as a mechanism linking in utero stress with offspring behavioural outcomes. Studies suggest that altered circulating levels of maternal cortisol during pregnancy and/or changes in placental gene expression or methylation, which result in increased glucocorticoid transfer to the developing foetus, are linked to changes in offspring behaviour and in activity of the offspring HPA axis. Further understanding of the underlying pathways and identification of any gestation of vulnerability are needed to help design interventions to reduce in utero stress and improve behavioural outcomes in the offspring.
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Affiliation(s)
- Theresia H Mina
- Endocrinology Unit, Queen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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Kalra B, Sridhar GR, Madhu K, Balhara YPS, Sahay RK, Kalra S. Psychosocial management of diabetes in pregnancy. Indian J Endocrinol Metab 2013; 17:815-8. [PMID: 24083162 PMCID: PMC3784864 DOI: 10.4103/2230-8210.117216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This consensus based national guideline addresses the need for psychological, psychiatric and social assessment, as well as management, in antenatal women with diabetes. It builds upon the earlier Indian guidelines on psychological management of diabetes, and should be considered as an addendum to the parent guideline.
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Affiliation(s)
- Bharti Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - G. R. Sridhar
- Endocrine and Diabetes Centre, Andhra University, Vishakhapatnam, India
| | - K. Madhu
- Department of Psychology, Andhra University, Vishakhapatnam, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, AIIMS, New Delhi,, India
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
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