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Maxwell SD, Fineberg AM, Drabick DA, Murphy SK, Ellman LM. Maternal Prenatal Stress and Other Developmental Risk Factors for Adolescent Depression: Spotlight on Sex Differences. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 46:381-397. [PMID: 28393324 PMCID: PMC5828524 DOI: 10.1007/s10802-017-0299-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Maternal stress during pregnancy has been linked to premorbid abnormalities associated with depression (e.g., difficult temperament, cognitive deficits) in offspring. However, few studies have looked across developmental periods to examine maternal stress during pregnancy and offspring depression during adolescence and whether these associations differ by sex. The current study used data from 1711 mother-offspring dyads (offspring sex: 49.8% male) in a longitudinal birth cohort study. Maternal narratives collected during pregnancy were qualitatively coded for stress-related themes by independent raters. Latent class analysis (LCA) identified distinct subgroups of offspring based on exposure to maternal prenatal stress and other developmental factors from the prenatal, childhood, and adolescent periods that have been associated with depression and/or maternal prenatal stress. LCA identified subgroups that were compared to determine whether and to what extent they differed on adolescent depressive symptoms. LCA revealed a subgroup of "high-risk" individuals, characterized by maternal factors during pregnancy (higher ambivalence/negativity and lower positivity towards the pregnancy, higher levels of hassles, lower maternal education and higher maternal age at birth, higher pre-pregnancy BMI) and offspring developmental factors (decreased cognitive functioning during childhood and adolescence, lower perceived parental support during adolescence, and higher levels of maternal depression during adolescence). High-risk females exhibited elevated conduct symptoms and higher birth order, while high-risk males exhibited decreased internalizing symptoms and lower birth order. Both high-risk males and females reported elevated depressive symptoms during adolescence relative to their "low-risk" counterparts.
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Affiliation(s)
- Seth D Maxwell
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Anna M Fineberg
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Deborah A Drabick
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Shannon K Murphy
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA.
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102
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Galbally M, van IJzendoorn M, Permezel M, Saffery R, Lappas M, Ryan J, van Rossum E, Johnson AR, Teti D, Lewis AJ. Mercy Pregnancy and Emotional Well-being Study (MPEWS): Understanding maternal mental health, fetal programming and child development. Study design and cohort profile. Int J Methods Psychiatr Res 2017; 26:e1558. [PMID: 28120519 PMCID: PMC6877189 DOI: 10.1002/mpr.1558] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/13/2016] [Accepted: 12/01/2016] [Indexed: 11/05/2022] Open
Abstract
Maternal mental health represents a significant global health burden. The Mercy Pregnancy and Emotional Well-being Study (MPEWS) was established to provide a comprehensive investigation of early developmental mechanisms and modifiers for maternal, fetal and child emotional well-being. MPEWS is a prospective, longitudinal study from pregnancy to 36 months postpartum that includes diagnostic measures of maternal mental health, observational measures of the mother-infant relationship, measures of child development, and repeat biological sampling. A total of 282 pregnant women were recruited in early pregnancy from the Mercy Hospital for Women in Melbourne, Australia, including 52 women on antidepressant medication, 31 non-medicated women meeting diagnostic criteria for current unipolar depression or dysthymia, and 65 women with a past history of depression. Sample recruitment characteristics included a mean age of 31 years and average gestation of 16 weeks. The MPEWS cohort was comparable to national averages for Australia on key pregnancy and birth variables. Those participants taking antidepressant medication had higher mean Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Inventory (STAI) scores than the cohort as a whole but were comparable on other key variables. The MPEWS protocol provides a unique opportunity to evaluate the impact of pregnancy mental health on future maternal mental health and child development to aid the development of evidence-based interventions. The study is open for collaborative proposals via approach to the principal investigators.
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Affiliation(s)
- Megan Galbally
- School of Psychology and Exercise Science, Murdoch University, Perth, Australia.,School of Medicine, University of Notre Dame, Fremantle, Australia.,Fiona Stanley Hospital, Perth, Australia
| | | | - Michael Permezel
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, and Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia.,Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Australia
| | - Joanne Ryan
- Murdoch Children's Research Institute, Royal Children's Hospital, and Department of Paediatrics, University of Melbourne, Parkville, Australia.,Inserm U1061, University Montpellier, Montpellier, France
| | - Elisabeth van Rossum
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Andrew R Johnson
- School of Psychology and Speech Pathology, Curtin University, Bentley, Australia
| | - Douglas Teti
- Human Development and Family Studies, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Andrew J Lewis
- School of Psychology and Exercise Science, Murdoch University, Perth, Australia
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103
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Murphy SK, Fineberg AM, Maxwell SD, Alloy LB, Zimmermann L, Krigbaum NY, Cohn BA, Drabick DAG, Ellman LM. Maternal infection and stress during pregnancy and depressive symptoms in adolescent offspring. Psychiatry Res 2017; 257:102-110. [PMID: 28750213 PMCID: PMC5823248 DOI: 10.1016/j.psychres.2017.07.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/26/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022]
Abstract
Maternal infection during pregnancy has been linked to increased risk of offspring depression. Additionally, maternal stress during pregnancy has been consistently linked with adverse offspring outcomes associated with depression. Relatedly, stress has been associated with increased risk of infection; however no study has investigated stress-infection interactions during pregnancy and risk for offspring depression. Participants were drawn from the Child Health and Development Studies (CHDS), a prospective, longitudinal study that enrolled pregnant women from 1959 to 1966. Maternal health and birth outcome information were collected, as well as open-ended interviews about worrisome events during pregnancy. The present study included participants from a subsample of women whose offspring (n = 1711) completed self-reports of depressive symptoms during adolescence. Results indicated that maternal infection during only the second trimester was associated with higher scores on adolescent offspring depressive symptoms, while controlling for maternal education at birth, adolescent age, and maternal depressive symptoms at adolescence. Maternal experiences of daily stress during pregnancy moderated this association, such that mothers diagnosed with second trimester infection and who experienced daily stress had offspring with significantly higher depression scores than mothers of adolescents diagnosed with an infection alone. Findings have potential implications for prevention and intervention strategies.
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Affiliation(s)
| | - Anna M. Fineberg
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | - Seth D. Maxwell
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | - Lauren B. Alloy
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | - Lauren Zimmermann
- Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA
| | - Nickilou Y. Krigbaum
- Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA
| | - Barbara A. Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA
| | | | - Lauren M. Ellman
- Temple University, Department of Psychology, Philadelphia, PA, USA,Corresponding author. Lauren M. Ellman, Ph.D., Temple University, Department of Psychology, Weiss Hall, 1701 North 13 Street, Philadelphia, PA, 19122,
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104
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Bayrampour H, McNeil DA, Benzies K, Salmon C, Gelb K, Tough S. A qualitative inquiry on pregnant women's preferences for mental health screening. BMC Pregnancy Childbirth 2017; 17:339. [PMID: 28974195 PMCID: PMC5627476 DOI: 10.1186/s12884-017-1512-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 09/15/2017] [Indexed: 01/23/2023] Open
Abstract
Background Approaches to screening can influence the acceptance of and comfort with mental health screening. Qualitative evidence on pregnant women’s comfort with different screening approaches and disclosure of mental health concerns is scant. The purpose of this study was to understand women’s perspectives of different mental health screening approaches and the perceived barriers to the communication and disclosure of their mental health concerns during pregnancy. Methods A qualitative descriptive study was undertaken. Fifteen women, with a singleton pregnancy, were recruited from a community maternity clinic and a mental health clinic in Calgary, Canada. Semi-structured interviews were conducted during both the 2nd and 3rd trimesters. Data were analyzed using thematic analysis. Results Preferences for mental health screening approaches varied. Most women with a known mental health issue preferred a communicative approach, while women without a known mental health history who struggled with emotional problems were inclined towards less interactive approaches and reported a reluctance to share their concerns. Barriers to communicating mental health concerns included a lack of emotional literacy (i.e., not recognizing the symptoms, not understanding the emotions), fear of disclosure outcomes (i.e., fear of being judged, fear of the consequences), feeling uncomfortable to be seen vulnerable, perception about the role of prenatal care provider (internal barriers); the lack of continuity of care, depersonalized care, lack of feedback, and unfamiliarity with/uncertainty about the availability of support (structural barriers). Conclusions The overlaps between some themes identified for the reasons behind a preferred screening approach and barriers reported by women to communicate mental health concerns suggest that having options may help women overcome some of the current disclosure barriers and enable them to engage in the process. Furthermore, the continuity of care, clarity around the outcomes of disclosing mental health concerns, and availability of immediate support can help women move from providing “the best answer” to providing an authentic answer.
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Affiliation(s)
- Hamideh Bayrampour
- Department of Family Practice, Midwifery Program, University of British Columbia, 3rd Floor David Strangway Building, 320-5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| | - Deborah A McNeil
- Alberta Health Services and Associate Professor in Faculty of Nursing and Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, T2W 3N2, Canada
| | - Karen Benzies
- Professor in Faculty of Nursing, University of Calgary, Calgary, T2N 1N4, Canada
| | - Charleen Salmon
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, T2N 1N4, Canada
| | - Karen Gelb
- Midwifery Program, Department of Family Practice, Faculty of Medicine, University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Suzanne Tough
- Alberta Innovates Health Solutions Health Scholar and Professor in Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, T3B 6A8, Canada
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105
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Nolvi S, Pesonen H, Bridgett DJ, Korja R, Kataja EL, Karlsson H, Karlsson L. Infant Sex Moderates the Effects of Maternal Pre- and Postnatal Stress on Executive Functioning at 8 Months of Age. INFANCY 2017. [DOI: 10.1111/infa.12206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Saara Nolvi
- The FinnBrain Birth Cohort Study; Turku Brain and Mind Center; Institute of Clinical Medicine; University of Turku
| | - Henri Pesonen
- The FinnBrain Birth Cohort Study; Turku Brain and Mind Center; Institute of Clinical Medicine; University of Turku
- Department of Mathematics and Statistics; University of Turku
| | | | - Riikka Korja
- The FinnBrain Birth Cohort Study; Turku Brain and Mind Center; Institute of Clinical Medicine; University of Turku
- Department of Psychology; University of Turku
| | - Eeva-Leena Kataja
- The FinnBrain Birth Cohort Study; Turku Brain and Mind Center; Institute of Clinical Medicine; University of Turku
- Department of Psychology; University of Turku
| | - Hasse Karlsson
- The FinnBrain Birth Cohort Study; Turku Brain and Mind Center; Institute of Clinical Medicine; University of Turku
- Department of Psychiatry; Turku University Hospital and University of Turku
| | - Linnea Karlsson
- The FinnBrain Birth Cohort Study; Turku Brain and Mind Center; Institute of Clinical Medicine; University of Turku
- Department of Child Psychiatry; Turku University Hospital and University of Turku
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106
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Andiarena A, Balluerka N, Murcia M, Ibarluzea J, Glover V, Vegas O. Evening salivary cortisol and alpha-amylase at 14months and neurodevelopment at 4years: Sex differences. Horm Behav 2017; 94:135-144. [PMID: 28750755 DOI: 10.1016/j.yhbeh.2017.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 12/13/2022]
Abstract
Stress system activity in early life can have long-term effects on neurodevelopment. The main aim of this study was to assess the association of child evening salivary cortisol and alpha-amylase basal levels at 14months of age with longer-term neuropsychological development at 4years in a low-risk population-based birth cohort derived from the INMA (Environment and Childhood) project in Spain. We included 186 parent-children pairs with information on both stress system activity and neurodevelopment. Both stress markers at 14months of age showed an association with neuropsychological development at 4years. Salivary cortisol showed a sex-specific pattern of association. In girls, cortisol levels at 14months were negatively associated with cognitive development [long-term declarative memory (β=-17.8, p=0.028; 95% CI=-33.2 to -2.5); executive function (β=-9.8, p=0.08; 95% CI=-21 to 1)] and gross motor development (β=-13; p=0.022; 95% CI=-24 to -2), whereas in boys cortisol levels were negatively associated with socioemotional development [autistic-like behaviours: Incidence Rate Ratio (IRR)=1.6, p=0.039; 95% CI=1.01 to 2.41]. Salivary alpha-amylase was positively associated with socioemotional development in boys only [social competence (β=2.11, p=0.013; 95% CI=0.47 to 3.72), autistic-like behaviours (IRR=0.93, p=0.042; 95% CI=0.87 to 0.99) and hyperactivity symptoms (IRR=0.81, p=0.021; 95% CI=0.69 to 0.97)]. These results suggest that stress system activity in early life is associated with longer-term neurodevelopment and that sex is an important factor in this relationship.
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Affiliation(s)
- Ainara Andiarena
- University of the Basque Country (UPV/EHU), San Sebastian, Spain; Biodonostia Health Research Institute, San Sebastian, Spain.
| | - Nekane Balluerka
- University of the Basque Country (UPV/EHU), San Sebastian, Spain; Biodonostia Health Research Institute, San Sebastian, Spain
| | - Mario Murcia
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; FISABIO, Universitat Jaume I, Universitat de València Epidemiology and Environmental Health Joint Research Unit, Valencia, Spain
| | - Jesús Ibarluzea
- University of the Basque Country (UPV/EHU), San Sebastian, Spain; Biodonostia Health Research Institute, San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Departamento de Sanidad Gobierno Vasco, Subdirección de Salud Pública de Gipuzkoa, San Sebastián, Spain
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, United Kingdom
| | - Oscar Vegas
- University of the Basque Country (UPV/EHU), San Sebastian, Spain; Biodonostia Health Research Institute, San Sebastian, Spain
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107
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Mina TH, Lahti M, Drake AJ, Denison FC, Räikkönen K, Norman JE, Reynolds RM. Prenatal exposure to maternal very severe obesity is associated with impaired neurodevelopment and executive functioning in children. Pediatr Res 2017; 82:47-54. [PMID: 28288149 DOI: 10.1038/pr.2017.43] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/06/2017] [Indexed: 01/09/2023]
Abstract
BackgroundPrenatal maternal obesity has been associated with an increased risk of neurocognitive problems in childhood, but there are fewer studies on executive functioning.MethodsTests and questionnaires to assess neurodevelopment, executive functioning, and the ability to delay gratification were conducted in 113 children (mean (SD)=4.24 (0.63) years of age) born to mothers with very severe obesity (SO, body mass index (BMI)⩾40 kg/m2, n=51) or to lean mothers (BMI⩽25 kg/m2, n=62).ResultsPrenatal maternal SO predicted poorer neurodevelopment (unstandardized regression coefficient (B)=-0.42, 95% confidence interval (CI) (-0.82; -0.02)), worse problem-solving (odd ratio (OR)=0.60, 95% CI (1.13; 0.07)), and fine motor skills (OR=4.91, 95% CI (1.27; 19.04)), poorer executive functioning in areas of attention, inhibitory control, and working memory (standardized B=3.75, 95% CI (1.01; 13.93)) but not in self-gratification delay. The effects were independent of maternal concurrent psychological well-being and child's BMI, but not independent of maternal education.ConclusionFuture studies should investigate whether perinatal management of maternal obesity could prevent adverse outcomes in child neurodevelopment.
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Affiliation(s)
- Theresia H Mina
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Marius Lahti
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | - Amanda J Drake
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Katri Räikkönen
- Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Rebecca M Reynolds
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
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108
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Levine TA, Grunau RE, Segurado R, Daly S, Geary MP, Kennelly MM, O’Donoghue K, Hunter A, Morrison JJ, Burke G, Dicker P, Tully EC, Malone FD, Alderdice FA, McAuliffe FM. Pregnancy-specific stress, fetoplacental haemodynamics, and neonatal outcomes in women with small for gestational age pregnancies: a secondary analysis of the multicentre Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction. BMJ Open 2017; 7:e015326. [PMID: 28637734 PMCID: PMC5734406 DOI: 10.1136/bmjopen-2016-015326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/12/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To examine associations between maternal pregnancy-specific stress and umbilical (UA PI) and middle cerebral artery pulsatility indices (MCA PI), cerebroplacental ratio, absent end diastolic flow (AEDF), birthweight, prematurity, neonatal intensive care unit admission and adverse obstetric outcomes in women with small for gestational age pregnancies. It was hypothesised that maternal pregnancy-specific stress would be associated with fetoplacental haemodynamics and neonatal outcomes. DESIGN This is a secondary analysis of data collected for a large-scale prospective observational study. SETTING This study was conducted in the seven major obstetric hospitals in Ireland and Northern Ireland. PARTICIPANTS Participants included 331 women who participated in the Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction. Women with singleton pregnancies between 24 and 36 weeks gestation, estimated fetal weight <10th percentile and no major structural or chromosomal abnormalities were included. PRIMARY AND SECONDARY OUTCOME MEASURES Serial Doppler ultrasound examinations of the umbilical and middle cerebral arteries between 20 and 42 weeks gestation, Pregnancy Distress Questionnaire (PDQ) scores between 23 and 40 weeks gestation and neonatal outcomes. RESULTS Concerns about physical symptoms and body image at 35-40 weeks were associated with lower odds of abnormal UAPI (OR 0.826, 95% CI 0.696 to 0.979, p=0.028). PDQ score (OR 1.073, 95% CI 1.012 to 1.137, p=0.017), concerns about birth and the baby (OR 1.143, 95% CI 1.037 to 1.260, p=0.007) and concerns about physical symptoms and body image (OR 1.283, 95% CI 1.070 to 1.538, p=0.007) at 29-34 weeks were associated with higher odds of abnormal MCA PI. Concerns about birth and the baby at 29-34 weeks (OR 1.202, 95% CI 1.018 to 1.421, p=0.030) were associated with higher odds of AEDF. Concerns about physical symptoms and body image at 35-40 weeks were associated with decreased odds of neonatal intensive care unit admission (OR 0.635, 95% CI 0.435 to 0.927, p=0.019). CONCLUSIONS These findings suggest that fetoplacental haemodynamics may be a mechanistic link between maternal prenatal stress and fetal and neonatal well-being, but additional research is required.
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Affiliation(s)
- Terri A Levine
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
- Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Ricardo Segurado
- UCD CSTAR and School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Sean Daly
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael P Geary
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Mairead M Kennelly
- University College Dublin Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Keelin O’Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Alyson Hunter
- Department of Obstetrics and Gynaecology, Royal Jubilee Maternity Hospital, Belfast, Northern Ireland
| | - John J Morrison
- Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland
| | - Gerard Burke
- Department of Obstetrics and Gynaecology, Mid-Western Regional Maternity Hospital, Limerick, Ireland
| | - Patrick Dicker
- Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elizabeth C Tully
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergal D Malone
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona A Alderdice
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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109
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O’Donnell KJ, Glover V, Lahti J, Lahti M, Edgar RD, Räikkönen K, O’Connor TG. Maternal prenatal anxiety and child COMT genotype predict working memory and symptoms of ADHD. PLoS One 2017; 12:e0177506. [PMID: 28614354 PMCID: PMC5470664 DOI: 10.1371/journal.pone.0177506] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/30/2017] [Indexed: 12/31/2022] Open
Abstract
Maternal prenatal anxiety is an important risk factor for altered child neurodevelopment but there is uncertainty concerning the biological mechanisms involved and sources of individual differences in children's responses. We sought to determine the role of functional genetic variation in COMT, which encodes catechol-O-methyltransferase, in the association between maternal prenatal anxiety and child symptoms of ADHD and working memory. We used the prospectively-designed ALSPAC cohort (n = 6,969) for our primary data analyses followed by replication analyses in the PREDO cohort (n = 425). Maternal prenatal anxiety was based on self-report measures; child symptoms of ADHD were collected from 4-15 years of age; working memory was assessed from in-person testing at age 8 years; and genetic variation in COMT at rs4680 was determined in both mothers and children. The association between maternal prenatal anxiety and child attention/hyperactivity symptoms and working memory was moderated by the child's rs4680 genotype, with stronger effects obtained for the val/val (G:G) genotype relative to val/met (A:G) (all p<0.01) and met/met (A:A) groups (all p<0.05). Similar findings were observed in the PREDO cohort where maternal prenatal anxiety interacted with child rs4680 to predict symptoms of ADHD at 3.5 years of age. The findings, from two cohorts, show a robust gene-environment interaction, which may contribute to inter-individual differences in the effects of maternal prenatal anxiety on developmental outcomes from childhood to mid-adolescence.
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Affiliation(s)
- Kieran J. O’Donnell
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Centre, Department of Psychiatry, McGill University, Montreal, Canada
- Child and Brain Development Program, Canadian Institute for Advanced Research, Toronto, Canada
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
- Helsinki Collegium for Advanced Studies, University of Helsinki, Finland
| | - Marius Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
- Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Rachel D. Edgar
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
- Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Thomas G. O’Connor
- Wynne Center for Family Research, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States of America
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110
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Buss C, Entringer S, Moog NK, Toepfer P, Fair DA, Simhan HN, Heim CM, Wadhwa PD. Intergenerational Transmission of Maternal Childhood Maltreatment Exposure: Implications for Fetal Brain Development. J Am Acad Child Adolesc Psychiatry 2017; 56:373-382. [PMID: 28433086 PMCID: PMC5402756 DOI: 10.1016/j.jaac.2017.03.001] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Growing evidence suggests the deleterious consequences of exposure to childhood maltreatment (CM) not only might endure over the exposed individual's lifespan but also might be transmitted across generations. The time windows, mechanisms, and targets of such intergenerational transmission are poorly understood. The prevailing paradigm posits that mother-to-child transmission of the effects of maternal CM likely occurs after her child's birth. The authors seek to extend this paradigm and advance a transdisciplinary framework that integrates the concepts of biological embedding of life experiences and fetal origins of health and disease risk. METHOD The authors posit that the period of embryonic and fetal life represents a particularly sensitive time for intergenerational transmission; that the developing brain represents a target of particular interest; and that stress-sensitive maternal-placental-fetal biological (endocrine, immune) pathways represent leading candidate mechanisms of interest. RESULTS The plausibility of this model is supported by theoretical considerations and empirical findings in humans and animals. The authors synthesize several research areas and identify important knowledge gaps that might warrant further study. CONCLUSION The scientific and public health relevance of this effort relates to achieving a better understanding of the "when," "what," and "how" of intergenerational transmission of CM, with implications for early identification of risk, prevention, and intervention.
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Affiliation(s)
- Claudia Buss
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH); the University of California-Irvine; and the University of California-Irvine Development, Health and Disease Research Program, Orange, CA.
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111
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Wen DJ, Poh JS, Ni SN, Chong YS, Chen H, Kwek K, Shek LP, Gluckman PD, Fortier MV, Meaney MJ, Qiu A. Influences of prenatal and postnatal maternal depression on amygdala volume and microstructure in young children. Transl Psychiatry 2017; 7:e1103. [PMID: 28440816 PMCID: PMC5416711 DOI: 10.1038/tp.2017.74] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 02/07/2023] Open
Abstract
Maternal depressive symptoms influence neurodevelopment in the offspring. Such effects may appear to be gender-dependent. The present study examined contributions of prenatal and postnatal maternal depressive symptoms to the volume and microstructure of the amygdala in 4.5-year-old boys and girls. Prenatal maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) at 26 weeks of gestation. Postnatal maternal depression was assessed at 3 months using the EPDS and at 1, 2, 3 and 4.5 years using the Beck's Depression Inventory-II. Structural magnetic resonance imaging and diffusion tensor imaging were performed with 4.5-year-old children to extract the volume and fractional anisotropy (FA) values of the amygdala. Our results showed that greater prenatal maternal depressive symptoms were associated with larger right amygdala volume in girls, but not in boys. Increased postnatal maternal depressive symptoms were associated with higher right amygdala FA in the overall sample and girls, but not in boys. These results support the role of variation in right amygdala structure in transmission of maternal depression to the offspring, particularly to girls. The differential effects of prenatal and postnatal maternal depressive symptoms on the volume and FA of the right amygdala suggest the importance of the timing of exposure to maternal depressive symptoms in brain development of girls. This further underscores the need for intervention targeting both prenatal and postnatal maternal depression to girls in preventing adverse child outcomes.
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Affiliation(s)
- D J Wen
- Department of Biomedical Engineering, Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
| | - J S Poh
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - S N Ni
- Department of Biomedical Engineering, Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
| | - Y-S Chong
- Singapore Institute for Clinical Sciences, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - H Chen
- KK Women's and Children's Hospital, Singapore, Singapore
| | - K Kwek
- KK Women's and Children's Hospital, Singapore, Singapore
| | - L P Shek
- Department of Pediatrics, Khoo Teck Puat – National University Children's Medical Institute, National University of Singapore, Singapore, Singapore
| | - P D Gluckman
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - M V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - M J Meaney
- Singapore Institute for Clinical Sciences, Singapore, Singapore
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Sackler Program for Epigenetics and Psychobiology at McGill University, Montreal, QC, Canada
| | - A Qiu
- Department of Biomedical Engineering, Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Singapore, Singapore
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112
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Newman L, Judd F, Komiti A. Developmental implications of maternal antenatal anxiety mechanisms and approaches to intervention. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/20017022.2017.1309879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Louise Newman
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Fiona Judd
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Angela Komiti
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- Centre for Women’s Mental Health, The Royal Women’s Hospital, Parkville, VIC, Australia
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113
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Maschietto M, Bastos LC, Tahira AC, Bastos EP, Euclydes VLV, Brentani A, Fink G, de Baumont A, Felipe-Silva A, Francisco RPV, Gouveia G, Grisi SJFE, Escobar AMU, Moreira-Filho CA, Polanczyk GV, Miguel EC, Brentani H. Sex differences in DNA methylation of the cord blood are related to sex-bias psychiatric diseases. Sci Rep 2017; 7:44547. [PMID: 28303968 PMCID: PMC5355991 DOI: 10.1038/srep44547] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/10/2017] [Indexed: 12/19/2022] Open
Abstract
Sex differences in the prevalence of psychiatric disorders are well documented, with exposure to stress during gestation differentially impacting females and males. We explored sex-specific DNA methylation in the cord blood of 39 females and 32 males born at term and with appropriate weight at birth regarding their potential connection to psychiatric outcomes. Mothers were interviewed to gather information about environmental factors (gestational exposure) that could interfere with the methylation profiles in the newborns. Bisulphite converted DNA was hybridized to Illumina HumanMethylation450 BeadChips. Excluding XYS probes, there were 2,332 differentially methylated CpG sites (DMSs) between sexes, which were enriched within brain modules of co-methylated CpGs during brain development and also differentially methylated in the brains of boys and girls. Genes associated with the DMSs were enriched for neurodevelopmental disorders, particularly for CpG sites found differentially methylated in brain tissue between patients with schizophrenia and controls. Moreover, the DMS had an overlap of 890 (38%) CpG sites with a cohort submitted to toxic exposition during gestation. This study supports the evidences that sex differences in DNA methylation of autosomes act as a primary driver of sex differences that are found in psychiatric outcomes.
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Affiliation(s)
- Mariana Maschietto
- Brazilian Biosciences National Laboratory (LNBio), Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, Brazil
| | | | | | | | | | - Alexandra Brentani
- Department of Pediatrics, University of São Paulo Medical School, SP, Brazil
| | - Günther Fink
- Department of Global Health and Population, Harvard School of Public Health, USA
| | | | | | | | - Gisele Gouveia
- Institute of Psychiatry, University of São Paulo Medical School, SP, Brazil
| | | | | | | | | | | | - Helena Brentani
- Institute of Psychiatry, University of São Paulo Medical School, SP, Brazil
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114
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Chen PJ, Yang L, Chou CC, Li CC, Chang YC, Liaw JJ. Effects of prenatal yoga on women's stress and immune function across pregnancy: A randomized controlled trial. Complement Ther Med 2017; 31:109-117. [PMID: 28434463 DOI: 10.1016/j.ctim.2017.03.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/18/2016] [Accepted: 03/06/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The effects of prenatal yoga on biological indicators have not been widely studied. Thus, we compared changes in stress and immunity salivary biomarkers from 16 to 36 weeks' gestation between women receiving prenatal yoga and those receiving routine prenatal care. DESIGN For this longitudinal, prospective, randomized controlled trial, we recruited 94 healthy pregnant women at 16 weeks' gestation through convenience sampling from a prenatal clinic in Taipei. Participants were randomly assigned to intervention (n=48) or control (n=46) groups using Clinstat block randomization. INTERVENTION The 20-week intervention comprised two weekly 70-min yoga sessions led by a midwife certified as a yoga instructor; the control group received only routine prenatal care. MAIN OUTCOME MEASURES In both groups, participants' salivary cortisol and immunoglobulin A levels were collected before and after yoga every 4 weeks from 16 to 36 weeks' gestation. RESULTS The intervention group had lower salivary cortisol (p<0.001) and higher immunoglobulin A (p<0.001) levels immediately after yoga than the control group. Specifically, the intervention group had significantly higher long-term salivary immunoglobulin A levels than the control group (p=0.018), and infants born to women in the intervention group weighed more than those born to the control group (p<0.001). CONCLUSION Prenatal yoga significantly reduced pregnant women's stress and enhanced their immune function. Clinicians should learn the mechanisms of yoga and its effects on pregnant women. Our findings can guide clinicians to help pregnant women alleviate their stress and enhance their immune function.
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Affiliation(s)
- Pao-Ju Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, 11490, Taiwan, ROC; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, 32544, Taiwan, ROC.
| | - Luke Yang
- Department of Social Welfare, Hsuan Chuang University, Hsinchu, 30092, Taiwan, ROC.
| | - Cheng-Chen Chou
- School of Nursing, Taipei Medical University, Taipei, 110, Taiwan, ROC.
| | - Chia-Chi Li
- School of Nursing, National Defense Medical Center, Taipei, 11490, Taiwan, ROC.
| | - Yu-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei, 25137, Taiwan, ROC.
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei, 11490, Taiwan, ROC.
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115
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Moog NK, Entringer S, Heim C, Wadhwa PD, Kathmann N, Buss C. Influence of maternal thyroid hormones during gestation on fetal brain development. Neuroscience 2017; 342:68-100. [PMID: 26434624 PMCID: PMC4819012 DOI: 10.1016/j.neuroscience.2015.09.070] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/22/2015] [Accepted: 09/25/2015] [Indexed: 01/09/2023]
Abstract
Thyroid hormones (THs) play an obligatory role in many fundamental processes underlying brain development and maturation. The developing embryo/fetus is dependent on maternal supply of TH. The fetal thyroid gland does not commence TH synthesis until mid gestation, and the adverse consequences of severe maternal TH deficiency on offspring neurodevelopment are well established. Recent evidence suggests that even more moderate forms of maternal thyroid dysfunction, particularly during early gestation, may have a long-lasting influence on child cognitive development and risk of neurodevelopmental disorders. Moreover, these observed alterations appear to be largely irreversible after birth. It is, therefore, important to gain a better understanding of the role of maternal thyroid dysfunction on offspring neurodevelopment in terms of the nature, magnitude, time-specificity, and context-specificity of its effects. With respect to the issue of context specificity, it is possible that maternal stress and stress-related biological processes during pregnancy may modulate maternal thyroid function. The possibility of an interaction between the thyroid and stress systems in the context of fetal brain development has, however, not been addressed to date. We begin this review with a brief overview of TH biology during pregnancy and a summary of the literature on its effect on the developing brain. Next, we consider and discuss whether and how processes related to maternal stress and stress biology may interact with and modify the effects of maternal thyroid function on offspring brain development. We synthesize several research areas and identify important knowledge gaps that may warrant further study. The scientific and public health relevance of this review relates to achieving a better understanding of the timing, mechanisms and contexts of thyroid programing of brain development, with implications for early identification of risk, primary prevention and intervention.
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Affiliation(s)
- N K Moog
- Department of Medical Psychology, Charité University Medicine Berlin, Luisenstrasse 57, 10117 Berlin, Germany
| | - S Entringer
- Department of Medical Psychology, Charité University Medicine Berlin, Luisenstrasse 57, 10117 Berlin, Germany; University of California, Irvine, Development, Health, and Disease Research Program, 333 The City Drive West, Suite 1200, Orange, CA 92868, USA; Department of Pediatrics, University of California, Irvine, School of Medicine, 505 South Main Street, Suite 525, Orange, CA 92868, USA
| | - C Heim
- Department of Medical Psychology, Charité University Medicine Berlin, Luisenstrasse 57, 10117 Berlin, Germany; Department of Biobehavioral Health, Pennsylvania State University, College of Health and Human Development, 219 Biobehavioral Health Building, University Park, PA 16802, USA
| | - P D Wadhwa
- University of California, Irvine, Development, Health, and Disease Research Program, 333 The City Drive West, Suite 1200, Orange, CA 92868, USA; Department of Pediatrics, University of California, Irvine, School of Medicine, 505 South Main Street, Suite 525, Orange, CA 92868, USA; Department of Psychiatry and Human Behavior, University of California, Irvine, School of Medicine, 3117 Gillespie Neuroscience Research Facility, 837 Health Sciences Drive, Irvine, CA 92697, USA; Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, 3117 Gillespie Neuroscience Research Facility, 837 Health Sciences Drive, Irvine, CA 92697, USA; Department of Epidemiology, University of California, Irvine, School of Medicine, 3117 Gillespie Neuroscience Research Facility, 837 Health Sciences Drive, Irvine, CA 92697, USA
| | - N Kathmann
- Department of Clinical Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - C Buss
- Department of Medical Psychology, Charité University Medicine Berlin, Luisenstrasse 57, 10117 Berlin, Germany; University of California, Irvine, Development, Health, and Disease Research Program, 333 The City Drive West, Suite 1200, Orange, CA 92868, USA; Department of Pediatrics, University of California, Irvine, School of Medicine, 505 South Main Street, Suite 525, Orange, CA 92868, USA.
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116
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Cytokine profile and maternal depression and anxiety symptoms in mid-pregnancy-the FinnBrain Birth Cohort Study. Arch Womens Ment Health 2017; 20:39-48. [PMID: 27699637 DOI: 10.1007/s00737-016-0672-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/19/2016] [Indexed: 12/13/2022]
Abstract
Maternal prenatal psychological symptoms are associated with child health outcomes, e.g., atopic diseases. Altered prenatal functioning of the immune system is a potential mechanism linking maternal symptoms with child health. Research on prenatal distress and cytokines is warranted. The study population comprised consecutive N = 139 women from a general population-based FinnBrain Birth Cohort Study. Standardized questionnaires for depressive, overall anxiety, and pregnancy-related anxiety symptoms were used. Serum concentrations of selected cytokines were analyzed using Multiplex bead arrays from samples drawn at the gestational week 24. The concentrations of T helper (Th)2-related interleukins (IL)-9 and IL-13 and Th1-related IL-12 correlated positively with prenatal depressive and overall anxiety symptom scores (p values, range 0.011-0.029). Higher interferon (IFN)-γ/IL-4 ratio (p = 0.039) and Th2-related IL-5 (p = 0.007) concentration correlated positively with depressive symptoms. Pregnancy-related anxiety score correlated positively with IL-12 (p = 0.041), IL-13 (p = 0.025), and anti-inflammatory IL-10 (p = 0.048) concentrations. IL-6 and TNF-α concentrations were unrelated to prenatal symptoms. As a novel finding, we observed positive correlations between concentrations of potentially proallergenic cytokines and maternal prenatal psychological symptoms. Different symptom measures may yield distinct cytokine responses. This provides hypotheses for studies on mechanisms bridging prenatal stress and child health.
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117
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Scheinost D, Sinha R, Cross SN, Kwon SH, Sze G, Constable RT, Ment LR. Does prenatal stress alter the developing connectome? Pediatr Res 2017; 81:214-226. [PMID: 27673421 PMCID: PMC5313513 DOI: 10.1038/pr.2016.197] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/30/2016] [Indexed: 12/22/2022]
Abstract
Human neurodevelopment requires the organization of neural elements into complex structural and functional networks called the connectome. Emerging data suggest that prenatal exposure to maternal stress plays a role in the wiring, or miswiring, of the developing connectome. Stress-related symptoms are common in women during pregnancy and are risk factors for neurobehavioral disorders ranging from autism spectrum disorder, attention deficit hyperactivity disorder, and addiction, to major depression and schizophrenia. This review focuses on structural and functional connectivity imaging to assess the impact of changes in women's stress-based physiology on the dynamic development of the human connectome in the fetal brain.
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Affiliation(s)
- Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Rajita Sinha
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Child Study, Yale School of Medicine, New Haven, Connecticut,Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut
| | - Sarah N. Cross
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Soo Hyun Kwon
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Gordon Sze
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - R. Todd Constable
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut,Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Laura R. Ment
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut,Department of Neurology, Yale School of Medicine, New Haven, Connecticut,()
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118
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Prenatal anxiety, maternal stroking in infancy, and symptoms of emotional and behavioral disorders at 3.5 years. Eur Child Adolesc Psychiatry 2017; 26:325-334. [PMID: 27464490 PMCID: PMC5323471 DOI: 10.1007/s00787-016-0886-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 06/28/2016] [Indexed: 12/27/2022]
Abstract
Animal findings of long-term effects of maternal behaviors mediated via altered GR gene expression will, if translated into humans, have far reaching implications for our understanding of child and adolescent psychopathology. We have previously shown that mothers' self-reported stroking of their infants modifies associations between prenatal depression and anxiety and child outcomes at 29 weeks and 2.5 years. Here, we examine whether the effect of early maternal stroking is evident at 3.5 years, and in a much larger sample than in previous publications. A general population sample of 1233 first-time mothers completed anxiety measures at 20 weeks gestation, 865 reported on infant stroking at 9 weeks, and 813 on child symptoms at 3.5 years. Maternal stroking moderated the association between pregnancy-specific anxiety and internalizing (p = 0.010) and externalizing (p = 0.004) scores, such that an effect of PSA to increase symptoms was markedly reduced for mothers who reported high levels of stroking. There was no effect of maternal stroking on general anxiety. The findings confirm the previously reported effect of maternal stroking, and in a much larger sample. They indicate that there are long-term effects of early maternal stroking, modifying associations between prenatal anxiety and child emotional and behavioral symptoms.
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119
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Toepfer P, Heim C, Entringer S, Binder E, Wadhwa P, Buss C. Oxytocin pathways in the intergenerational transmission of maternal early life stress. Neurosci Biobehav Rev 2016; 73:293-308. [PMID: 28027955 DOI: 10.1016/j.neubiorev.2016.12.026] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/08/2016] [Accepted: 12/17/2016] [Indexed: 12/17/2022]
Abstract
Severe stress in early life, such as childhood abuse and neglect, constitutes a major risk factor in the etiology of psychiatric disorders and somatic diseases. Importantly, these long-term effects may impact the next generation. The intergenerational transmission of maternal early life stress (ELS) may occur via pre-and postnatal pathways, such as alterations in maternal-fetal-placental stress physiology, maternal depression during pregnancy and postpartum, as well as impaired mother-offspring interactions. The neuropeptide oxytocin (OT) has gained considerable attention for its role in modulating all of these assumed transmission pathways. Moreover, central and peripheral OT signaling pathways are highly sensitive to environmental exposures and may be compromised by ELS with implications for these putative transmission mechanisms. Together, these data suggest that OT pathways play an important role in the intergenerational transmission of maternal ELS in humans. By integrating recent studies on gene-environment interactions and epigenetic modifications in OT pathway genes, the present review aims to develop a conceptual framework of intergenerational transmission of maternal ELS that emphasizes the role of OT.
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Affiliation(s)
- Philipp Toepfer
- Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany
| | - Christine Heim
- Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany; Department of Biobehavioral Health, Penn State University, 219 Biobehavioral Health Building University Park, PA, 16802, USA
| | - Sonja Entringer
- Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany; UC Irvine Development, Health and Disease Research Program, 333 The City Blvd. W, Suite 810, Orange, CA, 92868, USA
| | - Elisabeth Binder
- Max-Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804, Munich, Germany; Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, School of Medicine Atlanta, GA, 30307, USA
| | - Pathik Wadhwa
- UC Irvine Development, Health and Disease Research Program, 333 The City Blvd. W, Suite 810, Orange, CA, 92868, USA
| | - Claudia Buss
- Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany; UC Irvine Development, Health and Disease Research Program, 333 The City Blvd. W, Suite 810, Orange, CA, 92868, USA.
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120
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Rondó PHC, Ferreira RF, Lemos JO, Pereira-Freire JA. Mental disorders in pregnancy and 5-8 years after delivery. Glob Ment Health (Camb) 2016; 3:e31. [PMID: 28596899 PMCID: PMC5454791 DOI: 10.1017/gmh.2016.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/14/2016] [Accepted: 10/08/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Even though mental disorders represent a major public health problem for women and respective children, there remains a lack of epidemiological longitudinal studies to assess the psychological status of women throughout pregnancy and later in life. This epidemiological cohort study assessed the relationship between mental disorders of 409 Brazilian women in pregnancy and 5-8 years after delivery. METHODS The women were followed from 1997 to 2000 at 17 health services, and subsequently from 2004 to 2006 at their homes. Mental disorders were investigated by the Perceived Stress Scale-PSS, General Health Questionnaire-GHQ and State-Trait Anxiety Inventories-STAI. The relationship between scores of the PSS, GHQ and STAI 5-8 years after delivery and in pregnancy was assessed by multivariate linear regression analysis, controlling for the following confounders: maternal age, education, per capita income, family size, work, marital status and body mass index. RESULTS Scores of the PSS, GHQ and STAI 5-8 years after delivery were positively associated with scores of the PSS, GHQ and STAI in the three trimesters of pregnancy, and inversely associated with maternal age and per capita income (adj. R2 varied from 0.15 to 0.37). PSS, GHQ and STAI scores in the 3rd trimester of pregnancy were positively associated with scores of the PSS, GHQ and STAI in the 1st and 2nd trimesters of pregnancy (adj. R2 varied from 0.31 to 0.65). CONCLUSIONS The results of this study reinforce the urgency to integrate mental health screening into routine primary care for pregnant and postpartum women.
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Affiliation(s)
- P. H. C. Rondó
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr Arnaldo 715, São Paulo, CEP: 01246-904, Brazil
| | - R. F. Ferreira
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr Arnaldo 715, São Paulo, CEP: 01246-904, Brazil
| | - J. O. Lemos
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr Arnaldo 715, São Paulo, CEP: 01246-904, Brazil
| | - J. A. Pereira-Freire
- Federal University of Piauí, Campus Senador Helvídio Nunes de Barros, Rua Cícero Eduardo s/n, Bairro Junco, Picos PI, CEP: 64600-000, Brazil
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121
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Faa G, Manchia M, Pintus R, Gerosa C, Marcialis MA, Fanos V. Fetal programming of neuropsychiatric disorders. ACTA ACUST UNITED AC 2016; 108:207-223. [DOI: 10.1002/bdrc.21139] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Gavino Faa
- Division of Pathology, Department of Surgery; University Hospital San Giovanni di Dio; Cagliari Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine; University of Cagliari; Cagliari Italy
- Department of Pharmacology; Dalhousie University; Halifax Nova Scotia Canada
| | - Roberta Pintus
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
| | - Clara Gerosa
- Division of Pathology, Department of Surgery; University Hospital San Giovanni di Dio; Cagliari Italy
| | - Maria Antonietta Marcialis
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
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122
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Levine TA, Alderdice FA, Grunau RE, McAuliffe FM. Prenatal stress and hemodynamics in pregnancy: a systematic review. Arch Womens Ment Health 2016; 19:721-39. [PMID: 27329120 DOI: 10.1007/s00737-016-0645-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
Maternal prenatal stress is associated with preterm birth, intrauterine growth restriction, and developmental delay. However, the impact of prenatal stress on hemodynamics during pregnancy remains unclear. This systematic review was conducted in order to assess the quality of the evidence available to date regarding the relationship between prenatal stress and maternal-fetal hemodynamics. The PubMed/Medline, EMBASE, PsycINFO, Maternity and Infant Care, Trip, Cochrane Library, and CINAHL databases were searched using the search terms pregnancy; stress; fetus; blood; Doppler; ultrasound. Studies were eligible for inclusion if prenatal stress was assessed with standardized measures, hemodynamics was measured with Doppler ultrasound, and methods were adequately described. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-accepted quality appraisal guidelines. Of 2532 studies reviewed, 12 met the criteria for inclusion. Six reported that prenatal stress significantly affects maternal or fetal hemodynamics; six found no significant association between maternal stress and circulation. Significant relationships between prenatal stress and uterine artery resistance (RI) and pulsatility (PI) indices, umbilical artery RI, PI, and systolic/diastolic ratio, fetal middle cerebral artery PI, cerebroplacental ratio, and umbilical vein volume blood flow were found. To date, there is limited evidence that prenatal stress is associated with changes in circulation. More carefully designed studies with larger sample sizes, repeated assessments across gestation, tighter control for confounding factors, and measures of pregnancy-specific stress will clarify this relationship.
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Affiliation(s)
- Terri A Levine
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Fiona A Alderdice
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Ruth E Grunau
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Child and Family Research Institute, Vancouver, Canada
| | - Fionnuala M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Northern Ireland.
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Wallensteen L, Zimmermann M, Thomsen Sandberg M, Gezelius A, Nordenström A, Hirvikoski T, Lajic S. Sex-Dimorphic Effects of Prenatal Treatment With Dexamethasone. J Clin Endocrinol Metab 2016; 101:3838-3846. [PMID: 27482827 DOI: 10.1210/jc.2016-1543] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Dexamethasone (DEX) is used to prevent virilization in female fetuses at risk of congenital adrenal hyperplasia (CAH). Given that treatment has to be started before the genotype is known, 7 out of 8 fetuses will be exposed to DEX without benefit. OBJECTIVE To evaluate long-term cognitive effects of prenatal DEX therapy in healthy (non-CAH) DEX-treated children. DESIGN AND SETTING Observational study with patient and control groups from a single research institute. PARTICIPANTS Healthy (non-CAH) DEX-treated subjects (n = 34) and untreated population controls (n = 66) from Sweden, aged 7-17 years. INTERVENTION DEX-treatment used in unborn children at risk of CAH, during first trimester of fetal life. MAIN OUTCOME MEASURES Standardized neuropsychological tests and questionnaires were used. RESULTS DEX treatment has widespread negative effects in girls. In Wechsler Intelligence Scales for Children-III scale subtests, we observed significant interactions between DEX and GENDER (coding, P = .044; block design, P = .013; vocabulary, P = .025) and a trend for the subtest digit span (P = .074). All interactions were driven by DEX effects in girls, but not boys, with DEX-treated females showing lower scores than female untreated controls (coding, P = .068, d = 0.66; block design, P = .021, d = 0.81; vocabulary, P = .014, d = 0.84; digit span, P = .001, d = 1.0). Likewise, DEX-treated girls tend to have poorer visual spatial working memory performance than controls (span board test forward: P = .065, d = .80). We observed no effects on long-term memory, handedness, speed of processing, nor self-perceived or parentally reported scholastic performance. CONCLUSIONS Early prenatal DEX exposure affects cognitive functions in healthy girls, ie, children who do not benefit from the treatment. It can therefore not be considered safe to use this therapy in the context of CAH.
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Affiliation(s)
- Lena Wallensteen
- Department of Women's and Children's Health (L.W., M.Z., M.T.S., A.G., A.N., S.L.), Karolinska Institutet, Pediatric Endocrinology Unit (Q2:08), Karolinska University Hospital, and Department of Women's and Children's Health (T.H.), Karolinska Institutet, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Marius Zimmermann
- Department of Women's and Children's Health (L.W., M.Z., M.T.S., A.G., A.N., S.L.), Karolinska Institutet, Pediatric Endocrinology Unit (Q2:08), Karolinska University Hospital, and Department of Women's and Children's Health (T.H.), Karolinska Institutet, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Malin Thomsen Sandberg
- Department of Women's and Children's Health (L.W., M.Z., M.T.S., A.G., A.N., S.L.), Karolinska Institutet, Pediatric Endocrinology Unit (Q2:08), Karolinska University Hospital, and Department of Women's and Children's Health (T.H.), Karolinska Institutet, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Anton Gezelius
- Department of Women's and Children's Health (L.W., M.Z., M.T.S., A.G., A.N., S.L.), Karolinska Institutet, Pediatric Endocrinology Unit (Q2:08), Karolinska University Hospital, and Department of Women's and Children's Health (T.H.), Karolinska Institutet, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Anna Nordenström
- Department of Women's and Children's Health (L.W., M.Z., M.T.S., A.G., A.N., S.L.), Karolinska Institutet, Pediatric Endocrinology Unit (Q2:08), Karolinska University Hospital, and Department of Women's and Children's Health (T.H.), Karolinska Institutet, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Tatja Hirvikoski
- Department of Women's and Children's Health (L.W., M.Z., M.T.S., A.G., A.N., S.L.), Karolinska Institutet, Pediatric Endocrinology Unit (Q2:08), Karolinska University Hospital, and Department of Women's and Children's Health (T.H.), Karolinska Institutet, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Svetlana Lajic
- Department of Women's and Children's Health (L.W., M.Z., M.T.S., A.G., A.N., S.L.), Karolinska Institutet, Pediatric Endocrinology Unit (Q2:08), Karolinska University Hospital, and Department of Women's and Children's Health (T.H.), Karolinska Institutet, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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Dunkel Schetter C, Niles AN, Guardino CM, Khaled M, Kramer MS. Demographic, Medical, and Psychosocial Predictors of Pregnancy Anxiety. Paediatr Perinat Epidemiol 2016; 30:421-9. [PMID: 27221458 DOI: 10.1111/ppe.12300] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pregnancy anxiety is associated with risk of preterm birth and an array of other birth, infant, and childhood outcomes. However, previous research has not helped identify those pregnant women at greatest risk of experiencing this specific, contextually-based affective condition. METHODS We examined associations between demographic, medical, and psychosocial factors and pregnancy anxiety at 24-26 weeks of gestation in a prospective, multicentre cohort study of 5271 pregnant women in Montreal, Canada. RESULTS Multivariate analyses indicated that higher pregnancy anxiety was independently related to having an unintended pregnancy, first birth, higher medical risk, and higher perceived risk of complications. Among psychosocial variables, higher pregnancy anxiety was associated with lower perceived control of pregnancy, lower commitment to the pregnancy, more stressful life events, higher perceived stress, presence of job stress, lower self-esteem and more social support. Pregnancy anxiety was also higher in women who had experienced early income adversity and those who did not speak French as their primary language. Psychosocial variables explained a significant amount of the variance in pregnancy anxiety independently of demographic and medical variables. CONCLUSIONS Women with pregnancy-related risk factors, stress of various kinds, and other psychosocial factors experienced higher pregnancy anxiety in this large Canadian sample. Some of the unique predictors of pregnancy anxiety match those of earlier US studies, while others point in new directions. Screening for high pregnancy anxiety may be warranted, particularly among women giving birth for the first time and those with high-risk pregnancies.
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Affiliation(s)
| | - Andrea N Niles
- Department of Psychology, Univeristy of California, Los Angeles, CA
| | | | - Mona Khaled
- Department of Psychology, Univeristy of California, Los Angeles, CA
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Newman L, Judd F, Olsson CA, Castle D, Bousman C, Sheehan P, Pantelis C, Craig JM, Komiti A, Everall I. Early origins of mental disorder - risk factors in the perinatal and infant period. BMC Psychiatry 2016; 16:270. [PMID: 27473074 PMCID: PMC4966730 DOI: 10.1186/s12888-016-0982-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 07/26/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is increasing understanding of the significance of early neurodevelopment in establishing risk for the range of mental disorders. Models of the early aetiology of mental disorders are complex with a range of potential factors from genetic and epigenetic to environmental influencing neurological and psychological development. Whilst the mechanisms are not fully understood, this paper provides an overview of potential biological and neurobiological factors that might be involved. METHOD An aetiological model is presented and discussed. The discussion includes a range of risk factors for mental disorder. Maternal anxiety disorder is presented and reviewed as an example of the interaction of placental, epigenetic and early parenting factors elevating risk of poor neonatal outcome. RESULTS Available evidence points to the importance of in-utero influences as well as the role of early attachment and emotional care. Transgenerational mechanisms such as the impact of maternal mental disorder on foetal development are important models for examination of early risk. Maternal anxiety, as an example, is a significant risk factor for compromised mental health. CONCLUSIONS Development of models for understanding the early origins of mental disorder is an important step in elaborating risk reduction strategies. Comprehensive early identification of risk raises the possibility of preventive interventions.
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Affiliation(s)
- Louise Newman
- The Centre For Women’s Mental Health, Royal Women’s Hospital, Parkville, Victoria 3015 Australia ,Department of Psychiatry, The University of Melbourne, Parkville, Victoria Australia
| | - Fiona Judd
- The Centre For Women’s Mental Health, Royal Women’s Hospital, Parkville, Victoria 3015 Australia ,Department of Psychiatry, The University of Melbourne, Parkville, Victoria Australia
| | - Craig A. Olsson
- Murdoch Children’s Research Institute, The Royal Children’s Hospital Melbourne, Parkville, Victoria Australia ,Department of Paediatrics, The University of Melbourne, Parkville, Victoria Australia ,Centre for Social & Early Emotional Development, School of Psychology, Deakin University, Geelong, Victoria Australia
| | - David Castle
- Psychiatry, St Vincent’s Hospital Melbourne, Fitzroy, Victoria Australia ,Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria Australia
| | - Chad Bousman
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria Australia ,Department of General Practice, The University of Melbourne, Parkville, Victoria Australia ,Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria Australia ,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Victoria Australia
| | - Penelope Sheehan
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, Parkville, Victoria Australia ,Pregnancy Research Centre, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Christos Pantelis
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria Australia ,Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria Australia ,Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne & Melbourne Health, Parkville, Victoria Australia ,NorthWest Mental Health, Melbourne Health, Parkville, Victoria Australia ,Department of Electrical and Electronic Engineering, Centre for Neural Engineering, The University of Melbourne, Parkville, Victoria Australia
| | - Jeffrey M. Craig
- Murdoch Children’s Research Institute, The Royal Children’s Hospital Melbourne, Parkville, Victoria Australia ,Department of Paediatrics, The University of Melbourne, Parkville, Victoria Australia
| | - Angela Komiti
- The Centre For Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, 3015, Australia. .,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia. .,Department of Psychiatry, The Royal Melbourne Hospital, L1 North, Main Block, Parkville, VIC, 3050, Australia.
| | - Ian Everall
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria Australia ,Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria Australia ,NorthWest Mental Health, Melbourne Health, Parkville, Victoria Australia ,Department of Electrical and Electronic Engineering, Centre for Neural Engineering, The University of Melbourne, Parkville, Victoria Australia
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126
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Nolvi S, Karlsson L, Bridgett DJ, Korja R, Huizink AC, Kataja EL, Karlsson H. Maternal prenatal stress and infant emotional reactivity six months postpartum. J Affect Disord 2016; 199:163-70. [PMID: 27107891 DOI: 10.1016/j.jad.2016.04.020] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Maternal prenatal stress has been related to infant negative affect. However, it is still unclear how different sources of maternal prenatal stress such as depressive, anxiety and pregnancy-specific anxiety symptoms are associated with reactivity outcomes. This study aimed to test the associations between different sources of maternal prenatal stress and the aspects of infant emotional reactivity at six months. METHOD Our study population (n=282) was drawn from the FinnBrain Birth Cohort Study. Prenatal stress was measured by questionnaires on maternal depression, general anxiety and pregnancy-specific anxiety at three time points across pregnancy (gwk 14, 24, 34). Based on the symptom scores, the sample was divided into mothers with high stress during pregnancy (n=110) and mothers with low stress during pregnancy (n=172). Mother-reported infant emotional reactivity and its subscales were measured six months postpartum. RESULTS After controlling for background variables and maternal postnatal symptoms, overall negative emotional reactivity (β=0.20, p<0.01), and its aspects fearfulness (β=0.15, p=.057) and falling reactivity (β=-0.22, p<0.01), were predicted by only pregnancy-specific anxiety. No significant predictors were found for infant positive reactivity after adjusting for confounders. LIMITATIONS Mother reports of both maternal symptoms and infant reactivity were used, which might increase the risk of reporting bias. CONCLUSIONS The findings suggest that mothers experiencing stress should be provided intervention during pregnancy, and that screening should have a particular focus on pregnancy-related worries.
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Affiliation(s)
- Saara Nolvi
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland.
| | - Linnea Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, Turku University Hospital and University of Turku, Finland
| | - David J Bridgett
- Department of Psychology, Northern Illinois University, United States
| | - Riikka Korja
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Psychology, University of Turku, Finland
| | - Anja C Huizink
- Department of Clinical Developmental Psychology, VU University Amsterdam, Netherlands
| | - Eeva-Leena Kataja
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Psychology, University of Turku, Finland
| | - Hasse Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Psychiatry, University of Turku, Finland
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Uguz F. Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach. BRAZILIAN JOURNAL OF PSYCHIATRY 2016; 37:334-42. [PMID: 26692431 DOI: 10.1590/1516-4446-2015-1673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/13/2015] [Indexed: 01/07/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder in the perinatal period. However, specific pharmacological treatment approaches for patients with OCD during pregnancy have not been satisfactorily discussed in the literature. In addition, there are no randomized controlled studies on the treatment of this disorder during pregnancy. The present paper discusses the pharmacological treatment of OCD in the light of data on the safety of antipsychotics and serotonergic antidepressants during pregnancy and their efficacy in the non-perinatal period. Treatment decisions should be individualized because the risk-benefit profile of pharmacotherapy is an important issue in the treatment of pregnant women with any psychiatric diagnosis.
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Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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128
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Winter C, Van Acker F, Bonduelle M, Van Berkel K, Belva F, Liebaers I, Nekkebroeck J. Depression, pregnancy-related anxiety and parental-antenatal attachment in couples using preimplantation genetic diagnosis. Hum Reprod 2016; 31:1288-99. [DOI: 10.1093/humrep/dew074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
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Pearson RM, Bornstein MH, Cordero M, Scerif G, Mahedy L, Evans J, Abioye A, Stein A. Maternal perinatal mental health and offspring academic achievement at age 16: the mediating role of childhood executive function. J Child Psychol Psychiatry 2016; 57:491-501. [PMID: 26616637 PMCID: PMC4789117 DOI: 10.1111/jcpp.12483] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Elucidating risk pathways for under-achieving at school can inform strategies to reduce the number of adolescents leaving school without passing grades in core subjects. Maternal depression can compromise the quality of parental care and is associated with multiple negative child outcomes. However, only a few small studies have investigated the association between perinatal maternal depression and poor academic achievement in adolescence. The pathways to explain the risks are also unclear. METHOD Prospective observational data from 5,801 parents and adolescents taking part in a large UK population cohort (Avon-Longitudinal-Study-of-Parents-and-Children) were used to test associations between maternal and paternal depression and anxiety in the perinatal period, executive function (EF) at age 8, and academic achievement at the end of compulsory school at age 16. RESULTS Adolescents of postnatally depressed mothers were 1.5 times (1.19, 1.94, p = .001) as likely as adolescents of nondepressed mothers to fail to achieve a 'pass' grade in math; antenatal anxiety was also an independent predictor of poor math. Disruption in different components of EF explained small but significant proportions of these associations: attentional control explained 16% (4%, 27%, p < .001) of the association with postnatal depression, and working memory explained 17% (13%, 30%, p = .003) of the association with antenatal anxiety. A similar pattern was seen for language grades, but associations were confounded by maternal education. There was no evidence that paternal factors were independently associated with impaired child EF or adolescent exams. CONCLUSION Maternal postnatal depression and antenatal anxiety are risk factors for adolescents underachieving in math. Preventing, identifying, and treating maternal mental health in the perinatal period could, therefore, potentially increase adolescents' academic achievement. Different aspects of EF partially mediated these associations. Further work is needed, but if these pathways are causal, improving EF could reduce underachievement in math.
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Affiliation(s)
- Rebecca M. Pearson
- School of Social & Community MedicineUniversity of BristolBristolUK,Section of Child & Adolescent PsychiatryDepartment of PsychiatryUniversity of OxfordOxfordUK
| | - Marc H. Bornstein
- Child and Family ResearchEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMDUSA
| | - Miguel Cordero
- School of Social & Community MedicineUniversity of BristolBristolUK
| | - Gaia Scerif
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Liam Mahedy
- Institute of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | - Jonathan Evans
- School of Social & Community MedicineUniversity of BristolBristolUK
| | - Abu Abioye
- Section of Child & Adolescent PsychiatryDepartment of PsychiatryUniversity of OxfordOxfordUK
| | - Alan Stein
- Section of Child & Adolescent PsychiatryDepartment of PsychiatryUniversity of OxfordOxfordUK,School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa
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Negrón-Oyarzo I, Lara-Vásquez A, Palacios-García I, Fuentealba P, Aboitiz F. Schizophrenia and reelin: a model based on prenatal stress to study epigenetics, brain development and behavior. Biol Res 2016; 49:16. [PMID: 26968981 PMCID: PMC4787713 DOI: 10.1186/s40659-016-0076-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 02/22/2016] [Indexed: 11/20/2022] Open
Abstract
Schizophrenia is a severe psychiatric disorder that results in a significant disability for the patient. The disorder is characterized by impairment of the adaptive orchestration of actions, a cognitive function that is mainly dependent on the prefrontal cortex. This behavioral deficit, together with cellular and neurophysiological alterations in the prefrontal cortex, as well as reduced density of GABAergic cells and aberrant oscillatory activity, all indicate structural and functional deficits of the prefrontal cortex in schizophrenia. Among the several risk factors for the development of schizophrenia, stress during the prenatal period has been identified as crucial. Thus, it is proposed that prenatal stress induces neurodevelopmental alterations in the prefrontal cortex that are expressed as cognitive impairment observed in schizophrenia. However, the precise mechanisms that link prenatal stress with the impairment of prefrontal cortex function is largely unknown. Reelin is an extracellular matrix protein involved in the development of cortical neural connectivity at embryonic stages, and in synaptic plasticity at postnatal stages. Interestingly, down-regulation of reelin expression has been associated with epigenetic changes in the reelin gene of the prefrontal cortex of schizophrenic patients. We recently showed that, similar to schizophrenic patients, prenatal stress induces down-expression of reelin associated with the methylation of its promoter in the rodent prefrontal cortex. These alterations were paralleled with altered prefrontal cortex functional connectivity and impairment in prefrontal cortex-dependent behavioral tasks. Therefore, considering molecular, cellular, physiological and behavioral evidence, we propose a unifying framework that links prenatal stress and prefrontal malfunction through epigenetic alterations of the reelin gene.
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Affiliation(s)
- Ignacio Negrón-Oyarzo
- Departamento de Psiquiatría, Escuela de Medicina, and Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ariel Lara-Vásquez
- Departamento de Psiquiatría, Escuela de Medicina, and Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ismael Palacios-García
- Departamento de Psiquiatría, Escuela de Medicina, and Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Fuentealba
- Departamento de Psiquiatría, Escuela de Medicina, and Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Aboitiz
- Departamento de Psiquiatría, Escuela de Medicina, and Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
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Rash JA, Thomas JC, Campbell TS, Letourneau N, Granger DA, Giesbrecht GF. Developmental origins of infant stress reactivity profiles: A multi-system approach. Dev Psychobiol 2016; 58:578-99. [DOI: 10.1002/dev.21403] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/19/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Joshua A. Rash
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Jenna C. Thomas
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Tavis S. Campbell
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Nicole Letourneau
- Faculty of Nursing and Cumming School of Medicine (Pediatrics and Psychiatry); University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
- Alberta Children's Hospital Research Institute; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Douglas A. Granger
- Institute for Interdisciplinary Saliva Bioscience Research; Arizona State University; Tempe AZ 85287
- Bloomberg School of Public Health and School of Medicine; The John Hopkins University School of Nursing; Baltimore MD 21205
| | - Gerald F. Giesbrecht
- Alberta Children's Hospital Research Institute; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
- Department of Pediatrics, Cumming School of Medicine; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
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Bayrampour H, Ali E, McNeil DA, Benzies K, MacQueen G, Tough S. Pregnancy-related anxiety: A concept analysis. Int J Nurs Stud 2016; 55:115-30. [DOI: 10.1016/j.ijnurstu.2015.10.023] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/11/2015] [Accepted: 10/22/2015] [Indexed: 12/20/2022]
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133
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Early-life stress exposure associated with altered prefrontal resting-state fMRI connectivity in young children. Dev Cogn Neurosci 2016; 19:107-14. [PMID: 27010576 PMCID: PMC4912914 DOI: 10.1016/j.dcn.2016.02.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 11/21/2022] Open
Abstract
Relations between early stress exposure (ELS) and brain in childhood are unexamined. We examine the association of ELS to resting-state fMRI in young children. Higher ELS relates to greater ReHo of resting-state fMRI in left prefrontal cortex. ReHo in left prefrontal cortex negatively relates to children's cognitive control. Coupling of left prefrontal with right temporal cortex negatively relates to control. ELS effects are independent of other stress indicators, such as violence exposure. Better understanding of ELS effects on child brain might inspire targeted preventions.
Early-life stress (ELS) exposure is associated with adverse outcomes across the lifespan. We examined the relation of ELS exposure to resting-state fMRI in children ages 4–7 years. ELS in the first years of life, but not concurrent, was associated with higher regional homogeneity of resting-state fMRI in the left lateral frontal cortex. Resting-state fMRI functional connectivity analyses showed that the region of left lateral frontal cortex demonstrating heightened regional homogeneity associated with ELS was negatively correlated with right temporal/parahippocampal areas. Moreover, higher regional homogeneity in the left lateral frontal cortex and its negative coupling with the right middle temporal/parahippocampal areas were associated with poorer performance on a reversal-learning task performed outside the scanner. Association of ELS exposure with regional homogeneity was independent of other early adversities. These findings suggest that ELS may influence the development of cognitive control in the lateral prefrontal cortex and its interactions with temporal cortex.
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134
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Smit M, Dolman KM, Honig A. Mirtazapine in pregnancy and lactation - A systematic review. Eur Neuropsychopharmacol 2016; 26:126-135. [PMID: 26631373 DOI: 10.1016/j.euroneuro.2015.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 05/01/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
Depression is common in pregnancy and associated with increased risk of adverse effects for the neonate. Treatment and prevention options include antidepressant therapy. The aim of this paper was to review the literature on safety of mirtazapine during pregnancy and lactation. In 31 papers a total of 390 cases of neonates exposed to mirtazapine during pregnancy or lactation have been described. There might be an association between mirtazapine and spontaneous abortion, however, this might be attributable to underlying psychiatric disease. An increased risk of major neonatal malformations associated with mirtazapine in pregnancy has not been reported. Although one study showed a nearly significant increase in occurrence of respiratory problems and hypoglycaemia, no indication of causality could be given. No other significant adverse effects on neonates were reported. Limited available data, four papers on 11 exposed neonates, suggest that use of mirtazapine during breastfeeding is safe due to a low relative infant dose. High plasma levels might be associated with increased body weight and sleep. However, the reported data are too scarce to come to a clear assessment of the risk of mirtazapine in lactation. No information is available on the use of mirtazapine in pregnancy and Poor Neonatal Adaptation Syndrome (PNAS) or neurobehavioral development at an age over one year. In conclusion, mirtazapine seems to be safe in pregnancy, especially regarding incidence of congenital malformations. There are not enough data available to come to a conclusion on the safety of mirtazapine during lactation.
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Affiliation(s)
- Mirte Smit
- Department of Paediatrics, OLVG West Medical Center, Amsterdam, The Netherlands
| | - Koert M Dolman
- Department of Paediatrics, OLVG West Medical Center, Amsterdam, The Netherlands
| | - A Honig
- Department of Psychiatry, OLVG West Medical Center /VU Medical Center, Amsterdam, The Netherlands.
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Bowers ME, Yehuda R. Intergenerational Transmission of Stress in Humans. Neuropsychopharmacology 2016; 41:232-44. [PMID: 26279078 PMCID: PMC4677138 DOI: 10.1038/npp.2015.247] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/19/2015] [Accepted: 07/20/2015] [Indexed: 01/03/2023]
Abstract
The hypothesis that offspring are affected by parental trauma or stress exposure, first noted anecdotally, is now supported empirically by data from Holocaust survivor offspring cohorts and other populations. These findings have been extended to less extreme forms of stress, where differential physical, behavioral, and cognitive outcomes are observed in affected offspring. Parental stress-mediated effects in offspring could be explained by genetics or social learning theory. Alternatively, biological variations stemming from stress exposure in parents could more directly have an impact on offspring, a concept we refer to here as 'intergenerational transmission', via changes to gametes and the gestational uterine environment. We further extend this definition to include the transmission of stress to offspring via early postnatal care, as animal studies demonstrate the importance of early maternal care of pups in affecting offsprings' long-term behavioral changes. Here, we review clinical observations in offspring, noting that offspring of stress- or trauma-exposed parents may be at greater risk for physical, behavioral, and cognitive problems, as well as psychopathology. Furthermore, we review findings concerning offspring biological correlates of parental stress, in particular, offspring neuroendocrine, epigenetic, and neuroanatomical changes, in an attempt to determine the extent of parental stress effects. Although understanding the etiology of effects in offspring is currently impeded by methodological constraints, and limitations in our knowledge, we summarize current information and conclude by presenting hypotheses that have been prompted by recent studies in the field.
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Affiliation(s)
- Mallory E Bowers
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, NY, USA,Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Department of Neuroscience, Icahn School of Medicine at Mount, NY, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, James J. Peters Veterans Affairs Medical Center, 526 OOMH PTSD 116/A, JJP VAMC, 130 W Kingsbridge Road, Bronx, NY 10468, USA, Tel: +718 741 4000, ext. 6964, Fax: +718 741 4703, E-mail:
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136
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Entringer S, Buss C, Wadhwa PD. Prenatal stress, development, health and disease risk: A psychobiological perspective-2015 Curt Richter Award Paper. Psychoneuroendocrinology 2015; 62:366-75. [PMID: 26372770 PMCID: PMC4674548 DOI: 10.1016/j.psyneuen.2015.08.019] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 12/14/2022]
Abstract
The long-term consequences of exposure to excess stress, particularly during sensitive developmental windows, on the initiation and progression of many complex, common physical and mental disorders that confer a major global burden of disease are well established. The period of intrauterine life represents among the most sensitive of these windows, at which time the effects of stress may be transmitted inter-generationally from a mother to her as-yet-unborn child. As explicated by the concept of fetal or developmental programming of health and disease susceptibility, a growing body of evidence supports the notion that health and disease susceptibility is determined by the dynamic interplay between genetic makeup and environment, particularly during intrauterine and early postnatal life. Except in extreme cases, an adverse intrauterine exposure may not, per se, 'cause' disease, but, instead, may determine propensity for disease(s) in later life (by shaping phenotypic responsivity to endogenous and exogenous disease-related risk conditions). Accumulating evidence suggests that maternal psychological and social stress during pregnancy represents one such condition that may adversely affect the developing child, with important implications for a diverse range of physical and mental health outcomes. In this paper we review primarily our own contributions to the field of maternal stress during pregnancy and child mental and physical health-related outcomes. We present findings on stress-related maternal-placental-fetal endocrine and immune/inflammatory processes that may mediate the effects of various adverse conditions during pregnancy on the developing human embryo and fetus. We enunciate conceptual and methodological issues related to the assessment of stress during pregnancy and discuss potential mechanisms of intergenerational transmission of the effects of stress. Lastly, we describe on-going research and some future directions of our program.
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Affiliation(s)
- Sonja Entringer
- Department of Medical Psychology, Charité University Medicine Berlin, Luisenstraβe 57, 10117 Berlin, Germany; Departments of Pediatrics, University of California, Irvine, School of Medicine, 3117 Gillespie Neuroscience Research Facility (GNRF), 837 Health Sciences Road Irvine, CA 92697, USA.
| | - Claudia Buss
- Department of Medical Psychology, Charité University Medicine Berlin, Luisenstraβe 57, 10117 Berlin, Germany; Departments of Pediatrics, University of California, Irvine, School of Medicine, 3117 Gillespie Neuroscience Research Facility (GNRF), 837 Health Sciences Road Irvine, CA 92697, USA.
| | - Pathik D. Wadhwa
- Department of Pediatrics, University of California, Irvine, 3117
Gillespie Neuroscience Research Facility (GNRF), 837 Health Sciences Drive, Mail
Code: 4260, Irvine, CA 92697, USA,Department of Obstetrics & Gynecology, University of California,
Irvine, 3117 Gillespie Neuroscience Research Facility (GNRF), 837 Health Sciences
Drive, Mail Code: 4260, Irvine, CA 92697, USA,Department of Epidemiology, University of California, Irvine, 3117
Gillespie Neuroscience Research Facility (GNRF), 837 Health Sciences Drive, Mail
Code: 4260, Irvine, CA 92697, USA,Department of Psychiatry & Human Behavior, University of
California, Irvine, 3117 Gillespie Neuroscience Research Facility (GNRF), 837 Health
Sciences Drive, Mail Code: 4260, Irvine, CA 92697, USA
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137
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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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138
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Kantonen T, Karlsson L, Nolvi S, Karukivi M, Tolvanen M, Karlsson H. Maternal alexithymic traits, prenatal stress, and infant temperament. Infant Behav Dev 2015; 41:12-6. [DOI: 10.1016/j.infbeh.2015.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/25/2015] [Accepted: 06/30/2015] [Indexed: 12/12/2022]
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139
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Punamäki RL, Tiitinen A, Lindblom J, Unkila-Kallio L, Flykt M, Vänskä M, Poikkeus P, Tulppala M. Mental health and developmental outcomes for children born after ART: a comparative prospective study on child gender and treatment type. Hum Reprod 2015; 31:100-7. [DOI: 10.1093/humrep/dev273] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/08/2015] [Indexed: 11/13/2022] Open
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140
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Graham AM, Buss C, Rasmussen JM, Rudolph MD, Demeter DV, Gilmore JH, Styner M, Entringer S, Wadhwa PD, Fair DA. Implications of newborn amygdala connectivity for fear and cognitive development at 6-months-of-age. Dev Cogn Neurosci 2015; 18:12-25. [PMID: 26499255 PMCID: PMC4819011 DOI: 10.1016/j.dcn.2015.09.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 01/06/2023] Open
Abstract
The first year of life is an important period for emergence of fear in humans. While animal models have revealed developmental changes in amygdala circuitry accompanying emerging fear, human neural systems involved in early fear development remain poorly understood. To increase understanding of the neural foundations of human fear, it is important to consider parallel cognitive development, which may modulate associations between typical development of early fear and subsequent risk for fear-related psychopathology. We, therefore, examined amygdala functional connectivity with rs-fcMRI in 48 neonates (M=3.65 weeks, SD=1.72), and measured fear and cognitive development at 6-months-of-age. Stronger, positive neonatal amygdala connectivity to several regions, including bilateral anterior insula and ventral striatum, was prospectively associated with higher fear at 6-months. Stronger amygdala connectivity to ventral anterior cingulate/anterior medial prefrontal cortex predicted a specific phenotype of higher fear combined with more advanced cognitive development. Overall, findings demonstrate unique profiles of neonatal amygdala functional connectivity related to emerging fear and cognitive development, which may have implications for normative and pathological fear in later years. Consideration of infant fear in the context of cognitive development will likely contribute to a more nuanced understanding of fear, its neural bases, and its implications for future mental health.
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Affiliation(s)
- Alice M Graham
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States
| | - Claudia Buss
- Department of Medical Psychology, Charité University of Medicine Berlin, Luisenstrasse 57, 10117 Berlin, Germany; Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, CA 92697, United States.
| | - Jerod M Rasmussen
- Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, CA 92697, United States
| | - Marc D Rudolph
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States
| | - Damion V Demeter
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina, 333 South Columbia Street, Chapel Hill, NC 27514, United States
| | - Martin Styner
- Department of Psychiatry, University of North Carolina, 333 South Columbia Street, Chapel Hill, NC 27514, United States
| | - Sonja Entringer
- Department of Medical Psychology, Charité University of Medicine Berlin, Luisenstrasse 57, 10117 Berlin, Germany; Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, CA 92697, United States
| | - Pathik D Wadhwa
- Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, CA 92697, United States
| | - Damien A Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States; Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States; Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, United States.
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141
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Premji SS, Yim IS, Dosani (Mawji) A, Kanji Z, Sulaiman S, Musana JW, Samia P, Shaikh K, Letourneau N, MiGHT Group. Psychobiobehavioral Model for Preterm Birth in Pregnant Women in Low- and Middle-Income Countries. BIOMED RESEARCH INTERNATIONAL 2015; 2015:450309. [PMID: 26413524 PMCID: PMC4564601 DOI: 10.1155/2015/450309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/03/2015] [Indexed: 12/19/2022]
Abstract
Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in stress responses leading to PTB and explain the basis of this approach. We discuss ethical considerations for a psychosocial, biological, and behavioral screening tool to predict PTB from a LMI country perspective.
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Affiliation(s)
- Shahirose S. Premji
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, Canada T2N 4Z6
| | - Ilona S. Yim
- Department of Psychology and Social Behavior, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - Aliyah Dosani (Mawji)
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, Canada T3E 6K6
| | - Zeenatkhanu Kanji
- School of Nursing and Midwifery, Aga Khan University-East Africa, Opposite Aga Khan Primary School Plot (9/11), Colonel Muammar Gaddafi Road, P.O. Box 8842, Kampala, Uganda
| | - Salima Sulaiman
- School of Nursing and Midwifery, Aga Khan University-Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Joseph W. Musana
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, Aga Khan University-Nairobi, 3rd Parklands Avenue off Limuru Road, P.O. Box 30270, Nairobi 00100, Kenya
| | - Pauline Samia
- Department of Pediatrics, Aga Khan University-Nairobi, 2nd Parklands Avenue, East Tower Block, Room 505, Nairobi 00100, Kenya
| | - Kiran Shaikh
- School of Nursing and Midwifery, Aga Khan University-Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1
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142
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DiPietro JA, Voegtline KM. The gestational foundation of sex differences in development and vulnerability. Neuroscience 2015; 342:4-20. [PMID: 26232714 DOI: 10.1016/j.neuroscience.2015.07.068] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 01/06/2023]
Abstract
Despite long-standing interest in the role of sex on human development, the functional consequences of fetal sex on early development are not well-understood. Here we explore the gestational origins of sex as a moderator of development. In accordance with the focus of this special issue, we examine evidence for a sex differential in vulnerability to prenatal and perinatal risks. Exposures evaluated include those present in the external environment (e.g., lead, pesticides), those introduced by maternal behaviors (e.g., alcohol, opioid use), and those resulting from an adverse intrauterine environment (e.g., preterm birth). We also provide current knowledge on the degree to which sex differences in fetal neurobehavioral development (i.e., cardiac and motor patterns) are present prior to birth. Also considered are contemporaneous and persistent sex of fetus effects on the pregnant woman. Converging evidence confirms that infant and early childhood developmental outcomes of male fetuses exposed to prenatal and perinatal adversities are more highly impaired than those of female fetuses. In certain circumstances, male fetuses are both more frequently exposed to early adversities and more affected by them when exposed than are female fetuses. The mechanisms through which biological sex imparts vulnerability or protection on the developing nervous system are largely unknown. We consider models that implicate variation in maturation, placental functioning, and the neuroendocrine milieu as potential contributors. Many studies use sex as a control variable, some analyze and report main effects for sex, but those that report interaction terms for sex are scarce. As a result, the true scope of sex differences in vulnerability is unknown.
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Affiliation(s)
- J A DiPietro
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - K M Voegtline
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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143
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Abstract
Anxiety disorders and pregnancy may occur concurrently in some women. Although, several epidemiological or clinical studies about anxiety disorders in pregnancy exist, data on their treatment are very limited. Similar to other anxiety disorders, specific pharmacological treatment approaches in pregnant women with panic disorder (PD) have not been discussed in the literature. An important issue in the treatment of pregnant women with any psychiatric diagnosis is the risk-benefit profile of pharmacotherapy. Therefore, the treatment should be individualized. Untreated PD seems to be associated with several negative outcomes in the pregnancy. When the results of current study regarding the safety of pharmacological agents on the fetus and their efficacy in PD were gathered, sertraline, citalopram, imipramine and clomipramine at low doses for pure PD, and venlafaxine appeared to be more favorable than the other potential drugs. However, controlled studies examining optimum dosing, efficacy of antipanic medications and risk-benefit profile of intrauterine exposure to treated or untreated PD are urgently needed.
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Affiliation(s)
- Faruk Uguz
- a Department of Psychiatry, Meram Faculty of Medicine , Necmettin Erbakan University , Konya , Turkey
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144
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Giesbrecht GF, Campbell T, Letourneau N. Sexually dimorphic adaptations in basal maternal stress physiology during pregnancy and implications for fetal development. Psychoneuroendocrinology 2015; 56:168-78. [PMID: 25827961 DOI: 10.1016/j.psyneuen.2015.03.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 12/22/2022]
Abstract
There is clear evidence of reciprocal exchange of information between the mother and fetus during pregnancy but the majority of research in this area has focussed on the fetus as a recipient of signals from the mother. Specifically, physiological signals produced by the maternal stress systems in response to the environment may carry valuable information about the state of the external world. Prenatal stress produces sex-specific adaptations within fetal physiology that have pervasive and long-lasting effects on development. Little is known, however, about the effects of sex-specific fetal signals on maternal adaptations to pregnancy. The current prospective study examined sexually dimorphic adaptations within maternal stress physiology, including the hypothalamic-adrenal-pituitary (HPA) axis and the autonomic nervous system (ANS) and associations with fetal growth. Using diurnal suites of saliva collected in early and late pregnancy, we demonstrate that basal cortisol and salivary alpha-amylase (sAA) differ by fetal sex. Women carrying female fetuses displayed greater autonomic arousal and flatter (but more elevated) diurnal cortisol patterns compared to women carrying males. Women with flatter daytime cortisol trajectories and more blunted sAA awakening responses also had infants with lower birth weight. These maternal adaptations are consistent with sexually dimorphic fetal developmental/evolutionary adaptation strategies that favor growth for males and conservation of resources for females. The findings provide new evidence to suggest that the fetus contributes to maternal HPA axis and ANS regulation during pregnancy and that these systems also contribute to the regulation of fetal growth.
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Affiliation(s)
- Gerald F Giesbrecht
- Department of Paediatrics, University of Calgary, 2888 Shaganappi Trail N.W., Calgary, AB, Canada T3B 6A8; Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada T2N 1N4; Alberta Children's Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive, N.W., Calgary, AB, Canada T2N 4N1.
| | - Tavis Campbell
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada T2N 1N4
| | - Nicole Letourneau
- Department of Paediatrics, University of Calgary, 2888 Shaganappi Trail N.W., Calgary, AB, Canada T3B 6A8; Alberta Children's Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive, N.W., Calgary, AB, Canada T2N 4N1; Faculty of Nursing, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada T2N 1N4
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145
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Doyle C, Werner E, Feng T, Lee S, Altemus M, Isler JR, Monk C. Pregnancy distress gets under fetal skin: Maternal ambulatory assessment & sex differences in prenatal development. Dev Psychobiol 2015; 57:607-25. [PMID: 25945698 DOI: 10.1002/dev.21317] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 04/08/2015] [Indexed: 12/12/2022]
Abstract
Prenatal maternal distress is associated with an at-risk developmental profile, yet there is little fetal evidence of this putative in utero process. Moreover, the biological transmission for these maternal effects remains uncertain. In a study of n = 125 pregnant adolescents (ages 14-19), ambulatory assessments of daily negative mood (anger, frustration, irritation, stress), physical activity, blood pressure, heart rate (every 30 min over 24 hr), and salivary cortisol (six samples) were collected at 13-16, 24-27, 34-37 gestational weeks. Corticotropin-releasing hormone, C-reactive protein, and interleukin 6 from blood draws and 20 min assessments of fetal heart rate (FHR) and movement were acquired at the latter two sessions. On average, fetuses showed development in the expected direction (decrease in FHR, increase in SD of FHR and in the correlation of movement and FHR ("coupling")). Maternal distress characteristics were associated with variations in the level and trajectory of fetal measures, and results often differed by sex. For males, greater maternal 1st and 2nd session negative mood and 2nd session physical activity were associated with lower overall FHR (p < .01), while 1st session cortisol was associated with a smaller increase in coupling (p < .01), and overall higher levels (p = .05)-findings suggesting accelerated development. For females, negative mood, cortisol, and diastolic blood pressure were associated with indications of relatively less advanced and accelerated outcomes. There were no associations between negative mood and biological variables. These data indicate that maternal psychobiological status influences fetal development, with females possibly more variously responsive to different exposures.
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Affiliation(s)
- Colleen Doyle
- Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Elizabeth Werner
- Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Tianshu Feng
- New York State Psychiatric Institute, New York, NY
| | - Seonjoo Lee
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - Margaret Altemus
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Joseph R Isler
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Catherine Monk
- Department of Psychiatry, Columbia University Medical Center, New York, NY. .,New York State Psychiatric Institute, New York, NY. .,Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.
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146
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Bridgett DJ, Burt NM, Edwards ES, Deater-Deckard K. Intergenerational transmission of self-regulation: A multidisciplinary review and integrative conceptual framework. Psychol Bull 2015; 141:602-654. [PMID: 25938878 PMCID: PMC4422221 DOI: 10.1037/a0038662] [Citation(s) in RCA: 313] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review examines mechanisms contributing to the intergenerational transmission of self-regulation. To provide an integrated account of how self-regulation is transmitted across generations, we draw from over 75 years of accumulated evidence, spanning case studies to experimental approaches, in literatures covering developmental, social, and clinical psychology, and criminology, physiology, genetics, and human and animal neuroscience (among others). First, we present a taxonomy of what self-regulation is and then examine how it develops--overviews that guide the main foci of the review. Next, studies supporting an association between parent and child self-regulation are reviewed. Subsequently, literature that considers potential social mechanisms of transmission, specifically parenting behavior, interparental (i.e., marital) relationship behaviors, and broader rearing influences (e.g., household chaos) is considered. Finally, evidence that prenatal programming may be the starting point of the intergenerational transmission of self-regulation is covered, along with key findings from the behavioral and molecular genetics literatures. To integrate these literatures, we introduce the self-regulation intergenerational transmission model, a framework that brings together prenatal, social/contextual, and neurobiological mechanisms (spanning endocrine, neural, and genetic levels, including gene-environment interplay and epigenetic processes) to explain the intergenerational transmission of self-regulation. This model also incorporates potential transactional processes between generations (e.g., children's self-regulation and parent-child interaction dynamics that may affect parents' self-regulation) that further influence intergenerational processes. In pointing the way forward, we note key future directions and ways to address limitations in existing work throughout the review and in closing. We also conclude by noting several implications for intervention work.
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Affiliation(s)
| | - Nicole M Burt
- Department of Psychology, Northern Illinois University
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147
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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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Moncayo R, Ortner K. Multifactorial determinants of cognition - Thyroid function is not the only one. BBA CLINICAL 2015; 3:289-98. [PMID: 26672993 PMCID: PMC4661586 DOI: 10.1016/j.bbacli.2015.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/11/2015] [Accepted: 04/14/2015] [Indexed: 12/31/2022]
Abstract
Background Since the 1960s hypothyroidism together with iodine deficiency have been considered to be a principal determinant of cognition development. Following iodine supplementation programs and improved treatment options for hypothyroidism this relation might not be valid in 2015. On the other hand neurosciences have added different inputs also related to cognition. Scope of review We will examine the characteristics of the original and current publications on thyroid function and cognition and also add some general determinants of intelligence and cognition. One central issue for us is the relation of stress to cognition knowing that both physical and psychological stress, are frequent elements in subjects with thyroid dysfunction. We have considered a special type of stress called pre-natal stress which can influence cognitive functions. Fear and anxiety can be intermingled requiring mechanisms of fear extinction. Major conclusions Recent studies have failed to show an influence of thyroid medication during pregnancy on intellectual development. Neuroscience offers a better explanation of cognition than hypothyroidism and iodine deficiency. Additional factors relevant to cognition are nutrition, infection, prenatal stress, and early life stress. In turn stress is related to low magnesium levels. Magnesium supplementation can correct both latent hypothyroidism and acquired mild cognitive deficits. General significance Cognition is a complex process that depends on many determinants and not only on thyroid function. Magnesium deficiency appears to be a basic mechanism for changes in thyroid function as well as of cognition. Untreated hypothyroidism, i.e. hypothyroxinemia, can influence IQ. Thyroxine administration to euthyroid pregnant women has no effect on cognition. The hippocampus and NMDA receptors play a central role in cognitive processes. Antenatal and early life stressors can influence cognition later in life. Stressors can lead to decreased levels of magnesium and demands supplementation.
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Affiliation(s)
- Roy Moncayo
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Karina Ortner
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
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Abstract
Depression is a common disorder in pregnancy and associated with adverse effects for both mother and neonate. Pharmacological treatment and prevention options include mirtazapine. In a series of 56 cases, we investigated neonatal outcome after intrauterine exposure to mirtazapine and exposure through lactation in the first days postpartum.No increase in any neonatal complication was observed. None of the infants exposed to mirtazapine in the first trimester were born with a major malformation. Of the 54 infants exposed to mirtazapine in the third trimester, 14 were diagnosed with poor neonatal adaptation syndrome (PNAS). This incidence (25.9%) is similar to the incidence of PNAS after intrauterine exposure to other antidepressants. The incidence of PNAS after exposure to mirtazapine was significantly diminished in children who were partially or fully breastfed (18.6% versus 54.5%, P = 0.024).
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Bayrampour H, Salmon C, Vinturache A, Tough S. Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions. J Obstet Gynaecol Res 2015; 41:1040-8. [PMID: 25772686 DOI: 10.1111/jog.12683] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/29/2014] [Indexed: 11/30/2022]
Abstract
AIM The effect of prenatal mental health on the risk of obstetric interventions is unclear. The present study examined the associations between depressive and anxiety symptoms in the second and third trimesters and mode of delivery, epidural use and labor induction in a large community-based pregnancy cohort, in Alberta, Canada. MATERIAL AND METHODS Women who had singleton pregnancies, delivered in hospital, and had medical data were selected (n = 2825). Obstetric intervention data were obtained from the medical records, and depressive and anxiety symptoms were measured by the Edinburgh Postnatal Depression Scale and the Spielberger State Anxiety Inventory. Data were evaluated with multivariate multinomial and logistic regression analyses using a hierarchical modeling. RESULTS After accounting for factors known to increase the risk of each intervention, including demographic variables, smoking, hospital site, gestational age, previous history of cesarean delivery, prepregnancy body mass index, assisted conception, and antepartum risk score, the only mental health variable associated with obstetric interventions was depressive symptoms in the third trimester, which increased the risk of emergency cesarean delivery (adjusted odds ratio, 2.04; 95% confidence interval, 1.26-3.29). No associations were found between antenatal depressive and anxiety symptoms and other obstetric interventions. CONCLUSION The present findings support an association between depressive symptoms and adverse obstetric outcomes and suggest that anxiety and depression may have different effects on obstetric outcomes. Understanding the mechanism in which depression increases the risk of emergency cesarean birth needs further research.
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Affiliation(s)
- Hamideh Bayrampour
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Charleen Salmon
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angela Vinturache
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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