[Effects of stress during pregnancy on infant and child development]

Exploring the impact of prior spontaneous miscarriage on stress among pregnant women during the first trimester: an observational study

BACKGROUND

Spontaneous miscarriage (SM) is the most common complication of pregnancy. Its psychological repercussions are widely documented but few studies have investigated its effect on women's experience of a subsequent pregnancy.

AIM

To evaluate the impact of prior SM on the level of stress experienced by pregnant women during the first trimester of pregnancy.

DESIGN AND SETTING

Cross-sectional, observational study, which was conducted between June and October 2021 in France.

METHOD

A self-report questionnaire was distributed to women in the first trimester of pregnancy. Stress was assessed using the Antenatal Perceived Stress Inventory to yield an overall score and a score for three dimensions ('medical and obstetric risks or fetal health'; 'psychosocial changes during pregnancy'; and the 'prospect of childbirth'). Women with a history of prior SM and those without were compared.

RESULTS

In total, 93 women were included; 63 without and 30 with a history of prior SM. Prior SM was not associated with the overall score. The score for the dimension 'medical and obstetric risks or fetal health' was significantly higher in women with prior SM (3.00±0.86 versus 2.34±0.80; β = 0.61 [95% confidence interval {CI} = 0.25 to 0.96]; P = 0.001). Prior SM was significantly associated with the items 'the baby's health' (P = 0.048) and 'the echography' (P = 0.002).

CONCLUSION

This study shows a significant impact of prior SM on the level of stress of pregnant women during the first trimester, particularly relating to the medical and obstetric risks or fetal health, underlining the need for appropriate psychological support to be provided to women who experience SM.

Sustained social withdrawal behavior and 'difficult' temperament among infants, in relation to maternal affectivity in a low-income area of Kinshasa, Democratic Republic of Congo

Little is known about the relationship between maternal affectivity, social withdrawal and temperament in infants in low-income countries. The goal of the study was to assess the prevalence of social withdrawal behavior in infants aged 8 ± 2.3 months and to explore associations between maternal affectivity during pregnancy and postpartum, infant social withdrawal (as a sign of stress) and 'difficult' temperament as assessed by the mothers. 458 mother-infant dyads were recruited in the city's public mother and child health-care centers. The eight items of the Alarm Distress Baby scale (8-ADBB) and the five-item M (modified) ADBB (M-ADBB) were used to assess sustained withdrawal behavior (ISSWB). The Goldberg Depression and Anxiety Scales were used to assess maternal affectivity and mental well-being. A specially designed questionnaire was used to identify stressful events faced by the mother during pregnancy. The ELDEQ-QCB was used to assess the degree of difficulty in managing the baby. Using the M-ADBB, we found a striking figure of 69.2% for ISSWB with 8-ABB (range 0-29) and 72.7% with the M-ADBB (range 0-10). ISSWB was linked to negative maternal affectivity and to high incidence of stressful events for the mothers, and to the child being viewed as 'difficult' by the mother. Positive prenatal affectivity was a protective factor of ISSWB (OR 0.46). Results are compared with previous studies in Africa. Early screening for ISSWB and identification of factors affecting maternal mental well-being could help in early intervention and increase the chances of better child development.

Sex-specific association of high maternal psychological stress during pregnancy on newborn birthweight

Birthweight is an important predictor of newborn health and has been linked to maternal psychological stress during pregnancy. However, it is unclear whether prenatal stress affects birthweight similarly for both male and female infants. We used a well-established pregnancy cohort to investigate the impact of high maternal psychological stress during pregnancy on birthweight as a function of infant sex. Overall, 5702 mother-newborn pairs were analysed. Of these, 198 mothers reported high levels of stress using the Psychological Stress Measure (nine-items version; PSM-9). Maternal psychological stress was assessed between the 24^th and 28^th week of gestation and analyses were performed jointly and independently as a function of neonatal sex (separate analyses for male and female infants). Newborns exposed to high maternal psychological stress during pregnancy (a score above 26 measured using the PSM-9 questionnaire, corresponding to >97.5^th percentile) were compared to newborns of mothers who reported lower stress. ANCOVAs revealed that high levels of maternal stress during pregnancy were linked to infant birthweight as a function of infant sex. Male infants of mothers who reported high levels of stress had a greater birthweight whereas female infants had a lower birthweight under the same conditions, in comparison to mothers who did not report greater levels of stress. Although the effect size is small, these results underline the possibility that male and female fetuses may use different strategies when adapting to maternal adversity and highlight the need to consider infant sex as a moderator of the association between maternal psychological stress during pregnancy and infant birthweight.

[Maternal affectivity during pregnancy, mother-child relationship, infant´s health and development in Kinshasa]

INTRODUCTION

the impact of prenatal maternal affectivity on infant development is poorly documented in Africa. The purpose of our study is to determine the relationship between mother feelings about pregnancy and childbirth, infant´s behavior and development.

METHODS

one hundred and twenty mothers aged 28,4 years (± 12,18 years) with their babies aged 38,70 months (± 19,19) were enrolled in a cross-sectional study based on an interview and questionnaire on maternal affectivity, mother-child relationship, infant´s behavior and psychosocial development. Maternal depression was assessed by Edinburgh (EPDS), Goldberg Depression and anxiety scales and DSM-IV (MINI) criteria. Chi-square and Mann-Whitney were used to describe the relationship between maternal affectivity and infant's behavior and health.

RESULTS

unintended pregnancy and fear of childbirth were associated with high anxiety and depression scores. Negative feelings about pregnancy were associated with the lack of social support by the child´s father (0.0110), stress when women were pregnant with a frustrated child (p=0.046), difficult consolability (p<0.001), poor baby's health (p=0.010), infant non-affiliative behavior (p=0.034) and depression identified by using EPDS (p=0.028). Fear of childbirth was associated with delayed or absent responses to infant´s signals (p=0.002) and stress if they were carrying a frustrated baby (p=0.020).

CONCLUSION

negative feelings during pregnancy are predictive of maternal depression, mother-child relationship disorders, infant´s health and development.

Factors influencing the quality of life of pregnant women: a systematic review

Background

Pregnancy is a period of transition with important physical and emotional changes. Even in uncomplicated pregnancies, these changes can affect the quality of life (QOL) of pregnant women, affecting both maternal and infant health. The objectives of this study were to describe the quality of life during uncomplicated pregnancy and to assess its associated socio-demographic, physical and psychological factors in developed countries.

Methods

A systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and BDSP (Public Health Database). Two independent reviewers extracted the data. Countries with a human development index over 0.7 were selected. The quality of the articles was evaluated on the basis of the STROBE criteria.

Results

In total, thirty-seven articles were included. While the physical component of QOL decreased throughout pregnancy, the mental component was stable and even showed an improvement during pregnancy. Main factors associated with better QOL were mean maternal age, primiparity, early gestational age, the absence of social and economic problems, having family and friends, doing physical exercise, feeling happiness at being pregnant and being optimistic. Main factors associated with poorer QOL were medically assisted reproduction, complications before or during pregnancy, obesity, nausea and vomiting, epigastralgia, back pain, smoking during the months prior to conception, a history of alcohol dependence, sleep difficulties, stress, anxiety, depression during pregnancy and sexual or domestic violence.

Conclusions

Health-related quality of life refers to the subjective assessment of patients regarding the physical, mental and social dimensions of well-being. Improving the quality of life of pregnant women requires better identification of their difficulties and guidance which offers assistance whenever possible.

Links between early child maltreatment, mental disorders, and cortisol secretion anomalies

Early child maltreatment has been widely associated with the development of mental disorders in both childhood and adulthood. However, such association cannot be systematically established, as only few factors are observed regularly, such as high prevalence of comorbidities and externalized disorders. Similarly, the association between early abuse and cortisol secretion anomalies has been well-documented. Whereas early hypercortisolism followed by hypocortisolism was often described, the results proved inconsistent and at times contradictory. The physiopathological mechanisms are quite complex and varied, including mixed neurotoxicity and stress response anomalies, linked to circadian rhythm disturbances. One of the difficulties inherent to research on this topic is to better define maltreatment in childhood. Studying children's groups at risk of maltreatment, such as children followed by juvenile justice or in child welfare systems, could be a very good tool, provided that social, judiciary, and mental health professionals are able to work together and implement common research objectives.

Retrospective study of factors related to preterm labor in Yasuj, Iran

INTRODUCTION

Premature labor is a serious worldwide problem that can cause neonatal death and other serious disorders. This study aimed to determine the most important factors related to preterm labor in Yasuj, Iran.

METHOD

This case-control study was conducted in the maternity ward of Imam Sajjad Hospital, the obstetrics and gynecology center of Yasuj, in 2010. Among eligible samples, mothers with preterm labor were selected as the case group, and for each sample in the case group, one mother with full-term labor was selected by using clipper-matched sampling to make up the control group. Data were collected by a researcher-made questionnaire and the 28-item General Health Questionnaire. Finally, after deleting imperfect questionnaires, collected data of 52 subjects of case group and the same amount in control group were analyzed.

RESULTS

Among the 5400 live birth infants in Yasuj in 2010, 130 infants were premature (2.4%). The preterm labor risk in women with two or more pregnancies was 5.5 times more than women with less than two pregnancies, its risk in women with low general health status was 2.9 times more than in women with normal general health status, and the preterm labor risk in women with a history of diabetes mellitus/thyroid dysfunction/cardiac disease was 2.3 times more than healthy mothers (P < 0.01).

CONCLUSION

With respect to the above and due to the role and importance of mother-infant health in community health, it is necessary that the health-care system improve health education with regard to the appropriate number of pregnancies, diagnose and cure disease during pregnancy, especially diabetes and cardiovascular disease (hypertension and/or eclampsia), and recognize pregnant mothers with mental pressure or lack of sufficient support and help them.

Neurobehavioral manifestations of developmental impairment of the brain

Individual characteristics of human nature (e.g. introversion, extroversion, mood, activity, adaptability, aggressiveness, social ability, anxiety) do not need to be primarily innate. They can be determined by the action of various influences and their interactions on functional development of the brain. There is ample epidemiological and experimental evidence that chemical and/or physical factors acting during sensitive time windows of the brain development can cause mental, behavioral, emotional and/or cognitive disorders. Environmental pollutants, addictive substances, drugs, malnutrition, excessive stress and/or hypoxia-ischemia were reported to induce functional maldevelopment of the brain with consequent neurobehavioral disorders. The article provides review on most significant neurobehavioral manifestations of developmental impairment of the brain during prenatal, perinatal and early postnatal period. The most known adverse factors causing developmental neurobehavioral dysfunctions in humans as well as in experimental animals are discussed.