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Cattaneo A, Begni V, Zonca V, Riva MA. Early life adversities, psychopathologies and novel pharmacological strategies. Pharmacol Ther 2024; 260:108686. [PMID: 38969307 DOI: 10.1016/j.pharmthera.2024.108686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/05/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024]
Abstract
Exposure to adversities during early life stages (early life adversities - ELA), ranging from pregnancy to adolescence, represents a major risk factor for the vulnerability to mental disorders. Hence, it is important to understand the molecular and functional underpinning of such relationship, in order to develop strategies aimed at reducing the psychopathologic burden associated with ELA, which may eventually lead to a significant improvement in clinical practice. In this review, we will initially recapitulate clinical and preclinical evidence supporting the link between ELA and psychopathology and we will primarily discuss the main biological mechanisms that have been described as potential mediators of the effects of ELA on the psychopathologic risk, including the role for genetic factors as well as sex differences. The knowledge emerging from these studies may be instrumental for the development of novel therapeutic strategies aimed not only at correcting the deficits that emerge from ELA exposure, but also in preventing the manifestation of a full-blown psychopathologic condition. With this respect, we will specifically focus on adolescence as a key time frame for disease onset as well as for early therapeutic intervention. We believe that incorporating clinical and preclinical research data in the context of early life adversities can be instrumental to elucidate the mechanisms contributing to the risk for psychopathology or that may promote resilience. This will ultimately allow the identification of 'at risk' individuals who may benefit from specific forms of interventions that, by interfering with disease trajectories, could result in more benign clinical outcomes.
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Affiliation(s)
- Annamaria Cattaneo
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy; Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Veronica Begni
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy
| | - Valentina Zonca
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy
| | - Marco A Riva
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy; Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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2
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Chen LM, Pokhvisneva I, Lahti-Pulkkinen M, Kvist T, Baldwin JR, Parent C, Silveira PP, Lahti J, Räikkönen K, Glover V, O'Connor TG, Meaney MJ, O'Donnell KJ. Independent Prediction of Child Psychiatric Symptoms by Maternal Mental Health and Child Polygenic Risk Scores. J Am Acad Child Adolesc Psychiatry 2024; 63:640-651. [PMID: 37977417 PMCID: PMC11105503 DOI: 10.1016/j.jaac.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/10/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Prenatal maternal symptoms of depression and anxiety are associated with an increased risk for child socioemotional and behavioral difficulties, supporting the fetal origins of mental health hypothesis. However, to date, studies have not considered specific genomic risk as a possible confound. METHOD The Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (n = 5,546) was used to test if child polygenic risk score for attention-deficit/hyperactivity disorder (ADHD), schizophrenia, or depression confounds or modifies the impact of prenatal maternal depression and anxiety on child internalizing, externalizing, and total emotional/behavioral symptoms from age 4 to 16 years. Longitudinal child and adolescent symptom data were analyzed in the ALSPAC cohort using generalized estimating equations. Replication analyses were done in an independent cohort (Prevention of Preeclampsia and Intrauterine Growth Restriction [PREDO] cohort; n = 514) from Finland, which provided complementary measures of maternal mental health and child psychiatric symptoms. RESULTS Maternal depression and anxiety and child polygenic risk scores independently and additively predicted behavioral and emotional symptoms from childhood through mid-adolescence. There was a robust prediction of child and adolescent symptoms from both prenatal maternal depression (generalized estimating equation estimate = 0.093, 95% CI 0.065-0.121, p = 2.66 × 10-10) and anxiety (generalized estimating equation estimate = 0.065, 95% CI 0.037-0.093, p = 1.62 × 10-5) after adjusting for child genomic risk for mental disorders. There was a similar independent effect of maternal depression (B = 0.156, 95% CI 0.066-0.246, p = .001) on child symptoms in the PREDO cohort. Genetically informed sensitivity analyses suggest that shared genetic risk only partially explains the reported association between prenatal maternal depression and offspring mental health. CONCLUSION These findings highlight the genomic contribution to the fetal origins of mental health hypothesis and further evidence that prenatal maternal depression and anxiety are robust in utero risks for child and adolescent psychiatric symptoms. PLAIN LANGUAGE SUMMARY Depression and anxiety affect approximately 15% of pregnant women, and children exposed to maternal depression or anxiety during pregnancy are at higher risk of developing mental health problems. However, the degree to which shared genetics explains the association between maternal and child mental health is unknown. In this study the authors generated polygenic risk scores (PRS), which provide a single measure of genetic risk for complex traits, to investigate the impact of shared genetic risk on the development of childhood mental health problems. Utilizing two longitudinal studies (n = 6,060), the authors found that PRS only partially explained the association between prenatal maternal depression and childhood mental health problems. These analyses show prenatal maternal depression remained a significant predictor of childhood mental health problems after accounting for shared genetic risk, further highlighting that prenatal maternal mental health is a robust predictor of child and adolescent mental health problems.
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Affiliation(s)
- Lawrence M Chen
- Douglas Research Centre, McGill University, Canada; Ludmer Centre for Neuroinformatics & Mental Health, McGill University, Canada
| | - Irina Pokhvisneva
- Douglas Research Centre, McGill University, Canada; Ludmer Centre for Neuroinformatics & Mental Health, McGill University, Canada
| | - Marius Lahti-Pulkkinen
- University of Helsinki, Finland; Finnish Institute for Health and Welfare, Finland; University of Edinburgh, United Kingdom
| | | | | | - Carine Parent
- Douglas Research Centre, McGill University, Canada; Ludmer Centre for Neuroinformatics & Mental Health, McGill University, Canada
| | - Patricia P Silveira
- Douglas Research Centre, McGill University, Canada; Ludmer Centre for Neuroinformatics & Mental Health, McGill University, Canada
| | - Jari Lahti
- University of Helsinki, Finland; Turku Institute for Advanced Studies, University of Turku, Finland
| | | | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom
| | - Thomas G O'Connor
- University of Rochester, Rochester, New York; Wynne Center for Family Research, University of Rochester, Rochester, New York
| | - Michael J Meaney
- Douglas Research Centre, McGill University, Canada; Ludmer Centre for Neuroinformatics & Mental Health, McGill University, Canada; Child and Brain Development Program, Canadian Institute for Advanced Research (CIFAR), Canada; Singapore Institute for Clinical Sciences, Agency for Science, Technology & Research (A∗STAR), Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kieran J O'Donnell
- Douglas Research Centre, McGill University, Canada; Ludmer Centre for Neuroinformatics & Mental Health, McGill University, Canada; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut.
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3
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Zecchinato F, Ahmadzadeh YI, Kreppner JM, Lawrence PJ. A Systematic Review and Meta-analysis: Paternal Anxiety and the Emotional and Behavioral Outcomes in Their Offspring. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00197-7. [PMID: 38697345 DOI: 10.1016/j.jaac.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 03/04/2024] [Accepted: 04/23/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Anxiety disorders are highly prevalent worldwide; however, the literature lacks a meta-analytic quantification of the risk posed by fathers' anxiety for offspring development. This systematic review and meta-analysis aimed to provide a comprehensive estimate of the magnitude of the association between paternal anxiety and emotional and behavioral problems of offspring. METHOD In February 2022, Web of Science, Ovid (Embase, MEDLINE, PsycINFO), Trip Database, and ProQuest were searched to identify all quantitative studies that measured anxiety in fathers and emotional and/or behavioral outcomes in offspring. No limits were set for offspring age, publication language, or publication year. Summary estimates were extracted from the primary studies. Meta-analytic random-effects 3-level models were used to calculate correlation coefficients. Quality was assessed using the Newcastle-Ottawa Scale. The study protocol was preregistered with PROSPERO (CRD42022311501) and adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines. RESULTS Of 11,746 records identified, 98 were included in the meta-analysis. Small but significant associations were found between paternal anxiety and offspring emotional and behavioral problems overall (r = 0.16, 95% CI [0.13, 0.19]) and behavioral (r = 0.19, 95% CI [0.13, 0.24]), emotional (r = 0.15, 95% CI [0.12, 0.18]), anxiety (r = 0.13, 95% CI [0.11, 0.16]), and depression (r = 0.13, 95% CI [0.03, 0.23]) problems. Some significant moderators were identified. CONCLUSION Paternal mental health is associated with offspring development, and the offspring of fathers with anxiety symptoms or disorders are at increased risk of negative emotional and behavioral outcomes, in line with the principles of multifinality and pleiotropy. The substantial heterogeneity among studies and the overrepresentation of White European American groups in this literature highlight the need for further research. DIVERSITY & INCLUSION STATEMENT While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.
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Affiliation(s)
- Francesca Zecchinato
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.
| | - Yasmin I Ahmadzadeh
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jana M Kreppner
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Peter J Lawrence
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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Scheible K, Beblavy R, Sohn MB, Qui X, Gill AL, Narvaez-Miranda J, Brunner J, Miller RK, Barrett ES, O’Connor TG, Gill SR. Affective Symptoms in Pregnancy are Associated with the Vaginal Microbiome. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.12.589254. [PMID: 38645042 PMCID: PMC11030453 DOI: 10.1101/2024.04.12.589254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Composition of the vaginal microbiome in pregnancy is associated with adverse maternal, obstetric, and child health outcomes. Identifying the sources of individual differences in the vaginal microbiome is therefore of considerable clinical and public health interest. The current study tested the hypothesis that vaginal microbiome composition during pregnancy is associated with an individual's experience of affective symptoms and stress exposure. Data were based on a prospective longitudinal study of a diverse and medically healthy community sample of 275 mother-infant pairs. Affective symptoms and stress exposure and select measures of associated biomarkers (diurnal salivary cortisol, serum measures of sex hormones) were collected at each trimester; self-report, clinical, and medical records were used to collect detailed data on socio-demographic factors and health behavior, including diet and sleep. Vaginal microbiome samples were collected in the third trimester (34-40 weeks) and characterized by 16S rRNA sequencing. Identified taxa were clustered into three community state types (CST1-3) based on dissimilarity of vaginal microbiota composition. Results indicate that depressive symptoms during pregnancy were reliably associated with individual taxa and CST3 in the third trimester. Prediction of functional potential from 16S taxonomy revealed a differential abundance of metabolic pathways in CST1-3 and individual taxa, including biosynthetic pathways for the neuroactive metabolites, serotonin and dopamine. With the exception of bioavailable testosterone, no significant associations were found between symptoms- and stress-related biomarkers and CSTs. Our results provide further evidence of how prenatal psychological distress during pregnancy alters the maternal-fetal microbiome ecosystem that may be important for understanding maternal and child health outcomes.
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Affiliation(s)
- Kristin Scheible
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Robert Beblavy
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Michael B. Sohn
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Xing Qui
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ann L. Gill
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Janiret Narvaez-Miranda
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jessica Brunner
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Richard K. Miller
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Emily S. Barrett
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey, USA
| | - Tom G. O’Connor
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Wynne Center for Family Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Steven R. Gill
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Golding J, Bickerstaffe I, Iles-Caven Y, Northstone K. Paternal health in the first 12-13 years of the ALSPAC study. Wellcome Open Res 2024; 8:8. [PMID: 37476649 PMCID: PMC10354460 DOI: 10.12688/wellcomeopenres.18639.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 07/22/2023] Open
Abstract
The Avon Longitudinal Study of Parents and Children (ALSPAC) collected information from the enrolled pregnancy onwards to identify features of the environment in which the study child was brought up. Among data collected were features concerning the health of the mothers' partners - generally the study father. This was an important feature since the father's physical and mental health can have a long-term effect on the family. In this Data Note we describe the data available on the father's health from pregnancy until 12 years after the offspring was born. Not only is this a valuable addition to the environmental information available for studies of the child's development and the mental health of the mother over time, but it will provide a useful description of the father himself during adulthood.
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Affiliation(s)
- Jean Golding
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Iain Bickerstaffe
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Yasmin Iles-Caven
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
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Chan SY, Low XZ, Ngoh ZM, Ong ZY, Kee MZL, Huang P, Kumar S, Rifkin-Graboi A, Chong YS, Chen H, Tan KH, Chan JKY, Fortier MV, Gluckman PD, Zhou JH, Meaney MJ, Tan AP. Neonatal Nucleus Accumbens Microstructure Modulates Individual Susceptibility to Preconception Maternal Stress in Relation to Externalizing Behaviors. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00071-6. [PMID: 38423282 DOI: 10.1016/j.jaac.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 11/20/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Maternal stress influences in utero brain development and is a modifiable risk factor for offspring psychopathologies. Reward circuitry dysfunction underlies various internalizing and externalizing psychopathologies. This study examined (1) the association between maternal stress and microstructural characteristics of the neonatal nucleus accumbens (NAcc), a major node of the reward circuitry, and (2) whether neonatal NAcc microstructure modulates individual susceptibility to maternal stress in relation to childhood behavioral problems. METHOD K-means longitudinal cluster analysis was performed to determine trajectories of maternal stress measures (Perceived Stress Scale [PSS], hair cortisol) from preconception to the third trimester. Neonatal NAcc microstructural measures (orientation density index [ODI] and intracellular volume fraction [ICVF]) were compared across trajectories. We then examined the interaction between maternal stress and neonatal NAcc microstructure on child internalizing and externalizing behaviors, assessed between ages 3 and 4 years. RESULTS Two trajectories of maternal stress magnitude ("low"/"high") were identified for both PSS (n = 287) and hair cortisol (n = 336). Right neonatal NAcc ODI (rNAcc-ODI) was significantly lower in "low" relative to "high" PSS trajectories (n = 77, p = .04). PSS at preconception had the strongest association with rNAcc-ODI (r = 0.293, p = .029). No differences in NAcc microstructure were found between hair cortisol trajectories. A significant interaction between preconception PSS and rNAcc-ODI on externalizing behavior was observed (n = 47, p = .047). CONCLUSION Our study showed that the preconception period contributes to in utero NAcc development, and that NAcc microstructure modulates individual susceptibility to preconception maternal stress in relation to externalizing problems.
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Affiliation(s)
- Shi Yu Chan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Xi Zhen Low
- National University Health System, Singapore, Singapore
| | - Zhen Ming Ngoh
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Zi Yan Ong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Michelle Z L Kee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Pei Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | | | - Anne Rifkin-Graboi
- National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore; National University Health System, Singapore, Singapore; National University of Singapore, Singapore, Singapore
| | - Helen Chen
- KK Women's and Children's Hospital, Duke-National University of Singapore, Singapore, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Duke-National University of Singapore, Singapore, Singapore
| | - Jerry K Y Chan
- KK Women's and Children's Hospital, Duke-National University of Singapore, Singapore, Singapore
| | - Marielle V Fortier
- KK Women's and Children's Hospital, Duke-National University of Singapore, Singapore, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | | | - Michael J Meaney
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore; National University of Singapore, Singapore, Singapore; Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Ai Peng Tan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore; National University Health System, Singapore, Singapore; National University of Singapore, Singapore, Singapore.
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Dachew BA, Adane AA, Alati R. Maternal Pregnancy and Pre-Pregnancy Weight and Behavioural Outcomes in Children. Behav Sci (Basel) 2024; 14:49. [PMID: 38247701 PMCID: PMC10812996 DOI: 10.3390/bs14010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
Reported associations of pre-pregnancy weight and/or gestational weight gain with offspring behavioural outcomes are inconsistent. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), this study aimed to examine these associations at five developmental stages between the ages of 3 and 16. Over 6800 mother-offspring pairs at age 3 and 3925 pairs at age 16 were included. Pre-pregnancy underweight was associated with a 22% increased risk of total behavioural difficulties (OR = 1.22, 95% CI 1.02-1.45). In separate analyses using the SDQ subscales, pre-pregnancy underweight was linked to a 37% (OR = 1.37, 95% CI 1.14-1.65) and 33% (OR = 1.33, 95% CI 1.01-1.76) increased risk of emotional symptoms and prosocial behaviour problems over time, respectively. While pre-pregnancy overweight was associated with an 11% (OR = 1.11, 95% CI 1.03-1.20) and 18% (OR = 1.18, 95% CI 1.03-1.36) increased risk of conduct and peer relationship problems, respectively, pregnancy obesity was associated with a 43% increased risk of emotional problems (OR = 1.43, 95% CI 1.16-1.77). We found no evidence of associations between gestational weight gain and child behaviour except for a reduced risk in prosocial behaviour problems (OR = 0.82, 95% CI 0.70-0.96). Our findings provide insights into the link between preconception BMI and child behaviour, underscoring the necessity for further research to validate these associations and elucidate underlying mechanisms.
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Affiliation(s)
- Berihun A. Dachew
- School of Population Health, Curtin University, Bentley, WA 6102, Australia;
- enAble Institute, Curtin University, Bentley, WA 6102, Australia
| | - Akilew A. Adane
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA 6150, Australia;
| | - Rosa Alati
- School of Population Health, Curtin University, Bentley, WA 6102, Australia;
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD 4068, Australia
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Bruinhof N, Sehic E, Hancock GR, Gartstein MA, de Weerth C. Prenatal anticipatory stress: Baby preparation and worry scale-revised in the Dutch context. Compr Psychiatry 2024; 128:152437. [PMID: 38007905 DOI: 10.1016/j.comppsych.2023.152437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/20/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Prenatal distress encompasses a range of different emotions, worries, and experiences of stress. The Baby Preparation and Worry Scale (Baby-PAWS) was recently developed to target anticipatory worries during pregnancy about the postnatal period. However, the Baby-PAWS questionnaire was only examined in the United States of America, limiting the questionnaire's generalizability to different countries. To address this issue, we performed a psychometric evaluation of the questionnaire in a Dutch sample and examined associations between the Baby-PAWS questionnaire and established measures of maternal distress (i.e., EPDS, STAI, PRAQ-R) and infant temperament (i.e., IBQ-R). METHODS Healthy pregnant women (N = 521) completed questionnaires during their third trimester and postnatally, including the Baby-PAWS and distress measures. A subsample of mothers (N = 194) also reported on infant temperament at 12 weeks postpartum. RESULTS Exploratory factor analysis suggested a four-factor structure for the 16-item questionnaire in our Dutch sample, as compared to the expected three-factor structure found in the original psychometric evaluation with the American sample. The total Baby-PAWS score was related to pre-and postnatal depression, anxiety, stress, and specific scales of infant temperament. American women scored higher on the Baby-PAWS items than Dutch women. LIMITATIONS Our participants had higher-than-average socioeconomic status, limiting the generalizability of the findings. CONCLUSION The current analyses indicate good validity of the Baby-PAWS in a Dutch sample. Furthermore, our results highlight cross-cultural differences in perinatal mental health and show the importance of examining instrument structure of context-dependent constructs, such as prenatal worries.
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Affiliation(s)
- Nina Bruinhof
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, P.O. Box 9010, 6500, GL, Nijmegen, the Netherlands.
| | - Ela Sehic
- Washington State University, Department of Psychology, Pullman, WA, United States of America.
| | | | - Maria A Gartstein
- Washington State University, Department of Psychology, Pullman, WA, United States of America.
| | - Carolina de Weerth
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, P.O. Box 9010, 6500, GL, Nijmegen, the Netherlands.
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Dibabu AM, Ketema TG, Beyene MM, Belachew DZ, Abocherugn HG, Mohammed AS. Preoperative anxiety and associated factors among women admitted for elective obstetric and gynecologic surgery in public hospitals, Southern Ethiopia: a cross-sectional study. BMC Psychiatry 2023; 23:728. [PMID: 37807071 PMCID: PMC10561508 DOI: 10.1186/s12888-023-05005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/05/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Preoperative anxiety is a major mental health problem during the preoperative period. Admission of women to surgery is stressful, and a high level of anxiety was associated with increased perioperative morbidity and mortality, poor treatment satisfaction, and bad obstetric outcomes, including long-term cognitive impairment in children. Despite its negative consequences, little is known on this area, particularly in the study area. OBJECTIVE To assess preoperative anxiety and associated factors among women admitted for elective obstetrics and gynecologic surgeries in public hospitals in Southern Ethiopia, 2022. METHODS AND MATERIALS An institution-based cross-sectional study design was conducted among 389 women using structured interviewer-administered samples who were selected by systematic random sampling from May 20th to June 20th, 2022. The Amsterdam preoperative anxiety and information scale (APAIS) was used to assess the level of anxiety. Data were collected electronically using the Open Data Kit version 2022.2.3 and analyzed with the Statistical Package for Social Sciences version 26.0. Bivariate and multivariable logistic regression analyses were done. The strength of the association was declared by using an adjusted odds ratio (AOR) with a 95% confidence interval, and a statistical significance of P < 0.05. RESULTS The magnitude of preoperative anxiety was 57.1% (95% CI = 51.4-61.5), and 48.1% of women required an average amount of information. Being a gynecologic patient (AOR = 2.0, 95% CI = 1.21, 3.32), having previous anesthesia and surgery (AOR = 2.09, 95% CI = 1.10, 3.96), having fear of postoperative pain (AOR = 1.96, 95% CI = 1.08, 3.53), having concern for family (AOR = 2.56, 95% CI = 1.49, 4.37), having poor social support (AOR = 3.75, 95% CI = 1.99, 7.09), and moderate social supports (AOR = 3.27, 95% CI = 1.74, 6.17), and having a high information requirement about anesthesia and surgery (AOR = 4.68, 95%CI = 2.16, 10.13) were statistically associated with preoperative anxiety. CONCLUSION Preoperative anxiety was often high in the region. Associated factors were the type of surgery, previous anesthesia and surgery, fear of postoperative pain, fear for family, social support, and a high information need. So the national and regional health bureau should develop guidelines and implement strategies to reduce women preoperative anxiety as part of midwifery care. The women should be assessed regularly during the preoperative visits; and appropriate anxiety reduction and information regarding surgery, and anesthesia should be provided.
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Affiliation(s)
- Abera Mamo Dibabu
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia.
| | - Teklemariam Gultie Ketema
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Maechel Maile Beyene
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Dereje Zeleke Belachew
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia
| | | | - Abdu Seid Mohammed
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia
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10
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Rogers AM, Youssef GJ, Teague S, Sunderland M, Le Bas G, Macdonald JA, Mattick RP, Allsop S, Elliott EJ, Olsson CA, Hutchinson D. Association of maternal and paternal perinatal depression and anxiety with infant development: A longitudinal study. J Affect Disord 2023; 338:278-288. [PMID: 37302506 DOI: 10.1016/j.jad.2023.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Maternal and paternal perinatal depression and anxiety are theorised to adversely impact infant development. Yet, few studies have assessed both mental health symptoms and clinical diagnoses within the one study. Moreover, research on fathers is limited. This study therefore aimed to examine the association between symptoms and diagnoses of maternal and paternal perinatal depression and anxiety with infant development. METHOD Data were from the Triple B Pregnancy Cohort Study. Participants included 1539 mothers and 793 partners. Depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale and Depression Anxiety Stress Scales. Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia were assessed using the Composite International Diagnostic Interview in trimester three. Infant development was assessed at 12-months using the Bayley Scales of Infant and Toddler Development. RESULTS Antepartum, maternal depressive and anxiety symptoms were associated with poorer infant social-emotional (d = -0.11, p = .025) and language development (d = -0.16, p = .001). At 8-weeks postpartum, maternal anxiety symptoms were associated with poorer overall development (d = -0.11, p = .030). No association was observed for clinical diagnoses in mothers, nor paternal depressive and anxiety symptoms or clinical diagnoses; albeit risk estimates were largely in the expected direction of adverse effects on infant development. CONCLUSIONS Evidence suggests that maternal perinatal depression and anxiety symptoms may adversely impact infant development. Effects were small but findings underscore the importance of prevention, early screening and intervention, alongside consideration of other risk factors during early critical periods.
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Affiliation(s)
- Alana M Rogers
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia.
| | - George J Youssef
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia.
| | - Samantha Teague
- Department of Psychology, College of Healthcare Sciences, James Cook University, Queensland, Australia.
| | - Matthew Sunderland
- University of Sydney, Matilda Centre for Research in Mental Health and Substance Use, New South Wales, Australia.
| | - Genevieve Le Bas
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia.
| | - Jacqui A Macdonald
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Australia.
| | - Richard P Mattick
- The University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia.
| | - Steve Allsop
- Curtin University, National Drug Research Institute, Western Australia, Australia.
| | - Elizabeth J Elliott
- University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescence, New South Wales, Australia; Sydney Children's Hospitals Network, Westmead, Sydney, Australia.
| | - Craig A Olsson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Australia.
| | - Delyse Hutchinson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia; The University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Australia.
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11
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Milgrom J, Hirshler Y, Holt C, Skouteris H, Galbally M, East C, Glover V, Reece J, O'Donnell KJ, Walker SP, Malloy S, Gemmill AW. Early intervention to prevent adverse child emotional and behavioural development following maternal depression in pregnancy: study protocol for a randomised controlled trial. BMC Psychol 2023; 11:222. [PMID: 37542332 PMCID: PMC10401817 DOI: 10.1186/s40359-023-01244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Substantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development. Children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. These enduring effects also constitute an enormous economic cost. Despite the seriousness of this problem, until recently there existed very few controlled studies evaluating whether active psychological treatment for antenatal depression can prevent adverse child outcomes. Our previous pilot randomised controlled trial (RCT) exploring the effect of cognitive behavioural therapy (CBT) for antenatal depression on child outcomes showed promising results. We aim to assess whether treating antenatal depression with an evidence-based 8-week structured CBT program can prevent or ameliorate adverse child developmental outcomes at 2 years of age. METHODS Pregnant women ≤ 30 weeks gestation diagnosed with a depressive disorder are recruited and randomised to CBT or treatment as usual (TAU). The target sample size is 230 and the primary outcome measure is the infant Internalising scale of the Child Behaviour Checklist (CBCL) at 24 months of age. Secondary infant outcome measures at 24 months are the Externalising scale of the CBCL and the motor and cognitive development subscales of the Ages & Stages Questionnaire (ASQ-3). Additional secondary outcome measures are subscales of the Revised Infant Behaviour Questionnaire (IBQ-R), ASQ-3 and the ASQ-Socio-Emotional (ASQ-SE) at 3 and 12 months of age and the quality of mother-infant interaction at 3 and 24 months. Maternal measures, including demographic data, depression diagnosis, depressive and anxiety symptoms, perceived stress and parenting stress, are collected across all time points. DISCUSSION The trial is ongoing and recruitment was slowed due to the COVID-19 pandemic. If results suggest a beneficial effect of antenatal depression treatment on infant outcomes, the project could have repercussions for standard antenatal care, for maternal and infant health services and for preventing the intergenerational transmission of mental health disorders. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register: ACTRN12618001925235 Date Registered: 27 November 2018.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Yafit Hirshler
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
| | - Charlene Holt
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Megan Galbally
- Health Futures Institute, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
- Mental Health, Program Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Christine East
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Plenty Rd & Kingsbury Drive, Bundoora, VIC, 3086, Australia
- Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 ONN, UK
| | - John Reece
- School of Psychological Sciences, Australian College of Applied Professions, 123 Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - Kieran J O'Donnell
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT, 06519, USA
- Department of Obstetrics Gynecology and Reproductive Sciences, 230 South Frontage Road, New Haven, CT, 06519, USA
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Susan P Walker
- Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Melbourne Medical School, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | | | - Alan W Gemmill
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia.
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12
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Morales MF, Girard LC, Raouna A, MacBeth A. The association of different presentations of maternal depression with children's socio-emotional development: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001649. [PMID: 36963088 PMCID: PMC10021281 DOI: 10.1371/journal.pgph.0001649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
Maternal depression from the perinatal period onwards is a global health priority associated with an increased likelihood of suboptimal socio-developmental outcomes in offspring. An important aspect of this association is the extent to which sustained maternal depression impacts on these outcomes. The current review synthesised the evidence on maternal depression from the perinatal period onwards and offspring internalising, externalising, and social competence outcomes. We also identified sources of methodological bias. A systematic review following PRISMA guidelines was conducted. Longitudinal studies targeting biological mothers with depressive symptomology, detailing onset, using repeated validated measures, and assessing children's outcomes between three and 12 years were included. Twenty-four studies met inclusion criteria. Findings supported the validity of different presentations of maternal depression, including consistent identification of a group of chronically depressed mothers across countries. Mothers within this group reported poorer internalising, externalising, and social competence outcomes for their offspring, with the highest levels of child problems associated with greater maternal chronicity and symptom severity. Results differed by measurement type with mothers rating poorer outcomes in comparison to teachers reports. For timing of depression, evidence was inconsistent for independent effects of antenatal or postnatal depression on child outcomes. There was substantial variability in study quality assessment. Assessing different presentations of maternal depression is essential for capturing the longitudinal associations between maternal depression and offspring outcomes to inform targets of early intervention. Chronicity, severity, and concurrent maternal depression have important implications for children's development and should be targeted in future programme planning. Further research in low- and middle-income countries is warranted.
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Affiliation(s)
- María Francisca Morales
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Lisa-Christine Girard
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Aigli Raouna
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
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13
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Challacombe FL, Pietikäinen JT, Kiviruusu O, Saarenpää-Heikkilä O, Paunio T, Paavonen EJ. Paternal perinatal stress is associated with children's emotional problems at 2 years. J Child Psychol Psychiatry 2023; 64:277-288. [PMID: 36215991 PMCID: PMC10092317 DOI: 10.1111/jcpp.13695] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Paternal mental health in pregnancy and postpartum has been increasingly highlighted as important both in its own right, but also as crucial for the development of children. Rates of help-seeking among fathers is low, possibly due to conceptualising their own difficulties as stress rather than problems with mood. The relationship between paternal stress and child outcomes has not been investigated. METHODS This study used data from the Finnish CHILD-SLEEP birth cohort. Data were available for 901 fathers and 939 mothers who completed questionnaires on demographics, stress, anxiety and depression at 32 weeks gestation, 3 months, 8 months and 24 months postpartum. Parental report of child emotional and behavioural problems was collected at 24 months. RESULTS Around 7% of fathers experienced high stress (over 90% percentile) at each timepoint measured in the perinatal period, rising to 10% at 2 years postpartum. Paternal stress measured antenatally, at 3 and 24 months was associated with child total problems at 24 months, while paternal depression and anxiety were not related to child outcomes when in the same model. After adjusting for concurrent maternal depression, anxiety and stress, an association remained between paternal stress at each timepoint and child total problem scores at 24 months. The strongest association was with paternal stress at 3 months (OR 3.17; 95% CI 1.63-6.16). There were stronger relationships between paternal stress and boys' rather than girls' total problem scores, although the interactions were not statistically significant. CONCLUSIONS Paternal stress is an important manifestation of perinatal distress and is related to child mental health, particularly when present in the early postpartum months. Paternal stress should therefore be assessed in the perinatal period, which presents opportunities for early intervention and prevention of difficulties for both father and child.
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Affiliation(s)
| | - Johanna T Pietikäinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Olli Kiviruusu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Outi Saarenpää-Heikkilä
- Pediatric Clinics, Tampere University Hospital, Tampere, Finland.,Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Tiina Paunio
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - E Juulia Paavonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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14
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Glover V, O'Connor TG, O'Donnell KJ. Fetal Programming and Public Policy. J Am Acad Child Adolesc Psychiatry 2023; 62:618-620. [PMID: 36608741 DOI: 10.1016/j.jaac.2022.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/13/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
Fetal programming is a core concept within the broader developmental origins of health and disease framework, which acknowledges the contribution of the prenatal and early postnatal environment to health across the life span. Fetal programming suggests that the fetus adapts to environmental exposures and that altered biological systems can have lasting effects on child and adult health. The theory derived from the widely replicated finding that infants who are smaller at birth are more likely to die of cardiovascular disease in later life.1 Although initially concerned with cardiometabolic phenotypes, the model has been extended to other systems, including neural development and psychiatric phenotypes.
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15
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Azar N, Booij L. DNA methylation as a mediator in the association between prenatal maternal stress and child mental health outcomes: Current state of knowledge. J Affect Disord 2022; 319:142-163. [PMID: 36113690 DOI: 10.1016/j.jad.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Prenatal maternal stress is increasingly recognized as a risk factor for offspring mental health challenges. DNA methylation may be a mechanism, but few studies directly tested mediation. These few integrative studies are reviewed along with studies from three research areas: prenatal maternal stress and child mental health, prenatal maternal stress and child DNA methylation, and child mental health and DNA methylation. METHODS We conducted a narrative review of articles in each research area and the few published integrative studies to evaluate the state of knowledge. RESULTS Prenatal maternal stress was related to greater offspring internalizing and externalizing symptoms and to greater offspring peripheral DNA methylation of the NR3C1 gene. Youth mental health problems were also related to NR3C1 hypermethylation while epigenome-wide studies identified genes involved in nervous system development. Integrative studies focused on infant outcomes and did not detect significant mediation by DNA methylation though methodological considerations may partially explain these null results. LIMITATIONS Operationalization of prenatal maternal stress and child mental health varied greatly. The few published integrative studies did not report conclusive evidence of mediation by DNA methylation. CONCLUSIONS DNA methylation likely mediates the association between prenatal maternal stress and child mental health. This conclusion still needs to be tested in a larger number of integrative studies. Key empirical and statistical considerations for future research are discussed. Understanding the consequences of prenatal maternal stress and its pathways of influence will help prevention and intervention efforts and ultimately promote well-being for both mothers and children.
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Affiliation(s)
- Naomi Azar
- Department of Psychology, Concordia University, 7141 Sherbrooke Street West, Montreal, Quebec H4B 1R6, Canada; Sainte-Justine University Hospital Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Linda Booij
- Department of Psychology, Concordia University, 7141 Sherbrooke Street West, Montreal, Quebec H4B 1R6, Canada; Sainte-Justine University Hospital Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Pavillon Roger-Gaudry, Université de Montréal, P.O. Box 6128, succursale Centre-ville, Montréal, Québec H3C 3J7, Canada.
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16
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Gemmill AW, Oliva JL, Ericksen J, Holt C, Holt CJ, Milgrom J. Web-based treatment for depression in pregnancy: a feasibility study of Mum2BMoodBooster. BMC Psychiatry 2022; 22:476. [PMID: 35842616 PMCID: PMC9287696 DOI: 10.1186/s12888-022-04111-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression in pregnancy is prevalent, under-treated, and has serious impacts on the wellbeing of women and on child development. Internet programs can reach women who may not access traditional treatments due to distance, stigma or concern about taking medication. We adapted our online postnatal depression program, MumMoodBooster, for antenatal use. We aimed to trial feasibility, acceptability, and potential efficacy of the new Mum2BMoodBooster intervention with depressed pregnant women. METHODS Twenty-seven pregnant women with Edinburgh Postnatal Depression Scale score > 11 used the program in a feasibility trial. Twenty-one had current diagnoses of major or minor depression on the Structured Clinical Interview for the DSM-IV. Assessment of symptoms occurred at screening/baseline, post-test (8 weeks post-enrollment), and at follow-up (3 months postpartum) using the Patient Health Questionnaire (PHQ-9) and the Depression Anxiety Stress Scales (DASS-21). RESULTS In this feasibility trial, depression scores on both the PHQ-9 and the DASS-21, showed significant reductions representing large effects, with average symptom scores reduced by > 50%, and maintained in the 'minimal or no depression' range at 3 month follow-up. Anxiety scores also decreased significantly. Program usage was high with 74% of women visiting all six sessions. Program acceptability ratings were moderate to high. CONCLUSIONS Findings paralleled the magnitude of symptom reductions seen in randomised trials of the postnatal MumMoodBooster program, suggesting that Mum2BMoodBooster is an effective treatment for depressed pregnant women. Effective internet therapies are likely to become increasingly important as the COVID-19 pandemic continues to make face-to-face access to health care problematic during 'lockdowns'.
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Affiliation(s)
- Alan W. Gemmill
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia
| | - Jessica Lee Oliva
- grid.1011.10000 0004 0474 1797Department of Psychology, College of Health Care Science, James Cook University, Townsville, QLD Australia
| | - Jennifer Ericksen
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia
| | - Charlene Holt
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia
| | | | - Jeannette Milgrom
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia ,grid.1008.90000 0001 2179 088XMelbourne School of Psychological Sciences, University of Melbourne, VIC, 3010 Australia
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17
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Galbally M, Watson SJ, Lappas M, de Kloet ER, Wyrwoll CS, Mark PJ, Lewis AJ. Exploring sex differences in fetal programming for childhood emotional disorders. Psychoneuroendocrinology 2022; 141:105764. [PMID: 35462201 DOI: 10.1016/j.psyneuen.2022.105764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
In examining maternal depression, placental 11β-HSD2 mRNA expression and offspring cortisol regulation as a potential fetal programming pathway in relation to later child emotional disorders, it has become clear that sex differences may be important to consider. This study reports on data obtained from 209 participants in the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) recruited before 20 weeks of pregnancy. Maternal depressive disorders were diagnosed using the SCID-IV and maternal childhood trauma using the Childhood Trauma Questionnaire. Placental 11β-HSD2 mRNA was measured using qRT-PCR. For assessment of stress-induced cortisol reactivity, salivary cortisol samples were taken at 12 months of age. At 4 years of age, measurement of Childhood Emotional Disorders (depression and anxiety) was based on maternal report using the Preschool Age Psychiatric Assessment (PAPA) and internalizing symptoms using the Child Behavior Checklist (CBCL). Maternal depression in pregnancy and postpartum, and infant cortisol reactivity, was associated with internalizing symptoms for females only. For female offspring only, increased 12-month cortisol reactivity was also associated with increased emotional disorders at 4 years of age; however, there was no association with placental 11β-HSD2 mRNA expression. In females only, the combination of lower placental 11β-HSD2 mRNA expression and higher cortisol reactivity at 12 months of age predicted increased internalising problems. These findings suggest there may be sex differences in prenatal predictors and pathways for early childhood depression and anxiety symptoms and disorder.
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Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Monash University, Victoria, Australia; Health Futures Institute, Murdoch University, Perth, WA, Australia; School of Medicine, University of Notre Dame, Fremantle, WA, Australia.
| | - Stuart J Watson
- Health Futures Institute, Murdoch University, Perth, WA, Australia; School of Medicine, University of Notre Dame, Fremantle, WA, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia; Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - E Ron de Kloet
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Caitlin S Wyrwoll
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Peter J Mark
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
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18
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Charrois EM, Mughal MK, Arshad M, Wajid A, Bright KS, Giallo R, Kingston D. Patterns and predictors of depressive and anxiety symptoms in mothers affected by previous prenatal loss in the ALSPAC birth cohort. J Affect Disord 2022; 307:244-253. [PMID: 35339570 DOI: 10.1016/j.jad.2022.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/13/2022] [Accepted: 03/20/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies investigating the patterns or predictors of psychological distress in expecting and postpartum mothers affected by previous prenatal loss, are limited. The study objectives were to explore longitudinal trajectory patterns of depressive and anxiety symptoms in mothers affected by previous prenatal loss from early in a subsequent pregnancy up to pre-adolescence, and to identify early factors predictive of elevated symptom trajectory patterns. METHODS A total of 2854 mothers from the Avon Longitudinal Study of Parents and Children self-identified as having experienced a previous prenatal loss. A latent class analysis identified trajectory patterns of symptoms across 10 timepoints from 18-weeks' gestation up to 134-months postpartum, multivariate regression analysis identified predictors of elevated symptom trajectories, and hierarchical regression analysis determined predictive accuracy between predictors and elevated trajectory patterns. RESULTS Three distinct longitudinal trajectory patterns of depressive and anxiety symptoms reflected low (54%), sub-clinical (34%), and clinical symptoms (12%). Key factors that predicted elevated symptom trajectory patterns better than increased symptom scores early in subsequent pregnancy include history of severe depression or other psychiatric problem, experiencing three or more stressful events from mid-pregnancy, inadequate social support, history of induced abortion, and history of abuse. Predictive accuracy of elevated trajectories was 0.542 (depression) and 0.432 (anxiety). LIMITATIONS Generalizability may be compromised by attrition, under-reporting, and recall bias. CONCLUSION Including factors predictive of long-term sub-clinical or clinical depressive and anxiety symptoms in early assessments will improve clinician's ability to identify mothers who may benefit from immediate and/or ongoing monitoring, and psychotherapeutic intervention after prenatal loss.
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Affiliation(s)
- Elyse M Charrois
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
| | - Muhammad Kashif Mughal
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada.
| | - Muhammad Arshad
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Bioinformatics Core, Centre for Genomics and Systems Biology, New York University, Abu Dhabi, UAE.
| | - Abdul Wajid
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
| | - Katherine S Bright
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada.
| | - Rebecca Giallo
- Deakin University, Geelong, Australia; Murdoch Children's Research Institute.
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
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McGuinn LA, Tamayo-Ortiz M, Rosa MJ, Harari H, Osorio-Valencia E, Schnaas L, Hernandez-Chavez C, Wright RJ, Klein DN, Téllez-Rojo MM, Wright RO. The influence of maternal anxiety and cortisol during pregnancy on childhood anxiety symptoms. Psychoneuroendocrinology 2022; 139:105704. [PMID: 35286908 PMCID: PMC8977283 DOI: 10.1016/j.psyneuen.2022.105704] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The etiology of child and adolescent anxiety remains poorly understood. Although several previous studies have examined associations between prenatal maternal psychological functioning and infant and child health outcomes, less is known about the impact of maternal anxiety specific to pregnancy and cortisol during pregnancy on childhood anxiety outcomes. METHODS Participants included 496 mother-child pairs from the PROGRESS longitudinal birth cohort in Mexico City. Anxiety symptoms were assessed at age 8-11 years during 2018-2019 using the Revised Children's Manifest Anxiety Scale. Pregnancy-specific anxiety was assessed using an expanded version of the Pregnancy Anxiety Scale. Maternal biological stress response during pregnancy was assessed using salivary cortisol measures (area under the curve, cortisol awakening response, and diurnal slope). Linear regression models were used to estimate associations between maternal anxiety and cortisol in relation to continuous child anxiety symptom T-scores. Models were adjusted for maternal age, socioeconomic status, child sex and age, and gestational age at saliva collection. RESULTS We found that higher levels of pregnancy-specific anxiety in the mother were associated with higher anxiety symptoms in the child (β: 1.30, 95% CI: 0.19, 2.41). We additionally observed an association between higher maternal total cortisol output during pregnancy and higher anxiety symptoms in the child (β: 1.13, 95% CI: 0.25, 2.01). DISCUSSION These findings highlight the importance of screening for maternal pregnancy-specific anxiety and the need to identify interventions and support for mothers during pregnancy in order to promote healthy outcomes for mothers and their children.
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Affiliation(s)
- Laura A McGuinn
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Marcela Tamayo-Ortiz
- Occupational Health Research Unit, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Maria José Rosa
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Homero Harari
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Kravis Children's Hospital, Department of Pediatrics, Division of Pediatric Pulmonology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Martha Maria Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Negative emotionality as a candidate mediating mechanism linking prenatal maternal mood problems and offspring internalizing behaviour. Dev Psychopathol 2022; 35:604-618. [PMID: 35440354 DOI: 10.1017/s0954579421001747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Negative emotionality (NE) was evaluated as a candidate mechanism linking prenatal maternal affective symptoms and offspring internalizing problems during the preschool/early school age period. The participants were 335 mother-infant dyads from the Maternal Adversity, Vulnerability and Neurodevelopment project. A Confirmatory Bifactor Analysis (CFA) based on self-report measures of prenatal depression and pregnancy-specific anxiety generated a general factor representing overlapping symptoms of prenatal maternal psychopathology and four distinct symptom factors representing pregnancy-specific anxiety, negative affect, anhedonia and somatization. NE was rated by the mother at 18 and 36 months. CFA based on measures of father, mother, child-rated measures and a semistructured interview generated a general internalizing factor representing overlapping symptoms of child internalizing psychopathology accounting for the unique contribution of each informant. Path analyses revealed significant relationships among the general maternal affective psychopathology, the pregnancy- specific anxiety, and the child internalizing factors. Child NE mediated only the relationship between pregnancy-specific anxiety and the child internalizing factors. We highlighted the conditions in which prenatal maternal affective symptoms predicts child internalizing problems emerging early in development, including consideration of different mechanistic pathways for different maternal prenatal symptom presentations and child temperament.
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21
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Specific fear of vomiting (SPOV) in early parenthood: assessment and treatment considerations with two illustrative cases. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Specific phobia of vomiting (SPOV) can be a severe and debilitating anxiety disorder and affects women in the childbearing years. The perinatal period and early parenthood is a time of increased risk for the onset or exacerbation of anxiety problems, which can have an impact on both the woman and the developing child. There are particular issues pertinent to the physical experience of pregnancy and tasks of early caregiving that women with SPOV may find difficult or distressing to confront, but these are not well documented. Cognitive behavioural therapy (CBT) focused on exposure to vomit cues and processing distressing early memories of vomiting is an effective treatment for SPOV. This paper describes the successful CBT treatment of two young mothers with SPOV, outlining the challenges faced by parents at this time and the need to take this into account in treatment, using illustrative case material.
Key learning aims
(1)
To understand how specific phobia of vomiting (SPOV) affects women in early parenthood.
(2)
To know how to target and update traumatic early memories of vomiting with imagery rescripting.
(3)
To know how to design and carry out effective behavioural experiments for perinatal SPOV.
(4)
To understand how to take mother, baby, and the mother–infant relationship into account in SPOV treatment.
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22
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Galbally M, Watson SJ, van Rossum EFC, Chen W, de Kloet ER, Lewis AJ. The perinatal origins of childhood anxiety disorders and the role of early-life maternal predictors. Psychol Med 2022; 52:506-514. [PMID: 32597740 DOI: 10.1017/s0033291720002147] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The development of childhood anxiety disorders (CADs) is likely to depend on pathways that can be programmed by early-life risk factors. We test the hypothesis that early-life maternal factors can predict this programming effect on CAD. METHODS Data were obtained from 198 women and children from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a cohort study with data collected across pregnancy, postpartum and until 4 years of age. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV), together with antenatal hair cortisol concentrations, maternal childhood trauma and parenting stress at 6 months postpartum. CAD was assessed with the Preschool Age Psychiatric Assessment and the Child Behaviour Checklist. RESULTS Antenatal depression, a history of maternal childhood trauma and lower gestational age at birth were each associated with anxiety disorders at 4 years of age in their children. A multivariate binary logistic model with these early predictors explained approximately 9% of variance in CAD outcome at 4 years of age; however, only maternal trauma and gestational age were significant predictors in the model. The effect of early parenting stress on CAD was found to vary by the concentration of maternal antenatal hair cortisol, whereby postpartum parenting stress was associated with CAD only when there were higher maternal antenatal cortisol levels. CONCLUSIONS This study suggests the importance of maternal factors pre-conception, pregnancy and in the postnatal period, which predict CADs and this is consistent with a developmental programming hypothesis for CAD.
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Affiliation(s)
- Megan Galbally
- 1. The College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
- King Edward Memorial Hospital, Subiaco, Australia
| | - Stuart J Watson
- 1. The College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wai Chen
- School of Medicine, University of Notre Dame, Fremantle, Australia
- Graduate School of Education, University of Western Australia, Crawley, Australia
| | - Edo Ronald de Kloet
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J Lewis
- 1. The College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
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23
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Sinesi A, Cheyne H, Maxwell M, O'Carroll R. THE STIRLING ANTENATAL ANXIETY SCALE (SAAS): DEVELOPMENT AND INITIAL PSYCHOMETRIC VALIDATION. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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24
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Experiences of Discrimination and Depression Trajectories over Pregnancy. Womens Health Issues 2022; 32:147-155. [PMID: 34774402 PMCID: PMC9701536 DOI: 10.1016/j.whi.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Research on risk factors for prenatal depression is critical to improve the understanding, prevention, and treatment of women's psychopathology. The current study examines the relation between experiences of racial discrimination and trajectories of depression symptoms over the course of pregnancy. METHOD Participants completed standardized measures regarding symptoms of depression at four timepoints during pregnancy and reported on experiences of racial discrimination at one timepoint. Latent growth curve modeling was used to examine the relation between discrimination and initial levels (intercept) and trajectories (slope) of depression symptoms over pregnancy. RESULTS Participants were 129 pregnant individuals recruited from obstetric clinics and oversampled for elevated depression symptoms. Thirty-six percent of the participants were living at or below 200% of the federal poverty line. Fifty-four percent of the sample identified as non-Latinx White, 26% as Latinx, and 13% as non-Latinx Black. An unconditional latent growth curve modeling revealed a negative quadratic trajectory of depression symptoms during pregnancy. When women's report of discrimination was added as a predictor of depression trajectories, discrimination predicted the initial value (intercept) of depression symptoms, but not change over the course of pregnancy (slope). Specifically, higher levels of experiences of discrimination were associated with higher levels of depression symptoms. When sociodemographic and contextual covariates were included in the model, a low family income-to-needs ratio was also related to higher levels of depression symptoms. CONCLUSIONS These findings provide evidence that women's experiences of racial discrimination and family financial strain are risk factors for prenatal depression, with implications for screening, treatment, and policy.
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25
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Furtado M, Frey BN, Green SM. Validation of the intolerance of uncertainty scale as a screening tool for perinatal anxiety. BMC Pregnancy Childbirth 2021; 21:829. [PMID: 34903196 PMCID: PMC8670292 DOI: 10.1186/s12884-021-04296-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background To date, there is a significant lack of research validating clinical tools for early and accurate detection of anxiety disorders in perinatal populations. Intolerance of uncertainty was recently identified as a significant risk factor for postpartum anxiety symptoms and is a key trait of non-perinatal anxiety disorders. The present study aimed to validate the Intolerance of Uncertainty Scale (IUS) in a perinatal population and evaluate its use as a screening tool for anxiety disorders. Methods Psychiatric diagnoses were assessed in a sample of perinatal women (n = 198), in addition to completing a self-report battery of questionnaires. Psychometric properties including internal consistency and convergent and discriminant validity were assessed. Determination of an optimal clinical cut-off score was measured through a ROC analysis in which the area under the curve, sensitivity, specificity, as well as positive and negative predictive values were calculated. Results The IUS demonstrated excellent internal consistency (α = 0.95) and an optimal clinical cut-off score of 64 or greater was established, yielding a sensitivity of 89%. The IUS also demonstrated very good positive (79%) and negative (80%) predictive values. Conclusions These findings suggest that the IUS represents a clinically useful screening tool to be used as an aid for the early and accurate detection of perinatal anxiety.
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Affiliation(s)
- Melissa Furtado
- Department of Psychology, Neuroscience and Behaviour, McMaster University, 1280 Main Street West, Ontario, Hamilton, L8S 4L8, Canada. .,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
| | - Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Administration B3, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada
| | - Sheryl M Green
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Administration B3, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada
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26
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Demers CH, Bagonis MM, Al-Ali K, Garcia SE, Styner MA, Gilmore JH, Hoffman MC, Hankin BL, Davis EP. Exposure to prenatal maternal distress and infant white matter neurodevelopment. Dev Psychopathol 2021; 33:1526-1538. [PMID: 35586027 PMCID: PMC9109943 DOI: 10.1017/s0954579421000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The prenatal period represents a critical time for brain growth and development. These rapid neurological advances render the fetus susceptible to various influences with life-long implications for mental health. Maternal distress signals are a dominant early life influence, contributing to birth outcomes and risk for offspring psychopathology. This prospective longitudinal study evaluated the association between prenatal maternal distress and infant white matter microstructure. Participants included a racially and socioeconomically diverse sample of 85 mother-infant dyads. Prenatal distress was assessed at 17 and 29 weeks' gestational age (GA). Infant structural data were collected via diffusion tensor imaging at 42-45 weeks' postconceptional age. Findings demonstrated that higher prenatal maternal distress at 29 weeks' GA was associated with increased fractional anisotropy (b = .283, t(64) = 2.319, p = .024) and with increased axial diffusivity (b = .254, t(64) = 2.067, p = .043) within the right anterior cingulate white matter tract. No other significant associations were found with prenatal distress exposure and tract fractional anisotropy or axial diffusivity at 29 weeks' GA, nor earlier in gestation.
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Affiliation(s)
- Catherine H. Demers
- Department of Psychology University of Denver, Denver CO,
USA
- Department of Psychiatry, University of Colorado Anschutz
Medical Campus, Aurora CO, USA
| | - Maria M. Bagonis
- Department of Psychiatry, University of North Carolina at
Chapel Hill, Chapel Hill NC, USA
| | - Khalid Al-Ali
- Department of Psychiatry, University of North Carolina at
Chapel Hill, Chapel Hill NC, USA
| | - Sarah E. Garcia
- Department of Psychology University of Denver, Denver CO,
USA
| | - Martin A. Styner
- Department of Psychiatry, University of North Carolina at
Chapel Hill, Chapel Hill NC, USA
- Department of Computer Science, University of North
Carolina at Chapel Hill, Chapel Hill NC, USA
| | - John H. Gilmore
- Department of Psychiatry, University of North Carolina at
Chapel Hill, Chapel Hill NC, USA
| | - M. Camille Hoffman
- Department of Psychiatry, University of Colorado Anschutz
Medical Campus, Aurora CO, USA
- Department of Obstetrics and Gynecology, Division of
Maternal and Fetal Medicine, University of Colorado Denver School of Medicine,
Aurora, Colorado, USA
| | - Benjamin L. Hankin
- Department of Psychology, University of Illinois at
Urbana-Champaign, Champaign IL, USA
| | - Elysia Poggi Davis
- Department of Psychology University of Denver, Denver CO,
USA
- Department of Psychiatry and Human Behavior, University of
California, Irvine, CA, USA
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27
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Hypertensive disorders during pregnancy and perinatal mental health symptoms. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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28
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Cena L, Gigantesco A, Mirabella F, Palumbo G, Camoni L, Trainini A, Stefana A. Prevalence of comorbid anxiety and depressive symptomatology in the third trimester of pregnancy: Analysing its association with sociodemographic, obstetric, and mental health features. J Affect Disord 2021; 295:1398-1406. [PMID: 34583842 DOI: 10.1016/j.jad.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the prevalence of comorbid anxiety and depression (CAD) during pregnancy and its risk factors. The aims of this study are to determine the prevalence of CAD in the third trimester of pregnancy and analyse its association with socio-demographic, obstetric, and mental health features. METHODS In a sample of 934 Italian pregnant women, CAD was defined as having (1) a score of ≥ 10 on the EPDS - depression subscale and/or on the PHQ-9, and (2) a score of ≥ 40 on the State-Trait Anxiety Inventory State and/or a score of ≥ 6 on the EPDS - anxiety subscale. Logistic regression analyses were used to identify socio-demographic, obstetrics, and mental health risk factors of CAD. RESULTS The prevalence of CAD was 6.8%. Age between 30 and 35 years (OR=3.01, 95% CI: 1.22-7.45) compared to younger age, current sleep disorders (OR=7.88, 95% CI: 3.83-16.23), and preconception mood disorders (OR=2.76, 95% CI: 1.31-5.84) were associated with higher odds of CAD. Conversely, the presence of no or few economic problems (OR=0.21, 95% CI: 0.07-0.65; OR=0.26, 95% CI: 0.09-0.77) and the perception of enough or more than enough practical support from friends or relatives (OR=0.32, 95% CI: 0.13-0.80; OR=0.22, 95% CI: 0.09-0.53) were associated with lower odds of developing CAD. LIMITATIONS The cross-sectional design; the use of self-report questionnaires. CONCLUSION CAD is relatively common among third-trimester antepartum women. The provision of economic/practical support may reduce CAD prevalence and its direct and indirect costs.
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Affiliation(s)
- Loredana Cena
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy.
| | - Antonella Gigantesco
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Fiorino Mirabella
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Gabriella Palumbo
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Laura Camoni
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Alice Trainini
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Alberto Stefana
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy
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Gestational urinary tract infections and the risk of antenatal and postnatal depressive and anxiety symptoms: A longitudinal population-based study. J Psychosom Res 2021; 150:110600. [PMID: 34547662 DOI: 10.1016/j.jpsychores.2021.110600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/28/2021] [Accepted: 08/14/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Urinary tract infections (UTIs) are among the most common bacterial infections in pregnant women. This is the first longitudinal study investigating the association between gestational UTIs and the risk of maternal antenatal and postnatal depressive and anxiety symptoms. METHODS Data were utilised from the Avon Longitudinal Study of Parents and Children (ALSPAC). Maternal depressive and anxiety symptoms during pregnancy and the postpartum period were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Crown-Crisp Experiential Index (CCEI), respectively. We used logistic regression analyses to examine the associations using the recommended EPDS and CCEI cut-off scores. We also ran sensitivity analyses and repeated the analyses with the continuous scores. RESULTS More than 10,000 mothers had completed exposure and outcome measures during pregnancy and the postpartum period. After adjustments were made for a wide range of confounders, our findings showed that mothers with UTI during pregnancy were 1.72 (95% CI; 1.45-2.04) and 1.70 (95% CI: 1.44-1.99) times more likely to report antenatal depressive and anxiety symptoms compared with mothers without UTI, respectively. Mothers with UTI also had a 35% and a 28% higher risk of postnatal depressive symptoms at eight weeks and eight months, respectively, and the risk of postnatal anxiety was 55% higher in mothers who had UTI during pregnancy (aOR = 1.55; 95% CI, 1.26-1.91). CONCLUSIONS The present study found positive associations between UTI during pregnancy and antenatal and postnatal depressive and anxiety symptoms. Replication and further research determining the cause of these associations is warranted.
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30
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Mountain RV, Zhu Y, Pickett OR, Lussier AA, Goldstein JM, Roffman JL, Bidlack FB, Dunn EC. Association of Maternal Stress and Social Support During Pregnancy With Growth Marks in Children's Primary Tooth Enamel. JAMA Netw Open 2021; 4:e2129129. [PMID: 34751761 PMCID: PMC8579236 DOI: 10.1001/jamanetworkopen.2021.29129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Exposure to maternal psychosocial stressors during the prenatal and perinatal periods can have major long-term mental health consequences for children. However, valid and inexpensive biomarkers are currently unavailable to identify children who have been exposed to psychosocial stress and the buffers of stress exposure. OBJECTIVE To assess whether a growth mark in tooth enamel, the neonatal line, is associated with exposure to prenatal and perinatal maternal psychosocial factors. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used exfoliated primary canine teeth and epidemiological survey data from 70 children enrolled in the Avon Longitudinal Study of Parents and Children, a birth cohort based in Bristol, England. Exfoliated teeth were collected from children at 5 to 7 years of age. Data were collected from January 1, 1991, to December 31, 1998, and were analyzed from January 1, 2019, to August 10, 2021. EXPOSURES Four types of prenatal and perinatal maternal psychosocial factors were studied: stressful life events, psychopathological history, neighborhood disadvantage, and social support. Data were collected from mailed-in questionnaires completed during and shortly after pregnancy. MAIN OUTCOMES AND MEASURES Neonatal line width measured within 3 portions of the tooth crown (the cuspal, middle, and innermost third) in exfoliated primary canines. RESULTS A total of 70 children (34 of 70 [48.7%] male; 63 of 67 [94.0%] White) were studied. Most children were born full term (57 [83.8%]) and to mothers of typical child-bearing age (60 [88.2%]). Neonatal lines were wider in the canines of children born to mothers who self-reported severe lifetime depression (β = 3.35; 95% CI, 1.48-5.23; P = .001), any lifetime psychiatric problems (β = 2.66; 95% CI, 0.92-4.41; P = .003), or elevated anxiety or depressive symptoms at 32 weeks' gestation (β = 2.29; 95% CI, 0.38-4.20; P = .02). By contrast, neonatal lines were narrower in children born to mothers who self-reported high social support shortly after birth (β = -2.04; 95% CI, -3.70 to -0.38; P = .02). The magnitude of these associations was large, up to 1.2 SD unit differences, and persisted after adjusting for other risk factors. CONCLUSIONS AND RELEVANCE In this cohort study, neonatal line width was associated with exposure to maternal perinatal psychosocial factors. Replication and validation of these findings can further evaluate teeth as possible new biomarkers.
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Affiliation(s)
- Rebecca V. Mountain
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yiwen Zhu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Olivia R. Pickett
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | - Alexandre A. Lussier
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jill M. Goldstein
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston
- Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Boston
| | - Joshua L. Roffman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Felicitas B. Bidlack
- Forsyth Institute, Cambridge, Massachusetts
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Erin C. Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston
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31
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Nawa N, Trude ACB, Black MM, Richiardi L, Surkan PJ. Associations between Paternal Anxiety and Infant Weight Gain. CHILDREN 2021; 8:children8110977. [PMID: 34828690 PMCID: PMC8618665 DOI: 10.3390/children8110977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to examine the relationship between parental anxiety (father-only, mother-only, or both) and infant weight change. We performed a secondary data analysis among 551 children in the Avon Longitudinal Study of Parents and Children, a birth cohort with weight measurements collected prospectively at 4, 8, and 12 months of age. Paternal and maternal anxiety symptoms were based on the eight-item anxiety subscale of the Crown-Crisp Experiential Index. Scores in the top 15% at 8 weeks postpartum were classified as high anxiety. Generalized Estimating Equations were employed to estimate the joint association between parental anxiety and change in child weight-for-age z-score. Children who had fathers, but not mothers, with anxiety showed a 0.15 (95% CI: 0.01, 0.29) greater increase in weight-for-age z-score than children with neither parent anxious. This result suggests that paternal anxiety, not maternal anxiety, was associated with increases in child weight gain in the first year of life. Public health practitioners and clinicians should consider the use of robust measures of both maternal and paternal anxiety in the postpartum period, in addition to the suggested screening for postpartum depression. Given the limitations of the study, this study should be considered preliminary and hypothesis generating.
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Affiliation(s)
- Nobutoshi Nawa
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
- Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
- Correspondence:
| | - Angela C. B. Trude
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.C.B.T.); (M.M.B.)
| | - Maureen M. Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.C.B.T.); (M.M.B.)
- RTI International, Research Triangle Park, NC 27709, USA
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, CPO-Piemonte, University of Turin, 10126 Turin, Italy;
| | - Pamela J. Surkan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
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Callanan F, Tuohy T, Bright AM, Grealish A. The effectiveness of psychological interventions for pregnant women with anxiety in the antenatal period: A systematic review. Midwifery 2021; 104:103169. [PMID: 34749125 DOI: 10.1016/j.midw.2021.103169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/17/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Anxiety is a significant public health concern, that if untreated may lead to adverse outcomes for mother, baby and the family unit. The aim of this review was to determine the efficacy of psychological interventions for pregnant women with anxiety in the antenatal period. Although guidelines recommend psychological interventions for managing anxiety in the perinatal period, there is a lack of strong evidence on the most effective psychological intervention for use in the antenatal period. Effective non-pharmacological interventions are an important area that requires significant clinical attention. DESIGN A systematic review of quantitative and qualitative studies was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Applied Social Sciences Index and Abstracts (ASSIA), Web of Science and PsychInfo. Quality appraisal was performed using The Joanna Briggs Institute (JBI) critical appraisal tool to assess methodological quality on all six included papers. All four RCT's were assessed separately using the Cochrane Risk of Bias Tool. FINDINGS Of the 7278 articles, six quantitative studies were included. The overall results of this review found that mindfulness based interventions are by far the most effective intervention for the treatment of anxiety in the antenatal period. These findings are not in line with current guidance on treatment of women with anxiety in the antenatal period and warrants immediate attention. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Healthcare professionals need to be aware of the potential benefits of mindfulness based interventions in practice. There is some evidence to support their use in the antenatal period, however, there remains insufficient evidence to confidently advocate for their use in practice. Follow-up research needs to be conducted on the efficacy of mindfulness based interventions on women with anxiety in the antenatal period using rigorous RCT's. Education and training of Midwives to help promote and use this intervention is recommended.
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Affiliation(s)
| | | | | | - Annmarie Grealish
- University of Limerick, Limerick, Ireland; King's College London, London, United Kingdom
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Dachew BA, Scott JG, Heron JE, Ayano G, Alati R. Association of Maternal Depressive Symptoms During the Perinatal Period With Oppositional Defiant Disorder in Children and Adolescents. JAMA Netw Open 2021; 4:e2125854. [PMID: 34591106 PMCID: PMC8485171 DOI: 10.1001/jamanetworkopen.2021.25854] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE An association between perinatal maternal depression and risk of oppositional defiant disorder (ODD) in offspring has not been established. Identifying early determinants of ODD can help inform preventative intervention efforts. OBJECTIVE To investigate the association between maternal perinatal depressive symptoms and the risk of ODD in offspring aged 7 to 15 years. DESIGN, SETTING, AND PARTICIPANTS This population-based longitudinal birth cohort study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), in Bristol, UK. All pregnant women residents in Avon, UK, with expected delivery dates from April 1, 1991, to December 31, 1992, were invited to participate in the study. The study cohort ranged from approximately 8000 (at 7 years of age) to 4000 (at 15 years of age) mother-offspring pairs. Data were analyzed from November 2020 to July 2021. MAIN OUTCOMES AND MEASURES Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) antenatally at 18 and 32 weeks of gestation and postnatally at 8 weeks and 8 months. This study primarily used a cutoff score of 12 or more on the EPDS to identify mothers with symptoms of depression, and the continuous EPDS scores were used to confirm the results of the main analyses. Offspring ODD at 7, 10, 13, and 15 years of age were diagnosed using the parent-reported Development and Well-Being Assessment. RESULTS Of 7994 mother-offspring pairs for whom data were available on offspring ODD at 7 years, 4102 offspring (51.3%) were boys. The mean (SD) age of mothers was 28.6 (4.6) years. Maternal antenatal depressive symptoms (measured at 32 weeks of gestation) were associated with offspring ODD (adjusted odds ratio [AOR], 1.75; 95% CI, 1.33-2.31). Offspring of mothers with postpartum depressive symptoms at 8 weeks and 8 months were more than 2 times more likely to have a diagnosis of ODD over time (AOR at 8 weeks, 2.24 [95% CI, 1.74-2.90]; AOR at 8 months, 2.04 [95% CI, 1.55-2.68]), and maternal persistent depressive symptoms were associated with a 4-fold increased risk of offspring ODD (AOR, 3.59; 95% CI, 1.98-6.52). CONCLUSIONS AND RELEVANCE These findings suggest that perinatal depressive symptoms are associated with ODD in offspring and further support the need for early identification and management of prenatal and postnatal depression in women of childbearing age.
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Affiliation(s)
| | - James G. Scott
- QIMR Berghofer Medical Research Institute, Herston, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, Australia
- Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, Australia
| | - Jon E. Heron
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Getinet Ayano
- School of Population Health, Curtin University, Perth, Australia
- Research Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Rosa Alati
- School of Population Health, Curtin University, Perth, Australia
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
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O'Leary N, Jairaj C, Nixon E, Quigley J, O'Keane V. Antenatal depression and maternal infant directed speech during the first postnatal year. Infant Behav Dev 2021; 64:101605. [PMID: 34229207 DOI: 10.1016/j.infbeh.2021.101605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/28/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antenatal depression is emerging as a potential risk factor for lower maternal sensitivity during postnatal mother-infant interactions. The present study investigated the relationship between both antenatal and postnatal depression and features of infant directed speech, a key indicator of maternal sensitivity during the first postnatal year. METHODS Pregnant women with either a clinical diagnosis of Major Depressive disorder (MDD; n = 20) or a history of MDD (n = 26) and a control group (n = 34) were recruited to the study and followed up at two, six and twelve months postpartum. A free-play mother-infant interaction was recorded at each time-point and the lexical and syntactic complexity of the mothers' speech was measured from the transcript. RESULTS No significant group differences were observed at either two, six or twelve months. However, mediation analyses indicated that antenatal depression was indirectly associated with maternal syntactic complexity at two and twelve months through concurrent maternal depression scores. LIMITATIONS The findings of this study are limited by its small sample size. The sample also comprised predominantly well-resourced women which limits the generalisability of the findings to wider or less advantaged populations. CONCLUSIONS This study contributes to the emerging evidence base concerning the impact of antenatal depression and postnatal depression on early mother-infant interactive behaviour, specifically infant-directed speech. These findings further highlight the importance of identifying women with antenatal depression in order to support them to engage in therapeutic interventions at the earliest possible opportunity.
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Affiliation(s)
- Niamh O'Leary
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland.
| | - Chaitra Jairaj
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| | | | - Jean Quigley
- School of Psychology, Trinity College Dublin, Ireland
| | - Veronica O'Keane
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
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Ahmadzadeh YI, Schoeler T, Han M, Pingault JB, Creswell C, McAdams TA. Systematic Review and Meta-analysis of Genetically Informed Research: Associations Between Parent Anxiety and Offspring Internalizing Problems. J Am Acad Child Adolesc Psychiatry 2021; 60:823-840. [PMID: 33675965 PMCID: PMC8259118 DOI: 10.1016/j.jaac.2020.12.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/09/2020] [Accepted: 02/25/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Parent anxiety is associated with offspring internalizing problems (emotional problems related to anxiety and depression). This may reflect causal processes, whereby exposure to parent anxiety directly influences offspring internalizing (and/or vice versa). However, parent-offspring associations could also be attributable to their genetic relatedness. A systematic review and meta-analysis were conducted to investigate whether exposure to parent anxiety is associated with offspring internalizing after controlling for genetic relatedness. METHOD A literature search across 5 databases identified 429 unique records. Publications were retained if they used a quasi-experimental design in a general population sample to control for participant relatedness in associations between parent anxiety and offspring internalizing outcomes. Publications were excluded if they involved an experimental exposure or intervention. Studies of prenatal and postnatal anxiety exposure were meta-analyzed separately. Pearson's correlation coefficient estimates (r) were pooled using multilevel random-effects models. RESULTS Eight publications were retained. Data were drawn from 4 population cohorts, each unique to a quasi-experimental design: adoption, sibling-comparison, children-of-twins or in vitro fertilization. Cohorts were located in northern Europe or America. Families were predominantly of European ancestry. Three publications (Nfamilies >11,700; offspring age range, 0.5-10 years) showed no association between prenatal anxiety exposure and offspring internalizing outcomes after accounting for participant relatedness (r = .04; 95% CI: -.07, .14). Six publications (Nfamilies >12,700; offspring age range, 0.75-22 years) showed a small but significant association between concurrent symptoms in parents and offspring after accounting for participant relatedness (r = .13; 95% CI: .04, .21). CONCLUSION Initial literature, derived from homogeneous populations, suggests that prenatal anxiety exposure does not cause offspring internalizing outcomes. However, postnatal anxiety exposure may be causally associated with concurrent offspring internalizing via nongenetic pathways. Longitudinal stability, child-to-parent effects, and the role of moderators and methodological biases require attention.
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Affiliation(s)
| | | | | | | | | | - Tom A McAdams
- King's College London, United Kingdom; University of Oslo, Norway
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Ayano G, Betts K, Lin A, Tait R, Alati R. Associations of maternal and paternal mental health problems with offspring anxiety at age 20 years: Findings from a population-based prospective cohort study. Psychiatry Res 2021; 298:113781. [PMID: 33592400 DOI: 10.1016/j.psychres.2021.113781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/31/2021] [Indexed: 11/26/2022]
Abstract
Epidemiological studies indicate that children of parents with mental health problems are at an increased risk of developing anxiety disorders. Few studies have investigated this relationship in young adults. Participants were from the Raine Study, which is a multi-generational birth cohort study in Australia. Maternal anxiety and depression in late childhood were assessed using the Depression, Anxiety, and Stress Scale (DASS-42), and paternal lifetime mental health problems were assessed using a self-reported questionnaire. The short form of DASS-42 (DASS-21) was used to assess anxiety symptoms among offspring at age 20. Negative binomial regression model was used to quantify the association. Data were available for 1,220 mother-offspring and 1,190 father-offspring pairs. After adjusting for potential confounders, we found an increased risk of anxiety in young adult offspring exposed to maternal anxiety in late childhood and paternal lifetime mental health problems. However, we observed no increased risks of anxiety in offspring exposed to maternal depressive symptoms. Our sensitivity analysis based on the log-binomial model (binary outcome) as well as the linear model (log-transformed data) confirmed the robustness of the main results. Our findings suggest there can be value to consider and apply targeted screening and intervention programs of anxiety in the young adult offspring with parental mental health problems.
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Affiliation(s)
- Getinet Ayano
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Kim Betts
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - Robert Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Rosa Alati
- School of Public Health, Curtin University, Perth, WA, Australia; Institute of social science research, The University of Queensland, QLD, Australia.
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Comorbid anxiety and depression: Prevalence and associated factors among pregnant women in Arba Minch zuria district, Gamo zone, southern Ethiopia. PLoS One 2021; 16:e0248331. [PMID: 33690693 PMCID: PMC7946223 DOI: 10.1371/journal.pone.0248331] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 02/24/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Prenatal anxiety and depression are major health problems all over the world. The negative sequela of prenatal comorbid anxiety and depression (CAD) has been suggested to be higher than that of anxiety or depression alone. CAD increases the odds of preterm birth, low birth weight, prolonged labor, operative deliveries, postpartum psychiatric disorders and long term cognitive impairment for the newborn. Despite its significant ill consequences, there is a dearth of studies in low-and middle-income countries. So far, to the best of our knowledge, no study assessed the prevalence of CAD in Ethiopia. Hence, the purpose of this study was to assess CAD and associated factors among pregnant women in Arba Minch Zuria district, Gamo zone, southern Ethiopia. Methods A community-based cross-sectional study was conducted among 676 pregnant women from January 01 to November 30, 2019. Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales were used to assess depression and anxiety respectively. The data were collected electronically using an open data kit (ODK) collect android application and analyzed using Stata version 15.0. Bivariate and multivariable analyses were carried out to identify factors associated with CAD using binary logistic regression. Statistical significance was set at p-value < 0.05. Results A total of 667 women were involved. The prevalence of CAD was 10.04% [95% confidence interval (CI): 7.76, 12.33]. Being married [adjusted odds ratio (AOR): 0.16, 95% CI: 0.05, 0.56], categorized in the highest wealth quintile [AOR: 2.83, 95% CI: 1.17, 6.84], having medical illness [AOR: 3.56, 95% CI: 1.68, 7.54], encountering pregnancy danger signs [AOR: 2.66, 95% CI: 1.06, 6.67], experiencing life-threatening events [AOR: 2.11, 95% CI: 1.15, 3.92] and household food insecurity [AOR: 3.51, 95% CI: 1.85, 6.64] were significantly associated with CAD. Conclusions In general, one in every ten women faced CAD in the study area. Nutritional interventions, early identification and treatment of pregnancy-related illness and medical ailments, prenatal mental health problems screening and interventions are imperative to minimize the risk of CAD in pregnant women.
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Caparros-Gonzalez RA, Torre-Luque ADL, Romero-Gonzalez B, Quesada-Soto JM, Alderdice F, Peralta-Ramírez MI. Stress During Pregnancy and the Development of Diseases in the offspring: A Systematic-Review and Meta-Analysis. Midwifery 2021; 97:102939. [PMID: 33647755 DOI: 10.1016/j.midw.2021.102939] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/21/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The goal of this systematic-review and meta-analysis was to assess whether high maternal stress during pregnancy is associated with the development of pediatric pathology. DESIGN Epidemiological peer-reviewed studies published in English or Spanish assessing associations between maternal stress during pregnancy and psychiatric and medical diseases were selected. PARTICIPANTS We retrieved 73,024 citations; 42 studies meeting inclusion criteria were assessed. Overall sample included 65,814,076 women. FINDINGS Overall odds ratio for the development of a medical disease was OR=1.24 (CI95=1.11, 1.39), Z=3.85, p<.01. Overall odds ratio for psychiatric disorders was OR=1.28 (CI95=1.06, 1.56), Z=2.54, p<.02. Multivariate meta-analysis showed a significant coefficient for autism spectrum disorder studies, B=0.42, SE=0.16, Z=2.67, p<.01. We found a significant overall effect size for autism spectrum disorder (OR=1.45 [CI95=1.24, 1.70], Z=4.69, p<.01). In terms of medical diseases, studies including obesity and infantile colic presented a significant overall effect size, as OR=1.20 (CI95=1.03, 1.39), Z=2.41, p<.02. The highest effect size was found regarding the first trimester (B=1.62, SE=0.16, Z=9.90, p<.01). KEY CONCLUSIONS We concluded that exposure to high levels of stress during pregnancy are associated with autism spectrum disorder, obesity, and infantile colic in offspring. IMPLICATIONS FOR PRACTICE Maternal stress during pregnancy should be addressed to tackle its potential impact in health across the life span.
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Affiliation(s)
| | | | - Borja Romero-Gonzalez
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | | | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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Crombie GK, Palliser HK, Shaw JC, Hodgson DM, Walker DW, Hirst JJ. Effects of prenatal stress on behavioural and neurodevelopmental outcomes are altered by maternal separation in the neonatal period. Psychoneuroendocrinology 2021; 124:105060. [PMID: 33333379 DOI: 10.1016/j.psyneuen.2020.105060] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chronic psychosocial stress during pregnancy and/or after birth, and the associated elevation in cortisol, is linked with the onset of behavioural disorders in childhood. Previously, prenatal stress has been shown to reduce neurosteroid pathways in the fetus and the levels of the neurosteroid and GABAA receptor agonist, allopregnanolone. In late gestation, elevated levels of GABAergic activity increases inhibitory tone and protects against excessive excitation. These levels of allopregnanolone may also contribute to promoting myelination, thus stress-induced suppression of protective neurosteroid levels may disrupt neurodevelopmental processes and can result in reduced myelination. The objective of this study was to examine whether prenatal and postnatal stress reduces levels of inhibitory pathways to result in behavioural, myelin, and GABAergic/glutamatergic pathway deficits in the hippocampus at a postnatal time point in the guinea pig equivalent to childhood in humans. METHODS Pregnant guinea pig dams were exposed to prenatal stress (PRE) with strobe light exposure for 2 h/day on gestational age (GA) 50, 55, 60 and 65 (term is ∼GA70), with postnatal stress (POST) caused by maternal separation for 2 h/day from postnatal day (PND) 1-7), or a double-hit of both stressors (PRE + POST). Control dams and offspring groups (CON) were handled at the same time each day without causing stress. Behavioural outcomes were assessed using open field and elevated plus maze testing on PND27. After euthanasia on PND30, plasma samples were collected for steroid quantification of cortisol, allopregnanolone and progesterone by ELISA. Hippocampal samples were collected to assess markers of oligodendrocyte development and mature cells by myelin basic protein (MBP) immunostaining and GABAergic and glutamatergic pathway component gene expression by real time PCR. RESULTS Male guinea pig offspring exposed to prenatal stress exhibited hyperactive-like behaviour at childhood equivalence, while female offspring displayed anxious-like behaviour, to a lesser extent. In both sexes, MBP immunostaining was significantly decreased in the hippocampal region following prenatal stress, despite normal levels of MBP mRNA, which suggests a disruption to the MBP protein translation pathway. Many components of the GABAergic and glutamatergic pathways were disrupted following prenatal stress, notably GABAA receptor subunits, GABA production and uptake, glutamate ionotropic and metabotropic receptor subunits and glutamate transport. Following prenatal + postnatal stress, many of the behavioural and neurodevelopmental deficits were improved compared to the prenatal stress only group. CONCLUSION We conclude that prenatal stress disrupts GABAergic and glutamatergic pathways that may contribute to reduced myelination and subsequent behavioural deficits in the offspring. The deficits seen following prenatal stress are ameliorated when paired with subsequent postnatal stress, which highlights the early postnatal period as an important treatment window.
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Affiliation(s)
- Gabrielle K Crombie
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia.
| | - Hannah K Palliser
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
| | - Julia C Shaw
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
| | | | - David W Walker
- School of Health and Biomedical Sciences, RMIT University, VIC, Australia
| | - Jonathan J Hirst
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
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Cattane N, Räikkönen K, Anniverno R, Mencacci C, Riva MA, Pariante CM, Cattaneo A. Depression, obesity and their comorbidity during pregnancy: effects on the offspring's mental and physical health. Mol Psychiatry 2021; 26:462-481. [PMID: 32632208 PMCID: PMC7850968 DOI: 10.1038/s41380-020-0813-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 02/08/2023]
Abstract
Depression and obesity represent two of the most common complications during pregnancy and are associated with severe health risks for both the mother and the child. Although several studies have analysed the individual effects of depression or obesity on the mothers and their children, the effects associated with the co-occurrence of both disorders have so far been poorly investigated. The relationship between depression and obesity is very complex and it is still unclear whether maternal depression leads to obesity or vice versa. It is well known that the intrauterine environment plays an important role in mediating the effects of both depression and obesity in the mother on the fetal programming, increasing the child's risk to develop negative outcomes.
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Affiliation(s)
- Nadia Cattane
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Roberta Anniverno
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Claudio Mencacci
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Marco A Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Wang X, Xie J, Wu Y, Wu X, Yan S, Xu Y, Zhu P, Hao J, Tao F, Huang K. Gender-specific effect of pregnancy-related anxiety on preschooler's emotional and behavioral development: A population-based cohort study. J Affect Disord 2021; 279:368-376. [PMID: 33099051 DOI: 10.1016/j.jad.2020.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pregnancy-related anxiety plays a major role in shaping offspring's neural development. However, its gender-specific effect on children's emotional and behavioral development is controversial and the knowledge of critical period is limited. This study aims to examine gender-specific effect of pregnancy-related anxiety on preschooler's emotional and behavioral development. METHODS This study was based on the China-Anhui Birth Cohort Study (C-ABCS). A total of 3443 mother-child pairs were included in final data analysis. Pregnancy-related anxiety was assessed by Pregnancy-Related Anxiety Questionnaire respectively in the 1st and 3rd trimester of pregnancy. Strengths and Difficulties Questionnaires (SDQ) were completed by parents to assess preschool emotional and behavioral development in boys and girls. Logistic regression models were used to examine the association between pregnancy-related anxiety and preschoolers' emotional and behavioral problems. RESULTS The overall prevalence of pregnancy-related anxiety was 31.6%. Compared with those whose mothers without pregnancy-related anxiety in either 1st or 3rd trimester, preschool boys born of mothers with pregnancy-related anxiety in the 1st trimester and in the 3rd trimester had an increased risk of conduct problems. Pregnancy-related anxiety in the 1st, 3rd trimester and in both trimesters all related with preschool boys' hyperactivity and total difficult problems. Pregnancy-related anxiety in the 1st trimester and in both 1st and 3rd trimester increased the risk of preschool girls' emotional problems and total difficult problems. CONCLUSION Pregnancy-related anxiety may relate with preschool boys' externalizing problems in early and late of pregnancy and increase the risk of internalizing problems in girls in early pregnancy. LIMITATIONS There was no data on pregnancy-related anxiety in the second trimester.
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Affiliation(s)
- Xiaoxu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui Province, China; Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Province, China; Key Laboratory of study on abnormal gametes and reproductive tract, National Health and Health Commission of the People's Republic of China, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Province, China
| | - Jingjing Xie
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui Province, China; Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Province, China; Key Laboratory of study on abnormal gametes and reproductive tract, National Health and Health Commission of the People's Republic of China, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Province, China
| | - Ya Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui Province, China; Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Province, China; Key Laboratory of study on abnormal gametes and reproductive tract, National Health and Health Commission of the People's Republic of China, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Province, China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui Province, China; Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Province, China; Key Laboratory of study on abnormal gametes and reproductive tract, National Health and Health Commission of the People's Republic of China, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Province, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Center, No 72 Jiashan Road, Ma'anshan, Anhui Province, China
| | - Yeqing Xu
- Ma'anshan Maternal and Child Health Center, No 72 Jiashan Road, Ma'anshan, Anhui Province, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui Province, China; Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Province, China; Key Laboratory of study on abnormal gametes and reproductive tract, National Health and Health Commission of the People's Republic of China, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Province, China
| | - Jiahu Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui Province, China; Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Province, China; Key Laboratory of study on abnormal gametes and reproductive tract, National Health and Health Commission of the People's Republic of China, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Province, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui Province, China; Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Province, China; Key Laboratory of study on abnormal gametes and reproductive tract, National Health and Health Commission of the People's Republic of China, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Province, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui Province, China; Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Province, China; Key Laboratory of study on abnormal gametes and reproductive tract, National Health and Health Commission of the People's Republic of China, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Province, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Anhui Province, China.
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Maternal Depression and Mother-Child Oxytocin Synchrony in Youth with Anxiety Disorders. Res Child Adolesc Psychopathol 2021; 49:381-392. [PMID: 33403493 DOI: 10.1007/s10802-020-00744-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 02/01/2023]
Abstract
The neuropeptide oxytocin (OT) plays a central role in the regulation of affiliative bonds and anxiety. However, the degree to which its levels are synchronized between interaction partners has not yet been assessed. Physiological synchrony assessed using other peripheral measures (e.g., heart rate, etc.) has been tied to positive outcomes for the individual and the dyad. The present study examined OT synchrony in the context of child anxiety and maternal depression by examining mother-child dyads. Mothers and their children with anxiety disorders participated in a behavioral interaction task. Changes in OT levels and mother-child OT synchrony before and after the interaction, as well as their moderation by maternal depression, were assessed. Ninety-eight youth with anxiety disorders (ages 10 to 17) and their mothers underwent psychiatric evaluation, and mothers rated their own depressive symptoms and their children's behavior problems. Salivary OT was assayed from mother and child before and after the task. Behavioral coding showed that interactions were characterized by high behavioral synchrony between mothers and their children, and both individuals displayed higher levels of positive vs. negative affect during the interactions. Mothers and their children also showed decreases in OT levels after the interaction. As hypothesized, OT synchrony increased following the task, but only dyads in which mothers showed high levels of depressive symptoms showed this increase. As hypothesized, lower levels of OT-synchrony were associated with higher levels of child internalizing symptoms. The findings suggest that positive interactions may be beneficial for youth with anxiety disorders with mothers with depression.
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Tuovinen S, Lahti-Pulkkinen M, Girchenko P, Heinonen K, Lahti J, Reynolds RM, Hämäläinen E, Villa PM, Kajantie E, Laivuori H, Raikkonen K. Maternal antenatal stress and mental and behavioral disorders in their children. J Affect Disord 2021; 278:57-65. [PMID: 32950844 DOI: 10.1016/j.jad.2020.09.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Maternal antenatal stress, including symptoms of depression, anxiety and perceived stress, is associated with mental and behavioral problems in children. Whether it is associated with child mental and behavioral disorders remains uncertain. We examined if maternal antenatal symptoms of depression, anxiety and perceived stress were associated with mental and behavioral disorders in their children, if the associations varied according to gestational week, stress type, fluctuating or consistently high symptoms, and if they were driven by maternal or paternal lifetime mood or anxiety disorders. METHODS 3365 mothers participating in the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction (PREDO) study completed the Center for Epidemiologic Studies Depression Scale, the State Anxiety Inventory and the Perceived Stress Scale up to 14 times throughout pregnancy. The Care Register for Health Care provided data on mental and behavioral (including neurodevelopmental) disorders for their children from birth (11/07/2006-07/24/2010) until 12/31/2016 and for parental lifetime mood and anxiety disorders until 12/31/2016. RESULTS The hazard of any childhood mental and behavioral disorder (HR=1.91, 95% CI: 1.39-2.51) was significantly higher for children whose mothers reported consistently high in comparison to consistently low levels of all types of stress throughout pregnancy. The associations remained significant when adjusted for maternal and paternal lifetime mood and anxiety disorders (and their comorbidity and timing and mood disorder type). CONCLUSION Maternal antenatal stress is associated with higher risk of childhood mental and behavioral disorders. Efforts to reduce maternal antenatal stress should be given a high priority to improve child mental health.
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Affiliation(s)
- Soile Tuovinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
| | - Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Polina Girchenko
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Kati Heinonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Rebecca M Reynolds
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Esa Hämäläinen
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia M Villa
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Helsinki, Finland; PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Katri Raikkonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
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Lisi G, Ribolsi M, Siracusano A, Niolu C. Maternal Vitamin D and its Role in Determining Fetal Origins of Mental Health. Curr Pharm Des 2020; 26:2497-2509. [PMID: 32370709 DOI: 10.2174/1381612826666200506093858] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/26/2020] [Indexed: 12/21/2022]
Abstract
There is evidence that mental health disorders may have roots in fetal life and are associated with deficiencies in various micronutrients, including vitamin D. During pregnancy, vitamin D balance is influenced by an increase in maternal calcitriol and a substantial increase in maternal Vitamin D Binding Protein concentrations. In the early stages of life, vitamin D is necessary to mediate numerous brain processes such as proliferation, apoptosis, and neurotransmission. Furthermore, Vitamin D has a recognized anti-inflammatory activity that normally suppresses inflammation. Increased activation of hypothalamo-pituitary-adrenal axis (HPA) and inflammation during gestation may influence maternal health and fetal neurodevelopment during and beyond pregnancy. A deficit of Vitamin D and maternal stressful events during gestation, such as perinatal depression, could influence the efficacy of the immune system altering its activity. Vitamin D deficiency during gestation associated with a reduction in fetal brain development has been widely described and correlated with alteration in the production of the brain-derived neurotrophic factor. To this regard, many studies highlights that low maternal vitamin D dosage during gestation has been related to a significantly greater risk to develop schizophrenia and other severe mental illnesses in later life. The objective of this paper is a comprehensive overview of maternal vitamin D balance in determining the fetal origins of mental health with some references to the link between vitamin D levels, inflammatory responses to stress and mental disorders in adult life.
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Affiliation(s)
- Giulia Lisi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Mental Health, ASL ROMA 1, Rome, Italy
| | - Michele Ribolsi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Policlinico Tor Vergata Foundation, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Policlinico Tor Vergata Foundation, Rome, Italy
| | - Cinzia Niolu
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Policlinico Tor Vergata Foundation, Rome, Italy
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45
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Stark EL, Miller ES. Diabesity and Perinatal Mental Health: Evidence-based Recommendations for Screening and Intervention. Clin Obstet Gynecol 2020; 64:204-213. [PMID: 33284142 DOI: 10.1097/grf.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perinatal mental illness, obesity, and diabetes mellitus are common complications of the perinatal period that are becoming ever more prevalent and frequently co-occur. This review seeks to examine the prevalence of comorbid obesity/diabetes (termed "diabesity") and mental illness in the perinatal period and current understandings of the psychosocial and pathophysiological relationships between these diseases. We will present current guidelines for screening and make recommendations for adaptations of mental health treatment in patients with this comorbidity. Finally, we present future directions for research and clinical intervention.
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Affiliation(s)
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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46
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Davis EP, Narayan AJ. Pregnancy as a period of risk, adaptation, and resilience for mothers and infants. Dev Psychopathol 2020; 32:1625-1639. [PMID: 33427164 PMCID: PMC7863987 DOI: 10.1017/s0954579420001121] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The pregnancy period represents a unique window of opportunity to identify risks to both the fetus and mother and to deter the intergenerational transmission of adversity and mental health problems. Although the maternal-fetal dyad is especially vulnerable to the effects of stress during pregnancy, less is known about how the dyad is also receptive to salutary, resilience-promoting influences. The present review adopts life span and intergenerational perspectives to review four key areas of research. The first part describes how pregnancy is a sensitive period for both the mother and fetus. In the second part, the focus is on antecedents of maternal prenatal risks pertaining to prenatal stress response systems and mental health. The third part then turns to elucidating how these alterations in prenatal stress physiology and mental health problems may affect infant and child outcomes. The fourth part underscores how pregnancy is also a time of heightened fetal receptivity to maternal and environmental signals, with profound implications for adaptation. This section also reviews empirical evidence of promotive and protective factors that buffer the mother and fetus from developmental and adaptational problems and covers a sample of rigorous evidence-based prenatal interventions that prevent maladaptation in the maternal-fetal dyad before babies are born. Finally, recommendations elaborate on how to further strengthen understanding of pregnancy as a period of multilevel risk and resilience, enhance comprehensive prenatal screening, and expand on prenatal interventions to promote maternal-fetal adaptation before birth.
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Affiliation(s)
- Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
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Ståhlberg T, Khanal P, Chudal R, Luntamo T, Kronström K, Sourander A. Prenatal and perinatal risk factors for anxiety disorders among children and adolescents: A systematic review. J Affect Disord 2020; 277:85-93. [PMID: 32799108 DOI: 10.1016/j.jad.2020.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prenatal and perinatal risk factors for anxiety disorders have rarely been studied, even though they are highly prevalent in children and adolescents. It is important to identify the common risk factors, so that targeted preventive care and early interventions can be provided. METHODS A systematic review of the PubMed and PsycInfo databases was conducted to 25 October 2019, according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses guidelines. The protocol was registered on the Prospective Register of Systematic Reviews and the quality assessment was carried out using the Joanna Briggs tools. RESULTS The review identified 31 studies from eight countries, including three register studies. Cohort sizes ranged from 69 to 89,404 and diagnoses cases ranged from 4 to 7867. Although various risk factors had been researched, only few of them had been repeatedly studied and the findings were highly inconsistent. The associations between the different risk factors and anxiety disorders seemed weak compared to many other psychiatric disorders, but preterm birth and maternal somatic illnesses may increase the risk for anxiety disorders in offspring. LIMITATIONS The studies varied considerably by study design, risk factors and anxiety disorders studied, sample sizes and follow up periods. CONCLUSIONS Prenatal and perinatal risk factors for anxiety disorders have been under-researched, compared to other psychiatric disorders. Our systematic review found weak links to prenatal events, but flagged up preterm birth and maternal somatic illnesses as possible avenues for future research.
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Affiliation(s)
- Tiia Ståhlberg
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland.
| | - Prakash Khanal
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland
| | - Roshan Chudal
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland
| | - Terhi Luntamo
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland
| | - Kim Kronström
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland; Department of Adolescent Psychiatry, Turku University Hospital, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland; Turku University Hospital, Turku, Finland; INVEST Research Flagship, University of Turku, (Principal Investigator), Turku, Finland
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48
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Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neurosci Biobehav Rev 2020; 117:26-64. [DOI: 10.1016/j.neubiorev.2017.07.003] [Citation(s) in RCA: 438] [Impact Index Per Article: 109.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 04/09/2017] [Accepted: 07/11/2017] [Indexed: 01/17/2023]
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49
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Dachew BA, Scott JG, Mamun A, Alati R. Hypertensive disorders of pregnancy and emotional and behavioural problems in children: a longitudinal population-based study. Eur Child Adolesc Psychiatry 2020; 29:1339-1348. [PMID: 31758357 DOI: 10.1007/s00787-019-01443-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/12/2019] [Indexed: 12/31/2022]
Abstract
There is evidence that offspring of mothers who have hypertensive disorders of pregnancy (HDP) are at increased risk of adverse health outcomes. This study aims to examine the association between maternal HDP and emotional- and behavioural problems in offspring at age 11 years as reported by teachers and parents. The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, population-based study that has followed a cohort of offspring since their mothers were pregnant. Childhood emotional- and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ), completed by parents (n = 7196) and the child's teacher (n = 7411). Maternal preeclampsia, but not gestational hypertension, was associated with teacher-reported total behavioural difficulties (RR = 1.62; 95% CI 1.03-2.52) and internalising problems in children [peer problems (RR = 1.48; 95% CI 1.06-2.08) and emotional problems (RR = 1.68; 95% CI 1.13-2.51)]. No associations between preeclampsia and/or gestational hypertension and parent-reported emotional- and behaviour problems were observed. Our study showed that children exposed to preeclampsia had higher risk of teacher-reported total behavioural difficulties and internalising problems compared with unexposed children. The findings suggest emotional- and behavioural difficulties may not be evident in all settings, hence the importance of collecting evidence from multiple informants.
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Affiliation(s)
- Berihun Assefa Dachew
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia. .,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - James G Scott
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia
| | - Rosa Alati
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
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50
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Tirumalaraju V, Suchting R, Evans J, Goetzl L, Refuerzo J, Neumann A, Anand D, Ravikumar R, Green CE, Cowen PJ, Selvaraj S. Risk of Depression in the Adolescent and Adult Offspring of Mothers With Perinatal Depression: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e208783. [PMID: 32602910 PMCID: PMC7327545 DOI: 10.1001/jamanetworkopen.2020.8783] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Maternal depression during pregnancy is associated with emotional and behavioral difficulties of offspring during childhood that can increase the risk of depression in adolescence and adulthood. OBJECTIVE To investigate the association between perinatal maternal depression and an increased long-term risk of depression in their adolescent and adult offspring. DATA SOURCES A systematic search of the electronic databases of PubMed and PsycINFO was conducted from May 2019 to June 2019. STUDY SELECTION A total of 6309 articles were identified, of which 88 articles were extracted for full-text review by 2 reviewers. Only articles reporting data from prospective longitudinal studies that assessed maternal depression during antenatal and/or postnatal periods and resulting offspring 12 years or older with measures of established psychometric properties were included. Exclusion criteria consisted of all other study designs, mothers with other medical and psychiatric comorbidities, and offspring younger than 12 years. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers, and discrepancies were mediated by an expert third reviewer. Meta-analysis was performed using Bayesian statistical inference and reported using Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline. The association of depression timing with the sex of offspring was explored using metaregression. MAIN OUTCOMES AND MEASURES Offspring depression was evaluated using standardized depression scales or clinical interviews. RESULTS Six studies with a total of 15 584 mother-child dyads were included in the meta-analysis, which found the offspring of mothers who experienced perinatal depression to have increased odds of depression (odds ratio [OR], 1.70; 95% credible interval [CrI], 1.60-2.65; posterior probability [PP] [OR >1], 98.6%). Although metaregression found no evidence for an overall association between perinatal depression timing and offspring depression (antenatal vs postnatal, PP [OR >1] = 53.8%), subgroup analyses showed slightly higher pooled odds for the antenatal studies (OR, 1.78; 95% CrI, 0.93-3.33; PP [OR >1] = 96.2%) than for the postnatal studies (OR, 1.66; 95% CrI, 0.65-3.84; PP [OR >1] = 88.0%). Female adolescent offspring recorded higher rates of depression in metaregression analyses, such that a 1% increase in the percentage of female (relative to male) offspring was associated with a 6% increase in the odds of offspring depression (OR, 1.06; 95% CrI, 0.99-1.14; τ2 = 0.31). CONCLUSIONS AND RELEVANCE In this study, maternal perinatal depression, especially antenatal depression, was associated with the risk of depression in adolescence and adulthood. More research into the mechanisms of depression risk transmission and assessments of postinterventional risk reduction could aid in the development of future strategies to tackle depressive disorders in pregnancy.
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Affiliation(s)
- Vaishali Tirumalaraju
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Jonathan Evans
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laura Goetzl
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern School of Medicine, University of Texas Health Science Center at Houston
| | - Jerrie Refuerzo
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Alexander Neumann
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Deepa Anand
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Rekha Ravikumar
- Department of Internal Medicine, Mercy Health St Vincent Medical Center, Toledo, Ohio
| | - Charles E. Green
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Philip J. Cowen
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sudhakar Selvaraj
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
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