Maternal late pregnancy anxiety and stress is associated with children's health: a longitudinal study

Higher prenatal anxiety predicts lower neonatal hair cortisol

BACKGROUND

Prenatal glucocorticoids are one of the most widely proposed prenatal programming mechanisms, yet few studies exist that measure fetal cortisol via neonatal hair. Neonatal hair provides a window into the fetal experience and represents cortisol accumulation in the third trimester of pregnancy. In the current study, we test the links between two types of anxiety over the course of gestation (pregnancy-related anxiety and general anxiety) with neonatal hair cortisol.

METHOD

Pregnant individuals (N = 107) and their neonates (59.8% female) participated in the current study. Prenatal pregnancy-related anxiety and general anxiety were measured using the Pregnancy Related Anxiety Scale (PRAS) and the State-Trait Anxiety Inventory (STAI), in each trimester of pregnancy. Hierarchical linear modeling was used to model the intercept and slope of each type of anxiety over gestation. Neonatal hair samples were collected shortly after birth (Median days = 1.17, IQR = 0.75-2.00).

RESULTS

Both higher pregnancy-related anxiety and general anxiety at the beginning of pregnancy and a flatter decline of pregnancy-related anxiety over gestation were associated with lower neonatal hair cortisol. After inclusion of gestational age at birth and parity as covariates, pregnancy-related anxiety (intercept: β = -0.614, p =.012; slope: β = -0.681, p =.006), but not general anxiety (intercept: β = -0.389, p =.114; slope: β = -0.302, p =.217) remained a significant predictor. Further, when both general and pregnancy-related anxiety were entered into the same model, only pregnancy-related anxiety (intercept and slope) were significant predictors of neonatal hair cortisol, indicating an association with pregnancy-related anxiety above and beyond general anxiety.

CONCLUSION

Cortisol plays a central role in maturation of fetal organ systems, and at the end of gestation, higher cortisol has beneficial effects such as promoting fetal lung maturation. Further, lower maternal cortisol is linked to less optimal cognitive development and altered brain development. As maternal higher anxiety in early pregnancy and a flatter decrease over time are both associated with lower neonatal hair cortisol, maternal pregnancy-related anxiety could be a target of future intervention efforts.

Parental sensitivity modifies the associations between maternal prenatal stress exposure, autonomic nervous system functioning and infant temperament in a diverse, low-income sample

Evidence suggests that adversity experienced during fetal development may shape infant physiologic functioning and temperament. Parental sensitivity is associated with child stress regulation and may act as a buffer against risk for intergenerational health effects of pre- or postnatal adversity. Building upon prior evidence in a racially and ethnically diverse sample of infants (M infant age = 6.5 months) and women of low socioeconomic status, this study examined whether coded parenting sensitivity moderated the association between an objective measure of prenatal stress exposures (Stressful Life Events (SLE)) and infant parasympathetic (respiratory sinus arrhythmia; RSA) or sympathetic (pre-ejection period; PEP) nervous system functioning assessed during administration of the Still-Face-Paradigm (SFP) (n = 66), as well as maternal report of temperament (n = 154). Results showed that parental sensitivity moderated the associations between prenatal stress exposures and infant RSA reactivity, RSA recovery, PEP recovery, and temperamental negativity. Findings indicate that greater parental sensitivity is associated with lower infant autonomic nervous system reactivity and greater recovery from challenge. Results support the hypothesis that parental sensitivity buffers infants from the risk of prenatal stress exposure associations with offspring cross-system physiologic reactivity and regulation, potentially shaping trajectories of health and development and promoting resilience.

Negative/Positive Emotions, Perceived Self-Efficacy and Transition to Motherhood during Pregnancy: A Monitoring Study

BACKGROUND

Several studies have investigated the topic of emotion regulation and self-perception in women during pregnancy, which turns out to be a critical event for the woman approaching psycho-physical changes. The objectives of the study were the evaluation and monitoring, during pregnancy, of emotional states and levels of self-efficacy and the analysis of the representations of self and the child.

METHODS

Twenty women (M = 34.60; SD = 4.60) in the 28-week gestation period participated in the research. We performed three administrations (T0-1-2) of an ad hoc questionnaire containing: personal data; Maternal Representations in Pregnancy Interview-IRMAG; Multidimensional Emotion Questionnaire-MEQ; Perceived Self-Efficacy in Complex Situations Scale.

RESULTS

Both qualitative and quantitative analyses show that the future mother's strategies and functional resources focus on perceiving herself as effective in the acquired role, despite the pregnancy itself being a highly stressful critical event. Positive emotions tend to increase, just as the frequency, intensity, persistence and regulation of emotion undergo a linear and constant increase with respect to the first and second administration.

CONCLUSIONS

Qualitative research has produced significant results with regard to the representations of mothers-to-be as they attempt to cope with states of change during pregnancy with their own personal adaptive resources.

Prenatal hair cortisol concentrations during the COVID-19 outbreak: Associations with maternal psychological stress and infant temperament

BACKGROUND

Maternal psychological stress during pregnancy, including stress resulting from disasters and trauma, has been linked to temperamental difficulties in offspring. Although heightened cortisol concentrations are often hypothesized as an underlying mechanism, evidence supporting this mechanism is not consistent, potentially because of methodological issues and low stress in the population.

AIM

To address these issues, this preregistered study investigated the following associations between: 1) prenatal psychological stress and hair cortisol, as a biomarker for chronic stress, during the COVID-19 outbreak (i.e., as a major worldwide psychological stressor), and 2) maternal hair cortisol during the COVID-19 outbreak and later infant temperamental negative affectivity and orienting/regulation. Additionally, we explored whether associations were different for women with low versus high socioeconomic status (SES; maternal education and annual household income) and at different stages of pregnancy.

METHOD

Pregnant women (N = 100) filled out online questionnaires during the first COVID-19 lockdown. Six months later, when most mothers were still pregnant or had just given birth, maternal hair samples were collected during home visits. When infants were six months old, mothers reported on their infant's temperament.

RESULTS

Although hierarchical regression analyses revealed no associations between prenatal COVID-19 psychological stress and hair cortisol during the COVID-19 outbreak, SES proved to be a moderator in this association. Only pregnant women with higher levels of SES, not lower levels, showed a positive association between work-related and social support-related COVID-19 worries and hair cortisol. Finally, prenatal hair cortisol was not associated with later infant temperamental negative affectivity and orienting/regulation.

CONCLUSION

Although the COVID-19 outbreak proved to be a major psychological stressor worldwide, the physiological impact of the crisis might be different for pregnant women with higher SES as compared to lower SES.

No evidence for association between late pregnancy maternal cortisol and gray matter volume in a healthy community sample of young adolescents

A compelling amount of animal and human research has shown that perceived maternal stress during pregnancy can affect the neurodevelopment of the offspring. Prenatal maternal cortisol is frequently proposed as the biological key mechanism underlying this link; however, literature that investigates the effects of prenatal cortisol on subsequent neurodevelopment in humans is scarce. By using longitudinal data from a relatively large community sample of mother-child dyads (N = 73), this pre-registered study prospectively examined the role of maternal prenatal cortisol concentrations on subsequent individual differences in gray matter volume (GMV) and hippocampal subfield volumes at the onset of puberty of the offspring (12 years of age). Two markers of cortisol, that is, evening cortisol and circadian decline over the day, were used as indicators of maternal physiological stress during the last trimester of pregnancy. The results indicate that prenatal maternal cortisol levels were not associated with GMV or hippocampal subfield volumes of the children. These findings suggest that late pregnancy maternal cortisol may not be related to the structural development of the offspring's brain, at least not in healthy community samples and at the onset of puberty. When examining the influence of prenatal stress on offspring neurodevelopment, future investigations should delineate gestational timing effects of the cortisol exposure, cortisol assessment method, and impact of additional biomarkers, as these were not investigated in this study.

Pregnant in a Pandemic: Connecting Perceptions of Uplifts and Hassles to Mental Health

How women experience pregnancy as uplifting or a hassle is related to their mental and physical health and birth outcomes. Pregnancy during a pandemic introduces new hassles, but may offer benefits that could affect how women perceive their pregnancy. Surveying 118 ethnically and racially diverse pregnant women, we explore (1) women's traditional and pandemic-related pregnancy uplifts and hassles and (2) how these experiences of pregnancy relate to their feelings of loneliness, positivity, depression, and anxiety. Regressions show that women who experience more intense feelings of uplifts than hassles also feel more positive, less lonely, and have better mental health. Findings suggest that focusing on positive aspects of being pregnant, in general and during a pandemic, might be beneficial for pregnant women's mental health.

Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health

Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.

Development of the gut microbiota in healthy children in the first ten years of life: associations with internalizing and externalizing behavior

BACKGROUND

Increasing evidence indicates that psychopathological disorders are associated with the gut microbiota. However, data are largely lacking from long-term longitudinal birth cohorts, especially those comprising low-risk healthy individuals. Therefore, this study aims to describe gut microbiota development in healthy children from birth till age 10 years, as well as to investigate potential associations with internalizing and externalizing behavior.

RESULTS

Fecal microbial composition of participants in an ongoing longitudinal study (N = 193) was analyzed at 1, 3 and 4 months, and 6 and 10 years of age by 16S ribosomal RNA gene sequencing. Based on these data, three clusters were identified in infancy, two of which were predominated by Bifidobacterium. In childhood, four clusters were observed, two of which increased in prevalence with age. One of the childhood clusters, similar to an enterotype, was highly enriched in genus-level taxon Prevotella_9. Breastfeeding had marked associations with microbiota composition up till age 10, implying an extended role in shaping gut microbial ecology. Microbial clusters were not associated with behavior. However, Prevotella_9 in childhood was positively related to mother-reported externalizing behavior at age 10; this was validated in child reports.

CONCLUSIONS

This study validated previous findings on Bifidobacterium-enriched and -depleted clusters in infancy. Importantly, it also mapped continued development of gut microbiota in middle childhood. Novel associations between gut microbial composition in the first 10 years of life (especially Prevotella_9), and externalizing behavior at age 10 were found. Replications in other cohorts, as well as follow-up assessments, will help determine the significance of these findings.

Perinatal factors and high-sensitive C-reactive protein levels during adolescence

Objective

To examine whether perinatal factors are associated with low-grade inflammation measured by high-sensitivity C-reactive protein levels during adolescence.

Methods

Nested case-control study of 125 teenagers who were born by Cesarean delivery and had high-sensitivity C-reactive protein levels determined at 15–17 years. Data on obstetric and perinatal factors were recorded prospectively at the time of their birth.

Results

Median values of high-sensitivity C-reactive protein were significantly higher in teenagers, who were born as large for gestational age or with maternal diabetes compared to others (2.54 vs 0.34 mg/L; p < 0.024), and born during spring or summer compared to those born during winter or autumn (0.48 vs 0.27 mg/L; p < 0.023). No other perinatal associations were detected (for ex. such as electivity of operation, onset of labor, rupture of fetal membranes, cervical dilatation at delivery, gestational age, Apgar scores at 5 min, umbilical blood pH value, administration of neonatal antibiotics or need of neonatal intensive care treatment) in CRP levels. Further, teenagers with current body mass index in the highest tertile, regular medication for chronic disease and girls using oral contraceptives had significantly higher high-sensitivity C-reactive protein levels than others.

Conclusion

Prenatal exposures such as maternal metabolic environment and seasonality may have longterm effects on the low-grade inflammation and later cardiometabolic risks. Seasonality might be partly explained by maternal vitamin D levels during pregnancy, and thus future efforts are warranted to ensure sufficient vitamin D availability during pregnancy. Surprisingly, no other significant associations were detected between perinatal characteristics and high-sensitivity C-reactive protein levels.

The effect of kangaroo care on modulate chronic stress response in preterm infants and mothers

To assess stress experienced during Neonatal Intensive Care Unit (NICU) stay, we analyzed fingernail Cortisol (CORT) and Dehydroepiandrosterone (DHEA) levels and ratios in mothers and preterm infants (PI); compared hormones levels/ratio (CORT and DHEA) in kangaroo care (KC) versus standard care (SC) groups and examined relationships between PI hormone levels total days spent in the NICU. Mothers and their infants were recruited in the NICU, included levels I-IV and kangaroo care unit, within one week of infant birth in hospitals in Brazil. At 3 months after birth, mothers provided 3-month growth clippings from all ten digits of their own and their infants' fingernails. CORT and DHEA were measured using enzyme immunoassays (mothers) and high-performance-liquid-chromatography-with-mass-spectrometry (infants). Sample: n = 59 mothers (KC = 30/SC = 29) and 63 infants (KC = 32/SC = 31). Data were analyzed using non-parametric/parametric comparative statistics. NICU stay ranged from 3-103 days. For mothers in Kangaroo and Standard Care the CORT, DHEA levels and DHEA:CORT ratio (DC) ratio did not differ. Infants in KC had higher DHEA (p = 0.003) and a higher DC ratio (p = 0.011) than SC infants. Even though KC infants stayed in the NICU for a greater number of days than infants in SC, they had higher mean level of DHEA, and DC ratio, suggesting that KC played a role in promoting their stress regulatory capacities and may mitigate toxic effects of chronic hypercortisolemia. However, for mothers, KC did not reduce chronic stress compared to that in women in the SC condition. Further research warranted.

Association between gestational period and obesity in children with the use of dermatoglyphic traits: A preliminary study

Events occurring during the gestational period can influence the development of diseases and conditions such as obesity. This study aimed to analyze the association between events occurring in the gestational period and the occurrence of obesity in children based on dermatoglyphic traits. The sample comprised 73 children born in 2009, living in Palhoça, Santa Catarina (SC), Brazil, regularly enrolled in public and private schools in that municipality and who are participants of an ongoing major cohort study project called Coorte Brasil Sul. The results show predictive traits of obesity when comparing BMI and fingerprint groups. Obese male group, presented the figure Ulnar Loop (UL) in the right hand (MDT1) thumb and greater number of ridges in the (MDSQL1) right thumb the greater the BMI; likewise, the older the woman getting pregnant the greater the number of ridges that the child presented in the (MESQL2) left index finger and (MESQL1) right thumb. The results obtained infer the presence of predictive traits of BMI ranges and a possible association between the dermatoglyphic traits of children with obesity and late pregnancy women.

"We do not know how to screen and provide treatment": a qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia

BACKGROUND

Qualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population. We conducted a qualitative study to explore barriers to, enablers of, or opportunities for perinatal depression health services implementations in Ethiopia.

METHODS

We conducted a total of 13 face to face interviews with mental and maternal health service administrators from different levels of the Ethiopian healthcare system. We interviewed in Amharic (a local language), transcribed and translated into English, and imported into NVivo. We analysed the translated interviews inductively using thematic framework analysis.

RESULTS

The study identified: (i) health administrators' low literacy about perinatal depression as individual level barriers; (ii) community low awareness, health-seeking behaviours and cultural norms about perinatal depression as socio-cultural level barriers; (iii) lack of government capacity, readiness, and priority of screening and managing perinatal depression as organisational level barriers; and (iv) lack of mental health policy, strategies, and healthcare systems as structural level barriers of perinatal mental health implementation in Ethiopia. The introduction of the new Mental Health Gap Action Programme (mhGap), health professionals' commitment, and simplicity of screening programs were identified enablers of, or opportunities for, perinatal mental health service implementation.

CONCLUSIONS

This qualitative inquiry identified important barriers and potential opportunities that could be used to address perinatal depression in Ethiopia. Building the capacity of policy makers and planners, strengthening the mental healthcare system and governance should be a priority issue for an effective integration of maternal mental health care with the routine maternal health services in Ethiopia.

Interactions of genetic variants and prenatal stress in relation to the risk for recurrent respiratory infections in children

Genetic variants may predispose children to recurrent respiratory infections (RRIs) but studies on genotype-environment interaction are rare. We hypothesized that the risk for RRIs is elevated in children with innate immune gene variants, and that prenatal exposure to maternal psychological distress further increases the risk. In a birth cohort, children with RRIs (n = 96) were identified by the age of 24 months and compared with the remaining cohort children (n = 894). The risk for RRIs in children with preselected genetic variants and the interaction between maternal distress during pregnancy and child genotype were assessed with logistic regression. The IL6 minor allele G was associated with elevated risk for RRIs (OR 1.55; 95% CI 1.14-2.12). Overall, there was no interaction between maternal psychological distress and child genotype. Exploratory analyses showed that, the association between the variant type of IL6 and the risk for RRIs was dependent on prenatal exposure to maternal psychological distress in males (OR 1.96; 95% CI 1.04-3.67). Our study didn't find genotype-environment interaction between prenatal maternal distress and child genotype. Exploratory analyses suggest sex differences in gene-environment interaction related to susceptibility to RRIs.

The relationship of maternal anxiety, positive and negative affect schedule, and fatigue with neonatal psychological health upon childbirth

BACKGROUND

Exposure of mothers to negative moods and stress before childbirth leads to negative consequences for the infants. Given the importance of psychological health, this study aimed to examine the effect of these factors on the infants' psychological health.

METHOD

This cross-sectional study was conducted in Shiraz hospitals on 110 pregnant women selected with multistage random sampling. Research tools included The McGill Pain Questionnaire (MPQ) to measure fatigue with three criteria; The Positive and Negative Emotion Schedule (PANAS); and The Spielberger State-Trait Anxiety Inventory (STAI) were used to measure maternal mood and anxiety level. Also, neonatal psychological health was assessed by a checklist. Neonatal psychological health's correlation with maternal anxiety, fatigue, and mental state was assessed. Data were analyzed by SPSS-19 software using Pearson correlation coefficient and statistical regression at the significance level of 0.05.

RESULT

Although there was no significant relationship between maternal anxiety score and neonatal psychological health after birth (p = 0.231; r=-0.343), the relationship was significant immediately after birth with positive (P < 0.001; r = 0.343) and negative affect scores (P < 0.001; r=-0.357).

CONCLUSIONS

There was a statistically significant relationship between the neonatal psychological health and maternal fatigue (p ≤ 0.001; r = -0.357) and PANAS (p ≤ 0.001) of the mother; however, it had no significant relationship with maternal anxiety (p = 0.231; r=- 0.343). Therefore, nurses and midwives can reduce maternal anxiety and improve neonatal mental health by supporting mothers.

Searching for host immune-microbiome mechanisms in obsessive-compulsive disorder: A narrative literature review and future directions

Obsessive-compulsive disorder (OCD) is disabling and often treatment-refractory. Host immunity and gut microbiota have bidirectional communication with each other and with the brain. Perturbations to this axis have been implicated in neuropsychiatric disorders, but immune-microbiome signaling in OCD is relatively underexplored. We review support for further pursuing such investigations in OCD, including: 1) gut microbiota has been associated with OCD, but causal pathogenic mechanisms remain unclear; 2) early environmental risk factors for OCD overlap with critical periods of immune-microbiome development; 3) OCD is associated with increased risk of immune-mediated disorders and changes in immune parameters, which are separately associated with the microbiome; and 4) gut microbiome manipulations in animal models are associated with changes in immunity and some obsessive-compulsive symptoms. Theoretical pathogenic mechanisms could include microbiota programming of cytokine production, promotion of expansion and trafficking of peripheral immune cells to the CNS, and regulation of microglial function. Immune-microbiome signaling in OCD requires further exploration, and may offer novel insights into pathogenic mechanisms and potential treatment targets for this disabling disorder.

Parity-related variation in cortisol concentrations in hair during pregnancy

Objective

To investigate hair cortisol concentrations (HCC) monthly in pregnant women and to explore the effect of parity.

Design

Prospective cohort study from gestational week (GW) 26, at childbirth and postpartum.

Setting

An antenatal care clinic in southeast Sweden.

Sample

390 pregnant women.

Methods

Cortisol was measured using radioimmunoassay in methanol extracts of ground hair samples.

Main outcome measures

Hair cortisol concentrations.

Results

Both primi‐ and multiparae exhibited an increase in HCC throughout pregnancy. Primiparae had significantly higher HCC in the latter part of the last trimester compared with multiparae (1 month P = 0.003, 2 months P = 0.038). The use of psychotropic medication in the first trimester correlated to HCC postpartum (P < 0.001). HCC in GW 14–17 was associated with HCC in GW 18–21 (primiparae and multiparae, P < 0.001), GW 22–25 (primiparae P = 0.036, multiparae P = 0.033), and 2 months postpartum (primiparae P = 0.049). HCC in GW 18–21 was associated with GW 22–25 in both primiparae (P < 0.001) and multiparae (P < 0.001) as well as 2 months prior to childbirth among primiparae (<0.037). In general, all estimates of HCC in pregnancy and postpartum showed a significant association between HCC for a specific month and the HCC in the previous month (all P < 0.001), except for the association of HCC among primiparae in GW 22–25 and 3 months prior to childbirth.

Conclusions

Increased cortisol concentrations in hair were observed during pregnancy, which decreased 3 months prior to childbirth in multiparae. The results indicate a quicker suppression of the hypothalamic CRH (corticotropin‐releasing hormone) production by placenta CRH in multiparous women.

Tweetable abstract

Multiparae have a quicker suppression of hypothalamic CRH production by placenta CRH during pregnancy compared to primiparae.

Multiparae have a quicker suppression of hypothalamic CRH production by placenta CRH during pregnancy compared with primiparae.

Effects of a labour and delivery simulated practice programme for elderly primigravidas

Aim

Increasing numbers of older gravidas compel research into best practices for their labour-related outcomes. Responding to this need, this study sought to develop and evaluate a programme for older primigravidas.

Design

The authors developed a simulated practice programme for older primigravidas and tested its effects.

Methods

A non-equivalent control group pre- and post-test design was used with 49 community-dwelling primigravidas. The programme taught the stages of labour using a realistic scenario-based practice and a debriefing session. Data were collected between June and September 2015. Participants were divided into intervention (N = 25) and control (N = 24) groups. Postintervention group effects were analysed with independent t tests.

Results

The intervention group's levels of anxiety and stress decreased and their knowledge and self-confidence increased. The intervention group's labour duration was also shorter than that of the control group.

Technology-Supported Interventions for Pregnant Women: A Systematic Review

Technology is deeply embedded in daily life; thus, more pregnant women seek information through the Internet and incorporate the use of technological devices during their pregnancies. This systematic review aimed to examine to what extent and how technology-supported interventions were developed and delivered to pregnant women, as well as intervention effects on the targeted outcomes. Electronic data were collected from MEDLINE, CINAHL, and Scopus. Among the 11 selected studies, most were pilot studies to test the feasibility, acceptability, or preliminary effects of technology-supported interventions. The studies included both women with healthy pregnancies and pregnancies complicated by factors including preterm labor, smoking, and alcohol abuse. Most were conducted in the US, and most participants were white or African American. Interventions were primarily developed by research teams and focused on mental health issues including depression, anxiety, and stress. Interventions incorporated the use of technology including computers, mobile phones, and audiovisual aids. The overall interventions were reported to be feasible, acceptable, and beneficial in all the selected studies. Based on the review of literature, suggestions were provided for future research including the need for careful selection of intervention topics and objectives to target women who can benefit more from technology-supported interventions.

How do personality characteristics of risky pregnant women affect their prenatal distress levels?

Purpose

The prenatal distress level of the pregnant woman is influenced by many variables. Personality characteristics are one of the most important of these variables. Knowing personality characteristics of pregnant women contributes to the personalization of care. The purpose of this paper is to identify the effect of personality characteristics of pregnant women at risk on the prenatal distress level.

Design/methodology/approach

A total of 438 women who were hospitalized based on a medical diagnosis associated with pregnancy were included in the study. The participants were administered the Personal Information Form, Cervantes Personality Scale and Revised Prenatal Distress Questionnaire. Data were evaluated using the SPSS 22.0 software program.

Findings

Of the pregnant women, 27.4 percent found their ability to cope with stress insufficient, and one-fifth of them found their social support insufficient. The pregnant women at risk with introverted, neurotic and inconsistent personality were found to have high levels of prenatal distress.

Research limitations/implications

This study was conducted on a group of Turkish pregnant women and cannot be generalized to other cultures. The data obtained from the research cannot be used to evaluate the psychological and physical disorders of the pregnant woman.

Practical implications

All health care professionals should evaluate women not only physically but also mentally and emotionally, beginning with the preconceptional period. They should determine the conditions that create distress and identify the personality characteristics that prevent from coping with stress. By using cognitive and behavioral techniques, pregnant women should be trained to gain skills on subjects such as risk perception and stress management, personality characteristics and coping, problem solving, psychological endurance and optimism. Caring initiatives should be personalized in line with personality characteristics of pregnant women. The care offered within this framework will contribute to the strengthening and development of the health of not only the women but also the family and society, and to the reduction of health care costs.

Social implications

Researchers have determined that pregnant women at risk with introverted, neurotic and inconsistent personality characteristics have higher distress levels. They have determined that these pregnant women find their ability to cope with stress more inadequate. It is vital to cope with stress during pregnancy due to its adverse effects on maternal/fetal/neonatal health.

Originality/value

The prenatal distress level of the pregnant woman is influenced by many demographic (age, marital status and socioeconomic level), social (marital dissatisfaction, and lack of social support), personal (self-esteem, neuroticism and negative life experiences) and pregnancy-related (experiencing risky pregnancy, and previous pregnancy experiences) variables. Personality characteristics are one of the most important of these variables. This research is original because there are limited number of studies examining the effect of personality characteristics on prenatal distress level in the literature. And knowing the relationship between personality characteristics and distress by health professionals enables individualization of care. The care offered within this framework will contribute to the strengthening and development of the health of not only the women, but also the family and society, and to the decrease of health care costs.

When should cardiovascular prevention begin? The importance of antenatal, perinatal and primordial prevention

Cardiovascular diseases represent a major health problem, being one of the leading causes of morbidity and mortality worldwide. Therefore, in this scenario, cardiovascular prevention plays an essential role although it is difficult to establish when promoting and implementing preventive strategies. However, there is growing evidence that prevention should start even before birth, during pregnancy, aiming to avoid the onset of cardiovascular risk factors, since events that occur early in life have a great impact on the cardiovascular risk profile of an adult. The two pillars of this early preventive strategy are nutrition and physical exercise, together with prevention of cardio-metabolic diseases during pregnancy. This review attempts to gather the growing evidence of the benefits of antenatal, perinatal and primordial prevention, discussing also the possibility to reverse or to mitigate the cardiovascular profile developed in the initial stages of life. This could pave the way for future research, investigating the optimal time and duration of these preventing measures, their duration and maintenance in adulthood, and the most effective interventions according to the different age and guiding in the next years, the best clinical practice and the political strategies to cope with cardiovascular disease.

Effect of lipopolysaccharide-induced immune stimulation and maternal fish oil and microalgae supplementation during late pregnancy on nursery pig hypothalamic-pituitary-adrenal function1

The present study used Escherichia coli lipopolysaccharide (LPS) to investigate whether maternal immune challenge during late gestation altered programming of the offspring hypothalamus and hypothalamic-pituitary-adrenal axis (HPAA). In addition, interactions of maternal diet, supplementation with fish oil (FO) or microalgae (AL), and complex vs. simple weaning diets were investigated. Briefly, Landrace × Yorkshire sows (N = 48) were randomly assigned to diets supplemented with FO, AL, or a standard gestation control diet (CON) from day 75 of gestation (gd 75) until parturition. On gd 112, half the sows from each dietary treatment were immune challenged with LPS (10 μg/kg BW) or saline as a control. At 21 d postpartum, the offspring were weaned, and half the animals from each maternal treatment were allocated to either a complex or simple weaning diet. At 28 d postpartum, the offspring's hourly fever and 2-h cortisol responses to LPS immune challenge (40 μg/kg BW) were measured to assess hypothalamus and HPAA function. Results indicated that the maternal temperature of sows on the FO diet returned to baseline levels faster than sows on the AL and CON diets after LPS immune challenge (P < 0.05). In contrast, there was no difference in the maternal cortisol response across the dietary treatments (P > 0.10). Regardless of the dietary treatments, the maternal LPS immune challenge induced a greater cortisol response in male offspring (P = 0.05) and a greater fever response in female offspring (P = 0.03) when they were LPS immune challenged post-weaning. Male offspring from LPS-immune-challenged sows fed the FO and AL diets had a greater fever response than male offspring from the maternal CON diet group (P ≤ 0.05). Last, no effect of the complex or simple weaning diets was observed for the nursery pig cortisol or fever responses to LPS immune challenge. In conclusion, LPS immune challenge during late pregnancy altered responsiveness of the offspring hypothalamus and HPAA to this same microbial stressor, and a sex-specific response was influenced by maternal dietary supplementation with FO and AL.

Maternal high-decibel acoustic exposure elevates prenatal stress, impairing postnatal hearing thresholds associated with decreasing ribbon synapses in young rats

Maternal stress may affect the fetal auditory system than direct sound exposure. The objective of this study was to evaluate the role of prenatal stress due to high-decibel (dB) sound exposure on postnatal hearing and cochlear structure. Pregnant rats were exposed to 95 or 65 dB noise or music for 2 h once a day from gestational day 15 until delivery. The serum corticosterone was measured in the pregnant dams and pups. On postnatal day 22, pups underwent auditory brainstem response (ABR) testing. Then, the cochleae were immediately harvested for biochemical and molecular investigations. Prenatal stress impaired reproductive parameters, increased serum corticosterone and ABR thresholds with the decrease in wave I peak amplitude and the number of pre-synaptic ribbon. Thus, prenatal stress induces postnatal hearing loss in young rats, which are related to the reduction of ribbon synapses.

Effect of music interventions on anxiety during labor: a systematic review and meta-analysis of randomized controlled trials

Background

Anxiety is commonly experienced during the delivery process and has shown to have adverse effects on maternal and infant health outcomes. Music interventions tend to reduce the effects of anxiety in diverse populations, are low cost, are easily accessible, and have high acceptability. The aim of this review and meta-analysis was to assess the effectiveness of music interventions in reducing anxiety levels among women during labor.

Methods

Seven databases from inception to the end of December, 2018, without any language or time restriction including Embase, PubMed, the Cochrane Library, the Cumulative Index to Nursing and Allied Health, PsycINFO, Airiti Library, and PerioPath: Index to Taiwan Periodical Literature were searched using key terms related to pregnancy, anxiety, and music. Randomized controlled trials that assessed the effect of music during labor and measured anxiety levels as an outcome were included. Meta-analyses were conducted to assess anxiety reduction following a music intervention compared to that after placebo treatment.

Results

A total of 14 studies that investigated a total of 1,310 participants were included in this review. The meta-analyses indicated that those in the intervention group had a significant decrease in anxiety scores (standardized mean difference = −2.40, 95% confidence interval (CI) [−3.29 to −1.52], p < 0.001; I² = 97.66%), heart rate (HR) (difference in means = −3.04 beats/min, 95% CI [−4.79 to −1.29] beats/min, p = 0.001; I² = 0.00%), systolic blood pressure (SBP) (difference in means = −3.71 mmHg, 95% CI [−7.07 to −0.35] mmHg, p = 0.031; I² = 58.47%), and diastolic blood pressure (DBP) (difference in means = −3.54 mmHg, 95% CI [−5.27 to −1.81] mmHg, p < 0.001; I² = 0.00%) as compared to the women in the control group.

Conclusions

Music interventions may decrease anxiety scores and physiological indexes related to anxiety (HR, SBP, and DBP). Music interventions may be a good non-pharmacological approach for decreasing anxiety levels during labor.

Association between Psychosocial Stress and Fecal Microbiota in Pregnant Women

Maternal prenatal psychosocial stress is associated with altered child emotional and behavioral development. One potential underlying mechanism is that prenatal psychosocial stress affects child outcomes via the mother's, and in turn the child's, intestinal microbiota. This study investigates the first step of this mechanism: the relation between psychosocial stress and fecal microbiota in pregnant mothers. Mothers (N = 70) provided a late pregnancy stool sample and filled in questionnaires on general and pregnancy-specific stress and anxiety. Bacterial DNA was extracted and analysed by Illumina HiSeq sequencing of PCR-amplified 16 S ribosomal RNA gene fragments. Associations between maternal general anxiety and microbial composition were found. No associations between the other measured psychosocial stress variables and the relative abundance of microbial groups were detected. This study shows associations between maternal pregnancy general anxiety and microbial composition, providing first evidence of a mechanism through which psychological symptoms in pregnancy may affect the offspring.

Prospective Relations Between Prenatal Maternal Cortisol and Child Health Outcomes

OBJECTIVE

The aim of the study was to investigate prospective, longitudinal associations between maternal prenatal cortisol response to an interpersonal stressor and child health for the subsequent 3 years.

METHODS

One hundred twenty-three women expecting their first child provided salivary cortisol samples between 12 and 32 weeks of gestation (M (SD) = 22.4 (4.9) weeks) before and after a videotaped couple conflict discussion with their partner. Mothers reported on overall child health and several indicators of child illness (sick doctor visits, fevers, ear, and respiratory infections) when children were 6 months (n = 114), 1 (n = 116), and 3 (n = 105) years old. Associations between maternal prenatal cortisol reactivity and recovery and later child health at each of the three time points were analyzed using longitudinal regression models.

RESULTS

Greater cortisol reactivity in response to the couple conflict discussion was associated with maternal self-report of better overall child health (p = .016, 95% CI = 0.06-1.30, Cohen's f = 0.045) across the study period. Greater cortisol reactivity was also associated with lower incidence rate ratios for maternal reports of sick doctor visits (incidence rate ratio 95% CI = 0.25-0.83, p = .006), fevers (95% CI = 0.25-0.73, p = .002), ear infections (95% CI = 0.25-0.58, p < .001), and respiratory infections (95% CI = 0.08-1.11, p = .073). Cortisol recovery was unrelated to study outcomes (all p's > 0.05). Maternal prenatal depressive symptoms moderated the association between cortisol reactivity and overall child health (p = .034, 95% CI = 0.07-1.87 for interaction term) but no other health outcomes (p's > 0.05). Among women with lower depressive symptoms, cortisol reactivity was not associated with overall child health; among women with higher levels of depressive symptoms, greater cortisol reactivity was associated with better overall child health.

CONCLUSIONS

This study provides longitudinal evidence that greater maternal cortisol reactivity to a salient interpersonal stressor during pregnancy is associated with fewer child health problems and better maternal report of overall child health during infancy and into early childhood.

TRIAL REGISTRATION

Clinicaltrials.gov ID NCT01901536.

Transportation noise exposure, noise annoyance and respiratory health in adults: A repeated-measures study

Transportation noise leads to sleep disturbance and to psychological and physiological sustained stress reactions, which could impact respiratory health. However, epidemiologic evidence on associations of objective transportation noise exposure and also perceived noise annoyance with respiratory morbidity is limited. We investigated independent associations of transportation noise exposure and noise annoyance with prevalent respiratory symptoms and incident asthma in adults. Using 17,138 observations (from 7049 participants) from three SAPALDIA (Swiss Cohort Study on Lung and Heart Diseases in Adults) surveys, we assessed associations of transportation noise exposure and noise annoyance with prevalent respiratory symptoms, and with incident asthma (in 10,657 nested observations from 6377 participants). Annual day-evening-night transportation noise comprising road, railway and aircraft Lden (Transportation Lden) was calculated for the most exposed façade of participants' residence using Swiss noise models. Transportation noise annoyance was assessed using an 11-point scale, and participants reported respiratory symptoms and doctor-diagnosed asthma at each survey. We estimated associations with transportation Lden (as well as source-specific Lden) and noise annoyance, independent of air pollution and other potential confounders, using mutually-adjusted mixed logistic and Poisson models and applying random intercepts at the level of the participants. Prevalent respiratory symptoms ranged from 5% (nocturnal dyspnoea) to 23% (regular cough/phlegm). Transportation noise annoyance, but not Lden, was independently associated with respiratory symptoms and current asthma in all participants, with odds ratios (OR) and 95% confidence intervals (CI) ranging between 1.03 (95%CI: 1.01, 1.06) and 1.07 (95% CI: 1.04, 1.11) per 1-point difference in noise annoyance. Both noise annoyance and Lden showed independent associations with asthma symptoms among asthmatics, especially in those reporting adult-onset asthma [OR_Lden: 1.90 (95% CI: 1.25, 2.89) per 10 dB; p-value of interaction (adult-onset vs. childhood-onset): 0.03; OR_{noise annoyance}: 1.06 (95%CI: 0.97, 1.16) per 1-point difference; p-value of interaction: 0.06]. No associations were found with incident asthma. Transportation noise level and annoyance contributed to symptom exacerbation in adult asthma. This suggests both psychological and physiological noise reactions on the respiratory system, and could be relevant for asthma care. More studies are needed to better understand the effects of objective and perceived noise in asthma aetiology and overall respiratory health.

Maternal psychological distress during pregnancy and childhood health outcomes: a narrative review

Maternal psychological distress is common in pregnancy and may influence the risk of adverse outcomes in children. Psychological distress may cause a suboptimal intrauterine environment leading to growth and developmental adaptations of the fetus and child. In this narrative review, we examined the influence of maternal psychological distress during pregnancy on fetal outcomes and child cardiometabolic, respiratory, atopic and neurodevelopment-related health outcomes. We discussed these findings from an epidemiological and life course perspective and provided recommendations for future studies. The literature in the field of maternal psychological distress and child health outcomes is extensive and shows that exposure to stress during pregnancy is associated with multiple adverse child health outcomes. Because maternal psychological distress is an important and potential modifiable factor during pregnancy, it should be a target for prevention strategies in order to optimize fetal and child health. Future studies should use innovative designs and strategies in order to address the issue of causality.