Emotional Stress During Pregnancy - Associations With Maternal Anxiety Disorders, Infant Cortisol Reactivity, and Mother-Child Interaction at Pre-school Age

The effect of antepartum depressive and anxiety symptoms on mother-infant interaction: The mediating role of antepartum maternal emotional stress

Anxiety disorders, depression, and emotional stress during the antepartum period are interlinked with adverse child development. The quality of the dyadic interaction seems to play a crucial role in the transmission of these effects. In this study, we explored the mediating effect of antepartum maternal emotional stress (assessed via the Prenatal Emotional Stress Index) regarding the relationship of antepartum maternal depressive (assessed via the Edinburgh Postpartum Depression Scale), anxiety symptoms (assessed via the Stat-Trait-Anxiety-Inventory), and depressive and anxiety disorders (assessed according to the DSM-IV-TR) in the antepartum period on postpartum interactive quality in a longitudinal design. The Face-to-Face-Still-Face Paradigm (FFSF) and the Infant and Caregiver Engagement Phases (ICEP-R) coding system were used to assess the postpartum interactive qualities of the mother-infant dyads. The sample consisted of 59 women, 38 in the clinical and 21 in the control group. We found significant indirect effects of antepartum depressive symptoms and maternal diagnostic status on the mother's neutral engagement and on the latency to the first social positive interactive match during the interaction - effects that were mediated by antepartum stress. Moreover, there was an indirect effect of state anxiety on neutral engagement - mediated by antepartum stress. Therapeutic intervention studies focusing on maternal antepartum regulation of emotional stress and postpartum interactive patterns might be crucial to encounter maladaptive developmental trajectories.

A perspective-based analysis of attachment from prenatal period to second year postnatal life

Attachment is one of the foundational themes in the history of the psychological development of human beings. For this reason, we assume that it must be approached by taking into account multiple scientific perspectives. The present review aims at analyzing the state of the art regarding the genetic, neurobiological and cognitive mechanisms underlying the development of attachment bonding, considering the child as the frame of reference. We hypothesize that attachment may be present in prototypical forms even in the prenatal period, thus our analysis has a temporal origin in the intrauterine period preceding birth. The intrauterine period is assumed to be a period of maximum sensitivity to stimuli and in particular to those coming from a potential primary caregiver: the biological mother. We conclude with a reframing of the state of the art and propose that future research work would benefit from a superordinate model of attachment, capable of containing and regulating all its components and variables.

Depression, anxiety, and stress and adverse pregnancy outcomes in pregnant women with history of recurrent pregnancy loss in Nigeria

OBJECTIVE

The primary purpose of this study was to examine whether pregnant women with a history of recurrent pregnancy loss (RPL) are more likely to experience moderate-to-severe depression, anxiety, or stress symptoms than pregnant women without a history of RPL. The secondary purpose was to determine whether women with prior RPL experienced more unfavorable pregnancy outcomes if they had depression, anxiety, or stress.

METHODS

A prospective case-control study was conducted that included 47 pregnant women with a history of RPL and 94 pregnant women without prior RPL. Participants 20 weeks of gestation or earlier were included. Both groups completed the Depression, Anxiety, and Stress Scale (DASS-21), and were followed up until delivery to determine the pregnancy outcomes. Multivariate logistic regression was used to compare adverse pregnancy outcomes.

RESULT

Among the 47 women with prior RPL, 10 had primary RPL (two or more miscarriages without a successful pregnancy) and 37 secondary RPL (two or more miscarriages with a history of successful pregnancy). RPL was significantly associated with moderate-to-severe levels of depression (P < .001), anxiety (P < .001), and stress (P < .001). Among the RPL group, high stress level was significantly associated with repeat miscarriage (adjusted odds ratio (AOR) = 5.28, 95%CI = 1.25-100.0, P = .03) and preterm labor (AOR = 6.07, 95%CI = 1.61-100.0, P = .04). Depression and anxiety were not associated with adverse pregnancy outcomes.

CONCLUSION

Pregnant women with a history of RPL had considerably higher rates of moderate-to-severe depression, anxiety, and stress. Repeat miscarriage and preterm labor were considerably higher among pregnant women with RPL who were experiencing high stress levels at baseline.

Parent-child interactive behavior in a German sample of parents with and without a mental illness: model replication and adaption of the Coding Interactive Behavior system

Studies using observational measures often fail to meet statistical standards for both reliability and validity. The present study examined the psychometric properties of the Coding Interactive Behavior (CIB) System within a German sample of parent-child dyads. The sample consisted of 149 parents with and without a mental illness and their children [n experimental group (EG) = 75, n control group (CG) = 74] who participated in the larger Children of Mentally Ill Parents at Risk Evaluation (COMPARE) study. The age of the children ranged from 3 to 12 years (M = 7.99, SD = 2.5). Exploratory factor analysis supported a five-factor model of the CIB with items describing 1) parental sensitivity/reciprocity, 2) parental intrusiveness, 3) child withdrawal, 4) child involvement, and 5) parent limit setting/child compliance. Compared to international samples, the model was reduced by two independent dyadic factors. Testing for predictive validity identified seven items with predictive power to differentiate parental group membership. The CIB factors did not seem to be sufficiently sensitive to illustrate differences in interaction within a sample of parents with various mental illnesses. To apply the CIB to the described sample or similar ones in the future, additional measurement instruments may be necessary.

Increased stress vulnerability in the offspring of socially isolated rats: Behavioural, neurochemical and redox dysfunctions

Stressful events during pregnancy impact on the progeny neurodevelopment. However, little is known about preconceptional stress effects. The rat social isolation represents an animal model of chronic stress inducing a variety of dysfunctions. Moreover, social deprivation during adolescence interferes with key neurodevelopmental processes. Here, we investigated the development of behavioural, neurochemical and redox alterations in the male offspring of socially isolated female rats before pregnancy, reared in group (GRP) or in social isolation (ISO) from weaning until young-adulthood. To this aim, females were reared in GRP or in ISO conditions, from PND21 to PND70, when they were mated. Their male offspring was housed in GRP or ISO conditions through adolescence and until PND70, when passive avoidance-PA, novel object recognition-NOR and open field-OF tests were performed. Levels of noradrenaline (NA), serotonin (5-HT), 5-hydroxyindoleacetic acid (5-HIAA), glutamate (GLU) and GABA were assessed in the prefrontal cortex (PFC). Moreover, cortical ROS levels were quantified, as well as NF-kB and the NADPH oxidase NOX2 expression, redox status (expressed as GSH:GSSG ratio) and SOD1 amount. A significant decrease of the latency time in the PA was observed in the offspring of ISO females. In the NOR test, while a significant increase in the exploratory activity towards the novel object was observed in the offspring of GRP females, no significant differences were found in the offspring of ISO females. No significant differences were found in the OF test among experimental groups. Theoffspring of ISO females showed increased NA and 5-HIAA levels, whereas in the offspring persistently housed in isolation condition from weaninguntil adulthood, we detected reduced 5-HT levels and ehnanced 5-HIAA amount. No significant changes in GLU concentrations were detected, while decreased GABA content was observed in the offspring of ISO females exposed to social isolation. Increased ROS levels as well as reduced NF-κB, NOX2 expression were detected in the offspring of ISO females. This was accompanied by reduced redox status and enhanced SOD1 levels. In conclusion, our results suggest that female exposure to chronic social stress before pregnancy might have a profound influence on the offspring neurodevelopment in terms of cognitive, neurochemical and redox-related alterations, identifying this specific time window for possible preventive and therapeutic strategies.

An investigation into the correlation between early-to-mid pregnancy exercise combined with cognitive behavioral therapy and anxiety levels and quality of life in patients

OBJECTIVE

The aim of this study was to investigate the effects of exercise combined with cognitive behavioral therapy (CBT) on anxiety and quality of life in pregnant women.

METHODS

This study adopted a prospective randomized controlled trial design, and divided 60 pregnant women in the first and second trimesters into two groups. The control group received routine prenatal education, and the experimental group added moderate exercise and CBT on the basis of routine prenatal education. All participants completed the Hamilton Anxiety Rating Scale (HARS) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) at the start of the study (baseline) and at 6 weeks after the intervention.

RESULTS

Baseline data, scores on HARS, and scores on WHOQOL-BREF were found to be consistent among the two groups of patients prior to the intervention (all P > 0.05). Following the intervention, the implementation of exercise combined with CBT resulted in significant improvements in anxiety levels within the experimental group, particularly with respect to aspects such as anxious mood, tension, insomnia, cognitive function, cardiovascular symptoms, and gastrointestinal symptoms (all P < 0.05). Similarly, the combination of exercise and CBT led to significant enhancement in the quality of life in the experimental group, particularly in areas such as physical health, psychological health, and environmental factors (all P < 0.05). Nevertheless, no significant disparities were observed between the two groups in terms of fears, depressive mood, muscular and sensory somatic symptoms, respiratory symptoms, genitourinary symptoms, autonomic symptoms, behavior during the interview, and social relationships (all P > 0.05).

CONCLUSION

Exercise combined with CBT can effectively reduce the anxiety of pregnant women and improve their quality of life, which has important clinical significance for improving the mental health and quality of life of pregnant women in the first and second trimesters.

The science of uncertainty guides fetal-neonatal neurology principles and practice: diagnostic-prognostic opportunities and challenges

Fetal-neonatal neurologists (FNNs) consider diagnostic, therapeutic, and prognostic decisions strengthened by interdisciplinary collaborations. Bio-social perspectives of the woman's health influence evaluations of maternal-placental-fetal (MPF) triad, neonate, and child. A dual cognitive process integrates "fast thinking-slow thinking" to reach shared decisions that minimize bias and maintain trust. Assessing the science of uncertainty with uncertainties in science improves diagnostic choices across the developmental-aging continuum. Three case vignettes highlight challenges that illustrate this approach. The first maternal-fetal dyad involved a woman who had been recommended to terminate her pregnancy based on an incorrect diagnosis of an encephalocele. A meningocele was subsequently identified when she sought a second opinion with normal outcome for her child. The second vignette involved two pregnancies during which fetal cardiac rhabdomyoma was identified, suggesting tuberous sclerosis complex (TSC). One woman sought an out-of-state termination without confirmation using fetal brain MRI or postmortem examination. The second woman requested pregnancy care with postnatal evaluations. Her adult child experiences challenges associated with TSC sequelae. The third vignette involved a prenatal diagnosis of an open neural tube defect with arthrogryposis multiplex congenita. The family requested prenatal surgical closure of the defect at another institution at their personal expense despite receiving a grave prognosis. The subsequent Management of Myelomeningocele Study (MOMS) would not have recommended this procedure. Their adult child requires medical care for global developmental delay, intractable epilepsy, and autism. These three evaluations involved uncertainties requiring shared clinical decisions among all stakeholders. Falsely negative or misleading positive interpretation of results reduced chances for optimal outcomes. FNN diagnostic skills require an understanding of dynamic gene-environment interactions affecting reproductive followed by pregnancy exposomes that influence the MPF triad health with fetal neuroplasticity consequences. Toxic stressor interplay can impair the neural exposome, expressed as anomalous and/or destructive fetal brain lesions. Functional improvements or permanent sequelae may be expressed across the lifespan. Equitable and compassionate healthcare for women and families require shared decisions that preserve pregnancy health, guided by person-specific racial-ethnic, religious, and bio-social perspectives. Applying developmental origins theory to neurologic principles and practice supports a brain health capital strategy for all persons across each generation.

Exposure to prenatal stressors and infant autonomic nervous system regulation of stress

OBJECTIVES

The purpose of this study was to determine the relationship between fetal exposure to maternal prenatal stressors and infant parasympathetic (PNS) and sympathetic (SNS) nervous function at 3 timepoints across the first year of life.

BACKGROUND

Autonomic nervous system impairments may mediate associations between gestational exposure to stressors and later infant health problems. Heart rate variability (HRV) provides a sensitive index of PNS and SNS function. However, no studies have assessed longitudinal associations between prenatal stressors and infant HRV measures of both PNS and SNS over the first year of life.

METHODS

During the third trimester of pregnancy, 233 women completed measures of life stressors and depression. At 1, 6 and 12 months of age, a stressor protocol was administered while infant electrocardiographic (ECG) data were collected from a baseline through a post-stressor period. HRV measures of PNS and SNS activity (HF, LF, LF/HF ratio) were generated from ECG data. We used multilevel regression to examine the aims, adjusting for maternal depression and neonatal morbidity.

RESULTS

There were no associations between prenatal stressors and any baseline or reactivity HRV metric over the infant's first year of life. However, exposure to more stressors was associated with lower post-stressor LF HRV at both 6 (β = -.44, p = .001) and 12 (β = -.37, p = .005) months of age.

CONCLUSIONS

Findings suggest potential alterations in development of the vagally mediated baroreflex function as a result of exposure to prenatal stressors, with implications for the infants' ability to generate a resilient recovery in response to stressors.

Sex differences in frailty among older adults

By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.

Javanese Women's Experiences during the First Pregnancy

Background

Women experience physical, hormonal, and psychological changes during pregnancy. Similarly, some traditions are prevalent among Javanese women, which could affect their pregnancy. The experiences of first-time pregnant women in this area remain unclear. This study aimed to explore the lived experiences of women during their first pregnancy.

Materials and Methods

The qualitative study with a phenomenological approach was conducted in Kesambon village in Malang Regency, Indonesia. Eight women in their third trimester were selected purposively. Data were gathered using semi-structured interviews and subsequently open-coded using the NVivo-12 software manufactured by the QS International.

Results

The participants were married primigravida women aged 17 to 22 years. Four themes emerged as follows: pregnancy is a positive experience, pregnant women are not independent, belief in pregnancy-related myths and traditions, and pregnancy-related information seeking.

Conclusions

During the first pregnancy, pregnant women believed and practiced Javanese traditions regarding pregnancy. Although they were happy, they were still dependent and lacked the motivation to seek pregnancy-related information. Hence, midwives should provide them with adequate pregnancy-related information while addressing harmful myths and misconceptions. This should culminate in a successful pregnancy.

Effects of Prenatal Stress on Behavior, Cognition, and Psychopathology: A Comprehensive Review

Prenatal stress is increasingly recognized as a significant factor impacting an individual's life from the beginning. This comprehensive review explores the intricate relationship between prenatal stress and its effects on behaviour, cognition, and psychopathology. Key findings reveal that prenatal stress can lead to a wide range of adverse outcomes in offspring, including neurodevelopmental disorders, emotional dysregulation, cognitive deficits, mood disorders, and an increased risk of psychopathological conditions. These effects' mechanisms involve epigenetic modifications, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, neurodevelopmental alterations, inflammatory processes, and changes in brain structure and function. Moreover, moderating factors such as maternal stress levels, maternal mental health, socioeconomic status, social support, and early-life adversity can significantly influence the impact of prenatal stress. The review also discusses intervention and prevention strategies, emphasizing the importance of prenatal stress reduction programs, maternal mental health support, nutritional interventions, and targeted early interventions for at-risk populations. These findings have substantial implications for public health and clinical practice, highlighting the need for a holistic approach to prenatal care that prioritizes maternal well-being and mitigates the lasting effects of prenatal stress. Addressing this critical issue promises healthier generations and stronger communities in the future.

[The parent-child relationship in the context of parental mental illness-Possibilities for intervention]

The parent-child relationship is the earliest and one of the most important close social relationships in a person's life. It begins even during pregnancy, is expressed in interactions and is accompanied by many neurobiological processes. A sensitive interaction with the parent who is well-adapted to the needs of the child, is necessary for a healthy child development; however, parents with mental disorders often face more difficulties in parenting than healthy parents. They tend to exhibit more intrusive or withdrawn behavior and report experiencing increased stress in parenting, which in turn can be a risk factor for the mental disorder. At the same time, parenting can be a great resource. Early recognition of stress in parenting is central to healthy child development and also to the parent's mental health. In addition to disorder-specific treatment for parents, parent-child focused interventions can be used in relationship or interaction disorders. This article presents and discusses different prevention and intervention approaches.

Prioritizing the Psychosocial Support Needs of Mothers with Gestational Diabetes: A Delphi Study

Background

Gestational diabetes is the most common medical complication in pregnancy, and the psychosocial health of women suffering from this condition affects their adherence to treatment and self-efficacy. However, since it is not possible to design interventions dealing with all of these needs, the aim of this study was to prioritize the psychosocial supportive needs of women with gestational diabetes.

Materials and Methods

This was a modified Delphi design study involving 22 experts who were selected using purposive and snowball sampling methods. The study was conducted between April 2021 and June 2021. First, the psychosocial needs of diabetic pregnant women were extracted through a qualitative study involving interviews with multidisciplinary specialists and diabetic pregnant mothers (22 participants) and a systematic review of reputable scientific databases. Throughout the two Delphi stages, the questionnaire was classified, quantified, and analyzed.

Results

Based on the results of this study, the following are the top priorities when addressing the psychosocial needs of mothers with gestational diabetes: paying attention to and identifying the mother's worries and anxiety, husband and family support for diabetic pregnant women, the inclusion of specialized nutrition counseling services in mothers' treatment plan, timely education of mothers about diabetes and its complications, and proper nutrition for diabetic mothers.

Conclusions

The priorities of the supportive needs obtained in this study can be used to design interventions aimed at promoting psychosocial health, reducing stress and anxiety, and improving medication adherence in women with gestational diabetes.

Parent-child interactions in early life mediating association between prenatal maternal stress and autistic-like behaviors among preschoolers

A range of studies have shown that prenatal maternal stress (PNMS) exposure is associated with offspring autistic-like behaviors, however the potential pathways remain unexplored. This study aimed to evaluate the mediating role of parent-child interactions in early life in the association between PNMS exposure and preschoolers' autistic-like behaviors. Data from 65,928 child-parent dyads were obtained via a primary caregiver-reported questionnaire administered as part of the Longhua Child Cohort Study. To strengthen confidence in the reliability of the results, the analyses were initially conducted on a random selection of 70% of the total sample, and then validated on the remaining 30% of the sample. Analysis of covariance and multiple linear models were employed to estimate the associations between PNMS exposure, parent-child interactions in early life, and children's autistic-like behaviors. The results showed that PNMS exposure was positively associated with the presence of autistic-like behaviors at preschool age. The total indirect effect of the frequency of positive parent-child interactions in early life accounted for 9.69% or 8.99% of the variance of the association. Our findings indicate that parent-child interactions in early life might function as potential mediators of the association between PNMS and the increased risk of offspring autistic-like behaviors.

Stress and resilience during pregnancy: A comparative study between pregnant and non-pregnant women in Ethiopia

BACKGROUND

Stress during pregnancy is associated with perturbances in maternal psychology and physiology, and results in adverse pregnancy and birth outcomes. However, little attention has been given to understand maternal stress and its potential negative consequences in many low- and middle-income countries. We aimed to investigate whether pregnancy is associated with greater stress and lower psychological resilience among women living in Jimma, Southwest Ethiopia.

METHOD

An institution-based comparative cross-sectional study design was implemented in Jimma University Medical Center and Jimma health centers from 15 September to 30 November 2021. Women attending antenatal care and family planning services were invited to participate in the study. Participants were interviewed using the Perceived Stress Scale (PSS-10), Brief Resilience Scale (BRS), distress questionnaire-5, and the Household Food Insecurity Access Scale (HFIAS). Linear regression analysis was used to test associations between pregnancy (exposure) and outcomes of interest (stress and resilience scores), while adjusting for potential confounders. Stress and resilience were mutually adjusted for one another in the final model.

RESULTS

A total of 166 pregnant and 154 non-pregnant women participated, with mean age of 27.0 SD 5.0 and 29.5 SD 5.3 years respectively. Pregnancy was associated with increased stress score by 4.1 points (β = 4.1; 95% CI: 3.0, 5.2), and with reduced resilience by 3.3 points (β = -3.3; 95% CI: -4.5, -2.2) in a fully adjusted model. In mutually-adjusted models, pregnancy was independently associated with greater stress (β = 2.9, 95% CI 1.8, 3.9) and lower resilience (β = -1.3, 95% CI: -2.5, -0.2) compared to non-pregnant women.

CONCLUSION

In this low income setting, pregnancy is associated with greater vulnerability in the mental health of women, characterized by greater perceived stress and diminished resilience. Context-relevant interventions to improve resilience and reduce stress could help improve the health and wellbeing of mothers, with potential benefits for their offspring.

Maternal postpartum anxiety and the development of infant attachment: The effect of body sensations on infant attachment

BACKGROUND

Knowledge about the influences of maternal postpartum anxiety disorders (PAD) on infant development is limited. Aim of this present study is to evaluate the influence of PAD on infant attachment.

METHODS

In a longitudinal study, self-reported anxiety symptoms of N = 70 mothers (N = 28 with PAD diagnosed according to the DSM-IV, N = 42 controls) were examined in the postpartum period and one year later. Infants' attachment was observed in the Strange Situation Test (SST) at the age of 12-24 months.

RESULTS

Results indicate a strong relationship between PAD and infant attachment: infants of mothers with PAD were significantly more likely to be classified as insecure or disorganized than infants of control mothers. Logistic regression analysis led to a significant model with 76.8 % correct classification of infant attachment dependent on the maternal fear of anxiety associated body sensations (OR = 4.848) in the postpartum period. Including maternal sensitivity and interaction behavior, only maternal intrusiveness was additionally associated with infant attachment (ρ = 0.273, p < .05; OR = 45.021, p = .153).

LIMITATIONS

Participants were highly educated. Different anxiety disorders included led to a heterogenous sample. Generalization is diminished. Maternal sensitivity was measured on a global scale, and body tension was self-reported.

CONCLUSIONS

PAD plays a crucial role in the development of infant attachment. Interaction-focused interventions, helping mothers to decrease intrusiveness, and body-focused interventions, helping mothers to deal with their fear of anxiety symptoms, might be promising pathways to buffer the influence of PAD on infant attachment.

Maternal Mental Health Care Matters: The Impact of Prenatal Depressive and Anxious Symptoms on Child Emotional and Behavioural Trajectories in the French EDEN Cohort

Few studies have investigated longitudinal trajectories of child socioemotional and behavioural development in relation to maternal prenatal mental health exposure or taken into consideration of the potential buffering effects of psychological intervention during pregnancy. Using data from 1135 mother-child dyads from the EDEN cohort from the general French population, Group-based trajectory modelling was used to model trajectories of behavioural and emotional characteristics measured at four timepoints via a parent-administered Strengths and Difficulties Questionnaire. Using propensity scores and inverse probability weighting to account for confounding factors, multinomial logistic regressions were used to quantify the associations with maternal symptoms of prenatal depression and anxiety. Stratified analyses were conducted by reporting psychologist and psychiatrist consultations during pregnancy. Compared to those without psychological problems, children of mothers with comorbid anxiety and depression retained a higher probability of following high and intermediate trajectories of emotional problems and a high trajectory of conduct problems throughout childhood. This increased risk was not present in the children of mothers who sought support through a prenatal psychologist or psychiatrist consultation. This article adds to a body of evidence underlining the importance of mental health care for expecting mothers.

What is prenatal stress? A scoping review of how prenatal stress is defined and measured within the context of food insecurity, housing instability, and immigration in the United States

BACKGROUND

Stress during pregnancy can lead to significant adverse outcomes for maternal mental health. Early evaluation of prenatal stress can help identify treatment needs and appropriate interventions. Disparities in the social determinants of health can contribute to stress, but what constitutes stress during pregnancy within the social determinants of health framework is poorly understood.

OBJECTIVE

To scope how prenatal stress is defined and measured among pregnant people exposed to three prominent social stressors in the United States: insecurity pertaining to food, housing, and immigration.

ELIGIBILITY CRITERIA

We included all studies that focused on stress during pregnancy in the context of food insecurity, housing instability, and immigration, given their recent policy focus due to the COVID-19 pandemic and ongoing political discourse, in addition to their importance in American College of Obstetricians and Gynecologists (ACOG's) social determinants of health screening tool.

SOURCES OF EVIDENCE

We searched PubMed, Scopus, and Web of Science for articles published between January 2012 and January 2022.

CHARTING METHODS

Using a piloted charting tool, we extracted relevant study information from the selected articles and analyzed the content pertaining to stress.

RESULTS

An initial search identified 1,023 articles, of which 24 met our inclusion criteria. None of the studies defined prenatal stress, and only one used the Prenatal Distress Questionnaire, a prenatal stress-specific tool to measure it. The Perceived Stress Scale was the most common instrument used in seven studies. Fifteen studies measured over 25 alternative exposures that researchers theorized were associated with stress, and 4 of the 15 studies did not explain the association between the measure and stress.

CONCLUSIONS

Our findings demonstrate a fundamental inconsistency in how prenatal stress is defined and measured in the context of social determinants of health, limiting the comparison of results across studies and the potential development of effective interventions to promote better maternal mental health.

Relationships between anxiety induced by COVID-19 and perceived social support among Iranian pregnant women

BACKGROUND

The rapid spread of COVID-19 and the time needed to develop a vaccine or definitive treatment for the disease have caused great anxiety in communities, especially in pregnant women whose high levels of distress may have short and/or long-term maternal and fetal consequence. This study was conducted to investigate the relationship between anxiety induced by COVID-19 and perceived social support in Iranian pregnant women.

METHODS

This online cross-sectional study was conducted on 801 pregnant women from all over Iran in 2020. The data were collected using a demographic questionnaire, the multidimensional scale of perceived social support, and the coronavirus disease anxiety scale. A standard multiple linear regression model was used to identify the association between perceived social support and anxiety, controlling for possible confounding variables. Partial r was used as an estimate of effect size.

RESULTS

The mean anxiety score was 10.7 ± 8.0, in which its level was moderate in 122 (15.2%; 95% confidence interval (CI): 12.8-17.9%)) of the participants, and severe in 28 (3.4%; 95% CI: 2.3-5.0%) of them. The mean score of perceived social support was 48.2 ± 7.6. 6.9% (95% CI: 5.2-8.8%) and 93.1% (95% CI: 91.2-94.8%) of the participants reported mild and moderate levels of perceived social support, respectively. The results of the multiple linear model showed a significant negative correlation between perceived social support and anxiety levels in a way that for every 10 units increase in the perceived social support score, the anxiety level of pregnant women was decreased by 0.8 units (B= -0.08, t= -2.08, p = 0.037), which was a small effect size (partial r = -0.07).

CONCLUSION

There was a small significant relationship between the perceived social support and COVID-19 anxiety. Further studies are required to identify associated factors of anxiety level during COVID-19 in pregnant women.

Antenatal depressive symptoms and behavioral outcomes in children at 78 months: A study from South India

Background:

Low and middle income countries report a higher prevalence of antenatal depression. The association between antenatal depressive symptoms and behavioral outcomes in children at 78 months in motherchild dyads who participated in a randomized control trial of maternal B12 supplementation during pregnancy was examined in this study.

Methods:

Children of 140 women, out of 366 who had participated in the placebo-controlled, randomized trial of vitamin B12 supplementation during pregnancy and 6 weeks post-partum, on whom serial assessments of depressive symptoms in each of the trimesters were done using the Kessler’s 10 Psychological Distress Scale (K10), were assessed using the Strength and Difficulties Questionnaire (SDQ) at 78 months.

Results:

Thirty seven women (26.4%) reported depressive symptoms at one trimester (intermittent group) and 28 women (20%) had depressive symptoms in at least 2 trimesters (persistent group). On adjusted bivariate regression analysis, children of women with intermittent antenatal depressive symptoms scored lower on the prosocial behavior subscale of SDQ compared to children of mothers with no depressive symptoms ( B=;−0.91, 95% CI: −1.65,−0.18; p=0.016).

Limitations:

The use of a screening measure to assess maternal depression, the assessment of the children’s behavior based only on the mothers’ reports and the small number of women with persistent depressive symptoms in our sample is important limitations.

Conclusions:

The possible association between antenatal depressive symptoms and prosocial behavior in children point to the need for routine assessment and intervention for emotional disorders during pregnancy.

The possible effect of lactoferrin on the epigenetic characteristics of early mammalian embryos exposed to bisphenol A

BACKGROUND

The main objective of this review was to state a hypothetical mechanism of the antitoxic effect of lactoferrin (Lf) on embryos exposed to bisphenol A (BPA). On this basis, it is possible to suggest Lf as a potential protective health component before conception upon toxic effects and viral infections.

METHODS

The narrative review was performed using systematic review methods to identify relevant literature. The resources required for this study were obtained by searching the electronic database PubMed (MEDLINE). Articles were searched using the keywords "BPA," "lactoferrin," "DNA-methylation," "epigenetic," "mammals," "human," and "mouse." The inclusion criteria were as follows: (a) primary or original research; (b) study of epigenetic modification; and (c) study focuses on early mammalian development.

RESULTS

Presented data demonstrate that Lf can modulate epigenetical characteristic, such as DNA methylation and reactive oxygen species (ROS), and, thereby, may serve as a potential readily available pharmaceutical product.

CONCLUSION

Suggested hypothesis is based on the important interrelated role of changes in epigenetic modifications and oxidative stress in early embryogenesis under the influence of BPA and virus infection as a cause of the development of pathologies in the adult organism.

From Early Micro-Temporal Interaction Patterns to Child Cortisol Levels: Toward the Role of Interactive Reparation and Infant Attachment in a Longitudinal Study

Parental mental disorders increase the risk for insecure attachment in children. However, the quality of caregiver–infant interaction plays a key role in the development of infant attachment. Dyadic interaction is frequently investigated via global scales which are too rough to uncover micro-temporal mechanisms. Prior research found that the latency to reparation of uncoordinated dyadic states is associated with infant behavioral and neuroendocrine regulation. We investigated the hypothesis that this interactive mechanism is critical in predicting secure vs. insecure attachment quality in infancy. We also assessed the predictive quality of infant attachment regarding neuroendocrine reactivity later in childhood. A subsample of N = 58 dyads (n = 22 mothers with anxiety disorders, n = 36 controls) from a larger study were analyzed. At 3–8 months postpartum, maternal anxiety disorders were diagnosed via a structured clinical interview as well as dyadic interaction during the Face-to-Face-Still-Face (FFSF) was observed and coded on a micro-temporal scale. Infant attachment quality was assessed with the strange situation paradigm at 12–24 months of age. In an overlapping subsample of N = 39 (n = 13 mothers with anxiety disorder; n = 26 controls), we assessed child cortisol reactivity at 5 to 6 years of age. Generalized linear modeling revealed that longer latencies to interactive reparation during the reunion episode of the FFSF as well as maternal diagnosis at 3–8 months of age predict insecure attachment in children aged 12–24 months. Cox regressions demonstrated that dyads with infants who developed insecure attachment at 12–24 months of age were 48% less likely to achieve an interactive reparation at 3–8 months of age. Mixed models revealed that compared to securely attached children, children who had developed an insecure attachment at 12–24 months of age had an increased cortisol reactivity at 5 to 6 years of age during free play. The results confirm the hypothesis that the development of attachment is affected by experienced micro-temporal interactive patterns besides diagnostic categories. They also showed that infants of mothers with postpartum anxiety disorders have a more than fivefold increased risk of developing an insecure attachment than the infants of the control group. Moreover, results imply that these patterns may influence neurohormonal regulation even in preschool aged children.

Study protocol of the COMPARE-Interaction study: the impact of maternal comorbid depression and anxiety disorders in the peripartum period on child development

INTRODUCTION

To date, there are only few studies that compare the consequences of peripartum maternal depressive disorders (PD) versus depressive with comorbid anxiety disorders (PDCA) for infant and child development. As comorbidity is associated with greater impairment and symptom severity related to the primary diagnosis, comorbidity in mothers might raise their offspring's risk of developing internalising or externalising disorders even more than has been noted in conjunction with PD alone.

METHODS AND ANALYSIS

This study aims to analyse the impact of parental psychopathology, particularly peripartum depression in mothers with and without comorbid anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) on child cognitive and socioemotional development. Maternal/paternal psychopathology, mother-infant/father-infant interaction and child development are assessed at four measurement points over the first 2 years (T1: 3-4 months postpartum, T2: 12 months postpartum, T3: 18 months postpartum and T4: 24 months postpartum). The mediating role of mother-infant/father-infant interaction and infant stress reactivity in the relationship between PD/PDCA and infant cognitive and socioemotional development will be analysed. In the ongoing study, 174 families (n=58 mothers with PD, n=58 mothers with PDCA and n=58 healthy controls) will be recruited in inpatient and outpatient centres as well as maternity hospitals in Munich and Heidelberg.

ETHICS AND DISSEMINATION

This study is implemented in accordance with the current guidelines of the World Medical Association (revised Declaration of Helsinki) and the General Data Protection Regulation of the European Union. The study procedures were approved by the independent ethics committees of the Department of Psychology, Ludwig-Maximilians-University Munich (74_Reck_b) and of the Medical Faculty, University Heidelberg (S-446/2017). Participation is voluntary. A signed written informed consent form must be obtained from each study subject prior to any study-specific procedure. Participants can withdraw from the study at any point in time without giving a reason or being subjected to any future disadvantages. In case of withdrawal from the study, the subject's data and material will be kept unless the participant asks for data removal. Results will be published and disseminated to further the discussion on the effects of maternal PD and PDCA on parent-infant interaction, infant stress reactivity and child development. Furthermore, study results will be presented at international congresses and expert conferences.

Atypical maternal interaction is associated with elevated levels of hair cortisol in children

The quality of maternal caregiving is an important factor in the healthy development of a child. One consequence of prolonged insensitive and atypical maternal interaction behavior (e.g., withdrawing from interactions with the child and role-reversal, i.e., the takeover of the parental role or parts of it by the child) in mother-child-dyads can cause alteration of the child's stress response system. Higher salivary cortisol concentrations were reported in infants and toddlers directly after negative interactions with their parents. However, no study to date has examined the association between atypical maternal interaction behavior and hair cortisol concentrations (HCC) in infants. Here, we studied the association of maternal interaction behavior with HCC of the child. Mother-child dyads (N = 112) participated in the longitudinal study My Childhood-Your Childhood. The AMBIANCE scale and its subscales were used to assess atypical maternal interaction behavior during the Strange Situation Procedure. Chronic stress levels in the child were assessed by HCC of 3 cm hair strands at the age of 12 months. Maternal educational level (operationalized in highest education level) served as a control variable. Robust multiple linear regression analyses revealed that role/boundary confusion was associated with HCC, i.e., the higher atypical interaction behavior of the mother the higher the HCC in the children. By measuring hair cortisol in this study, it is possible to determine the average long-term activity of the child's stress response system.Thus, atypical maternal interaction behavior could be a risk factor for persistent stress in children, contributing to a higher risk for negative health outcomes in later life. The results of this study highlight the importance of early intervention programs that focus on the relationship between mother and child.

Theory of Mind in Pre-school Aged Children: Influence of Maternal Depression and Infants' Self-Comforting Behavior

A milestone of child development is theory of mind (ToM): the ability to attribute mental states, especially beliefs and desires, to other persons and to understand that their behavior is guided by mental states. The learning process about the mental world also takes place in social communication and interaction, beginning in infancy. Infancy is assumed to be a sensitive period for the development of social skills through interaction. Due to limited self-regulatory skills, infants depend on sensitive behavior of their caregivers to regulate affective states and physiological arousal, and in turn, mutually regulated affects allow the infant to gradually acquire the capability to self-regulate negative affective states. Effective and adequate affect regulation is an important prerequisite for environmental interaction and thus for the development of socio-emotional skills. The present study investigated the relation of self-regulatory abilities in infancy and later ToM in pre-school aged children of clinically depressed mothers and healthy controls. The sample comprised of N = 55 mother-child dyads, n = 22 diagnosed with postpartum or lifetime depression according to DSM-IV and n = 33 healthy controls. Mother-infant-interaction was videotaped during the Face-to-Face Still-Face paradigm. At 3 and 42 months postpartum mothers were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to evaluate maternal psychopathological status according to DSM-IV. At the age of M = 4.0 years, children's ToM abilities were assessed using content-false-belief and location-false-belief tasks. The results of this study show that contrary to our hypotheses, maternal depression did not impair the development of children's ToM-abilities per se. Rather, an interaction effect highlights the role of infant's self-comforting behavior during mother-infant interaction in infancy (3 months postpartum) for ToM-development at pre-school age assessed with the Maxi-task; this association was distinct for female in comparison to male children. The results of this longitudinal study shed light on the discussion, how maternal depression influences child development and point in the direction that self-comforting behaviors in infancy can also be seen as a resource.

The Prolactin Family of Hormones as Regulators of Maternal Mood and Behavior

Transition into motherhood involves profound physiological and behavioral adaptations that ensure the healthy development of offspring while maintaining maternal health. Dynamic fluctuations in key hormones during pregnancy and lactation induce these maternal adaptations by acting on neural circuits in the brain. Amongst these hormonal changes, lactogenic hormones (e.g., prolactin and its pregnancy-specific homolog, placental lactogen) are important regulators of these processes, and their receptors are located in key brain regions controlling emotional behaviors and maternal responses. With pregnancy and lactation also being associated with a marked elevation in the risk of developing mood disorders, it is important to understand how hormones are normally regulating mood and behavior during this time. It seems likely that pathological changes in mood could result from aberrant expression of these hormone-induced behavioral responses. Maternal mental health problems during pregnancy and the postpartum period represent a major barrier in developing healthy mother-infant interactions which are crucial for the child's development. In this review, we will examine the role lactogenic hormones play in driving a range of specific maternal behaviors, including motivation, protectiveness, and mother-pup interactions. Understanding how these hormones collectively act in a mother's brain to promote nurturing behaviors toward offspring will ultimately assist in treatment development and contribute to safeguarding a successful pregnancy.

Major depression and generalised anxiety disorder: An analysis of the effects of remission status and comorbidity on mother-infant emotional availability in the perinatal period

BACKGROUND

The effects of maternal depression on mother-infant relationship quality likely vary according to depression heterogeneity. We investigated the effects of different presentations of major depression on mother-infant emotional availability (EA).

METHODS

Data were obtained from 115 mother-infant dyads from a longitudinal pregnancy cohort. Disorders, symptoms, and antidepressant use were assessed in pregnancy and postpartum, and EA was observed 6-month postpartum. Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) were assessed using the Structured Clinical Interview for the DSM-5. A series of multivariate analyses of covariance analyses' examining the effects of disorder on EA were conducted.

RESULTS

After controlling for maternal age, antidepressant use, and postpartum depressive symptoms, MDD accounted for 20% of the variance in EA. In the MDD/GAD group, 93% of interactions were rated as emotionally unavailable, nearly threefold the comparison group rate.

CONCLUSIONS

Findings demonstrate that different presentations of major depression are associated with observed differences in mother-infant EA.

Determining factors for the prevalence of depressive symptoms among postpartum mothers in lowland region in southern Nepal

Background

Postpartum depression is the most common mental health problem among women of childbearing age in resource-poor countries. Poor maternal mental health is linked with both acute and chronic negative effects on the growth and development of the child. This study aimed to assess the prevalence and factors associated with depressive symptoms among postpartum mothers in the lowland region in southern Nepal.

Methods

A hospital-based analytical cross-sectional study was conducted from 1^st July to 25^th August 2019 among 415 randomly selected postpartum mothers attending the child immunization clinic at Narayani hospital. The postpartum depressive symptoms were measured using the validated Nepalese version of the Edinburg Postnatal Depression Scale (EPDS). The data were entered into EpiData software 3.1v and transferred into Stata version 14.1 (StataCorp LP, College Station, Texas) for statistical analyses. To identify the correlates, backward stepwise binary logistic regression models were performed separately for the dichotomized outcomes: the presence of postpartum depressive symptoms. The statistical significance was considered at p-value <0.05 with 95% confidence intervals (CIs).

Results

Among the total 415 study participants, 33.7% (95% CI: 29.2–38.5%) of postpartum mothers had depressive symptoms. Study participant’s whose family monthly income <150 USD compared to ≥150 USD (aOR = 13.76, 95% CI: 6.54–28.95), the husband had migrated for employment compared to not migrated (aOR = 8.19, 95% CI:4.11–15.87), nearest health facility located at more than 60 minutes of walking distance (aOR = 4.52, 95% CI: 2.26–9.03), delivered their last child by cesarean section compared to normal (vaginal) delivery (aOR = 2.02, 95% CI: 1.12–3.59) and received less than four recommended antenatal care (ANC) visits (aOR = 2.28, 95% CI:1.25–4.15) had higher odds of depressive symptoms. Participants who had planned pregnancy (aOR = 0.44, 95% CI: 0.25–0.77) were associated with 56% lower odds of depressive symptoms.

Conclusions

One-third of the mothers suffered from postpartum depressive symptoms. The participant’s husband migrated for employment, family income, distance to reach a health facility, delivery by cesarean section, not receiving recommended ANC visits, and plan of pregnancy were independent predictors for postpartum depressive symptoms. The study results warranted the urgency for clinical diagnosis of PPD and implementation of preventive package in study settings. Mental health education to pregnant women during ANC visits and proper counseling during the antepartum and postpartum period can also play a positive role in preventing postpartum depression.

An exercise program throughout pregnancy: Barakat model

The physiologic processes of pregnancy and childbirth can determine the future well-being of mothers and children due to the great quantity and quality of modifications that these processes require in all areas of the female body and fetus. Recent evidence has confirmed that modern unhealthy lifestyles negatively affect pregnancy outcomes. Engaging in unhealthy habits during pregnancy increases the risk of chronic disease in both the mother and the fetus. Regarding physical exercise during pregnancy, throughout history, many professionals and scientists have reported the best gestational conditions for the mother, fetus, and newborn. The perspectives and advice have changed over time, including periods of strong conservatism. This history has affected the recommendations for the type and amount of exercise that a healthy woman should perform during pregnancy. The aim of this article is to determine the basic aspects that physical exercise programs during pregnancy should define in the near future. Additionally, from the results of this article, we propose an exercise program model that includes many exercises spanning throughout pregnancy (3 blocks = until 20 weeks, until 30 weeks and until the end of the pregnancy). An exercise session model divided into seven parts and recommendations of operative position to exercise during pregnancy are also provided.