The impact of prenatal maternal stress due to potentially traumatic events on child temperament: A systematic review

Effects of Peruvian mothers' experiences of violence, resilience, and posttraumatic stress on infant temperament: A longitudinal path model

Worldwide, research has demonstrated that maternal experiences of violence can adversely affect infant development, but moderating and mediating effects on this pathway are less understood, particularly within low- and middle-income countries. Using longitudinal structural equation modeling, the present study analyzed data from 251 Peruvian mothers during the prenatal and postpartum periods. We evaluated the relations between mothers' experiences of childhood violence (CV), prenatal intimate partner violence (IPV), posttraumatic stress symptoms (PTSS), and resilience, and how these factors influenced domains of their infants' temperament (i.e., surgency, negative affectivity, and regulatory capacity). Consistent with hypotheses, analyses revealed that mothers' CV exposure was associated with increased prenatal IPV and PTSS, and prenatal IPV was linked to increased prenatal PTSS and lower resilience. Prenatal PTSS was linked to lower infant regulatory capacity. Maternal prenatal resilience was negatively associated with prenatal PTSS. High postpartum maternal resilience mitigated the adverse effects of maternal CV on infant regulatory capacity. Inconsistent with hypotheses, postpartum PTSS was associated with higher infant regulatory capacity, though sensitivity testing suggested this finding may be spurious. Findings underscore the need for violence prevention and prenatal mental health interventions to reduce maternal PTSS and bolster resilience to support positive infant outcomes in Peru.

Advancing the Study of Maternal Prenatal Stress Phenotypes and Infant Temperament Outcomes

Exposure to the in utero environment provides offspring risk or protection with respect to postpartum development and health across the lifespan. We used latent profile analysis (LPA), considering self-report and physiological indicators to assess the influence of maternal prenatal stress/distress on infant temperament. We predicted that participants who reported greater prenatal stress/distress would have infants with less optimal temperament characteristics (e.g., higher fearfulness, lower smiling/laughter). Women (N = 67) were recruited in the Southwest Washington and Eastern Washington/North Idaho areas. Participants responded to surveys during the third trimester and provided hair samples for cortisol analyses. Postpartum mothers reported on infant temperament. LPA resolved two statistically supported profiles, reflecting lower and higher maternal stress/distress during pregnancy, which we compared with respect to infant temperament (e.g., fearfulness, smiling/laughter). The greater stress/distress exposure group demonstrated higher cortisol concentrations, depression, general anxiety, and perceived stress. Mothers with greater prenatal stress/distress profiles reported their children exhibiting more challenging temperaments (e.g., higher negative emotionality). This pattern of results suggests that groups discernable in terms of prenatal stress/distress exposure also differ with respect to infant reactivity and regulation.

Maternal exposure to general anesthesia and labor epidural analgesia during pregnancy and delivery, and subsequent neurodevelopmental outcomes in children

Gestation is a vulnerable developmental period, and exposures during that time may have longterm implications. While evaluating the implications of early exposures on children is an important public health concern, as opposed to other chemical exposures, medications are given for a clinical purpose, and any potential injury must be weighed against the benefits of these medications to the mother and child. This review examines neurodevelopmental outcomes in children following two maternal anesthetic exposures: general anesthesia and labor epidural analgesia. Exposure to general anesthetic agents has been found to interfere with neurodevelopment in animal models, and exposures in children, including prenatal exposures are also associated with worse neurodevelopmental outcomes. While these medications are likely to impact neurodevelopment in animals, it remains unclear if prenatal general anesthetic exposure causes the reported differences in children. As a result, since avoidance or delay of necessary surgery in mothers may result in adverse outcomes in mothers and children, necessary surgery in pregnant mothers should proceed without delay. Concerns about the safety of maternal neuraxial labor analgesia ("epidurals") have also emerged due to a reported association with autism spectrum diagnoses in their children. This may be due to familial factors in pregnant women electing for neuraxial labor analgesia rather than the "epidural" itself. In addition, since clinically significant differences in neurodevelopmental scores in children following exposure have not been found, and a mechanism of injury has not yet been identified in preclinical studies, the benefits of neuraxial labor analgesia appear to outweigh the potential risks.

Psychological intimate partner violence, child witnessing of parental arguments, and emotional-behavioral outcomes in five-years old: The French ELFE cohort

BACKGROUND

Intimate partner violence (IPV) is associated with children's emotional and behavioral difficulties. Psychological-IPV (P-IPV) is most common, and occurs alone or along other forms of IPV. Little is known about the longitudinal course of P-IPV exposure and its consequences on children taking into account whether or not they are present during parental arguments.

OBJECTIVE

To identify longitudinal trajectories of P-IPV from preconception through the child's second year of life and examine associations with children's emotional-behavioral outcomes at age five years, depending on the child's presence during parental arguments in the second year of life.

PARTICIPANTS AND SETTING

Data from the nationally representative French birth cohort ELFE including children born in 2011 were used.

METHODS

P-IPV exposure was assessed before conception, during pregnancy, at two months and at two years postpartum. Parents completed the Strengths and Difficulties Questionnaire (SDQ) at five years. Group-based trajectory modelling was used to identify P-IPV trajectories. Multivariate logistic regression models were used to study the relationship between P-IPV trajectories and SDQ.

RESULTS

9639 children were included. Five trajectories of exposure to P-IPV were identified: minimal (70.6 %), prenatal (10.0 %), increasing (6.4 %), decreasing (7.5 %), persistent (5.5 %). Persistent and decreasing P-IPV trajectories and frequent child presence during parental arguments were associated with children's increased odds of having abnormal total SDQ scores (OR 2.31 95 % CI 1.54-3.47; OR 1.64 95%CI: 1.11-2.43; OR 1.88 95%CI:1.17-3.02, respectively).

CONCLUSIONS

Early identification and consideration of children living in a home where IPV occurs could allow provision of timely and appropriate support.

Threshold effects of prenatal stress on striatal microglia and relevant behaviors

Prenatal stress, a risk factor for neurodevelopmental disorders (NDDs), leads to immune alterations, including offspring neuroimmune cells. Differences in offspring outcomes may arise from whether the extent of prenatal stress crosses "thresholds" for effects on specific outcomes. Therefore, we sought to determine offspring outcomes using models with different extents of prenatal stress. We focused on striatal outcomes, because of their relevance for NDDs. Pregnant CD1 mice were assigned to four groups (each: N=6): no stress ("NoS") or one of the following stressors administered three times daily: i.p. saline injections (low prenatal stress, LoS), Interleukin-6 injections as a component of prenatal stress (immune prenatal stress; ImS), or restraint stress + saline injections (high prenatal stress, HiS), embryonic day 12-18. In adult offspring, HiS altered striatal-dependent behavior across males and females, while ImS induced fewer behavioral changes, and LoS did not affect behavior. Adult striatal microglia morphologies were mostly unchanged across groups, with only HiS leading to altered striatal density of minimally ramified cells. However, embryonic striatal microglia were affected by all models of stress, albeit in distinct ways. The HiS model, and to a lesser extent LoS, also influenced immune components of the maternal-fetal interface: placental macrophages. In conclusion, high and immune stress affected adult striatal-dependent behavior, exceeding the threshold necessary for persistent impacts, but all stress models affected embryonic microglia, suggesting that early neuroimmune outcomes had a lower threshold for impacts. Distinct severities and aspects of prenatal stress may therefore underlie different outcomes relevant to NDDs.

Exploring and comparing the relationship between maternal anxiety and children's anxiety during admission, hospitalization, and discharge in pediatric wards of Iranian hospitals

BACKGROUND

Parental anxiety levels increase during their child's hospitalization. Consequently, anxiety can disrupt parental functioning as a caregiver and potentially transfer distress to the child. This study seeks to explore how maternal anxiety affects the anxiety levels of hospitalized children across three key stages: admission, in-hospital stay, and discharge.

METHODS

A cross-sectional study was conducted with hospitalized children aged 8 to 15 years their mothers. The sample size was determined based on the formula. Data were collected using demographic questionnaires and validated tools, including the State-Trait Anxiety Inventory (STAI) and the Spence Children's Anxiety Scale (SCAS). The STAI measures state and trait anxiety, while the SCAS assesses various domains of child anxiety. Data analysis involved descriptive statistics, Pearson correlation coefficients, and fractional polynomial modeling to assess anxiety trends.

RESULTS

The study involved 179 participants, with mothers averaging 36.95 years old. Most participants were homemakers (82.7%) and had less than a high school education (62.6%). The average number of children per mother was 2.02, and only 2.8% utilized assisted reproductive technologies. Maternal anxiety levels were notably high, with mean state anxiety scores decreasing slightly from 45.74 at admission to 44.53 at discharge. Trait anxiety scores followed a similar trend, averaging 42.79 at admission and dropping to 41.60 at discharge. The Spence Children's Anxiety Scale scores were relatively stable, starting at 50.93 at admission and ending at 50.89 at discharge. Severe state anxiety affected 25.7% of participants, while 11.2% experienced severe trait anxiety. Importantly, significant positive correlations were identified between maternal anxiety and children's anxiety throughout the hospitalization period.

CONCLUSION

This study reveals high levels of both maternal and pediatric anxiety throughout hospitalization. Mean scores for state and trait anxiety remained elevated at all stages, with significant correlations between maternal and child anxiety. These results highlight the need for targeted interventions to address and manage anxiety in both mothers and children during hospital stays. Future research should focus on strategies to mitigate these anxieties and improve support for families.

The Impact of Early Life Experiences on Stress Neurobiology and the Development of Anxiety

We examine the association between stress exposure during early development (i.e., the prenatal period through the first two postnatal years) and variation in brain structure and function relevant to anxiety. Evidence of stress-related effects occurring in regions essential for emotional processing and regulation may increase susceptibility to anxiety.

Pandemic babies: A systematic review of the association between maternal pandemic-related stress during pregnancy and infant development

The COVID-19 pandemic, with its far-reaching influence on daily life, constituted a highly stressful experience for many people worldwide, jeopardizing individuals' mental health, particularly in vulnerable populations such as pregnant women. While a growing body of evidence links prenatal maternal stress to biological and developmental alterations in offspring, the specific impact of prenatal exposure to maternal pandemic-related stress (PRS) on infant development remains unclear. A comprehensive literature search was performed in October 2023 according to the PRISMA guidelines, which yielded a total of 28 records. The selected papers investigated a vast range of developmental and biological outcomes in the offspring with large methodological variations. The reviewed studies showed mixed results. Either direct associations between maternal PRS during pregnancy and infant temperament and socio-emotional development, or indirect links, mediated by maternal mental health, emerged in most studies. Furthermore, maternal PRS was associated with epigenetic and brain alterations in the offspring, although studies were limited in number. Collectively, the reviewed findings contribute to a deeper understanding of the role of early adverse exposures on infant development.

Climate change, air pollution and maternal and newborn health: An overview of reviews of health outcomes

Background

Climate change represents a fundamental threat to human health, with pregnant women and newborns being more susceptible than other populations. In this review, we aimed to describe the current landscape of available epidemiological evidence on key climate risks on maternal and newborn health (MNH).

Methods

We sought to identify published systematic and scoping reviews investigating the impact of different climate hazards and air pollution on MNH outcomes. With this in mind, we developed a systematic search strategy based on the concepts of 'climate/air pollution hazards, 'maternal health,' and 'newborn health,' with restrictions to reviews published between 1 January 2010 and 6 February 2023, but without geographical or language restriction. Following full text screening and data extraction, we synthesised the results using narrative synthesis.

Results

We found 79 reviews investigating the effects of climate hazards on MNH, mainly focussing on outdoor air pollution (n = 47, 59%), heat (n = 24, 30%), and flood/storm disasters (n = 7, 9%). Most were published after 2015 (n = 60, 76%). These reviews had consistent findings regarding the positive association of exposure to heat and to air pollution with adverse birth outcomes, particularly preterm birth. We found limited evidence for impacts of climate-related food and water security on MNH and did not identify any reviews on climate-sensitive infectious diseases and MNH.

Conclusions

Climate change could undermine recent improvements in maternal and newborn health. Our review provides an overview of key climate risks to MNH. It could therefore be useful to the MNH community to better understand the MNH needs for each climate hazard and to strengthen discussions on evidence and research gaps and potential actions. Despite the lack of comprehensive evidence for some climate hazards and for many maternal, perinatal, and newborn outcomes, we observed repeated findings of the impact of heat and air pollutants on birth outcomes, particularly preterm birth. It is time for policy dialogue to follow to specifically design climate policy and actions to protect the needs of MNH.

Maternal lifetime stress and psychological functioning in pregnancy is associated with preschoolers' temperament: Exploring effect modification by race and ethnicity

BACKGROUND

Psychosocial stress and psychopathology frequently co-occur, with patterns differing by race and ethnicity. We used statistical mixtures methodology to examine associations between prenatal stress and child temperament in N = 382 racially and ethnically diverse maternal-child dyads to disentangle associations among maternal stressful life events, maternal psychological functioning in pregnancy, childhood neurobehavior, and maternal race and ethnicity.

METHODS

This study utilized data from a longitudinal pregnancy cohort, PRogramming of Intergenerational Stress Mechanisms (PRISM). Mothers completed the Lifetime Stressor Checklist-Revised, Edinburgh Postnatal Depression Scale, and Spielberger State-Trait Anxiety Scale during pregnancy. When their children were 3-5 years of age, they completed the Children's Behavior Questionnaire, which yields three temperament dimensions: Negative Affectivity (NA), Effortful Control (EC), and Surgency (S). We used weighted quantile sum regression to derive a weighted maternal stress index encompassing lifetime stress and depression and anxiety symptoms and examined associations between the resulting stress index and child temperament. Differential contributions of individual stress domains by race and ethnicity also were examined.

RESULTS

Mothers self-identified as Black/Black Hispanic (46.1 %), non-Black Hispanic (31.9 %), or non-Hispanic White (22 %). A higher maternal stress index was significantly associated with increased child NA (β = 0.72 95 % CI = 0.35, 1.10). Lifetime stress was the strongest contributor among Hispanic (36.7 %) and White (17.8 %) mothers, whereas depressive symptoms in pregnancy was the strongest contributor among Black (16.7 %) mothers.

CONCLUSION

Prenatal stress was most strongly associated with negative affectivity in early childhood. Consideration of multiple stress measures as a mixture accounted for differential contributions of individual stress domains by maternal race and ethnicity. These findings may help elucidate the etiology of racial/ethnic disparities in childhood neurobehavior.

Efficacy of B-vitamins and vitamin D therapy in improving depressive and anxiety disorders: a systematic review of randomized controlled trials

OBJECTIVES

This systematic review aimed to evaluate the efficacy of B vitamins and vitamin D therapy in improving the standard treatment of depression and anxiety disorders. We also aimed to gather the evidence supporting the recommendations for supplementation in clinical practice.

METHODS

Performed between March 2020 and September 2021, the main inclusion criteria were randomized controlled trials (RCTs), with patients ≥ 18 years old, both sexes, fulfilling target diagnoses of major depressive disorder (MDD), generalized anxiety disorder (GAD), or mild to severe depressive and anxiety symptoms. In addition, the RCTs were included if the scales to assess the severity of the symptoms were standardized rating scales in psychiatric. Trials that reported diagnoses of schizophrenia, perinatal depression, bipolar depression, sleep disorders, eating disorders, cancer, and multiple sclerosis in association with any of the mentioned diagnoses were excluded.

RESULTS

We identified 20 RCTs that matched all eligibility criteria, totaling 2,256 subjects, diagnosed with MDD, GAD, and depressive or anxiety symptoms. Supplementation with folic acid or L-methylfolate, B1, B12 or methylcobalamin, and vitamin D (in different doses and study duration) significantly decreased depression score scales by increasing response to standard pharmacological treatment or as monotherapy, including partial or complete remission. As for anxiety symptoms, the availability of results is limited to adjuvant vitamin D therapy.

DISCUSSION

B vitamins and vitamin D associated with other compounds also showed significant results, so the improvement in symptoms cannot be attributed strictly to those. Our results suggest that intervention with B vitamins and/or vitamin D may be an effective and well-tolerated adjuvant strategy for improving the symptoms of depression and anxiety, according to the patient's clinical status and nutritional biomarkers.

Pandemic beyond the virus: maternal COVID-related postnatal stress is associated with infant temperament

BACKGROUND

Studies have shown that infant temperament varies with maternal psychosocial factors, in utero illness, and environmental stressors. We predicted that the pandemic would shape infant temperament through maternal SARS-CoV-2 infection during pregnancy and/or maternal postnatal stress. To test this, we examined associations among infant temperament, maternal prenatal SARS-CoV-2 infection, maternal postnatal stress, and postnatal COVID-related life disruptions.

METHODS

We tested 63 mother-infant dyads with prenatal maternal SARS-CoV-2 infections and a comparable group of 110 dyads without infections. To assess postnatal maternal stress, mothers completed the Perceived Stress Scale 4 months postpartum and an evaluation of COVID-related stress and life disruptions 6 months postpartum. Mothers reported on infant temperament when infants were 6-months-old using the Infant Behavior Questionnaire-Revised (IBQ-R) Very Short Form.

RESULTS

Maternal SARS-CoV-2 infection during pregnancy was not associated with infant temperament or maternal postnatal stress. Mothers with higher self-reported postnatal stress rated their infants lower on the Positive Affectivity/Surgency and Orienting/Regulation IBQ-R subscales. Mothers who reported greater COVID-related life disruptions rated their infants higher on the Negative Emotionality IBQ-R subscale.

CONCLUSIONS

Despite no effect of prenatal maternal SARS-CoV-2 infection, stress and life disruptions incurred by the COVID-19 pandemic were associated with infant temperament at 6-months.

IMPACT

SARS-CoV-2 infection during pregnancy is not associated with postnatal ratings of COVID-related life disruptions, maternal stress, or infant temperament. Postnatal ratings of maternal stress during the COVID-19 pandemic are associated with normative variation in maternal report of infant temperament at 6 months of age. Higher postnatal ratings of maternal stress are associated with lower scores on infant Positive Affectivity/Surgency and Orienting/Regulation at 6 months of age. Higher postnatal ratings of COVID-related life disruptions are associated with higher scores on infant Negative Emotionality at 6 months of age.

Effects of Maternal and Child Lifetime Traumatic Stress Exposures, Infant Temperament, and Caregiving Quality on Preschoolers' Executive Functioning

We examined effects of maternal and child lifetime traumatic stress exposures, infant temperament, and caregiving quality on parent ratings of preschoolers' executive functioning (EF). Maternal lifetime trauma was associated with preschoolers' EF problems; this association was mediated by greater child trauma exposure. Infant temperament was associated with EF abilities, particularly among females. Among males, infant extraversion/surgency mediated the association of maternal lifetime trauma with poorer child EF. Caregiving quality was negatively associated with maternal and child trauma exposures but did not predict child EF. Findings have implications for interventions to identify children at risk for poor EF and optimize outcomes.