Maternal anxiety in late pregnancy and fetal hemodynamics

Dose-dependent increase in risk of bleeding and bleeding complications in relation to SSRI use at delivery

INTRODUCTION

Depression during pregnancy is a severe state that increases the risk of suicide, as well as adverse newborn outcomes. Selective serotonin re-uptake inhibitors (SSRIs) are effective for the treatment of depression, but increase the risk of bleeding complications at delivery. Knowledge on the dose dependency of this association is lacking.

METHODS

A hospital-based cohort study of all women who gave birth at Karolinska University Hospital in Stockholm over the 5-year period from 2007 to 2011, with or without SSRI use, was undertaken. In total, 334 women who delivered vaginally and were exposed to SSRIs at delivery were identified. All other women who delivered vaginally formed the control group (n = 31,929). The electronic maternal health records of the 334 SSRI users were scrutinized, and the women were categorized into two groups: moderate (n = 246) or high (n = 88) SSRI dose at delivery. The main outcome was bleeding complications at delivery in relation to SSRI dose.

RESULTS

A dose-dependent increase in the rate of postpartum haemorrhage (≥1000 ml) was found, affecting 8.4 %, 14.6 % and 23.9 % (p ≤ 0.001) of women in the control group, the moderate-dose group and the high-dose group, respectively. In addition, a dose-dependent increase in the rate of postpartum anaemia was found, affecting 7.0 %, 9.3 % and 15.9 % (p = 0.001) of women in the control group, the moderate-dose group and the high-dose group, respectively. Mean blood loss of 406 ml, 483 ml and 482 ml (p ≤ 0.001) was found in the control group, the moderate-dose group and the high-dose group, respectively. Women exposed to SSRIs delivered earlier, but did not have higher prevalence of pre-eclampsia compared with the control group.

CONCLUSIONS

The dose-dependent relationship between SSRIs and bleeding complications may be clinically useful in the management of this vulnerable group of women.

Care of the Fetus With Congenital Cardiovascular Disease: From Diagnosis to Delivery

BACKGROUND

The majority of congenital cardiovascular disease including structural cardiac defects, abnormalities in cardiac function, and rhythm disturbances can be identified prenatally using screening obstetrical ultrasound with referral for fetal echocardiogram when indicated.

METHODS

Diagnosis of congenital heart disease in the fetus should prompt assessment for extracardiac abnormalities and associated genetic abnormalities once maternal consent is obtained. Pediatric cardiologists, in conjunction with maternal-fetal medicine, neonatology, and cardiothoracic surgery subspecialists, should counsel families about the details of the congenital heart defect as well as prenatal and postnatal management.

RESULTS

Prenatal diagnosis often leads to increased maternal depression and anxiety; however, it decreases morbidity and mortality for many congenital heart defects by allowing clinicians the opportunity to optimize prenatal care and plan delivery based on the specific lesion. Changes in prenatal care can include more frequent assessments through the remainder of the pregnancy, maternal medication administration, or, in selected cases, in utero cardiac catheter intervention or surgical procedures to optimize postnatal outcomes. Delivery planning may include changing the location, timing or mode of delivery to ensure that the neonate is delivered in the most appropriate hospital setting with the required level of hospital staff for immediate postnatal stabilization.

CONCLUSIONS

Based on the specific congenital heart defect, prenatal echocardiogram assessment in late gestation can often aid in predicting the severity of postnatal instability and guide the medical or interventional level of care needed for immediate postnatal intervention to optimize the transition to postnatal circulation.

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Objective This study examined the independent effect of delivery type and preoperative anxiety on placenta oxidative stress response.

Materials and methods A total of 126 patients who gave birth were divided into two groups according to delivery type: vaginal delivery group (VD) (n=56) and elective cesarean section delivery group (CS) (n=70). The preoperative anxiety levels of pregnant women who came to the delivery room were evaluated with the State Anxiety Inventory (SAI) scale. Malonyldialdehyde (MDA), superoxide dismutase (SOD), total antioxidative status (TAS), total oxidative state (TOS), and oxidative stress index (OSI) levels in umbilical cord blood were compared according to preoperative anxiety level and type of delivery.

Results The CS group had significantly higher MDA (0.88±0.15 versus 0.79±0.09, p=0.001) and TOS (8.37±1.81 versus 7.53±0.77, p=0.019) values compared to the VD group. TAS levels did not differ significantly between the groups. SOD levels were higher in VD group compared to CS group (p=0.049). When the factors affecting oxidative stress biomarkers are analyzed by regression analysis, factors affecting MDA were found to be SAI score (Beta=0.358), CS (Beta=0.212), the factor affecting SOD was found to be VD (Beta=0.318), the factors affecting TOS were found to be SAI score (Beta=0.317) and CS (Beta=0.183).

Conclusıon Oxidative stress biomarker levels in umbilical cord blood and preoperative anxiety levels were higher in patients who underwent elective caesarean section than those who delivered vaginally. Preoperative anxiety was the factor that increased oxidative stress biomarkers of umbilical cord blood the most.

Maternal Prenatal Stress, Thyroid Function and Neurodevelopment of the Offspring: A Mini Review of the Literature

Fetal brain is extremely plastic and vulnerable to environmental influences that may have long-term impact on health and development of the offspring. Both the Hypothalamic-Pituitary-Adrenal (HPA) and the Hypothalamic-Pituitary-Thyroid (HPT) axes are involved in stress responses, whereas, their final effectors, the Glucocorticoids (GCs) and the Thyroid Hormones (TH s), mediate several fundamental processes involved in neurodevelopment. The effects of these hormones on brain development are found to be time and dose-dependent. Regarding THs, the developing fetus depends on maternal supply of hormones, especially in the first half of pregnancy. It is acknowledged that inadequate or excess concentrations of both GCs and THs can separately cause abnormalities in the neuronal and glial structures and functions, with subsequent detrimental effects on postnatal neurocognitive function. Studies are focused on the direct impact of maternal stress and GC excess on growth and neurodevelopment of the offspring. Of particular interest, as results from recent literature data, is building understanding on how chronic stress and alterations of the HPA axis interacts and influences HPT axis and TH production. Animal studies have shown that increased GC concentrations related to maternal stress, most likely reduce maternal and thus fetal circulating THs, either directly or through modifications in the expression of placental enzymes responsible for regulating hormone levels in fetal microenvironment. The purpose of this review is to provide an update on data regarding maternal stress and its impact on fetal neurodevelopment, giving particular emphasis in the interaction of two axes and the subsequent thyroid dysfunction resulting from such circumstances.

Parental Prenatal Symptoms of Depression and Offspring Symptoms of ADHD: A Genetically Informed Intergenerational Study

Objective: The primary aim of the present study was to separate the direct effect of maternal prenatal depression on offspring ADHD from the passive transmission of genetic liability. Method: A children-of-twins and siblings design including 17,070 extended-family units participating in the Norwegian Mother and Child Cohort Study was used. Self-ratings were obtained from parents using the Symptom Checklist during pregnancy. Maternal ratings using Conner's Parent Rating Scale were obtained when the children were 5 years of age. Results: Genetic influences were important for explaining similarity between parents and offspring. There was also evidence for a maternal effect after accounting for genetic transmission (m = 0.06, 95% confidence interval [CI] = [0.02, 0.09]). Conclusion: Our results were consistent with hypotheses suggesting that maternal prenatal depression influences symptoms of ADHD in offspring. However, the effect was weak and a substantial portion of the association could be accounted for by shared genetic influences.

Association between fetoplacental Doppler results, placental pathology, and angiogenic factors among pregnant women with anxiety

OBJECTIVE

This study aimed to evaluate whether state and trait anxiety among pregnant women were associated with fetoplacental Doppler findings, abnormal placental pathology, and placental angiogenic factors.

MATERIALS AND METHODS

A total of 102 pregnant women at 32-35 gestational weeks were recruited and examined prospectively. State and trait anxiety were measured using the State-Trait Anxiety Inventory. Using Doppler ultrasound, pulsatility index (PI) of the umbilical artery (UA), middle cerebral artery (MCA), and uterine artery (UtA) and cerebroplacental ratio (CPR) were determined. Doppler parameters were converted into multiples of the median (MoM). Abnormal placental pathology was classified into 2 groups: vascular underperfusion (VU) and histological chorioamnionitis (HCA). Immunohistochemical analysis was performed to examine placental cells staining positive for placental growth factor (PLGF) and hypoxia-inducible factor-1-α (HIF-1α), which are markers for angiogenesis and hypoxic status, respectively.

RESULTS

Women with high state anxiety scores had low MCA-PI MoM and CPR MoM, while those with high trait anxiety scores had low MCA-PI MoM. VU was associated with a higher incidence of high trait anxiety scores, and HCA was associated with a higher incidence of high state and trait anxiety scores. Regression analysis showed a relationship between maternal state anxiety on MCA-PI MoM and HCA after controlling for covariates. Maternal trait anxiety exhibited relationships with VU and HCA after adjustment.

CONCLUSION

Our results demonstrated that maternal anxiety is associated with altered fetal cerebral blood flow and abnormal placental pathology but is not associated with uteroplacental insufficiency and placental angiogenic factors.

Fetal lower urinary tract obstruction: What should we tell the prospective parents?

Fetal lower urinary tract obstruction (LUTO), which often results in marked perinatal morbidity and mortality, is caused by a heterogeneous group of anatomical defects that lead to blockage of the urethra. The classic prenatal presentation of LUTO includes megacystis with hydronephrosis. While mild forms of the disease can be associated with favorable outcomes, more severe disease commonly leads to dysplastic changes in the fetal kidneys, and ultimately oligohydramnios, which can result in secondary pulmonary hypoplasia and renal failure at birth. The aim of this review is to provide practitioners with a general overview of the diagnosis and treatment of LUTO based on disease severity, along with some points to consider when counseling prospective parents of fetuses with this condition.

Association between antenatal maternal anxiety and fetal middle cerebral artery Doppler depends on fetal gender

Objective: Several studies have demonstrated that antenatal maternal anxiety (AMA) during pregnancy is associated with an increased risk of abnormal fetal Doppler parameters and adverse perinatal outcomes. Despite these studies, the evidence of the association between them remains inconclusive due in part to the methodological limitations of existing studies. Hence, in the present study, we established strict criteria and excluded patients who may have moderate or confounding variables to investigate the relationship between AMA and fetal Doppler findings and adverse perinatal outcomes.Methods: This was a cross-sectional study of 160 healthy nulliparous pregnant women (gestational age 31-33 weeks) with uncomplicated obstetric histories, who underwent Doppler flow studies on uterine, umbilical and fetal middle cerebral artery (MCA). Maternal anxiety was measured by STAI-State and STAI-Trait inventory.Results: Statistical analyses revealed that STAI-Trait anxiety was associated with lower MCA pulsatility index at 31-33 weeks gestational age and lower birth weight for the female fetus. There were no significant differences in the birth weight of boys of mothers with high anxiety and without high anxiety.Conclusions: The adaptation of the fetus to this hostile environment as AMA differs by gender. Adaptation for the female fetus means the "brain sparing effect" and reduced birth weight. The findings emphasize the potential importance of maternal psychological wellbeing during pregnancy for fetal development.

Cardiovascular effects of prenatal stress-Are there implications for cerebrovascular, cognitive and mental health outcome?

Prenatal stress programs offspring cognitive and mental health outcome. We reviewed whether prenatal stress also programs cardiovascular dysfunction which potentially modulates cerebrovascular, cognitive and mental health disorders. We focused on maternal stress and prenatal glucocorticoid (GC) exposure which have different programming effects. While maternal stress induced cortisol is mostly inactivated by the placenta, synthetic GCs freely cross the placenta and have different receptor-binding characteristics. Maternal stress, particularly anxiety, but not GC exposure, has adverse effects on maternal-fetal circulation throughout pregnancy, probably by co-activation of the maternal sympathetic nervous system, and by raising fetal catecholamines. Both effects may impair neurodevelopment. Experimental data also suggest that severe maternal stress and GC exposure during early and mid-gestation may increase the risk for cardiovascular disorders. Human data are scarce and especially lacking for older age. Programming mechanisms include aberrations in cardiac and kidney development, and functional changes in the renin-angiotensin-aldosterone-system, stress axis and peripheral and coronary vasculature. Adequate experimental or human studies examining the consequences for cerebrovascular, cognitive and mental disorders are unavailable.

Cellular stress mechanisms of prenatal maternal stress: Heat shock factors and oxidative stress

Development of the brain prenatally is affected by maternal experience and exposure. Prenatal maternal psychological stress changes brain development and results in increased risk for neuropsychiatric disorders. In this review, multiple levels of prenatal stress mechanisms (offspring brain, placenta, and maternal physiology) are discussed and their intersection with cellular stress mechanisms explicated. Heat shock factors and oxidative stress are closely related to each other and converge with the inflammation, hormones, and cellular development that have been more deeply explored as the basis of prenatal stress risk. Increasing evidence implicates cellular stress mechanisms in neuropsychiatric disorders associated with prenatal stress including affective disorders, schizophrenia, and child-onset psychiatric disorders. Heat shock factors and oxidative stress also have links with the mechanisms involved in other kinds of prenatal stress including external exposures such as environmental toxicants and internal disruptions such as preeclampsia. Integrative understanding of developmental neurobiology with these cellular and physiological mechanisms is necessary to reduce risks and promote healthy brain development.

Depression in Children and Adolescents Involved in the Child Welfare System

Child maltreatment presents a significant public health challenge and is strongly associated with development of depression during childhood and adolescence. Not all abused or neglected children are in the child welfare system, but most children in the foster care system have a history of maltreatment. Involvement with the child welfare system presents an additional risk for psychopathology. The role of child maltreatment and child welfare involvement in development of depression in children and adolescents is reviewed and effective treatments are discussed. Clinicians working with foster children must collaborate with care providers and other stakeholders to enhance the child's placement permanence.

Prenatal Exposure to an Acute Stressor and Children's Cognitive Outcomes

Exposure to environmental stressors is highly prevalent and unequally distributed along socioeconomic lines and may have enduring negative consequences, even when experienced before birth. Yet, estimating the consequences of prenatal stress on children's outcomes is complicated by the issue of confounding (i.e., unobserved factors correlated with stress exposure and with children's outcomes). I combine a natural experiment-a strong earthquake in Chile-with a panel survey to capture the effect of prenatal exposure on acute stress and children's cognitive ability. I find that stress exposure in early pregnancy has no effect on children's cognition among middle-class families, but it has a strong negative influence among disadvantaged families. I then examine possible pathways accounting for the socioeconomic stratification in the effect of stress, including differential exposure across socioeconomic status, differential sensitivity, and parental responses. Findings suggest that the interaction between prenatal exposures and socioeconomic advantage provides a powerful mechanism for the intergenerational transmission of disadvantage.

Neonatal outcomes in pregnant women with untreated and treated panic disorder

OBJECTIVE

The objective of the present study was to compare neonatal outcomes including gestational age, birth weight and hospitalization of newborns of pregnant women with treated with antidepressants and untreated panic disorder.

METHODS

The study sample included 146 pregnant women (44 patients with panic disorder treated with antidepressants, 52 patients with untreated panic disorder, and 50 healthy controls). Panic disorder was diagnosed by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

RESULTS

The highest proportions of preterm birth (28.8%), low birth weight (34.6%) and requirement of neonatal care (25.0%) were observed in infants of untreated patients. Pharmacotherapy group and control subjects had similar neonatal outcomes. Compared with infants of healthy subjects and the pharmacotherapy group, infants of untreated patients had significantly lower birth weight and gestational age at delivery. In addition, newborns of untreated patients had higher rate of hospitalization at the neonatal care unit.

CONCLUSION

Our results suggest that treatment with pharmacotherapy of panic disorder during pregnancy may have beneficial effects on the risk of negative neonatal outcomes due to maternal panic disorder in the infants.

A Meta-Analysis of Maternal Prenatal Depression and Anxiety on Child Socioemotional Development

OBJECTIVE

Observed associations between maternal prenatal stress and children's socioemotional development have varied widely in the literature. The objective of the current study was to provide a synthesis of studies examining maternal prenatal anxiety and depression and the socioemotional development of their children.

METHOD

Eligible studies through to February 2018 were identified using a comprehensive search strategy. Included studies examined the association between maternal prenatal depression or anxiety and the future development of their children's socioemotional development (eg, difficult temperament, behavioral dysregulation) up to 18 years later. Two independent coders extracted all relevant data. Random-effects meta-analyses were used to derive mean effect sizes and test for potential moderators.

RESULTS

A total of 71 studies met full inclusion criteria for data analysis. The weighted average effect size for the association between prenatal stress and child socioemotional problems was as follows: odds ratio (OR) = 1.66 (95% CI = 1.54-1.79). Effect sizes were stronger for depression (OR = 1.79; 95% CI = 1.61-1.99) compared to anxiety (OR = 1.50; 95% CI = 1.36-1.64). Moderator analyses indicated that effect sizes were stronger when depression was more severe and when socio-demographic risk was heightened.

CONCLUSION

Findings suggest that maternal prenatal stress is associated with offspring socioemotional development, with the effect size for prenatal depression being more robust than for anxiety. Mitigating stress and mental health difficulties in mothers during pregnancy may be an effective strategy for reducing offspring behavioral difficulties, especially in groups with social disadvantage and greater severity of mental health difficulties.

The relationship between maternal anxiety and cortisol during pregnancy and birth weight of chinese neonates

BACKGROUND

To determine the relationship between maternal anxiety and cortisol values and birth weight at various stages of pregnancy.

METHODS

Two hundred sixteen pregnant Chinese women were assessed for anxiety and depression and had measurement of morning fasting serum cortisol. Women were assessed either in the first (71), second (72) or third (73) trimester. Birth weights of all children were recorded.

RESULTS

There were significant negative correlations between anxiety level and birth weight of - 0.507 (p < 0.01) and - 0.275 (p < 0.05) in trimesters 1and 2. In trimester 3 the negative relation between anxiety and birth weight of -.209 failed to reach significance (p = 0.070). There was no relation between depression and birth weight in any trimester (p > 0.5 for all). Maternal cortisol was significantly inversely related to birth weight in trimester 1 (r = - 0.322) and with borderline significance in trimester 2 (r = - 0.229). Anxiety score and maternal cortisol were significantly correlated in each trimester (r = 0.551, 0.650, 0.537). When both anxiety score and maternal cortisol were simultaneously included in multiple regression analyses only anxiety score remained significant.

CONCLUSION

Whilst both maternal anxiety score and maternal cortisol are inversely related to birth weight the associations with anxiety score were more robust perhaps indicating the importance of mechanisms other than, or in addition to, maternal cortisol in mediating the effects of anxiety. The findings indicate the importance of measures to reduce maternal anxiety, particularly of a severe degree, at all stages of pregnancy.

TRIAL REGISTRATION

The study was approved by the Ethics Committee of the 1st Affiliated Hospital of Xi'an Jiaotong University.

State-trait anxiety levels during pregnancy and foetal parameters following intervention with music therapy

BACKGROUND

Research indicates that anxiety during pregnancy may be a risk factor for the development of alterations in the mental health of the pregnant woman and of obstetric complications.

OBJECTIVE

to investigate the effect of music therapy on maternal anxiety, before and after a non-stress test (NST), and the effect of maternal anxiety on the birthing process and birth size.

METHODS

409 nulliparous women coming for routine prenatal care were randomized in the third trimester to receive either music therapy (n = 204) or no music therapy (n = 205) during an NST. Maternal anxiety was assessed using the Spielberger State-Trait Anxiety Inventory before and after the NST.

RESULTS

After the NST, the women from the music group showed significantly lower scores in state anxiety (OR = 0.87; p < 0.001) as well as trait anxiety (p < 0.001) than the control group. Furthermore, the pregnant women from the music group presented lower levels of state-trait anxiety than the control group in relation to the variables of birth process, and higher birth weight and chest circumference in the newborn (OR = 3.5 and OR = 0.81, respectively; p < 0.05).

LIMITATIONS

This study was limited by the fact that it was a single-centre study; the observers conducting the NST were not blinded to the allocation, although neither midwife had any knowledge of the maternal anxiety scores, and we could not apply the double-blind method due to the nature of the observation.

CONCLUSIONS

Our findings confirm that music therapy intervention during pregnancy could reduce elevated state-trait anxiety levels during the third trimester. Further research into the influence of music therapy as intervention on maternal anxiety and on the birthing process and birth size is required during pregnancy.

Associations between biological markers of prenatal stress and infant negative emotionality are specific to sex

PURPOSE

Fetal programming is the idea that environmental stimuli can alter the development of the fetus, which may have a long-term effect on the child. We have recently reported that maternal prenatal cortisol predicts infant negative emotionality in a sex-dependent manner: high prenatal cortisol was associated with increased negative emotionality in females, and decreased negative emotionality in males. This study aims to test for this sex-specific effect in a different cohort, and investigate whether sex differences in fetal programming may be specific to glucocorticoid mechanisms by also examining a maternal salivary alpha-amylase (sAA) by sex interaction.

METHODS

88 pregnant women (mean gestational age=27.4 weeks, SD=7.4) collected saliva samples at home over two working days to be assayed for the hormone cortisol (range=0.13-88.22nmol/l) and the enzyme alpha-amylase (range=4.57-554.8units/ml). Samples were collected at waking, 30-min post-waking and 12h post-waking. Two months after birth participants reported infant negative emotionality using the distress to limits subscale of the Infant Behavior Questionnaire.

RESULTS

The interaction between maternal prenatal cortisol and infant sex to predict distress to limits approached significance (p=0.067). In line with our previous finding there was a positive association between prenatal cortisol and negative emotionality in females, and a negative association in males. The interaction between sAA and sex to predict distress was significant (p=0.025), and the direction of effect was the same as for the cortisol data; high sAA associated with increased negative emotionality in females and reduced negative emotionality in males.

CONCLUSIONS

In line with our previous findings, this research adds to an emerging body of literature, which suggests that fetal programming mechanisms may be sex-dependent. This is the first study to demonstrate that maternal prenatal sAA may be an important biomarker for infant behavior, and the findings have implications for understanding sex differences in developmental psychopathology.

Correlation between maternal anxiety, reactivity of fetal cerebral circulation to auditory stimulation, and birth outcome in normotensive and gestational hypertensive women

This study investigated the correlation between maternal anxiety and blood flow changes through the fetal middle cerebral artery (MCA) after defined acoustic stimulation in 43 normotensive (C) and 40 gestational hypertensive (GH) subjects. Neonatal outcomes (gestational age at birth, Apgar score, birth weight) in the C and GH groups were analyzed. State (STAI-S) and trait (STAI-T) anxiety was assessed using Spielberger's questionnaire. The MCA blood flow was assessed once between 28 and 41 weeks of gestation using color Doppler ultrasound before and after application of defined acoustic stimulus. Relative size of the Pulsatility index (Pi) change (RePi) was calculated. The general hypotheses were: (1) women in GH group would have higher anxiety; (2) higher anxiety correlates with higher RePi change and poorer neonatal outcome; (3) fetuses from the GH group would have poorer neonatal outcome. Subjects from the GH group had higher STAI-T and RePi compared to the C group. A positive correlation between RePi and STAI-S, STAI-T, and systolic/diastolic blood pressure was found in both groups. There were more preterm deliveries in the GH group compared to the C group. A significant effect of STAI-T on body weight was observed in the C and GH group. There was a predictive effect of STAI-T and RePi on the C group, and STAI-S, STAI-T, diastolic blood pressure, and RePi on the GH group in terms of neonatal body weight. This study demonstrates an association between antenatal anxiety in GH women and increased fetal cerebral circulation in response to defined auditory stimulation.

Are Major Depression and Generalized Anxiety Disorder Associated With Oligohydramnios in Pregnant Women? A Case-Control Study

PURPOSE

This study examined the prevalence of major depression and generalized anxiety disorder (GAD) in pregnant women with and without a diagnosis of oligohydramnios.

DESIGN AND METHODS

The study sample included 53 pregnant women with a diagnosis of oligohydramnios and 80 healthy pregnant women subjects. Major depression and GAD were diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I).

FINDINGS

Pregnant women with oligohydramnios had higher scores of depressive and anxiety symptom, and a higher prevalence rate of major depression (24.5% vs. 6.2%) and GAD (30.2% vs. 3.2%).

PRACTICE IMPLICATIONS

The results of the present study suggest that oligohydramnios appears to be associated with both major depression and GAD in pregnant women.

Pregnancy-specific stress, fetoplacental haemodynamics, and neonatal outcomes in women with small for gestational age pregnancies: a secondary analysis of the multicentre Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction

OBJECTIVES

To examine associations between maternal pregnancy-specific stress and umbilical (UA PI) and middle cerebral artery pulsatility indices (MCA PI), cerebroplacental ratio, absent end diastolic flow (AEDF), birthweight, prematurity, neonatal intensive care unit admission and adverse obstetric outcomes in women with small for gestational age pregnancies. It was hypothesised that maternal pregnancy-specific stress would be associated with fetoplacental haemodynamics and neonatal outcomes.

DESIGN

This is a secondary analysis of data collected for a large-scale prospective observational study.

SETTING

This study was conducted in the seven major obstetric hospitals in Ireland and Northern Ireland.

PARTICIPANTS

Participants included 331 women who participated in the Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction. Women with singleton pregnancies between 24 and 36 weeks gestation, estimated fetal weight <10th percentile and no major structural or chromosomal abnormalities were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Serial Doppler ultrasound examinations of the umbilical and middle cerebral arteries between 20 and 42 weeks gestation, Pregnancy Distress Questionnaire (PDQ) scores between 23 and 40 weeks gestation and neonatal outcomes.

RESULTS

Concerns about physical symptoms and body image at 35-40 weeks were associated with lower odds of abnormal UAPI (OR 0.826, 95% CI 0.696 to 0.979, p=0.028). PDQ score (OR 1.073, 95% CI 1.012 to 1.137, p=0.017), concerns about birth and the baby (OR 1.143, 95% CI 1.037 to 1.260, p=0.007) and concerns about physical symptoms and body image (OR 1.283, 95% CI 1.070 to 1.538, p=0.007) at 29-34 weeks were associated with higher odds of abnormal MCA PI. Concerns about birth and the baby at 29-34 weeks (OR 1.202, 95% CI 1.018 to 1.421, p=0.030) were associated with higher odds of AEDF. Concerns about physical symptoms and body image at 35-40 weeks were associated with decreased odds of neonatal intensive care unit admission (OR 0.635, 95% CI 0.435 to 0.927, p=0.019).

CONCLUSIONS

These findings suggest that fetoplacental haemodynamics may be a mechanistic link between maternal prenatal stress and fetal and neonatal well-being, but additional research is required.

Prenatal stress and hemodynamics in pregnancy: a systematic review

Maternal prenatal stress is associated with preterm birth, intrauterine growth restriction, and developmental delay. However, the impact of prenatal stress on hemodynamics during pregnancy remains unclear. This systematic review was conducted in order to assess the quality of the evidence available to date regarding the relationship between prenatal stress and maternal-fetal hemodynamics. The PubMed/Medline, EMBASE, PsycINFO, Maternity and Infant Care, Trip, Cochrane Library, and CINAHL databases were searched using the search terms pregnancy; stress; fetus; blood; Doppler; ultrasound. Studies were eligible for inclusion if prenatal stress was assessed with standardized measures, hemodynamics was measured with Doppler ultrasound, and methods were adequately described. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-accepted quality appraisal guidelines. Of 2532 studies reviewed, 12 met the criteria for inclusion. Six reported that prenatal stress significantly affects maternal or fetal hemodynamics; six found no significant association between maternal stress and circulation. Significant relationships between prenatal stress and uterine artery resistance (RI) and pulsatility (PI) indices, umbilical artery RI, PI, and systolic/diastolic ratio, fetal middle cerebral artery PI, cerebroplacental ratio, and umbilical vein volume blood flow were found. To date, there is limited evidence that prenatal stress is associated with changes in circulation. More carefully designed studies with larger sample sizes, repeated assessments across gestation, tighter control for confounding factors, and measures of pregnancy-specific stress will clarify this relationship.

The Role of Prenatal Maternal Stress in Child Development

The notion that a woman's psychological state during pregnancy affects the fetus is a persistent cultural belief in many parts of the world. Recent results indicate that prenatal maternal distress in rodents and nonhuman primates negatively influences long-term learning, motor development, and behavior in their offspring. The applicability of these findings to human pregnancy and child development is considered in this article. Potential mechanisms through which maternal psychological functioning may alter development of the fetal nervous system are being identified by current research, but it is premature to conclude that maternal prenatal stress has negative consequences for child development. Mild stress may be a necessary condition for optimal development.

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder in the perinatal period. However, specific pharmacological treatment approaches for patients with OCD during pregnancy have not been satisfactorily discussed in the literature. In addition, there are no randomized controlled studies on the treatment of this disorder during pregnancy. The present paper discusses the pharmacological treatment of OCD in the light of data on the safety of antipsychotics and serotonergic antidepressants during pregnancy and their efficacy in the non-perinatal period. Treatment decisions should be individualized because the risk-benefit profile of pharmacotherapy is an important issue in the treatment of pregnant women with any psychiatric diagnosis.

Cross-generational influences on childhood anxiety disorders: pathways and mechanisms

Anxiety disorders are common across the lifespan, cause severe distress and impairment, and usually have their onset in childhood. Substantial clinical and epidemiological research has demonstrated the existence of links between anxiety and its disorders in children and parents. Research on the pathways and mechanisms underlying these links has pointed to both behavioral and biological systems. This review synthesizes and summarizes several major aspects of this research. Behavioral systems include vicarious learning, social referencing, and modeling of parental anxiety; overly protective or critical parenting styles; and aspects of parental responses to child anxiety including family accommodation of the child's symptoms. Biological systems include aspects of the prenatal environment affected by maternal anxiety, development and functioning of the oxytocinergic system, and genetic and epigenetic transmission. Implications for the prevention and treatment of child anxiety disorders are discussed, including the potential to enhance child anxiety treatment outcomes through biologically informed parent-based interventions.

The Placenta as a Mediator of Stress Effects on Neurodevelopmental Reprogramming

Adversity experienced during gestation is a predictor of lifetime neuropsychiatric disease susceptibility. Specifically, maternal stress during pregnancy predisposes offspring to sex-biased neurodevelopmental disorders, including schizophrenia, attention deficit/hyperactivity disorder, and autism spectrum disorders. Animal models have demonstrated disease-relevant endophenotypes in prenatally stressed offspring and have provided unique insight into potential programmatic mechanisms. The placenta has a critical role in the deleterious and sex-specific effects of maternal stress and other fetal exposures on the developing brain. Stress-induced perturbations of the maternal milieu are conveyed to the embryo via the placenta, the maternal-fetal intermediary responsible for maintaining intrauterine homeostasis. Disruption of vital placental functions can have a significant impact on fetal development, including the brain, outcomes that are largely sex-specific. Here we review the novel involvement of the placenta in the transmission of the maternal adverse environment and effects on the developing brain.

Symptoms of prenatal depression are associated with raised salivary alpha-amylase levels

PURPOSE

Prenatal depression increases risk for a number of adverse offspring outcomes, however the biological mechanisms underlying this association remain unclear. It has been suggested that maternal glucocorticoids may mediate this link, though supporting evidence has been mixed. An alternative mechanism of effect may be via depression-induced changes in maternal sympathetic nervous system (SNS) function. We examined this hypothesis by determining the relationship between symptoms of maternal prenatal depression and diurnal salivary alpha-amylase (sAA) levels.

METHODS

76 pregnant women were recruited during either the second or third trimester of pregnancy. Participants self-reported depressive symptoms using the Edinburgh postnatal depression scale. Saliva samples, to be assayed for alpha-amylase activity, were collected at home over two working days.

RESULTS

Participants with depressive symptoms in later pregnancy had elevated awakening sAA levels compared with non-depressed controls (t(73) = -2.737, p = 0.008), and continued to have raised sAA throughout the day (F(1) = 10.924, p = 0.002).

CONCLUSIONS

Our findings highlight that symptoms of depression during late pregnancy are associated with increased maternal SNS activity. Thus, changes in maternal SNS function, which may include increased vasoconstriction and reduced foetal blood flow, could, in part, mediate associations between prenatal depression and adverse offspring outcomes.

Limited Depressive and Anxiety Symptoms Late in Pregnancy Are Not Related to Neonatal Outcomes

Background:

Prior studies have reported inconsistent findings regarding the link between antenatal depressive and anxiety symptomatology, with neonatal outcomes.

Objectives:

The aim of the present study was to assess the possible association of prenatal depressive and anxiety symptoms, in the third trimester of pregnancy, with perinatal outcomes (birth weight of the newborn, Apgar score and the newborn’s admission in neonatal intensive care unit) in a sample of pregnant women, in Greece.

Patients and Methods:

A total of 117 women from Athens, during the 32^nd to 35^th week of pregnancy, participated in the study. Demographic and obstetric history data, as well as neonatal outcomes, were recorded. Three self-administered psychometric scales (Beck depression inventory (BDI), Edinburg postnatal depression scale (EPDS) and beck anxiety inventory (BAI)) were used to evaluate in detail the prenatal depressive and anxiety symptoms. Descriptive statistics, Spearman’s Rho coefficients, Mann-Whitney U and Kruskal-Wallis testes were applied to analyze the data.

Results:

On the basis of BDI, 81.1% of the sample showed minimal, 15.4% mild, 2.6% moderate and 0.9% severe depressive symptoms, respectively. Furthermore, 80.3% of the participants, scored on EPDS below the cut-off point for a likely diagnosis of depression. According to BAI scale, 43.6% showed minimal, 42.7% women mild, 10.3% moderate and 3.4% severe anxiety symptoms. No statistically significant correlations were found between depressive and anxiety symptoms and neonatal outcomes (birth weight, Apgar score and admission in neonatal intensive care unit).

Conclusions:

Limited levels of prenatal depressive and anxiety symptoms do not seem to be associated with neonatal outcomes. In clinical practice, pregnant women, who suffer from low levels of prenatal depressive and anxiety symptoms, may be reassured, in respect of the adverse outcomes of these mood symptoms on the neonate.

A pharmacological approach to panic disorder during pregnancy

Anxiety disorders and pregnancy may occur concurrently in some women. Although, several epidemiological or clinical studies about anxiety disorders in pregnancy exist, data on their treatment are very limited. Similar to other anxiety disorders, specific pharmacological treatment approaches in pregnant women with panic disorder (PD) have not been discussed in the literature. An important issue in the treatment of pregnant women with any psychiatric diagnosis is the risk-benefit profile of pharmacotherapy. Therefore, the treatment should be individualized. Untreated PD seems to be associated with several negative outcomes in the pregnancy. When the results of current study regarding the safety of pharmacological agents on the fetus and their efficacy in PD were gathered, sertraline, citalopram, imipramine and clomipramine at low doses for pure PD, and venlafaxine appeared to be more favorable than the other potential drugs. However, controlled studies examining optimum dosing, efficacy of antipanic medications and risk-benefit profile of intrauterine exposure to treated or untreated PD are urgently needed.

Psychosocial predictors of fetoplacental blood flow during pregnancy

BACKGROUND

Although a number of studies have found significant associations between maternal psychological distress, anxiety and changes in fetoplacental blood flow, findings remain inconsistent. A recent pilot study by our group highlighted some of these inconsistencies. In the current study, we expanded this pilot analysis to include psychological distress, anxiety and a range of antenatal variables, with the aim of identifying predictors of fetoplacental blood flow.

METHODS

Healthy pregnant women (n=148) underwent Doppler flow studies on uterine, umbilical and fetal arteries; as well as assessments of distress, anxiety and other antenatal variables (e.g. perceived social support, resilience, nicotine and alcohol use) in each trimester.

RESULTS

Stepwise regression analyses found that state anxiety was associated with lower mid-cerebral artery pulsatility index at trimester 3.

LIMITATIONS

Subjects were recruited from selected midwife obstetric units in the same health district, so the generalizability of our results may be limited. While most subjects received Doppler assessment at trimesters 2 and 3, only approximately half of our sample was assessed at trimester 1.

CONCLUSION

The finding that anxiety is associated with increased blood flow to the fetal brain during trimester 3 of pregnancy, coincide with previous work. The findings emphasize a growing appreciation of the potential importance of psychological well-being during pregnancy for infant development. However, as associations were small and variable, further research using multivariate models to determine the precise mechanisms underlying these associations would be warranted.

Long-term impact of early life events on physiology and behaviour

This review discusses the effects of stress and nutrition throughout development and summarises studies investigating how exposure to stress or alterations in nutrition during the pre-conception, prenatal and early postnatal periods can affect the long-term health of an individual. In general, the data presented here suggest that that anything signalling potential adverse conditions later in life, such as high levels of stress or low levels of food availability, will lead to alterations in the offspring, possibly of an epigenetic nature, preparing the offspring for these conditions later in life. However, when similar environmental conditions are not met in adulthood, these alterations may have maladaptive consequences, resulting in obesity and heightened stress sensitivity. The data also suggest that the mechanism underlying these adult phenotypes might be dependent on the type and the timing of exposure.

Neuroinflammation in the fetus exposed to maternal obsessive-compulsive disorder during pregnancy: a comparative study on cord blood tumor necrosis factor-alpha levels

OBJECTIVE

The relationship between maternal psychiatric disorders and fetal neurodevelopment is unclear. Obsessive-compulsive disorder (OCD) is relatively frequent during pregnancy. The study aimed to investigate whether maternal OCD during pregnancy affects fetal circulating tumor necrosis factor-alpha (TNF-α) levels, an important pro-inflammatory cytokine, by comparing cord blood TNF-α levels in newborn infants of women with and without OCD.

METHODS

The study sample included 7 women with OCD and 30 healthy women. OCD and other psychiatric diagnoses were screened by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The blood sample for the determination of TNF-α level was obtained from the umbilical cord during delivery.

RESULTS

Cord blood TNF-α levels in newborn infants exposed to maternal OCD were significantly higher compared to non-exposed infants. Maternal anxiety symptom level was found to positively correlate with cord blood TNF-α levels in newborn infants of women with OCD.

CONCLUSION

The study results imply that maternal OCD during pregnancy may lead to neuroinflammation in the developing fetal brain through higher levels of circulating TNF-α.

Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association

BACKGROUND

The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease.

METHODS AND RESULTS

A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease.

CONCLUSIONS

Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

The influence of anxiety and depressive symptoms during pregnancy on birth size

BACKGROUND

Mental health problems during pregnancy can influence fetal growth. However, studies examining the influence of maternal mental health across the normal range of birth outcomes are uncommon. This study examined the associations between symptoms of maternal depression and anxiety during pregnancy on birth size among term Asian infants.

METHODS

One thousand forty-eight Asian pregnant women from a cohort Growing Up in Singapore Towards Healthy Outcomes were recruited between 2009 to 2010 at two Singaporean maternity hospitals. At 26 weeks gestation, depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory II (BDI-II), and anxiety was measured with the Spielberger State-Trait Anxiety Inventory (STAI). Health personnel recorded birthweight, birthlength, gestational age, and head circumference at birth.

RESULTS

Nine hundred forty-six women who delivered term infants had complete data. For this sample, the mean birthweight was 3146.6 g [standard deviation (SD) 399.0], the mean birthlength was 48.9 cm (SD 2.0). After controlling for several potential confounders, there was a significant negative association between STAI and birthlength [β = -0.248, confidence interval (CI) [-0.382, -0.115], P < 0.001] and a small negative association between EPDS and birthlength (β = -0.169, CI [-0.305, -0.033], P = 0.02). No associations were found between scores on the EPDS, BDI-II, and STAI with birthweight or head circumference.

CONCLUSIONS

Our preliminary data suggest that among term infants, anxiety and depressive symptoms are not associated with birthweight, while anxiety and depressive symptoms are associated with a shorter birthlength.

Guided imagery for stress and symptom management in pregnant african american women

The purpose of this study was to evaluate the efficacy of a guided imagery (GI) intervention for stress reduction in pregnant African American women beginning early in the second trimester. This prospective longitudinal study of 72 women used a randomized controlled experimental design with two groups conducted over 12 weeks. The intervention was a CD with 4 professionally recorded tracts designed and sequenced to influence study variables. Participants in both GI and usual care (UC) completed measures and donated 5 cc of blood at baseline, 8 weeks and 12 weeks. Participants also completed a daily stress scale. A mixed-effects linear model tested for differences between groups for self-reported measures of stress, anxiety, and fatigue as well as corticotrophin releasing hormone (CRH), a biologic marker of stress. Significant differences in perceived stress daily scores and at week 8 but not week 12 were found in the GI group compared to UC group. The GI group reported significantly less fatigue and anxiety than the UC group at week 8 but not week 12. There were no significant differences in CRH levels between groups. Results suggest that GI intervention may be effective in reducing perceived stress, anxiety, and fatigue measures among pregnant African American women.

In-utero exposure to bereavement and offspring IQ: a Danish national cohort study

BACKGROUND

Intelligence is a life-long trait that has strong influences on lifestyle, adult morbidity and life expectancy. Hence, lower cognitive abilities are therefore of public health interest. Our primary aim was to examine if prenatal bereavement measured as exposure to death of a close family member is associated with the intelligence quotient (IQ) scores at 18-years of age of adult Danish males completing a military cognitive screening examination.

METHODS

We extracted records for the Danish military screening test and found kinship links with biological parents, siblings, and maternal grandparents using the Danish Civil Registration System (N = 167,900). The prenatal exposure period was defined as 12 months before conception until birth of the child. We categorized children as exposed in utero to severe stress (bereavement) during prenatal life if their mothers lost an elder child, husband, parent or sibling during the prenatal period; the remaining children were included in the unexposed cohort. Mean score estimates were adjusted for maternal and paternal age at birth, residence, income, maternal education, gestational age at birth and birth weight.

RESULTS

When exposure was due to death of a father the offsprings' mean IQ scores were lower among men completing the military recruitment exam compared to their unexposed counterparts, adjusted difference of 6.5 standard IQ points (p-value = 0.01). We did not observe a clinically significant association between exposure to prenatal maternal bereavement caused by death of a sibling, maternal uncle/aunt or maternal grandparent even after stratifying deaths only due to traumatic events.

CONCLUSION

We found maternal bereavement to be adversely associated with IQ in male offspring, which could be related to prenatal stress exposure though more likely is due to changes in family conditions after death of the father. This finding supports other literature on maternal adversity during fetal life and cognitive development in the offspring.

Early-life stress impacts the developing hippocampus and primes seizure occurrence: cellular, molecular, and epigenetic mechanisms

Early-life stress includes prenatal, postnatal, and adolescence stress. Early-life stress can affect the development of the hypothalamic-pituitary-adrenal (HPA) axis, and cause cellular and molecular changes in the developing hippocampus that can result in neurobehavioral changes later in life. Epidemiological data implicate stress as a cause of seizures in both children and adults. Emerging evidence indicates that both prenatal and postnatal stress can prime the developing brain for seizures and an increase in epileptogenesis. This article reviews the cellular and molecular changes encountered during prenatal and postnatal stress, and assesses the possible link between these changes and increases in seizure occurrence and epileptogenesis in the developing hippocampus. In addititon, the priming effect of prenatal and postnatal stress for seizures and epileptogenesis is discussed. Finally, the roles of epigenetic modifications in hippocampus and HPA axis programming, early-life stress, and epilepsy are discussed.

Maternal psychological distress and placental circulation in pregnancies after a previous offspring with congenital malformation

Introduction

Antenatal maternal psychological distress may be associated with reduced placental circulation, which could lead to lower birthweight. Studies investigating this in humans show mixed results, which may be partially due to type, strength and timing of distress. In addition, the arterial vascular resistance measures often used as outcome measures do not detect smaller changes in placental volume blood flow. We aimed to investigate the effect of a specific stressor, with increased levels of stress early in pregnancy, on the fetoplacental volume blood flow in third trimester.

Methods

This was a prospective observational study of 74 pregnant women with a congenital malformation in a previous fetus or child. Psychological distress was assessed twice, around 16 and 30 weeks' gestation. Psychometric measures were the General Health Questionnaire-28 (subscales anxiety and depression), Edinburgh Postnatal Depression Scale, and Impact of Event Scale-22 (subscales intrusion, avoidance, and arousal). Placental circulation was examined at 30 weeks, using Doppler ultrasonography, primarily as fetoplacental volume blood flow in the umbilical vein, normalized for abdominal circumference; secondarily as vascular resistance measures, obtained from the umbilical and the uterine arteries.

Results

Maternal distress in second but not third trimester was associated with increased normalized fetoplacental blood flow (P-values 0.006 and 0.013 for score > mean for depression and intrusion, respectively). Post-hoc explorations suggested that a reduced birthweight/placental weight ratio may mediate this association. Psychological distress did not affect vascular resistance measures in the umbilical and uterine arteries, regardless of adjustment for confounders.

Conclusions

In pregnant women with a previous fetus or child with a congenital malformation, higher distress levels in second trimester were associated with third trimester fetoplacental blood flow that was higher than expected for the size of the fetus. The results do not support placental blood flow reduction as a pathway between maternal distress and reduced birthweight.

Maternal generalized anxiety disorder during pregnancy and fetal brain development: a comparative study on cord blood brain-derived neurotrophic factor levels

OBJECTIVES

The study aimed to investigate whether maternal GAD during pregnancy affects fetal circulating brain-derived neurotrophic factor (BDNF), which plays important roles in neuronal development, by comparing cord blood BDNF levels in newborn infants of women with and without GAD.

METHODS

Study sample included 19 women with GAD and 25 women without any psychiatric disorder. GAD and other psychiatric diagnoses were screened by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The blood sample for the determination of BDNF level was obtained from the umbilical cord during delivery.

RESULTS

Cord blood BDNF levels in newborn infants of healthy women were approximately two-fold compared to newborn infants of women with GAD, and the difference was statistically significant. The duration of GAD during pregnancy was the only variable correlating with cord blood BDNF levels.

CONCLUSIONS

The study results imply that prolonged maternal GAD during pregnancy may negatively influence neurodevelopment of the fetus through lower levels of circulating BDNF.

The effects of maternal major depression, generalized anxiety disorder, and panic disorder on birth weight and gestational age: a comparative study

OBJECTIVE

The present study comparatively examined the impact of maternal major depression, generalized anxiety disorder and panic disorder on gestational age and birth weight.

METHODS

A total of 90 women (24 subjects with major depression, 19 subjects with panic disorder, 22 subjects with generalized anxiety disorder, and 25 healthy subjects) in the perinatal period who were admitted to three hospitals were included in the study. Psychiatric diagnoses were determined by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The birth weight and gestational age of the subjects in each groups were compared with one-way analysis of variance (ANOVA).

RESULTS

There were significant differences among the study groups for birth weight and gestational age (P<0.001 for both variables). These parameters were significantly lower in the subjects with major depression (P=0.021 and P=0.015, respectively) and panic disorder (P<0.001 for both variables) compared to healthy controls. Compared with major depression, panic disorder was associated more negatively with birth weight (P=0.036).

CONCLUSION

Major depression, and especially panic disorder, may negatively affect the gestational length and birth weight.

Women's decision-making regarding medication use in pregnancy for anxiety and/or depression

AIM

To increase understanding of women's decision-making process concerning the medication use for anxiety and/or depression while pregnant.

BACKGROUND

Anxiety and depression affects many pregnant women, yet the decision to take psychotropic medication is complex and possibly subject to social oppression.

DESIGN

Cross-sectional descriptive survey design.

METHODS

A web-based survey was used to collect data from a convenience sample of 143 pregnant women over 3 months beginning in early 2011. An independent t-test was conducted to determine differences in satisfaction between women with high and low levels of emancipated decision-making (EDM). A multiple regression analysis was conducted to determine which subscales of the emancipation scale best predict level of satisfaction with the decision.

FINDINGS

The majority of respondents were White, between 25-34 years of age. The group with lower levels of emancipation reported lower mean satisfaction scores compared with those with higher levels of emancipation. Regression analysis showed that the three subscale emancipation model was a statistically significant predictor of satisfaction with the decision and accounted for 54% of the variance in satisfaction. The subconcept of personal knowledge was most predictive of satisfaction with decision.

CONCLUSIONS

Women may be able to overcome oppressive forces by using an EDM process. EDM allows them to make a decision that feels right for them and to feel satisfied with the decision.

Does antenatal maternal psychological distress affect placental circulation in the third trimester?

Introduction

Some types of antenatal maternal psychological distress may be associated with reduced fetal growth and birthweight. A stress-mediated reduction in placental blood flow has been suggested as a mechanism. Previous studies have examined this using ultrasound-derived arterial resistance measures in the uterine (UtA) and umbilical (UA) arteries, with mixed conclusions. However, a reduction in placental volume blood flow may occur before changes in arterial resistance measures are seen. Fetoplacental volume blood flow can be quantified non-invasively in the umbilical vein (UV). Our objective was to study whether specific types of maternal psychological distress affect the placental circulation, using volume blood flow quantification in addition to arterial resistance measures.

Methods

This was a prospective observational study of 104 non-smoking pregnant women (gestational age 30 weeks) with uncomplicated obstetric histories. Psychological distress was measured by General Health Questionnaire-28 (subscales anxiety and depression) and Impact of Event Scale-22 (subscales intrusion, avoidance and arousal). UtA and UA resistance measures and UV volume blood flow normalized for fetal abdominal circumference, were obtained by Doppler ultrasound.

Results

IES intrusion scores above the mean were associated with a reduction in normalized UV volume blood flow (corresponding to –0.61 SD; P = 0.003). Adjusting for UA resistance increased the strength of this association (difference –0.66 SD; P<0.001). Other distress types were not associated with UV volume blood flow. Maternal distress was not associated with arterial resistance measures, despite adjustment for confounders.

Conclusions

Intrusive thoughts and emotional distress regarding the fetus were associated with reduced fetoplacental volume blood flow in third trimester. Uterine and umbilical artery resistance measures were not associated with maternal distress. Our findings support a decrease in fetoplacental blood flow as a possible pathway between maternal distress and reduced fetal growth.

Maternal psychological stress after prenatal diagnosis of congenital heart disease

OBJECTIVE

To determine whether prenatal diagnosis of congenital heart disease (CHD) increases maternal stress.

STUDY DESIGN

Self-report instruments were administered to mothers carrying a fetus with CHD. Domains included: (1) traumatic stress (Impact of Events Scale-Revised); (2) depression (Beck Depression Index II); and (3) anxiety (State-Trait Anxiety Index). Modifiers included: (1) coping skills (COPE Inventory); (2) partner satisfaction (Dyadic Adjustment Scale); and (3) demographics. Multivariate linear regression models were used to assess relationships between stress measures and modifiers.

RESULTS

Fifty-nine mothers (gestational age 27 ± 3 weeks) completed all measures. Clinically important traumatic distress was seen in 39%, depression in 22%, and state anxiety in 31%. Lower partner satisfaction was associated with higher depression (P < .01) and higher anxiety (P < .01). After controlling for partner satisfaction and income, "denial" was most associated with increased traumatic stress, anxiety, and depression (P < .01).

CONCLUSIONS

Posttraumatic stress, depression, and anxiety are common after prenatal diagnosis of CHD. Healthy partner relationships and positive coping mechanisms can act as buffers.