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El-Heis S, Barton SJ, Chang HF, Nield H, Cox V, Galani S, Cutfield W, Chan SY, Godfrey KM. Maternal mood, anxiety and mental health functioning after combined myo-inositol, probiotics, micronutrient supplementation from preconception: Findings from the NiPPeR RCT. Psychiatry Res 2024; 334:115813. [PMID: 38402742 DOI: 10.1016/j.psychres.2024.115813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/24/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Observational studies have reported associations between nutrition during pregnancy and mental wellbeing. As secondary outcomes, the NiPPeR double-blind randomized trial in women planning conception investigated whether a myo-inositol, probiotics and enriched micronutrients formulation (intervention) taken preconception and throughout pregnancy could improve mental wellbeing during pregnancy and post-delivery, compared with a standard micronutrient supplement (control). Mood and anxiety symptoms were ascertained (Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI-state)) at preconception (baseline), 7, 28 and 34 weeks gestation, 3-weeks and 6-months post-delivery. EPDS>=13 was categorised as low mood; STAI-state>=45 as high anxiety. Change in mental health functioning was assessed as difference between preconception baseline and 6-month post-delivery 12-item Short-Form Health Survey (SF-12v2) mental component scores. Adjusting for site, ethnicity and baseline scores, there were no robust differences in EPDS and STAI-state scores between intervention and control groups across pregnancy (n = 630) and post-delivery (n = 532). Compared to controls, intervention group women averaged a 1.21 (95 %CI 0.04,2.39) higher change in SF-12v2 mental component score from preconception to 6-months post-delivery. Taking a myo-inositol, micronutrient and probiotic supplement during preconception/pregnancy had no effect on mood and anxiety, but there was evidence of a modest improvement in mental health functioning from preconception to 6-months post-delivery.
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Affiliation(s)
- Sarah El-Heis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom.
| | - Sheila J Barton
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom
| | - Hsin Fang Chang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228
| | - Heidi Nield
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Vanessa Cox
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Sevasti Galani
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228; Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, 117609, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom
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Swider-Cios E, Turk E, Levy J, Beeghly M, Vroomen J, van den Heuvel MI. The association of maternal-infant interactive behavior, dyadic frontal alpha asymmetry, and maternal anxiety in a smartphone-adapted still face paradigm. Dev Cogn Neurosci 2024; 66:101352. [PMID: 38310719 PMCID: PMC10847859 DOI: 10.1016/j.dcn.2024.101352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/18/2023] [Accepted: 01/30/2024] [Indexed: 02/06/2024] Open
Abstract
Mother-infant interactions form a strong basis for emotion regulation development in infants. These interactions can be affected by various factors, including maternal postnatal anxiety. Electroencephalography (EEG) hyperscanning allows for simultaneous assessment of mother-infant brain-to-behavior association during stressful events, such as the still-face paradigm (SFP). This study aimed at investigating dyadic interactive behavior and brain-to-behavior association across SFP and identifying neural correlates of mother-infant interactions in the context of maternal postnatal anxiety. We measured frontal alpha asymmetry (FAA), a physiological correlate of emotion regulation and a potential marker of risk for psychopathology. To emulate real-life interactions, EEG and behavioral data were collected from 38 mother-infant dyads during a smartphone-adapted dual-SFP. Although the behavioral data showed a clear still-face effect for the smartphone-adapted SFP, this was not reflected in the infant or maternal FAA. Brain-to-behavior data showed higher infant negative affect being associated with more infant leftward FAA during the still-face episodes. Finally, mothers with higher postnatal anxiety showed more right FAA during the first still-face episode, suggesting negative affectivity and a need to withdraw from the situation. Our results form a baseline for further research assessing the effects of maternal postnatal anxiety on infants' FAA and dyadic interactive behavior.
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Affiliation(s)
- Edyta Swider-Cios
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5000 LE, Tilburg, the Netherlands
| | - Elise Turk
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5000 LE, Tilburg, the Netherlands; Department of Neonatology, University Medical Center Utrecht, Utrecht University Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Jonathan Levy
- Department of Criminology and Gonda Brain Research Center, Bar-Ilan University, Ramat-Gan, 5290002 Israel; Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2, 02150, Espoo, Finland
| | - Marjorie Beeghly
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, USA
| | - Jean Vroomen
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5000 LE, Tilburg, the Netherlands
| | - Marion I van den Heuvel
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5000 LE, Tilburg, the Netherlands.
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Benny C, Pietrosanu M, Lowe SAJ, Yamamoto SS, Kong L, McDonald S, Pabayo R. An investigation into the relationship between community engagement and maternal mental health in Calgary, Alberta using the All Our Families cohort. Soc Psychiatry Psychiatr Epidemiol 2024; 59:695-704. [PMID: 37017657 DOI: 10.1007/s00127-023-02456-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 02/27/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION Existing literature shows that increased community engagement is associated with decreased depressive symptoms. To our knowledge, no existing studies have investigated the relationship between community engagement and adverse mental health among mothers in a Canadian context, nor has this relationship been studied over time. The current study aims to address these gaps by modelling the association between community engagement and anxiety and depression longitudinally using a cohort of prenatal and postnatal mothers living in Calgary, Alberta. METHODS We used data from the All our Families (AOF) study, a prospective cohort study of expectant and new mothers in Calgary, Alberta from 2008 to 2017 across seven timepoints. We used three-level latent growth curves to model the relationship between individual-level community engagement and maternal depression and anxiety scores, while adjusting for both individual and neighborhood-level characteristics. RESULTS The study sample consisted of 2129 mothers across 174 neighborhoods in Calgary. Adjusted latent growth curve models demonstrated that community engagement was associated with lower depression (b = - 0.28, 95% CI - 0.33, - 0.23) and anxiety (b = - 0.07, 95% CI - 0.12, - 0.02) scores among mothers over time. DISCUSSION Adjusted results show that community engagement has a protective effect against depression and anxiety amongst mothers. The results of this study are in line with existing evidence suggesting that social cohesion, civic participation, and community engagement are protective against adverse mental health outcomes.
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Affiliation(s)
- Claire Benny
- 3-300 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada.
| | - Matthew Pietrosanu
- CAB 632, Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, T6G 2G1, Canada
| | - Samuel A J Lowe
- 3-300 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Shelby S Yamamoto
- 3-300 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Linglong Kong
- CAB 632, Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, T6G 2G1, Canada
| | - Sheila McDonald
- Child Development Centre 391, University of Calgary, 3820-24 Avenue NW, Calgary, AB, T2M 1Z7, Canada
| | - Roman Pabayo
- 3-300 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
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Del Hoyo-Bilbao J, Orue I. Relationship between maternal anxiety and infants' temperament: The mediating role of mindful parenting. Infant Behav Dev 2024; 75:101931. [PMID: 38458100 DOI: 10.1016/j.infbeh.2024.101931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/14/2023] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
Abstract
Research has indicated that maternal anxiety does have an effect on infant temperament. Therefore, it is important to study the variables that could play a role in this relationship. In this study, we propose that mindful parenting could act as a mediator in this relationship. Thus, the main objective was to evaluate the relationship between maternal anxiety and child temperament (i.e., negative affectivity, surgency, and effortful control) through the mindful parenting of mothers. Mothers (N = 225) self-reported their anxiety, mindful parenting use, and the temperament of their old infants (aged 4-18 months). First, the reliability and validity results showed that the infant version of the Interpersonal Mindful Parenting questionnaire was a good tool for the assessment of mindful parenting among parents with infants. The five-factor structure of the questionnaire was confirmed; it involved self-regulation in the parenting relationship, listening with full attention, emotional awareness of the child, compassion for the child, and non-judgmental acceptance of parenting behavior. Correlational analyses showed that maternal anxiety was related to negative affectivity and effortful control in infants. Furthermore, mediational analyses indicated that the relation between maternal anxiety and infant negative affectivity was mediated by self-regulation in parenting and the emotional awareness of the child. In addition, the relation between maternal anxiety and infant effortful control was mediated by compassion for the child and listening with full attention. These results contribute to knowledge about the relation between maternal anxiety and child temperament, which may increase the risk of psychological symptoms. The results of this study suggest that promoting mindful parenting skills may be beneficial for affectivity and effortful control in infants.
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Affiliation(s)
- Joana Del Hoyo-Bilbao
- Deusto Stress Research, Department of Psychology, Health Sciences Faculty, University of Deusto, Spain.
| | - Izaskun Orue
- Deusto Stress Research, Department of Psychology, Health Sciences Faculty, University of Deusto, Spain
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DeVries L, Pickard K, Boles R, Blakeley-Smith A, Duncan A, Keefer A, Klinger L, Meyer A, Reaven J. The Role of Maternal Anxiety in Treatment Response for Youth with ASD and Co-occurring Anxiety. Child Psychiatry Hum Dev 2023; 54:1789-1798. [PMID: 35678890 DOI: 10.1007/s10578-022-01381-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 11/28/2022]
Abstract
Anxiety disorders occur at higher rates in youth with ASD than in neurotypical youth. Although the efficacy of CBT for anxiety in children with ASD is widely supported, factors that influence treatment outcomes are not well understood. This study examined the role of maternal anxiety in treatment outcomes for youth with ASD. Youth with ASD and anxiety (ages 8 to 14), along with their mothers (n = 87), participated in a group CBT intervention. Results indicated that maternal anxiety did not improve over the course of treatment. However, findings suggest that high levels of maternal anxiety at pre-treatment predicted higher levels of youth anxiety post-treatment. Importantly, the relationship between parent anxiety and youth outcomes was moderated by child age. The findings of the present study may provide initial insight into the role that maternal anxiety plays in treatment outcomes for children with ASD and co-occurring anxiety, particularly when considering child age.
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Affiliation(s)
- Lindsey DeVries
- Division of Developmental and Behavioral Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, 13123 East 16th Avenue, 80045, Aurora, CO, USA.
| | - Katherine Pickard
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Richard Boles
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Audrey Blakeley-Smith
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Amie Duncan
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amy Keefer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Laura Klinger
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison Meyer
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Judy Reaven
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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Reesor-Oyer L, Marshall AN, Hernandez DC. Examination of co-parenting support and parenting stress as mediators of the food insecurity-maternal depression/anxiety relationship. J Affect Disord 2023; 341:96-103. [PMID: 37625705 DOI: 10.1016/j.jad.2023.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Identifying family environment factors related to food insecurity and maternal mental health could inform additional support for mothers who experience food insecurity. This study seeks to examine the mechanistic roles of co-parenting support and parenting stress on the food insecurity-maternal mental health relationship. METHODS Data from the Future of Families and Child Well-being Study, which recruited mothers post-delivery from 75 urban hospitals, was utilized. Analysis includes 1808 mothers followed for 15 years. Food insecurity was assessed at year 5, co-parenting support and parenting stress at year 9, and maternal depression and anxiety at year 15. Structural equation models evaluated the role of food insecurity on maternal depression (model 1) and anxiety (model 2) through co-parenting support and parenting stress simultaneously, adjusting for socio-demographics. RESULTS Co-parenting support did not mediate the relationships of food insecurity and maternal depression and anxiety, controlling for parenting stress. Controlling for co-parenting support, parenting stress did not mediate the food insecurity-maternal depression relationship, but partially mediated the food insecurity-maternal anxiety relationship (specific indirect: B = 0.026, CI:0.01, 0.05; specific direct: B = 0.131, CI:-0.04, 0.32). LIMITATIONS There was a significant period of time (10 years) between assessment of food insecurity and assessment of maternal mental health. Self-reported data on sensitive topics may be susceptible to bias. With observational research, it is possible that unobserved confounding variables impact the findings. CONCLUSIONS Cumulative support in the form of - parenting, economic (e.g., utilities), and food - may help reduce parenting stress and anxiety among mothers who experience food insecurity.
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Affiliation(s)
- Layton Reesor-Oyer
- Department of Health Education & Behavior, University of Florida, Gainesville, PO Box 118210, Gainesville, FL 32611-8210, USA.
| | - Allison N Marshall
- Cizik School of Nursing, University of Texas Health Science Center-Houston, 6901 Bertner Avenue, Houston, TX 77030, USA.
| | - Daphne C Hernandez
- Cizik School of Nursing, University of Texas Health Science Center-Houston, 6901 Bertner Avenue, Houston, TX 77030, USA.
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De Asis-Cruz J, Kim JH, Krishnamurthy D, Lopez C, Kapse K, Andescavage N, Vezina G, Limperopoulos C. Examining the relationship between fetal cortical thickness, gestational age, and maternal psychological distress. Dev Cogn Neurosci 2023; 63:101282. [PMID: 37515833 PMCID: PMC10407290 DOI: 10.1016/j.dcn.2023.101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023] Open
Abstract
In utero exposure to maternal stress, anxiety, and depression has been associated with reduced cortical thickness (CT), and CT changes, in turn, to adverse neuropsychiatric outcomes. Here, we investigated global and regional (G/RCT) changes associated with fetal exposure to maternal psychological distress in 265 brain MRI studies from 177 healthy fetuses of low-risk pregnant women. GCT was measured from cortical gray matter (CGM) voxels; RCT was estimated from 82 cortical regions. GCT and RCT in 87% of regions strongly correlated with GA. Fetal exposure was most strongly associated with RCT in the parahippocampal region, ventromedial prefrontal cortex, and supramarginal gyrus suggesting that cortical alterations commonly associated with prenatal exposure could emerge in-utero. However, we note that while regional fetal brain involvement conformed to patterns observed in newborns and children exposed to prenatal maternal psychological distress, the reported associations did not survive multiple comparisons correction. This could be because the effects are more subtle in this early developmental window or because majority of the pregnant women in our study did not experience high levels of maternal distress. It is our hope that the current findings will spur future hypothesis-driven studies that include a full spectrum of maternal mental health scores.
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Affiliation(s)
| | - Jung-Hoon Kim
- Developing Brain Institute, Children's National, Washington, DC, USA
| | | | - Catherine Lopez
- Developing Brain Institute, Children's National, Washington, DC, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National, Washington, DC, USA
| | - Nickie Andescavage
- Developing Brain Institute, Children's National, Washington, DC, USA; Division of Neonatology, Children's National Medical Center, Washington, DC, USA
| | - Gilbert Vezina
- Division of Diagnostic Imaging and Radiology, Children's National, Washington, DC, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National, Washington, DC, USA; Division of Diagnostic Imaging and Radiology, Children's National, Washington, DC, USA.
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Nakidde G, Kumakech E, Mugisha JF. Maternal mental health screening and management by health workers in southwestern Uganda: a qualitative analysis of knowledge, practices, and challenges. BMC Pregnancy Childbirth 2023; 23:477. [PMID: 37370024 DOI: 10.1186/s12884-023-05763-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Maternal mental health (MMH) problems, such as perinatal depression, maternal anxiety, suicide ideation and puerperal psychosis among others, have a significant impact on maternal morbidity and mortality, as well as the health and development of children. One in every four pregnant women and one in every five postpartum women in low-income countries, suffer from maternal mental health (MMH) problems. Despite this, MMH screening, diagnosis, and reporting remain scanty in Uganda. Consequently, this study aimed to investigate the knowledge, practices, and impediments that maternity care workers face when screening and managing women with maternal mental health disorders in health facilities in south-western Uganda. METHODS In-depth interviews were conducted with 22 health-care professionals who work in maternity care departments in primary and tertiary healthcare facilities in southwestern Uganda to investigate their medical knowledge, clinical practices, and challenges related to the screening and management of maternal mental health problems. Using qualitative content analysis, distinct categories and subcategories were found. RESULTS Medical staff especially midwives lacked specialized training in screening and managing women with maternal mental health problems They screened and managed MMH problems solely based on history and physical examination, and they referred nearly every mother displaying signs of mental illness because they felt ill-prepared to handle them. On the other hand, medical staff with some level of specialized training in mental health particularly staff working in mental health units, were more likely to use a mental health screening tool in addition to history and physical examination; and to treat any women exhibiting signs and symptoms of maternal mental problems without referring them. Lack of in-service training on maternal mental health, poorly coordinated referral systems, reluctance of mentally ill to visit medical facilities, scarcity of mental health specialists, and shortage of relevant medications were identified as the major challenges. Age, experience level, or gender had no effect on screening or management practices. CONCLUSIONS The results suggest that specialized training in mental health, and particularly maternal mental health, is essential for the effective screening and management of maternal mental health conditions in South Western Uganda.
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Affiliation(s)
- Gladys Nakidde
- Department of Obstetrics and Gynecology, College of medicine, Pan African University of life and Earth Sciences Institute, University of Ibadan, Ibadan, Nigeria.
- Department of Nursing, Faculty of Nursing and Health sciences, Bishop Stuart University, Mbarara, Uganda.
| | - Edward Kumakech
- Department of Nursing and midwifery, Faculty health sciences, Lira University, Lira, Uganda
| | - John F Mugisha
- Department of Obstetrics and Gynecology, College of medicine, Pan African University of life and Earth Sciences Institute, University of Ibadan, Ibadan, Nigeria
- Department of Health sciences, Faculty of Science and Technology, Cavendish University, Kampala, Uganda
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Guma E, Andrýsková L, Brázdil M, Chakravarty MM, Marečková K. Perinatal maternal mental health and amygdala morphology in young adulthood. Prog Neuropsychopharmacol Biol Psychiatry 2023; 122:110676. [PMID: 36372293 DOI: 10.1016/j.pnpbp.2022.110676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/11/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
The pre- and perinatal environment is thought to play a critical role in shaping brain development. Specifically, maternal mental health and maternal care have been shown to influence offspring brain development in regions implicated in emotional regulation such as the amygdala. In this study, we used data from a neuroimaging follow-up of a prenatal birth-cohort, the European Longitudinal Study of Pregnancy and Childhood, to investigate the impact of early postnatal maternal anxiety/co-dependence, and prenatal and early-postnatal depression and dysregulated mood on amygdala volume and morphology in young adulthood (n = 103). We observed that in typically developing young adults, greater maternal anxiety/co-dependence after birth was significantly associated with lower volume (right: t = -2.913, p = 0.0045, β = -0.523; left: t = -1.471, p = 0.144, β = -0.248) and non-significantly associated with surface area (right: t = -3.502, q = 0.069, <10%FDR, β = -0.090, left: t = -3.137, q = 0.117, <10%FDR, = -0.088) of the amygdala in young adulthood. Conversely, prenatal maternal depression and mood dysregulation in the early postnatal period was not associated with any volumetric or morphological changes in the amygdala in young adulthood. Our findings provide evidence for subtle but long-lasting alterations to amygdala morphology associated with differences in maternal anxiety/co-dependence in early development.
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Affiliation(s)
- Elisa Guma
- Computational Brain Anatomy Laboratory, Cerebral Imaging Center, Douglas Mental Health University Institute, Montreal, Quebec, Canada; Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Lenka Andrýsková
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Milan Brázdil
- Brain and Mind Research, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - M Mallar Chakravarty
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada.
| | - Klára Marečková
- Brain and Mind Research, Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
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Zhang T, Luo ZC, Ji Y, Chen Y, Ma R, Fan P, Tang N, Li J, Tian Y, Zhang J, Ouyang F. The impact of maternal depression, anxiety, and stress on early neurodevelopment in boys and girls. J Affect Disord 2023; 321:74-82. [PMID: 36280196 DOI: 10.1016/j.jad.2022.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/02/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the effects of prenatal maternal depression, anxiety and stress, and postnatal depression on infant early neurodevelopment, and the sex dimorphism. STUDY DESIGN We used data from 3379 mother-infant pairs from the Shanghai Birth Cohort. Maternal mental health was assessed using the Center for Epidemiological Studies-Depression Scale, Zung Self-Rating Anxiety Scale, Perceived Stress Scale at mid-pregnancy, and the Edinburgh Postnatal Depression Scale at postpartum. Infant neurodevelopment was evaluated using the Ages & Stages Questionnaires and Bayley Scales at ages 6, 12, and 24 months, respectively. Linear mixed models and linear regression models were used. RESULTS Among 3379 mothers, 11.07 %, 5.42 %, and 34.85 % of women experienced depression, anxiety, and elevated stress, separately. As maternal prenatal mental scores increased per 1SD, infant social-emotional scores decreased -2.82 (-3.86, -1.79) vs -2.86 (-3.94, -1.79) for depression, -2.34 (-3.38, -1.31) vs -2.72 (-3.81, -1.64) for anxiety, and -2.55 (-3.60, -1.50) vs -3.41 (-4.48, -2.35) for stress among boys and girls at age 24 months, respectively. Associations were also observed on social-emotional and communication scores in boys and girls, and fine motor in girls at age 6 and 12 months. These associations were not observed for postpartum depression. LIMITATION Generalizability of the results to other population remains to be determined. CONCLUSIONS Prenatal maternal depression, anxiety, and stress were negatively associated with infant early neurodevelopment, which were not observed for postpartum depression. We underscore the importance of maternal prenatal mental health in optimizing infant neuropsychiatric development.
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Affiliation(s)
- Ting Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong-Cheng Luo
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto M5G 1X5, Canada
| | - Yuelong Ji
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Yuanzhi Chen
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Ma
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pianpian Fan
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Tang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiong Li
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Tian
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengxiu Ouyang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Beqiraj L, Denne LD, Hastings RP. Short report: Correlates of behaviours that challenge in children with intellectual disability in special education settings. Res Dev Disabil 2022; 131:104367. [PMID: 36279677 DOI: 10.1016/j.ridd.2022.104367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Understanding the correlates of behaviours that challenge (CB) can help in both identifying children with intellectual disabilities (ID) at risk of developing CB and designing support programmes and interventions. AIMS This study explores the correlates of CB exhibited by children with ID in special educational settings in the UK. METHODS AND PROCEDURES Data on behaviours that challenge were provided by educators of 71 children with ID. Additional measures of adaptive and pro-social behaviours, maternal anxiety, depression, and stress, and demographic variables were included in the cross-sectional binary logistic regression analyses. OUTCOMES AND RESULTS Results showed that pro-social behaviours of children with ID were associated negatively with overall CB (OR=0.72, 95% CI [0.62, 0.84], p < 0.001), stereotyped (OR=0.81, 95% CI [0.70, 0.94], p = 0.005), self-injurious (OR=0.80, 95% CI [0.70, 0.90], p < 0.001), and aggressive/destructive behaviours (OR=0.79, 95% CI [0.69, 0.90], p < 0.001). Stereotyped behaviours were associated with lower adaptive skills (OR=0.95, 95% CI [0.91, 0.99], p = 0.026) and male gender (OR=9.20, 95% CI [1.07, 79.44], p = 0.044). Aggressive/Destructive behaviours were associated with maternal stress (OR=0.82, 95% CI [0.70, 0.97], p = 0.022), and increased maternal anxiety (OR=1.21, 95% CI [1.00, 1.47], p = 0.050) was a marginally significant predictor of self-injurious behaviours. CONCLUSIONS AND IMPLICATIONS The findings of this study emphasise the potential role of pro-social and adaptive behaviours, gender of children with ID, and maternal stress, as factors associated with CB in special education settings. Therefore, the present study contributes to extending the literature on correlates of CB for children with ID in special education settings while adopting an evidence-informed methodology for defining and measuring CB that facilitates replicability and allows for comparisons across findings of studies that explore CB thus increasing a more coherent evidence-base regarding assessment of CB.
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Affiliation(s)
- Lorena Beqiraj
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, UK.
| | - Louise D Denne
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, UK.
| | - Richard P Hastings
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, UK; Centre for Developmental Psychiatry and Psychology, Monash University, Australia.
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12
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Ierardi E, Dascalu A, Shai D, Spencer R, Riva Crugnola C. Parental embodied mentalizing: Associations with maternal depression, anxiety, verbal mentalizing, and maternal styles of interaction. J Affect Disord 2022; 311:472-8. [PMID: 35609764 DOI: 10.1016/j.jad.2022.05.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Maternal depression and anxiety in the perinatal period affect the quality of maternal sensitivity and mentalizing abilities. Few studies analyzed implicit mentalizing in relation to maternal distress. The aims of the study were: to examine the relation between nonverbal mentalizing - parental embodied mentalizing (PEM) - and maternal depression and anxiety, verbal mentalizing, and maternal styles of interaction; and to test PEM as a mediator of the effect of maternal distress on styles of interaction. METHOD 81 mother-infant dyads have been recruited. At infant three months, maternal depression was assessed using the Edinburgh Postnatal Depression Scale, anxiety with State Trait Anxiety Inventory, and reflective functioning with Reflective Functioning Scale. Mother-infant interactions were coded with various approaches: PEM for nonverbal mentalizing, Mind-mindedness coding system for Mind-mindedness, and CARE-Index for maternal styles of interaction. RESULTS Maternal depression and state anxiety were negatively correlated with PEM. PEM was also negatively correlated to maternal controlling style. Mothers with psychopathological problems (vs. mothers with no psychopathological problems) had lower PEM and sensitivity and more controlling style. Moreover, maternal depression and anxiety had direct effects on maternal sensitivity and had indirect effects mediated by PEM on controlling style. LIMITATIONS The study evaluates interactions at three months; longitudinal studies will be able to examine maternal mentalizing and sensitivity in various stages and identify the effect on the child's attachment. CONCLUSIONS PEM is associated to maternal anxiety and depression and mediates the effects of depression and anxiety on mother controlling style. These results emphasize the importance of early prevention programs for mothers focused also on implicit mentalizing.
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Yan Q, Li D, Yin X, Jiang N, Sun N, Luo Q, Pang X, Fan L, Gong Y. Development and validation of a maternal anxiety for neonatal jaundice scale in China. BMC Psychiatry 2022; 22:526. [PMID: 35927624 PMCID: PMC9351162 DOI: 10.1186/s12888-022-04161-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal anxiety induced by neonatal jaundice has adverse effects on maternal and infant health, but there was no specific tool to identify the anxiety level of mothers. This study aims to develop a Maternal Anxiety for Neonatal Jaundice Scale (MANJS) and to validate it in the target population. METHODS An initial 11-items MANJS was developed through literature review, expert panel consultation, and a pilot-test. Subsequently, mothers of neonates with jaundice were recruited from the Maternal and Child Health Hospital of Hainan Province, China, from June to December 2018, for a formal questionnaire survey. Based on the data collected, the scale was validated for construct validity, convergent validity, discriminant validity, content validity, and internal consistency reliability after the items screening. RESULTS The reliability and validity of MANJS were validated in 1127 mothers of jaundiced neonates. After the item with cross-loadings was removed using exploratory factor analysis, MANJS consisted of two dimensions and 10 items, with a cumulative variance contribution of 74.36% and factor loadings above 0.6 for all items. The confirmatory factor analysis identified three items with cross-factor loading or error correlation and then they were removed orderly. The further confirmatory factor analysis showed a good construct validity for the 7-item MANJS, with standardized root mean square residual (SRMR) = 0.029, root mean square error of approximation (RMSEA) = 0.068, comparative fit index (CFI) = 0.961, Tucker-Lewis index (TLI) = 0.937, incremental fit index (IFI) = 0.961, normed fit index (NFI) = 0.954, goodness of fit index (GFI) = 0.998, adjusted goodness of fit index (AGFI) = 0.996, respectively. The average variance extracted values (AVE) of the two factors were 0.80 and 0.72, and the combined reliability (CR) were 0.94 and 0.88, respectively. Cronbach's alpha was 0.90 for the MANJS, and split-half reliability was 0.72. CONCLUSIONS MANJS was demonstrated to have satisfactory reliability and validity in evaluating maternal anxiety caused by neonatal jaundice among Chinese postpartum women.
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Affiliation(s)
- Qin Yan
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, 430030 Wuhan, P. R. China
| | - Dandan Li
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, 430030 Wuhan, P. R. China
| | - Xiaoxv Yin
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, 430030 Wuhan, P. R. China
| | - Nan Jiang
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, 430030 Wuhan, P. R. China
| | - Na Sun
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, 430030 Wuhan, P. R. China
| | - Qing Luo
- grid.502812.cDepartment of Child Heath Care, Hainan Women and Children’s Medical Center, NO.15 South of Longkun Road, Haikou, P.R. China
| | - Xin Pang
- grid.502812.cDepartment of Pediatrics, Hainan Women and Children’s Medical Center, NO.15 South of Longkun Road, Haikou, China
| | - Lichun Fan
- Department of Child Heath Care, Hainan Women and Children's Medical Center, NO.15 South of Longkun Road, Haikou, P.R. China.
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, 430030, Wuhan, P. R. China.
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Trinh NTH, Nordeng HME, Bandoli G, Eberhard-Gran M, Lupattelli A. Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: An interrupted time-series analysis. J Affect Disord 2022; 308:458-465. [PMID: 35461816 DOI: 10.1016/j.jad.2022.04.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about mental health care utilization patterns in pregnant women with depression/anxiety in Norway according to antidepressant fill trajectories in pregnancy. METHOD We conducted a registry-linkage cohort study of pregnancies within women having outpatient visit for depression/anxiety and antidepressant fills prior to pregnancy identified from four national registries of Norway (2009-2018). Number of consultations for depression/anxiety per 100 pregnancies as proxy of mental health care utilization was modelled using interrupted time-series analysis with first month into pregnancy and first month after delivery as interruption points. We investigated the time window spanning from six months prior to one year postpartum. Antidepressant fill trajectories in the corresponding time window were identified using longitudinal k-means trajectory modelling. RESULTS The cohort included 8460 pregnancies within 8062 women with depression/anxiety. We observed reduced mental health care utilization when pregnant women entered the course of pregnancy (negative slopes during pregnancy for psychiatric specialists and psychologists). The declines were observed for all antidepressant fill trajectories (i.e., discontinuers and continuers) except interrupters (i.e., discontinued then resumed treatment). We found increased mental health care utilization in the postpartum year, notably in interrupters (positive slopes in consultation rates with specialists of outpatient clinics and public-contracted psychiatrists). LIMITATIONS It was not possible to measure directly the use of psychosocial interventions and psychotherapy. CONCLUSIONS Pregnancy was associated with reduced mental health care utilization regardless of whether antidepressant treatment was maintained during pregnancy or not. Increases in mental health care utilization were observed in the postpartum year, especially in interrupters.
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Affiliation(s)
- Nhung T H Trinh
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
| | - Hedvig M E Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women's and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
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Bowman LC, McCormick SA, Kane-Grade F, Xie W, Enlow MB, Nelson CA. Infants' neural responses to emotional faces are related to maternal anxiety. J Child Psychol Psychiatry 2022; 63:152-164. [PMID: 33993507 PMCID: PMC9644832 DOI: 10.1111/jcpp.13429] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Postnatal maternal anxiety is common (estimates as high as 40% prevalence) and is associated with altered mother-infant interactions (e.g., reduced maternal emotional expression and engagement). Neural circuitry supporting infants' face and emotion processing develops in their first year. Thus, early exposure to maternal anxiety may impact infants' developing understanding of emotional displays. We examine whether maternal anxiety is associated with individual differences in typically developing infants' neural responses to emotional faces. METHODS One hundred and forty two mother-infant dyads were assessed when infants were 5, 7, or 12 months old. Infants' electroencephalographic (EEG) data were recorded while passively viewing female happy, fearful, and angry faces. Three event-related potential (ERP) components, each linked to face and emotion processing, were evaluated: NC, N290, and P400. Infant ERP amplitude was related to concurrent maternal-report anxiety assessed with the Spielberger State-Trait Anxiety Inventory (Trait form). RESULTS Greater maternal anxiety predicted more negative NC amplitude for happy and fearful faces in left and mid-central scalp regions, beyond covarying influences of maternal depression symptoms, infant negative emotionality, and infant age. CONCLUSIONS Postnatal maternal anxiety is related to infants' neural processing of emotional expressions. Infants of mothers endorsing high trait anxiety may need additional attentional resources to process happy and fearful faces (expressions less likely experienced in mother-infant interactions). Future research should investigate mechanisms underlying this association, given possibilities include experiential, genetic, and prenatal factors.
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Affiliation(s)
- Lindsay C. Bowman
- Center for Mind and Brain and Department of Psychology, University of California Davis, Davis, CA,Correspondence to: Lindsay C. Bowman, Center for Mind and Brain at UC Davis, 267 Cousteau Place, Davis, CA, USA, 95616
| | - Sarah A. McCormick
- Department of Psychology and Brain Sciences, University of Massachusetts, Amherst, MA
| | - Finola Kane-Grade
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA
| | - Wanze Xie
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Charles A. Nelson
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA,Harvard Graduate School of Education, Cambridge, MA
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Frigerio A, Nettuno F, Nazzari S. Maternal mood moderates the trajectory of emotional and behavioural problems from pre- to during the COVID-19 lockdown in preschool children. Eur Child Adolesc Psychiatry 2022;:1-11. [PMID: 35001205 DOI: 10.1007/s00787-021-01925-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/30/2021] [Indexed: 11/03/2022]
Abstract
The COVID-19 outbreak and subsequent lockdown have dramatically impacted families' life, raising serious concerns about children's emotional wellbeing. However, few studies have investigated whether the impact of the COVID-19 lockdown on psychological adjustment in youngest can be moderated by maternal mood and, to our knowledge, none of them has adopted a longitudinal design. The main aim of the current study was to explore if the intensity and directionality of maternal mood symptoms moderated the trajectory of emotional and behavioural problems in Italian pre-schoolers from pre- to during the lockdown adopting a longitudinal design. To assess maternal anxiety and depression symptoms, the EPDS and the STAI-Y were filled in by 94 and 88 women before the lockdown, when their children were 1 (Wave P1) and 3 years old (Wave P2), respectively, and by 74 women during the lockdown, when their children were 4 years old (Wave L). Mothers also filled in the CBCL/1 ½-5 to assess their children's emotional and behavioural problems at each assessment wave. As a whole, children's emotional and behavioural problems significantly increased from pre- to during the lockdown. Furthermore, maternal mood moderated this trajectory. In particular, greater maternal mood symptoms were significantly associated with a greater increase in emotional reactive, anxious-depressed, withdrawn and aggressive symptoms during the lockdown. These results contribute to shed light on the role played by maternal emotional wellbeing in buffering the impact of the COVID-19 lockdown on children's behavioural development. Albeit preliminary, the current findings highlight the need to provide timely psychological interventions to distressed mothers to help their children to better cope with the effects of the pandemic.
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Fallon V, Davies SM, Christiansen P, Harrold JA, Silverio SA. The Postpartum Specific Anxiety Scale: Confirmatory factor analyses and relationships with birth experience. Arch Womens Ment Health 2022; 25:655-665. [PMID: 35488935 PMCID: PMC9055017 DOI: 10.1007/s00737-022-01233-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
The Postpartum Specific Anxiety Scale [PSAS] was developed and validated as a research tool with a four-factor structure; with predictive validity corroborated in studies examining infant-feeding and maternal bonding outcomes. The PSAS has not been examined in relation to birth experiences. We aimed to confirm the PSAS four-factor structure and examine these domains of anxiety in relation to subjective and objective birth experiences. Postpartum mothers (≤ 12-months; N = 500) completed the PSAS alongside measures of subjective birth satisfaction and objective obstetric interventions/complications. Confirmatory factor analyses [CFA] tested eight models, theoretically derived from the preceding exploratory work. Structural equation modelling [SEM] tested associations between each PSAS factor and birth experience variables in the best-fitting model. An identical 51-item four-factor model fits the data well. SEM analyses revealed associations between lower perceptions of quality of intrapartum care and increased maternal competence and attachment anxieties, practical infant care anxieties, and infant safety and welfare anxieties. High subjective stress and negative emotional response to labour were associated with increased psychosocial adjustment to motherhood anxieties. Specific associations were found between neonatal care unit admission and practical infant care anxieties; and infant asphyxia and infant safety and welfare anxieties. Findings confirm construct and convergent validity of the four-factor PSAS and its use in measuring postpartum anxiety. Unique associations were also identified, indicating specific subjective and objective experiences occurring during birth may elicit a differential anxiety response, in that they are related to specific forms of postpartum anxiety which occur during the first postpartum year.
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Affiliation(s)
- Victoria Fallon
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Siân M Davies
- School of Psychology, Faculty of Health, Liverpool John Moore's University, Liverpool, UK
| | - Paul Christiansen
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Joanne A Harrold
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK.
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Jones LB, Hall BA, Kiel EJ. Systematic review of the link between maternal anxiety and overprotection. J Affect Disord 2021; 295:541-551. [PMID: 34509069 PMCID: PMC8551038 DOI: 10.1016/j.jad.2021.08.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 08/10/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Theoretical and empirical evidence suggests that maternal anxiety relates to overprotection, yet studies have found conflicting evidence. The literature would benefit from a systematic review. METHODS In April 2020, a systematic review on the relation between maternal anxiety and overprotection was conducted. The search was updated in January 2021. A total of 13 articles were included. RESULTS Of 16 reported bivariate correlations, 12 showed that maternal anxiety accounted for significant variance in overprotection (7 reported a small effect and 5 reported a medium effect). In a group differences study, mothers with anxiety showed greater overprotection. Additionally, in 4 out of 7 multivariate relations maternal anxiety accounted for significant variance in overprotection over and above other factors while 3 suggested that maternal anxiety did not account for significant variance in overprotection. In a multivariate, longitudinal study, maternal anxiety predicted overprotection, over and above other factors. Given conflicting evidence, we evaluated article's methodological strength and found stronger evidence supporting a small to medium size relation compared to evidence supporting no significant relation. LIMITATIONS We report ranges of coefficients and effect sizes, but meta-analytic results are needed to determine the magnitude of these relations based on various factors. More longitudinal studies are needed to determine directionality. CONCLUSIONS Although the literature shows conflicting results, the present review supports that maternal anxiety relates to overprotection, though the effect of this relation is small to medium. It may be beneficial to incorporate mental health for parents into existing parenting interventions.
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Affiliation(s)
- Lauren B. Jones
- Lauren B. Jones may be contacted at or 513-529-2400. Additionally, she may be contacted at Miami University, 90 N. Patterson Ave., Oxford, OH, 45056
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Töz N, Arikan G, Üstündağ-Budak AM. The role of emotion regulation and maternal symptoms in Turkish mothers' caregiving helplessness during toddlerhood. Curr Psychol 2021; 42:6106-6116. [PMID: 34121827 PMCID: PMC8180383 DOI: 10.1007/s12144-021-01855-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/28/2022]
Abstract
To support mothers' positive parenting practices and designing effective early interventions in developing countries like Turkey, understanding the factors associated with feelings of helplessness in caregiving can play an important role. Therefore, we explored how mothers' depression and anxiety symptoms, and emotion regulation strategies of expressive suppression and cognitive reappraisal can contribute to caregiving helplessness during toddlerhood. We also examined whether depression and anxiety can mediate the relationship between emotion regulation strategies and caregiving helplessness. A sample of 552 healthy Turkish mothers (MAge = 32.11) with 1-4 year old healthy children (MAge = 1.51) replied to advertisements we shared face-to-face and filled out a pack of questionnaires including a demographic form, Emotion Regulation Questionnaire, Brief Symptom Inventory and Caregiving Helplessness Questionnaire. A series of path analysis were conducted to reveal the association between emotion regulation strategies (cognitive reappraisal and emotional suppression), depression and anxiety symptoms, and caregiving helplessness. After controlling for socio-economic status (SES), maternal anxiety but not maternal depression positively predicted caregiving helplessnes. Unlike cognitive reappraisal, expressive suppression positively predicted caregiving helplessness. SES had an indirect effect (via suppression) on caregiving helplessness on caregiving helplessness. In toddlerhood, maternal anxiety rather than depression, and expressive supression rather than cogntivie reappraisal could be potential risk factors for caregiving helplessness. Thus, these can be critical target areas for effective early interventions.
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Affiliation(s)
- Naz Töz
- Ozyegin University, Nisantepe, 34794, Cekmekoy, İstanbul, Turkey
| | - Gizem Arikan
- Ozyegin University, Nisantepe, 34794, Cekmekoy, İstanbul, Turkey
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Celik H, Acikel SB, Ozdemir FMA, Aksoy E, Oztoprak U, Cucu E, Kucur O, Ceylan N, Yuksel D. Evaluation of the Anxiety Level of Mothers of Children with Epilepsy during the COVID-19 Pandemic Period. Eur Neurol 2021; 84:192-199. [PMID: 33853068 PMCID: PMC8089456 DOI: 10.1159/000514826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/27/2021] [Indexed: 11/19/2022]
Abstract
Background and Aim Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. Methods The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers' anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. Results There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. Conclusion Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.
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Affiliation(s)
- Halil Celik
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sadettin Burak Acikel
- Child and Adolescent Psychiatry Department, University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatih Mehmet Akif Ozdemir
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Erhan Aksoy
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ulkuhan Oztoprak
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ergin Cucu
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ozge Kucur
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nesrin Ceylan
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Deniz Yuksel
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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Zengin Akkus P, Bahtiyar Saygan B, Ilter Bahadur E, Ozdemir G, Celik HT, Ozmert EN. Longitudinal changes in attachment patterns of preterm infants born in a non-Western country. Infant Ment Health J 2021; 42:517-528. [PMID: 33410526 DOI: 10.1002/imhj.21906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Unexpected early birth of an infant may affect the attachment formation of mother-child dyads. This longitudinal study aimed to explore mother-infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term-born peers in a non-Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and sociodemographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants' developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother-child attachment.
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Affiliation(s)
- P Zengin Akkus
- Division of Developmental Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - E Ilter Bahadur
- Division of Developmental Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - G Ozdemir
- Division of Developmental Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - H T Celik
- Department of Pediatrics, Department of Neonatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - E N Ozmert
- Division of Developmental Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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22
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Gross MS, Ju H, Osborne LM, Jelin EB, Sekar P, Jelin AC. Indeterminate Prenatal Ultrasounds and Maternal Anxiety: A Prospective Cohort Study. Matern Child Health J 2021; 25:802-812. [PMID: 33392932 DOI: 10.1007/s10995-020-03042-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Prenatal ultrasounds often yield indeterminate (incomplete or minor abnormality) findings with limited clinical utility. We evaluate impact of indeterminate findings on maternal anxiety. METHODS A single-U.S.-center prospective cohort study administered the Perinatal Anxiety Screening Scale (PASS; control mean = 13.4; > 20 denotes clinically significant anxiety) before and after prenatal ultrasounds in February-May 2017. Ultrasound reports were coded as: normal; indeterminate; or major abnormality. Primary outcome was anxiety after indeterminate vs. normal ultrasounds. Secondary outcomes included anxiety change from pre-to-post-ultrasound and relative to women's characteristics. Linear regression adjusted for confounders. RESULTS Of 286 ultrasounds, 51.0% were normal, 40.5% indeterminate (22.0% incomplete; 18.5% minor abnormality), and 8.0% major abnormalities. Indeterminate findings were unrelated to age, race, parity, infertility, or psychiatric history, but associated with gestational age (26.6%/45.0%/52.5% for first/second/third trimesters; p < 0.001), and obesity (48.8 vs. 37.0%; p = 0.031). Pretest anxiety was highest in second/third trimesters (p = 0.029), and in subjects aged age ≤ 24 or younger(p < 0.001), with a history of anxiety (p < 0.001),) or with prior pregnancy loss (p = 0.011). Mean anxiety score decreased pre-to-posttest across all groups. Indeterminate findings were associated with higher PASS scores than normal findings: pretest 20.1 vs. 16.4 (p = 0.026) and posttest 16.9 vs. 12.2 (p = 0.009; adjusted-p = 0.01). Versus normal ultrasounds, incomplete findings were associated with higher post-ultrasound anxiety (p = 0.007; adjusted-p = 0.01) and smaller decreases from pre-to-posttest (adjusted-p = 0.03), whereas minor abnormalities had higher pretest anxiety (p = 0.029) with larger pre-to-posttest decreases (adjusted-p =0.010). DISCUSSION Indeterminate ultrasounds, especially incomplete findings, are associated with significantly higher anxiety than normal findings, suggesting need for evidence-based counseling, management and strategies for decreasing number of indeterminate results.
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Affiliation(s)
- Marielle S Gross
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Baltimore, MD, 21205, USA. .,Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Women's Mood Disorders Center, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, 15222, USA.
| | - Hyeyoung Ju
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Women's Mood Disorders Center, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Lauren M Osborne
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Women's Mood Disorders Center, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA.,Psychiatry and Behavioral Sciences, Women's Mood Disorders Center, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Eric B Jelin
- Children's Center Fetal Program, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD, M230721287, USA
| | - Priya Sekar
- Pediatric Cardiology, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD, M230721287, USA
| | - Angie C Jelin
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Women's Mood Disorders Center, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
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23
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Zengin Akkus P, Ciki K, Mete Yesil A, Ilter Bahadur E, Karahan S, Ozmert EN, Sivri S. Developmental and behavioral outcomes of preschool-aged children with biotinidase deficiency identified by newborn screening. Eur J Pediatr 2021; 180:217-224. [PMID: 32683535 DOI: 10.1007/s00431-020-03740-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/22/2020] [Accepted: 07/13/2020] [Indexed: 11/24/2022]
Abstract
Biotinidase deficiency (BD) may cause neurological symptoms and developmental problems. However, newborn screening of BD and early biotin treatment prevent the manifestation of the majority of symptoms. This study intended to examine the developmental and behavioral outcomes as well as maternal anxiety and depressive symptoms of preschool-aged children with BD and to compare these with the outcomes of healthy preschool-aged children. In total, 49 children with BD and 23 healthy children are included. All children were screened for developmental and behavioral problems. Moreover anxiety and depressive symptomatology of their mothers were evaluated. Despite the high percentage of developmental delay in BD group, the numbers of children screened positive for a developmental delay were statistically similar in children with BD and healthy children. Among patients with BD, children with risk of developmental delay had more unfavorable socio-demographic features compared to typically developing ones. Behavioral problem scores, maternal anxiety, and depressive symptoms scores of children with BD were not higher than the healthy children.Conclusion: Children with BD were not different from their healthy peers in terms of developmental and behavioral outcomes. Developmental problems of children with BD may be related to the unfavorable socio-demographic features, not the BD itself. What is known: • Biotinidase deficiency (BD) may result in neurological symptoms and developmental problems. • Newborn screening and early biotin supplementation prevent the manifestation of the majority of symptoms. What is new: • Preschool-aged children with BD identified by newborn screening are not different from their healthy peers in terms of developmental and behavioral outcomes. • Maternal anxiety and depressive symptoms scores of children with BD are similar to scores of healthy children.
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Affiliation(s)
- P Zengin Akkus
- Department of Pediatrics, Division of Developmental Pediatrics, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey.
| | - K Ciki
- Department of Pediatrics, Division of Pediatric Metabolism, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - A Mete Yesil
- Department of Pediatrics, Division of Developmental Pediatrics, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - E Ilter Bahadur
- Department of Pediatrics, Division of Developmental Pediatrics, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - S Karahan
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - E N Ozmert
- Department of Pediatrics, Division of Developmental Pediatrics, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - S Sivri
- Department of Pediatrics, Division of Pediatric Metabolism, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
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24
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Franke K, Van den Bergh BRH, de Rooij SR, Kroegel N, Nathanielsz PW, Rakers F, Roseboom TJ, Witte OW, Schwab M. Effects of maternal stress and nutrient restriction during gestation on offspring neuroanatomy in humans. Neurosci Biobehav Rev 2020; 117:5-25. [PMID: 32001273 PMCID: PMC8207653 DOI: 10.1016/j.neubiorev.2020.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 01/06/2023]
Abstract
Cognitive and mental health are major determinants of quality of life, allowing integration into society at all ages. Human epidemiological and animal studies indicate that in addition to genetic factors and lifestyle, prenatal environmental influences may program neuropsychiatric disorders in later life. While several human studies have examined the effects of prenatal stress and nutrient restriction on brain function and mental health in later life, potentially mediating effects of prenatal stress and nutrient restriction on offspring neuroanatomy in humans have been studied only in recent years. Based on neuroimaging and anatomical data, we comprehensively review the studies in this emerging field. We relate prenatal environmental influences to neuroanatomical abnormalities in the offspring, measured in utero and throughout life. We also assess the relationship between neuroanatomical abnormalities and cognitive and mental disorders. Timing- and gender-specific effects are considered, if reported. Our review provides evidence for adverse effects of an unfavorable prenatal environment on structural brain development that may contribute to the risk for cognitive, behavioral and mental health problems throughout life.
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Affiliation(s)
- Katja Franke
- Department of Neurology, Jena University Hospital, Jena, Germany.
| | - Bea R H Van den Bergh
- Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Department for Welfare, Public Health and Family, Flemish Government, Brussels, Belgium
| | - Susanne R de Rooij
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands
| | - Nasim Kroegel
- Department of Neurology, Jena University Hospital, Jena, Germany; acatech - National Academy of Science and Engineering, Berlin, Germany
| | - Peter W Nathanielsz
- Texas Pregnancy & Life Course Health Research Center, Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States; Dept. of Animal Science, University of Wyoming, Laramie, WY, United States
| | - Florian Rakers
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Tessa J Roseboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Matthias Schwab
- Department of Neurology, Jena University Hospital, Jena, Germany
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25
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Riva Crugnola C, Ierardi E, Prino LE, Brustia P, Cena L, Rollè L. Early styles of interaction in mother-twin infant dyads and maternal mental health. Arch Womens Ment Health 2020; 23:665-671. [PMID: 32451704 DOI: 10.1007/s00737-020-01037-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/12/2020] [Indexed: 12/01/2022]
Abstract
Transition to parenthood is considered a critical process for mothers of twins. There are, however, few studies on the subject. This study aims to evaluate the differences between mother-twin infant dyads and mother-singleton infant dyads with regard to maternal depression, anxiety, parenting stress, and the quality of mother-infant interaction. Mothers of twin infants (N = 40) were compared to mothers of singletons (N = 72). At infant 3 months, maternal depression, anxiety, and parenting stress were assessed via a questionnaire and styles of interaction with the Care-Index. The results indicated that mothers of twins (vs mothers of singletons) had significantly higher state anxiety and higher scores on the Difficult Child Scale of the Parenting Stress Index at infant 3 months. No significant differences between the two groups were found with regard to maternal depression. Mothers of twins had significantly lower sensitivity and were more unresponsive than mothers of singletons. Twin infants had significantly more difficult and compliant behaviours than singleton infants. Assisted reproductive treatment (ART) and prematurity had no effect on any of the examined variables. State anxiety was shown to partially mediate the relationship between twin parenthood and maternal sensitivity and to completely mediate the relationship between twin parenthood and infant difficult style. Maternal unresponsiveness was shown to be exclusively linked to being the parent of twins. The study shows that twin parenthood has a significant effect on maternal mental health and on the quality of mother-infant interaction and highlights the importance of early prevention programmes for twin parents.
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Affiliation(s)
| | - Elena Ierardi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Laura Elvira Prino
- Department of Philosophy and Educational Sciences, University of Turin, Turin, Italy
| | - Piera Brustia
- Department of Psychology, University of Turin, Turin, Italy
| | - Loredana Cena
- Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Luca Rollè
- Department of Psychology, University of Turin, Turin, Italy
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26
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Gozali A, Gibson S, Lipton LR, Pressman AW, Hammond BS, Dumitriu D. Assessing the effectiveness of a pediatrician-led newborn parenting class on maternal newborn-care knowledge, confidence and anxiety: A quasi-randomized controlled trial. Early Hum Dev 2020; 147:105082. [PMID: 32512498 DOI: 10.1016/j.earlhumdev.2020.105082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The postpartum hospital stay is a unique opportunity for clinicians to educate parents on the importance of promoting early child development. Pediatricians are well-positioned to address both medical and developmental concerns during critical periods of development, yet very few parenting interventions are led by pediatricians. AIMS To assess the impact of a novel one-hour long pediatrician-led Newborn Class on maternal knowledge, confidence, and anxiety. METHODS We conducted a quasi-randomized controlled trial to evaluate the effectiveness of the Newborn Class. First-time mothers who delivered a full-term singleton vaginally with no major complications and attended the class were recruited. Mothers who expressed a desire to attend the class but were discharged before a class was offered served as controls. OUTCOME MEASURES Maternal self-perceived parental confidence and anxiety were measured using standardized scales [Karitane Parenting Confidence Scale (KPCS) and State-Trait Anxiety Inventory for Adults (STAI-AD)]. Knowledge on newborn care was assessed using a novel scale. RESULTS A total of 84 participants (intervention n = 36, control n = 48) were included in the study. Mothers who attended the class showed significantly higher levels of knowledge compared to the control group (Knowledge test, Two-tailed t-test, mean [SD], 8.08 [1.06] vs 6.78 [1.25]; P<0.001) as well as significantly higher parenting confidence levels (KPCS, Two-tailed t-test, mean [SD], 39.31 [3.88] vs 35.20 [3.99]; P<0.001). No change was observed in the overall level of anxiety (STAI-AD, Two-tailed t-test, mean [SD], 35.50 [8.73] vs 38.5 [9.53]; P=0.164). CONCLUSIONS A short pediatrician-led parenting intervention may be an effective tool in improving maternal confidence and newborn care knowledge. Given the importance of the newborn period in establishing healthy developmental trajectories, there is a crucial need for cost- and time-effective intervention that can be widely implemented to promote parental knowledge and confidence with the ultimate goal of fostering healthy development in children.
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Affiliation(s)
- Aileen Gozali
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, One Gustave L. Levy Place, New York, NY 10029, United States; Columbia University Irving Medical Center, Departments of Pediatrics and Psychiatry, Pardes Rm 4932, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Sherika Gibson
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, One Gustave L. Levy Place, New York, NY 10029, United States.
| | - Lianna R Lipton
- Boston Children's Hospital, Department of Pediatrics - Division of Developmental Medicine, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Aliza W Pressman
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, One Gustave L. Levy Place, New York, NY 10029, United States.
| | - Blair S Hammond
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, One Gustave L. Levy Place, New York, NY 10029, United States.
| | - Dani Dumitriu
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, One Gustave L. Levy Place, New York, NY 10029, United States; Columbia University Irving Medical Center, Departments of Pediatrics and Psychiatry, Pardes Rm 4932, 1051 Riverside Drive, New York, NY 10032, United States.
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27
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Kungl MT, Rutherford HJ, Heinisch C, Beckmann MW, Fasching PA, Spangler G. Does anxiety impact the neural processing of child faces in mothers of school-aged children? An ERP study using an emotional Go/NoGo task. Soc Neurosci 2020; 15:530-543. [PMID: 32662322 DOI: 10.1080/17470919.2020.1788988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Maternal anxiety during pregnancy and the early postpartum period is associated with heightened neural processing of neutral infant faces as measured by event-related potentials (ERPs). However, less is known about how anxiety shapes neural face processing in mothers of older children. In our study, 36 mothers of 8-10 year old children completed a Go/NoGo task consisting of neutral and emotional (happy, fearful) facial expressions posed by unfamiliar school-aged children while EEG was recorded. Higher levels of maternal anxiety -indexed via self-report- were associated with delayed behavioral responses to children's fearful faces and increased N170 and LPP amplitudes elicited by children's neutral faces. While anxiety was also positively related to the LPP elicited by children's emotional faces, it only led to increased N170 amplitude responses to children's fearful, but not happy, faces and only when they were NoGo cues. The study replicates and extends prior findings examining the impact of maternal anxiety on neural responses to neutral infant faces to later stages of parenting with further neural markers and emotional expressions being affected. Findings evidence the importance of studying these associations beyond infancy to increase our knowledge about processes potentially underlying the relation between anxiety and less optimal parenting across development.
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Affiliation(s)
- Melanie T Kungl
- Department of Developmental Psychology and Developmental Psychopathology, Friedrich-Alexander University Erlangen-Nuremberg (FAU) , Erlangen, Germany
| | - Helena Jv Rutherford
- Yale Child Study Center, University of Yale, Yale University , New Haven, CT, USA
| | - Christine Heinisch
- Department of Developmental Psychology and Developmental Psychopathology, Friedrich-Alexander University Erlangen-Nuremberg (FAU) , Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nuremberg (FAU) , Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nuremberg (FAU) , Erlangen, Germany
| | - Gottfried Spangler
- Department of Developmental Psychology and Developmental Psychopathology, Friedrich-Alexander University Erlangen-Nuremberg (FAU) , Erlangen, Germany
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28
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Gül H, Gül A, Kara K. Maternal depression, anxiety, psychoticism and paranoid ideation have effects on developmental delay types of infants: A study with clinical infant-mother dyads. Arch Psychiatr Nurs 2020; 34:184-190. [PMID: 32513470 DOI: 10.1016/j.apnu.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Developmental delay in infancy includes cognitive-language delay, fine motor delay, gross motor delay, and social-self help delay. Delay in one intellectual domain frequently effects the other areas of development; therefore, determining risk factors are essential. In this study, we evaluated the relationship between maternal psychiatric symptoms and developmental delay types of infants who have not a known risk factor and are expected to show healthy development but have some behavioral and developmental problems. METHODS The sample consisted of 79 infant-mother (26 girls, 53 boys) dyads who had been admitted to the Department of Child and Adolescent Psychiatry at Gulhane Research and Training Hospital over a one year period. Brief Infant-Toddler Social and Emotional Assessment Scale, Brief Symptom Inventory and Ankara Developmental Screening Inventory were used. RESULTS The most frequent developmental delay types were fine motor and social -self-help delay in this sample. For all developmentally delayed infants, maternal interpersonal sensitivity, and depression scores were higher than healthy developed ones. Logistic regression analyses revealed the risk factors: Higher maternal paranoid ideation increases the language-cognitive delay; maternal hostility and anxiety increase the gross motor delay; maternal psychoticism increases the social and self-help delay, and maternal depression increases the total development delay of infants. CONCLUSION Maternal depression, anxiety, psychoticism, and paranoid ideation are important risk factors for infants' developmental delay types and should be addressed while evaluating infant-mother dyads in clinical practice.
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Affiliation(s)
- Hesna Gül
- Department of Child and Adolescent Psychiatry, Gulhane Research and Training Hospital, Ankara, Turkey.
| | - Ahmet Gül
- Department of Psychiatry, Ufuk University School of Medicine, Ankara, Turkey
| | - Koray Kara
- Department of Child and Adolescent Psychiatry, Gulhane Research and Training Hospital, Ankara, Turkey
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29
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Hoyer J, Wieder G, Höfler M, Krause L, Wittchen HU, Martini J. Do lifetime anxiety disorders (anxiety liability) and pregnancy-related anxiety predict complications during pregnancy and delivery? Early Hum Dev 2020; 144:105022. [PMID: 32220767 DOI: 10.1016/j.earlhumdev.2020.105022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence suggests that maternal anxiety is associated with adverse pregnancy and delivery outcomes, such as preterm birth, vaginal bleedings and low birth weight. AIMS To examine the association of lifetime anxiety disorders and pregnancy-related anxiety and complications during pregnancy and delivery. STUDY DESIGN Prospective-longitudinal study (MARI). SUBJECTS N = 306 pregnant women who were investigated repeatedly during the peripartum period. OUTCOME MEASURES Information on lifetime anxiety disorders was assessed using a dimensional score (lifetime anxiety liability index) based on the standardized Composite International Diagnostic Interview for Women (CIDI-V). Pregnancy-related anxiety was surveyed with the Pregnancy and Childbirth Related Fears (PCF) questionnaire. Common pregnancy (e.g. vaginal bleedings) and delivery complications (e.g. labor induction) were assessed via medical records, interviews and questionnaires. RESULTS The global tests on the association between lifetime anxiety liability and pregnancy complications and on the association between pregnancy-related anxiety and pregnancy/delivery complications revealed significant associations. Further analyses revealed associations of lifetime anxiety liability with preterm labor (OR = 1.6, 95% CI = 1.2-2.0) as well as pregnancy-related anxiety with vaginal bleedings (OR = 1.4, 95% CI = 1.0-1.8), preterm labor (OR = 1.3, 95% CI = 1.0-1.7), gestational diabetes (OR 0.5, 95% CI = 0.2-0.9), labor induction (OR = 1.5, 95% CI = 1.1-1.9) and use of labor medication (OR = 1.6, 95% CI = 1.2-2.0). After adjustment for maternal age, maternal body mass index, maternal smoking, socioeconomic status (occupation, household income) and social support (cohabitation), the associations between pregnancy-related anxiety and labor induction as well as use of labor medication remained significant. CONCLUSIONS Pregnancy-related anxiety should be regularly assessed and, if necessary, treated during (early) pregnancy to minimize risks for complications during delivery.
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Affiliation(s)
- Jana Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Behavioral Epidemiology, Department of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| | - Gesine Wieder
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Differential and Personality Psychology, Technische Universität Dresden, Zellescher Weg 17, 01069 Dresden, Germany.
| | - Michael Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Clinical Psychology and Behavioural Neuroscience, Department of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| | - Linda Krause
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Hans-Ulrich Wittchen
- Department of Psychiatry & Psychotherapy, Ludwig-Maximilians-Universität, Nußbaumstr. 7, 80336 Munich, Germany.
| | - Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
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30
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Kafali HY, Biler ED, Palamar M, Ozbaran B. Ocular injuries, attention deficit and hyperactivity disorder, and maternal anxiety/depression levels: Is there a link? Chin J Traumatol 2020; 23:71-77. [PMID: 32201230 PMCID: PMC7156958 DOI: 10.1016/j.cjtee.2019.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/25/2020] [Accepted: 02/18/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Given the increased risk of accidents in patients with attention deficit and hyperactivity disorder (ADHD) or maternal anxiety/depression, we aimed to investigate the frequency of the two diseases in children with penetrating eye injury (PEI). METHODS Altogether 79 children, 39 with PEIs and 40 healthy individuals (control group), aged 5-15 years, underwent a complete ophthalmologic examination. Afterwards, schedule for affective disorders and schizophrenia for school-aged children was conducted to assess the psychiatric diagnosis of all children. Turgay diagnostic and statistical manual of mental disorders (DSM-IV)-based child and adolescent behavior disorders screening and rating scale (T-DSM-IV-S) was filled by parents to evaluate the severity of ADHD symptoms. The depression and anxiety levels of mothers of each group were evaluated by two self-report measures: the Beck depression scale and the state-trait anxiety inventory (STAI), respectively. Data were analyzed by IBM SPSS version 22.0. The Chi-square and Fisher's exact test were used to determine whether there is a significant difference between qualitative variables while independent sample t and Mann-Whitney U tests to compare quantitative variables. RESULTS The only diagnostic difference was a significantly higher frequency of ADHD among patients with PEIs (48.7% in PEI vs. 17.5% in control group, χ2 = 7.359, p = 0.007). The total scores of the T-DSM-IV-S (attention subscale U = 418.000, p = 0.006; hyperactivity subscale U = 472.000, p = 0.022) and maternal state-trait anxiety inventory (maternal STAI-state U = 243.000, p = 0.003; maternal STAI-trait U = 298.000, p = 0.021) were significantly higher in the PEI group than in control group. In logistic regression, children with PEI had a tendency to have a 3.5-fold increased risk for ADHD (OR = 3.538, CI = 0.960-13.039, p = 0.058). CONCLUSION ADHD was detected almost 1 in 2 children with PEIs. Besides, the maternal anxiety level was significantly higher in the PEI group than in the control group. This association should be further explored via a future prospective longitudinal study. Since a proper treatment of ADHD in children and anxiety treatment in mothers may prevent vision loss following PEIs in children.
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Affiliation(s)
- Helin Yilmaz Kafali
- Department of Child and Adolescent Psychiatry, Ankara City Hospital, Ministry of Health, Ankara, Turkey,Corresponding author.
| | | | - Melis Palamar
- Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey
| | - Burcu Ozbaran
- Department of Child and Adolescent Psychiatry, Ege University School of Medicine, Izmir, Turkey
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Maria A, Nissilä I, Shekhar S, Kotilahti K, Tuulari JJ, Hirvi P, Huotilainen M, Heiskala J, Karlsson L, Karlsson H. Relationship between maternal pregnancy-related anxiety and infant brain responses to emotional speech - a pilot study. J Affect Disord 2020; 262:62-70. [PMID: 31710930 DOI: 10.1016/j.jad.2019.10.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/09/2019] [Accepted: 10/28/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Maternal pregnancy-related anxiety (PRA) is reportedly related to neurodevelopmental outcomes of infants. However, the relationship between maternal PRA and the processing of emotions in the infant brain has not been extensively studied with neuroimaging. The objective of the present pilot study is to investigate the relationship between maternal PRA and infant hemodynamic responses to emotional speech at two months of age. METHODS The study sample included 19 mother-infant dyads from a general sample of a population of Caucasian mothers. Self-reported Pregnancy-Related Anxiety Questionnaire (PRAQ-R2) data was collected from mothers during pregnancy at gestational weeks (gwks) 24 (N = 19) and 34 (N = 18). When their infants were two months old, the infants' brains functional responses to emotional speech in the left fronto-temporoparietal cortex were recorded using diffuse optical tomography (DOT). RESULTS Maternal PRAQ-R2 scores at gwk 24 correlated negatively with the total hemoglobin (HbT) responses to sad speech on both sides of the temporoparietal junction (Spearman's rank correlation coefficient ρ = -0.87). The correlation was significantly greater at gwk 24 than gwk 34 (ρ = -0.42). LIMITATIONS The field of view of the measurement did not include the right hemisphere or parts of the frontal cortex. The sample size is moderate and the mothers were relatively highly educated, thus there may be some differences between the study sample and the general population. CONCLUSIONS Maternal pregnancy-related anxiety may affect child brain emotion processing development. Further research is needed to understand the functional and developmental significance of the findings.
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Affiliation(s)
- Ambika Maria
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
| | - Ilkka Nissilä
- Aalto University, Department of Neuroscience and Biomedical Engineering, Finland.
| | - Shashank Shekhar
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Mississippi Medical Center, Department of Neurology, MS, USA
| | - Kalle Kotilahti
- Aalto University, Department of Neuroscience and Biomedical Engineering, Finland
| | - Jetro J Tuulari
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; The Turku Collegium for Science and Medicine (TCSM); University of Oxford, Department of Psychiatry, Oxford, United Kingdom; University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
| | - Pauliina Hirvi
- Aalto University, Department of Neuroscience and Biomedical Engineering, Finland; Aalto University, Department of Mathematics and Systems Analysis, Finland
| | - Minna Huotilainen
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Helsinki, Faculty of Educational Sciences, CICERO Learning, Finland
| | - Juha Heiskala
- Helsinki University Central Hospital, Department of Clinical Neurophysiology, Finland
| | - Linnea Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Turku and Turku University Hospital, Department of Child Psychiatry, Turku, Finland
| | - Hasse Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
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Yamamoto SS, Premji SS, Nyanza EC, Jahanpour O. Investigating the association between stress. Anxiety and geophagy among pregnant women in mwanza, Tanzania. Appetite 2019; 142:104328. [PMID: 31238080 DOI: 10.1016/j.appet.2019.104328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 11/05/2018] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
Geophagy, the craving and intentional consumption of soil, is common especially among pregnant women in some low- and middle-income settings. Soils may contain a variety of non-nutritive components such as heavy metals and microbes or substances that interfere with gastrointestinal absorptive processes, posing health risks to pregnant women. Several hypotheses regarding the practice have been proposed but very few have examined the role of maternal stress. The practice of geophagy may help to alleviate stress or anxiety during gestation from perceived dietary or other pregnancy-related concerns. In this study, we evaluated several measures of maternal stress (general anxiety, Pregnancy-Related Anxiety Scores (10-item revised), and Perceived Stress Scores) and other covariates in relation to geophagic behaviour in early pregnancy in 227 women (12-19 weeks gestation) recruited from two hospitals in the Nyamagana district of Mwanza City, Tanzania. Geophagy was reported by 24.7% of the pregnant women. Using LASSO regression, self-reported treatment of nausea or vomiting during pregnancy (adjusted OR = 3.12, 95%CI: 1.43 to 6.83), paternal education level (adjusted OR = 2.79, 95%CI: 1.32 to 5.87 for primary or lower education level), antenatal hospital site (adjusted OR = 3.71, 95%CI: 1.78 to 7.75), prescription drug use prior to pregnancy (adjusted OR = 1.76, 95%CI: 0.87 to 3.56) and general anxiety (feeling worried, tense or anxious in the past four weeks) (adjusted OR = 1.81, 95%CI: 0.88 to 3.72) were associated with geophagic behaviour. Given that relatively little has been done to examine geophagy in relation to the public health risk it may pose to pregnant women, these findings suggest the need for further investigations regarding maternal stress.
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Affiliation(s)
- Shelby S Yamamoto
- School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405-87Ave, Edmonton, Alberta, T6G 1C9, Canada.
| | - Shahirose S Premji
- School of Nursing, Faculty of Health, York University, 313 HNES Building, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
| | - Elias C Nyanza
- Department of Environmental and Occupational Health, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando Area, Mwanza, Tanzania.
| | - Ola Jahanpour
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, P.O. Box 2240, Tanzania.
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Ierardi E, Ferro V, Trovato A, Tambelli R, Riva Crugnola C. Maternal and paternal depression and anxiety: their relationship with mother-infant interactions at 3 months. Arch Womens Ment Health 2019; 22:527-33. [PMID: 30341645 DOI: 10.1007/s00737-018-0919-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/11/2018] [Indexed: 01/23/2023]
Abstract
While there have been studies on the effects of maternal depression and anxiety on mother-infant styles of interaction in infancy, there have been no studies on the effects of paternal depression and anxiety or on the joint effects of maternal and paternal depression and anxiety on mother-infant styles of interaction. The aims of the study were to examine the associations between maternal depression and anxiety and paternal depression and anxiety and to examine the relationship between maternal and paternal depression and anxiety and mother-infant styles of interaction at infant 3 months. Seventy mother and father couples were administered the EPDS for depression and the STAI-Y for anxiety and mother-infant interactions were video-recorded and coded with the CARE-INDEX. Analyses with Pearson correlation indicated an association between maternal depression and paternal anxiety and between maternal anxiety with paternal depression and anxiety. Moreover maternal and paternal depression and anxiety were found to be associated with the quality of maternal style of interaction. Maternal sensitive style was negatively associated with maternal depression and state anxiety. Maternal unresponsive style was positively associated with both paternal depression and state and trait anxiety. Multiple regression analysis has shown that maternal state anxiety was a greater predictor of a lower level of maternal sensitivity than maternal depression.
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Petch S, DeMaio A, Daly S. Prediction of recurrent preterm delivery in asymptomatic women- an anxiety reducing measure? Eur J Obstet Gynecol Reprod Biol X 2019; 4:100064. [PMID: 31673690 PMCID: PMC6817671 DOI: 10.1016/j.eurox.2019.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 10/30/2022] Open
Abstract
Objectives The QUiPP application is used to predict the risk of recurrent preterm birth (PTB) in asymptomatic high risk women with a previous PTB. Our study aims to evaluate the impact of the use of the QUiPP app on maternal anxiety levels. Study design A retrospective cohort study on asymptomatic pregnant women attending the Prevention of Preterm Birth Clinic in a busy tertiary unit. Women included in the study had a history of previous PTB. The study assessment occurred at approximately 4 weeks prior to the gestation of the earliest previous PTB and included measurement of cervical length and vaginal fetal fibronectin. Data was inputted into the QUiPP application, which in turn estimated risk of preterm delivery at specific intervals. Measured outcomes were gestation at delivery, time from risk assessment to delivery, infant birth weight, NICU admission and length of stay. In addition, maternal anxiety levels were retrospectively assessed using a questionnaire with a Likert scale. Results Seventy six women were included in the study. All women were asymptomatic for preterm labour at assessment. The mean gestation at the time of risk assessment was 27 weeks, the mean time from risk assessment to delivery was 72 days. Average gestation at time of delivery was 37 weeks (range 22-42 weeks). The preterm birth rate was 29% (n = 22).Seventy seven percent of women who delivered <37 weeks, and 80% who delivered <34 weeks were given QUiPP scores predicting a ≥5% chance of PTB within four weeks of their actual delivery date. Sixteen percent of infants were admitted to NICU (n = 12) with a mean length of stay of 21 days. All infants went home well with their parents.Eighty four percent of respondents to our questionnaire reported feeling anxious about their pregnancy prior to attending the clinic. After receiving a QUIPP score 90% said they felt reassured and 79% reported that the felt less anxious. Conclusion In asymptomatic women, the use of the QUiPP app helps to predict, prevent, and optimise PTB. This surveillance has a beneficial role for maternal mental well-being in that it reduces anxiety at a key time during a pregnancy.
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Affiliation(s)
- Sarah Petch
- Coombe Women & Infant's University Hospital, Dublin, Ireland
| | - Alison DeMaio
- Coombe Women & Infant's University Hospital, Dublin, Ireland
| | - Sean Daly
- Coombe Women & Infant's University Hospital, Dublin, Ireland
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Havewala M, Felton JW, Lejuez CW. Friendship Quality Moderates the Relation Between Maternal Anxiety and Trajectories of Adolescent Internalizing Symptoms. J Psychopathol Behav Assess 2019; 41:495-506. [PMID: 31983803 DOI: 10.1007/s10862-019-09742-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The current study examined the moderating role of friendship quality on the relation between maternal anxiety and internalizing symptoms in a 3-year prospective study of adolescent development. Participants included 177 adolescents (M age = 16.05, SD age = 0.91) and their mothers. Mothers reported their own levels of anxiety; youth completed self-reports of internalizing symptoms and friendship quality. Positive friendship quality moderated the relation between maternal anxiety and initial levels of internalizing symptoms. Maternal anxiety was associated with steeper increases in internalizing symptoms over time, but only for those with greater negative peer interactions. Findings underscore the important role of both parental and peer relationships in the development of internalizing symptoms and highlight specific avenues for clinical interventions.
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Affiliation(s)
- Mazneen Havewala
- Department of Psychology, University of Maryland, College Park, MD
| | - Julia W Felton
- Division of Public Health, Michigan State University, Flint, MI
| | - Carl W Lejuez
- Department of Psychology, University of Kansas, Lawrence, KS
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36
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Woolhouse H, Gartland D, Papadopoullos S, Mensah F, Hegarty K, Giallo R, Brown S. Psychotropic medication use and intimate partner violence at 4 years postpartum: Results from an Australian pregnancy cohort study. J Affect Disord 2019; 251:71-77. [PMID: 30904778 DOI: 10.1016/j.jad.2019.01.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the perinatal period, maternal mental health problems and intimate partner violence often co-occur. We aimed to examine associations between psychotropic medication use and intimate partner violence (IPV) in an Australian population-based sample. METHODS Prospective cohort study of 1507 first-time mothers recruited in early pregnancy (mean gestation 15 weeks) from public maternity hospitals in Melbourne Australia. Follow-up questionnaires at 12 months and four years included validated measures of intimate partner violence (Composite Abuse Scale), and maternal mental health (Edinburgh Postnatal Depression Scale, SF-36). Data on use of psychotropic medications was collected using a self-report measure at four years postpartum. RESULTS At four years postpartum, almost one in eight mothers (13.9%) were taking psychotropic medication. The prevalence of psychotropic medication use in women experiencing concurrent IPV was considerably higher compared to women not experiencing IPV (25% vs 11%, Odds Ratio = 2.68, 95% CI 1.73-4.15). Women experiencing IPV were significantly more likely to be taking psychotropic medication, even after adjusting for sociodemographic factors and depressive symptoms (Adj OR = 1.86, 95% CI 1.16 to 2.96). Only 5% of women reporting IPV at four years postpartum had discussed this with a general practitioner. LIMITATIONS Limitations include use of a self-report measure to assess psychotropic medication use, lack of data on the use of psychological counselling and/or other specialist mental health services and potential for attrition to bias results (addressed using multiple imputation). CONCLUSIONS Our findings reinforce the need for health professionals treating women for depressive symptoms to inquire about IPV and tailor responses accordingly.
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Affiliation(s)
- Hannah Woolhouse
- Intergenerational Health Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC 3052, Australia
| | - Deirdre Gartland
- Intergenerational Health Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville VIC 3052, Australia
| | - Sandra Papadopoullos
- Intergenerational Health Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC 3052, Australia
| | - Fiona Mensah
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Parkville VIC 3052, Australia
| | - Rebecca Giallo
- Intergenerational Health Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville VIC 3052, Australia
| | - Stephanie Brown
- Intergenerational Health Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville VIC 3052, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia; Department of General Practice, The University of Melbourne, Parkville VIC 3052, Australia; South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia.
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Klampfl SM, Bosch OJ. Mom doesn't care: When increased brain CRF system activity leads to maternal neglect in rodents. Front Neuroendocrinol 2019; 53:100735. [PMID: 30684507 DOI: 10.1016/j.yfrne.2019.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/22/2018] [Accepted: 01/18/2019] [Indexed: 12/18/2022]
Abstract
Mothers are the primary caregivers in mammals, ensuring their offspring's survival. This strongly depends on the adequate expression of maternal behavior, which is the result of a concerted action of "pro-maternal" versus "anti-maternal" neuromodulators such as the oxytocin and corticotropin-releasing factor (CRF) systems, respectively. When essential peripartum adaptations fail, the CRF system has negative physiological, emotional and behavioral consequences for both mother and offspring often resulting in maternal neglect. Here, we provide an elaborate and unprecedented review on the implications of the CRF system in the maternal brain. Studies in rodents have advanced our understanding of the specific roles of brain regions such as the limbic bed nucleus of the stria terminalis, medial preoptic area and lateral septum even in a CRF receptor subtype-specific manner. Furthermore, we discuss potential interactions of the CRF system with other neurotransmitters like oxytocin and noradrenaline, and present valuable translational aspects of the recent research.
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Affiliation(s)
- Stefanie M Klampfl
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Regensburg, Germany
| | - Oliver J Bosch
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Regensburg, Germany.
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Mughal MK, Giallo R, Arnold PD, Kehler H, Bright K, Benzies K, Wajid A, Kingston D. Trajectories of maternal distress and risk of child developmental delays: Findings from the All Our Families (AOF) pregnancy cohort. J Affect Disord 2019; 248:1-12. [PMID: 30690110 DOI: 10.1016/j.jad.2018.12.132] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 12/19/2018] [Accepted: 12/26/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Existing literature on the impact of the course of maternal distress symptoms in the perinatal period and beyond has mainly focused on one source of distress (e.g., anxiety or depression) and only selected aspects of child development. This study examined the relative impact of trajectories of maternal depression, anxiety, and stress symptoms from mid-pregnancy to early childhood on child communication, gross motor, fine motor, problem solving, and personal social development at three years of age. METHODS Data were analyzed from 1983 mother-child dyads who participated in the three-year follow-up of the All Our Families (AOF) study. Maternal distress and child development across five domains were measured using validated tools. Latent class analysis (LCA) was conducted to identify trajectories of maternal distress over time. Multivariable logistic regression was used to explore the relationship between the trajectories and child development while adjusting for the covariates. RESULTS At age three years, 5.2% of children were at risk communication delay; 12.7% for gross motor delay; 15.4% for fine motor delay; 11.2 for problem solving delay; and 5.6% for personal-social delay on ASQ-3 domains. Multivariable analysis showed children born to mothers with persistent high anxiety symptoms from pregnancy to 3-years postpartum had an increased risk of delays in communication and personal-social domains. LIMITATIONS The use of self-reported maternal mental health symptoms and maternal reported child development are the study limitations. CONCLUSIONS The impact of high levels of maternal anxiety symptoms on the increased risk of child developmental delay in communication and personal-social domains highlights the importance of early intervention and addressing maternal anxiety from pregnancy through early childhood.
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Affiliation(s)
- Muhammad Kashif Mughal
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
| | - Rebecca Giallo
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia.
| | - Paul D Arnold
- Mathison Center for Mental Health Research & Education, Cumming Schol of Medicine, University of Calgary, 3280 Hospital Dr. N.W., Calgary, Alberta T2N 4Z6, Canada.
| | - Heather Kehler
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
| | - Katherine Bright
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
| | - Abdul Wajid
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
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Cardenas A, Faleschini S, Cortes Hidalgo A, Rifas-Shiman SL, Baccarelli AA, DeMeo DL, Litonjua AA, Neumann A, Felix JF, Jaddoe VWV, El Marroun H, Tiemeier H, Oken E, Hivert MF, Burris HH. Prenatal maternal antidepressants, anxiety, and depression and offspring DNA methylation: epigenome-wide associations at birth and persistence into early childhood. Clin Epigenetics 2019; 11:56. [PMID: 30925934 PMCID: PMC6441191 DOI: 10.1186/s13148-019-0653-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 03/12/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Maternal mood disorders and their treatment during pregnancy may have effects on the offspring epigenome. We aim to evaluate associations of maternal prenatal antidepressant use, anxiety, and depression with cord blood DNA methylation across the genome at birth and test for persistence of associations in early and mid-childhood blood DNA. METHODS A discovery phase was conducted in Project Viva, a prospective pre-birth cohort study with external replication in an independent cohort, the Generation R Study. In Project Viva, pregnant women were recruited between 1999 and 2002 in Eastern Massachusetts, USA. In the Generation R Study, pregnant women were recruited between 2002 and 2006 in Rotterdam, the Netherlands. In Project Viva, 479 infants had data on maternal antidepressant use, anxiety, depression, and cord blood DNA methylation, 120 children had DNA methylation measured in early childhood (~ 3 years), and 460 in mid-childhood (~ 7 years). In the Generation R Study, 999 infants had data on maternal antidepressants and cord blood DNA methylation. The prenatal antidepressant prescription was obtained from medical records. At-mid pregnancy, symptoms of anxiety and depression were assessed with the Pregnancy-Related Anxiety Scale and the Edinburgh Postnatal Depression Scale in Project Viva and with the Brief Symptom Inventory in the Generation R Study. Genome-wide DNA methylation was measured using the Infinium HumanMethylation450 BeadChip in both cohorts. RESULTS In Project Viva, 2.9% (14/479) pregnant women were prescribed antidepressants, 9.0% (40/445) experienced high pregnancy-related anxiety, and 8.2% (33/402) reported symptoms consistent with depression. Newborns exposed to antidepressants in pregnancy had 7.2% lower DNA methylation (95% CI, - 10.4, - 4.1; P = 1.03 × 10-8) at cg22159528 located in the gene body of ZNF575, and this association replicated in the Generation R Study (β = - 2.5%; 95% CI - 4.2, - 0.7; P = 0.006). In Project Viva, the association persisted in early (β = - 6.2%; 95% CI - 10.7, - 1.6) but not mid-childhood. We observed cohort-specific associations for maternal anxiety and depression in Project Viva that did not replicate. CONCLUSIONS The ZNF575 gene is involved in transcriptional regulation but specific functions are largely unknown. Given the widespread use of antidepressants in pregnancy, as well as the effects of exposure to anxiety and depression, implications of potential fetal epigenetic programming by these risk factors and their impacts on development merit further investigation.
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Affiliation(s)
- Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | | | - Andrea Cortes Hidalgo
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Andrea A. Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Dawn L. DeMeo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, University of Rochester Medical Center, Rochester, NY USA
| | - Alexander Neumann
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Janine F. Felix
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Vincent W. V. Jaddoe
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Emily Oken
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA USA
| | - Heather H. Burris
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
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Ahmed A, Bowen A, Feng CX, Muhajarine N. Trajectories of maternal depressive and anxiety symptoms from pregnancy to five years postpartum and their prenatal predictors. BMC Pregnancy Childbirth 2019; 19:26. [PMID: 30642277 PMCID: PMC6332639 DOI: 10.1186/s12884-019-2177-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/04/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Maternal depression and anxiety have distinct constellations of symptom trajectories, which are associated with factors that may vary between different groups of women. The aim of this study was to identify subgroups of women who exhibit unique longitudinal trajectory patterns of depressive and anxiety symptoms from pregnancy to 5 years postpartum and the antenatal predictors associated with these maternal groups. METHODS The study used a longitudinal data collected from 615 women in Saskatchewan from pregnancy to 5 years postpartum. Semiparametric group-based models were used to identify latent maternal depressive and anxiety trajectory groups. Multinomial logit models were then used to assess the association between maternal characteristics and the identified latent trajectory groups. RESULTS We identified four trajectory groups of maternal depressive symptoms: low-stable (35%); moderate-stable (54%); moderate-increasing (5%); and high-decreasing (6%), and three trajectory groups of maternal anxiety symptoms: very low-stable (13%); low-stable (58%); and moderate-stable (29%). We also identified several risk factors, most notably history of depression and stress, that were significantly associated with these trajectories. CONCLUSION History of depression and increased stress are significant risk factors that can be identified during regular perinatal visits; therefore, clinicians should inquire about these risk factors to identify women at high risk of ongoing depression or anxiety.
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Affiliation(s)
- Asma Ahmed
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall, 1020 Pine Avenue W, Room 27, Montreal, Quebec H3A 1A2 Canada
| | - Angela Bowen
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Health Sciences Building, Room 4246, Saskatoon, Saskatchewan S7N 2Z4 Canada
| | - Cindy Xin Feng
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Health Sciences Building, Room 3338, Saskatoon, Saskatchewan S7N 2Z4 Canada
| | - Nazeem Muhajarine
- College of Medicine, University of Saskatchewan, 104 Clinic Place, Health Sciences Building, Room 3246, Saskatoon, Saskatchewan S7N 2Z4 Canada
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Rees S, Channon S, Waters CS. The impact of maternal prenatal and postnatal anxiety on children's emotional problems: a systematic review. Eur Child Adolesc Psychiatry 2019; 28:257-280. [PMID: 29948234 PMCID: PMC6510846 DOI: 10.1007/s00787-018-1173-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/22/2018] [Indexed: 12/12/2022]
Abstract
Maternal mental health problems during pregnancy and the postnatal period are a major public health issue. Despite evidence that symptoms of both depression and anxiety are common during pregnancy and the postpartum, the impact of maternal anxiety on the child has received relatively less attention than the impact of maternal depression. Furthermore, the evidence base for the direct impact of maternal anxiety during pregnancy and the postpartum on children's emotional outcomes lacks cohesion. The aim of this systematic review is to summarise the empirical evidence regarding the impact of maternal prenatal and postnatal anxiety on children's emotional outcomes. Overall, both maternal prenatal and postnatal anxiety have a small adverse effect on child emotional outcomes. However, the evidence appears stronger for the negative impact of prenatal anxiety. Several methodological weaknesses make conclusions problematic and replication of findings is required to improve the identification of at-risk parents and children with appropriate opportunities for intervention and prevention.
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Affiliation(s)
- Sarah Rees
- 0000 0001 0807 5670grid.5600.3Cardiff University, Cardiff, Wales UK
| | - Susan Channon
- 0000 0001 0807 5670grid.5600.3Cardiff University, Cardiff, Wales UK
| | - Cerith S. Waters
- 0000 0001 0807 5670grid.5600.3Cardiff University, Cardiff, Wales UK
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Reissland N, Froggatt S, Reames E, Girkin J. Effects of maternal anxiety and depression on fetal neuro-development. J Affect Disord 2018; 241:469-474. [PMID: 30149334 DOI: 10.1016/j.jad.2018.08.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/17/2018] [Accepted: 08/12/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Fetal development is affected by maternal mental health with research indicating that maternal anxiety and depression are co-morbid; nevertheless differential effects on the fetus have been found. This study examines, prenatally, effects of maternal stress, anxiety and depression on fetal eye-blink reactions to experimental sound and light stimulation. METHODS Two groups of singleton fetuses (mean 32-weeks gestation) were examined using 4D ultrasound: a control group (N = 14, 7 female) with no stimulation and an experimental group (N = 21, 13 female) exposed to experimental sound, light and cross-modal stimulation. For both groups ultrasound scans were performed and fetal eye-blink was assessed. Mothers completed the Hospital-Anxiety-and-Depression Scale and the Perceived-Stress Scale. Analysis was carried out using Poisson mixed effects modelling. RESULTS Fetal eye-blink rate during experimental stimulation was significantly and differentially associated with maternal mental health with a 20% increase of fetal eye-blink rate for each unit increase in anxiety score (p = 0.02) and a decrease of 21% of eye blink rate for each unit of increase in depression score (p = 0.02). Sound stimulation but not light stimulation significantly affected blink-rate with fetuses habituating to the stimuli (p < 0.001). LIMITATIONS Limitations are the relatively small number of fetuses and that a follow up after birth is essential to establish potential long-term effects. CONCLUSIONS Of clinical importance is the finding that although fetuses are affected by maternal mental health in general here we demonstrate, using eye-blink-rate during stimulation as measure of neuro-development, that fetuses are differentially affected by maternal anxiety and depression with anxiety increasing and depression decreasing fetal reactivity significantly.
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Affiliation(s)
- N Reissland
- Department of Psychology, Durham University, Science Site, South Road, Durham DH1 3LE, United Kingdom.
| | - S Froggatt
- Department of Psychology, Durham University, Science Site, South Road, Durham DH1 3LE, United Kingdom
| | - E Reames
- Department of Psychology, Durham University, Science Site, South Road, Durham DH1 3LE, United Kingdom
| | - J Girkin
- Department of Physics, Durham University, Science Site, South Road, Durham DH1 3LE, United Kingdom
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Zhang H, Shao S, Su Q, Yao D, Sun H, Ding D, Dang S, Wang S, Zhu Z, Li H. Involvement of prolactin in newborn infant irritability following maternal perinatal anxiety symptoms. J Affect Disord 2018; 238:526-533. [PMID: 29936391 DOI: 10.1016/j.jad.2018.05.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/01/2018] [Accepted: 05/28/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Newborn irritability could be an unique and special status and/or adverse neurobehavioral outcomes which was independent of serious disease. To determine whether maternal perinatal anxiety symptoms was associated with newborn irritability, and whether the alteration of serum prolactin in newborns were involved in newborn irritability. METHODS 205 pregnant women were recruited: normal group (n = 100), and anxiety group (n = 105), which was randomly divided to Newborn Behavioral Observations (NBO)+anxiety group(n = 65) and control+anxiety group(n = 40). Newborn Irritability was assessed by Neonatal Behavioral Assessment Scale(NBAS). Serum prolactin, cortisol and 5-HT in mothers and infants were measured. RESULTS 1. The scores of irritability items in the newborns of anxiety group were higher than that of the normal group (p < 0.05). 2. Lower serum PRL, 5-HT and higher serum cortisol were found in the newborns of anxiety group compared with that of the control group both postpartum 2d and 15 (p < 0.05). 3. The level of serum PRL in newborn infants were significantly and negatively correlated to the scores of irritability items (p < 0.05). 4. After 7 rounds of NBO interventions, the anxiety scores of mothers and the scores of irritability items of newborns in the NBO intervention group were all lower than those of the control group (p < 0.05) . LIMITATIONS In future experiments, we should explore the effect of PRL in the breast milk on newborn infant serum PRL. CONCLUSIONS Prolactin could be a potential mediator in newborn irritability following maternal perinatal anxiety symptoms.
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Affiliation(s)
- Huiping Zhang
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Shuya Shao
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Qian Su
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Dan Yao
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Hongli Sun
- Shaanxi Institute of Pediatric Diseases, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710003, China
| | - Ding Ding
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Shaokang Dang
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Shan Wang
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Zhongliang Zhu
- Shaanxi Province Biomedicine Key Laboratory, College of Life Sciences, Northwest University, 229 Taibai North Road, Xi'an, Shaanxi 710069, China.
| | - Hui Li
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China.
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van den Heuvel MI, van Assen MALM, Glover V, Claes S, Van den Bergh BRH. Associations between maternal psychological distress and salivary cortisol during pregnancy: A mixed-models approach. Psychoneuroendocrinology 2018; 96:52-60. [PMID: 29902667 DOI: 10.1016/j.psyneuen.2018.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/02/2018] [Accepted: 06/04/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Maternal psychological distress during pregnancy is related to adverse child behavioral and emotional outcomes later in life, such as ADHD and anxiety/depression. The underlying mechanisms for this, however, are still largely unknown. The hypothalamic-pituitary-adrenal (HPA)-axis, with its most important effector hormone cortisol, has been proposed as a mechanism, but results have been inconsistent. The current study investigated the association between maternal psychological distress (i.e. anxiety and depressive symptoms) and maternal cortisol levels during pregnancy using a mixed models approach. METHOD During three pregnancy trimesters, mothers (N = 170) collected four salivary samples for two consecutive days. Mothers reported symptoms of anxiety and depression three times during pregnancy (at 13.3 ± 1.1, 20.2 ± 1.5, and 33.8 ± 1.5 weeks of pregnancy, respectively) using the anxiety subscale of the Symptom Checklist (SCL-90), the Spielberger State and Trait Anxiety Inventory (STAI), and the Edinburgh Postnatal Depression Scale (EPDS). Specific fears and worries during pregnancy were measured with the short version of the Pregnancy Related Anxiety Questionnaire (PRAQ-R). RESULTS We found a significant effect of SCL-90 anxiety subscale on cortisol levels at awakening (p = .008), indicating that mothers with higher anxiety showed lower cortisol at awakening. Maternal psychological variables explained 10.5% of the variance at the person level in awakening cortisol level, but none in the overall diurnal cortisol model. CONCLUSION More research is necessary to unravel the underlying mechanisms of the association between maternal psychological distress and cortisol and the search for mechanisms other than the HPA-axis should be continued and extended.
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Affiliation(s)
| | - Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg University, The Netherlands; Department of Sociology, Utrecht University, The Netherlands
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, UK
| | - Stephan Claes
- Department of Neurosciences, University of Leuven (KU Leuven), Leuven, Belgium
| | - Bea R H Van den Bergh
- Health Psychology, University of Leuven (KU Leuven), Leuven, Belgium; Department of Welfare, Public Health and Family, Flemish Government, Brussels, Belgium.
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Ranger A, Helmert E, Bott TS, Ostermann T, Als H, Bassler D, Hautzinger M, Vagedes J. Physiological and emotional effects of pentatonic live music played for preterm neonates and their mothers in the Newborn Intensive Care Unit: A randomized controlled trial. Complement Ther Med 2018; 41:240-246. [PMID: 30477847 DOI: 10.1016/j.ctim.2018.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Despite attempts to increase calmness in the Newborn Intensive Care Unit (NICU), preterm neonates still experience stress. The question arises how to further promote the infants' wellbeing. Therefore, the immediate effects of pentatonic live music on preterm infants and their mothers were examined. DESIGN AND METHODS In a two-centre randomized controlled trial with crossover design preterm infants were exposed sequentially to two conditions: live pentatonic harp music (LPHM) used in Anthroposophic Medicine or standard care. The order of the conditions was randomized within each subject. The primary outcome was change of the number of oxygen desaturations < 90%/h, whereas secondary outcomes were: heart rate, respiratory rate, oxygen saturation, heart rate variability (HRV), the perfusion index, pulse-transit-time and maternal anxiety and others not reported on in this article. RESULTS 21 preterm infants were randomized (14 girls), mean gestational age at measurement 35 + 0 weeks (SD 1 week). The primary outcome parameter showed no significant changes. Regarding the secondary outcomes the comparison of the pre-post-differences between the conditions showed significant effects for the HRV parameters pNN50 (ΔpNN50 = 1.46%, z = -2.47, p = .001) and SDNN (ΔSDNN=-0.06 ms, z = -2.25, p = .002). The music intervention significantly increased the values of pNN50 (Mdn 1.2% vs. 2.6%, p = 0.04) and marginally those of SDNN (Mdn 31.7 ms vs. 36.4 ms, p = 0.05). No changes were found in the other parameters. CONCLUSIONS While the use of music in the NICU had no effect on the number of oxygen desaturations, it increased two HRV parameters indicative of infants' parasympathetic tone.
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Affiliation(s)
- A Ranger
- ARCIM Institute, Fidlerstadt, Germany
| | - E Helmert
- ARCIM Institute, Fidlerstadt, Germany
| | - T S Bott
- Department of Pediatric Surgery Olgahospital, Stuttgart, Germany
| | - T Ostermann
- Department of Psychology, University of Witten-Herdecke, Germany
| | - H Als
- Department of Psychiatry, Boston Children`s Hospital and Harvard Medical School, Boston, MA, USA
| | - D Bassler
- Department of Neonatology, Zurich University Hospital, Zurich, Switzerland
| | - M Hautzinger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Tübingen, Germany
| | - J Vagedes
- ARCIM Institute, Fidlerstadt, Germany; University Hospital, Department of Neonatology, University of Tuebingen, Germany.
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John HB, Philip RM, Santhanam S, Padankatti SM, Sebastian T, Balan I, Rajapandian E. Activity based group therapy reduces maternal anxiety in the Neonatal Intensive Care Unit - a prospective cohort study. Early Hum Dev 2018; 123:17-21. [PMID: 30031995 DOI: 10.1016/j.earlhumdev.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/31/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND A large proportion of mothers in the Neonatal Intensive Care Unit (NICU) experience psychological distress, which is associated with adverse infant and parenting outcomes. Interventions addressing maternal anxiety in the NICU are scarce. AIMS To assess the effect of activity based group therapy on maternal anxiety in the NICU when compared to a control group. STUDY DESIGN The study was a prospective phase lag cohort study. In Phase 1 the control group was recruited and assessed using the State-Trait Anxiety Inventory (STAI-S) once at recruitment and again 4 weeks later. In phase 2, mothers were invited to take part in activity-based groups of 1 h duration once a week for 4 weeks. The STAI-S was administered before and after every group session. SUBJECTS Mothers of babies admitted in the NICU who consented to participate, had a working knowledge of Tamil or English and were likely to stay for 4 weeks for the treatment were included. OUTCOME MEASURES State anxiety assessed using the STAI-S. RESULTS Seventeen mothers each in the control and experimental groups completed the study. In the experimental group, there was a significant reduction in the post-test anxiety scores when compared to the pre-test in the first (p = 0.005), third (p = 0.07) and fourth (p = 0.009) sessions. The post-test anxiety scores of the intervention group was significantly lower than that of the control group (p = 0.009). CONCLUSION Activity based group therapy is effective as an intervention in reducing maternal anxiety in the NICU. SUMMARY Anxiety in mothers of infants admitted in the NICU has been associated with adverse infant and parenting outcomes. This study evaluated the feasibility and effectiveness of an activity based group intervention to reduce anxiety levels in mothers in the NICU. The study was a prospective phase lag cohort study. Anxiety levels were assessed in mothers in the control group at recruitment and then 4 weeks later. In the intervention group, activity based group sessions were conducted once a week for 4 weeks. State anxiety was assessed before and after every group session. In the intervention group the anxiety levels were significantly lower in the post-test, when compared to the pre-test. Also the number of mothers suffering from moderate to severe anxiety and the anxiety scores in the post-test were significantly lower in the intervention group when compared to the control group. We conclude that activity based group sessions are effective in reducing the state anxiety in mothers in the NICU. Improving maternal psychological wellbeing may indirectly contribute to better infant outcomes.
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Affiliation(s)
- Hima B John
- Department of Neonatology, Christian Medical College, Vellore, India.
| | - Rima Mary Philip
- Department of Occupational Therapy, Christian Medical College, Vellore, India
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College, Vellore, India
| | | | - Tunny Sebastian
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Indira Balan
- Department of Neonatology, Christian Medical College, Vellore, India
| | - Earnest Rajapandian
- Department of Occupational Therapy, Christian Medical College, Vellore, India
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Mughal MK, Giallo R, Arnold P, Benzies K, Kehler H, Bright K, Kingston D. Trajectories of maternal stress and anxiety from pregnancy to three years and child development at 3 years of age: Findings from the All Our Families (AOF) pregnancy cohort. J Affect Disord 2018; 234:318-326. [PMID: 29604550 DOI: 10.1016/j.jad.2018.02.095] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Existing literature on maternal distress has focused on stress and anxiety during the pregnancy or postnatally and their relationship with child development. However, few studies have investigated the association between maternal stress and anxiety symptoms over time and child development in preschool children. The aim of this study was to examine the association between trajectories of maternal stress and anxiety symptoms from mid-pregnancy to three years postpartum and child development at age three years. METHODS Data were analyzed from 1983 mother-child dyads who participated in the three year follow-up of the All Our Families (AOF) study. Latent class analysis (LCA) was conducted to identify trajectories of women's stress and anxiety across from mid-pregnancy to three years postpartum. Multivariate logistic regression was used to explore the relationship between the stress and anxiety trajectories and child developmental delays while adjusting for the covariates. RESULTS LCA identified three distinct trajectories of maternal stress and anxiety symptoms over time. Multivariate analysis showed mothers assigned to the high anxiety symptoms class had an increased risk (adjusted OR 2.80, 95% CI 2.80 (1.42 ─ 5.51), p = 0.003) of having a child with developmental delays at 3 years. LIMITATIONS The use of self-reported maternal mental health symptoms and no data on fathers' mental health are our study's limitations. CONCLUSIONS The findings from a population-based Canadian sample provide empirical support for a relationship between maternal anxiety overtime and risk of child developmental delays. Identifying and supporting mothers experiencing high anxiety symptoms in the perinatal period may mitigate the risk of these delays in children.
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Affiliation(s)
| | - Rebecca Giallo
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, Australia
| | - Paul Arnold
- Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Heather Kehler
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Katherine Bright
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Petzoldt J. Systematic review on maternal depression versus anxiety in relation to excessive infant crying: it is all about the timing. Arch Womens Ment Health 2018; 21:15-30. [PMID: 28900745 DOI: 10.1007/s00737-017-0771-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/14/2017] [Indexed: 10/24/2022]
Abstract
Different types of studies suggest a link between maternal depression/anxiety and excessive infant crying (EC). However, comparability is hampered due to different designs, definitions and measurements. This systematic review investigates the specific role of maternal depression and anxiety considering them as preceding, concurrent and subsequent conditions of EC. A computerised literature search was conducted in January 2017 using Medline, PubMed, PsycINFO and Web of Science. After screening n = 399 records for inclusion/exclusion criteria, n = 33 records based on n = 30 projects were eligible for systematic qualitative data synthesis. All studies on maternal depression/anxiety and EC within the first 3 years of life were included. Included studies investigated predominantly maternal depression (25/30) and secondly maternal anxiety (17/30). Significant positive results were found in the majority of studies for maternal depression (21/25) as well as for maternal anxiety (12/17) in relation to EC. In-depth analyses further revealed that concurrent and subsequent maternal depression was robustly related with EC, whilst preceding maternal depression was not. In contrast, preceding and concurrent (but not subsequent) maternal anxiety was consistently related to subsequent EC. Maternal depression is more likely a correlate or even a consequence of EC, whereas anxiety is rather a temporally preceding condition and thus a potential risk factor or risk marker for both subsequent EC and associated maternal depression. Interventions for EC should address concurrent maternal depression, whilst preventive approaches might target preceding maternal anxiety as early as prior to or during pregnancy.
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Greene MM, Rossman B, Meier P, Patra K. Elevated maternal anxiety in the NICU predicts worse fine motor outcome in VLBW infants. Early Hum Dev 2018; 116:33-39. [PMID: 29127891 PMCID: PMC8114942 DOI: 10.1016/j.earlhumdev.2017.10.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/15/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022]
Abstract
AIM The literature is sparse with respect to the impact of elevated maternal psychological distress in the neonatal intensive care unit (NICU) on later neurodevelopmental outcome in VLBW infants. The objective of this study is to examine the impact of elevated maternal distress, defined as elevated depression, anxiety and perinatal-specific post-traumatic stress, during the NICU hospitalization on VLBW infant ND outcome at 20months corrected age (CA). METHODS This was a prospective study of 69 mothers and their VLBW infants recruited in 2011-2012. Elevated maternal distress was collected by maternal questionnaire in the NICU. Elevated depression was quantified with the Center for Epidemiological Studies-Depression Scale, anxiety with the Spielberger State-Trait Anxiety Inventory and perinatal-specific post-traumatic stress with the Modified Perinatal Posttraumatic Stress Disorder Questionnaire. VLBW infant ND outcome was assessed using the Bayley Scales of Infant & Toddler Development-III at 20months CA. Regression analyses determined the impact of elevated distress on ND outcome after adjusting for infant medical and maternal sociodemographic variables. RESULTS After controlling for infant and maternal covariates, elevated maternal anxiety in the NICU predicted lower fine motor scores at 20months CA. CONCLUSION Elevated maternal anxiety in the NICU is associated with adverse ND outcome in VLBW infants in the 2nd year of life. NICU-based support services may help mothers' quality of life and VLBW infant outcome.
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Affiliation(s)
- Michelle M. Greene
- Department of Behavioral Sciences, Rush University Medical Center, 1653 W Congress Parkway, 1200 Kellogg Building, Chicago, IL 60612, United States,Department of Pediatrics, Rush University Medical Center, 1653 W Congress Parkway, 1200 Kellogg Building, Chicago, IL 60612, United States,Corresponding author at: Department of Pediatrics, Rush University Medical Center, 1653 W Congress Parkway, 1200 Kellogg Building, Chicago, IL 60612, United States. (M.M. Greene)
| | - Beverly Rossman
- College of Nursing, Rush University Medical Center, Chicago, IL, United States
| | - Paula Meier
- College of Nursing, Rush University Medical Center, Chicago, IL, United States
| | - Kousiki Patra
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
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Pinto TM, Caldas F, Nogueira-Silva C, Figueiredo B. Maternal depression and anxiety and fetal-neonatal growth. J Pediatr (Rio J) 2017; 93:452-459. [PMID: 28219626 DOI: 10.1016/j.jped.2016.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Maternal depression and anxiety have been found to negatively affect fetal and neonatal growth. However, the independent effects of maternal depression and anxiety on fetal-neonatal growth outcomes and trajectories remain unclear. This study aimed to analyze simultaneously the effects of maternal prenatal depression and anxiety on (1) neonatal growth outcomes, and (2), on fetal-neonatal growth trajectories, from the 2nd trimester of pregnancy to childbirth. METHODS A sample of 172 women was recruited and completed self-reported measures of depression and anxiety during the 2nd and 3rd trimesters of pregnancy, and at childbirth. Fetal and neonatal biometrical data were collected from clinical reports at the same assessment moments. RESULTS Neonates of prenatally anxious mothers showed lower weight (p=0.006), length (p=0.025), and ponderal index (p=0.049) at birth than neonates of prenatally non-anxious mothers. Moreover, fetuses-neonates of high-anxiety mothers showed a lower increase of weight from the 2nd trimester of pregnancy to childbirth than fetuses-neonates of low-anxiety mothers (p<0.001). Considering maternal depression and anxiety simultaneously, only the effect of maternal anxiety was found on these markers of fetal-neonatal growth outcomes and trajectories. CONCLUSION This study demonstrates the independent longitudinal effect of maternal anxiety on major markers of fetal-neonatal growth outcomes and trajectories, simultaneously considering the effect of maternal depression and anxiety.
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Affiliation(s)
| | - Filipa Caldas
- Universidade do Minho, Escola de Ciências da Saúde, Braga, Portugal
| | - Cristina Nogueira-Silva
- Universidade do Minho, Escola de Ciências da Saúde, Instituto de Pesquisa em Ciências de Vida e Saúde (ICVS), Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Hospital de Braga, Departamento de Obstetrícia e Ginecologia, Braga, Portugal
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