Abstract
Maternal mental disorders over pregnancy show a clear influence on child development. This review is focused on the possible mechanisms by which maternal mental disorders influence fetal development via programming effects. This field is complex since mental health symptoms during pregnancy vary in type, timing and severity and maternal psychological distress is often accompanied by higher rates of smoking, alcohol use, poor diet and lifestyle. Studies are now beginning to examine fetal programming mechanisms, originally identified within the DOHaD framework, to examine how maternal mental disorders impact fetal development. Such mechanisms include hormonal priming effects such as elevated maternal glucocorticoids, alteration of placental function and perfusion, and epigenetic mechanisms. To date, mostly high prevalence mental disorders such as depression and anxiety have been investigated, but few studies employ diagnostic measures, and there is very little research examining the impact of maternal mental disorders such as schizophrenia, bipolar disorder, eating disorders and personality disorders on fetal development. The next wave of longitudinal studies need to focus on specific hypotheses driven by plausible biological mechanisms for fetal programming and follow children for a sufficient period in order to examine the early manifestations of developmental vulnerability. Intervention studies can then be targeted to altering these mechanisms of intergenerational transmission once identified.
Highlights
Maternal mental disorders are known to be a major complication of pregnancy [1] and there is already substantial evidence from cohort studies that there are important implictions for child development [2,3].the specific mechanisms driving poor child outcomes are not well understood
Fetal growth is a complex process that is regulated by a variety of factors including maternal and fetal genetics, maternal health and nutrition that determines nutrient and oxygen availability to the fetus, maternal endocrine systems and the functioning of the utero-placental system [46,55]
Birth size is not an ideal proxy for fetal development since variation of growth within pregnancy is not captured [33,57] and there are several distinct patterns of fetal growth restriction that impact on different parameters of growth
Summary
Maternal mental disorders are known to be a major complication of pregnancy [1] and there is already substantial evidence from cohort studies that there are important implictions for child development [2,3]. Women who are depressed in pregnancy are more likely to use psychotropic medications [13] and this adds major complication to research into fetal exposures [21,22,23]. To date the most comprehensive investigations have been undertaken examining antidepressant use in pregnancy it is unclear whether this is associated with effects on fetal development either in terms of reducing depressive symptoms and thereby reducing any negative impact of maternal depression on the fetus, or showing subtle adverse effects on fetal development [24,25,26]. Given the increasing use of antidepressants during pregnancy to treat maternal depression and anxiety [27], the influence of antidepressants on fetal development and child outcomes is of particular clinical interest [13,26]. These are pertinent when considering that dietary and lifestyle enhancement are highly feasible and promising interventions which may even preserve optimal fetal development in the context of maternal psychological distress, such approaches require further development and evaluation [33]
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