Maternal Psychological Stress Research Articles

Maternal Psychological Stress after Prenatal Diagnosis of Congenital Heart Disease

To determine whether prenatal diagnosis of congenital heart disease (CHD) increases maternal stress. Self-report instruments were administered to mothers carrying a fetus with CHD. Domains included: (1) traumatic stress (Impact of Events Scale-Revised); (2) depression (Beck Depression Index II); and (3) anxiety (State-Trait Anxiety Index). Modifiers included: (1) coping skills (COPE Inventory); (2) partner satisfaction (Dyadic Adjustment Scale); and (3) demographics. Multivariate linear regression models were used to assess relationships between stress measures and modifiers. Fifty-nine mothers (gestational age 27 ± 3 weeks) completed all measures. Clinically important traumatic distress was seen in 39%, depression in 22%, and state anxiety in 31%. Lower partner satisfaction was associated with higher depression (P < .01) and higher anxiety (P < .01). After controlling for partner satisfaction and income, "denial" was most associated with increased traumatic stress, anxiety, and depression (P < .01). Posttraumatic stress, depression, and anxiety are common after prenatal diagnosis of CHD. Healthy partner relationships and positive coping mechanisms can act as buffers.

Relaxation therapy for preventing and treating preterm labour

Preterm birth (PTB) is a leading cause of perinatal mortality and morbidity. Although the pathogenesis of preterm labour (PTL) is not well understood, there is evidence about the relationship between maternal psychological stress and adverse pregnancy outcomes. Relaxation or mind-body therapies cover a broad range of techniques, e.g. meditation, massage, etc. There is no systematic review investigating the effect of relaxation techniques on preventing PTL and PTB. This review does not cover hypnosis as this is the subject of a separate Cochrane review. To assess the effectiveness of relaxation therapies for preventing or treating PTL and preventing PTB. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 December 2011),CENTRAL (2011, Issue 4 of 4), CINAHL (1982 to 14 December 2011) and contacted study authors for additional information. Randomized controlled trials, cluster- and quasi-randomized trials comparing relaxation techniques with usual care, no treatment or sham interventions to prevent or treat PTL. Two review authors (B Khianman (BK) and P Pattanittum (PP)) independently assessed all search results for potential inclusion studies. Disagreements were resolved by discussion with a third review author (J Thinkhamrop (JT)). Data were independently extracted onto the standardized data collection form by BK and PP and checked for accuracy. Two review authors independently assessed the risk of bias of all included studies. All differences were resolved by discussion with JT. Mean difference (MD) and its 95% confidence intervals (CI) were calculated for continuous outcomes and risk ratio (RR) and 95% CI for dichotomous data. Eleven randomized controlled trials with a total of 833 women were included in this review. However, the results of this review are based on single studies with small numbers of participants.The majority of included studies reported insufficient information on sequence generation, allocation concealment as well as blinding. There were no included studies that assessed PTL or PTB as the primary outcome. The included studies were different in terms of intervention, practice, and time, and there were no clear coherent hypotheses.For women not in PTL, the benefits of relaxation was found in one study for maternal stress (Anxiety Stress Scale) at 26 to 29 weeks gestational age (mean difference (MD) -7.04; 95% confidence interval (CI) -13.91 to -0.17). In addition, there were some beneficial effects of relaxation including baby birthweight (MD 285.00 g; 95% CI 76.94 to 493.06); type of delivery; (vaginal delivery; risk ratio (RR) 1.52; 95% CI 1.13 to 2.04), (cesarean section; RR 0.38; 95% CI 0.19 to 0.78); maternal anxiety (MD -15.79; 95% CI -18.33 to -13.25); and stress (MD -13.08; 95% CI -15.29 to -10.87) when applying relaxation therapy together with standard treatment. For women in PTL, the results for the main outcome of PTB in the intervention and control groups from a single study were not different (RR 0.95; 95% CI 0.57 to 1.59). The MD of birthweight in grams from the fixed-effect model from two included studies was MD -5.68; (95% CI -174.09 to 162.74). According to the results of this review, there is some evidence that relaxation during pregnancy reduces stress and anxiety. However, there was no effect on PTL/PTB. These results should be interpreted with caution as they were drawn from included studies with limited quality.

Maternal stress in pregnancy: considerations for fetal development.

There is significant current interest in the degree to which prenatal exposures, including maternal psychological factors, influence child outcomes. Studies that detect an association between prenatal maternal psychological distress and child developmental outcomes are subject to a number of interpretative challenges in the inference of causality. Some of these are common to many types of prenatal exposures that must necessarily rely on observational designs. Such challenges include the correlation between prenatal and postnatal exposures and the potential role of other sources of shared influence, such as genetic factors. Others are more specific to this area of research. These include confounding between maternal report of child outcomes and the maternal psychological attributes under study, difficulties in distinguishing maternal stress from more ubiquitous aspects of maternal personality, and the lack of association between cortisol and measures of maternal psychological stress. This article considers these methodological issues and offers an additional methodology focused on fetal neurobehavior for discerning potential mechanisms that may mediate associations between maternal psychological functioning and the developing fetal nervous system.

Risk factors in the occurrence of molar–incisor hypomineralization amongst a group of Iraqi children

BACKGROUND. Despite the worldwide increasing interest in the prevalence studies of molar-incisor hypomineralization (MIH), there is still insufficient evidence to verify the aetiological factors of this condition. AIMS. To investigate risk factors involved in the development of MIH in a group of school-aged Iraqi children. DESIGN. Seven- to nine-year-old school children (823 of 1000 eligible, response rate of 82.3%) had their first permanent molars and incisors evaluated using the European Academy of Paediatric Dentistry evaluation criteria for MIH. Mothers completed a medical history questionnaire-based interview performed in the schools by a trained examiner. RESULTS. For children with MIH, 6% reported no relevant medical history; the remaining 94% reported various medical conditions putatively associated with MIH compared with 70% for the non-affected group. Post-natal medical conditions (33.3%) were most frequently reported. When data were split into the possible risk effect groups, maternal psychological stress (OR, 3.24), frequent exposure to ultrasonic scans during the last gestational trimester (OR, 2.51) and birth order as a fourth sibling or later (OR, 3.17 and 5.73, respectively) were previously unreported significant risk factors and postulated as contributing to, or causing the defect. CONCLUSIONS. Children with MIH had experienced a greater number of medical conditions than their unaffected peers with no single health event identified as a risk factor.

P-1390 - Prenatal stress and affective disorders in a population birth cohort

Maternal psychological stress during pregnancy has been associated with the risk for mood disorders in offspring, although there is no consensus about the influence of the timing of the stress on outcomes. We examined the relationship of prenatal stress at specific times in pregnancy to the incidence of mood disorders in offspring using data from a large birth cohort. We linked data on 90,079 offspring born in Jerusalem in 1964–76 to Israel's psychiatric registry. We used proportional hazards models to evaluate the link between discharge diagnoses and gestational age during the Arab-Israeli war of June, 1967. Those in their first trimester of fetal development during the war were significantly more likely to be admitted to hospitals for any mood disorders (RR = 3.01, 1.68–5.39, p = .0002), and the subgroups of bipolar disorder (2.44; 1.0–5.99; p = .054) and “other” mood disorders (3.61; 1.68–7.80; p = .001). Mood disorders were substantially increased in offspring whose mothers had been in the third month of pregnancy in June, 1967 (5.54, 2.73–11.24, p < .0001). These findings suggest that acute maternal stress in early pregnancy may contribute to the etiology of mood disorders in offspring. They point to the third month of fetal development as a moment of special vulnerability.

Polymorphisms of stress‐related genes and the risk of nonsyndromic cleft lip with or without cleft palate

Nonsyndromic cleft lip with or without cleft palate (NCL/P) is a common structural malformation with a complex and multifactorial etiology. It has been shown that maternal psychological stress in the periconceptional period can contribute to an increase in the risk of NCL/P affecting pregnancy. Twenty-four single nucleotide polymorphisms of 11 stress-related genes (COMT, CRHR1, FKBP5, GABRA6, HSD11β2, MAOA, NPY, NR3C1, SERPINA6, SLC6A4, and TPH2) were investigated in 220 healthy mothers of children with facial clefts and 210 matched controls using restriction fragment-length polymorphism and high-resolution melting analysis. We found that polymorphisms in SLC6A4, TPH2, and SERPINA6 appear to be maternal factors increasing the risk of having a child with facial clefts. The closest correlations with NCL/P were found for the SLC6A4 rs2020942 and TPH2 rs10879357 gene variants (odds ratio [OR], 1.720; 95% confidence interval [CI], 1.158-2.553; p = 0.0069; p(trend) = 0.0036; and OR, 1.837; 95% CI, 1.226-2.753, p = 0.0030, p(trend) = 0.0057; respectively). Moreover, haplotype analysis revealed that several combinations of markers in SLC6A4, TPH2, and SERPINA6 might be significantly associated with the risk of NCL/P affected pregnancies. However, these associations were not statistically significant after correction for multiple testing. This study suggests that nucleotide variants of genes encoding components of the hypothalamus-pituitary-adrenal axis and serotoninergic system have a role in the etiology of NCL/P in the Polish population. SLC6A4, TPH2, and SERPINA6 might be novel candidate genes for this common congenital anomaly.

Prenatal Maternal Stress and the Developing Fetus and Infant: A Review of Animal Models as Related to Human Research

Prenatal stress, a function of severe maternal psychological or physiological stress, including trauma and illness, can influence the development of the fetus in profound ways, extending into childhood and adulthood. Maternal trauma, acute and chronic, physiological and emotional, can create an environment for the fetus that may disrupt development in the womb, potentially setting the infant on a path of maladaptive reactivity to stressors in the world beyond. Prenatal stress influences psychological systems, including attachment, affect, and stress regulation; physiological systems, including endocrine and cardiovascular systems; and even neuroanatomical structure. This article reviews some of the findings from animal models associated with this important line of research and indicates the critical nature of early intervention for families such as those described in this issue on the Project for Mothers, Infants, and Young Children of September 11, 2001.

The Ages & Stages Questionnaire: Social-Emotional: A validation study of a mother-report questionnaire on a clinical mother-infant sample.

Mother-report questionnaires of infant socioemotional functioning are increasingly used to screen for clinical referral to infant mental health services. The validity of the Ages & Stages Questionnaire: Social Emotional (ASQ:SE; J. Squires, D. Bricker, K. Heo, & E. Twombly, 2002) was investigated in a sample of help-seeking mothers with young infants. It was compared with independent observer-rated dyadic interactions, and the quality of dyadic relationships was rated by expert clinicians. The ASQ:SE ratings also were compared with questionnaires on maternal psychological stress and distress. The ASQ:SE did not correlate significantly with either external ratings of dyadic interaction or clinically assessed relationship qualities, though the latter two were strongly associated with each other. In contrast, ASQ:SE scores were associated with questionnaires relating to maternal psychological distress. This was especially true for mothers classified as depressed. Furthermore, reports on the ASQ:SE were strongly predicted by maternal stress. The study points to some problems with the concurrent validity of the ASQ:SE in clinical samples. It also demonstrates a close link between mothers' psychological distress and their ratings of infant social and emotional functioning. Further research should investigate the extent to which the ASQ:SE specifically measures infant functioning or maternal distress, and how it functions in clinical versus nonclinical samples.

Characterization of the Cognitive Impairments Induced by Prenatal Exposure to Stress in the Rat

We have previously shown that male rats exposed to gestational stress exhibit phenotypes resembling what is observed in schizophrenia, including hypersensitivity to amphetamine, blunted sensory gating, disrupted social behavior, impaired stress axis regulation, and aberrant prefrontal expression of genes involved in synaptic plasticity. Maternal psychological stress during pregnancy has been associated with adverse cognitive outcomes among children, as well as an increased risk for developing schizophrenia, which is characterized by significant cognitive deficits. We sought to characterize the long-term cognitive outcome of prenatal stress using a preclinical paradigm, which is readily amenable to the development of novel therapeutic strategies. Rats exposed to repeated variable prenatal stress during the third week of gestation were evaluated using a battery of cognitive tests, including the novel object recognition task, cued and contextual fear conditioning, the Morris water maze, and iterative versions of a paradigm in which working and reference memory for both objects and spatial locations can be assessed (the “Can Test”). Prenatally stressed males were impaired relative to controls on each of these tasks, confirming the face validity of this preclinical paradigm and extending the cognitive implications of prenatal stress exposure beyond the hippocampus. Interestingly, in experiments where both sexes were included, the performance of females was found to be less affected by prenatal stress compared to that of males. This could be related to the finding that women are less vulnerable than men to schizophrenia, and merits further investigation.

Prenatal antecedents of newborn neurological maturation.

Fetal neurobehavioral development was modeled longitudinally using data collected at weekly intervals from 24 to 38 weeks gestation in a sample of 112 healthy pregnancies. Predictive associations between 3 measures of fetal neurobehavioral functioning and their developmental trajectories to neurological maturation in the first weeks after birth were examined. Prenatal measures included fetal heart rate (FHR) variability, fetal movement, and coupling between fetal motor activity and heart rate patterning; neonatal outcomes include a standard neurologic examination (n = 97) and brainstem auditory evoked potential (BAEP; n = 47). Optimality in newborn motor activity and reflexes was predicted by fetal motor activity, FHR variability, and somatic-cardiac coupling predicted BAEP parameters. Maternal pregnancy-specific psychological stress was associated with accelerated neurologic maturation.

446: Maternal psychological stress (MPS) as a novel causative and modifiable risk factor in preterm birth (PTB)

Most interventions to predict and prevent PTB have focused on biochemical and physical changes that occur too late to achieve a difference. MPS has been shown to affect the maternal and fetal hypothalamic-pituitary-adrenal axes, and stress is a known immune system modulator. We sought to quantify MPS in women with PTB using readily available risk factors and compare to a control group that had term deliveries.

The Moderating Effects of Maternal Psychopathology on Children's Adjustment Post–Hurricane Katrina

This study investigated the role of maternal psychopathology in predicting children's psychological distress in a disaster-exposed sample. Participants consisted of 260 children (ages 8–16) recruited from public schools and their mothers. These families were displaced from New Orleans because of Hurricane Katrina in 2005. Assessment took place 3 to 7 months postdisaster. Hierarchical regression analyses revealed that global maternal psychological distress and maternal posttraumatic stress disorder moderated the relation between child hurricane exposure and mother-reported child internalizing and externalizing symptoms.

Short-term maternal psychological stress in the post-conception period in ewes affects fetal growth and gestation length

Fetal development can be influenced by maternal environment in the peri-conceptional period. This study investigated the effect of maternal feed intake and psychological stress within the first 6 days after conception on embryo development and fetal growth. Superovulated ewes (n=40) were artificially inseminated with semen from one ram. Ewes were then divided into four groups (n=10): group 1 (control) was fed at maintenance level, group 2 (high) at 2x maintenance, and group 3 (low) at 0.5x maintenance on days 2-6 after conception. Group 4 (stress) was fed at maintenance level and then an intense physical and psychological stress challenge was applied for 1 h only on days 2 and 3 after conception. Embryos were recovered at day 6. A total of 113 transferable grade embryos were transferred singly into synchronized untreated recipients, while the remaining embryos (n=165) were fixed and stained for cell counts. Post-conception maternal stress or feed intake did not alter the cell count or grade of day 6 embryos. Fetuses from the stress group had longer crown-rump lengths at day 30 and longer femur length at day 58. Fetuses from the stressed and high feed groups had greater abdominal circumferences at day 85. Subsequent birth weights were not significantly different. Ewes carrying lambs from the stress treatment had shorter gestation lengths. These results show that short-term perturbations of the post-conception maternal environment have measurable effects on fetal development and gestation length.

Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants

(1) To compare maternal characteristics and psychological stress profile among African-American, Caucasian and Hispanic mothers who delivered very low birthweight infants. (2) To investigate associations between psychosocial factors, frequency of milk expression, skin-to-skin holding (STS), and lactation performance, defined as maternal drive to express milk and milk volume. Self-reported psychological questionnaires were given every 2 weeks after delivery over 10 weeks. Milk expression frequency, STS, and socioeconomic variables were collected. Infant birthweight, education, and milk expression frequency differed between groups. Trait anxiety, depression and parental stress in a neonatal intensive care unit (PSS:NICU) were similar. African-American and Caucasian mothers reported the lowest scores in state anxiety and social desirability, respectively. Maternal drive to express milk, measured by maintenance of milk expression, correlated negatively with parental role alteration (subset of PSS:NICU) and positively with infant birthweight and STS. Milk volume correlated negatively with depression and positively with milk expression frequency and STS. Differences between groups were observed for certain psychosocial factors. The response bias to self-reported questionnaires between groups may not provide an accurate profile of maternal psychosocial profile. With different factors correlating with maintenance of milk expression and milk volume, lactation performance can be best enhanced with a multi-faceted intervention program, incorporating parental involvement in infant care, close awareness and management of maternal mental health, and encouragement for frequent milk expression and STS.

Possible interactions of genetic and immuno-neuro-endocrine regulatory mechanisms in pathogenesis of congenital anomalies

The process of organogenesis depends on genetic and environmental factors. Besides genetic background, congenital anomalies can also be influenced by micro environmental changes, which are related to maternal-foetal interactions followed by the production of cytokines, hormones, neurotransmitters, growth factors and biochemical mediators, and stress proteins. Pre-natal maternal stress, including infections, psychological stress and other teratogens, can influence a disregulation of maternal immune, endocrine and nervous systems, during pregnancy. This is a crucial condition for the abnormal growth and development of the foetus. Activated maternal immune system can alter the cytokine network and make it inadequate for normal embryogenesis and organogenesis. Heat-shock proteins play an important role in stress physiology repairing DNA errors or activating pro-inflammatory response. Regarded from this aspect, the altered cytokine network suggests aetiopathogenetic basis of congenital anomalies in neonates. It is our wish to point out our potentially harmful conditions in the development of congenital anomalies, as well as their control by using pre-natal and pre-conceptional diagnostics and treatment.

Maternal posttraumatic stress response after the birth of a very low-birth-weight infant

Objective For parents, the premature birth of a child represents a traumatic event for which they are poorly prepared. To date, the focus of scientific interest has been on maternal psychological stress responses, such as anxiety and depression, or on appropriate coping mechanisms, whereas only scant attention has been paid to the traumatic aspect of the maternal experience after very low-birth-weight (VLBW) birth. The present study is the first to investigate the posttraumatic stress response of mothers after the birth of a VLBW infant in a prospective longitudinal study. Methods Fifty mothers of VLBW infants were examined at four measuring time points (1–3 days pp, 14 days pp and 6 and 14 months pp) with respect to posttraumatic symptoms [Impact of Event Scale (IES-R)], psychiatric diagnosis (SKID I for DSM-IV) and the extent of depression [Beck Depression Inventory (BDI) and Montgomery Asberg Depression Scale (MADRS)] and anxiety [State–Trait Anxiety Inventory (STAI) and Hamilton Anxiety Scale (HAMA)]. The control group comprised a group of 30 mothers after the uncomplicated spontaneous birth of a healthy child. Results At all four measuring timepoints (except 6 months pp), the mothers of the premature infants recorded significantly higher values for traumatic experience and depressive symptoms and anxiety compared with the controls. In contrast to the mothers in the control group, the mothers of the premature infants displayed no significant reduction in posttraumatic symptoms (IES-total), even 14 months after birth. Conclusion The results indicate that the situation of a mother who has given birth to a VLBW infant is a complex, with long-term traumatic event necessitating ongoing emotional support extending beyond the period immediately after the birth.

Fetal response to induced maternal stress

Background: Despite increased attention to the role of antenatal maternal psychological stress in postnatal development, remarkably little information is available on the nature of the intrauterine fetal response to maternal psychological state. Aims: To determine whether: (1) the fetus responds to maternal stress; (2) the fetal response changes over gestation; and (3) individual maternal and fetal response patterns are stable over time. Study design: Induced maternal stress at 24 and 36 weeks gestational age using the Stroop color–word task. Subjects: 137 low-risk pregnant women with normally developing fetuses. Outcome measures: Maternal (heart rate and skin conductance) and fetal (heart rate, heart rate variability, and motor activity) responses. Results: The manipulation evoked maternal sympathetic activation, which declined in magnitude from 24 to 36 weeks gestation. Fetuses responded to the manipulation with increased variability in heart rate ( F(2,256)=7.80, p<0.001) and suppression of motor activity ( F(2,216)=15.47, p<0.001). The magnitude of the fetal response increased over gestation. The degree of maternal reactivity to and recovery from the stressor were correlated over time ( r's=0.53 and 0.60 for heart rate; r's=0.31 and 0.36 for skin conductance; p's<0.001). There was moderate stability in the magnitude of the fetal motor response ( r=0.25, p<0.01). Conclusions: Demonstration of fetal responses to maternal sympathetic activation evoked by a benign cognitive stressor suggests that fetal neurobehavioral regulation is routinely disrupted by maternal environmental intrusions. There is no evidence of a protective effect of diminished maternal sensitivity to stress on the fetus. Individual stability in the magnitude of the evoked maternal physiologic and psychological responses from 24 to 36 weeks and stability in the fetal motor response implies that characteristic response patterns emerge in utero. We propose that autonomic development is partially entrained through these processes.

Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation.

To evaluate: (1) the associations between maternal psychological stress, distress and low birth weight (LBW), prematurity and intrauterine growth retardation (IUGR); (2) the interactions between maternal stress, distress and smoking, alcohol and coffee intake; (3) the prevalences of stress and distress in pregnancy. Longitudinal cohort study. Jundiaí city, São Paulo state, Brazil. A total of 865 pregnant women who attended antenatal care between September 1997 and August 2000. Measures of stress and distress were obtained, by interview, three times in pregnancy: at a gestational age (GA) lower than 16 weeks, from 20 to 26 weeks and from 30 to 36 weeks. Stress was investigated by the perceived stress scale, PSS, and distress by both the general health questionnaire, GHQ, and the State Trait Anxiety inventories, STAI. The outcomes were: LBW (birth weight <2500 g), prematurity (gestational age (GA) at birth <37 weeks) and IUGR (birth weight for GA <or=10th percentile of William's curve). The associations between the outcomes and the psychological measures were assessed in multiple logistic regression models. Maternal distress was associated with LBW (RR=1.97, P=0.019) and prematurity (RR=2.32, P=0.015), respectively. There was an interaction between distress and smoking in the second interview (P=0.05). The prevalences of stress and distress in the different interviews of pregnancy varied from 22.1 to 52.9%. The present study has confirmed that distress is associated with both birthweight and GA. Further research is needed to evaluate the effectiveness of psychological interventions that can improve maternal and foetal well-being.

Stress and preterm birth: neuroendocrine, immune/inflammatory, and vascular mechanisms.

A growing literature suggests that maternal psychological and social stress is a significant and independent risk factor for a range of adverse reproductive outcomes including preterm birth. Several issues remain to be addressed about stress and vulnerability to stress during pregnancy. Of these, perhaps one of the most important questions relates to biologic plausibility. Parturition, the process that results in birth, is a biological phenomenon. Very little empirical research to date, however, has examined the role of biological processes, if any, as mediators of the relationship between stress and preterm birth. In this paper we discuss the maternal, placental, and fetal neuroendocrine, immune/inflammatory, and vascular processes that may bridge the experience of social adversity before and during pregnancy and the biological outcome of preterm birth.

Birth weight and environmental pollution in the county of Telemark, Norway.

The possible effect of environmental pollution on fetal growth was examined in 3,231 consecutively liveborn single infants (>/=37 weeks' gestation) of Caucasian parents born between 1986 and 1988. The parents lived in an industrial area or in less polluted urban and rural residential areas. Information about lifestyle, health, and work exposures was collected from the parents. A significantly lower arithmetic mean birth weight was observed for newborns in the industrial residential area (3,517 g, SD, 482), compared with the urban (3,592 g, SD 495) and rural (3,618 g, SD 517) areas (P < 0.05). Even controlling for gestational age, sex, parity, maternal smoking habits, and social class, residential area still had a significant effect on birth weight. Among other factors examined, only maternal psychological stress at work had a significant effect on birth weight. If the observed association reflects a causal relationship, birth weight may represent a potential outcome parameter for surveillance of effects on humans of environmental exposures.