Prenatal Anxiety Symptoms Research Articles

Prenatal paternal anxiety symptoms predict child DHEA levels and internalizing symptoms during adrenarche.

This study examined (1) whether measures of paternal anxious and depressive symptoms collected prenatally and during a follow-up assessment when the child was in middle childhood, predict child neuroendocrine outcomes, and (2) whether neuroendocrine outcomes are intermediate factors between paternal mental health and child cognitive/behavioral outcomes. Middle childhood coincides with increased autonomy as the child transitions into grade school, and with adrenarche, as the maturing adrenal gland increases secretion of dehydroepiandrosterone (DHEA) and its sulfated metabolite (DHEA-S), hormones that are implicated in corticolimbic development which regulate emotions and cognition. Participants were recruited from a subsample of a large prospective birth cohort study (3D study). We conducted a follow-up study when children were 6-8 years old (N = 61 families, 36 boys, 25 girls). Parental symptoms of anxiety, stress and depression were assessed via validated self-report questionnaires: prenatally using an in-house anxiety questionnaire, the Perceived Stress Scale (PSS) and the Center for Epidemiologic Studies Depression (CES-D), and at the follow up, using the Beck Anxiety and Beck Depression Inventories. Children provided salivary hormone samples, and their pituitary gland volume was measured from structural Magnetic Resonance Imaging (MRI) scans. Child behaviors were measured using the Strengths and Difficulties Questionnaire and cognitive outcomes using the WISC-V. Multiple regression analyses were used to test whether paternal mental health symptoms assessed prenatally and during childhood are associated with child neuroendocrine outcomes, adjusting for maternal mental health and child sex. Indirect-effect models assessed whether neuroendocrine factors are important intermediates that link paternal mental health and cognitive/behavioral outcomes. (1) Fathers' prenatal anxiety symptoms predicted lower DHEA levels in the children, but not pituitary volume. (2) Higher prenatal paternal anxiety symptoms predicted higher child internalizing symptoms via an indirect pathway of lower child DHEA. No associations were detected between paternal anxiety symptoms measured in childhood, and neuroendocrine outcomes. No child sex differences were detected on any measure. These results highlight the often-overlooked role of paternal factors during pregnancy on child development, suggesting that paternal prenatal anxiety symptoms are associated with child neuroendocrine function and in turn internalizing symptoms that manifest at least up to middle childhood.

Effects of a structured Tai Chi program on improving physical activity levels, exercise self-efficacy and health outcomes among pregnant women: study protocol for a randomised controlled trial

IntroductionTai Chi is a traditional Chinese martial art developed over 300 years ago. Although studies report that Tai Chi benefits practitioners’ cardiovascular health, respiratory system and psychological outcomes, only limited...

Associations between Self-Rated Health and Perinatal Depressive and Anxiety Symptoms among Latina Women.

Purpose: The objective of this study was to determine whether decreases in or consistently low preconception to pregnancy self-rated health (SRH) were associated with perinatal depressive and anxiety symptoms among Latinas. Methods: This is a secondary data analysis of 153 perinatal Latinas. Three groups were created to capture SRH from preconception to pregnancy: a decline in ratings, consistently low, and good+ (i.e., good, very good, or excellent). SRH was measured using two questions about their perceived physical health before and during pregnancy. Depressive symptoms and anxiety symptoms were assessed in the third trimester and six weeks postpartum using the Edinburgh Postnatal Depression Scale and State-Trait Anxiety Inventory, respectively. Life stressors were assessed in pregnancy using a modified version of the Life Experiences Survey. Linear regressions tested the associations. Results: Women with consistently low (i.e., fair or poor) SRH reported significantly more prenatal depressive symptoms than women who reported consistently good+ SRH. Women who reported a decline in SRH to fair or poor reported more prenatal anxiety symptoms but decreased postpartum anxiety symptoms than women who reported consistently good+ ratings. Life stressors were positively associated with prenatal depressive and anxiety symptoms. Conclusions: Healthcare practitioners should assess changes in SRH ratings to identify risks for prenatal depressive and anxiety symptoms among Latinas, who have elevated rates of depressive and anxiety symptoms compared to non-Hispanic White women. Policymakers should provide healthcare providers with mental health resources to support at-risk Latinas during the prenatal period.

Psychological Interventions for Prenatal Anxiety in Latinas and Black Women: A Scoping Review and Recommendations.

Anxiety symptoms are common among pregnant women worldwide. In the United States, prenatal anxiety symptoms tend to be elevated among Black and Latin American women as compared to non-Latina White women. Despite the high prevalence of anxiety and associations with adverse maternal and offspring outcomes, interventions have not been developed or tailored sufficiently to Black women or Latinas who need efficacious treatment. This article provides a scoping review of articles published since 2017 that test the effects of randomized and non-randomized psychological interventions designed to reduce prenatal anxiety in samples comprised primarily of ethnic/racial minority women. We also review published protocols of planned psychological interventions to reduce prenatal anxiety in order to highlight novel approaches. In addition to summarizing intervention efficacy and participant acceptability, we highlight gaps in the literature which, if addressed, could improve perinatal mental health equity. Finally, we discuss future directions in prenatal anxiety intervention science beginning preconception including intervention design and prevention models.

Investigating prenatal perceived support as protective factor against adverse birth outcomes: a community cohort study

ABSTRACT Background Studies show that prenatal maternal anxiety may act as a risk factor for adverse birth outcomes, whilst prenatal social support may rather act as a protective factor. However, studies examining prenatal anxiety symptoms, prenatal perceived support, and neonatal and/or obstetric outcomes are lacking. Objective This study investigated whether, in a community sample, prenatal perceived support: (1) had a protective influence on birth outcomes (gestational age (GA), birthweight (BW), 5-minute Apgar score, and mode of delivery); (2) acted as a protective factor, moderating the relationship between anxiety symptoms and the aforementioned birth outcomes. Method During their third trimester of pregnancy, 182 nulliparous child-bearers completed standardized questionnaires of anxiety (HADS-A) and perceived support (MOS-SSS). Birth outcomes data was extracted from medical records. Results (1) Perceived support did not significantly predict any birth outcomes. However, perceived tangible support – MOS-SSS subscale assessing perceived material/financial aid – significantly positively predicted the 5-minute Apgar score. (2) Perceived support did not significantly moderate the relationship between anxiety symptoms and birth outcomes. However, perceived tangible support significantly moderated the relationship between anxiety symptoms and the 5-minute Apgar score. Conclusion When experienced within non-clinical thresholds, prenatal anxiety symptoms do not increase the risk of adverse neonatal and obstetric outcomes when perceived support is present.

The Impact of the COVID-19 Pandemic on Pregnant Women with Perinatal Anxiety Symptoms in Pakistan: A Qualitative Study.

The impact of coronavirus disease 2019 (COVID-19) on people with existing mental health conditions is likely to be high. We explored the consequences of the pandemic on women of lower socioeconomic status with prenatal anxiety symptoms living in urban Rawalpindi, Pakistan. This qualitative study was embedded within an ongoing randomized controlled trial of psychosocial intervention for prenatal anxiety at a public hospital in Rawalpindi. The participants were women with symptoms of anxiety who had received or were receiving the intervention. In total, 27 interviews were conducted; 13 women were in their third trimester of pregnancy, and 14 were in their postnatal period. The data were collected through in-depth interviews and analyzed using framework analysis. Key findings were that during the pandemic, women experienced increased perinatal anxiety that was linked to greater financial problems, uncertainties over availability of appropriate obstetric healthcare, and a lack of trust in health professionals. Women experienced increased levels of fear for their own and their baby’s health and safety, especially due to fear of infection. COVID-19 appears to have contributed to symptoms of anxiety in women already predisposed to anxiety in the prenatal period. Efforts to address women’s heightened anxiety due to the pandemic are likely to have public health benefits.

Prenatal Anxiety and Depression: Treatment Uptake, Barriers, and Facilitators in Midwifery Care.

Background: While many women experience prenatal symptoms of anxiety and/or depression (PSAD), treatment uptake rates are relatively low. Left untreated, symptoms can unfavorably affect maternal and infant health. The first aim of this study was to identify the treatment uptake rate and modalities of treatment received in a community sample of Dutch pregnant women. The second aim was to investigate reasons for not engaging in treatment and to describe facilitators for treatment uptake. The third aim was to determine facilitators and barriers for self-disclosure of feelings to midwives. Materials and Methods: Data were collected from a convenience sample of 1439 Dutch women with low-risk mid-term pregnancies in midwifery care. PSAD was assessed with online questionnaires on symptoms. Reasons, facilitators, and barriers were determined with checklists and open questions. Data were analyzed using conventional content analysis and open code quantification. Results: Only 15% of women with PSAD (scoring above cutoffs; 22% of the full sample) received treatment. Psychotherapy was the most commonly received treatment. The main reason for not engaging in treatment was regarding PSAD as a natural part of pregnancy (71%). The main facilitator to engage in treatment was referral by midwives (16%), and for self-disclosure was the midwife asking about PSAD (59%), whereas not asking formed the main barrier for self-disclosure (23%). Conclusions: Relatively few pregnant women received treatment for PSAD. Midwives play an essential role in identifying and referring women for treatment. Routine screening may be a starting point to offer support and, if needed, referral.

Prenatal symptoms of anxiety and depression associated with sex differences in both maternal perceptions of one year old infant temperament and researcher observed infant characteristics

BackgroundSex differences in the behaviour of children exposed to prenatal maternal depression and anxiety have been reported. This study compared depression and anxiety symptoms reported by mothers at term with maternal perceptions of one year old male and female infant temperament and with researcher observed infant characteristics, identifying differences for males and females with both approaches. MethodsInfant behaviour and temperament was assessed via maternally completed questionnaires including Infant Behavioural Questionnaire Revised – Short form and by researcher administered subcomponents of Laboratory Temperament Assessment Battery and Bayley Scales of Infant Development III. ResultsFor female infants, higher prenatal scores for depression and anxiety were associated with maternal perceptions of lower bonding, higher aggression and negativity, and lower soothability (n = 67 mother-infant dyads). In the laboratory assessment, intensity of escape was the only female infant factor significantly associated with maternal mood (n = 41). For male infants, there was minimal association between prenatal mood scores and maternal perceptions (n = 46) whereas in the laboratory assessment (n = 35) depression scores were associated with expressive language, facial interest and facial fear while anxiety scores were associated with expressive and receptive language, parent behaviour and facial fear. LimitationsFindings may be restricted to a single ethnicity or mode of delivery. Fewer infants attended the infant assessment. A laboratory setting may mask symptomatology in females. ConclusionsAtypical maternal perceptions may present a barrier to the early identification of male infants impacted by maternal depression and anxiety.

Mediating Role of Labor on the Relationship Between Prenatal Psychopathologic Symptoms and Symptoms of Postpartum Depression in Women Who Give Birth Vaginally

ObjectiveTo investigate how prenatal symptoms of anxiety and depression and clinical aspects of labor (duration of labor, administration of oxytocin and epidural analgesia) interact with each other to contribute to symptoms of postpartum depression in women who give birth vaginally. DesignA longitudinal design with measurement at three different time points: Time 1, 31 to 32 weeks gestation; Time 2, the day of labor and birth; and Time 3, 1 month after birth. SettingMaternity ward of the Misericordia e Dolce Hospital in Prato, Italy. ParticipantsA total of 186 women at 31 to 32 weeks gestation were recruited during childbirth preparation courses at the maternity ward. MethodsAt Time 1, women completed the Beck Depression Inventory and the State portion of the State–Trait Anxiety Inventory. At Time 2, midwives recorded clinical data related to labor, including duration of labor and administration of oxytocin and epidural analgesia. At Time 3, the women completed the Edinburgh Postnatal Depression Scale. Structural equation modeling was performed. ResultsSymptoms of depression (β = 0.36; p < .001; 95% confidence interval [CI] [0.17, 0.49]) and state anxiety (β = 0.25; p < .001; 95% CI = [0.04, 0.27]) during pregnancy positively affected symptoms of depression after birth. Greater levels of these prenatal symptoms predicted a more complicated labor (depression: β = 0.29; p < .01; 95% CI [0.00, 0.19]; anxiety: β = 0.30; p < .01; 95% CI [0.01, 0.14]), which, in turn, positively predicted greater levels of symptoms of depression at 1 month after birth (β = 0.34; p < .001; 95% CI [0.38, 1.51]). Moreover, results highlighted indirect effects that high levels of anxiety symptoms during pregnancy have on postpartum symptoms of depression through the clinical aspects of labor (β = 0.10; p < .01; 95% CI [0.00, 0.13]). These indirect effects were not significant for antenatal symptoms of depression (β = 0.10; p < .05; 95% CI [–0.02, 0.20]). ConclusionOur findings confirm that symptoms of anxiety and depression during pregnancy represent significant risk factors for the clinical aspects of labor and for the development of symptoms of postpartum depression in the first month after childbirth.

Infant temperament and perinatal depressive and anxiety symptoms in Mexican women

AimThis study explores the association between infant temperament at six months postpartum and pre- and postpartum depressive and anxiety symptoms. The association between infant temperament and stressful life events is also evaluated. MethodA total of 210 Mexican women were assessed during pregnancy (gestational age 32.39 ± 4.01) and at six months postpartum. The instruments used were: Patient Health Questionnaire (PHQ-9), the Anxiety Subscale of the Hopkins Symptoms Checklist (SCL-90R), a short form of Stressful Life Events and The Infant Characteristics Questionnaire, when infants were six months old. ResultsAlthough a mother’s emotional state during pregnancy (depressive and anxiety symptoms and stressful life events) was not associated with difficult infant temperament, it was associated with depressive and anxious symptomatology during the postpartum period. Mothers with prenatal depressive symptoms who remained depressed and mothers who only had depression symptoms during the postpartum period reported having more difficult infants. Likewise, mothers with prenatal anxiety symptoms who maintained anxiety symptoms postpartum and mothers with anxiety symptoms during the postpartum period alone reported having more difficult infants. Comorbidity was found between depressive and anxious postnatal symptomatology in its association with difficult infant temperament. ConclusionIn this study, postpartum depressive and anxiety symptoms played an important role in shaping difficult infant temperament. Comorbidity between the two conditions warrants clinical attention and additional research, since it is related to maternal perception of difficult infant temperament. Psychological interventions are required, since these women may require assistance with emotional adaptation in the transition to motherhood.

Maternal pre- and postnatal anxiety symptoms and infant attention disengagement from emotional faces

BackgroundBiases in socio-emotional attention may be early markers of risk for self-regulation difficulties and mental illness. We examined the associations between maternal pre- and postnatal anxiety symptoms and infant attention patterns to faces, with particular focus on attentional biases to threat, across male and female infants. MethodsA general population, Caucasian sample of eight-month old infants (N = 362) were tested using eye-tracking and an attention disengagement (overlap) paradigm, with happy, fearful, neutral, and phase-scrambled faces and distractors. Maternal self-reported anxiety symptoms were assessed with the Symptom Checklist-90/anxiety subscale at five time points between gestational week 14 and 6 months postpartum. ResultsProbability of disengagement was lowest for fearful faces in the whole sample. Maternal pre- but not postnatal anxiety symptoms associated with higher threat bias in infants, and the relation between maternal anxiety symptoms in early pregnancy and higher threat bias in infants remained significant after controlling for maternal postnatal symptoms. Maternal postnatal anxiety symptoms, in turn, associated with higher overall probability of disengagement from faces to distractors, but the effects varied by child sex. LimitationsThe small number of mothers suffering from very severe symptoms. No control for the comorbidity of depressive symptoms. ConclusionsMaternal prenatal anxiety symptoms associate with infant's heightened attention bias for threat. Maternal postnatal anxiety symptoms, in turn, associate with infant's overall disengagement probability differently for boys and girls. Boys may show enhanced vigilance for distractors, except when viewing fearful faces, and girls enhanced vigilance for all socio-emotional stimuli. Long-term implications of these findings remain to be explored.

Prenatal exposure to anxiolytic and hypnotic medication in relation to behavioral problems in childhood: A population-based cohort study

Benzodiazepines and benzodiazepine-related medications (BBRMs) are anxiolytics and hypnotics acting on γ-amino butyric acid (GABA)A receptors. BBRMs are assumed to have a low potential for major congenital malformations, but research on more subtle and protracted developing symptoms of these medications is lacking. Therefore, we prospectively investigated the association between BBRM use in pregnancy and long-term effects on child behavior in a large population-based cohort study. The study population consisted of 104 children prenatally exposed to BBRM, 527 children exposed to maternal prenatal anxiety or phobic anxiety symptoms (without exposure to BBRM), and 5609 control children. At child age, 6years, Oppositional Defiant Disorder (ODD), Aggressive Behavior and Anxiety Problems were assessed by the Child Behavior Checklist (CBCL) reported by the mother and the Teacher Report Form (TRF). Children prenatally exposed to BBRM had higher scores of ODD and aggressive behavior, but not of anxiety. However, these associations were explained by maternal anxiety symptoms during pregnancy. Moreover, prenatal exposure to anxiety (without exposure to BBRM) was associated with increased scores of child ODD, aggressive behavior, and anxiety. In conclusion, the current study demonstrates that prenatal BBRM exposure was not independently associated with ODD and aggressive behavior in childhood when prenatal anxiety symptoms were taken into account.

The Generation R Study: A Review of Design, Findings to Date, and a Study of the 5-HTTLPR by Environmental Interaction From Fetal Life Onward

First, we give an overview of child psychiatric research in the Generation R Study, a population-based cohort from fetal life forward. Second, we examine within Generation R whether the functional polymorphism (5-HTTLPR) in the promoter of the serotonin transporter gene interacts with prenatal maternal chronic difficulties, prenatal maternal anxiety or postnatal maternal anxiety to influence child emotional development. A total of 2,136 northern European children were genotyped for 5-HTTLPR and rs25531. Mothers reported chronic difficulties and anxiety symptoms at 20 weeks' pregnancy and when the child was 3 years old. Child emotion recognition was observed at 3 years, and child emotional problems were assessed with the CBCL/1½-5 at 5 years. There were consistent main effects of maternal difficulties and anxiety on child emotional problems, but no main effect of 5-HTTLPR. Moreover, children with the s allele were at increased risk for emotional problems if their mothers reported prenatal anxiety symptoms (β = 2.02, p < .001) or postnatal anxiety symptoms (β = 1.64, p < 0.001). Also, in children of mothers with prenatal anxiety symptoms, the s allele was associated with less accurate emotion-matching (β = -0.11, p = .004). This population-based study shows that vulnerability due to 5-HTTLPR is not specific for certain adverse exposures or severe events, but suggests that the small effects of gene-environment interaction on emotional development become manifest early in life.