Pregnancy support- Fetal Programming

Mental Health - updated: 03 November 2008

Consequences of antenatal mental health problems for child health and development

Curr Opin Obstet Gynecol. 2007 Dec;19(6):568-72

Hollins K.

PURPOSE OF REVIEW: The aim of this article is to review studies published in English in the last year which examine associations between maternal mental health problems during pregnancy and subsequent development and health outcomes for the fetus, infant, child and adolescent. The body of research into antenatal mental health consequences is now considerable so this article provides an introduction to the field by considering the most recent studies. RECENT FINDINGS: Research in the past 12 months has further developed understanding of the effects of mental health problems including antenatal anxiety and possible mechanisms for its effect on fetal neurodevelopment, infant temperament and later psychological, behavioural and cognitive outcomes for the child and adolescent. Delivery outcome studies again confirm the significant association between various mental illnesses, including depression and preterm birth and low birth weight. SUMMARY: Children's emotional, cognitive and physical health and development are affected by their mothers' mental health whilst pregnant. Prompt identification and referral of pregnant women for specialist treatment is important in order to reduce adverse child outcomes.

Publication Types:

• Review

The impact of gestational stress and prenatal growth on emotional problems in offspring: a review

Acta Psychiatr Scand. 2007 Mar;115(3):171-83

Rice F, Jones I, Thapar A.

OBJECTIVE: Events occurring very early in life, even prenatally, may have long-term effects on future health and behaviour. The influence of poor foetal growth and gestational stress in the mother on the risk of emotional problems in offspring was reviewed. METHOD: A selective review of the literature was undertaken. RESULTS: Studies of preterm infants and infants born small for gestational age have shown increased levels of emotional problems across the lifespan. In general, studies examining maternal depression/anxiety during pregnancy and other indices of gestational stress have shown significant associations with emotional problems in children. The results of several studies also point to the importance of psychosocial and genetic factors in moderating associations. CONCLUSION: Future research that focuses on identifying the mechanisms underlying these associations is needed. The moderating role of psychosocial and genetic risk factors is an important area in which future research should be directed. These findings have clinical implications for the provision of antenatal care.

Publication Types:

• Review

The effects of prenatal maternal stress on children's cognitive development: Project Ice Storm

Stress. 2005 Mar;8(1):35-45

King S, Laplante DP.

There exists considerable research on the effects of prenatal maternal stress on offspring. Animal studies, using random assignment to experimental and control groups, demonstrate the noxious effects of prenatal maternal stress on physical, behavioural and cognitive development. The generalizability of these results to humans is problematic given that cognitive attributions moderate reactions to stressors. In humans, researchers have relied upon maternal anxiety or exposure to life events as proxies for the stressors used with animals. Yet, the associations between maternal anxiety or potentially non-independent life events and problems in infants are confounded by genetic transmission of temperament from mother to child. We summarize the literature on prenatal maternal stress and infant cognitive development, leading to the conclusion that the human literature lacks the ability to separate the effects of the objective exposure to a stressor and the mother's subjective reaction. We then describe our prospective Project Ice Storm in which we are following 150 children who were exposed in utero to a natural disaster. We demonstrate significant effects of the objective severity of exposure on cognitive and language development at age two years with important moderating effects of the timing during pregnancy. The implications of our findings are discussed.

Publication Types:

• Review

Fetal origins of stress-related adult disease

Ann N Y Acad Sci. 2006 Nov;1083:11-27

Kajantie E.

During the past decade, a considerable body of evidence has emerged showing that circumstances during the fetal period may have lifelong programming effects on different body functions with a considerable impact on disease susceptibility. The purpose of this article is to provide a synopsis of these findings and their role in explaining the development of stress-related adult disease. In the context of Per Björntorp memorial symposium, stress-related disease will be interpreted broadly, including cardiovascular disease and components of the metabolic syndrome, for which the evidence of fetal origins is most abundant. It has however become evident that early-life programming has a much broader potential effect on an individual's health. For example, perinatal variables, such as low birth weight, have been associated with increased prevalence of depressive symptoms. Mechanistic studies in animals and humans have shown that lifelong programming of the hypothalamic-pituitary-adrenal axis (HPAA) function by fetal life conditions is likely to be a key factor in mediating associations with these disorders, which frequently are characterized by HPAA overactivity. Preliminary observations suggest a similar important role for early-life programming of sympathoadrenal function. Reduced HPAA activity is characteristic of a number of stress-related disorders, including posttraumatic stress disorder; chronic pain; fatigue; and atypical, melancholic depression. It is therefore highly plausible that susceptibility to these disorders originates in a similar manner during early life, although direct evidence is to a great deal lacking. Important targets for future research include distinction between the effects of different pregnancy conditions, such as maternal malnutrition, preeclampsia, and maternal infection, which may have dissimilar late-life consequences. This will be a crucial step when the associations that are currently emerging will be translated into disease prevention.

Publication Types:

• Review

Effects of psychologic stress on fetal development and pregnancy outcome

Curr Psychiatry Rep. 2005 Aug;7(4):274-80

Koubovec D, Geerts L, Odendaal HJ, Stein DJ, Vythilingum B.

Data from animal studies show that maternal stress is associated with disturbances in pregnancy outcomes and offspring development and behavior, possibly as a result of permanent structural and functional changes termed "early-life programming." There is growing interest in whether similar relationships are present in humans. Here we review recent significant findings from the literature on the impact of prenatal psychologic stressors on pregnancy outcome and offspring development, with a particular focus on the developing brain. Relevant papers were searched using PubMed, and reference lists from obtained articles were checked. In humans, prenatal stress is associated with pregnancy complications, developmental, cognitive, and behavioral disorders, and possible onset of psychopathology in later life. In contrast to the available research done in animals, virtually nothing is known about the effects of prenatal stress on morphologic fetal brain development, and the mechanisms underlying subsequent associated behavioral changes.

Publication Types:

• Review

Publication Types:

• Review