Maternal anxiety is related to infant neurological condition, paternal anxiety is not

Background

Parental anxiety and stress may have consequences for infant neurological development.

Aims

To study relationships between parental anxiety or well-being and infant neurological development approximately one year after birth.

Study design

Longitudinal study of a birth cohort of infants born to subfertile couples. Subjects: 206 parent-child dyads.

Outcome measures

Infant neurology was assessed with the Touwen Infant Neurological Examination (TINE) at 10 months and a developmental questionnaire at 12 months. Parental measures included trait anxiety measured by the State-Trait Anxiety Inventory (STAI) and well-being measured by the General Health Questionnaire (GHQ).

Results

Maternal trait anxiety was associated with a less optimal neurological condition (r_s = − 0.19, p < 0.01) of the infant. This association persisted after adjusting for confounders and results were confirmed by the outcome of the developmental questionnaire. Paternal trait anxiety and parental well-being were not related to the infant's neurodevelopmental outcome.

Conclusions

Infants of mothers with high trait anxiety have an increased vulnerability to develop a non-optimal nervous system. The association may be mediated in part by early programming of monoaminergic systems. Future research should include an exploration of specific windows of vulnerability to maternal anxiety.     

A prospective study of maternal anxiety, perceived stress, and depressive symptoms in relation to infant cognitive development

Aim

Our objective was to examine the associations between maternal psychological health (trait anxiety, perceived stress, and depressive symptoms) during pregnancy or postpartum and infant visual, language, motor, and overall cognitive development.

Study Design and Methods

In the prospective Pregnancy, Infection, and Nutrition Study (2001-2006), central North Carolina women completed self-administered questionnaires during pregnancy to assess trait anxiety and depressive symptoms. An in-person interview assessed maternal perceived stress and depressive symptoms in the 4th postpartum month. Infant development was assessed at 12 months using the Mullen Scales of Early Learning (n = 358). Multiple linear regression with restricted cubic splines was used to examine potential non-linear associations between trait anxiety, perceived stress, and depressive symptoms in relation to Mullen sub-scales and Composite scores.

Results

Increasing maternal anxiety was associated with poorer overall cognition (adjusted β for Composite = − 0.2, 95% CI: −0.4, 0.0). Postpartum stress was positively associated with language development and general cognition (adjusted β for Expressive Language = 0.2, 95% CI: 0.0, 0.4; adjusted β for Composite = 0.3, 95% CI: 0.0, 0.6). Elevated depressive symptoms throughout pregnancy and postpartum were associated with better fine motor skills (adjusted β = 9.7, 95% CI: 3.9, 15.5). Anxiety, postpartum depressive symptoms and stress were associated with gross motor skills in a non-linear fashion, as were postpartum depressive symptoms and stress with expressive language.

Conclusions

Maternal trait anxiety, depressive symptoms and stress had little negative influence on infant cognitive development. In fact, moderate psychosocial distress may slightly accelerate motor development in particular, and some aspects of language.     

Prediction of developmental performance in preterm infants at two years of corrected age: contribution of the neurological assessment at term age

Background

The population of preterm infants is increasing and resources available for follow-up are limited. Early markers are needed to identify children who will show major as well as more subtle neurodevelopmental impairments. Such a challenge could be achieved with the Amiel-Tison Neurological Assessment at Term (ATNAT).

Aims

This study assesses the usefulness of the ATNAT in the prediction of developmental problems at two years of corrected age (CA) in infants born between 29 and 37 weeks of gestation.

Method

Inclusion criteria were: gestational age between 29^0/7 and 36^6/7 weeks inclusively, birth weight below 2500 g and minimal 24-hour stay in the Neonatal Intensive Care Unit of Sainte-Justine Hospital. A sample of 147 was prospectively recruited and assessed at two ages: at term with the ATNAT and at 24 months CA with Bayley Scales of Infant Development-II.

Results

No major impairment such as cerebral palsy and no neurosensory impairment were observed. Developmental delay defined by an index < 70 on the mental or psychomotor scale was reported respectively in 6.2% and 5.4% of the cohort. Significant differences in mental, psychomotor and behavioral performances were found according to neurological status. Neurological status was the only variable to enter the predictive model for psychomotor and behavioral indexes. Gender and neurological status remained in the predictive model for mental performance.

Conclusion

This study supports the inclusion of the ATNAT among the eligibility criteria for systematic neurodevelopmental surveillance as it allows early identification of infants at higher risk of low developmental performances at 24 months CA.     

Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months

Background

Parental distress following the birth of a premature infant diminishes the parent's ability to be sensitive to the infant's cues, and this may affect infant developmental outcomes.

Aims

The present study examined the effects of maternal anxiety during infant hospitalization in the Neonatal Intensive Care Unit (NICU) on the interactive behavior of mothers with their very low birthweight (VLBW) children in toddlerhood.

Subjects

A sample of 56 mothers and their VLBW infants were recruited in the NICU.

Study design

During the infant's NICU stay, mothers completed a self-report measure of trait anxiety. These mothers and their infants were followed when the infants were 24 months corrected age, when mothers and their children were videotaped during free play at home. These videotapes were then coded using the Emotional Availability Scales.

Results

Maternal anxiety was not found to be related to severity of neonatal illness. Maternal anxiety in the NICU was associated with less sensitivity and less structure in interaction with their toddlers at 24 months corrected age, even controlling for maternal education and child birthweight. Children of mothers with higher anxiety scores in the NICU were less likely to involve their mothers in their play at 24 months corrected age.

Conclusions

Maternal anxiety in the NICU predicted adverse interactive behaviors when the children were 24 months corrected age. Early identification of anxious mothers in the NICU is needed in order to initiate preventive intervention to support the mother-infant relationship.     

Prenatal stress and infant affective reactivity at five months of age

Background

Prospective studies concerning prenatal stress and its outcome on children's emotional development postulated a potential influence of prenatal hormonal levels or emotional stressors on child development [1-3]. In a retrospective study, an influence of maternal emotional stress on infant affective reactivity was found [4].

Aims

This study was conducted in order to confirm these findings in a prospective study design.

Study design

A prospective longitudinal study design was conducted with three study waves during pregnancy and one time point five months postnatally.

Subjects

The final sample consisted of n = 104 mother-infant dyads.

Outcome measures

Maternal baseline cortisol levels and emotional stress were assessed in each trimester of pregnancy. Children were examined with the infant reactivity battery according to Kagan & Snidman [5] at the age of five months.

Results

Mothers of children with high affective reactivity (cry score ≥ 7) were significantly less depressed (p < .10) and perceived less stress (p < .05) in mid-pregnancy and were confronted with less external stress factors (p < .10) at the end of pregnancy. Cortisol levels did not differ in both groups in any pregnancy trimenon (p > .05).

Conclusions

These data add a new specific aspect to the ‘fetal programming hypothesis’ and are the first to confirm the speculative data from retrospective studies. Baseline cortisol does not seem to be the ‘hormonal mediator’ of this association. Therefore, cortisol stress reactivity or other neuroendocrine mechanisms should be assessed in future studies.     

Low Apgar score without acidosis may indicate neuromuscular disorder

Objective

We hypothesized that in term infants low Apgar score with normal umbilical artery pH (UApH) indicates prenatal damage to the neuromuscular system.

Study design

Retrospective database search of 42,117 liveborn infants born 1993—-2005. Medical record analysis of 3104 term infants with cardiorespiratory maladaptation referred for special neonatal care. Focus on infants with UApH > 7.00 and 5-min Apgar < 6 (group A, n = 74), UApH < 7.00 and 5-min Apgar > 5 (group B, n = 49), and UApH < 7.00 and 5-min Apgar < 6 (group C, n = 14).

Results

Incidence of 5-min Apgar score < 6 was 0.50% in term infants. Mean (SD) UApH was 7.262 (0.075, P = 0.075); incidence of UApH < 7.00 was 0.30% in term infants. Nucleated red blood cells were elevated without differences in all three groups. Parental consanguinity was present in 39 of the 137 maladapted infants. In groups A/B/C, 10/18/2 infants were small for gestational age (P = 0.002 for A vs B) and in 16/1/0 neuromuscular anomalies were identified (P = 0.004 for A vs B). Eight of the 17 anomalies had been suspected prenatally. Logistic regression proved neuromuscular disorder the only independent variable discriminating between groups A and B.

Conclusions

Neuromuscular problems are the cause rather than the result of maladaptation. For unexplained low Apgar score, especially without acidosis, meticulous examination of the infant including brain imaging and EEG is justified.     

Neurodevelopmental outcomes of very low birth weight and extremely low birth weight infants at 18 months of corrected age associated with prenatal risk factors

Background

Very premature infants occasionally have neurodevelopmental disabilities. However, there have been quite limited data on prenatal risk factors associated with their neurodevelopmental outcomes.

Aim

To clarify the relationship between prenatal risk factors and neurodevelopmental outcomes of very premature infants.

Study design

The study design is a retrospective review.

Subjects

One hundred seventy Japanese women with a singleton pregnancy and their infants whose birth weight being less than 1500 g were included. We classified those infants into 118 appropriate for gestational age (AGA) and 52 small for gestational age (SGA) infants.

Outcome measures

Infants' neurodevelopmental outcomes at 18 months of corrected age were evaluated by the Kyoto Scale of Psychological Development 2001 (KSPD). We analyzed and compared the infants' outcomes and prenatal risk factors between two groups.

Results

Mortality and rate of infants unevaluable by KSPD because of severe impairment were not significantly different between those groups. However, the developmental quotient score of the cognitive-adaptive area in SGA infants born between 25 and 31 weeks of gestation was significantly lower than that in AGA infants randomly selected as gestation-matched controls. More advanced gestational age and heavier birth weight protected against adverse neurodevelopmental outcomes in both groups. Moreover, male infants were related to the excess risk of adverse neurodevelopmental outcomes in the SGA group.

Conclusion

In view of the neurodevelopment of the infants, it seems that the most efficient obstetric strategy for improving prognosis of premature infants should be targeted to prolong the pregnancy period as long as the reassuring fetal status and maternal stable health condition are being confirmed.     

Episodes of hypocarbia and early-onset sepsis are risk factors for cystic periventricular leukomalacia in the preterm infant

Background

Septic episodes in preterm infants recently have been reported to be associated with periventricular leukomalacia (PVL). The role of hypocarbia as an independent risk factor for PVL in clinical studies raises many questions without conclusive answers.

Aims

To evaluate risk factors for cystic PVL focussing on the influence of hypocarbia.

Study design

Retrospective single centre case-control study.

Subjects

Preterm infants 24 to 35 weeks of gestational age and matched (1:2 for gender, birth year, gestational age and birth weight) controls.

Outcome measures

Multivariate analysis of perinatal factors being associated with cystic PVL diagnosed by serial ultrasound examinations.

Results

Univariate analysis of risk factors revealed lower 5 and 10 min Apgar scores, and higher rates of neonatal seizures, early-onset sepsis, neonatal steroids, respiratory distress syndrome with surfactant replacement therapy, and episodes of hypocarbia significantly being associated with PVL. Multivariate analysis using a logistic regression model revealed early-onset sepsis and hypocarbia being significantly associated with PVL (p = .022 and .024, respectively). Lowest PaCO₂ values did not differ as did not the duration of hypocarbia, but the onset of hypocarbia was significantly later in PVL cases compared to controls (mean 26 vs. 15 h, p = .033). Neurodevelopmental follow-up at a median time of 46 months was poor showing 88% of the cases having an adverse neurological outcome.

Conclusion

We found early-onset sepsis and episodes of hypocarbia within the first days of life being independently associated with PVL.     

A longitudinal study of differences in electroencephalographic activity among breastfed, milk formula-fed, and soy formula-fed infants during the first year of life

Background

The extent to which adequate nutrition from infant diets differentially influence developmental outcomes in healthy infants has not been determined.

Aim

To compare the effects of the major infant diets on the development of brain electrical activity during infancy.

Study design

Scalp EEG signals (124 sites) recorded from the same infants during quiet wakefulness at 3, 6, 9, and 12 months.

Subjects

Healthy, full-term infants (40/group; gender matched) either breastfed (BF) or fed milk formula (MF) or soy formula (SF) through the first 6 months.

Outcome measures

Power spectral values for frequencies in the 0.1-30 Hz range.

Results

Significant diet-related differences were present across frequency bands and included effects that were time- [peaks in 0.1-3 Hz at 6 (MF,SF) and 9 months (BF); 3-6 Hz at 6 months (MF, SF > BF); increases in 6-9 Hz from 3 to 6 months (MF > BF) and from 6 to 9 months (MF > SF)] and gender-related (9-12 Hz and 12-30 Hz: at 9 months BF > MF, SF boys, and MF > SF girls).

Conclusions

The development of brain electrical activity during infancy differs between those who are breastfed compared with those fed either milk or soy formula, but is generally similar for formula-fed groups. These variations in EEG activity reflect diet-related influences on the development of brain structure and function that could put infants on different neurodevelopmental trajectories along which cognitive and brain function development will proceed.     

A comparison of executive function in very preterm and term infants at 8 months corrected age

Background

Executive function (EF) emerges in infancy and continues to develop throughout childhood. Executive dysfunction is believed to contribute to learning and attention problems in children at school age. Children born very preterm are more prone to these problems than their full-term peers.

Aim

To compare EF in very preterm and full-term infants at 8 months after expected date of delivery.

Subjects

37 very preterm infants without identified disabilities, and 74 gender and age matched healthy full-term infants. The very preterm infants were all ≤ 32 weeks gestation and < 1250 g birthweight.

Outcome measures

EF tasks which measured working memory, inhibition of distraction, and planning at 8 months after expected date of delivery.

Results

The very preterm infants performed significantly more poorly than the full-term infants on all measures of executive function. No significant differences were found between very preterm and full-term infants on any of potentially confounding variables of, infant temperament, maternal education, family income and maternal psychological wellbeing. Very preterm infants had significantly lower scores on the Mental Development Index (MDI) and Psychomotor Development Index (PDI) on the Bayley Scales of Infant Development (BSID II), however when this was partialled out the differences in EF scores remained. Medical complications, lower birthweight and lower gestation age were all found to adversely affect the performance of very preterm infants on executive function tasks.

Conclusion

Very preterm infants performed more poorly than full-term infants on measures of EF. Further follow up studies are required to investigate whether EF measures in infancy can predict learning and attention outcome at school age.     

Maternal vitamin B-12 and folate status during pregnancy and excessive infant crying

Background

The etiology of excessive infant crying is largely unknown. We hypothesize that excessive infant crying may have an early nutritional origin during fetal development.

Aims

This study is the first to explore whether (1) maternal vitamin B-12 and folate status during pregnancy are associated with excessive infant crying, and (2) whether and how maternal psychological well-being during pregnancy affects these associations.

Study design

Women were approached around the 12th pregnancy week to complete a questionnaire (n = 8266) and to donate a blood sample (n = 4389); vitamin B-12 and folate concentrations were determined in serum. Infant crying behavior was measured through a postpartum questionnaire (± 3 months; n = 5218).

Subjects

Pregnant women living in Amsterdam and their newborn child.

Outcome measures

Excessive infant crying, defined as crying ≥ 3 h/day on average in the past week.

Results

Multiple logistic regression analysis was performed for 2921 (vitamin B-12) and 2622 (folate) women.Vitamin B-12 concentration (categorized into quintiles) was associated with excessive infant crying after adjustment for maternal age, parity, ethnicity, education, maternal smoking and psychological problems (OR[95%CI]: Q1 = 3.31[1.48-7.41]; Q2 = 2.50[1.08-5.77]; Q3 = 2.59[1.12-6.00]; Q4 = 2.77[1.20-6.40]; Q5 = reference). Stratified analysis suggested a stronger association among women with high levels of psychological problems during pregnancy. Folate concentration was not associated with excessive infant crying.

Conclusions

First evidence is provided for an early nutritional origin in excessive infant crying. A low maternal vitamin B-12 status during pregnancy could, in theory, affect infant crying behavior through two potential mechanisms: the methionine-homocysteine metabolism and/or the maturation of the sleep-wake rhythm.     

Prematurity, maternal posttraumatic stress and consequences on the mother-infant relationship

Objective

Premature birth is a stressful experience for parents. This study explores the links between maternal posttraumatic stress, maternal attachment representations of the infant and mother-infant dyadic interactions.

Methods

The study enrols 47 preterm (GA < 34 weeks) and 25 full-term infants. The Perinatal Posttraumatic Stress Disorder Questionnaire was administered to evaluate maternal posttraumatic stress symptoms. At 6 months of corrected age, maternal attachment representations of the infant were explored and coded with the Working Model of the Child Interview. Interactive characteristics were explored in a videotaped play session and coded with the Care Index.

Results

Full-term mothers were more likely to follow a “Cooperative” dyadic pattern of interaction with the infant and demonstrate Balanced representations of the infant. Preterm mothers with high posttraumatic stress symptoms were more likely to follow a “Controlling” dyadic pattern of interaction, with more Distorted representations. In contrast, preterm mothers with low posttraumatic stress symptoms were more likely to fall into a “Heterogeneous” group of patterns of dyadic interaction, with Disengaged representations. Interestingly, in Cooperative preterm dyads, only 23% of the mothers demonstrated Balanced representations, despite rates of 69% in full-term Cooperative dyads.

Conclusion

Premature birth affects both mother-infant interaction characteristics and maternal representations of attachment with the infant. In particular, a “Controlling” dyadic pattern was associated with high maternal posttraumatic stress symptoms and Distorted maternal representations. It is important to examine the impact of maternal posttraumatic stress on the parent-infant relationship in order to plan supportive, preventive interventions in the neonatal period.     

Mammary duct ectasia in children: report of a short series and review of the literature

Background

Mammary duct ectasia is uncommon in children, and is usually considered to be an acquired disease in adults. However the occurrence in infants and children suggest it may be developmental.

Aims

To report a case series of mammary duct ectasia, and review the published literature to ascertain the common findings and histological findings in children.

Study design

Case series report and review of the literature.

Results

We report three cases of mammary duct ectasia, an unusual disease in children. The most common presenting features are a bloody nipple discharge; there may also be a palpable mass or general breast enlargement. Two patients in this series presented with large masses simulating other conditions. Summary of all reported cases in children found that symptoms can arise from infancy, but is most common around the age of 3 years (range 2 months to 13 years), with a 5:2 male:female ratio. Histology centres on peri-ductal inflammation and dilation. Haemosiderin laden macrophages were seen commonly in this series; and may represent a histological marker in children. The disease is often self-limiting. Patients may require surgery for persistent nipple discharge or lump.

Conclusions

Duct ectasia should be entertained in small infants and children presenting with both small and large peri-areolar breast masses and/or bleeding. The occurrence of the disease in infants suggests that mammary duct ectasia may represent a developmental anomaly in the paediatric population.     

Infant developmental outcomes following prenatal exposure to antidepressants,and maternal depressed mood and positive affect

Background

Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants has been associated with delays in early developmental milestones, but there remains uncertainty. Even among a subset of studies examining the Bayley Scales of Infant Development (BSID), some have reported normal mental and psychomotor development while others have suggested a delay in motor development. Given an increasing number of infants exposed to SRIs, furthering our understanding of the possible developmental implications of SRI exposure in utero is critical.

Aims

To examine the effects of prenatal serotonin reuptake inhibitor exposure and maternal mood on infant developmental outcomes at 10 months of age.

Study design

Prospective study of mothers and their 10-month-old infants.

Subjects

We examined 31 mother–child pairs exposed prenatally to SRIs and 52 mother–child pairs who were nonexposed.

Outcome measure

The Bayley Scales of Infant Development (third edition) scores.

Results

Infants exposed prenatally to SRIs scored significantly lower than nonexposed infants on gross motor (P = 0.03), social–emotional (P = 0.04) and adaptive behavior (P = 0.05) subscales of the BSID-III, controlling for pre- and postnatal maternal depressed mood, smoking and alcohol use during pregnancy. No significant differences in any of the BSID-III subscales were observed between infants exposed and infants nonexposed to pre and postnatal maternal depressed mood (P > 0.05). Increased levels of maternal positive affect at 10 months predicted increased social–emotional scores (P = 0.03).

Conclusions

Infants prenatally exposed to SRIs score significantly lower on the gross motor, social–emotional and adaptive behavior subscales of the BSID-III, and this was not explained by underlying maternal depression.     

Hypothalamic-pituitary-adrenal (HPA) axis function in 3-month old infants with prenatal selective serotonin reuptake inhibitor (SSRI) antidepressant exposure

Background

Prenatal exposure to stress and selective serotonin reuptake inhibitors (SSRIs) alter hypothalamic-pituitary-adrenal (HPA) stress reactivity in offspring, however, the effects of combined exposure to HPA activity in human infants is unknown.

Objective

To examine HPA basal levels and stress responsiveness in 3-month olds with prenatal exposure to SSRIs.

Methods

Salivary cortisol levels in infants of SSRI treated mothers (n = 31, mean exposure 230.2 ± 72.2 days) were compared with non-SSRI exposed (n = 45) infants in response to a challenge (infant-controlled habituation task) and under basal conditions in the late afternoon/early evening. Mode of feeding, to account for possible postnatal drug exposure via breast milk, as well as measures of pre and postnatal maternal mood, were included as covariates.

Results

Lower post-stress cortisol levels were observed in non-SSRI exposed/non-breastfed infants compared with non-SSRI exposed infants who were breastfed at 3 months of age. Stress reactivity patterns among SSRI exposed infants did not differ with mode of feeding. The cortisol reactivity slope (CRS) was significantly lower among non-SSRI exposed non-breastfed infants compared with non-SSRI exposed breastfed infants. Early evening basal cortisol levels were lower in SSRI exposed infants than in non-SSRI exposed infants, controlling for maternal mood and mode of feeding. Postnatal SSRI exposure (infant SSRI drug levels) via breast milk was not associated with stress or basal cortisol levels. Total cortisol, reflected by the AUC measure, did not differ significantly between exposure groups.

Conclusions

Prenatal SSRI exposure altered HPA stress response patterns and reduced early evening basal cortisol levels. Stress challenge HPA response differences only became apparent when the moderating effect of method of feeding was accounted for. These findings suggest an early “programming” effect of antenatal maternal mood, prenatal SSRI exposure and postnatal maternal care giving on the HPA system.     

Patterns in sleep-wakefulness in three-month old infants exposed to methadone or buprenorphine

Background

Infants exposed to opioides in-utero frequently demonstrate withdrawal symptoms in the neonatal period and have difficulties with state regulation.

Aim

This study examines sleep-wakefulness-distress patterns as indicators of regulatory mechanisms at 3 months of age.

Participants

A national infant cohort (N = 35) born to women in high-dose maintenance treatment during pregnancy and a comparison group (N = 36) of low-risk infants born in the same period.

Outcome measures

Distributions and frequencies of sleep, wakefulness and distress measured in hours and episodes on sleep charts recorded by the mothers in the two groups.

Results

Women in maintenance treatment were monitored closely during pregnancy to avoid illicit drug use and to be prepared for motherhood. They were also offered residential treatment before pregnancy and after the child was born. There were no statistical differences between the two groups in any of the 10 measures reflecting diurnal and nocturnal rhythmicity at 3 months despite of neonatal abstinence syndrome in 47% of the exposed infants and significant differences in infant characteristics with respect to birth weight, gestational age and maternal characteristics.

Conclusions

Follow-up procedures combining drug monitoring and counseling during pregnancy and in the first months after birth enhance the development of state regulation in terms of sleep-wakefulness patterns.     

Postural control of pre-term infants at 6 and 12 months corrected age

Background

Pre-term infants are at high risk for motor disabilities. Postural control, the basis for motor development, develops rapidly during the first year of life. An early start to extra-uterine life with an immature motor system may influence a pre-term infant's postural control.

Aims

To identify important prognostic factors and determine the difference in postural control between full-term and pre-term infants.

Method

Medical records of 93 pre-term infants with birth weight of less than 1501 g (mean birth weight = 1136.03 ± 243.86 g; mean gestational age = 29.14 ± 2.78 weeks) were reviewed. Data was collected from the preemie clinical follow-up program at the National Cheng Kung University, Taiwan.

Results

Results demonstrated that pre-term infants had poorer postural control than full-term infants both at 6 and 12 months adjusted age, and that medical complication as measured by the Neonatal Medical Index was the best predictor of postural control in pre-term infants in the first year of life. In addition, our findings confirmed that the development of postural control at 6 months adjusted age predicts the development of postural control at 12 months adjusted age after controlling for prognostic factors.

Conclusions

Both biological and social environmental factors appeared to be associated with pre-term infants' postural control at 6 and 12 months adjusted age. The development of postural control at 6 months adjusted age predicted the development of postural control at 12 months adjusted age. This suggested the value of early follow-up examinations at 6 months adjusted age.     

Prenatal depression restricts fetal growth

Objective

To identify whether prenatal depression is a risk factor for fetal growth restriction.

Methods

Midgestation (18-20 weeks GA) estimated fetal weight and urine cortisol and birthweight and gestational age at birth data were collected on a sample of 40 depressed and 40 non-depressed women. Estimated fetal weight and birthweight data were then used to compute fetal growth rates.

Results

Depressed women had a 13% greater incidence of premature delivery (Odds ratio (OR) = 2.61) and 15% greater incidence of low birthweight (OR = 4.75) than non-depressed women. Depressed women also had elevated prenatal cortisol levels (p = .006) and fetuses who were smaller (p = .001) and who showed slower fetal growth rates (p = .011) and lower birthweights (p = .008). Mediation analyses further revealed that prenatal maternal cortisol levels were a potential mediator for the relationship between maternal symptoms of depression and both gestational age at birth and the rate of fetal growth. After controlling for maternal demographic variables, prenatal maternal cortisol levels were associated with 30% of the variance in gestational age at birth and 14% of the variance in the rate of fetal growth.

Conclusion

Prenatal depression was associated with adverse perinatal outcomes, including premature delivery and slower fetal growth rates. Prenatal maternal cortisol levels appear to play a role in mediating these outcomes.     

Intrauterine growth restriction in a low-income country: Risk factors, adverse perinatal outcomes and correlation with current WHO Multicenter Growth Reference

Objective

To determine risk factors and adverse perinatal outcomes including nutritional status in the first week of life for newborns with intrauterine growth restriction-low birth weight (IUGR-LBW) in settings lacking facilities for routine intrauterine growth monitoring.

Methods

A cross-sectional study of all infants in an inner-city hospital in Lagos, Nigeria. IUGR-LBW was defined as full-term (gestational age ≥ 37 weeks) infant with low birth weight (< 2500 g). Nutritional/growth status at enrolment was determined by z-scores for length-for-age (HAZ), head circumference-for-age (HCZ), weight-for-age (WAZ) and weight-for-length (WHZ) based on current World Health Organization's Multicentre Growth Reference (WHO-MGR). Factors and adverse outcomes associated with IUGR-LBW were explored with multivariable logistic regression analyses.

Results

Some 145 (4.3%) infants were IUGR-LBW out of 2619 eligible singletons enlisted for this study. IUGR-LBW was significantly associated with teenage mothers (OR:2.90, 95% CI:1.22-6.89), lack of antenatal care (OR:1.88, 95% CI:1.33-2.65) and female gender (OR:1.38, 95% CI: 0.98-1.93; p = 0.062). The incidence of adverse outcomes across gestational age showed significant linear trend only for low five-minute Apgar scores (p = 0.024) and WAZ (p = 0.065). IUGR-LBW was associated with poor nutritional status across all four indices (p < 0.001) as well as low 5-minute Apgar scores (p = 0.095), sepsis (p = 0.053), hyperbilirubinemia (p < 0.001) and admission into special care baby unit (p = 0.009) after multivariable logistic regression analyses.

Conclusions

IUGR-LBW correlates with poor nutritional status in the first week of life based on WHO-MGR and affected infants can be detected early for effective surveillance in resource-poor settings. Improved prenatal care among teenage mothers is necessary for reducing IUGR-LBW burden.     

Sex differences in the relation between prenatal maternal emotional complaints and child outcome

Background

Sex differences are found in animal studies concerning the relationship between prenatal maternal stress and outcome of the offspring. Most human studies in this field have not addressed sex differences, although differences between boys and girls may elucidate the biochemical as well as psychological processes involved. Associations between prenatal maternal emotional complaints and behavioural problems of toddlers and preschoolers as assessed by both mothers and fathers are studied separately for boys and girls.

Methods

Healthy Dutch Caucasian singleton, pregnant women (N = 444) answered questionnaires about anxiety and depression in every trimester of pregnancy. When their children (227 boys, 217 girls) were between 14 and 54 months old, both parents reported on their current feelings of depression and anxiety and on the behavioural problems of their children.

Results

Prenatal maternal emotional complaints were found to be associated with child behavioural problems both in boys and in girls, but in different ways. Prenatal maternal emotional complaints during the first trimester were associated with total and internalizing behavioural problems for boys. Emotional complaints during the third trimester were associated with total, internalizing, as well as externalizing behavioural problems for girls.

Conclusions

Differentiation according to sex and information on timing of emotional complaints during pregnancy is needed in studies concerning the relation between prenatal maternal emotional complaints and child outcome.