The prediction of pregnancy outcome: Maternal preparation, anxiety and attitudinal sets

Anxiety, participation in preparatory classes and maternal attitudinal sets were examined in a population of women attending a University Hospital outpatient obstetrical clinic. Using a multiple regression model of statistical analysis, class participation and maternal attitudes were found to be significantly predictive of pain ratings during labor. State anxiety on admission to the labor room was predictive of labor length; social class and maternal attitudes were predictive of patient manageability during labor. None of these variables were found to be associated with the incidence of complications, fetal apgar scores, or the use of analgesia and anesthesia. The implications of these findings are discussed from the perspective of research on developing screening instruments for identifying pregnancy complications and from the standpoint of designing new and potentially more effective preparatory treatment methods.     

Maternal panic disorder: Infant prematurity and low birth weight

The aim of this pilot research was to investigate whether infants of mothers with panic disorder (PD) would be at higher risk for prematurity and low birth weight (corrected for gestational age) than controls. Medical records were reviewed for 25 mothers with PD and 33 mothers without a lifetime history of anxiety disorders or other major psychopathology as determined by diagnostic interview. Mothers also completed questionnaires concerning demographic information and life stresses. Compared to controls, infants with PD mothers were not significantly more likely to be born prematurely or earlier than controls but did show smaller birth weight corrected for gestational age, even after accounting for possible confounding influences. Additional research is needed to confirm these preliminary findings. Studying PD mothers during pregnancy could provide insight concerning mechanisms for the development of low birth weight and psychopathology.     

Pregnancy anxiety and comorbid depression and anger: effects on the fetus and neonate

One hundred sixty-six women were classified as experiencing high or low anxiety during the second trimester of pregnancy. The high anxiety women also had high scores on depression and anger scales. In a follow-up across pregnancy, the fetuses of the high anxiety women were noted to be more active and to experience growth delays. The high anxiety mothers' high prenatal norepinephrine and low dopamine levels were followed by their neonates having low dopamine and serotonin levels. The high anxiety mothers' newborns also had greater relative right frontal EEG activation and lower vagal tone. Finally, the newborns of high anxiety mothers spent more time in deep sleep and less time in quiet and active alert states and showed more state changes and less optimal performance on the Brazelton Neonatal Behavior Assessment Scale (motor maturity, autonomic stability and withdrawal). These data highlight the need for prenatal intervention for elevated anxiety symptoms during pregnancy.     

Postponing pregnancy after perinatal death: perspectives on doctor advice

The Perinatal Loss Interview was administered to 24 mothers who had experienced perinatal loss and were raising a child born subsequent to the loss; mothers were asked about postponing subsequent pregnancy, including what their doctors advised. Mothers were dissatisfied with doctor advice, reporting that the timing of a subsequent pregnancy was a personal decision and many factors influenced their decision. Furthermore, regardless of timing, most mothers reported overprotective and replacement feelings toward the subsequent child. These results imply that physicians may be most effective by educating mothers about advantages and disadvantages of postponing pregnancy so that an informed decision can be made.     

Shattered Shangri-la: differences in depressive and anxiety symptoms in students born in Tibet compared to Tibetan students born in exile

OBJECTIVE: As a result of ongoing political tensions within Tibetan regions of the People's Republic of China, several thousand Tibetans escape across the Himalayas every year to seek refuge in India and Nepal. Prior studies have found a high prevalence of depressive and anxiety symptoms in these refugees, many of whom are young and have been exposed to significant trauma. However, it is not known whether depressive and anxiety symptoms are more prevalent in these refugees than in ethnic Tibetans born and raised in the relative political and social stability of exile communities in North India and Nepal. METHODS: We conducted a cross-sectional survey of a convenience sample of 319 students attending school at the Tibetan Children's Villages in Northern India to test the a priori hypothesis that adolescents and young adults who escaped from Tibet to India would demonstrate increased depressive and anxiety symptoms when compared to ethnic Tibetans born and raised in exile. The Hopkins Symptom Checklist-25 (HSCL-25) was used to measure depressive and anxiety symptoms. In addition, demographic information on age, sex, country of birth and frequency of family contact was collected. RESULTS: Students born in Tibet had higher mean HSCL-25 depressive and anxiety symptom scores than did ethnic Tibetans born in exile. Female students demonstrated higher depressive and anxiety scores, as did those with limited contact with immediate family. After adjusting for sex, age and frequency of family contact, being born in Tibet was associated with increased HSCL-25 depressive and anxiety symptom scores (depression: F[2, 316] = 29.96, P < 0.0001; anxiety: F[4, 316] = 43.57, P < 0.0001). CONCLUSIONS: The experience of being raised in Tibet and escaping to India appears to be a risk factor for increased depressive and anxiety symptoms when compared to being born and raised within an exile community in India or Nepal.     

Parenting stress and postpartum depression/anxiety in mothers with personality disorders: indications for differential intervention priorities

To date, parenting stress has rarely been examined in clinical samples of mothers with postpartum comorbid Axis-I disorders and Axis-II personality disorders (PD). Previous research has shown important links between maternal psychopathology and the development of child psychopathology. For these reasons, a clinical sample (N = 54) of mothers with various PD and comorbid depression/anxiety disorders were compared in this study. The clinical sample was divided into three groups based on PD: without PD, other PD, and borderline PD (BPD), and then matched according to depression/anxiety diagnoses and age. Parenting stress index (PSI, Abidin, 1995) scores were compared between these subsamples and to a nonclinical control group. No significant differences were found between mothers with various PD on global PSI scores. However, further examination of the PSI subscale scores revealed that PD were linked to an impaired sense of competence and positive reinforcement in relation to parenting. Compared to mothers with other PD, mothers with BPD had significantly more interpersonal issues. Compared to the nonclinical controls, clinically referred mothers had significantly higher PSI global and subscale scores, with notable PD-specific exceptions. These results illustrate the need for more differentiated treatment options for mothers with postpartum depression and/or anxiety disorders with PD to prevent later development of psychopathology in children of these mothers.     

Anorexia nervosa and motherhood: Reproductional pattern and mothering behavior of 50 women

ABSTRACT— A follow-up carried out on an average 12.5 years after hospital contact of 151 patients with a former diagnosis of Anorexia nervosa (AN), aimed at reproductional outcome. None of the 11 males had children. Fifty of the 140 women had born a total of 86 children, which is approximately 1:3 of the expected fertility. Involuntary childlessnes was of the same size as found in the background population. The rate of prematurity among the offspring was twice the expected and perinatal lethality six times the expected. Mentally the mothers did well, both during pregnancy and the post-partum period. They breastfed their children for the same mean time as did other women, and the development of the children did not differ from that found in a background population. More women in the group of mothers than in the group of non-mothers had better scores of all-round functioning at follow-up.     

Is alexithymia linked with marital satisfaction or attachment to the partner? A study in a pregnancy cohort of parents-to-be

Objective

To investigate possible associations of alexithymia with marital satisfaction and mutual attachment between the partners in a group of parents-to-be during pregnancy.

Methods

The present study was conducted in a pregnancy cohort. Cross-sectional data were available for 151 mothers and 106 fathers, and altogether 102 couples. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia, the Index of Marital Satisfaction (IMS) to assess romantic relationship satisfaction and the Experiences in Close Relationships Scale (ECR) to evaluate attachment-related anxiety and avoidance. Kruskal–Wallis test was used for categorized variable comparisons. For continuous variables, Spearman correlation analyses and linear regression analyses were conducted.

Results

The TAS-20 total score, as well as, two of its dimensions, difficulties in identifying and describing feelings, were significantly correlated (p < 0.01) with both the IMS scores and the ECR anxiety and avoidance scores. In the regression analyses, the most significant predictive factor for the subjects' IMS scores was their partners' corresponding scores, although among fathers the IMS scores were partly explained by their own TAS-20 factor 1 scores (p = 0.004). The subjects' own TAS-20 scores explained the ECR anxiety and avoidance scores to a significant extent, but the fathers' TAS-20 factor 3 scores were also associated with the mothers' avoidance scores (p = 0.037).

Conclusion

Alexithymia was not directly related to marital satisfaction. However, alexithymia appears to have a significant effect on relationship-related anxiety and avoidance. This association should be further studied in parents and their offspring in a longitudinal setting.     

Maternal anxiety: course and antecedents during the early postpartum period

The early course and antecedents of postpartum anxiety are unknown. This study sought to determine the course and antecedents of maternal anxiety during the first month postpartum and to develop a model to predict 1-month anxiety using information obtainable before perinatal hospital discharge. Two hundred and ninety-six mothers were screened before discharge with the State (SS) and Trait (TS) Scales of the State Trait Anxiety Inventory (STAI). Demographic characteristics were assessed by questionnaire and medical record review, and psychiatric history, measures of perinatal stress, and resilient factors were determined by focused questions and formal instruments. At 1-month postpartum, the SS was repeated. Scores on the SS were significantly higher at 1 month than immediately postpartum (35.30+/-0.68 versus 33.38+/-0.60, mean+/-standard error, P=.004), but only 58.6% of mothers with high pre-discharge anxiety had high anxiety at 1 month. One-month anxiety correlated with pre-discharge SS and TS scores, a history of psychiatric problems including depressed mood, medical and negative social life events, lack of pregnancy planning and prenatal class attendance, perceived peripartum stress, and duration of postpartum hospital stay. Inverse correlations were observed with education, household income, and resiliency factors. In multivariate modeling, anxiety trait, education, history >or=2 years of depression, and perception of peripartum stress accounted for 50% of the variance in the 1-month SS score. Maternal anxiety increases during the first postpartum month. Women with high trait anxiety, low education, a history of depressed mood, and a perception of high peripartum stress are at risk for experiencing anxiety at this time.     

Resolution of parental bereavement after a perinatal loss

This is a follow-up study of 25 middle-class, expectant, married couples who had experienced a perinatal loss (16 miscarriages, seven stillbirths, and two neonatal deaths) within the previous 2 years and who subsequently gave birth to a healthy child. The Perinatal Bereavement Scale (PBS) had been previously completed during the 8th month of the subsequent pregnancy and at 6 weeks postnatally. In this study, the PBS was completed 16 months after the birth of the subsequent child. The hypothesis was that the parents who experienced a late perinatal loss (stillbirth and neonatal death) would display more unresolved grief 16 months after the subsequent child was born compared to parents who had experienced an early loss (miscarriage). The late group mothers had significantly higher PBS scores than either the early group mothers or early group fathers at 16 months postnatally.     

Anxiety and depression in children with epilepsy and their mothers

OBJECTIVE: Children with epilepsy have high rates of depression and anxiety. The majority of studies concentrate on the children with epilepsy, but the emotional impact of epilepsy on family members is of clinical concern. In this cross-sectional study we aimed to examine the association between epilepsy in childhood and adolescence, and anxiety and depression in these patients and their mothers. METHODS: We studied 35 children and adolescents with seizures (age range, 7-19 years), 35 gender-matched healthy controls (age range, 8-17) who did not have any chronic medical illness, and mothers of these individuals (n=70) in a cross-sectional analysis. We administered the Kovac Child Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAIc) to the children. We administered the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) to the mothers of these children. Pearson correlations were used to analyze dependence between variables, and Student's t test was used to compare mean values between test scores. RESULTS: Patients with epilepsy had higher CDI scores (mean+/-SD, 12.48+/-6.35) than controls (9.31+/-5.11) (P<0.05), whereas the STAIc scores did not differ between cases (34.03+/-8.29) and controls (35.20+/-6.23) (P<0.05). Mothers of children with epilepsy did not have more depression or anxiety symptoms than mothers of children without epilepsy as measured by BDI and STAI scores (P>0.05). There was no correlation between mothers' scores and patients' or controls' scores. CONCLUSIONS: These results support findings from previous studies that children and adolescents with epilepsy have a higher frequency of depressive but not anxiety symptoms than the general population of healthy children and that this is independent of their mothers' symptoms.     

Children from unwanted pregnancies

The health and development of 220 children born of unwanted pregnancies (UP) was investigated in a case-control study 9 years after their births. The analysis was based partly on data from health records and school reports, and partly on direct examination of the child and parents by a team of professionals using psychological tests, sociograms, rating scales, questionnaires, structured interviews and medical examinations. Although differences between wanted and control children were not dramatic, they were consistent and multiple and tend to support the major hypothesis that the development of children born of unwanted pregnancies would be more problem prone. A child born from an unwanted pregnancy, especially a boy, is more likely to have deficiencies in psychosocial development and educational achievement than other children his own age, despite equivalent health status at birth. The mothers of unwanted children, compared with mothers who accepted their pregnancy (AP children), despite having the same level of education and socioeconomic background, show less stability in their marital lives, poorer interaction with their husbands, a higher abortion rate before and after the birth of the unwanted child, less involvement in the upbringing of the child, and somewhat poorer interaction with their social environments. Nevertheless the majority of the mothers studied seem to have gradually changed from an originally strongly negative attitude toward the pregnancy to an accepting attitude toward the child. A Maladaptation Score (MS) was developed as an overall measure of the social status of the child within the family and society. Differences between UP and AP children, which were not so definitive when viewed in terms of individual indicators, came into sharper focus when the cumulative effects of negative factors were noted. The MS findings confirmed more concretely that children born from unwanted pregnancies are more often in an unfavorable social situation and at greater future risk.     

The mental health of adults born of unwanted pregnancies,their siblings,and matched controls: a 35-year follow-up study from Prague,Czech Republic

This study tested the hypothesis that being born of an unwanted pregnancy is a risk factor for poor mental health in adulthood. Self-report and objective data were collected at ages 28 to 31 and 32 to 35 years in a cohort of nearly 200 "unwanted" subjects born after their mothers had been twice denied an abortion for the same pregnancy. The same data were collected in a sociodemographically matched control cohort of "accepted" subjects whose mothers had not requested an abortion, and from siblings of both the unwanted subjects and the accepted control subjects. Logistic regression analyses conducted with several indicators of poor mental health in adulthood as dependent variables brought partial support for the hypothesis. Specifically, unwanted subjects became psychiatric patients (especially psychiatric inpatients) more frequently than their siblings and the accepted controls. Criminality, alcohol-related disorders, and heavy smoking were not associated with unwanted pregnancy.     

Handedness and maternal smoking during pregnancy

Nonright-handedness (NRH) has been attributed to hypoxia-induced brain changes in the fetus and associated pregnancy and birth complications (PBCs). Maternal smoking during pregnancy is known to produce prenatal hypoxia for the fetus, which may result in low birth weight and other PBCs. It was hypothesized that maternal smoking during pregnancy results in a leftward shift of handedness in the offspring. This study compared the distribution of handedness in the offspring of mothers who did and did not smoke cigarettes during pregnancy. Information on maternal smoking, handedness, and PBCs was analyzed for 803 university students. There was a significant shift to the left in the distribution of handedness scores for the offspring of smoking mothers (N = 216), as compared to those of nonsmoking mothers (N = 587). Offspring of smoking mothers also reported significantly more PBCs. Results are consistent with the hypothesis that NRH is associated with pathological neurodevelopment.     

A prospective-longitudinal study on the association of anxiety disorders prior to pregnancy and pregnancy- and child-related fears

This study aimed to investigate the relation between anxiety disorders prior to pregnancy and specific pregnancy- and child-related fears during pregnancy and after delivery. 306 expectant mothers were interviewed regarding anxiety (and depressive) disorders prior to pregnancy and pregnancy- and child-related fears (e.g. fear of labor pain, fear of infant injury) using the Composite International Diagnostic Interview for Women (CIDI-V). Pregnancy- and child-related fears were particularly pronounced in women with multiple anxiety disorders and women with comorbid anxiety and depressive disorders prior to pregnancy. Further analyses revealed associations between particular anxiety disorders and specific pregnancy- and child-related fears. Results remained stable when considering potential confounders such as maternal age, education, marital status, parity, prior abortion and preterm delivery or low birth weight. Our study suggests that especially women with multiple anxiety and/or comorbid depressive disorders may benefit from early targeted interventions to prevent an escalation of anxiety and fears over the peripartum period.     

Cortical maldevelopment in congenital cytomegalovirus infection transmitted by a woman with preexisting immunity

Although cytomegalovirus (CMV) congenital infection is more severe in children born to women with primary infection, neurological symptoms have also been observed in infants born to mothers with preconceptional immunity. The authors describe for the first time a case of severe cortical development disorder associated with multiple abnormalities of the white matter, occurring in the second-born child of a woman found to be positive for anti-CMV immunoglobulin G (IgG) before pregnancy. CMV DNA was detected in the urine and blood of the infant. These findings indicate that the neurological outcome of CMV infection may be severe also in infants born to women with preexisting immunity.     

Neurodevelopment in the offspring of Japanese systemic lupus erythematosus patients

Objective: To evaluate pregnancy outcome of systemic lupus erythematosus (SLE) and the neuropsychological outcomes in offspring of SLE mothers. Study design: Pregnancy outcomes of SLE patients from 1989 to 2006 were determined and the neuropsychological development of the children born to SLE patients was examined suited for their age; Bayley Scales of Infant Development up to four years and Kauffmann Assessment Battery for Children from four years onwards. Results: Of the 233 deliveries, 58 (24.7%) were preterm, 72 (30.9%) were low-birth-weight, and 46 (19.7%) were IUGR. Twenty-six children enrolled in this study had normal intelligence. The mean MDI and PDI were 95.8 ± 10.1 and 94.6 ± 14.1, respectively. The mean scores for the Sequential Processing scale, Simultaneous Processing scale, and Mental Processing composite were 103.1 ± 13.3, 104.2 ± 10.2, and 104.2 ± 12.2, respectively. In the children with anti-Ro/SS-A antibody-positive mothers, mean gestational age and birth weight were significantly lower (p < 0.05), as a result, the mean score of Sequential Processing and Mental Processing were significantly lower than that of negative mothers. The presence of maternal antiphospholipid antibody was not related to gestational age, birth weight and any score on the intelligence tests, except for the rate of IUGR. Conclusion: The rates of preterm delivery and IUGR were frequent in the SLE patients and careful monitoring and management of the disease during pregnancy are still necessary. We should examine the neurodevelopment of the children born from mothers with anti-Ro/SS-A antibody prospectively.     

Parents of children with psychopathology: psychiatric problems and the association with their child’s problems

Knowledge is lacking regarding current psychopathology in parents whose children are evaluated in a psychiatric outpatient clinic. This especially accounts for fathers. We provide insight into the prevalence rates of parental psychopathology and the association with their offspring psychopathology by analyzing data on psychiatric problems collected in 701 mothers and 530 fathers of 757 referred children. Prevalence rates of parental psychopathology were based on (sub)clinical scores on the adult self report. Parent–offspring associations were investigated in multivariate analyses taking into account co-morbidity. Around 20 % of the parents had a (sub)clinical score on internalizing problems and around 10 % on attention deficit hyperactivity (ADH) problems. Prevalence rates did not differ between mothers and fathers. Parent–offspring associations did not differ between girls and boys. Maternal anxiety was associated with all offspring problem scores. In addition, maternal ADH problems were associated with offspring ADH problems. Paternal anxiety and ADH problems scores were specifically associated with offspring internalizing and externalizing problem scores, respectively. Associations with offspring psychopathology were of similar magnitude for mothers and fathers and were not influenced by spousal resemblance. Our study shows that both fathers and mothers are at increased risk for psychiatric problems at the time of a child’s evaluation and that their problems are equally associated with their offspring problems. The results emphasize the need to screen mothers as well as fathers for psychiatric problems. Specific treatment programs should be developed for these families in especially high need.     

Effects of Maternal Drinking on Neonate State Regulation

Sleep-awake state distribution during inter-feed intervals over a 24-hour period on the third day of life was investigated by means of a continuous non-intrusive bassinet sleep monitor. 31 infants were studied: 14 born to mothers who drank heavily throughout pregnancy (group A), eight whose mothers modified their heavy drinking (group B) and nine whose mothers never were heavy drinkers (group C). Over the 24-hour period, group A infants slept less than those in group B. In comparison with group C, group A infants had a larger proportion of quiet sleep episodes interrupted by awake or unclassified epochs, and were more restless, with more frequent major body movements. These pilot observations suggest that heavy maternal consumption of alcohol, when continued throughout pregnancy, is associated with a disturbance of sleep-awake state distribution. Successful therapy of heavy drinking during pregnancy may improve the physiological competence of the newborn to regulate sleep-awake states and facilitate interaction between mother and infant.     

Material anxiety following bereavement by cot death and emotional security of subsequent infants

State and trait anxiety were assessed for 60 mothers of young infants of whom 30 had previously been bereaved by cot death. Maternal state anxiety and infant emotional security were assessed 12 months later. It is concluded that while children born subsequently to a cot death are not inevitably at risk, there may be some relationship between maternal anxiety produced by an earlier trauma and infant insecurity. Problems of research with bereaved families, and directions for future research are discussed.