Antenatal Stress Flashcards
(26 cards)
What is the concept of fetal programming?
Environment in the womb,
during different sensitive periods for specific outcomes, can alter the development of the fetus,
with a long lasting effect
on the child.
What does the development of the foetal brain rely upon?
Signals it receives from the mother
What are the long term effects of antenatal stress of neurodevelopment?
Increase risk of changes in cognitive development and behaviour in the child
What is pregnancy specific anxiety?
Anxious about the outcome of the pregnancy
Will the child be alright?
Will the mother be alright?
What outcomes can be increased risk for the child?
Anxiety and Depression Behavioural problems-ADHD, conduct disorder Impaired cognitive development Neonatal behaviour More difficult infant temperament Victimisation in childhood Schizophrenia ( stress in first trimester) Autism spectrum Personality disorder
What physical outcomes is prenatal stress associated with increased risk for?
Reduced birthweight and gestational age Preterm delivery Mixed handedness Decreased telomere length Asthma Altered immune function Altered microbiome ( in meconium)
Is it causal, rather than genetic of postnatal?
Causation found in
- Animal studies
- Effects of natural disasters
- Studies which allow for confounders
- Underlying mechanisms
What is ALSPAC?
Avon Longitudinal Study of Parents and Children
Large prospective birth cohort ~14,000 pregnant women recruited around Bristol in 1990-1991
What data was collected during ALSAPC?
Maternal Postnatal anxiety and depression Paternal pre and postnatal anxiety Parenting Maternal age Birthweight Gestational age Smoking Alcohol Psychosocial factors: crowding (SES) Maternal education
n= 7,363 with complete data
What did ALSPAC find?
If the mother is in the top 15% anxiety the child had double the risk of a probable mental disorder
The combined effects or raised anxiety doubled from 6% to 12% at age 13
Attributable load of probable mental disorder in whole population due to prenatal anxiety/depression~10%
What is the significance of the COMT gene?
COMT inactivates catecholamines
–dopamine, adrenaline and noradrenaline-
gene variants associated with working memory and ADHD
What is the significance of the children’s own genetic vulnerabilities?
Children with certain genese were resilient
Maternal anxiety had no effect on working memory and ADHD status
But children with other genes did have an effect
What is the significance of the children’s own genetic vulnerabilities?
Children with certain genes were resilient
Maternal anxiety had no effect on working memory and ADHD status
But children with other genes did have an effect
What does what the placenta filters to the foetus dependent on?
Signals from the mother
What is the placenta rich in?
An enzyme that breaks down cortisol
1/11Beta-HSDS
What was found when assessing maternal anxiety prior to caesarean?
More anxious the mother was the lower the expression of this enzyme
Mothers is stressed - down-regulation of enzyme
Allows more cortisol to pass from mother to foetus
What is the significance of the amniotic cortosil?
Strong negative correlation between amniotic cortisol and IQ in children who are insecurely attached to their mothers
Those who were securely attached - this acted as a buffer. No correlation.
What are the patterns observed with increased in utero cortisol?
Associated with reduced attention
Associated with increased anxiety
Similar to those observed in children with early maltreatment
What is found on structural MRIs of those who have experienced pre-natal stress?
Thinner cortex ( associated with depression and cognitive problems) Enlarged amygdyla ( associated with increased anxiety)
What is found on diffusion MRIs of those who have experienced pre-natal stress?
Alterations in uncinate fasciculus which connects amygdyla with frontal cortex ( associated with mood disorders and antisocial behaviour)
Why are these association present?
Predictive adaptive value of changes due to prenatal stressin a stressful environment (predators)in the wild?
Anxiety/fear reactivity-beneficial effects of more vigilance
ADHD- shifting attention helps if predators about
What are the evolutionary benefits of other changes caused by prenatal stress?
Impulsive - more willing to explore new environments
Conduct disorder - more willing to break rules
Aggressive - fight predators or other tribes
Cognitive deficit - side effect of ADHD or autism spectrum
Autism spectrum - understand things in different ways
What is the role of professionals?
Detect and treat anxiety and depression both in pregnancy and postnatally
Help with relationship problems or domestic abuse
Help to create more social support
Practical help with housing etc
Help to teach sensitive mothering
What are some ways of reducing antenatal stress?
Yoga
Gardening
Music
