Lifecourse & Prenatal Stress

Question 1

Development & changes during childhood and adolescence

Answer 1

Biological Maturation - immune and endocrine system

Cognitive & language understanding

Attachment and Social Learning

Question 2

Early life development

Answer 2

is essential for development

Question 3

Stress & Pregnancy Environment

Answer 3

Negative birth outcomes

Greater body weight & length associated with resilience (Tegetoff 2010)

Question 4

Mastorakos & Ilias, 2000

Answer 4

“Pregnancy is a transient period of relative hypercortisolism

Question 5

HPA-Placental Axis

Answer 5

• Production of placental CRH stimulates a positive feedback loop  increased CRH, ACTH, cortisol & b endorphin
• CRH system increasingly activated over the course of pregnancy (gestation) & peaks prior to deliver

Question 6

Fetus Cortisol

Answer 6

10 - 20%

Question 7

Implications of increased CRH for maternal stress

Answer 7

Stress immunisation - normal reaction to stress is reduced as pregnancy goes on.

Stress amplification - CRH rise, which can lead to preterm birth

Question 8

Implications of Stress & CRH Findings for Birth Outcome

Answer 8

•Maternal stress in weeks 28-30 linked to birth outcome, gestational age at birth & birth weight (Wadhwa et al, 1996)

Evidence for stress immunization and amplification Increased placental CRH influences timing and delivery as well as further stress protection to mother via ACTH and b endorphin

Question 9

Evidence from birth statistics

Answer 9

Rates of preterm birth increasing in the UK (8% or 1 in 13 of live births) and the US (13% of live births)

Explanations include elective delivery due to better medical care, infection, and multiple births but also due to ‘unexplained and spontaneous’ reasons e.g. psychological factors (stressful life events) and social factors (socioeconomic status)

Question 10

An PNI evidence of fetal programming

Longer term/prospective studies have found effects across childhood and into adolescence:

Answer 10

Longer term/prospective studies have found effects across childhood and into adolescence:•Infancy e.g. Huizink et al, (2003) - stress (hassles) in early pregnancy (15-17 wks) and fear of giving birth (27-28 wks) linked to impaired mental and motor development and to reduced attention and adaptability at 8 months.

Question 11

An PNI evidence of fetal programming Childhood

Answer 11

Childhood e.g. Gutteling et al (2005) – higher maternal cortisol and higher anxiety linked to higher cortisol in 5-yr old children on first day of school; Buss et al (2010) - pregnancy anxiety at 19 weeks associated with reductions in volume of grey matter in brain on MRI scans indicating vulnerability for neurodevelopmental and cognitive impairment at age 6-9 years•

Question 12

An PNI evidence of fetal programming

Answer 12

•Adolescence e.g. Van den Bergh (2008) Anxiety at 12-22 weeks associated with high, flattened cortisol profile in 14-15 year old adolescents and additionally with depressive symptoms in girls (ie psychopathology/mental health link

Question 13

In Summary

Answer 13

The prenatal period is an important part of the lifespan in considering subsequent health outcomes

The normal endocrine environment during pregnancy can be altered by stress experience

Stress during pregnancy can have potential influence on health across the lifecourse

Pregnancy provides a unique short-term ‘window’ on the HPA axis enable valuable research in health psychology and