Prenatal Risks for Future Mental Health Problems

Question 1

Define foetal programming

Answer 1

How the environment in the womb can alter development of the foetus and have long-lasting effects on the child

Question 2

Describe the Barker hypothesis

Answer 2

The intrauterine environment affects a child’s risk of developing disease later in life - for example, CHD, T2 diabetes, stroke, and HTN develop due to developmental plasticity in response to undernutrition during foetal life

Question 3

Describe the effect of birth weight on coronary heart disease risk

Answer 3

A child of low birth weight is twice as likely to die of CHD in their 70s as a child of normal birth weight

Question 4

How many women are affected by postnatal depression?

Answer 4

1 in 10

Question 5

How much is a woman’s risk of psychosis increased in the month post-partum?

Answer 5

30x

Question 6

State 2 risk factors for post-partum psychosis

Answer 6

Personal or family history of bipolar disorder

Question 7

How much does the brain increase in size between 20 and 40 weeks gestation?

Answer 7

17x

Question 8

How much does the brain increase in size between birth and 5 years of age?

Answer 8

4x

Question 9

Name the steps involved in neural development

Answer 9

Proliferation, migration, differentiation, synaptogenesis, neural pruning

Question 10

When does neural proliferation start and end?

Answer 10

Starts: 5 weeks gestation
Ends: 18 months after birth

Question 11

Broadly, what occurs in the developing brain in the first and second half of gestation?

Answer 11

1st half: Migration

2nd half: Synaptogenesis

Question 12

State some prenatal stresses associated with developmental and behavioural changes in the child

Answer 12

Maternal anxiety and depression, maternal daily hassles, pregnancy-specific anxiety, partner or family discord, experience of acute distress

Question 13

Describe the association between maternal childhood trauma and pregnancy-related mental health issues (ALSPAC study)

Answer 13

A maternal history of sexual abuse preducts elevated anxiety and depression from pregnancy to 33 months post-partum. Early childhood trauma is associated with antenatal anxiety and depression

Question 14

Describe the difference in prenatal mental health in LICs and HICs

Answer 14

Prenatal stress is more common in LICS/MICS, with 25% of expectant mothers experiencing symptoms of perinatal depression and anxiety compared to 15% in HICS. Explanations include higher rates of maternal and infant death, higher rates of interpersonal violence, natural disasters, and war

Question 15

Name some developmental disorders associated with prenatal stress

Answer 15

Anxiety disorder, depressive disorder, ADHD, language impairment, sleep problems in infancy, difficult temperament, schizophrenia, autism spectrum disorder, intellectual disability

Question 16

What period of development is associated with schizophrenia?

Answer 16

Altered migration of cells during the first half of gestation

Question 17

Name some physical consequences to the child of maternal prenatal stress

Answer 17

Low birthweight, ambidextrosity, altered fingerprint pattern, decreased telomere length, asthma, altered microbiome, altered immune function

Question 18

Name some conditions associated with not being right-handed

Answer 18

ADHD, schizophrenia, dyslexia

Question 19

Describe the effect of pregnancy-related anxiety on the infant’s gut microbiome

Answer 19

It is associated with fewer Enterobacteriaceae species in the microbiome of the newborn meconium

Question 20

Describe some effects of prenatal stress on offspring in animal studies

Answer 20

Increased anxiety, reduced attention, learning deficits, reduced laterality, altered sexual behaviour with increased rates of homosexuality

Question 21

What appears to mediate the effects of prenatal stress on offspring in animal studies?

Answer 21

The HPA axis and cortisol

Question 22

What percentage of behavioural and emotional problems are likely to be attributable to antenatal anxiety, depression, or stress (ALSPAC)?

Answer 22

10-15%

Question 23

How much does high prenatal anxiety influence the child’s risk of developing a mental health disorder? (O’Donnell et al, 2014)

Answer 23

It doubles it - but only to 12.5%

Question 24

Gene variants of which enzyme are associated with working memory and ADHD?

Answer 24

Catecholamine methyl transferase (COMT)

Question 25

Describe the relationship between antenatal anxiety, working memory, and COMT (ALSPAC; O’Donnell et al, 2017)

Answer 25

Working memory is worse in children with the GG genotype of COMT, but only when their mothers had been anxious during pregnancy

Question 26

Describe the relationship between antenatal anxiety, ADHD, and COMT (ALSPAC; O’Donnell et al, 2017)

Answer 26

Children with the GG genotype of COMT have higher ADHD socres, but only if their mothers suffered from perinatal anxiety

Question 27

Describe the relationship between maternal anxiety and 11-betaHSD2 (O’Donnell et al, 2012)

Answer 27

Greater levels of maternal anxiety correlate with lower expression of 11-betaHSD2, allowing more cortisol to pass from mother to foetus - but only in Caucasian women; enzyme expression increases with antenatal stress in non-Caucasian women

Question 28

Describe the relationship between cortisol and Bayley scales of infant development 2 (BSD-II) scores

Answer 28

Higher amniotic fluid cortisol correlates with a slight impairment to cognitive development on the BSD-II - but only in children with insecure attachment, showing that secure attachment can ameliorate the effects of high cortisol during pregnancy

Question 29

Describe the brain changes in children associated with maternal stress during pregnancy (Sarkar et al, 2018)

Answer 29

During a rewarded continuous performance task, children of stressed mothers showed increased activation of the right cingulate gyrus and decreased activation of the left inferior frontal gyrus, right supramarginal gyrus, and left anterior cingulate cortex

Question 30

Describe the brain changes in children associated with high amniotic fluid cortisol (Sarkar et al, 2018)

Answer 30

Antenatal amniotic fluid cortisol correlated with increased fMRI activation during sustained attention in the right temporal pole, right angerior cingulate cortex, and right caudate, with decreased activation in the left primary visual cortex, right cingulate cortex, and right insula

Question 31

How do the brain changes in children of anxious mothers correlate with behavioural changes (Sarkar et al, 2018)

Answer 31

They are associated with reduced attention and increased anxiety

Question 32

What is the basis for foetal programming?

Answer 32

Epigenetic modifications

Question 33

Define epigenetic modification

Answer 33

Functionally relevant changes to the genome which do not involve a change in nucleotide sequence

Question 34

Describe how epigenetic modification can affect gradnchildren

Answer 34

Grandmaternal smoking in pregnancy is associated with autistic traits in grandchildren (Golding et al, 2016)

Question 35

Give a reason why stressors may be able to epigenetically modify offspring, with evidence

Answer 35

To improve the likelihood of survival in a stressful environment - e.g. ADHD enables rapid shifting of attention if predators are around, and heightened anxiety encourages more vigilance

Question 36

Describe the sex differences in consequences of maternal stress

Answer 36

Females are more likely to develop anxiety, whereas males are more likely to develop ADHD and conduct disorder

Question 37

Describe how the sex differences in consequences of maternal stress are explained by an evolutionary perspective

Answer 37

Females need to be vigilant in looking after offspring so develop anxiety, whereas males need to explore and fight so develop ADHD and conduct disorder

Question 38

How many cases of perinatal depression are recognised and treated respectively? (Gavin et al, 2015)

Answer 38

Recognised: 40%
Treated: 24%

Question 39

Describe the influence of breastfeeding on behavioural development

Answer 39

It can imrpove outcomes for IQ and hyperactivity, but not for emotional problems or conduct disorder