Antenatal Stress

Question 1

What is the concept of fetal programming?

Answer 1

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.

Question 2

What does the development of the foetal brain rely upon?

Answer 2

Signals it receives from the mother

Question 3

What are the long term effects of antenatal stress of neurodevelopment?

Answer 3

Increase risk of changes in cognitive development and behaviour in the child

Question 4

What is pregnancy specific anxiety?

Answer 4

Anxious about the outcome of the pregnancy
Will the child be alright?
Will the mother be alright?

Question 5

What outcomes can be increased risk for the child?

Answer 5

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

Question 6

What physical outcomes is prenatal stress associated with increased risk for?

Answer 6

Reduced birthweight and gestational age
Preterm delivery
Mixed handedness
Decreased telomere length
Asthma
Altered immune function
Altered microbiome ( in meconium)

Question 7

Is it causal, rather than genetic of postnatal?

Answer 7

Causation found in

• Animal studies
• Effects of natural disasters
• Studies which allow for confounders
• Underlying mechanisms

Question 8

What is ALSPAC?

Answer 8

Avon Longitudinal Study of Parents and Children

Large prospective birth cohort ~14,000 pregnant women recruited around Bristol in 1990-1991

Question 9

What data was collected during ALSAPC?

Answer 9

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

Question 10

What did ALSPAC find?

Answer 10

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%

Question 11

What is the significance of the COMT gene?

Answer 11

COMT inactivates catecholamines
–dopamine, adrenaline and noradrenaline-
gene variants associated with working memory and ADHD

Question 12

What is the significance of the children’s own genetic vulnerabilities?

Answer 12

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

Question 13

What is the significance of the children’s own genetic vulnerabilities?

Answer 13

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

Question 14

What does what the placenta filters to the foetus dependent on?

Answer 14

Signals from the mother

Question 15

What is the placenta rich in?

Answer 15

An enzyme that breaks down cortisol

1/11Beta-HSDS

Question 16

What was found when assessing maternal anxiety prior to caesarean?

Answer 16

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

Question 17

What is the significance of the amniotic cortosil?

Answer 17

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.

Question 18

What are the patterns observed with increased in utero cortisol?

Answer 18

Associated with reduced attention

Associated with increased anxiety

Similar to those observed in children with early maltreatment

Question 19

What is found on structural MRIs of those who have experienced pre-natal stress?

Answer 19

Thinner cortex ( associated with depression and cognitive problems)
Enlarged amygdyla ( associated with increased anxiety)

Question 20

What is found on diffusion MRIs of those who have experienced pre-natal stress?

Answer 20

Alterations in uncinate fasciculus which connects amygdyla with frontal cortex ( associated with mood disorders and antisocial behaviour)

Question 21

Why are these association present?

Answer 21

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

Question 22

What are the evolutionary benefits of other changes caused by prenatal stress?

Answer 22

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

Question 23

What is the role of professionals?

Answer 23

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

Question 24

What are some ways of reducing antenatal stress?

Answer 24

Yoga
Gardening
Music

Question 25

What can help after the baby is born?

Answer 25

Stroking babies

Breastfeeding can help with IQ

Question 26

What are the public health implications of reducing stress/anxiety/depression in pregnancy?

Answer 26

More than one million children in UK suffer from neurodevelopmental disorders

Attributable load of neurodevelopmental problems due to prenatal stress 10-15%

Potential to reduce number of affected children in the UK by 100,000-150,000