Prenatal Risks for Future Mental Health Problems Flashcards
Appreciate how prenatal stress, anxiety, and depression can all increase the risk of a range of mental health problems in the child Understand that while there is an increased risk of anxiety, depression, ADHD, conduct disorder, and cognitive problems in the child, most children are not affected Demonstrate that the effect on the child depends in part on specific genetic vulnerabilities and the sensitivity of postnatal care Appraise some of the biological mechanisms for such foetal programming,
Define foetal programming
How the environment in the womb can alter development of the foetus and have long-lasting effects on the child
Describe the Barker hypothesis
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
Describe the effect of birth weight on coronary heart disease risk
A child of low birth weight is twice as likely to die of CHD in their 70s as a child of normal birth weight
How many women are affected by postnatal depression?
1 in 10
How much is a woman’s risk of psychosis increased in the month post-partum?
30x
State 2 risk factors for post-partum psychosis
Personal or family history of bipolar disorder
How much does the brain increase in size between 20 and 40 weeks gestation?
17x
How much does the brain increase in size between birth and 5 years of age?
4x
Name the steps involved in neural development
Proliferation, migration, differentiation, synaptogenesis, neural pruning
When does neural proliferation start and end?
Starts: 5 weeks gestation
Ends: 18 months after birth
Broadly, what occurs in the developing brain in the first and second half of gestation?
1st half: Migration
2nd half: Synaptogenesis
State some prenatal stresses associated with developmental and behavioural changes in the child
Maternal anxiety and depression, maternal daily hassles, pregnancy-specific anxiety, partner or family discord, experience of acute distress
Describe the association between maternal childhood trauma and pregnancy-related mental health issues (ALSPAC study)
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
Describe the difference in prenatal mental health in LICs and HICs
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
Name some developmental disorders associated with prenatal stress
Anxiety disorder, depressive disorder, ADHD, language impairment, sleep problems in infancy, difficult temperament, schizophrenia, autism spectrum disorder, intellectual disability
What period of development is associated with schizophrenia?
Altered migration of cells during the first half of gestation
Name some physical consequences to the child of maternal prenatal stress
Low birthweight, ambidextrosity, altered fingerprint pattern, decreased telomere length, asthma, altered microbiome, altered immune function
Name some conditions associated with not being right-handed
ADHD, schizophrenia, dyslexia
Describe the effect of pregnancy-related anxiety on the infant’s gut microbiome
It is associated with fewer Enterobacteriaceae species in the microbiome of the newborn meconium
Describe some effects of prenatal stress on offspring in animal studies
Increased anxiety, reduced attention, learning deficits, reduced laterality, altered sexual behaviour with increased rates of homosexuality
What appears to mediate the effects of prenatal stress on offspring in animal studies?
The HPA axis and cortisol
What percentage of behavioural and emotional problems are likely to be attributable to antenatal anxiety, depression, or stress (ALSPAC)?
10-15%
How much does high prenatal anxiety influence the child’s risk of developing a mental health disorder? (O’Donnell et al, 2014)
It doubles it - but only to 12.5%
Gene variants of which enzyme are associated with working memory and ADHD?
Catecholamine methyl transferase (COMT)
Describe the relationship between antenatal anxiety, working memory, and COMT (ALSPAC; O’Donnell et al, 2017)
Working memory is worse in children with the GG genotype of COMT, but only when their mothers had been anxious during pregnancy
Describe the relationship between antenatal anxiety, ADHD, and COMT (ALSPAC; O’Donnell et al, 2017)
Children with the GG genotype of COMT have higher ADHD socres, but only if their mothers suffered from perinatal anxiety
Describe the relationship between maternal anxiety and 11-betaHSD2 (O’Donnell et al, 2012)
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
Describe the relationship between cortisol and Bayley scales of infant development 2 (BSD-II) scores
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
Describe the brain changes in children associated with maternal stress during pregnancy (Sarkar et al, 2018)
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
Describe the brain changes in children associated with high amniotic fluid cortisol (Sarkar et al, 2018)
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
How do the brain changes in children of anxious mothers correlate with behavioural changes (Sarkar et al, 2018)
They are associated with reduced attention and increased anxiety
What is the basis for foetal programming?
Epigenetic modifications
Define epigenetic modification
Functionally relevant changes to the genome which do not involve a change in nucleotide sequence
Describe how epigenetic modification can affect gradnchildren
Grandmaternal smoking in pregnancy is associated with autistic traits in grandchildren (Golding et al, 2016)
Give a reason why stressors may be able to epigenetically modify offspring, with evidence
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
Describe the sex differences in consequences of maternal stress
Females are more likely to develop anxiety, whereas males are more likely to develop ADHD and conduct disorder
Describe how the sex differences in consequences of maternal stress are explained by an evolutionary perspective
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
How many cases of perinatal depression are recognised and treated respectively? (Gavin et al, 2015)
Recognised: 40%
Treated: 24%
Describe the influence of breastfeeding on behavioural development
It can imrpove outcomes for IQ and hyperactivity, but not for emotional problems or conduct disorder
