Stress effects on Prenatal health

Question 1

what mental health problems or social situations can occur during pregnancy, which can affect the fetus

Answer 1

Depression, anxiety, and psychosis can occur during pregnancy and postnatally.

Domestic violence increases during pregnancy.

This can affect the mother’s emotional state in pregnancy and postnatally, which have lasting effects on the fetus

Question 2

How can emotional states during and after pregancy affect child? describe the mechanism

Answer 2

Environment in the womb is very sensitve to stress, etc and can alter fetal development which can havbe long lasting effects on child

Trajectory isn’t set in stone as it can be combated by sensitive mothering

Question 3

Explain the process of the fetal brain under construction

Answer 3

3mm neural tube needs to become a brain with billions of neurones, etc

250k neurons form per minute all through gestation-

process start wtih:

• Proliferation- 5wks gestation through 18 months after birth
• Migration
• Differentiation
• Synaptogenesis
• Neural Pruning - continues to puberty

Question 4

what types of prenatal stress can affect cognitive development and behaiviour in child?

Answer 4

Maternal anxiety and depression

Maternal daily hassles

Pregnancy specific anxiety

Domestic abuse; partner or family discord

Distress caused by war

Experience of acute disasters, e.g. freezing ice storm, hurricane or 9/11

N.B: it doesn’t have to be extreme, it is a gradient

Question 5

What are the psychological and societal impacts nn child due to prenatal stress

Answer 5

• Anxiety and Depression in child
• 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 are the physiological risks of prenatal stress on child

Answer 6

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

Question 7

We know that prenatal stress esp in top 15% can increase risk of mental health disorders in children.

For ADHD, why are only some kids affected by the prenatal stress and not other

Answer 7

Have gene variants of COM-T (GG, AA, AG)

COM-T breaks down catecholamines and is associated with working memory and ADHD

For same mothers exposed to stress, only those with GG variant of COMT will reduced working memory and HIGHER ADHD

Question 8

What molecule is involved in passing stress from mothers to baby

Answer 8

11-beta HSD2 enzyme in the placenta

this converts cortisol from mother to cortisone

During stress/anxiety, this enzyme is reduced and hence more maternal cortisol gets to fetus.

Hence can affect cognitive development of child

Question 9

what can reverse the effects of cortisol induced cognitive decline in fetus?

Answer 9

•Sensitive early mothering can reverse the effects of high in utero exposure to cortisol

Question 10

what are the patterns of behaviours (in brain) observed with increased in untero cortisol?

how do you measure the cortisol and the patterns elicited

Answer 10

In utero cortisol measure by amniotic fluid cortisol

Patterns: fMRI

• Associated with reduced attention
• Associated with increased anxiety
• Similar to those observed in children with early maltreatment

Question 11

what can you find on. structural and diffusional MRI on the effect on prenatal stress?

what does each finding suggest

Answer 11

Structural:

• Thinner cortex- depression and cognitive problem
• Enlarged amygdala- increased anxiety

Diffusion:

• alterations in uncinate fasciculus connecting amygdala to frontal cortex- associated with mood disorders ans antisocial behaivoiur

Question 12

How does epigenetic play a role in prenatal stress

Answer 12

Can make changes that can persist more than one generations

Question 13

Explain the evolutionary benefit of prenatal stress causing the following:

• Anxiety/fear reactivity
• ADHD
• Impulsiviity
• Conduct disorder
• Cognitive deficit
• Autism spectrum

Answer 13

Anxiety/fear reactivity: more vigilance to see predators

ADHD- shifting attention helps if predators about.

Impulsive - more willing to explore new environments

Conduct disorder- more willing to break rules

Aggressive (men) - fight predators or other tribes

Cognitive deficit - side effect of ADHD or autism spectrum

Autism spectrum : understand things in different ways.

Also increased cortisol helps to deliver the baby faster, push baby out to meet the world

Question 14

what can be done by professionals to help reduce the impact of prenatal stress

Answer 14

Detect and treat anxiety/depression early via CBT or drugs (whether prenatally or post natally)

Help with relationship problems or domestic abuse

Help to create more social support

Practical help with housing etc

Help to teach sensitive mothering – video feedback

Question 15

what things can be done by the mother to help reduce prenatal stress / reduce effect on baby

Answer 15

Music helps

Physical activity - yoga

Sensitive mothering- combat the effect of the stress

• Stroking the baby

Breastfeeding may help. Content of breast milk may help cognition

Question 16

what are the public implications of reducing stress/amxiety/depression in pregnancy

Answer 16

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