Prenatal Stress and its outcomes on child mental health
Pregnancy is very important phase in women’s life whereby she has unique attachment with her growing fetus. The three most addressed domains of this maternal fetal attachment theory are the cognitive attachment which is desire of the mother to know the baby, affective attachment which is described as pleasure from interaction with baby and altruistic attachment which is constant need to protect the unborn baby (1)
Fetal growth in mother’s womb is vulnerable to physical and psychological stressors. It can have a lasting impression on the neurological and behavioural development of the child. (2,3)
In 1992, a British physician David Barker proposed “Barker Hypothesis (4), this theory argued that adult health behaviours have a fetal origin. The most widely accepted possible mechanisms under this hypothesis are altered fetal nutrition and increased increased glucocorticoid exposure during pregnancy. During this period, the fetus is exposed to an insult or stimulus that can have irreversible long term effects on the development (5) and also he proposed that during a maternal infection, the maternal energy is diverted from the fetus and can result in negative sequelae of the body’s inflammatory response (6).
Death of a family member, catastrophic community wide disasters, household strain, homelessness, daily hassles and perceived stress during pregnancy can all increase the risk of preterm birth (7). Major life events and chronic stressors including food insecurity, chronic illness at home, increased crowding, and unemployment during pregnancy carry significant burden of low birth weight (8).
Although there is no direct neural connection between the mother and child, there are transport of stress related hormones to fetus through placenta, alteration in maternal behaviour and reduction in blood flow to fetus which translate maternal psychological functioning to physiological effects (9).
The Hypothalamus Pituitary Axis has centric role in the development of psychiatric disease. The high cortisol levels bring about significant changes in the number of neurotransmitters released particularly dopamine, serotonin, and noradrenaline (10). The associated changes are increased impulsivity, elevated attention deficit and aggression. Consequently these children have an increased tendency to develop psychiatric disease as a way of adapting to stressful situations (11).
Depression is psychiatric illness seen during pregnancy and in the postpartum period. It is generally unrecognized in prenatal care (12). Depression in pregnancy can lead to unfavourable outcomes such as poor compliance to prenatal care, smoking initiation, illicit drug abuse, inadequate nutrition, lack of exercise and elevated suicidal tendencies (13-15)
Maternal stress, anxiety, and depression during pregnancy have a substantial effect on the neurodevelopment of the child, it has long term implications with a negative effect on motor skills, learning ability, and behaviour. Psychological stress during pregnancy can also lead to life threatening situations including death of baby before or during delivery. In a prospective study conducted by Wisborg et al, it was revealed that psychological stress during pregnancy increases the risk of death of baby before or during pregnancy by 80 % (16).
Maternal anxiety during pregnancy can lead to smaller fetal head circumference, can restrict the intra uterine growth of the fetus (17), can cause low birth weight resulting in obesity and overweight, and severity of stress experienced can influence the development of attention deficit hyperactivity disorder in children (18) which is characterized by inattention, impulsivity and in some cases hyperactivity.
Author thanks to Rashmi Aggrawal, Amit Aggrawal and Janice Jacson Mandumpala for such a informative article entitled “ Influence of maternal stress during pregnancy and child outcomes.
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