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Running Head: ANXIETY AND STRESS ON INFANT OUTCOME
| Content Provider | Semantic Scholar |
|---|---|
| Author | Kay, Rachel E. |
| Copyright Year | 2009 |
| Abstract | Maternal depression is a debilitating disorder that places mothers and infants at an increased risk for physical and emotional delays and difficulties. The current study utilizes two samples of pregnant women, a screening sample of 2,030 and an interviewed sample of 152 who were screened for the presence or absence of psychopathology symptoms, with aims to determine if anxiety measures during gestation predict similar risks to depression. Based on data from Edinburg Postnatal Depression Scale (EPDS) and Structured Clinical Interview for DSM-IV (SCID) anxiety screening measures, the study supports the presence of an increased risk for demographically high-risk women, as well as those with higher anxiety EPDS scores and positive responses to the SCID anxiety screening. Findings suggest that anxiety can predict difficulties with pregnancy and delivery including increased infant respiratory distress, shorter gestational periods, lower Apgar scores, and other complications. These important findings must be further researched to find the effects of maternal anxiety on infant’s neurological and physical problems, its ability to inhibit child development, as well as potentially increase the infant’s susceptibility to psychopathology throughout the lifespan. Prevention and early action plans must also be implemented to create and sustain healthy moms and infants. Maternal Anxiety and Stress on Infant Outcome 3 Maternal Stress and Infant Outcomes: The Impact of Perinatal Anxiety on Pregnancy and Delivery Outcomes The transition into motherhood can be a challenging time for many women; however, many women are faced with the added difficulty of maternal depression. Maternal depression has been studied for decades and has been proposed to have several factors that negatively alter the pregnancy and delivery experience for both mother and baby. These women may experience signs of increased anxiety that either co-occur or are separate from depression. The effect of maternal stress and anxiety on infant outcomes has not been as widely studied as the effects of depression. Therefore, it is important for studies to include measures of anxiety in examining effects on maternal and infant outcomes. Research suggests that depression in mothers affects parent-child relationships, interactions and the emotional and behavioral reactions in children. Sutter-Dallay, GiaconneMarcesche, Glatigny-Dallay, & Verdoux(2004) found that the presence of anxiety symptoms and stress during pregnancy increased the likelihood of high scores on the Edinburgh Postnatal Depression Scale (EPDS). Other studies have found that prenatal anxiety is the strongest predictor of postnatal depression symptoms (Vythilingum, 2008). To better understand the connection between maternal anxiety and atypical pregnancy and delivery complications, perinatal anxiety and stress must remain a focus of scientific literature and studies. Current literature indicates that there may be a difference in the risk factors of mothers with antepartum anxiety and depression as compared to women with postpartum anxiety and depression (O’Connor, 2005). Understanding these differences is important in determining the timing of effective interventions. In addition, once a woman experiences a depressive episode, her likelihood of having another episode greatly increases due to her increased vulnerability Maternal Anxiety and Stress on Infant Outcome 4 (O’Hara, 1997). The influence of perinatal stress and anxiety symptoms on infant behavioral outcomes The relationship of anxiety and stress with infant outcomes such as increased prematurity, lower infant birth weight and length, head circumference, and Apgar scores have gained recent research attention. Findings have shown that such mental health symptoms during pregnancy may put infants and children at greater risk for developmental delays as well as an increased threat for development of psychopathology. Studies that have explored the impacts of maternal anxiety and stress on infant factors at birth have yielded some consistent finding. Specifically, low birth rate, shorter delivery length and shorter gestational length have all been found to be more likely among women with chronic stress symptoms and increased scores of state trait anxiety. For example, one study found that infants of mothers with elevated stress and anxiety had significantly decreased gestational lengths and had infants who were smaller overall in size (Hosseini, 2007). Similar findings with correlations between anxiety and stress and gestational length and preterm birth were found in several other studies examining women during pregnancy (Rini, Schetter, Wadhwa & Sandman, 1999; Glynn, Schetter, Hobel, & Sandman, 2008) Another study examined the implications of antenatal depression and anxiety on obstetric experiences with a focus on risk and prevalence of delivery complications. Along with reporting increased physical discomfort throughout the pregnancy, women with elevated anxiety scores were found to have more pregnancy concerns including an overall higher number of obstetric visits to alleviate fear of birth and misinterpreted contractions than control subjects (Andersson, Sundström-Poromaa, Wulff, Aström, & Bixo, 2004). Most interesting, however, were the differences in delivery procedures. Women experiencing high levels of stress and anxiety Comment [MCIT1]: Refs here Maternal Anxiety and Stress on Infant Outcome 5 throughout gestation showed increased use of, or perhaps need for, epidurals during the labor process. These women were also found to have significantly higher likelihood of having cesarean sections (Andersson, Sundström-Poromaa, Wulff, Aström, & Bixo, 2004). Findings were consistent with the several other assessments in the literature, and included measures of maternal stress and anxiety directly. In this study, it was seen that women who were given epidurals were also more likely to deliver through surgical, rather than vaginal means (Saunders, Lobel, Veleso, & Meyer, 2006). Another infant outcome that has been linked to anxiety during pregnancy is lower Apgar scores (Sopajaree, 2000), which are gross measures of infant functioning one and five minutes after birth. For example, a study by Berle et al. (2005), regarding neonatal outcomes with anxiety and depression in pregnancy found no association between birth weight and premature birth and anxiety scores, but the study did find a negative correlation with Apgar scores. It is important to note that such variability in birth weight findings may be attributed to cultural differences with a bias of "healthy women" in the sample, as the study was conducted in Norway where nutrition and health are highly emphasized. A study looking at psychiatric illness as a whole included women with depressive and anxiety disorders, schizophrenia, and other diagnoses in their sample to compare pregnancy outcomes. Results indicated that there was a negative correlation between psychiatric illness and infant Apgar score, where women with diagnoses or increased maladaptive psychiatric symptoms birthed infants with lower Apgar scores (Schneid-Kofman, Sheiner, & Levy, 2007). Another study showed that perceived stress of life-events, depression, and anxiety all predicted Apgar scores lower than the average, healthy infants (Marcus, 2009). A study conducted with a more focused research sample included women with high-risk pregnancies. Here, the relationship of maternal anxiety for these women and their infant Maternal Anxiety and Stress on Infant Outcome 6 outcomes was looked at more specifically. There may have been both mediating and moderating factors, such as other medical variables that originally placed women within a high-risk group. However, findings suggest a significant negative correlation between anxiety and Apgar scores for women with pregestational and gestational diabetes, and no difference for control participants. These findings were only significant for anxiety within the second trimester (Sopajaree, 2000). Anxiety, Stress and Maternal Demographic Characteristics Based on several studies, lower socioeconomic status is correlated with higher levels of maternal anxiety (Hosseini, 2007). Rini, Schetter, Wadhwa and Sandman (1999) examined connections between personal resources, stress, socio-cultural support and birth outcomes. The study concluded that the stronger a mother's resources, the higher the infant birth weight. As one would expect, better socioeconomic resources correlated with lower anxiety and stress scores. However, when controlling for the general difference in resources, the findings remained statistically significant, suggesting that resources alone may not be predictive of anxiety, and that there may be additional factors influencing anxiety symptoms (Rini, Schetter, Wadhwa & Sandman, 1999). For example, research suggests that there is a negative correlation between level of education of the mother and likelihood of anxiety (Langan, 1997). Other research examining the impact of stress and other factors on birth weight and infant growth measures evaluated mothers' co-occurring smoking habits. In a study by Lou et al. (1995), women experiencing high levels of stress while concurrently smoking cigarettes delivered infants with significantly lower birth weights and smaller head circumferences. The head measurements were found statistically significant for infants of anxious mothers even after controlling for an abnormally lower infant weight. Comparable findings were seen regarding lower birth weight, Maternal Anxiety and Stress on Infant Outcome 7 smaller head circumference and decreased gestational length in other studies as well (Marcus, 2009). Generally, research in this area has primarily focused on the relationship between perinatal depression and pregnancy and infant outcomes, with an under-emphasis in anxiety. Because of the prevalence of anxiety in childbearing aged women, this is an importa |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://deepblue.lib.umich.edu/bitstream/handle/2027.42/63952/kay_rachel_2009.pdf?sequence=1 |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
