Maternal Stress in Pregnancy: Considerations for Fetal Development

doi:10.1016/j.jadohealth.2012.04.008

Journal of Adolescent Health

Volume 51, Issue 2, Supplement, August 2012, Pages S3-S8

https://doi.org/10.1016/j.jadohealth.2012.04.008 Get rights and content

Abstract

There is significant current interest in the degree to which prenatal exposures, including maternal psychological factors, influence child outcomes. Studies that detect an association between prenatal maternal psychological distress and child developmental outcomes are subject to a number of interpretative challenges in the inference of causality. Some of these are common to many types of prenatal exposures that must necessarily rely on observational designs. Such challenges include the correlation between prenatal and postnatal exposures and the potential role of other sources of shared influence, such as genetic factors. Others are more specific to this area of research. These include confounding between maternal report of child outcomes and the maternal psychological attributes under study, difficulties in distinguishing maternal stress from more ubiquitous aspects of maternal personality, and the lack of association between cortisol and measures of maternal psychological stress. This article considers these methodological issues and offers an additional methodology focused on fetal neurobehavior for discerning potential mechanisms that may mediate associations between maternal psychological functioning and the developing fetal nervous system.

Section snippets

Maternal stress as a developmental teratogen

Maternal psychological stress has essentially been conceptualized as a teratogen, an agent that can generate deleterious perinatal and/or developmental outcomes. As such, it shares the same methodological challenges that all such studies do in attempting to isolate the effects of an exposure from other confounding influences because such studies are necessarily observational in design in humans [9]. In particular, as with exposure to contaminants found in the physical environment, prenatal

Toward an expanded view of the influence of maternal psychological factors

Pregnancy is a complex and dynamic condition. Maternal psychological state changes produce a cascade of reactions, including changes in blood flow to the uterus and alterations to the intrauterine sensory environment experienced by the fetus. Given the intricate physiological relationship between the pregnant woman and the fetus, it would be somewhat surprising if dynamic aspects of the maternal psychological environment did not serve to shape neurodevelopment of the fetus and ultimately that

Concluding reflections

The existing literature on whether and how maternal psychological stress during pregnancy affects the developing fetal brain, as measured by indicators of developmental functioning during childhood, is subject to a number of interpretative cautions in establishing causality. In part, these are no different from establishing causality between any prenatal exposure and postnatal outcome in which the exposures cannot be randomized across individuals. However, design features that are particular

Acknowledgments

Funding for preparation of the manuscript and research described within provided by NICHD 2 R01 HD27592-18.

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Pregnancy and the early postpartum signify a period of high stress. Perinatal stress can include psychological distress (PD), such as anxiety, depression, and stress, as well as neuroendocrine stress, indexed by activation of the hypothalamic-pituitary-adrenal (HPA) axis and the production of the hormone cortisol. Elevated PD and cortisol levels during the perinatal period can have long-term implications for the mother and child. Methodological advances have enabled the sampling of cortisol from hair, to provide a retrospective marker of HPA axis activity over several months. Despite knowing that maternal PD and HPA activity during the perinatal period independently impact health and development, research to date is unclear as to the association between maternal PD and hair cortisol. The present meta-analysis included 29 studies to assess the strength of the relation between maternal PD and hair cortisol levels during pregnancy and the early postpartum period. Several sample and methodological factors were assessed as moderators of this effect. Analyses were conducted using multilevel meta-analysis. Results of the multilevel meta-analysis indicated that the overall effect size between PD and HCC was small but not significant z = 0.039, 95% CI [− 0.001, 0.079]. Moderator analyses indicated that the strength of the association between PD and hair cortisol was moderated by pregnancy status (i.e., effects were stronger in pregnant compared to postpartum samples), timing of HCC and PD measurements (i.e., effects were larger when PD was measured before HCC) and geographic location (i.e., effects were larger in North American studies). The findings advance our understanding of the link between PD and HPA activity during the perinatal period, a time of critical impact to child development.
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Review articleMaternal Stress in Pregnancy: Considerations for Fetal Development

Abstract

Section snippets

Maternal stress as a developmental teratogen

Toward an expanded view of the influence of maternal psychological factors

Concluding reflections

Acknowledgments

Am J Obstet Gynecol

Am J Obstet Gynecol

Neurosci Biobehav Rev

J Affect Disord

J Am Acad Child Adolesc Psychiatry

Biol Psychol

Neurosci Biobehav Rev

Am J Obstet Gynecol

J Appl Dev Psychol

J Am Acad Child Adolesc Psychiatry

Clin Neurophysiol

Biol Psychiatry

Psychoneuroendocrinology

Psychoneuroendocrinology

Psychoneuroendocrinology

Eur J Obstet Gynecol Reprod Biol

Am J Obstet Gynecol

Early Hum Dev

Early Hum Dev

Biol Psychol

Curr Top Dev Biol

Biol Psychol

Biol Psychol

Early Hum Dev

Int J Neurosci

J Am Acad Child Adolesc Psychiatry

Continuity and change in early neural development

Studies in fetal behavior: IFetal heart rate as a behavioral indicator

Monogr Soc Res Child Dev

Depression and anxiety during pregnancy: A risk factor for obstetric, fetal and neonatal outcome?A critical review of the literature

J Matern Fetal Neonatal Med

Psychological science on pregnancy: Stress processes, biopsychosocial models, and emerging research issues

Annu Rev Psychol

Antenatal maternal stress and long-term effects on child neurodevelopment: How and why?

J Child Psychol Psychiatry

Methodological considerations in behavioral toxicology in infants and children

Dev Psychol

Continuity in self-report measures of maternal anxiety, stress, and depressive symptoms from pregnancy through two years postpartum

J Psychosom Obstet Gynaecol

Maternal personality, parenting cognitions, and parenting practices

Dev Psychol

Risk for psychopathology in the children of depressed mothers: A developmental model for understanding mechanisms of transmission

Psychol Rev

Emotional characteristics of infants associated with maternal depression and anxiety

Pediatrics

Conceptualizations, measurement, and effects of prenatal maternal stress on birth outcomes

J Behav Med

Stress and the individualMechanisms leading to disease

Arch Intern Med

The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development

Child Dev

The heritability of perceived stress

Psychol Med

Prenatal stress, glucocorticoids and the programming of adult disease

Front Behav Neurosci

Chernobyl exposure as stressor during pregnancy and hormone levels in adolescent offspring

J Epidemiol Community Health

Stress during pregnancy affects general intellectual and language functioning in human toddlers

Pediatr Res

Prenatal teratogens and the development of adult mental illness

Dev Psychopathol

Socioeconomic disadvantage and child development

Am Psychol

More than meets the eye: Parental and infant contributors to maternal and paternal reports of early infant difficultness

Parent Sci Pract

Measurement of infant difficultness

Child Dev

Review article
Maternal Stress in Pregnancy: Considerations for Fetal Development