Elsevier

Psychoneuroendocrinology

Volume 37, Issue 8, August 2012, Pages 1224-1233
Psychoneuroendocrinology

Prenatal psychobiological predictors of anxiety risk in preadolescent children

https://doi.org/10.1016/j.psyneuen.2011.12.016Get rights and content

Summary

Experimental animal models have demonstrated that one of the primary consequences of prenatal stress is increased fear and anxiety in the offspring. Few prospective human studies have evaluated the consequences of prenatal stress on anxiety during preadolescence. The purpose of this investigation is to determine the consequences of prenatal exposure to both maternal biological stress signals and psychological distress on anxiety in preadolescent children. Participants included 178 mother–child pairs. Maternal psychological distress (general anxiety, perceived stress, depression and pregnancy-specific anxiety) and biological stress signals were evaluated at 19, 25, and 31 gestational weeks. Anxiety was evaluated in the children at 6–9 years of age using the Child Behavior Checklist. Analyses revealed that prenatal exposure to elevated maternal cortisol, depression, perceived stress and pregnancy-specific anxiety was associated with increased anxiety in children. These associations remained after considering obstetric, sociodemographic and postnatal maternal psychological distress; factors that could influence child development. When all of the prenatal measures were considered together, cortisol and pregnancy-specific anxiety independently predicted child anxiety. Children exposed to elevated prenatal maternal cortisol and pregnancy-specific anxiety were at an increased risk for developing anxiety problems during the preadolescent period. This project identifies prenatal risk factors associated with lasting consequences for child mental health and raises the possibility that reducing maternal distress during the prenatal period will have long term benefits for child well-being.

Introduction

One out of seventeen Americans will suffer from a mental illness during their lifetime (Kessler et al., 2005). The origins of mental illness often begin early in life (De Bellis et al., 1999, Nemeroff, 2004, Gunnar and Quevedo, 2008, Green et al., 2010), yet surprisingly little is known about how early life experiences determine risk for mental illness. The prenatal period represents a time of extremely rapid change in brain development including neurogenesis, cell neuronal differentiation, dendritic arborization, axonal elongation, synapse formation, collateralization, pruning and myelination (Huttenlocher, 1994, Bourgeois, 1997, Huttenlocher and Dabholkar, 1997, Levitt, 2003). The rapid neurological advances during this period render the fetus susceptible to beneficial and detrimental influences with life-long implications for mental health. Maternal stress signals are a dominant early life influence contributing to the organization of the nervous system. The purpose of the present study was to investigate the programming influence of prenatal exposure to maternal psychological distress and biological indicators of stress on the development of anxiety during preadolescence.

Section snippets

Prenatal maternal glucocorticoids and child behavioral and emotional regulation

For a number of reasons, glucocorticoids have been proposed as a primary candidate for fetal programming of later health outcomes. Glucocorticoids are steroid hormones that are the end product of the hypothalamic-pituitary adrenocortical (HPA) axis and exert influences on nearly every organ and tissue in the body (Drake et al., 2007). Maternal cortisol increases two to four-fold over the course of normal gestation (Sandman et al., 2006). Fetal exposure to the increasing concentrations of

Prenatal maternal psychological distress and child behavioral and emotional regulation

Accumulating evidence has shown that human fetal exposure to maternal psychological distress during pregnancy additionally is associated with increased fearful and anxious behavior later in life. Prenatal exposure to maternal anxiety, stress and depression has been associated with impaired stress regulation (Van den Bergh et al., 2008, Grant et al., 2009, Davis et al., 2011a), behavioral/emotional problems (Huizink et al., 2002, O’Connor et al., 2002, O’Connor et al., 2003, Van den Bergh and

Study overview

Study participants included mother–child pairs from a prospective longitudinal study of prenatal stress and development. Women with singleton pregnancies less than 16 weeks gestational age were recruited from obstetric clinics in Southern California and assessed throughout gestation and when the child was 6–9 years of age.

Participants

The sample included 178 mothers and their 6–9 year old children (mean ± SD: 7.3 ± 0.8; 55% female). Initial prenatal recruitment criteria were as follows: Study participants were

Maternal cortisol

Maternal salivary cortisol levels increased from 0.24 μg/dl at 19 gestational weeks to 0.29 μg/dl at 25 weeks and to 0.34 μg/dl at 31 gestational weeks (p < 0.01). Intercorrelations among cortisol measures ranged from 0.17 to 0.29, ps < 0.05.

Maternal psychological state

Means and standard deviations for perceived stress, depression, general anxiety and pregnancy-specific anxiety are shown in Table 2. Perceived stress and depression did not significantly change over the course of pregnancy (ps > 0.3). Consistent with prior work, a

Discussion

In a prospective study with multiple prenatal assessments we document that prenatal maternal cortisol and prenatal psychosocial distress measures are associated with anxiety in preadolescent children. These are among the first prospective findings to document an association between both biological indicators of stress and psychological distress during gestation and risk for anxiety during preadolescence.

Conclusions

There is increasing evidence that the fetal environment plays a role in the development of psychiatric disorders (Schlotz & Phillips, 2009). There are important studies demonstrating associations between maternal psychological distress during pregnancy and risk for poor mental health during childhood and adolescence (O’Connor et al., 2003, Huizink et al., 2007, Van den Bergh et al., 2008). To our knowledge these are the first findings linking both biological and psychosocial measures of

Role of the funding source

Funding for this study was provided by awards from the NIH to EPD (HD-50662) and CAS (HD-51852, HD-28413, and NS-41298). The NIH had no further role in study design; in the collection analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Acknowledgements

The authors wish to thank the families who participated in this project. The assistance of Megan Faulkner, Christina Canino, Cheryl Crippen and Natalie Hernandez of the Women and Children's Health and Well-Being Project, Department of Psychiatry & Human Behavior, University of California is gratefully acknowledged.

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