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Vivette Glover Imperial College London

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1 Vivette Glover Imperial College London
Impact of antenatal maternal stress, anxiety and depression on the fetus and the child Vivette Glover Imperial College London Dunblane May 2010

2 The mother’s emotional state in pregnancy
can have a long lasting effect on the neurodevelopment her child

3 Anxiety and depression the scale of the problem
The single biggest cause of misery in our community is mental illness 40% of all disability is due to mental illness % of population Anxiety and depression Generalised anxiety Depression LSE report 2006 (Lord Layard)

4 Emotional health of women during pregnancy
Women have more symptoms of depression and anxiety during pregnancy than postnatally- about 10-15% suffer Pregnancy can also be a time of increased domestic abuse and relationship strain Antenatal anxiety and depression are strong risk factors for postnatal depression

5 More than one million children in UK suffer from neurodevelopmental disorders
Emotional disorder (anxiety and depression) (4%) Conduct disorder (6%) Hyperkinetic and/or attention disorder (ADHD) (2%) Other e.g autism (1%) Boys 11% girls 8% Social Trends 2007

6 Fetal programming Environment in utero , during different critical periods for specific outcomes, can alter the development of the fetus, with a permanent effect on the child.

7 National Institute of Child Health: Pregnancy and Perinatology Board
Strategic Plan 2005–2010 ‘ The programming hypothesis brings a new perspective to public health. Diseases that were once thought to arise near the time of their manifestation in adult life are now known to have roots in pre– and early post–natal life….’

8 Lower birthweight associated with increased risk for :
Metabolic syndrome Cardiovascular disease Diabetes type 2 Raised blood pressure Depression

9 Effect of stress/anxiety/depression during pregnancy and long term effects on the fetus and the child

10 Research in the last 10 years has shown
antenatal stress is associated with increased incidence in the offspring of : Anxiety and Depression Schizophrenia Autism Behavioural problems-ADHD, conduct disorder Impaired cognitive development

11 Examples of antenatal stress reported to cause changes in development and behavior in humans
Maternal anxiety and depression Maternal daily hassles Pregnancy specific anxiety Partner or family discord Distress caused by 6 day war in Israel, 1967 Experience of acute disasters, e.g. freezing ice storm, hurricane or 9/11 It’s not just extreme stress

12 ALSPAC Study. Does antenatal stress affect child behaviour in humans?
Aim of our study: To determine the long term effects of antenatal stress or anxiety on the behavioural development of the child O’Connor et al 2002, 2003

13 ALSPAC Avon Longitudinal Study of Parents and Children
Large prospective birth cohort ~14,000 pregnant women recruited around Bristol in Detailed information on children at 4, 7, 11 and 15 years

14 ALSPAC study Maternal anxiety-at 18 and 32 weeks of pregnancy
Compared 15% most anxious mothers with the rest Child behaviour –maternal report at 4 and 7 years old. Strengths and Difficulties questionnaire. Attention deficit/hyperactivity; anxiety and depression; conduct disorder O’Connor et al 2002, 2003

15 Multivariate Analysis Cohort with complete data n = 7, 363
Maternal age Birthweight Gestational age Smoking Alcohol Psychosocial factors: crowding Maternal education Postnatal depression and anxiety

16 maternal antenatal anxiety at 32 weeks
Multivariate analysis–ALSPAC cohort at 7 years Behavioural/emotional problems and maternal antenatal anxiety at 32 weeks BOYS GIRLS *** ** ** ** ** * ** * O’Connor et al 2003

17 For top 15% of most anxious women in pregnancy, symptom rate
of ADHD, anxiety, and conduct disorder in 4 and 7 year old children doubled from 5 to 10% (after multivariate analysis). Attributable load of behavioural/emotional problems in whole population due to antenatal anxiety/stress ~10-15% O’Connor et al 2002, 2003

18 Links are similar with antenatal anxiety and depression at 18 weeks gestation but less marked than anxiety at 32 weeks It is not just first trimester

19 17 4 20 week fetus birth 5 years

20 ALSPAC. Antenatal anxiety (top 15% v rest) at 32 weeks and child emotional problems-SDQ

21 ALSPAC Antenatal anxiety at 32 weeks and child ADHD-SDQ

22 ALSPAC Antenatal anxiety at 32 weeks and child conduct problems-SDQ

23 Possible evolutionary benefits of changes caused by prenatal stress
• Anxiety more vigilance • Attention deficit more alert to small signals • Impulsive more willing to explore new environments • Conduct disorder more willing to break rules • Aggressive fight predators or other tribes • Cognitive deficit side effect of ADHD or • Asberger’s understands things in a different way

24 Toddler “IQ” Study child’s cognitive (MDI) development at 17 months

25 Bergman et al 2007


27 Antenatal life events and Bayley’s Mental Development score at 18 months

28 Significant correlation coefficients between antenatal life event scores and child’s MDI
You were separated/divorced -0.33** You had a serious argument with your partner -0.28* Your partner was emotionally cruel to you -0.37** You suffered from mental illness -0.24* A friend or relative suffered from mental illness

29 Mental Developmental Index in child of those with and without relationship problems in pregnancy

30 It’s not all over at birth
Sensitive early mothering can reverse some of the effects of antenatal stress

31 How?

32 Placental weight *** N=33 N=8

33 Conclusions It is important to provide more emotional care for women during pregnancy Everyone should be suitably assessed and appropriate care provided

34 Conclusions contd This will help the woman herself, her family and her future child About one million children in the UK suffer from neuodevelopmental disorder (100,000 in Scotland) About 10-15% of this is due to prenatal stress/anxiety. Thus there is the potential to prevent these problems in 100,000 children in the UK (10,000 in Scotland)

35 Implications for Inequality
Inequality can result from the problems associated with experiencing mental illness Inequality can also be due to the problems arising from neurodevelopmental disorders ADHD, conduct disorder and cognitive problems are all strong risk factors for later criminal behaviour -so improved emotional care of pregnant women can help with the inequalities suffered by their children.


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