Decreased amygdala-sensorimotor connectivity mediates the association between prenatal stress and broad autism phenotype in young adults: Project Ice Storm.

Studies show that prenatal maternal stress (PNMS) is related to risk for child autism, and to atypical amygdala functional connectivity in the autistic child. Yet, it remains unclear whether amygdala functional connectivity mediates the association between PNMS and autistic traits, particularly in young adult offspring. We recruited women who were pregnant during, or within 3 months of, the 1998 Quebec ice storm crisis, and assessed three aspects of PNMS: objective hardship (events experienced during the ice storm), subjective distress (post-traumatic stress symptoms experienced as a result of the ice storm) and cognitive appraisal. At age 19, 32 young adults (21 females) self-reported their autistic-like traits (i.e., aloof personality, pragmatic language impairment and rigid personality), and underwent structural MRI and resting-state functional MRI scans. Seed-to-voxel analyses were conducted to map the amygdala functional connectivity network. Mediation analyses were implemented with bootstrapping of 20,000 resamplings. We found that greater maternal objective hardship was associated with weaker functional connectivity between the left amygdala and the right postcentral gyrus, which was then associated with more pragmatic language impairment. Greater maternal subjective distress was associated with weaker functional connectivity between the right amygdala and the left precentral gyrus, which was then associated with more aloof personality. Our results demonstrate that the long-lasting effect of PNMS on offspring autistic-like traits may be mediated by decreased amygdala-sensorimotor circuits. The differences between amygdala-sensory and amygdala-motor pathways mediating different aspects of PNMS on different autism phenotypes need to be studied further.

Atypical brain structure and function in young adults exposed to disaster-related prenatal maternal stress: Project Ice Storm.

Studies have shown that prenatal maternal stress (PNMS) affects brain structure and function in childhood. However, less research has examined whether PNMS effects on brain structure and function extend to young adulthood. We recruited women who were pregnant during or within 3 months following the 1998 Quebec ice storm, assessed their PNMS, and prospectively followed-up their children. T1-weighted magnetic resonance imaging (MRI) and resting-state functional MRI were obtained from 19-year-old young adults with (n = 39) and without (n = 65) prenatal exposure to the ice storm. We examined between-group differences in gray matter volume (GMV), surface area (SA), and cortical thickness (CT). We used the brain regions showing between-group GMV differences as seeds to compare between-group functional connectivity. Within the Ice Storm group, we examined (1) associations between PNMS and the atypical GMV, SA, CT, and functional connectivity, and (2) moderation by timing of exposure. Primarily, we found that, compared to Controls, the Ice Storm youth had larger GMV and higher functional connectivity of the anterior cingulate cortex, the precuneus, the left occipital pole, and the right hippocampus; they also had larger CT, but not SA, of the left occipital pole. Within the Ice Storm group, maternal subjective distress during preconception and mid-to-late pregnancy was associated with atypical left occipital pole CT. These results suggest the long-lasting impact of disaster-related PNMS on child brain structure and functional connectivity. Our study also indicates timing-specific effects of the subjective aspect of PNMS on occipital thickness.

Maternal mental health mediates the effect of prenatal stress on infant temperament: The Harvey Mom Study.

Prenatal maternal stress and mental health problems are known to increase risk for developmental psychopathology in offspring, yet pathways leading to risk or resiliency are poorly understood. In a quasi-experimental design, we prospectively examined associations between disaster-related prenatal stress, maternal mental health symptoms, and infant temperament outcomes. Mothers who were pregnant during Hurricane Harvey (N = 527) reported on objective hardships (e.g., loss of belongings or income, evacuation, home flooding) related to the storm and subsequent mental health symptoms (anxiety/depression, posttraumatic stress) across time. At a postpartum assessment, mothers reported on their infant's temperament (negative affect, positive affect, orienting/regulatory capacity). Greater objective hardship indirectly predicted higher levels of infant orienting/regulatory capacity through its association with increased maternal posttraumatic stress symptoms. Greater objective hardship also indirectly predicted higher levels of infant negative affect through its association with increased maternal anxiety/depression symptoms across time. Our findings suggest a psychological mechanism linking prenatal stress with specific temperamental characteristics via maternal mental health symptoms. Findings point to the importance of high-quality assessment and mental health services for vulnerable women and young children.

Experiencing Trauma During or Before Pregnancy: Qualitative Secondary Analysis After Two Disasters.

BACKGROUND: Despite the existing knowledge about stress, trauma and pregnancy and maternal stress during natural disasters, little is known about what types of trauma pregnant or preconception women experience during these disasters. In May 2016, the worst natural disaster in modern Canadian history required the evacuation of nearly 90,000 residents of the Fort McMurray Wood Buffalo (FMWB) area of northern Alberta. Among the thousands of evacuees were an estimated 1850 women who were pregnant or soon to conceive. In August 2017, Hurricane Harvey devastated areas of the United States including Texas, with 30,000 people forced to flee their homes due to the intense flooding. OBJECTIVE: To explore immediate and past traumatic experiences of pregnant or preconception women who experienced one of two natural disasters (a wildfire and a hurricane) as captured in their expressive writing. Research questions were: (1) What trauma did pregnant or preconception women experience during the fire and the hurricane? (2) What past traumatic experiences, apart from the disasters, did the women discuss in their expressive writing? METHODS: A qualitative secondary analysis of expressive writing using thematic content analysis was conducted on the expressive writing of 50 pregnant or preconception women who experienced the 2016 Fort McMurray Wood Buffalo Wildfire (n = 25) and the 2017 Houston Hurricane Harvey (n = 25) Narrative data in the form of expressive writing entries from participants of two primary studies were thematically analyzed. One of the expressive writing questions was used in this analysis: "What is the most traumatic, upsetting experience of your entire life, especially that you have never discussed in great detail with others?" NVivo 12 supported thematic content analysis. RESULTS: For some women, the disasters elicited immense fear and anxiety that surpassed previous traumatic life events. Others, however, disclosed significant past traumas that continue to impact them, including betrayal by a loved one, abuse, maternal health complications, and illness. CONCLUSION: We recommend a strengths-based and trauma-informed care approach in both maternal health and post-disaster relief care.

Prenatal maternal stress was not associated with birthweight or gestational age at birth during COVID-19 restrictions in Australia: The BITTOC longitudinal cohort study.

BACKGROUND: Various forms of prenatal maternal stress (PNMS) have been reported to increase risk for preterm birth and low birthweight. However, the associations between specific components of stress - namely objective hardship and subjective distress - and birth outcomes are not well understood. AIMS: Here, we aimed to determine the relationship between birthweight and gestational age at birth and specific prenatal factors (infant gender and COVID-19 pandemic-related objective hardship, subjective distress, change in diet), and to determine whether effects of hardship are moderated by maternal subjective distress, change in diet, or infant gender. MATERIALS AND METHODS: As part of the Birth in the Time of COVID (BITTOC study), women (N = 2285) who delivered in Australia during the pandemic were recruited online between August 2020 and February 2021. We assessed objective hardship and subjective distress related to the COVID pandemic and restrictions, and birth outcomes through questionnaires that were completed at recruitment and two months post-partum. Analyses included hierarchical multiple regressions. RESULTS: No associations between maternal objective hardship or subjective distress and gestational age at birth or birthweight were identified. Lower birthweight was significantly associated with female gender (adjusted ß = 0.083, P < 0.001) and with self-reported improvement in maternal diet (adjusted ß = 0.059, P = 0.015). CONCLUSIONS: In a socioeconomically advantaged sample, neither objective hardship nor subjective distress related to COVID-19 were associated with birth outcomes. Further research is warranted to understand how other individual factors influence susceptibility to PNMS and how these findings are applicable to women with lower socioeconomic status.

Unexpected effects of expressive writing on post-disaster distress in the Hurricane Harvey Study: a randomized controlled trial in perinatal women.

BACKGROUND: Expressive writing requires journaling stressor-related thoughts and feelings over four daily sessions of 15 min. Thirty years of research have popularized expressive writing as a brief intervention for fostering trauma-related resilience; however, its ability to surpass placebo remains unclear. This study aimed to determine the efficacy of expressive writing for improving post-traumatic stress symptoms in perinatal women who were living in the Houston area during major flooding caused by Hurricane Harvey. METHODS: A total of 1090 women were randomly allocated (1:1:1) to expressive writing, neutral writing or no writing. Interventions were internet-based. Online questionnaires were completed before randomization and at 2 months post-intervention. The primary outcome was post-traumatic stress symptoms, measured with the Impact of Event Scale-Revised; secondary outcomes were affective symptoms, measured with the 40-item Inventory of Depression and Anxiety Scales. Feelings throughout the intervention were reported daily using tailored questionnaires. RESULTS: In intention-to-treat analyses, no post-treatment between-group differences were found on the primary and secondary outcomes. Per-protocol analyses yielded similar results. A number of putative moderators were tested, but none interacted with expressive writing. Expressive writing produced greater feelings of anxiety and sadness during the intervention compared to neutral writing; further, overall experiences from the intervention mediated associations between expressive writing and greater post-traumatic stress at 2 months post-intervention. CONCLUSIONS: Among disaster-stricken perinatal women, expressive writing was ineffective in reducing levels of post-traumatic stress, and may have exacerbated these symptoms in some.

Early Environmental Upheaval and the Risk for Schizophrenia.

Why does prenatal exposure to wars, natural disasters, urbanicity, or winter increase the risk for schizophrenia? Research from the last two decades has provided rich insight about the underlying chains of causation at play during environmental upheaval, from conception to early infancy. In this review, we appraise the evidence linking schizophrenia spectrum disorder to prenatal maternal stress, obstetric complications, early infections, and maternal nutrition and other lifestyle factors. We discuss putative mechanisms, including the maternal stress system, perinatal hypoxia, and maternal-offspring immune activation. We propose that gene-environment interactions, timing during development, and sex differentiate the neuropsychiatric outcomes. Future research should pursue the translation of animal studies to humans and the longitudinal associations between early exposures, intermediate phenotypes, and psychiatric disorders. Finally, to paint a comprehensive model of risk and to harness targets for prevention, we argue that risk factors should be situated within the individual's personal ecosystem.

Maternal Mental Health after a Wildfire: Effects of Social Support in the Fort McMurray Wood Buffalo Study.

OBJECTIVE: Following disasters, perinatal women are vulnerable to developing post-traumatic stress disorder (PTSD)-like symptoms. Little is known about protective factors. We hypothesized that peritraumatic stress would predict PTSD-like symptoms in pregnant and postpartum women and would be moderated by social support and resilience. METHOD: Women (n = 200) who experienced the 2016 Fort McMurray Wood Buffalo wildfire during or shortly before pregnancy completed the Peritraumatic Distress Inventory (PDI), Peritraumatic Dissociative Experiences Questionnaire, and the Impact of Event Scale-Revised for current PTSD-like symptoms. They also completed scales of social support (Social Support Questionnaire-Short Form) and resilience (Connor-Davidson Resilience Scale). RESULTS: Greater peritraumatic distress (r = 0.56) and dissociative experiences (r = 0.56) correlated with more severe PTSD-like symptoms. Greater social support satisfaction was associated with less severe post-traumatic stress symptoms but only when peritraumatic distress was below average; at more severe levels of PDI, this psychosocial variable was not protective. CONCLUSIONS: Maternal PTSD-like symptoms after a wildfire depend on peritraumatic distress and dissociation. Higher social support satisfaction buffers the association with peritraumatic distress, although not when peritraumatic reactions are severe. Early psychosocial interventions may protect perinatal women from PTSD-like symptoms after a wildfire.

Cytokine and Growth Factor Response in a Rat Model of Radiation Induced Injury to the Submental Muscles.

Submental muscles (i.e., mylohyoid and geniohyoid) play a vital role during swallowing, protecting the airway from ingested material. To design therapies to reduce the functional deficits associated with radiation treatment relies in part on our understanding of the changes in the cytokine and growth factor response that can impact muscle function. The purpose of this study is to quantify changes in the inflammatory, pro-fibrotic, and pro-angiogenic factors following 48 Gy of fractionated radiation to the mylohyoid muscle. We hypothesized that (1) irradiation will provoke increases in TGF-1ß and MMP-2 mRNA in the mylohyoid muscle; and (2) muscles surrounding the target location (i.e., geniohyoid and digastric muscles) will exhibit similar alterations in their gene expression profiles. Rats were exposed to 6 fractions of 8 Gy using a 6 MeV electron beam on a clinical linear accelerator. The highest dose curve was focused at the mylohyoid muscle. After 2- and 4-weeks post-radiation, the mylohyoid, geniohyoid, and digastric muscles were harvested. Expression of TNF-α, IFNγ, IL-1ß, IL-6, TGF-1ß, VEGF, MMP-2, and MMP-9 mRNA was analyzed via PCR and/or RT-PCR. TGF-1ß, MMP-2, and IL-6 expression was upregulated in the irradiated mylohyoid compared to non-irradiated controls. No notable changes in TNF-α, IFNγ, and IL-1ß mRNA expression were observed in irradiated muscles. Differing expression profiles were found in the surrounding muscles post-radiation. Results demonstrated that irradiation provokes molecular signals involved in the regulation of wound healing, which could lead to fibrosis or atrophy in the swallowing muscle after radiation.

Childhood Anxiety: Prenatal Maternal Stress and Parenting in the QF2011 Cohort.

In this study we examine whether specific 'anxiety-maintaining' parenting behaviors (i.e., overinvolvement and/or negativity) exacerbate the effects of disaster-related prenatal maternal stress (PNMS) on school-age anxiety symptoms. Women (N = 230), pregnant at the time of the 2011 Queensland Floods, reported on their experience of flood-related PNMS (objective hardship, cognitive appraisal, subjective distress). At 4-years, mother-child dyads were coded for maternal overinvolvement and negativity during a challenging task; at 6-years mothers reported on their children's anxiety symptoms and their own mood, N = 83. Results showed no associations between PNMS and 6-year anxiety, nor did parenting moderate these effects. Poorer maternal concurrent mood was associated with greater anxiety symptoms at 6 years (ß = 0.52). Findings suggest maternal concurrent mood, but not exposure to disaster-related PNMS nor 'anxiety-maintaining' parenting behaviors at preschool age, is related to school-age anxiety symptoms.

Adaptations to Oral and Pharyngeal Swallowing Function Induced by Injury to the Mylohyoid Muscle.

Muscle injury is a frequent side effect of radiation treatment for head and neck cancer. To understand the pathophysiology of injury-related dysfunction, we investigated the effects of a single muscle injury to the mylohyoid on oropharyngeal swallowing function in the rat. The mylohyoid protects the airway from food/liquid via hyolaryngeal elevation and plays an active role during both oral and pharyngeal swallowing. We hypothesized (1) that fibrosis to the mylohyoid alters swallowing bolus flow and licking patterns and (2) that injury to the mylohyoid changes normal activity of submental, laryngeal, and pharyngeal muscles during swallowing. A chilled cryoprobe was applied to the rat mylohyoid muscle to create a localized injury. One and two weeks after injury, swallowing bolus transit was assessed via videofluoroscopy and licking behavior via an electrical lick sensor. The motor activity of five swallow-related muscles was analyzed immediately after injury using electromyography (EMG). Comparisons were made pre- and post-injury. Fibrosis was confirmed in the mylohyoid at 2 weeks after injury by measuring collagen content. One week after injury, bolus size decreased, swallowing rate reduced, and licking patterns were altered. Immediately post-injury, there was a significant depression in mylohyoid and thyropharyngeus EMG amplitudes during swallowing. Our results demonstrated that injury to the mylohyoid is sufficient to cause changes in deglutition. These disruptions in oral and pharyngeal swallowing were detected prior to long-term fibrotic changes, including delays in tongue movement, alterations in bolus flow, and changes in sensorimotor function. Therefore, injuring a single important swallowing muscle can have dramatic clinical effects.

The 5-HTTLPR polymorphism of the serotonin transporter gene and child's sex moderate the relationship between disaster-related prenatal maternal stress and autism spectrum disorder traits: The QF2011 Queensland flood study.

The 5-HTTLPR polymorphism of the serotonin transporter has been shown to play a role in autism spectrum disorders (ASD). Moreover, disaster-related prenatal maternal stress (PNMS) has also been shown to be associated with ASD. However, no study to date has examined whether these two factors, either individually or in combination, are predictive of ASD traits in the same sample. We hypothesized that children, particularly boys, with the LL genotype exposed to high levels of disaster-related PNMS would exhibit higher levels of ASD traits compared to boys with the LS or SS genotypes and girls regardless of genotype. Genotype and ASD levels obtained using the Australian normed Autism Spectrum Rating Scales - Short Form were available for 105 30-month-old children exposed to varying levels of PNMS following the 2011 Queensland Flood. For boys, higher ASD traits were associated with the 5-HTTLPR LL genotype in combination with either a negative maternal appraisal of the flood, or high levels of maternal composite subjective stress, PSTD-like or peritraumatic dissociation symptoms. For girls, maternal peritraumatic dissociation levels in combination with the 5-HTTLPR LS or SS genotype were associated with higher ASD traits. The present findings are the first to demonstrate that children's genotype moderates effects of disaster-related PNMS on ASD traits, with different pattern according to child sex.

Infant Behavior and Competence Following Prenatal Exposure to a Natural Disaster: The QF2011 Queensland Flood Study.

This study utilized a natural disaster to investigate the effects of prenatal maternal stress (PNMS) arising from exposure to a severe flood on maternally reported infant social-emotional and behavioral outcomes at 16 months, along with potential moderation by infant sex and gestational timing of flood exposure. Women pregnant during the Queensland floods in January 2011 completed measures of flood-related objective hardship and posttraumatic stress (PTS). At 16 months postpartum, mothers completed measures describing depressive symptoms and infant social-emotional and behavioral problems (n = 123) and competence (n = 125). Greater maternal PTS symptoms were associated with reduced infant competence. A sex difference in infant behavioral problems emerged at higher levels of maternal objective hardship and PTS; boys had significantly more behavioral problems than girls. Additionally, greater PTS was associated with more behavioral problems in boys; however, this effect was attenuated by adjustment for maternal depressive symptoms. No main effects or interactions with gestational timing were found. Findings highlight specificity in the relationships between PNMS components and infant outcomes and demonstrate that the effects of PNMS exposure on behavior may be evident as early as infancy. Implications for the support of families exposed to a natural disaster during pregnancy are discussed.

Disaster in pregnancy: midwifery continuity positively impacts infant neurodevelopment, QF2011 study.

BACKGROUND: Research shows that continuity of midwifery carer in pregnancy improves maternal and neonatal outcomes. This study examines whether midwifery group practice (MGP) care during pregnancy affects infant neurodevelopment at 6-months of age compared to women receiving standard hospital maternity care (SC) in the context of a natural disaster. METHODS: This prospective cohort study included 115 women who were affected by a sudden-onset flood during pregnancy. They received one of two models of maternity care: MGP or SC. The women's flood-related objective stress, subjective reactions, and cognitive appraisal of the disaster were assessed at recruitment into the study. At 6-months postpartum they completed the Ages and Stages Questionnaire (ASQ-3) on their infants' communication, fine and gross motor, problem solving, and personal-social skills. RESULTS: Greater maternal objective and subjective stress predicted worse infant outcomes. Even when controlling for maternal stress from the flood, infants of mothers who were in the MGP model of maternity care performed better than infants of mothers in SC on two of the five ASQ-3 domains (fine motor and problem solving) at 6-months of age. Furthermore, infants in the SC model were more likely to be identified as at risk for delayed development on these domains than infants in the MGP model of care. CONCLUSIONS: Continuity of midwifery care has positive effects on infant neurodevelopment when mothers experience disaster-related stress in pregnancy, with significantly better outcomes on two developmental domains at 6 months compared to infants whose mothers received standard hospital care.

The role of prenatal maternal stress in the development of childhood anxiety symptomatology: The QF2011 Queensland Flood Study.

It is possible that findings suggesting a link between prenatal maternal stress (PNMS) and anxiety symptoms in offspring are confounded by postnatal and/or shared mother-child heritability effects. Following exposure to a natural disaster, the Queensland Flood Study investigated the unique and additive effects of various types of disaster-related PNMS (objective hardship, cognitive appraisal, and subjective distress) on childhood anxiety symptomatology (internalizing and/or anxiety symptom measures). Timing of flood exposure during pregnancy and child sex were examined as potential moderators. After controlling for maternal psychosocial factors, greater objective hardship as a result of the floods was significantly associated with greater anxiety symptoms (N = 114) and marginally associated with greater internalizing behaviors (N = 115). Earlier timing of the flood in pregnancy was associated with greater anxiety symptoms. No such associations were found between any PNMS measure and teacher-rated child internalizing behaviors (N = 90). Sex and timing did not moderate associations. Our findings suggest that, in isolation, increased maternal hardship due to exposure to an independent stressor, during pregnancy, may have a programming effect on childhood anxiety symptoms.

Testosterone-cortisol dissociation in children exposed to prenatal maternal stress, and relationship with aggression: Project Ice Storm.

Prenatal maternal stress (PNMS) has been associated with postnatal behavioral alterations that may be partly explained by interactions between the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-gonadal (HPG) axes. Yet it remains unclear whether PNMS leads to enduring HPA-HPG alterations in the offspring, and whether HPA-HPG interactions can impact behavior during development, in particular levels of aggression in childhood. Here we investigated the relationship between a marker for HPG axis function (baseline testosterone) and a marker for HPA axis response (cortisol area under the curve) in 11½-year-olds whose mothers were exposed to the 1998 Quebec ice storm during pregnancy (n = 59 children; 31 boys, 28 girls). We examined (a) whether the degree of objective or subjective PNMS regulates the testosterone-cortisol relationship at age 11½, and (b) whether this testosterone-cortisol relationship is associated with differences in aggressive behavior. We found that, at lower levels of subjective PNMS, baseline testosterone and cortisol reactivity were positively correlated; in contrast, there was no relationship between these hormones at higher levels of subjective PNMS. Cortisol response moderated the relationship between testosterone and aggression. These results support the notion PNMS may explain variance in fetal HPA-HPG interactions, and that these interactions may be associated with aggressive behavior in late childhood.

Social Determinants of Health and Preclinical Glycemic Control in Newly Diagnosed First-Episode Psychosis Patients.

BACKGROUND: The abnormally high incidence of disorders of glucose metabolism (DGM) in psychotic-spectrum disorders (PSD) has often been attributed to the side effects of antipsychotics and unhealthy lifestyles. The influence of social determinants of health has been largely ignored, despite ample evidence linking social adversity with both PSD and DGM. The aim of this study is to examine the influence of well-established social determinants of health on preclinical levels of glycated hemoglobin (HbA1c) in a sample of first-episode psychosis (FEP) patients. METHODS: In a sample of newly admitted FEP patients, univariate analyses were used to select the main predictors of HbA1c levels from the following social determinants of health: childhood trauma, immigrant background, visible minority status, and indices of social and material deprivation. The predictors identified in the univariate analyses were tested in multivariate linear regression models including age, sex, BMI, depression, and physical anergia (proxy of sedentary behaviour) as covariates. RESULTS: Univariate analyses identified visible minority status and childhood physical abuse as predictors of HbA1c. After controlling for covariates, minority status significantly predicted higher levels of glycated hemoglobin (ß = 0.23; P = 0.01), and physical abuse had a marginally significant effect (ß = 0.23; P = 0.06). Other predictors were not significantly associated. CONCLUSION: FEP patients from a visible minority or who were victims of childhood physical abuse have higher levels of HbA1c at admission compared with other patients. This might suggest an increase in risk for the development of future DGM. If confirmed, preventive strategies could be tailored for these groups.

The impact of maternal flood-related stress and social support on offspring weight in early childhood.

The current study examined the moderating role of social support in the association between prenatal maternal stress (PNMS) and childhood body mass index (BMI) in the context of the Iowa floods of 2008. In addition, the mediating role of offspring birthweight was examined in the association between PNMS and childhood BMI. We recruited women from eastern Iowa who were pregnant in 2008 when disastrous floods occurred. Self-report measures of PNMS and cognitive appraisal of the flood's consequences were obtained shortly after the disaster. Social support was assessed during pregnancy. Offspring anthropometric measures were collected at birth and 30 months. Moderated mediation results indicated that greater PNMS predicted greater BMI at age 30 months through effects on higher birthweight as a mediator, but only for participants with low social support. High social support (satisfaction or number) buffered the effect of PNMS or a negative appraisal of the flood on birthweight. The combination of high PNMS or a negative appraisal of the flood's consequences and low social support resulted in higher offspring birthweight, which predicted greater BMI at 30 months. Providing strong social support to pregnant women following a stressor might buffer the effects of PNMS on offspring birthweight and later obesity.

Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study.

Poor postnatal mental health is a major public health issue, and risk factors include experiencing adverse life events during pregnancy. We assessed whether midwifery group practice, compared to standard hospital care, would protect women from the negative impact of a sudden-onset flood on postnatal depression and anxiety. Women either received midwifery group practice care in pregnancy, in which they were allocated a primary midwife who provided continuity of care, or they received standard hospital care provided by various on-call and rostered medical staff. Women were pregnant when a sudden-onset flood severely affected Queensland, Australia, in January 2011. Women completed questionnaires on their flood-related hardship (objective stress), emotional reactions (subjective stress), and cognitive appraisal of the impact of the flood. Self-report assessments of the women's depression and anxiety were obtained during pregnancy, at 6 weeks and 6 months postnatally. Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The benefits of midwifery continuity of carer in pregnancy extend beyond a more positive birth experience and better birthing and infant outcomes, to mitigating the effects of high levels of stress experienced by women in the context of a natural disaster on postnatal mental health.

A trajectory analysis of childhood motor development following stress in pregnancy: The QF2011 flood study.

This prospective, longitudinal cohort study examined the effects of flood-related stress in pregnancy on the trajectory of children's motor development; and the moderating effects of gestational timing of the flood or sex of the child. Women who were pregnant during a severe flood reported on their objective flood-related experiences, emotional reactions, and cognitive appraisal of the disaster. At 2-, 6-, 16-months, 2½- and 4-years postpartum, mothers' assessed their children's fine and gross motor development using the Ages and Stages-3 Questionnaire. High objective flood-exposure, or a negative appraisal, especially in later pregnancy, predicted poorer gross motor skills which rapidly improved across early childhood. Children's fine motor skill was influenced by the sex of the child with improvements in girls' fine motor skills over time, but not boys'. This demonstrates that stress in pregnancy has enduring influences on gross, but not fine, motor skills. Results are discussed in relation to fetal programming and stress appraisal theory.