Increases in maternal depressive symptoms during pregnancy and infant cortisol reactivity: Mediation by placental corticotropin-releasing hormone.

BACKGROUND: Maternal depressive symptoms in pregnancy may affect offspring health through prenatal programming of the hypothalamic-pituitary-adrenal (HPA) axis. The biological mechanisms that explain the associations between maternal prenatal depressive symptoms and offspring HPA axis regulation are not yet clear. This pre-registered investigation examines whether patterns of maternal depressive symptoms in pregnancy are associated with infant cortisol reactivity and whether this association is mediated by changes in placental corticotropin-releasing hormone (pCRH). METHOD: A sample of 174 pregnant women completed assessments in early, mid, and late pregnancy that included standardized measures of depressive symptoms and blood samples for pCRH. Infant cortisol reactivity was assessed at 1 and 6 months of age. RESULTS: Greater increases in maternal depressive symptoms in pregnancy were associated with higher cortisol infant cortisol reactivity at 1 and 6 months. Greater increases in maternal depressive symptoms in pregnancy were associated with greater increases in pCRH from early to late pregnancy which in turn were associated with higher infant cortisol reactivity. CONCLUSIONS: Increases in maternal depressive symptoms and pCRH over pregnancy may contribute to higher infant cortisol reactivity. These findings help to elucidate the prenatal biopsychosocial processes contributing to offspring HPA axis regulation early in development.

Pregnancy Anxiety and Beliefs Surrounding Motherhood in Latinas: A Qualitative Study.

Objectives: Prior research indicates that Latinas are at risk for experiencing high levels of anxiety during pregnancy. Pregnancy anxiety is a specific affective experience involving fears and worries about one's current pregnancy and it has been linked to heightened risk for preterm birth and developmental effects. Despite this concerning pattern, research has rarely examined Latina beliefs about the transition to motherhood and little is known about specific sources of pregnancy anxiety in Latinas, including whether fears are rooted in cultural concerns. The present study investigates the experiences of pregnancy anxiety among Latinas and explores their broader cultural beliefs surrounding pregnancy. Methods: Fourteen pregnant Latinas articulated their experience of pregnancy anxiety, how they coped with their anxiety, and the beliefs they held surrounding pregnancy in 11 individual interviews and one focus group of three participants, all conducted in Spanish. Results: Thematic analysis revealed that overall, Latinas felt that anxiety during pregnancy was normal, and that they worried about labor and delivery, losing their baby, their baby being born with a birth defect, and felt affected by the broader sociopolitical climate. Latinas felt lucky to be pregnant, believed that pregnancy was a blessing from God, and stressed the importance of maintaining a healthy pregnancy. Themes about family involvement and culturally-driven privileged status also emerged. Conclusions: The present study highlights specific themes that may be important to consider in the context of Latina perinatal health. Such findings set the stage for future investigations examining the experience of anxiety specific to pregnancy in Latinas.

Objetivos: Investigaciones anteriores indican que las latinas corren el riesgo de experimentar altos niveles de ansiedad durante el embarazo. La ansiedad relacionada con el embarazo es una experiencia afectiva específica que involucra temores y preocupaciones y se ha relacionado con un mayor riesgo de parto prematuro y consecuencias en el desarrollo. A pesar de este patrón preocupante, rara vez se han examinado las creencias de gestantes latinas sobre la transición a la maternidad y se sabe poco sobre las fuentes específicas de ansiedad relacionada con el embarazo entre las latinas, incluso si los temores tienen sus raíces en inquietudes culturales. El presente estudio investiga las experiencias de ansiedad relacionada con el embarazo en gestantes latinas y explora sus creencias culturales más amplias en torno al embarazo. Métodos: Catorce latinas embarazadas expresaron su experiencia de ansiedad relacionada con el embarazo, las formas en que lidiaron con dicha ansiedad y las creencias que tenían sobre el embarazo en 11 entrevistas individuales y un grupo de enfoque de tres participantes, todas realizadas en español. Resultados: El análisis temático reveló que, en general, las gestantes latinas sentían que la ansiedad relacionada con el embarazo era normal y que estaban preocupadas por el parto, la pérdida de su bebé, que su bebé naciera con un defecto de nacimiento y se sentían afectadas por el ambiente sociopolítico más amplio. Las latinas se sintieron afortunadas de estar embarazadas, creían que el embarazo era una bendición de Dios y enfatizaron la importancia de mantener un embarazo saludable. También surgieron temas sobre la participación familiar y el estatus privilegiado impulsado por la cultura. Conclusiones: El presente estudio destaca temas específicos que pueden ser importantes a considerar en el contexto de la salud perinatal de las latinas. Dichos hallazgos sientan las bases para futuras investigaciones que examinen la experiencia de ansiedad específica relacionada con el embarazo entre las latinas.

Pregnancy anxiety, placental corticotropin-releasing hormone and length of gestation.

OBJECTIVE: High pregnancy anxiety is a consistent predictor of earlier labor and delivery. Placental corticotropin-releasing hormone (pCRH) predicts earlier delivery consistently and it has been identified as a biological mediator of the association between pregnancy anxiety and gestational length. However, studies have not examined whether changes in pregnancy anxiety are associated with earlier birth as mediated by changes in pCRH during pregnancy. Accordingly, this study tests whether linear changes in pregnancy anxiety are associated with length of gestation indirectly through nonlinear increases in pCRH over pregnancy. METHODS: A sample of pregnant women (n=233) completed prenatal assessments in early pregnancy, second trimester, and third trimester that included a 4-item assessment of pregnancy anxiety and collection of blood samples assayed for pCRH using radioimmunoassay. Length of gestation was abstracted from medical records after birth. RESULTS: Increases in pregnancy anxiety from early pregnancy to third trimester predicted shorted length of gestation, as did nonlinear increases in pCRH over pregnancy. However, there was no evidence of an indirect effect of changes in pregnancy anxiety on length of gestation via changes in pCRH. CONCLUSIONS: These results indicate that linear changes in pregnancy anxiety and nonlinear changes in pCRH during pregnancy are independent risk factors for shortened gestational length. This study adds to a small but growing body of work on biopsychological processes in pregnancy and length of gestation. Modeling changes in psychological and biological processes during pregnancy could provide more insight into understanding risk for adverse pregnancy outcomes.

Pregnancy anxiety in expectant mothers predicts offspring negative affect: The moderating role of acculturation.

BACKGROUND: Pregnancy anxiety predicts adverse developmental outcomes in offspring from infancy through late childhood, but studies have not examined associations with outcomes in early childhood, nor clarified ethnic or cultural variations in these processes. AIMS: (1) To examine differences in pregnancy anxiety and related concerns between non-Hispanic White women, Latina women who prefer to speak in English, and Latinas who prefer Spanish; (2) To test prospective associations between pregnancy anxiety and child negative affect and moderation by ethnicity and language preference, used as a proxy for acculturation. STUDY DESIGN AND METHODS: This longitudinal study included 95 women (40 Non-Hispanic Whites, 31 Spanish-preference Latinas, and 24 English-preference Latinas). Language preference was provided at study entry. Pregnancy anxiety was assessed in the second and third trimesters of pregnancy with two standardized measures. Mothers reported child negative affect at age 4. RESULTS: Spanish-preference Latinas had significantly more pregnancy-related anxiety about their health and safety in childbirth and concerning the medical system compared to English-preference Latinas and non-Hispanic White women. Adjusting for covariates, pregnancy anxiety in the second trimester, though not the third trimester, predicted significantly higher child negative affect in the full sample. A significant moderation effect indicated that the association was strongest among the lower acculturated Latinas, i.e., those who preferred Spanish. CONCLUSION: These results document higher risk for offspring associated with pregnancy anxiety in the second trimester especially among less acculturated Latina women, and suggest the need for culturally-sensitive screening tools and interventions to improve outcomes for Latina mothers and their children.

Pregnancy anxiety predicts shorter gestation in Latina and non-Latina white women: The role of placental corticotrophin-releasing hormone.

OBJECTIVE: Previous research has shown that a woman's anxiety about her pregnancy predicts gestational length. Placental corticotrophin-releasing hormone (CRH) is a stress-responsive peptide proposed as a mechanism. We examined placental CRH as a physiological mediator of the association between pregnancy anxiety and gestational length in Latina and non-Latina White women to replicate evidence of associations between pregnancy anxiety, placental CRH and gestational length; to test whether placental CRH levels or changes mediate effects of pregnancy anxiety on gestational length; to examine ethnic differences in pregnancy anxiety, placental CRH, and gestational length; and to explore whether the effects of pregnancy anxiety on gestational length as mediated by placental CRH vary by ethnicity. METHODS: In a prospective study of 337 pregnant Latina and non-Latina White women, participants completed in-person interviews that included a 10-item measure of pregnancy anxiety and provided blood samples assayed using radioimmunoassay at three timepoints (19, 25, and 31 weeks gestation). RESULTS: Pregnancy anxiety at 19 and 31 weeks and levels of placental CRH at 31 weeks predicted gestational length. Tests of indirect effects were consistent with mediation such that both pregnancy anxiety at 19 weeks and increases from 19 to 31 weeks predicted placental CRH at 31 weeks, which in turn predicted gestational length. Tests of moderated mediation by ethnicity showed that the mediated effect of placental CRH at 31 weeks was significant for Latinas only. CONCLUSIONS: These findings add to growing evidence of the involvement of pregnancy anxiety in the timing of birth, address mechanisms, and suggest possible ethnic differences.

Prenatal and Postnatal Mother-to-Child Transmission of Acculturation's Health Effects in Hispanic Americans.

BACKGROUND: Hispanic Americans consistently exhibit an intergenerational increase in the prevalence of many noncommunicable chronic physical and mental disorders. METHODS: We review and synthesize evidence suggesting that a constellation of prenatal and postnatal factors may play crucial roles in explaining this trend. We draw from relevant literature across several disciplines, including epidemiology, anthropology, psychology, medicine (obstetrics, neonatology), and developmental biology. RESULTS: Our resulting model is based on evidence that among women, the process of postmigration cultural adjustment (i.e., acculturation) is associated, during pregnancy and after delivery, with psychological and behavioral states that can affect offspring development in ways that may alter susceptibility to noncommunicable chronic disease risk in subsequent-generation Hispanic Americans. We propose one integrated process model that specifies the biological, behavioral, psychological, and sociocultural pathways by which maternal acculturation may influence the child's long-term health. We synthesize evidence from previous studies to describe how acculturation among Hispanic American mothers is associated with alterations to the same biobehavioral systems known to participate in the processes of prenatal and postnatal developmental programming of disease risk. In this manner, we focus on the concepts of biological and cultural mother-to-child transmission across the prenatal and postnatal life phases. We critique and draw from previous hypotheses that have sought to explain this phenomenon (of declining health across generations). We offer recommendations for examining the transgenerational effects of acculturation. CONCLUSION: A life course model with a greater focus on maternal health and well-being may be key to understanding transgenerational epidemiological trends in minority populations, and interventions that promote women's wellness may contribute to the elimination or reduction of health disparities.