Prevalence of and relevant factors for depression and anxiety symptoms among pregnant women on the eastern seaboard of China in the post-COVID-19 era: a cross-sectional study.

BACKGROUND: Antenatal depression and anxiety symptoms may have negative consequences for both mothers and offspring, and upward trends in the prevalence of these symptoms were especially apparent during the COVID-19 epidemic. The purpose of this study was to evaluate the prevalence of and relevant factors influencing depressive and anxiety symptoms in Chinese pregnant women in the post-COVID-19 era. METHODS: We conducted an online survey of 1,963 pregnant women in Jiangsu Province, using a cross-sectional design, and collected their general demographic data. The nine-item Patient Health Questionnaire 9 (PHQ-9) was used to evaluate depression symptoms, and the seven-item Generalized Anxiety Disorder 7 (GAD-7) was used to measure anxiety symptoms. RESULTS: The prevalence of reported antenatal depressive symptoms, anxiety symptoms, and depression combined with anxiety symptoms was 25.2%, 27.9%, and 18.6%, respectively. Of the respondents, the prevalence of moderate to severe depression, and anxiety was 7.9% and 7.7%, respectively. Binary logistic regression analysis demonstrated that age, low level of education, rural area, unemployment, pregnancy complications, poor marital relationship, and fair household income were positively association with both depressive and anxiety symptoms (all P < 0.05). The proportion of women reporting anxiety symptoms in the third trimester was 1.91-fold higher than in first trimester. Parity was a relevant factor for depression and anxiety symptoms (all P < 0.05). CONCLUSIONS: In the post-COVID-19 era, the prevalence of depression and anxiety symptoms in pregnant women was higher than expected, and it is vital to establish hospital, community, and family psychological health screening systems based on relevant factors and enhance early preventive measures.

A new scale for fear of childbirth: the Fear of Childbirth Questionnaire (FCQ).

OBJECTIVE: To create a clear and acceptable measure of fear of childbirth with satisfactory content validity for use with English-speaking women in the UK. BACKGROUND: Fear of childbirth (FOC) can have a significant impact on a woman's view of her pregnancy, birth and her recovery post birth. Early identification is paramount to ensure that women's needs are recognised so that appropriately tailored care can be provided in pregnancy. Availability of reliable and valid measures to assess FOC in an English-speaking population are sparse, mainly due to issues with definitions of FOC or cultural sensitivity after translation. Recent research from phase one of the Fear of Childbirth study (FOCUS), has established key elements for FOC in an English-speaking UK population, and allows for a culturally sensitive measure of FOC to be developed. The aim was to ensure inclusion of all ten FOC elements and to attend to guidance from women in phase two of the FOCUS study about what would ensure clarity and acceptability. METHOD: A multidisciplinary team developed items in accordance with FOCUS. The measure was then piloted with one reviewer and further refined by the team of perinatal researchers. RESULTS: The FCQ is a new 20-item fear of childbirth questionnaire, which has been developed and is grounded in fears reported by women in the UK. CONCLUSION: A new tool to measure FOC in an English-speaking UK population with good content validity has undergone a preliminary phase of development and now needs testing for reliability and other forms of validity.

Hypomanic symptoms in early pregnancy: prevalence and associated factors.

Given that the perinatal period is a time of increased risk for pregnant women to manifest mental health problems, the identification of antenatal hypomanic symptoms is particularly important. However, data on antenatal hypomanic symptoms is lacking. The present study was aimed at filling this research gap by investigating the prevalence of hypomanic symptoms, including the "active-elated" and "irritable/risk-taking" sides of hypomanic symptoms at the first trimester, and examining their associations with anxiety and depressive symptoms at the following time points: the first trimester, the second trimester, and up to 6-week postpartum. A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 229 pregnant Chinese women in Hong Kong was assessed. Hypomanic symptoms were assessed with the Hypomania Checklist-32 (HCL-32). Of the sample, 43.6% had elevated levels of hypomanic symptoms in the first trimester. Multiple regression analysis showed that after adjusting for potential confounding factors, irritable/risk-taking symptoms were independently associated with higher anxiety symptoms in the first and second trimesters and in the 6-week postpartum period. Primary healthcare practitioners should be made aware of antenatal hypomanic symptoms in pregnant women to facilitate early identification and intervention for anxiety and depression to improve the well-being of both mothers and infants.

Identifying fear of childbirth in a UK population: qualitative examination of the clarity and acceptability of existing measurement tools in a small UK sample.

BACKGROUND: Fear of childbirth is related to but not synonymous with general anxiety, and represents a superior predictor for maternal and infant outcomes. There is a need to improve the identification and provision of support for women experiencing high fear of childbirth. However it is uncertain as to whether existing measurement tools have appropriate content validity (i.e. cover the relevant domains within the construct), practical utility, and whether they are acceptable for use with a UK population. This study aimed to (1) identify the utility and acceptability of existing measures of fear of childbirth (FOC) with a small UK sample and (2) map the content of existing measures to the key concepts of fear of childbirth established by previous research. METHODS: Ten pregnant women; five with high and five with low fear of childbirth participated in a cognitive interview covering four most commonly used measures of fear of childbirth: 1. The Wijma Delivery Expectancy Questionnaire (WDEQ A), 2. The Oxford Worries about Labour Scale (OWLS), 3. The Slade-Pais Expectations of Childbirth Scale - fear subscale (SPECS) and 4. The Fear of Birth scale (FOBS). Each measure was also reviewed by participants for ease and clarity of understanding and acceptability. The measures were then reviewed against the key domains identified in the fear of childbirth literature to ascertain the adequacy of content validity of each measure. Interviews were analysed using thematic analysis for each scale item. RESULTS: All measures except the FOBS, included items that either women did not understand or, if where there was understanding the meanings were inconsistent across women. All measures demonstrated limited acceptability and content validity for the specific construct of FOC. Therefore, none of the measurement tools currently used within the UK met criteria for understanding, acceptability and content validity for measurement of FOC. CONCLUSIONS: Findings emphasise a need to develop a specific fear of childbirth tool with good clarity which demonstrates appropriate content validity, and that is acceptable in presentation and length for pregnant women in a UK population.

The association between social support through contacts with Accredited Social Health Activists (ASHAs) and antenatal anxiety among women in Mysore, India: a cross-sectional study.

PURPOSE: In India, antenatal anxiety prevalence estimates range from 6 to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety. METHODS: Data were analyzed from the Saving Children, Improving Lives project, a quasi-experimental study conducted among rural, pregnant women in India. Regression models were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals for the relationship frequency of ASHA contacts and antenatal anxiety. Antenatal anxiety was measured using a subscale of the Edinburgh Postnatal Depression Scale. RESULTS: The sample consisted of 480 pregnant women. Reported antenatal anxiety prevalence was 27% (95% CI 23%, 31%). Participants who were more frequently visited by ASHAs at home (aPR: 0.90; 95% CI 0.76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR: 0.86, 95% CI 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women. CONCLUSIONS: ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety.

Establishing a valid construct of fear of childbirth: findings from in-depth interviews with women and midwives.

BACKGROUND: Fear of childbirth (FOC) can have a negative impact on a woman's psychological wellbeing during pregnancy and her experience of birth. It has also been associated with adverse obstetric outcomes and postpartum mental health difficulties. However the FOC construct is itself poorly defined. This study aimed to systematically identify the key elements of FOC as reported by women themselves. METHODS: Semi-structured interviews with pregnant women (n = 10) who reported to be fearful of childbirth and telephone interviews with consultant midwives (n = 13) who regularly work with women who are fearful of childbirth were conducted. Interviews were analysed using thematic analysis for each group independently to provide two sources of information. Findings were reviewed in conjunction with a third source, a recently published meta-synthesis of existing literature of women's own accounts of FOC. The key elements of FOC were determined via presence in two out of the three sources at least one of which was from women themselves, i.e. the reports of the women interviewed or the meta-synthesis. RESULTS: Seven themes were identified by the women and the consultant midwives: Fear of not knowing and not being able to plan for the unpredictable, Fear of harm or stress to the baby, Fear of inability to cope with the pain, Fear of harm to self in labour and postnatally, Fear of being 'done to', Fear of not having a voice in decision making and Fear of being abandoned and alone. One further theme was generated by the women and supported by the reports included the meta-synthesis: Fear about my body's ability to give birth. Two further themes were generated by the consultant midwives and were present also in the meta-synthesis: Fear of internal loss of control and Terrified of birth and not knowing why. CONCLUSIONS: Ten key elements in women's FOC were identified. These can now be used to inform development of measurement tools with verified content validity to identify women experiencing FOC, to support timely access to support during pregnancy.

A systematic review and meta-analysis of the effects of antenatal anxiety on postpartum outcomes.

To systematically review and meta-analyze research investigating the association between maternal anxiety during pregnancy and outcomes for mother and baby following the immediate delivery period. MEDLINE, Medline In-Process & Other Non-Indexed Citations, PsycINFO, Embase, CINAHL, and the Cochrane library were searched. English-language, prospective studies providing data on outcomes following delivery in women with and without antenatal anxiety (defined by clinical diagnosis or score on validated scale) were included. Three-hundred-fifty-eight articles were retrieved and 13 were included. Titles and abstracts were screened; two reviewers independently reviewed full text articles, conducted quality assessments, extracted, and checked the data. Where available for > 2 studies, random effect meta-analysis was conducted and heterogeneity was quantified. Subanalyses explored moderators, regardless of heterogeneity, including type of anxiety assessment and timing, among others. There were two outcomes that were amenable to meta-analysis. Antenatal anxiety was significantly associated with postpartum depression (PPD) measured within 6 months postpartum (pooled odds ratio [OR] = 2.64, 95% CI 2.02-3.46; 8 studies), regardless of restricting analyses to those studies controlling for prenatal depression (2.45, 1.77-3.39; 6 studies). Associations were also significant when PPD was measured at 1-3 months (2.57, 1.94-3.40; 7 studies) and 6-10 months (4.42, 1.45-13.49; 3 studies). Maternal anxiety was also associated with reduced odds of breastfeeding (0.63, 0.53-0.74; 5 studies). Antenatal anxiety is associated with PPD up to the first 10 months, independent of prenatal depression, and with lower odds of breastfeeding.

Risk factors for antenatal anxiety: A systematic review of the literature.

BACKGROUND: Given the prevalence of antenatal anxiety and its consistent associations with adverse pregnancy and child outcomes, early detection and management of anxiety are essential. OBJECTIVE: The aim was to identify risk factors for anxiety among pregnant women by systematically reviewing original research. METHODS: Cross-sectional, case-control and cohort studies that examined associations between antenatal anxiety and at least one potential risk factor prospectively or retrospectively and measured anxiety independent from other mental health conditions were included. Studies rated strong/moderate in methodological quality appraisal were used to synthesise the evidence. RESULTS: Factors associated with greater risk of anxiety included previous pregnancy loss, medical complications, childhood abuse, intimate partner violence, denial/acceptance coping styles, personality traits, inadequate social support, history of mental health problems, high perceived stress and adverse life events. CONCLUSIONS: Several risk factors identified in this review are detectable in routine prenatal care visits (e.g. previous pregnancy loss, pregnancy complications), potentially modifiable (e.g. coping styles, social support, partner factors) and can be identified prior to pregnancy (e.g. psychosocial factors), underlining the significance of pre-conception mental health screening.

Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study.

Anxiety is highly prevalent in many populations; however, the burden of anxiety disorders amongst pregnant women in low-resource settings is not well documented. We investigated the prevalence and predictors of antenatal anxiety disorders amongst low-income women living with psychosocial adversity. Pregnant women were recruited from an urban, primary level clinic in Cape Town, South Africa. The Mini-International Neuropsychiatric Interview diagnostic interview assessed prevalence of anxiety disorders. Four self-report questionnaires measured psychosocial characteristics. Logistic regression models explored demographic and socioeconomic characteristics, psychosocial risk factors and psychiatric comorbidity as predictors for anxiety disorders. Amongst 376 participants, the prevalence of any anxiety disorder was 23%. Although 11% of all women had post-traumatic stress disorder, 18% of the total sample was diagnosed with other anxiety disorders. Multivariable analysis revealed several predictors for anxiety including a history of mental health problems (adjusted odds ratio [AOR] 4.11; 95% confidence interval (CI) 2.03-8.32), Major depressive episode (MDE) diagnosis (AOR 3.83; CI 1.99-7.31), multigravidity (AOR 2.87; CI 1.17-7.07), food insecurity (AOR 2.57; CI 1.48-4.46), unplanned and unwanted pregnancy (AOR 2.14; CI 1.11-4.15), pregnancy loss (AOR 2.10; CI 1.19-3.75) and experience of threatening life events (AOR 1.30; CI 1.04-1.57). Increased perceived social support appeared to reduce the risk for antenatal anxiety (AOR 0.95; CI 0.91-0.99). A range of antenatal anxiety disorders are prevalent amongst pregnant women living in low-resource settings. Women who experience psychosocial adversity may be exposed to multiple risk factors, which render them vulnerable to developing antenatal anxiety disorders.

The prevalence of symptoms of depression and anxiety, and the level of life stress and worry in New Zealand Maori and non-Maori women in late pregnancy.

OBJECTIVE: To describe the prevalence of symptoms of depression and anxiety, and the level of life stress and worry in late pregnancy for Maori and non-Maori women. METHODS: In late pregnancy, women completed a questionnaire recording their prior history of mood disorders; self-reported current depressive symptoms (⩾13 on the Edinburgh Postnatal Depression Scale), current anxiety symptoms (⩾6 on the anxiety items from the Edinburgh Postnatal Depression Scale), significant life stress (⩾2 items on life stress scale) and dysfunctional worry (>12 on the Brief Measure of Worry Scale). RESULTS: Data were obtained from 406 Maori women (mean age = 27.6 years, standard deviation=6.3 years) and 738 non-Maori women (mean age = 31.6 years, standard deviation=5.3 years). Depressive symptoms (22% vs 15%), anxiety symptoms (25% vs 20%), significant life stress (55% vs 30%) and a period of poor mood during the current pregnancy (18% vs 14%) were more prevalent for Maori than non-Maori women. Less than 50% of women who had experienced ⩾2 weeks of poor mood during the current pregnancy had sought help. Being young was an independent risk factor for depressive symptoms, significant life stress and dysfunctional worry. A prior history of depression was also consistently associated with a greater risk of negative affect in pregnancy. CONCLUSION: Antenatal mental health requires at least as much attention and resourcing as mental health in the postpartum period. Services need to specifically target Maori women, young women and women with a prior history of depression.

Student midwives' awareness, knowledge, and experiences of antenatal anxiety within clinical practice.

OBJECTIVE: The current study aimed to explore student midwives' awareness, knowledge, and experiences of supporting women with antenatal anxiety (ANA) within clinical practice. BACKGROUND: ANA is associated with negative outcomes for mother and baby. Midwives play a key role in the screening of antenatal mental health and care of women suffering from ANA. METHODS: This study was conducted with student midwives at one UK university in the north-west of England. Twenty-five midwifery students completed a brief online survey informed by National Institute of Health and Care Excellence (NICE) guidelines. Of these, seven volunteered to participate in semi-structured interviews exploring the survey data. The interview topic guide was designed based on the findings of the survey. RESULTS: Thematic analysis of the seven interviews revealed four overarching themes: Perpetuating factors, Barriers to care, Skills required in role and Suggestions for future directions. Midwives had a varied knowledge and understanding of ANA and expressed a desire to learn more about their role in supporting women with ANA. CONCLUSION: Although a small study, the results highlight the need for education to be improved in order to best prepare student midwives for cases of ANA, with emphasis on integrating psychology and mental health information into teaching as well as time spent in clinical practice. Midwives are key in the screening of women for ANA and are in an ideal position to signpost for specialist care.

Dopamine receptor polymorphism modulates the relation between antenatal maternal anxiety and fetal movement.

We determined whether the combination of fetal genotype (dopamine D4 receptor; DRD4) and mothers' anxiety during pregnancy is associated with fetal behavior. Two hundred and six pregnant women underwent an ultrasound exam. Fetal movement measures (Movement Frequency, Total Activity, Movement Duration, and Longest Quiet Time) were derived from off-line coding. A moderating role of the DRD4-III polymorphism was found: Results indicate that higher levels of antenatal maternal anxiety symptoms were associated with more frequent fetal movements among fetuses carrying a 7R allele, but not among fetuses carrying shorter alleles. Total Activity did not show full moderation by DRD4, though the measure was correlated with maternal anxiety among fetuses in the Anxious Group with a 7R allele; not among fetuses without both factors. The findings provide the first evidence of a GXE interaction in association with fetal behavior. Results also demonstrate that some individuals are inherently more susceptible to uterine environmental influences than are others.

The Stirling Antenatal Anxiety Scale (SAAS): Turkish validity and reliability study.

AIMS: To examine the psychometric properties of the Stirling Antenatal Anxiety Scale (SAAS), developed by Sinesi et al., which assesses the level of anxiety of pregnant women in the prenatal period, in the Turkish culture, and to conduct a validity and reliability study. METHODS: This study had a methodological approach, with a cross-sectional and descriptive research design. Reporting was in accordance with the STROBE checklist. The sample included 160 pregnant women who were followed up in the maternity outpatient clinics of a public hospital and a private hospital in Istanbul. Data were collected face-to-face using a personal information form, the Turkish version of the SAAS, and the Generalized Anxiety Disorder-7 scale between June and August 2023. In the data analysis, validity analyses were performed with content and construct validity and multiple fit indices for confirmatory factor analysis. Item-total score analysis was conducted using Cronbach's alpha coefficient and Pearson's correlation analysis to assess reliability. Descriptive and reliability analyses were undertaken using SPSS v.28.0.1.0, and validity analyses were performed using SPSS AMOS v.26.0.0.0. FINDINGS: Based on expert opinions on the items in the Turkish version of the SAAS, the content validity ratio was 0.96. The decision was made to exclude Item 9 from the Turkish version because the item factor load was low. The Turkish version had a single factor, as did the original version. The Cronbach alpha coefficient was 0.87, so the Turkish version was determined to have high reliability. CONCLUSION: The Turkish version of the SAAS, originally produced in English, has high levels of validity and reliability. In addition, it is short and easy to apply in clinical and research settings. As such, the Turkish version of the SAAS is recommended for use to evaluate the level of anxiety in pregnant women.

Bibliometric analysis of published articles on perinatal anxiety from 1920 to 2020.

INTRODUCTION: Trends and gaps in perinatal anxiety research remain unknown. The objective of this bibliometric review was to analyze the characteristics and trends in published research on perinatal anxiety to inform future research. METHODS: All published literature in Web of Science on perinatal anxiety from January 1, 1920 to December 31, 2020 were screened by two reviewers. VOSViewer was utilized to visualize linkages between publications. Bibliometric data were extracted from abstracts. RESULTS: The search strategy identified 4561 publications. After screening, 2203 publications related to perinatal anxiety were used for the visualization analysis. For the bibliometric data, 1534 publications had perinatal anxiety as a primary focus. There were 7910 different authors, over half named only once (55.5 %), from 63 countries. 495 journals were identified, with over half (56.0 %) publishing only one article. Most articles were published between 2011 and 2020 (75.9 %). In terms of perinatal timing, over half (54.2 %) published on antenatal anxiety. Only 6.0 % of studies reported on perinatal anxiety in fathers and 56.5 % also reported on perinatal depression. LIMITATIONS: Web of Science was solely used, and manual screening of each publication was required. CONCLUSION: This bibliometric analysis found: (1) perinatal anxiety is a growing field of research, with publications increasing over time; (2) there is variation in authors and journals; (3) over half of the publications focus on antenatal anxiety; (4) paternal anxiety is understudied; and (5) only 6 % of publications came from low and lower-middle income countries. Gaps related to maternal postnatal anxiety and paternal perinatal anxiety exist.

Comparative analysis of general and pregnancy-related prenatal anxiety symptoms: progression throughout pregnancy and influence of maternal attachment.

Pregnancy-specific anxiety (PSA) has been differentiated from general anxiety (GA) to better account for the heterogeneity of prenatal anxiety and possible measurement bias. A longitudinal study was conducted to determine the evolution of maternal anxiety symptoms during pregnancy, distinguishing PSA and GA, and the influence of maternal attachment A sample of 155 women (mean age 32.5, SD 3.88) were enrolled in their first trimester of pregnancy (T1) in one center and follow throughout their pregnancy. The Relationship Scales Questionnaire (RSQ), the State-Trait Anxiety Inventory (STAI), and the Pregnancy-Related Anxiety Questionnaire (PRAQ) were completed at T1, and, for the last two, at the second (T2) and third trimesters of pregnancy (T3). Multi-level model found significant decreases in the PRAQ total score and the STAI total score between T1 and T3, but only the PRAQ total score decreased from T1 to T2. Preoccupied maternal attachment was independently associated with higher PRAQ and STAI total scores at T1, T2, and T3. Considering the progressive decline of the levels of PSA and GA during pregnancy, interventions should focus on pregnant mothers with risk factors for a persisting course of anxiety such as preoccupied attachment.

Climate change anxiety positively predicts antenatal distress in expectant female parents.

Clinical and subclinical levels of anxiety and depression are common experiences during pregnancy for expectant women; however, despite rising awareness of significant climate change anxiety around the world, the extent to which this particular type of anxiety may be contributing to overall antenatal psychological distress is currently unknown. Furthermore, the content of concerns that expectant women may have for their existing or future children remains unexplored. To address this gap in knowledge, 103 expectant Australian women completed standardised assessments of antenatal worry and depression, climate change anxiety, and perceived distance to climate change, and responded to several open-ended questions on concerns they had for their children. Results indicated that climate change anxiety accounted for significant percentages of variance in both antenatal worry and depression scores and, unexpectedly, neither child number nor perceived distance to climate change moderated these relationships. Content analysis of qualitative data highlighted the significant health-related anxieties for participants' children related to climate change (e.g., disease, exposure to extreme weather events, food/water insecurity). Given the escalating nature of climate change, further investigation of this relatively new stressor contributing to the experience of anxiety and distress, particularly in uniquely vulnerable groups such as expectant women, is urgently needed.

Antenatal anxiety symptoms outperform antenatal depression symptoms and suicidal ideation as a risk factor for postpartum suicidal ideation.

BACKGROUND AND OBJECTIVES: Suicidal ideation (SI) during the postpartum phase is linked with suicide, a leading cause of death during this period. Antenatal depression and anxiety symptoms have both been linked with increased risk for postpartum SI. However, research aimed at examining the relative contributions of antenatal anxiety and depression symptoms towards postpartum SI remains nascent. In this study, we investigated the relative contribution of antenatal anxiety symptoms, depression symptoms, and SI towards postpartum SI. DESIGN: These data are from a longitudinal study in which American mothers were assessed during pregnancy and again at six- to eight weeks postpartum. METHODS: Data were analyzed using correlations and logistic regression models. RESULTS: Antenatal anxiety symptoms and antenatal depression symptoms were significantly correlated with postpartum SI. Results from a logistic regression model indicated that antenatal anxiety symptoms (T1; OR = 1.185 [1.125, 1.245], p = .004), but not antenatal depression symptoms (T1; OR = 1.018 [0.943, 1.093], p = .812) or antenatal SI (T1; OR = 1.58 [0.11, 22.29], p = 0.73), were significantly associated with postpartum SI. CONCLUSIONS: Antenatal anxiety symptoms, depression symptoms, and SI were positively associated with postpartum SI. When examined simultaneously, anxiety symptoms during the antenatal phase (but not depression symptoms or SI) predicted SI in the postpartum phase.

Effects of a prenatal anxiety randomized controlled trial intervention on infant development in Pakistan.

OBJECTIVES: Given that infant development is influenced by caregiver mental health, we tested whether an intervention to reduce antenatal anxiety could affect infant development. A secondary aim was to test depressive symptoms, maternal responsiveness, and maternal infant bonding as mediators of this relationship. METHODS: Between 2020 and 2022, pregnant women participated in a randomized controlled trial of the Happy Mother-Healthy Baby (HMHB) program based on cognitive behavioral therapy. We collected data on child development from 202 intervention and 198 control participants in a public hospital in Pakistan. Child development was measured using the Ages and Stages Questionnaires-Version 3 at six weeks postpartum. Using intent-to-treat analyses, we examined whether the intervention was associated with performance on the five ASQ-3 domains. Causal mediation analysis was used to assess depressive symptoms, bonding, and maternal-infant responsiveness as mediators. RESULTS: Socio-demographic characteristics were evenly distributed between study arms. Intervention arm infants showed a 2.1-point increase (95% CI: 0.12, 4.17) in communication scores compared to controls. Though not achieving statistical significance, intervention infants also showed a 2.0-point increase (95% CI:-0.06, 4.09) in gross motor development performance. Bonding, depression, and responsiveness were mediators between the intervention and infant communication (Bindirect=1.94 (95%CI: 0.86, 3.25) depression; Bindirect=0.57 (95% CI: 0.09, 1.16) bonding; Bindirect=0.53 (95% CI: 0.01, 1.21) responsiveness; and Bindirect=1.94 (95%CI: 0.86, 3.25). Bonding, responsiveness, and depression mediated 25%, 23%, and 87% of the total association, respectively. CONCLUSIONS: HMHB positively affected infant communication at six-week follow-up. Larger studies with longer follow-up are needed to confirm and extend these findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT03880032; https://clinicaltrials.gov/ct2/show/NCT03880032.

Epigenetic modifications appear in the human placenta following anxiety and depression during pregnancy.

INTRODUCTION: The future health of the offspring can be influenced by longstanding maternal anxiety and depression disorders during pregnancy. The present study aimed to explore the effect of psychiatric disorders during pregnancy on placental epigenetics. METHODS: We measured DNA methylation patterns in term-placentas of women either suffering longstanding anxiety and depression symptoms (Index group, with overt symptoms), or a healthy population (Control, none/only mild symptoms). Whole genome DNA methylation profiling was performed using the TruSeq® Methyl Capture EPIC Library Prep Kit (Illumina, San Diego, CA, USA) for library preparation and NGS technology for genomic DNA sequencing. RESULTS: The results of high-throughput DNA methylation analysis revealed that the Index group had differential DNA methylation at epigenome-wide significance (p < 0.05) in 226 genes in the placenta. Targeted enrichment analyses identified hypermethylation of genes associated with psychiatric disorders (BRINP1, PUM1), and ion homeostasis (COMMD1), among others. The ECM (extracellular matrix)-receptor interaction pathway was significantly dysregulated in the Index group compared to the Control. In addition, DNA methylation/mRNA integration analyses revealed that four genes with key roles in neurodevelopment and other important processes (EPB41L4B, BMPR2, KLHL18, and UBAP2) were dysregulated at both, DNA methylation and transcriptome levels in the Index group compared to Control. DISCUSSION: The presented results increase our understanding of how maternal psychiatric disorders may affect the newborn through placental differential epigenome, suggesting DNA methylation status as a biomarker when aiming to design new preventive techniques and interventions.

Association of antenatal anxiety disorders with antenatal comorbidities and adverse pregnancy outcomes among clinic attendees at a tertiary-care hospital in Sri Lanka.

Purpose: Evidence on the association between antenatal anxiety disorders (AADs) and adverse pregnancy outcomes with detection of AADs using the gold-standard is scarce despite being vital to make decisions on interventions. We aimed to determine this association in women attending tertiary-care antenatal clinics in Sri Lanka. Material and methods: Presence/absence of AADs in a systematic random sample of 221 antenatal women attending routine antenatal clinics of a teaching hospital who participated in a questionnaire-validation study were confirmed by a psychiatrist. These women were followed up until the end of pregnancy. Information on antenatal comorbidities, adverse pregnancy outcomes was extracted from health records. The association between AADs with antenatal comorbidities and adverse pregnancy outcomes were reported using adjusted odds ratios (ORs) and 95%confidence intervals (CIs) generated from logistic regression models. Results: Mean (±SD) age of the women was 30 (±5.8) years. AADs were diagnosed in 81 (37%) women. Compared to women without AADs, those who had AADs were more at risk of pregnancy-induced hypertension (OR 6.1; 95% CI 1.2-31.9), gestational diabetes mellitus (OR 12.6; 95% CI 1.5-107.2), preterm labour (OR 4.3; 95% CI 1.4-13.0), prolonged labour (OR 19.0; 95% CI 7.1-51.1), lower segment caesarean section (OR 4.7; 95% CI 2.5-8.7) and low birthweight (OR 11.2; 95% CI 4.8-26.3). All miscarriages, stillbirths and assisted labour occurred exclusively in those with AADs. Conclusions: AADs are strongly associated with several adverse pregnancy outcomes. Causal pathways and effect of interventions for AADs must be explored in future research.