Anxiety Disorders: Glover V

Talge NM, Neal C, Glover V, Anonymous00261. · Institute of Child Development, University of Minnesota, USA. · J Child Psychol Psychiatry. · Pubmed #17355398 No free full text.

Abstract: We review a significant body of evidence from independent prospective studies that if a mother is stressed while pregnant, her child is substantially more likely to have emotional or cognitive problems, including an increased risk of attentional deficit/hyperactivity, anxiety, and language delay. These findings are independent of effects due to maternal postnatal depression and anxiety. We still do not know what forms of anxiety or stress are most detrimental, but research suggests that the relationship with the partner can be important in this respect. The magnitude of these effects is clinically significant, as the attributable load of emotional/behavioral problems due to antenatal stress and/or anxiety is approximately 15%. Animal models suggest that activity of the stress-responsive hypothalamic-pituitary-adrenal (HPA) axis and its hormonal end-product cortisol are involved in these effects in both mother and offspring. The fetal environment can be altered if stress in the mother changes her hormonal profile, and in humans, there is a strong correlation between maternal and fetal cortisol levels. However, many problems remain in understanding the mechanisms involved in this interaction. For example, maternal cortisol responses to stress decline over the course of pregnancy, and earlier in pregnancy, the link between maternal and fetal cortisol is less robust. It is possible that the effects of maternal anxiety and stress on the developing fetus and child are moderated by other factors such as a maternal diet (e.g., protein load). It is suggested that extra vigilance or anxiety, readily distracted attention, or a hyper-responsive HPA axis may have been adaptive in a stressful environment during evolution, but exists today at the cost of vulnerability to neurodevelopmental disorders.

Kammerer M, Taylor A, Glover V. · Institute of Reproductive and Developmental Biology, Fetal and Neonatal Stress Research Centre, Imperial College, London, UK. · Arch Womens Ment Health. · Pubmed #16708167 No free full text.

Abstract: Episodes of depression and anxiety are as common during pregnancy as postpartum. Some start in pregnancy and resolve postpartum, others are triggered by parturition and some are maintained throughout. In order to determine any biological basis it is important to delineate these different subtypes. During pregnancy, as well as the rise in plasma oestrogen and progesterone there is a very large increase in plasma corticotropin releasing hormone (CRH), and an increase in cortisol. The latter reaches levels found in Cushing's syndrome and major melancholic depression. Levels of all these hormones drop rapidly on parturition.We here suggest that the symptoms of antenatal and postnatal depression may be different, and linked in part with differences in the function of the hypothalamic pituitary adrenal (HPA) axis. There are two subtypes of major depression, melancholic and atypical, with some differences in symptom profile, and these subtypes are associated with opposite changes in the HPA axis. Antenatal depression may be more melancholic and associated with the raised cortisol of pregnancy, whereas postnatal depression may be more atypical, triggered by cortisol withdrawal and associated with reduced cortisol levels. There is evidence that after delivery some women experience mild bipolar II depression, and others experience post traumatic stress disorder. Both of these are associated with atypical depression. It may also be that some women are genetically predisposed to depression of the melancholic type and some to depression of the atypical type. These women may be more or less vulnerable to depression at the different stages of the perinatal period.

Van den Bergh BR, Mulder EJ, Mennes M, Glover V. · Department of Developmental Psychology, Catholic University of Leuven (KULeuven), Tiensestraat 102, 3000 Leuven, Belgium. · Neurosci Biobehav Rev. · Pubmed #15811496 No free full text.

Abstract: A direct link between antenatal maternal mood and fetal behaviour, as observed by ultrasound from 27 to 28 weeks of gestation onwards, is well established. Moreover, 14 independent prospective studies have shown a link between antenatal maternal anxiety/stress and cognitive, behavioural, and emotional problems in the child. This link generally persisted after controlling for post-natal maternal mood and other relevant confounders in the pre- and post-natal periods. Although some inconsistencies remain, the results in general support a fetal programming hypothesis. Several gestational ages have been reported to be vulnerable to the long-term effects of antenatal anxiety/stress and different mechanisms are likely to operate at different stages. Possible underlying mechanisms are just starting to be explored. Cortisol appears to cross the placenta and thus may affect the fetus and disturb ongoing developmental processes. The development of the HPA-axis, limbic system, and the prefrontal cortex are likely to be affected by antenatal maternal stress and anxiety. The magnitude of the long-term effects of antenatal maternal anxiety/stress on the child is substantial. Programs to reduce maternal stress in pregnancy are therefore warranted.

Bergman K, Sarkar P, O'Connor TG, Modi N, Glover V. · Imperial College London, UK · J Am Acad Child Adolesc Psychiatry. · Pubmed #18049295 No free full text.

Abstract: OBJECTIVE: To examine the effects of prenatal stress on cognition and behavioral fearfulness in infants. METHOD: Mothers were recruited at amniocentesis at Queen Charlotte's and Chelsea Hospital, London, between 2001 and 2005, and recalled when their children were 14 to 19 months to assess cognitive development using the Bayley Scales and fearfulness using the Lab-TAB. Measures of prenatal and postnatal life events and current psychological state were collected at the postnatal visit. RESULTS: Prenatal stress predicted both mental development (rs = -0.39, n = 123 p < .0001) and observed fearfulness (rs = 0.33, n = 106, p < .001); the magnitude of effect was essentially unchanged after covarying postnatal stressors, maternal education and psychological state, exposures to medications and substances during pregnancy, and birth outcomes. Prenatal stress accounted for 17% of the variance in cognitive ability and 10% of the variance in observed fearfulness. The correlation between mental development and fearfulness was minimal (r = -0.06, not significant). Prenatal partner relationship strain accounted for 73.5% and 75.0% of the prenatal stress related variance on infant cognitive and fearfulness scores, respectively. CONCLUSIONS: These findings strengthen previous research that suggests that fetal programming can be important for neurodevelopmental and psychiatric outcomes. They imply that the mechanisms by which mental development and fearfulness are affected are different and that prenatal stress due to relationship strain may warrant particular attention.

O'Connor TG, Caprariello P, Blackmore ER, Gregory AM, Glover V, Fleming P, Anonymous00031. · Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, USA. · Early Hum Dev. · Pubmed #17008033 No free full text.

Abstract: BACKGROUND: Experimental animal data link prenatal stress with sleep disturbance in offspring, but the link in humans is unclear. AIMS: To investigate the link between prenatal maternal anxiety and depression and infant sleep disturbance from 6 to 30 months of age. STUDY DESIGN: Longitudinal prospective study of a large birth cohort from pregnancy to 30 months. Questionnaire measures of anxiety and depression were completed by mothers at 18 and 32 weeks gestation and at 8 weeks and 8 months postpartum. SUBJECTS: The ALSPAC cohort, a prospective community study of women in the UK who have been followed since pregnancy. OUTCOME MEASURES: Measures of total sleep time, number of awakenings, and broadly defined sleep problems were available on children at ages 6, 18, and 30 months. RESULTS: Reliable measures of total sleep time, nighttime awakenings, and sleep problems were identified at 6, 18, and 30 months. Higher levels of prenatal maternal anxiety and depression predicted more sleep problems at 18 and 30 months, after controlling for postnatal mood and obstetric and psychosocial covariates; the association was not restricted to clinical extremes. No link with total sleep time was observed. CONCLUSIONS: Mood disturbance in pregnancy has persisting effects on sleep problems in the child, a finding that is consistent with experimental animal research. The findings add to a growing literature showing that maternal prenatal stress, anxiety, and depression may have lasting effects on child development.

Glover V, O'Connor TG, Heron J, Golding J, Anonymous00067. · Wolfson and Weston Research Centre for Family Health, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK. · Early Hum Dev. · Pubmed #15324991 No free full text.

Abstract: BACKGROUND: Animal studies have shown that prenatal stress is linked with altered laterality in the offspring. AIMS: The aim of this study was to test the hypothesis that antenatal maternal anxiety was associated with altered lateralisation in children, as demonstrated by mixed handedness. STUDY DESIGN AND SUBJECTS: We used the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective longitudinal study that has followed women since pregnancy. The final analysis included data on 7431 mother-child pairs. Maternal anxiety was measured at 18- and 32-week gestation and 8 weeks postnatally using a self-report inventory. Child handedness was assessed at 42 months using an established maternal report scale. Information on maternal and paternal handedness, as well as data on possible confounding variables such as obstetric and antenatal risks, were also assessed. RESULTS: Univariable analysis showed that antenatal anxiety at 18 weeks was associated with mixed-handedness in the child, OR=1.28 (95% CI 1.09-1.50, p<0.01). Although boys were more likely than girls to be mixed handed, the link with antenatal anxiety was similar. There was no significant association with antenatal anxiety at 32 weeks. Multivariable analyses indicated that maternal anxiety at 18 weeks of pregnancy predicted an increased likelihood of mixed-handedness in the child (OR=1.23, 95% CI 1.02-1.48, p<0.05), independently of parental handedness, obstetric and other antenatal risks, and postnatal anxiety. CONCLUSION: This result provides further evidence for a link between antenatal anxiety and fetal programming in humans.

Heron J, O'Connor TG, Evans J, Golding J, Glover V, Anonymous00165. · University of Bristol, UK. · J Affect Disord. · Pubmed #15094259 No free full text.

Abstract: BACKGROUND: Postnatal and antenatal depression are a focus of considerable clinical and research attention, but little is known about the patterns of anxiety across this period. METHODS: Self-reported anxiety and depression were assessed at 18 and 32 weeks gestation and 8 weeks and 8 months postnatally in a prospective longitudinal study of a community sample of women in England (n=8323). RESULTS: The majority of cases of postnatal depression were preceded by antenatal depression; similarly, postnatal anxiety was preceded by antenatal anxiety. Despite the stability of anxiety and depression across this period, there was a mean decrease in both anxiety and depression. Finally, antenatal anxiety predicted postnatal depression at 8 weeks and 8 months, even after controlling for antenatal depression (OR=3.22, p<0.001). Limitations: Data were based on self-report only and there was evidence of selective attrition. CONCLUSION: The findings confirm that antenatal anxiety occurs frequently, overlaps with depression and increases the likelihood of postnatal depression.

O'Connor TG, Heron J, Golding J, Glover V, Anonymous00408. · Department of Child & Adolescent Psychiatry, Institute of Psychiatry, London, UK. · J Child Psychol Psychiatry. · Pubmed #14531585 No free full text.

Abstract: BACKGROUND: Previous animal investigations link antenatal stress with a range of persistent behavioural abnormalities in the offspring. The current study examined if the effect was also found in humans through middle childhood. METHODS: The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, community-based study that has followed a cohort of women from pregnancy. Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period. Children's behavioural/emotional problems were assessed by parent report at age 47 and 81 months. Information on obstetric and psychosocial factors was obtained at several points in pregnancy and the postnatal period. RESULTS: Children whose mothers experienced high levels of anxiety in late pregnancy exhibited higher rates of behavioural/emotional problems at 81 months of age after controlling for obstetric risks, psychosocial disadvantage, and postnatal anxiety and depression (for girls, OR = 1.91, 95%CI = 1.26-2.89; for boys, OR = 2.16, 95%CI = 1.41-3.30). Furthermore, the effect at 81 months was comparable to what was previously obtained at 47 months, suggesting the kind of persistent effect proposed in the animal literature. CONCLUSIONS: There is evidence that antenatal stress/anxiety has a programming effect on the fetus which lasts at least until middle childhood.

O'Connor TG, Heron J, Glover V, Anonymous00342. · Department of Child and Adolescent Psychiatry and SGDP Research Centre, Institute of Psychiatry, London, England. · J Am Acad Child Adolesc Psychiatry. · Pubmed #12447034 No free full text.

Abstract: OBJECTIVE: To examine the hypothesis that the effects of postnatal depression on children's behavioral/emotional problems are explained by antenatal maternal mood. METHOD: The current study investigated this hypothesis in the Avon Longitudinal Study of Parents and Children, a prospective, community-based study that has followed a cohort of women since pregnancy (n = 7,144) who delivered their baby between April 1, 1991, and December 31, 1992. Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period. Children's behavioral/emotional problems were assessed by parent report at age 4 years. RESULTS: After controlling for smoking, alcohol use, birth weight for gestational age, maternal age, child sex, and socioeconomic status, postnatal depression at 8 weeks (OR = 2.27 [1.55-3.31]) and 8 months (OR = 1.68 [1.12-2.54]) was associated with children's behavioral/emotional problems. Subsequent analyses that included antenatal maternal mood indicated that antenatal anxiety in late pregnancy and not antenatal depression was also independently associated with behavioral/emotional problems at age 4 (OR = 1.72 [1.14-2.59]); 8 week postnatal depression remained a significant predictor after antenatal maternal mood was statistically controlled for (OR = 1.56 [1.04-2.32]). CONCLUSIONS: Antenatal anxiety and postnatal depression represent separate risks for behavioral/emotional problems in children and act in an additive manner.

O'Connor TG, Heron J, Golding J, Beveridge M, Glover V. · Institute of Psychiatry, Denmark Hill, London. · Br J Psychiatry. · Pubmed #12042228 links to  free full text

Abstract: BACKGROUND: Animal experiments suggest that maternal stress and anxiety during pregnancy have long-term effects on the behaviour of the offspring. AIMS: To test the hypothesis that antenatal maternal anxiety predicts behavioural problems at age 4 years. METHOD: Data were collected on multiple antenatal and postnatal assessments of maternal anxiety and depression, antenatal and obstetric risks, psychosocial risks and children's behavioural/emotional problems (n=7448). RESULTS: Antenatal maternal anxiety predicted behavioural/emotional problems in boys (OR=2.14, 95% CI 1.48-3.10) and girls (OR=1.88, 95% CI 1.3-2.69) after accounting for covariates. When covarying maternal anxiety up to 33 months postnatally, antenatal anxiety continued to predict total problems in boys (OR=1.56, 95% CI 1.02-2.41) and girls (OR=1.51, 95% CI 1.22-2.81). CONCLUSIONS: There could be a direct effect of maternal mood on foetal brain development, which affects the behavioural development of the child.