Fetal growth and the lifetime risk of generalized anxiety disorder

Vasiliadis, Helen‐Maria; Buka, Stephen L.; Martin, Laurie T.; Gilman, Stephen E.

doi:10.1002/da.20739

Cited by 20 publications

(28 citation statements)

References 57 publications

(102 reference statements)

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“…21 The occurrence of low birth weight and preterm birth has also been found to be a risk factor in itself for the development of GAD in later years. 22 Several studies have shown a link between stress in utero and adverse neurobehavioral outcomes in the neonatal period. This correlation has been proposed to be a result of dysregulation of the hypothalamic-pituitary axis of the mother and the offspring.…”

Section: Consequences Of Gad In Mother and Infantmentioning

confidence: 99%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

113

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Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

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Section: Consequences Of Gad In Mother and Infantmentioning

confidence: 99%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

113

View full text Add to dashboard Cite

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“…In another study, birth weight z-scores were divided into groups by quintiles and it was found that those in the lowest and highest quintile groups were at higher risk of anxious and depressive symptoms (115). Lastly, one study found high birth weight (>3.5 kg) was protective of GAD diagnosis, but no difference in risk between normal and low birth weight (<2.5 kg) (113). Conversely, three studies which divided birth weight into three, four or seven categories (107,112,133) found linear trends with better outcomes at higher weights.…”

Section: Non-linear Associations In Epidemiological Studiesmentioning

confidence: 99%

“…Epidemiological studies testing the association between various measures of birth weight with later psychopathology have found associations with symptoms of distress (103)(104)(105), depression (106)(107)(108)(109)(110)(111) and/or anxiety (112,113), stress susceptibility (114), depressive and anxious symptoms (115)(116)(117)(118) and psychiatric morbidity (119), which in some cases were found in females only (108,110,116,117). A number of studies which used alternative birth dimensions found associations between higher ponderal index and lifetime depression in women (109), smaller birth length adjusted for gestational length (GA) and child behavioural problems (120), and shorter GA and depression (105).…”

Section: Prenatal Risk Factors For Later Psychopathology Fetal Develomentioning

confidence: 99%

“…The first relates to greater specification of the psychopathological outcome by the use of specific clinical diagnoses drawn from a semi-structured interview, rather than broad-band self-report symptoms of psychological or behaviour problems. Although it has largely been believed that birth weight is a risk for generalised psychopathology (113), it may not be so, and the use of specific diagnoses may lead to replicable findings by identifying aspects of psychopathology related to fetal development (e.g., phobic symptoms compared with worry). The second seemingly paradoxical issue is that some of the specific disorders have such high levels of comorbidity (i.e., MDD and GAD) that it should be explored to reduce the potential that results are confounded by the outcome (i.e., anxiety by depression, or vice-versa).…”

Section: Specification Of the Psychiatric Outcomementioning

confidence: 99%

“…The mechanism by which antenatal maternal anxiety leads to smaller birth weight and shorter gestation also involves HPA programming. Despite this, less than half of the studies reviewed here adjusted for a measure of maternal mental disorder, and some of these included only a history of mental illness rather than prenatal exposure (108,109,112,113,115,122,133). Maternal prenatal anxiety has also been found to be independently associated with offspring mental illness, with a persistent but reduced effect after adjustment for birth weight, GA and concurrent maternal psychiatric measures (147,148).…”

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Early life course determinants of psychopathology

Betts¹

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Background: Mental health problems are associated with a range of adverse outcomes as well as increased risk of later morbidity and premature mortality. Help seeking is uncommon at the early stages of mental health problems. Rather, treatment is often sought by patients after illnesses have already caused considerable distress or had substantial adverse personal, social and economic impacts. The purpose of the current work is to investigate the role of a number of early life course risk factors in the development of later psychopathology, using advanced statistical and epidemiological approaches applied to longitudinal data to ascertain predictive and causal pathways. The overall scope of this thesis is to provide the evidence necessary for developing primary and secondary prevention programs aimed at reducing the burden of mental illness on society. Aim 1:To investigate the role of intrauterine growth restriction in increasing the risk of psychiatric disorders characterised by negative affectivity. Aim 2:To investigate the potential for a transmission of maternal psychopathology to offspring. Aim 3:To assess whether maternal prenatal infection and exposure to stressful life events predict positive psychotic experiences in the offspring directly, or indirectly via postnatal risks and antecedents of psychosis. Aim 4:To investigate potential risk factors for the increased rates of female post-traumatic stress disorders, including gender-specific vulnerability resulting from physical assault and cognitive ability. Methods:The data came from the Mater University Study of Pregnancy (MUSP), a prospective pre-birth cohort study which began in 1981 at the Mater Hospital in Brisbane, Australia. The baseline sample consisted of 7,223 pregnant women attending their first obstetric visit for that pregnancy. Since then follow-ups over 21 years have prospectively ascertained a range of health related data on both mother and child. The current work uses predictor variables and covariates from every measurement period, and behaviour and mental health measures ascertained from the offspring at ages 14 and 21 years. A number of statistical and methodological approaches were applied to estimate the longitudinal association between a number of early life course risk factors and later psychopathology, and to account for attrition. Key findings:The relationship between birth weight and later psychopathology was specific to particular psychiatric diagnoses, namely Post-Traumatic Stress Disorders, and comorbid Major Depression and Generalised Anxiety Disorders. The combination of maternal prenatal depressive, anxious and stress symptoms predicted increased internalising and externalising behaviour problems in adolescent and adult offspring. Prenatal maternal infections and stressful life events predicted later offspring psychotic experiences via the intermediaries of early infant illness iii susceptibility and child behaviour problems respectively. The risk of Post-Traumatic Stress Disorder associated with physical assault and ...

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