Mechanisms Linking In Utero Stress to Altered Offspring Behaviour

Mina, Theresia; Reynolds, Rebecca M.

doi:10.1007/7854_2014_291

Cited by 23 publications

(21 citation statements)

References 136 publications

(128 reference statements)

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“…This correlation has been proposed to be a result of dysregulation of the hypothalamic-pituitary axis of the mother and the offspring. 23 Although not specific to GAD, the relationship between maternal anxiety/stress and its negative impact on child development has been extensively studied. Consequences include: negative infant behavioral reactivity at 4 months, 13 difficult infant temperament at 4/6 months, 14 lower mental development at age 2 years, 15 negative affectivity at 2 years, 16 lower inhibitory control in girls, and lower visuospatial working memory in boys and girls aged 6-9 years.…”

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

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“…Increased glucocorticoid exposure during pregnancy in association with maternal A&D has been associated with cognitive and behavioural problems (Mina and Reynolds, 2014). It is also strongly linked to low birth weight, leading to increased metabolic and cardiovascular risk in later life (Reynolds, 2013).…”

Section: Introductionmentioning

confidence: 99%

Maternal distress associates with placental genes regulating fetal glucocorticoid exposure and IGF2: Role of obesity and sex

Mina

Räikkönen

Riley

et al. 2015

Psychoneuroendocrinology

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Maternal emotional distress symptoms, including life satisfaction, anxiety and depressed mood, are worse in Severely Obese (SO) than lean pregnancy and may alter placental genes regulating fetal glucocorticoid exposure and placental growth. We hypothesised that the associations between increased maternal distress symptoms and changes in placental gene expression including IGF2 and genes regulating fetal glucocorticoid exposure are more pronounced in SO pregnancy. We also considered whether there were sex-specific effects. Placental mRNA levels of 11β-HSDs, NR3C1-α, NR3C2, ABC transporters, mTOR and the IGF2 family were measured in term placental samples from 43 lean (BMI≤25kg/m(2)) and 50 SO (BMI≥40kg/m(2)) women, in whom distress symptoms were prospectively evaluated during pregnancy. The mRNA levels of genes with a similar role in regulating fetal glucocorticoid exposure were strongly inter-correlated. Increased maternal distress symptoms associated with increased NR3C2 and IGF2 isoform 1(IGF2-1) in both lean and SO group (p≤0.05). Increased distress was associated with higher ABCB1 and ABCG2 mRNA levels in SO but lower ABCB1 and higher 11β-HSD1 mRNA levels in lean (p≤0.05) suggesting a protective adaptive response in SO placentas. Increased maternal distress associated with reduced mRNA levels of ABCB1, ABCG2, 11β-HSD2, NR3C1-α and IGF2-1 in placentas of female but not male offspring. The observed sex differences in placental responses suggest greater vulnerability of female fetuses to maternal distress with potentially greater fetal glucocorticoid exposure and excess IGF2. Further studies are needed to replicate these findings and to test whether this translates to potentially greater negative outcomes of maternal distress in female offspring in early childhood.

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“…In the past two decades the reactivity and regulation of the hypothalamic pituitary adrenal (HPA) axis has received considerable empirical attention as a mechanism for mediating individual differences in health and human development. Particularly in the area of fetal programming, pregnant women's HPA axis function has generated considerable interest (Mina and Reynolds, 2014). This area of inquiry has been bolstered by the development of reliable salivary cortisol assays that enable researchers to assess HPA axis function using minimallyinvasive saliva collection procedures.…”

Section: Introductionmentioning

confidence: 99%

Latent trait cortisol (LTC) during pregnancy: Composition, continuity, change, and concomitants

Giesbrecht

Bryce

Letourneau

2015

Psychoneuroendocrinology

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Individual differences in the activity of the hypothalamic pituitary adrenal (HPA) axis are often operationalized using summary measures of cortisol that are taken to represent stable individual differences. Here we extend our understanding of a novel latent variable approach to latent trait cortisol (LTC) as a measure of trait-like HPA axis function during pregnancy. Pregnant women (n=380) prospectively collected 8 diurnal saliva samples (4 samples/day, 2 days) within each trimester. Saliva was assayed for cortisol. Confirmatory factor analyses were used to fit LTC models to early morning and daytime cortisol. For individual trimester data, only the daytime LTC models had adequate fit. These daytime LTC models were strongly correlated between trimesters and stable over pregnancy. Daytime LTC was unrelated to the cortisol awakening response and the daytime slope but strongly correlated with the area under the curve from ground. The findings support the validity of LTC as a measure of cortisol during pregnancy and suggest that it is not affected by pregnancy-related changes in HPA axis function.

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Mechanisms Linking In Utero Stress to Altered Offspring Behaviour

Cited by 23 publications

References 136 publications

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Maternal distress associates with placental genes regulating fetal glucocorticoid exposure and IGF2: Role of obesity and sex

Latent trait cortisol (LTC) during pregnancy: Composition, continuity, change, and concomitants

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