Impact of stress, anxiety and depression in pregnancy
- stress, anxiety and depression in pregnancy: what is the evidence of impact
- how can improving perinatal mental health improve infant mental health
- moving forward: Begin before Birth: ensuring an integrated approach
In her presentation Professor Glover stated:
'The environment of a human starts in the womb. The wiring of the brain starts in the womb, and is alterable by the signals it is getting'
'Fetal programming is changing the child in a way that effects them through childhood'
'why are some children affected an not others - it’s the nature of post natal care, also the genetic make up of the care'
'how does the mother feeling anxious affect the baby - there has been research done which shows the more stressed a mother is, the more cortisol is passed into the placenta. The placenta is very sensitive to the signals it gets from the mother'
' The care we have in place at the moment for Perinatal Mental Health is absolutely dreadful - we have a long way to go'
'If we can look after a pregnant woman better, then there is less of a chance of 100,000 children in the UK being affected by emotional , behavioral and cognitive developmental problems'
Abstract of Prof Glover’s presentation
Infant mental health and effects of prenatal stress, anxiety and depression on the developing foetus and the child
There is good evidence that maternal prenatal stress, anxiety and depression are associated with an increased risk of adverse emotional, behavioural and cognitive outcomes in the child. Studies, including ours with the large ASPAC cohort, which allow for multiple confounders, including both prenatal paternal and postnatal maternal mood, suggest that a component of this is due to fetal programming. Not all children are affected, and those that are, can be affected in different ways, due at least in part to gene/environment interactions. For example, we have found an interaction between prenatal maternal anxiety with the child COMT genotype in some cognitive and behavioural outcomes.
The underlying mechanisms for such fetal programming are still not well understood but alterations in the function of the placenta are likely to be important. We have studied placental 11 b-HSD2, the enzyme which metabolises cortisol, and found that prenatal anxiety was associated with a down regulation of its expression. More recently we have found an association between prenatal anxiety and an upregulation of the expression of the placental glucocorticoid receptor. We also have some evidence that these associations between prenatal maternal mood and placental gene expression are different in Caucasians and non Caucasian populations.
The clinical implications of effects of prenatal maternal mood on fetal and child neurodevelopment are substantial. At present most prenatal depression and anxiety are undetected and untreated. Better emotional care for pregnant women will eventually help not only them but their children.
Prof Glover's full PowerPoint presentation is available for download at the end of this page.
Vivette Glover is Professor of Perinatal Psychobiology at Imperial College London. Her first degree was in Biochemistry at Oxford University, and she did her PhD in neurochemistry at University College London. She then moved to Queen Charlotte’s Maternity Hospital, London. In more recent years she has applied her expertise in biological psychiatry to the problems of mothers and babies. In 1997 she set up the Fetal and Neonatal Stress Research Group. The aims are to study fetal and neonatal stress responses, methods to reduce them, and long term effects.
The effects of the emotional state of the mother during pregnancy, both on the developing fetus and longer term on the child are being studied. Recent projects include studies showing that maternal prenatal stress, depression or anxiety increases the probability for a range of adverse neurodevelopmental outcomes for the child. These include emotional problems, attention deficit/ hyperactivity disorder, conduct disorder, and cognitive impairment. Her group are also studying the biological mechanisms that may underlie such fetal programming, including how prenatal maternal mood can affect the function of the placenta. They are also showing that gene environment interactions can help to explain why children are affected in different ways.
She has published over 400 papers. She has been awarded the International Marcé Society Medal given biennially for research into perinatal mental health, and has been a special advisor to the Department of Health on the Family Nurse Partnership and Preparation for Pregnancy, Birth and Beyond. She is currently an advisor to the Early Intervention Foundation, the NSPCC, Best Beginnings and the biometric lead for A Better Start. Her work is contributing to changes in policy, with a growing awareness that better emotional care for women in pregnancy can improve the outcome for the next generation.
Future events of interest:
Improving Mental Health Services for Young Adults Supporting the Transition to Adulthood
Psychological Therapies in the NHS
Improving Mental Health Crisis Care: Maintaining Momentum
Eating Disorders: Developing a Gold Standard Service
Improving Physical Health for People with Mental Health Conditions
Implementing the NEW NICE Quality Standard for Domestic Violence & Improving the effectiveness of MARACs
Towards Zero Suicide: Preventing Suicide, Saving Lives
Download: Prof Viviette Glover1 December 2015