Prenatal depression effects on the fetus and newborn: a review
Section snippets
Pregnancy and birth complications
Depression is prevalent in pregnant women, affecting 10–25% of women (Anderson et al., 2003, Anderson et al., 2004; De Tychey et al., 2005; Marcus, Flynn, Blow & Barry, 2004; Stowe, Hostetter, & Newport, 2005). Prenatal depression increases in severity from the first to the second trimester (Hoffman & Hatch, 2000), negatively affecting fetal development and neonatal outcome. Prenatal and perinatal complications include higher rates of placental abnormalities (Jablesky, Morgan, Zubrick, Bower &
Infant neurobehavioral dysregulation
The earliest studies on infants of depressed mothers focused on mother–infant interactions during early infancy. These studies revealed less positive affect, less attentiveness and more fussiness during mother–infant interactions (Field, 1984) as well as during their interactions with non-depressed adults (Field et al., 1988). Physiological measures were also taken during these interactions. In one set of studies, vagal tone was recorded from 3–6- month-old infants of depressed and
Neonates of depressed mothers
Because prenatal depression had been noted in many of these mothers, infants of depressed mothers were then studied even earlier, shortly after birth. In these studies, the Brazelton neonatal behavior assessment scale was administered within 24 h after birth. In one study, newborns of depressed (N = 47) versus newborns of non-depressed mothers (N = 36) received inferior orientation and motor scores, and they showed more irritability and less activity, robustness and endurance during the assessment (
Prenatal depression effects on the neonate
A series of studies were then conducted to examine prenatal depression effects on fetal development and neonatal outcomes. In the first study, we recruited sixty-three pregnant women during their last trimester (Lundy et al., 1999). The depressed women had higher cortisol and norepinephrine levels and lower dopamine levels. Their newborns also had higher cortisol and norepinephrine levels and lower dopamine levels, thus mimicking their mothers’ biochemical profile. The neonates of depressed
Prenatal predictors of neonatal biochemistry and physiology
To assess the predictive validity of the depressed woman's biochemistry, depressed and nondepressed (N = 47) mothers were recruited as usual from an ultrasound clinic (Field et al., 2004b). Their urine samples were assayed for cortisol, catecholamines (norepinephrine, epinephrine, dopamine) and serotonin. Their urines were assayed again at the neonatal period, and their newborns’ urines were also assayed at that time. The depressed versus the nondepressed mothers showed significantly higher
Prenatal depression effects on the fetus
Prenatal depression also affects fetal activity (Dieter et al., 2001). In this study, pregnant women with (N = 45) and without (N = 45) symptoms of depression (CES-D scores greater than 16) were given ultrasound examinations across the second and third trimesters. Fetal movements (single limb, multiple limb, gross body) were recorded for 5 min prior to a standard ultrasound examination. The analyses revealed that the fetuses of depressed women were more active at 5, 6 and 7 months gestation (see
Potential underlying mechanisms
The effects of prenatal depression on fetal development appear to be mediated by elevated cortisol and norepinephrine levels (Field et al., 2004a, Lundy et al., 1999). Depression in general has been associated with both hypothalamic pituitary adrenal (HPA) axis (i.e. elevated cortisol and corticotropic releasing hormone (CRH)) and sympathoadrenal hyperactivation (i.e. elevated norepinephrine levels and cardiovascular function) (Arborelius, Owens, Plotsky & Nemeroff, 1999; de Kloet, 2003).
Data
Caveats or confounding variables
These prenatal depression data are confounded by moods that are comorbid with depression. Other prenatal moods or emotions have been noted to differentially affect fetal and infant development including different types of depression called withdrawn versus intrusive depression, prenatal anxiety, prenatal anger and even combined optimism and pessimism. Because many of these are comorbid with prenatal depression, the depression effects would appear to be confounded.
Infants of withdrawn mothers
Prenatal interventions
Interventions are, of course, needed to help depressed mothers reduce their depression, anxiety and anger and to provide medical, economic and social support. Psychotropic medications have been tried with mixed results. A very large literature has debated the efficacy of psychotropic medications for prenatal depression. Although some have concluded no efficacy (Gentile, 2005, Misri et al., 2004), others have reported negative effects on the neonates including lower Apgar scores and lower Bayley
Summary
A review of the research on prenatal depression effects on the fetus and newborn suggest that many prenatal, perinatal and postnatal complications occur. In addition, fetal activity is elevated, prenatal growth is delayed, and the incidence of prematurity and low birthweight are greater. Elevated prenatal maternal cortisol is the strongest predictor of these neonatal outcomes. Newborns of depressed mothers show a biochemical and physiological profile that mimics their mothers’ prenatal
Acknowledgements
We would like to thank the parents and infants who participated in these studies. This research was supported by a merit award (MH # 46586), Research Scientist Awards (MH # 00331 and AT# 001585) and March of Dimes Grant (# 12-FYO3-48) to Tiffany Field and funding from Johnson & Johnson Pediatric Institute to the Touch Research Institutes.
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