Over the last few years, the medical community has been using the term perinatal mood and anxiety disorders (PMADs) to describe the spectrum of psychological symptoms women may experience during pregnancy or the postpartum period.  This shift reflects the realization that the term “postpartum depression” describes only the tip of a much larger iceberg; many women experience symptoms of depression during pregnancy, as well as the postpartum period.  Furthermore, anxiety symptoms are prominent and may overshadow the depressive symptoms women experience.

We have many studies which indicate that exposure to maternal depression during pregnancy and the postpartum period may adversely affect a child’s development; we have less information regarding the effects of maternal anxiety.  However, preliminary studies indicate that maternal anxiety, independent of depression, may adversely affect the child.  

In a prospective cohort study, data was gathered from 1336 Norwegian women and their children.  Maternal anxiety symptoms were measured during the second trimester (17-19 weeks), during the third trimester (at 32 weeks), and at 8 weeks postpartum using the Symptom Checklist-90-R. In this group of women, 8.2% experienced prenatal anxiety, 4.0% had postpartum anxiety and 4.4% reported anxiety during both pregnancy and the postpartum period. 

Children’s development was assessed at two years of age using the Ages & Stages Questionnaire.  The researchers found that 5.6% of the 2-year-olds showed problems in their social-emotional behavior.  These problems were more common in children exposed to maternal anxiety during pregnancy (Odds Ratio, OR=?2.48, 95% CI 1.55-4.92) or during the postpartum period (OR 3.32, 95% CI 1.43-7.74). Social-emotional problems were most strongly associated with exposure to maternal anxiety both during pregnancy and the postpartum period (OR 3.98, 95% CI 1.85-8.56). 

Because perinatal anxiety is so commonly associated with or may lead to depressive symptoms; it would be important to look at the impact of depressive symptoms on the outcomes in this population.  After adjusting for these confounders, maternal anxiety continued to be a significant predictor of adverse child social-emotional development (postpartum anxiety: OR 2.46, 95% CI 1.01-5.97; combined antenatal and postpartum anxiety: OR 2.40, 95% CI 1.03-5.59).

Many of the psychological interventions used in peripartum women focus on managing depressive symptoms. While this approach is obviously important in women with depression, this study indicates that maternal anxiety may have a significant effect on the social-emotional development of children.  This, we must consider interventions that address anxiety, as well as depression.

 

Ruta Nonacs, MD PhD

 

Polte C, Junge C, von Soest T, Seidler A, Eberhard-Gran M, Garthus-Niegel S.  Impact of Maternal Perinatal Anxiety on Social-Emotional Development of 2-Year-Olds, A Prospective Study of Norwegian Mothers and Their Offspring : The Impact of Perinatal Anxiety on Child Development.  Matern Child Health J. 2019 Jan 4.