Anxiety disorders before birth and self-perceived distress during pregnancy: Associations with maternal depression and obstetric, neonatal and early childhood outcomes

Abstract 

Background

Maternal perinatal mental health has been shown to be associated with adverse consequences for the mother and the child. However, studies considering the effect of DSM-IV anxiety disorders beyond maternal self-perceived distress during pregnancy and its timing are lacking.

Aims

To examine the role of maternal anxiety disorders with an onset before birth and self-perceived distress during pregnancy for unfavourable maternal, obstetric, neonatal and childhood outcomes.

Study design

DSM-IV mental disorders and self-perceived distress of 992 mothers as well as obstetric, neonatal and childhood outcomes of their offspring were assessed in a cohort sampled from the community using the Munich-Composite International Diagnostic Interview. Logistic regression analyses revealed associations (odds ratios) between maternal anxiety disorders and self-perceived distress during pregnancy with maternal depression after birth and a range of obstetric, neonatal and childhood psychopathological outcomes.

Results

Lifetime maternal anxiety disorders were related to offspring anxiety disorders, but not to offspring externalizing disorders. Analyses focussing on maternal DSM-IV anxiety disorders before birth yielded associations with incident depression after birth. In addition, self-perceived distress during pregnancy was associated with maternal depression after birth, preterm delivery, caesarean section, separation anxiety disorder, ADHD, and conduct disorder in offspring.

Conclusion

Findings confirm the transmission of anxiety disorders from mother to offspring. Apart from maternal anxiety, self-perceived distress during pregnancy also emerged as a putative risk factor for adverse outcomes. The finding that maternal anxiety disorders before birth yielded less consistent associations, suggests that self-perceived distress during pregnancy might be seen as a putative moderator/mediator in the familial transmission of anxiety.

Abbreviations: ADHD, attention deficit/hyperactivity disorder, APGAR, Appearance, Pulse, Grimace, Activity, Respiration, ANX, anxiety disorder before birth, CD, conduct disorder, CI, confidence interval, DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth Edition, EDSP Study, Early Development Stages of Psychopathology Study, LBW, low birth weight, ODD, oppositional defiant disorder, OR, odds ratio, PTD, preterm delivery, SAD, separation anxiety disorder, SPD, self-perceived distress during pregnancy

Keywords: Anxiety disorders, Distress, Pregnancy, Obstetric, Neonate