Background Pregnancy-related anxiety (PrA) has attracted considerable research attention, but questions remain about its distinctiveness from conventional constructs and measures. In a high psychosocial risk, ethnically diverse sample, we examine the degree to which PrA is distinct from continuous and diagnostic measures of anxiety and worry in terms of longitudinal course, associations with psychosocial and perinatal risk, and prediction of postnatal mood disturbance. Methods 345 women oversampled for prenatal anxiety and depression were selected from an urban obstetrics clinic serving a predominantly low-income, ethnically diverse population. PrA was assessed at 20 and 32 weeks gestation; anxiety and depression symptoms were assessed from questionnaire and from clinical interview at 20 and 32 weeks gestation and again at 2 and 6 months postnatally. Data relevant to psychosocial and obstetric risks were ascertained from interview, medical exam, and chart review. Results Two distinct factors of PrA were identified, indexing specific concerns about the child’s health and about the birth; these two PrA factors showed distinct longitudinal patterns in the prenatal period, and modest associations with general measures of anxiety and depression from questionnaire and clinical interview. PrA was also distinguished from conventional symptom measures in its associated features and prediction of birth weight and postnatal mood. Limitations The sample was at high psychosocial risk and ethnically diverse; findings may not generalize to other samples. Conclusions PrA can be distinguished from general measures of anxiety in pregnancy in terms of longitudinal course, associated features, and prediction to postnatal mood disturbance, and may warrant specific clinical attention.

Objective Clinical studies suggest that psychiatric symptoms, particularly depression, anxiety and trauma, may be associated with inflammation, as indexed by proinflammatory cytokines. Such a link may be especially significant in pregnancy, and may shed additional light on the etiology of perinatal mood disorders. Methods We prospectively followed 145 women selected from a community obstetric clinic serving a primarily low-income, high psychosocial risk population. Women without evidence of medical high-risk pregnancies were screened (including psychiatric and trauma histories) and then assessed in detail (e.g. mood symptoms) at approximately 18 and 32 weeks gestation. Blood was drawn to measure key proinflammatory markers, interleukin (IL)-6 and tumor necrosis factor (TNF)-α. Data on pregnancy and obstetric outcome were derived from medical records. Results There was considerable stability of cytokine levels within individuals and a significant mean increase across pregnancy observed for IL-6 (p<.001) and TNF-α (p<.001). History of trauma was associated with significantly elevated TNF-α (F(1.135)=4.43, p<.05), controlling for psychosocial and obstetric covariates. In contrast, elevated measures of depression and anxiety were unrelated to proinflammatory cytokines (p>.10). Exploratory analyses indicated that neither psychiatric symptoms nor proinflammatory cytokines predicted birthweight, gestational age, or obstetric complications. Conclusions These findings suggest that antecedent trauma may be associated with persistently elevated TNF- α levels during pregnancy. No evidence was found that a generalized proinflammatory state was associated with symptoms of depression or anxiety in pregnant women.

Alteration in the HPA axis is a robust biomarker of anxiety and depression in adults, but questions remain about this association in pregnancy. We examined the longitudinal links between diurnal cortisol and mood symptoms from self-report questionnaire and diagnostic interview in an ethnically diverse, psychosocially at-risk sample of 101 women at mid-pregnancy and early third trimester. There were modest but significant associations between depression and elevated cortisol, indexed by a decreased morning level and diminished diurnal decline; the effects were strongest for diagnostic data from clinical interview. These effects were independent of socio-demographic factors and sleep disturbance. Associations with anxiety and trauma were generally non-significant. These findings extend prior work by showing that significant mood symptoms in pregnancy are associated with altered diurnal cortisol in pregnancy, which may have implications for maternal and child health.

Objective Limited data exist on child abuse-related immune variation during pregnancy, despite implications for maternal and infant health and extensive data showing that abuse history and depression are related to increased inflammation in other populations. This study examined associations among child abuse, depression, circulating levels of inflammatory markers, and perinatal health in pregnant adolescents, a group at high risk for childhood abuse and poor birth outcomes. Methods Pregnant teenagers (n=133; 14–19 years; 89.5% Latina) reported on abuse and depression and had two blood draws (24–27 and 34–37 gestational weeks, 2nd and 3rd trimesters, respectively) for Interleukin 6 (IL-6) and C-Reactive Protein (CRP); birth outcomes were collected. Results Abuse and depression interacted to predict higher IL-6 at 2nd trimester (B=.006, p=0.011) such that severely abused adolescents with high depression had higher IL-6 relative to severely abused adolescents with low depression; depression did not differentiate IL-6 levels for those with low abuse severity. Abuse and IL-6 also interacted to predict gestational age at birth (B=.004, p=0.040) such that those with low abuse and high IL-6 and those with high abuse and low IL-6 had infants with earlier gestational age at birth. Cortisol at the 2nd trimester mediated the association between IL-6 and gestational age at birth (Indirect effect estimate=−0.143, p<0.039). Conclusion Depression severity distinguished IL-6 levels among more severely abused pregnant Latina adolescents, but it was unrelated to IL-6 among less severely abused adolescents. Cortisol explained the relationship between IL-6 and earlier gestational age at birth. Multiple adversities and inflammation may influence birth outcomes and potentially affect intergenerational health.