The Effects of Preeclampsia on Perinatal Risks and Infant Temperaments Among Mothers With Antenatal Depression

Abstract

Importance Preeclampsia and depression are two most prevalent disorders known to affect pregnant women and unborn infant. However, few studies have prospectively examined the adverse influence of the in-utero exposures to the two disorders on the optimal development in their offspring, including mortality, adverse birth outcomes, and infant temperament styles. Objectives (1) To examine whether exposures to preeclampsia and antenatal depression were associated with developmental indices of offspring at birth and temperament at 3 months; and (2) To evaluate how preeclampsia and antenatal depression associated with offspring temperamental style. Design Prospective cohort study with regular assessment of mother’s blood pressure at each prenatal visit: offspring were followed till 3 months. Setting Two prenatal clinics, New York City, USA. Participants A cohort of 233 pregnant women was followed throughout pregnancy. Of those, 141 provided ratings of infant temperament at three months. Exposures Diagnostic outcome of maternal depression by clinical interviewers blind to preeclampsia status, were ascertained using the Structured Clinical Interview for DSM-IV Axis I Disorders. The development of preeclampsia, defined by the onset of hypertension (> 140/90 mm HG) after 20 weeks’ gestation, accompanied by 300 mg of protein, monitored via electronic medical records. Main Outcome Measures Birth outcomes were assessed via standardized ratings at delivery. Infant temperament was reported by the mother at three months, using 91-item IBQ-R (Infant Behavioral Questionnaire-Revised). Results Preeclampsia was associated with an over 5-fold increased risk for fetal/infant mortality, a 3- to 7-fold increased risk for poorer birth outcomes, and flatter affect and distress in infants. Furthermore, infants born to preeclamptic mothers with co-occurring depression displayed lower levels of smile/laughter, high-intensity pleasure seeking behavior, perceptual sensitivity, and approach behavior. Conclusion Preeclampsia was associated with a few difficult temperament styles in the first three months after birth. Moreover, its negative impact was amplified by mother’s antenatal depression. Our findings regarding additive risk for negative infant outcomes in babies exposed to preeclampsia and antenatal depression suggests that the development of early detection programs to identify and monitor women who are at heightened risk for these conditions can potentially have a positive influence on long-term infant neurobehavioral development.

Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy

“…In a very large-scale study (Bekkhus et al, 2011), child's crying behavior and aggressive behavior were highest if the mother showed high anxiety and depression both during and after pregnancy, while maternal symptoms that lasted during pregnancy only were not associated with child aggressive or crying behavior at age 3 years. Some studies confirm a previous observation (DiPietro et al, 2006) of a positive association between maternal distress in pregnancy and better infant self-regulation (i.e., duration of orientation; Kantonen et al, 2015;Lin et al, 2014), less infant affective reactivity (Rothenberger et al, 2011b), and/or observed that maternal distress is associated with infant positive affectivity (Lin et al, 2014;Nomura et al, 2014) and better social behavior (Lin et al, 2017). However, some studies found no associations between maternal distress during pregnancy and either self-regulation/adaptive functioning (Braeken et al, 2017;Zande and Sebre, 2014) or positive affectivity (Zande and Sebre, 2014) or other aspects of infant temperament (Baibazarova et al, 2013b;Bhat et al, 2015).…”

“…Most studies continue their follow-up until the age of six months, while some studies continue the follow-up study until 10 months (Braeken et al, 2013;Peltola et al, 2017;van den Heuvel et al, 2015b), 24 months (Blair et al, 2011;Stroustrup et al, 2016) or 36 months (Bekkhus et al, 2011;Lin et al, 2017;Stroustrup et al, 2016). As was seen in earlier studies (Räikkönen et al, 2011) and regardless of the kind of measurement of temperament or its timing, most evidence points to associations between prenatal stress and high scores on two partially overlapping temperament traits: namely, negative affectivity (sadness, distress to limitations, fear, discomfort, and anger) (Blair et al, 2011;Braithwaite et al, 2013;Green et al, 2016;Hill et al, 2013;Huynh, 2014;Lin et al, 2014;Nomura et al, 2014;Peltola et al, 2017;Pluess et al, 2011;Rouse and Goodman, 2014;van den Heuvel et al, 2015b;Zande and Sebre, 2014) and "difficult temperament" (negative affectivity, intense reactions, slowness in adapting to new situations and irregular routines; Chong et al, 2016;Della Vedova, 2014;Green et al, 2016;Lin et al, 2017;McMahon et al, 2013;Rode and Kiel, 2016;Stroustrup et al, 2016). In a very large-scale study (Bekkhus et al, 2011), child's crying behavior and aggressive behavior were highest if the mother showed high anxiety and depression both during and after pregnancy, while maternal symptoms that lasted during pregnancy only were not associated with child aggressive or crying behavior at age 3 years.…”

Maternal and paternal depression and anxiety and offspring infant negative affectivity: A systematic review and meta-analysis

“…We therefore meta-analysed unadjusted results. While associations remained after adjustment for baseline confounders in the few studies with adjustments (Erickson, 2018;Nomura et al, 2014Nomura et al, , 2019Spry et al, 2019;Zhang et al, 2017), potential for confounding remains. Thus, we describe meaningful patterns of associations rather than draw causal conclusions (Hernán et al, 2015).…”

“…A further possible explanation is confounding. In the few studies with adjusted analyses, associations remained after adjustment for demographic and substance use factors (Erickson, 2018;Nomura et al, 2014Nomura et al, , 2019Spry et al, 2019;Zhang et al, 2017). Nonetheless, potential for confounding remains.…”

MicroRNA-125b as a Preeclampsia Biomarker

“…[12] Infants born to preeclamptic mothers were associated with an over fivefold increased risk for infant mortality, a three to sevenfold increased risk for poorer birth outcomes, a three to fivefold increased risk for low birth weight, and compromised neurodevelopmental index. [13] MicroRNAs (miRNAs) are short RNA molecules consisting of 19 to 25 nucleotides in size that control posttranscriptional silencing of the targeting genes. [14] Recent studies suggest that miRNAs are shown to be upregulated in the development of preeclampsia and are suggested to inhibit angiogenesis, trophoblast cells proliferation, placentation and migration.…”