Maternal anxiety, depression, and stress during pregnancy: Effects on the fetus and the child, and underlying mechanisms

Abstract

There is good evidence that maternal stress, anxiety, and depression during pregnancy can have long-term effects on a variety of outcomes for the child. We need to understand how an altered emotional state in the pregnant woman affects her biology in a way that in turn affects the development of her fetus. Cortisol is one probable mediating factor, but many other systems also are likely to be important, including the pro-inflammatory cytokines. There is evidence that the function of the placenta is altered if the mother is anxious or depressed and this may control the exposure of the fetal brain to hormones including cortisol, neurotransmitters, and other factors such as brain derived neurotrophic factor that can affect brain development. Epigenetic changes are likely to underlie both changes in placental function and changes in brain structure. We know that most children are not affected by prenatal stress, and that those that are can be affected in different ways. There is evidence that this is, at least in part, because of differential genetic susceptibilities.