Angela Ascencio

Comorbid depression and anxiety effects on pregnancy and neonatal outcome

The effects of comorbid depression and anxiety were compared to the effects of depression alone and anxiety alone on pregnancy mood states and biochemistry and on neonatal outcomes in a large multi-ethnic sample. At the prenatal period the comorbid and depressed groups had higher scores than the other groups on the depression measure. But, the comorbid group had higher anxiety, anger and daily hassles scores than the other groups, and they had lower dopamine levels. As compared to the non-depressed group, they also reported more sleep disturbances and relationship problems. The comorbid group also experienced a greater incidence of prematurity than the depressed, the high anxiety and the non-depressed groups. Although the comorbid and anxiety groups were lower birthweight than the non-depressed and depressed groups, the comorbid group did not differ from the depressed and anxiety groups on birth length. The neonates of the comorbid and depressed groups had higher cortisol and norepinephrine and lower dopamine and serotonin levels than the neonates of the anxiety and non-depressed groups as well as greater relative right frontal EEG. These data suggest that for some measures comorbidity of depression and anxiety is the worst condition (e.g., incidence of prematurity), while for others, comorbidity is no more impactful than depression alone.

Preterm infant massage elicits consistent increases in vagal activity and gastric motility that are associated with greater weight gain.

Aim: To determine whether preterm infant massage leads to consistent increases in vagal activity and gastric motility and whether these increases are associated with greater weight gain.

Partner relationships during the transition to parenthood

Partner relationships are relevant in the psychological adjustment during the transition to parenthood, but mothers have been studied more often than fathers in this respect. The Relationship Questionnaire (RQ) to assess positive and negative dimensions of the partner relationship, the Center for Epidemiological Studies Depression Scale (CES‐D) to assess depression and the State Anxiety Inventory (STAI) to assess anxiety were administered to forty‐three women and their partners recruited during the second trimester of pregnancy and seen again until after delivery in order to assess differences in womens/mens anxiety and depression according to partner relationships. Results indicate that women/men with a less positive relationship with the partner show higher anxiety than women/men with a more positive partner relationship, and those women/men with a more negative relationship with the partner show both higher depression and higher anxiety than women/men with a less negative relationship with the partner. Also partners of women/men with a more negative partner relationship show higher depression than partners of women/men with a less negative partner relationship. Psychological adjustment during the transition to parenthood of both the women/men and the partner is impacted by the partner relationship.

CHRONIC PRENATAL DEPRESSION AND NEONATAL OUTCOME

Four hundred and thirty pregnant women were recruited at approximately 22 weeks gestation at prenatal clinics. Of these, 86 (20%) were diagnosed as depressed. The women were seen again at approximately 32 weeks gestation and after delivery. Chronicity of depression was evidenced by continuing high depression scores in those women diagnosed as depressed. Comorbid problems were chronically high anxiety, anger, sleep disturbance, and pain scores. Less optimal outcomes for the depressed women included lower gestational age and lower birthweight of their newborns.

Massage therapy reduces pain in pregnant women, alleviates prenatal depression in both parents and improves their relationships

Prenatally depressed women (N=47) were randomly assigned to a group that received massage twice weekly from their partners from 20 weeks gestation until the end of pregnancy or a control group. Self-reported leg pain, back pain, depression, anxiety and anger decreased more for the massaged pregnant women than for the control group women. In addition, the partners who massaged the pregnant women versus the control group partners reported less depressed mood, anxiety and anger across the course of the massage therapy period. Finally, scores on a relationship questionnaire improved more for both the women and the partners in the massage group. These data suggest that not only mood states but also relationships improve mutually when depressed pregnant women are massaged by their partners.

Prenatal dopamine and neonatal behavior and biochemistry

Depressed pregnant women (N=126) were divided into high and low prenatal maternal dopamine (HVA) groups based on a tertile split on their dopamine levels at 20 weeks gestation. The high versus the low dopamine group had lower Center for Epidemiological Studies-Depression Scale (CES-D) scores, higher norepinephrine levels at the 20-week gestational age visit and higher dopamine and serotonin levels at both the 20- and the 32-week gestational age visits. The neonates of the mothers with high versus low prenatal dopamine levels also had higher dopamine and serotonin levels as well as lower cortisol levels. Finally, the neonates in the high dopamine group had better autonomic stability and excitability scores on the Brazelton Neonatal Behavior Assessment Scale. Thus, prenatal maternal dopamine levels appear to be negatively related to prenatal depression scores and positively related to neonatal dopamine and behavioral regulation, although these effects are confounded by elevated serotonin levels.

Prenatal serotonin and neonatal outcome: brief report.

Interactions with other systems also occur. Numerous data, for example, have suggested reciprocal interactions between the serotonin system and the hypothalamic-pituitary-adrenal axis (cortisol levels) (Kitamura, Araki & Gomita, 2002; McAllister-Williams, Ferrier & Young, 1998). Dysfunction in serotonergic and glucocorticoid receptors produces lower mood. Dysfunctional interactions between serotonin and dopamine have also been reported (Esposito, 2006; Kalia, 2005; Triviedi, 2006). Lower serotonin and dopamine levels and higher cortisol levels have been noted in a recent study on depressed pregnant women (Field, Diego, Dieter, Hernandez-Reif, Schanberg, Kuhn, Yando & Bendell, 2004). In that study, this biochemical profile in the prenatally depressed women predicted similar profiles in their neonates (Field et al., 2004). The purpose of the present study was to determine the relationships between prenatal serotonin levels and other biochemical values during pregnancy as well as their relationships to neonatal biochemical and behavioral variables. To address that question, the pregnant women were divided into the top and bottom tertiles based on their serotonin levels at 20 weeks gestational age.