To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Infant self-regulation is shaped by early physiological systems and caregiver-infant co-regulatory interactions. Maternal perinatal (pre- and/or postnatal) depression may affect these processes and infants’ development of this critical construct. However, literature addressing the association between maternal perinatal depression and infant self-regulation has been mixed. We conducted a pre-registered meta-analysis of the association between maternal perinatal depression and several self-regulation constructs (e.g., effortful control, executive function) measured during the first 2 years of life. We included 68 reports comprising 193 effect sizes and 16,722 mother-infant dyads. On average, studies included an equal number of male and female infants, and, for most (68%) studies, most participants were White. Average infant age ranged from 0 – 16 months. Three-level random effects meta-analytic models indicated a small, significant overall association, with higher levels of depression associated with lower self-regulation (r = −.10, 95% CI = −.14, −.06, p < .001). There was substantial heterogeneity in this pooled effect. Subsequent analyses indicated moderation by methodological and conceptual variables. Evidence that maternal perinatal depression is associated with lower infant self-regulation underscores the importance of supporting dyads experiencing perinatal depression. Clarifying this association highlights a critical next step of examining potential causal processes linking maternal and infant well-being.
Perinatal obsessive-compulsive disorder (PNOCD) can impact up to one in five individuals in the perinatal period. Whilst effective treatment for PNOCD is available, parents experience barriers accessing this evidence-based psychological therapy. Healthcare professionals’ perspectives on barriers to accessing support are valuable to develop targeted interventions to increase access to support for PNOCD.
Aim:
This study aimed to prioritise a list of barriers to accessing therapy for PNOCD, in terms of importance and amenability to change, from the perspective of healthcare professionals.
Method:
203 healthcare professionals from across primary, community and secondary care services completed a survey where they ranked barriers in terms of importance and amenability to change. Barriers were ranked within clusters and across cluster names; 47 barriers were organised into seven clusters. Rankings were analysed using descriptive statistics and the non-parametric Friedman’s test.
Results:
Professionals ranked healthcare professionals’ knowledge and training on PNOCD as the barrier which was most important and amenable to change. Parents’ knowledge and awareness of PNOCD and services, their attitudes to mental health problems, and their attitudes towards healthcare professionals and services were ranked as the second most important and amenable to change.
Conclusion:
Professionals view their colleagues’ knowledge and training on PNOCD as the most important barrier impacting parents access to evidence-based therapy for PNOCD. Training for professionals could be targeted to increase access. Parents’ awareness and attitudes surrounding PNOCD, mental health and services were also identified by professionals as an important barrier and is recommended to be targeted to increase access.
Early life, or the neonatal period, is perhaps the most challenging time for ruminant livestock, as they adapt to the extra-uterine environment, undergo important physiological maturation, and navigate harsh ambient conditions. Maternal influences during gestation, especially energy and protein nutrition in late pregnancy, can alter many processes that affect the neonatal period. These processes include fetal growth and development, gestation length, difficulty of parturition, and maternal behavior, which interact to affect offspring vigor at birth. Moreover, colostrum and early milk production and composition are affected by gestational nutrition, and these along with the previous factors affect the neonate’s ability to obtain transfer of passive immunity, thermoregulate, perform basal metabolism, and ultimately survive to weaning. Often, the long-term effects of maternal nutrition during gestation on offspring are attributed solely to the prenatal environment, but it is critical to also consider influences of early life on later productivity and health. More research is needed to integrate these neonatal outcomes with prenatal and postnatal mechanisms as well as later ruminant livestock performance. Better understanding of the maternal environment’s effects on the neonatal period provides opportunity for improved management of ruminant livestock dams and offspring.
Women in the perinatal phase are at an increased risk of experiencing mental health problems, but in low and middle-income countries such as India, perinatal mental health (PMH) care provision is often scarce. This situational analysis presents the formative findings of the SMARThealth Pregnancy and Mental Health (PRAMH) project (Votruba et al. 2023). It investigates the nature and availability of maternal mental health policies, legislation, systems and services, as well as relevant context and community in India on a national, state (Haryana and Telangana) and district (Faridabad and Siddipet) level. A desktop, scoping review and informal interviews with mental health experts were conducted. Socio-demographic and maternal health indicators vary between Haryana and Telangana. No specific national PMH policy or plan is available. General mental health services exist at a district level within Siddipet and Faridabad, but no specific PMH services have been identified.
Paternal perinatal mental health influences subsequent child development, yet is under-investigated. This study aims to examine the impact of different timings of paternal perinatal anxiety (prenatal-only, postnatal-only, and both pre-and postnatally) on children’s subsequent emotional and behavioral difficulties.
Method:
We used data from the Avon Longitudinal Study of Parents and Children and tested the prospective associations between anxiety in fathers and adverse mental health outcomes in children at 3 years, 6 months and 7 years, 7 months.
Results:
Children whose fathers were anxious in the perinatal period were at higher risk of subsequent adverse outcomes, compared to children whose fathers were not anxious perinatally. At 3 years, 6 months, the highest risk group was the one with fathers anxious prenatally-only; compared to children with non-anxious fathers, children in the prenatal-only group were significantly more likely to present mental health difficulties, measured by total problems (unadjOR = 1.82, 95%CI [1.28, 2.53]). At 7 years, 7 months, children exposed to paternal anxiety both pre- and postnatally were at higher risk of any psychiatric disorder (unadjOR = 2.35, 95%CI [1.60, 3.37]) compared to the non-anxious group.
Conclusions:
Paternal perinatal anxiety is a risk factor for child adverse outcomes, even after accounting for maternal mental health, child temperament, and sociodemographic factors, and should not be overlooked in research and clinical practice.
Exposure to adversity during the perinatal period has been associated with cognitive difficulties in children. Given the role of the nucleus accumbens (NAcc) in attention and impulsivity, we examined whether NAcc volume at age six mediates the relations between pre- and postnatal adversity and subsequent attention problems in offspring. 306 pregnant women were recruited as part of the Growing Up in Singapore Towards Healthy Outcomes Study. Psychosocial stress was assessed during pregnancy and across the first 5 years postpartum. At six years of age, children underwent structural MRI and, at age seven years, mothers reported on their children’s attention problems. Separate factor analyses conducted on measures of pre- and postnatal adversity each yielded two latent factors: maternal mental health and socioeconomic status. Both pre- and postnatal maternal mental health predicted children’s attention difficulties. Further, NAcc volume mediated the relation between prenatal, but not postnatal, maternal mental health and children’s attention problems. These findings suggest that the NAcc is particularly vulnerable to prenatal maternal mental health challenges and contributes to offspring attention problems. Characterizing the temporal sensitivity of neurobiological structures to adversity will help to elucidate mechanisms linking environmental exposures and behavior, facilitating the development of neuroscience-informed interventions for childhood difficulties.
The prevalence of co-morbid anxiety and depression varies greatly between research studies, making it difficult to understand and estimate the magnitude of this problem. This systematic review and meta-analysis aim to provide up-to-date information on the global prevalence of co-morbid anxiety and depression in pregnant and postpartum women and to further investigate the sources of heterogeneity. Systematic searches of eight electronic databases were conducted for original studies published from inception to December 10, 2024. We selected studies that directly reported prevalence data on co-morbid anxiety and depression during the perinatal periods. We extracted data from published study reports and calculated the pooled prevalence of symptoms of co-morbid anxiety and depression. There are 122 articles involving 560,736 women from 43 different countries included in this review. The global prevalence of co-morbid anxiety and depression during the perinatal period was about 9% (95%CI 8%–10%), with approximately 9% (95%CI 8%–11%) in pregnant women and 8% (95%CI 7%–10%) in postpartum women. Prevalence varied significantly by the assessment time points, study country, study design, and the assessment tool used for anxiety and depression, while prevalence was not dependent on publication year, country income level, and COVID-19 context. No publication bias was observed for this prevalence rate. These findings suggest that approximately 1 in 10 women experience co-morbid anxiety and depression during pregnancy and postpartum. Targeted action is needed to reduce this burden.
Reproductive psychiatry specializes in mental illness in patients with a female reproductive system during the years from menarche to menopause. This topic is vital for all psychiatric clinicians that treat patients during their reproductive years. Syndromes included in this subspecialty include perinatal mood and anxiety disorders (PMADs), postpartum psychosis (PPP), premenstrual dysphoric disorder (PMDD), premenstrual exacerbation of underlying illness (PME), and mood changes associated with perimenopause. This chapter covers these topics including assessment diagnosis and treatment, along with special considerations for this unique population.
Perinatal stress and anxiety from conception to two years postpartum have important adverse outcomes for women and infants. This study examined (i) women’s perception of sources and experiences of perinatal stress and anxiety, (ii) women’s attitudes to and experiences of available supports, and (iii) women’s preferences for perinatal stress and anxiety supports in Ireland.
Methods:
An online mixed-methods cross-sectional survey was conducted with 700 women in Ireland. Participants were pregnant women (n = 214) or mothers of children ≤ 2 years old (n = 486). Participants completed closed-ended questionnaires on sociodemographic, birth and child factors, and on stress, anxiety, perceived social support, and resilience. Participants completed open-ended questions about experiences of stress and anxiety and the supports available for stress and anxiety during pregnancy and/or postpartum. Quantitative data were analysed descriptively and using correlations; qualitative data were analysed using thematic analysis.
Results:
Quantitative data indicated significant relationships between perinatal stress and/or anxiety and women’s perceived social support, resilience, having a previous mental health disorder diagnosis (both p < 0.001), and experiencing a high-risk pregnancy or pregnancy complications (p < 0.01). Themes developed in qualitative analyses included: ‘perceived responsibilities’; ‘self-care’; ‘care for maternal health and well-being’; ‘social support’; and ‘access to support and information’.
Conclusions:
Women’s stress and anxiety are impacted by multiple diverse factors related to the individual, to interpersonal relationships, to perinatal health and mental health outcomes, and to available services and supports. Development of support-based individual-level interventions and increased peer support, coupled with improvements to service provision is needed to provide better perinatal care for women in Ireland.
Maternity outcomes for women from certain ethnic groups are notably poor, partly owing to their not receiving treatment from services.
Aims
To explore barriers to access among Black and south Asian women with perinatal mental health problems who did not access perinatal mental health services and suggestions for improvements, and to map findings on to the perinatal care pathway.
Method
Semi-structured interviews were conducted in 2020 and 2021 in the UK. Data were analysed using the framework method.
Results
Twenty-three women were interviewed, and various barriers were identified, including limited awareness of services, fear of child removal, stigma and unresponsiveness of perinatal mental health services. Whereas most barriers were related to access, fear of child removal, remote appointments and mask-wearing during COVID-19 affected the whole pathway. Recommendations include service promotion, screening and enhanced cultural understanding.
Conclusions
Women in this study, an underrepresented population in published literature, face societal, cultural, organisational and individual barriers that affect different aspects of the perinatal pathway.
Functional neurological disorder (FND) most often presents in women of childbearing age, but little is known about its course and outcomes during pregnancy, labour and postpartum (the perinatal period). We searched MEDLINE, PsycInfo and Embase combining search terms for FND and the perinatal period. We extracted data on patient demographics, subtype of FND, timing of symptom onset, comorbidities, medications, type of delivery, investigations, treatment, pregnancy outcomes and FND symptoms at follow-up.
Results
We included 36 studies (34 case reports and 2 case series) describing 43 patients. Six subtypes of FND were identified: functional (dissociative) seizures, motor weakness, movement disorder, dissociative amnesia, speech disorders and visual symptoms. New onset of perinatal FND was more common in the third trimester and onwards. Some women with functional seizures were exposed to unnecessary anti-seizure prescriptions and intensive care admissions.
Clinical implications
Prospective studies are urgently needed to explore how FND interacts with women's health in the perinatal period.
Edited by
Rachel Thomasson, Manchester Centre for Clinical Neurosciences,Elspeth Guthrie, Leeds Institute of Health Sciences,Allan House, Leeds Institute of Health Sciences
Perinatal mental illnesses are common and carry significant morbidity for the mother and infant, the family and wider society. Suicide remains a leading cause of maternal death. Pregnancy, childbirth and the transition into parenthood presents a unique life stage where a combination of physical, biological and psychological stressors can leave many women vulnerable to developing perinatal mental illness. This is a time where individuals often reflect on their own experiences of parenting and early life trauma can be reactivated. In addition, there is now consistent evidence that perinatal mental illness is not confined to maternal mental health problems. Approximately 10% of fathers experience postnatal depression and a recent study by the National Childbirth Trust has shown that 38% of all first-time fathers are concerned about their mental health.
The perinatal period is a time in a family’s life when they are in contact with many health professionals.
Psychological interventions have demonstrated effectiveness in treating perinatal depression (PND), but understanding for whom, how and under what conditions they improve symptoms in low- and middle-income countries (LMICs) is largely unknown. This review aims to synthesise current knowledge about predictors, moderators and mediators of psychological therapies to treat PND in LMICs. Five databases were searched for studies quantitatively examining the effects of at least one mediator, moderator or predictor of therapies for PND in LMICs. The review sampled seven publications evaluating findings from randomised trials conducted in Asia and sub-Saharan Africa. The small number of included studies limited generalisability of findings. Analyses of trials with acceptable quality suggest that patient activation in Pakistan and social support in both India and Pakistan may mediate psychotherapy effectiveness, higher baseline depression severity may moderate treatment response in South Africa, and shorter depression duration at baseline may moderate intervention response in India. This review highlights current gaps in evidence quality and the need for future trials exploring PND psychotherapy effectiveness in LMICs to follow reporting guidelines to facilitate appropriate predictor, moderator and mediator analyses.
Common mental health problems (particularly depression and anxiety) are common among adolescents during the perinatal period. Previous research has identified the distinctive needs of this group and called for contextually appropriate psychosocial interventions. The current study conducted in Malawi aimed to explore risk and protective factors for common mental health problems, and barriers to accessing mental health care, among perinatal adolescents, to develop a contextually relevant intervention for preventing and treating perinatal depression and anxiety. An exploratory qualitative study was conducted in antenatal and postnatal clinics in Zomba district, Malawi in January–March 2022. In-depth individual interviews were completed with perinatal adolescents aged ≤19 (n = 14); their family members (n = 4); and healthcare workers (n = 8). Interview data were subjected to thematic framework analysis. Data were organised around two themes: “psychosocial risk and protective factors” (potential causes of common mental health problems among adolescents); and “health care services” (maternal and mental health services available, and adolescents’ experiences of using these services). Interventions need to go beyond targeting symptoms of depression and anxiety to addressing the wider contextual risk factors and barriers to care at the different socioecological levels.
During early life-sensitive periods (i.e., fetal, infancy), the developing stress response system adaptively calibrates to match environmental conditions, whether harsh or supportive. Recent evidence suggests that puberty is another window when the stress system is open to recalibration if environmental conditions have shifted significantly. Whether additional periods of recalibration exist in adulthood remains to be established. The present paper draws parallels between childhood (re)calibration periods and the perinatal period to hypothesize that this phase may be an additional window of stress recalibration in adult life. Specifically, the perinatal period (defined here to include pregnancy, lactation, and early parenthood) is also a developmental switch point characterized by heightened neural plasticity and marked changes in stress system function. After discussing these similarities, lines of empirical evidence needed to substantiate the perinatal stress recalibration hypothesis are proposed, and existing research support is reviewed. Complexities and challenges related to delineating the boundaries of perinatal stress recalibration and empirically testing this hypothesis are discussed, as well as possibilities for future multidisciplinary research. In the theme of this special issue, perinatal stress recalibration may be a mechanism of multilevel, multisystem risk, and resilience, both intra-individually and intergenerationally, with implications for optimizing interventions.
Anxiety is common during the perinatal period and despite effective treatments being available, many women with perinatal anxiety disorders experience barriers when accessing treatment.
Aims:
The aims of the current study were to explore women’s perceived barriers to treatment uptake; cognitive behavioural therapy (CBT) treatment delivery preferences; and the utility of the Health Belief Model (HBM) in predicting intention to seek psychological help for women with perinatal anxiety symptoms.
Method:
This study employed a cross-sectional design consisting of women with self-reported anxiety in the perinatal period. A total of 216 women (Mage=28.53 years; SD=4.97) participated in the study by completing a battery of online self-report measures.
Results:
The results indicated that the most salient barriers to accessing care were: (1) the cost of treatment, (2) wanting to solve the problem on their own, and (3) thinking the problem would go away without treatment. Group-delivered CBT was the least acceptable treatment method, while face-to-face individual CBT was the most acceptable treatment method. The HBM variables predicted approximately 35% of the variance in help-seeking intention.
Discussion:
This study has important implications for the delivery of psychological care in the perinatal period and may be used to improve treatment uptake.
Severe anxiety affects a huge number of women in pregnancy and the postnatal period, making a challenging time even more difficult. You may be suffering from uncontrollable worries about pregnancy and birth, distressing intrusive thoughts of accidental or deliberate harm to the baby, or fears connected to traumatic experiences. This practical self-help guide provides an active route out of feeling anxious. Step-by-step, the book teaches you to apply cognitive behaviour therapy (CBT) techniques in the particular context of pregnancy and becoming a new parent in order to overcome maternal anxiety in all its forms. Working through the book you will gain understanding of your anxiety and how factors from the past and present may be playing a role in how you feel. Together with practical exercises and worksheets to move through at your own pace, you will gain the tools you need to help you move forward and enjoy parenthood.
Pregnancy-related anxiety and fears of childbirth are very common indeed. This chapter focuses on anxiety about pregnancy and birth. It covers the range of fears that mothers can experience during pregnancy, including the health of your baby, your bond with your baby, what birth will be like, your appearance during pregnancy or after birth, your parenting abilities and / or how life might change after birth. It provides tips to understand why you migtht be feeling particularly anxious at this time, and techniques to tackle the factors that keep anxiety going, so that you can enjoy more of your pregnancy wihtout interference from anxiety.
Becoming a parent is a process that begins psychologically at the start of the journey to pregnancy and continues beyond birth. This chapter covers what to expect emotionally as you adjust to life after birth. We provide practical tips on finding your own way as a parent and tips on how to manage worries about being an ‘anxious parent’. There is a practical guide to navigating anxiety about bonding with your baby and tips to increase feelings of closeness as this relationship develops.
Panic attacks are frightening experiences. During a panic, you experience strong physical sensations that feel very serious and threatening at the time. This can leave you fearful of having further panic attacks. This chapter outlines how to understand and beat panic attacks at this time. Pregnancy is a time of lots of physical change and lots of focus on those changes, which can be difficult if you have become worried about physical sensations. It can be difficult managing panic attacks if you are caring for young children. We guide you through the cognitive understanding of panic attacks, that they are driven by understandable but incorrect interpretations of physical sensations. We will help you to apply this theory to your individual situation, to recognise which sensations are particularly frightening, and outline experiments to target behaviours such as avoidance, focus on sensations and other factors that keep the fear going.