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Anxiety During Pregnancy and Postpartum

Published online by Cambridge University Press:  07 November 2014

Margaret Altemus
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Extract

Perinatal depression is widely considered to be a major public health problem. Anxiety disorders are also common among women of childbearing years, but the course and consequences of anxiety during pregnancy have not yet been established.

Almost all studies of the prevalence and consequences of perinatal anxiety have used questionnaire measures of anxiety. Unlike the Edinburgh Postnatal Depression Scale, questionnaire measures of anxiety symptoms have not been validated for pregnant or postpartum patients, thus it is unclear to what degree these measures are detecting anxiety versus typical physical symptoms associated with pregnancy and infant care. For example, many items on the Beck Anxiety Inventory, including difficulty breathing, facial flushing, unsteadiness, light headedness, sweating, and indigestion, commonly occur during pregnancy. In a study of >8,000 women, more women scored above a cut-off score on the anxiety subscale of the Crown-Crisp Index during weeks 18 and 32 of pregnancy compared to 8 weeks and 8 months postpartum. Three studies have administered selected modules from the Structured Clinical Interview to postpartum women. All three studies found that >50% of women with postpartum anxiety disorders were not depressed and that anxiety disorders were at least as common postpartum as major depression. Antenatal anxiety was associated with an increased risk of postpartum depression, even after controlling for antenatal depression.

Type
Symposium Monograph Supplement
Information
CNS Spectrums , Volume 9 , Issue 9 , September 2004 , pp. 10 - 11
Copyright
Copyright © Cambridge University Press 2004

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References

1. Heron, J, O'Connor, TG, Evans, J, Golding, J, Glover, V. The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord. 2004;80:65–73.CrossRefGoogle Scholar
2. Matthey, S, Barnett, B, Howie, P, Kavanagh, DJ. Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Dhord. 2003;74:139–147.CrossRefGoogle ScholarPubMed
3. Wenzel, A, Haugen, EN, Jackson, LC, Robinson, K. Prevalence of generalized anxiety at eight weeks postpartum. Arch Wtmens Men! Health. 2003;6:43–49.CrossRefGoogle ScholarPubMed
4. Muzik, M, Klier, CM, Rosenlum, KL, Holzinger, A, Umek, W, Katschnig, H. Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders? Acta Psych Scand. 2000;102:71–73.CrossRefGoogle ScholarPubMed
5. Klein, DF, Skrobala, AM, Garfinkel, RS. Preliminary look at the effects of pregnancy on the course of panic disorder. Anxiety. 1995;1:227–232.CrossRefGoogle Scholar
6. Altemus, M. Obsessive-compulsive disorder during pregnancy and postpartum. In: Yonkers, K, Little, B, eds. Management of Psychiatric Disorders in Pregnancy. London, England: Arnold; 2001:149–163.Google Scholar
7. Lambert, EA, Thompson, J, Schlaich, M, et al. Sympathetic and cardiac baroreflex function in panic disorder J Hypertens. 2002;20:2445–2451.CrossRefGoogle ScholarPubMed
8. Wilhelm, FH, Trabert, W, Roth, WT. Physiologic instability in panic disorder. Biol Psychiatry. 2001;49:596–605.CrossRefGoogle ScholarPubMed
9. Alremus, M, Fong, J, Yang, R, Damasr, S, Luine, V, Ferguson, D. Changes in CSF neurochemistry during pregnancy. Biol Psychiatry. In press.Google Scholar
10. Altemus, M, Redwine, LS, Leong, Y-M, Frye, CA, Porges, SW, Carter, CS. Responses to laboratory psychosocial stress in postpartum women. Psychosomatic Med. 2001;63:814–821.CrossRefGoogle ScholarPubMed
11. Weisenfeld, AR, Malatesta, CZ, Whitman, PB, Grannose, C, Vile, R. Psychophysiological response of breast and bottle-feeding mothers to their infants' signals. Psychophysiology. 1985;22:79–86.CrossRefGoogle Scholar
12. Altemus, M, Deuster, P, Galliven, E, Carter, S, Gold, PW. Suppression of hypotha-lamic-pituitary-adrenal axis responses to stress in lactating women. J Clin Endo Metab. 1995;80:2954–2959.Google ScholarPubMed
13. Toufexis, DJ, Thrivikraman, KV, Plotsky, PM, Morilak, DA, Huang, N, Walker, C-D, Reduced noradrenergic tone to the hypothalamic paraventricular nucleus contributes to the stress hyporesponsiveness of lactation. J Neuroendocrinology. 1998;10:417–427.CrossRefGoogle Scholar
14. Kendrick, KM, Keverne, EB, Hinton, MR, Goode, JA. Oxytocin, amino acid and monoamine release in the region of the medial preoptic area and bed nucleus of the stria terminalis of the sheep during parturition and suckling. Brain Res. 1992;569:199–209.CrossRefGoogle ScholarPubMed
15. Qureshi, GA, Hansen, S, Sodersten, P. Offspring control of cerebrospinal fluid GABA concentrations in lactating rats. Neurosci Lett. 1987;75:85–88.CrossRefGoogle ScholarPubMed
16. Smolen, A, Smolen, TN, Han, PC. Alterations in regional brain GABA concentration and turnover during pregnancy. Pbarm Biocbem Behav. 1993;44:63–69.CrossRefGoogle ScholarPubMed
17. Mezzacappa, ES, Yu, AY, Myers, MM. Lactation and weaning effects on physiological and behavioral responses to stressors. Physiol Behav. 2003;78:1–9.CrossRefGoogle Scholar
18. Sakaihara, M, Yamada, H, Kato, EH, et al. Postpartum thyroid dysfunction in women with normal thyroid function during pregnancy. Clin Endocrinol. 2000;53:487–492.CrossRefGoogle ScholarPubMed
19. Lazarus, J, Hall, R, Ochman, S, et al. The clinical spectrum of postpartum thyroid disease. QJM. 1996;89:429–435.CrossRefGoogle ScholarPubMed
20. Harris, B, Othman, S, Davies, JA, et al. Association between postpartum thyroid dysfunction and thyroid antibodies and depression. Br Med J. 1992;305:152–156.CrossRefGoogle ScholarPubMed
21. Wadhwa, PD, Culhane, JF, Rauh, V, Barve, SS. Stress and preterm birth: Neuroendocrine, immune/inflammatory and vascular mechanisms. Maternal and Child Health Journal. 2001:5:119–125.CrossRefGoogle ScholarPubMed
22. Monk, C, Myers, MM, Sloan, RP, Ellman, LM, Fifer, WP. The effects of women's stress-elicited physiological activity and chronic anxiety on fetal heart rate. Dev Behav Fed. 2003;24(1):32–38.CrossRefGoogle ScholarPubMed
23. DiPietro, J, Hodgson, K, Costigan, S, Johnson, T. Developmental of fetal movement - fetal heart rate coupling from 20 weeks through term. Early Hum Dev. 1996;44:139–151.CrossRefGoogle Scholar
24. Brouwers, EPM, Van Baar, AL, Pop, VJM. Maternal anxiety during pregnancy and subsequent infant development. Infant Behav Dev. 2001;24:95–106.CrossRefGoogle Scholar
25. Huizink, AC, Robles de Medina, PG, Mulder, EJ, Visser, GH, Buitelaar, JK. Psychological measures of prenatal stress as a predictor of infant temperament. J Am Acad Child Adolesc Psychiatry. 2002;41:1078–1085.CrossRefGoogle ScholarPubMed
26. O'Connor, TG, Heron, J, Glover, V, Team, TAS. Antenatal anxiety predicts child behavior/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry. 2002;41(12):1470–1477.CrossRefGoogle ScholarPubMed