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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychol. | doi: 10.3389/fpsyg.2019.02179

Emotional stress during pregnancy – associations with maternal anxiety disorders, infant cortisol reactivity and mother-child interaction at pre-school age

  • 1Heidelberg University Hospital, Germany
  • 2Department Psychologie, Ludwig Maximilian University of Munich, Germany

There is growing evidence that even milder forms of maternal stress or anxiety during pregnancy affect the fetus causing possible long-term consequences for infant and child development. The mechanisms through which prenatal maternal stress may affect the unborn are not yet entirely clarified. Due to limited self-regulatory skills after birth, infants depend on sensitive behavior of their parents to regulate affective states and physiological arousal. Dyadic affect regulation has been linked to various developmental patterns up to adolescence and thereby represents a key element of early social relationships.
Aim of the study was to evaluate possible long-term consequences of emotional stress during pregnancy and postpartum anxiety disorders, as well as infant postpartum cortisol reactivity on mother-child-interaction at pre-school age. The sample comprised of N = 63 mother-infant dyads at study entry, n = 28 diagnosed with postpartum anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), n = 35 were healthy controls. Mothers were interviewed with the Structured Clinical Interview for DSM-IV Disorders at an average infant age of M = 4.1 months and filled out a questionnaire regarding emotional stress during pregnancy. Further, they were videotaped during the Face-to-Face-Still-Face paradigm (FFSF), a widely used mild socio-emotional stressor for infants. To determine infant stress-reactivity, infant salivary cortisol was collected before, immediately after and 20 minutes after the FFSF. Missing values were estimated by multiple imputations. At the age of M = 5.3 years, mother-child-interaction was re-assessed in a follow-up sample of n = 30 dyads via a free-play situation. Moreover, dimensional measures for anxiety were assessed.
Mothers in the clinical group reported significantly higher stress scores than the control group. Infant stress reactivity in the early postpartum period and maternal anxiety symptoms at the 5-year follow-up assessment were significantly associated with dyadic interaction quality at pre-school age. Even though maternal stress during pregnancy did not directly predict mother-child interaction quality at pre-school age, it was significantly correlated with infant cortisol reactivity during postpartum period. Nevertheless, caution should be taken when interpreting the results considering the small sample size.

Keywords: stress, Cortisol reactivity, Child Development, Pregnancy, Anxiety Disorders

Received: 21 Nov 2018; Accepted: 10 Sep 2019.

Copyright: © 2019 Zietlow, Nonnenmacher, Reck, Ditzen and Müller. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Anna-Lena Zietlow, Heidelberg University Hospital, Heidelberg, 69120, Baden-Württemberg, Germany,