Potentially Modifiable Risk and Protective Factors Affecting Mental and Emotional Wellness in Pregnancy

Overview

Journal Front Hum Neurosci

Specialty Neurology

Date 2024 Mar 6

PMID 38445095

Authors

Fiona Wohrer

Helen Ngo

Jared DiDomenico

Xingya Ma

Melissa H Roberts

Ludmila N Bakhireva

Affiliations

Soon will be listed here.

Abstract

Introduction: Impaired mental and emotional wellness often co-occurs with prenatal substance use, and both affect infant socio-emotional, cognitive, language, motor, and adaptive behavioral outcomes. Guided by the modified biopsychosocial framework, this study examined the role of common substance exposures during pregnancy (i.e., alcohol and cannabis), socio-cultural factors (social support during pregnancy, adverse childhood experiences), and reproductive health factors on maternal mental health (MMH).

Methods: Data were obtained from a prospective cohort study-Ethanol, Neurodevelopment, Infant, and Child Health (ENRICH-2), and included 202 pregnant persons. Alcohol and cannabis exposures were assessed through repeated prospective interviews and a comprehensive battery of drug and ethanol biomarkers. MMH outcomes were evaluated during the third trimester through the Perceived Stress Scale, Edinburgh Depression Scale, Generalized Anxiety Disorders-7, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders. Univariate and multivariable linear regression models evaluated significant predictors of MMH.

Results: Results of multivariable analysis indicate that both maternal adverse childhood experiences and alcohol exposure, even at low-to-moderate levels, during pregnancy were associated with poorer scores for most MMH measures, while higher level of social support and Spanish as the primary language at home (as a proxy of enculturation) had protective effects (all < 0.05).

Conclusion: These findings highlight the importance of assessing substance use, including periconceptional alcohol exposure, and mental health in pregnant persons as closely related risk factors which cannot be addressed in isolation. Our findings also emphasize a strong protective effect of socio-cultural factors on maternal mental and emotional wellbeing-a strong precursor to maternal-infant bonding and infant neurodevelopment.

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References

Waldrop J, Baker M, Salomon R, Moreton E . Parenting Interventions and Secondary Outcomes Related to Maternal Mental Health: A Systematic Review. Matern Child Health J. 2021; 25(6):870-880. PMC: 10916505. DOI: 10.1007/s10995-021-03130-6. View

Lever Taylor B, Mosse L, Stanley N . Experiences of social work intervention among mothers with perinatal mental health needs. Health Soc Care Community. 2019; 27(6):1586-1596. DOI: 10.1111/hsc.12832. View

Leis J, Heron J, Stuart E, Mendelson T . Associations between depressive and anxious symptoms and prenatal alcohol use. Matern Child Health J. 2011; 16(6):1304-11. DOI: 10.1007/s10995-011-0892-8. View

Haight S, Byatt N, Moore Simas T, Robbins C, Ko J . Recorded Diagnoses of Depression During Delivery Hospitalizations in the United States, 2000-2015. Obstet Gynecol. 2019; 133(6):1216-1223. PMC: 6842065. DOI: 10.1097/AOG.0000000000003291. View

Alarcon R, Parekh A, Wainberg M, Duarte C, Araya R, Oquendo M . Hispanic immigrants in the USA: social and mental health perspectives. Lancet Psychiatry. 2016; 3(9):860-70. DOI: 10.1016/S2215-0366(16)30101-8. View

Tripathi A, Das A, Kar S . Biopsychosocial Model in Contemporary Psychiatry: Current Validity and Future Prospects. Indian J Psychol Med. 2019; 41(6):582-585. PMC: 6875848. DOI: 10.4103/IJPSYM.IJPSYM_314_19. View

Grigoriadis S, VonderPorten E, Mamisashvili L, Tomlinson G, Dennis C, Koren G . The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013; 74(4):e321-41. DOI: 10.4088/JCP.12r07968. View

Chung E, Nurmohamed L, Mathew L, Elo I, Coyne J, Culhane J . Risky health behaviors among mothers-to-be: the impact of adverse childhood experiences. Acad Pediatr. 2010; 10(4):245-51. PMC: 2897837. DOI: 10.1016/j.acap.2010.04.003. View

Tsakiridis I, Bousi V, Dagklis T, Sardeli C, Nikolopoulou V, Papazisis G . Epidemiology of antenatal depression among women with high-risk pregnancies due to obstetric complications: a scoping review. Arch Gynecol Obstet. 2019; 300(4):849-859. DOI: 10.1007/s00404-019-05270-1. View

10.

Bedaso A, Adams J, Peng W, Sibbritt D . The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reprod Health. 2021; 18(1):162. PMC: 8320195. DOI: 10.1186/s12978-021-01209-5. View

11.

Davies C, Segre G, Estrade A, Radua J, De Micheli A, Provenzani U . Prenatal and perinatal risk and protective factors for psychosis: a systematic review and meta-analysis. Lancet Psychiatry. 2020; 7(5):399-410. DOI: 10.1016/S2215-0366(20)30057-2. View

12.

Bakhireva L, Savage D . Focus on: biomarkers of fetal alcohol exposure and fetal alcohol effects. Alcohol Res Health. 2013; 34(1):56-63. PMC: 3860558. View

13.

Rubio D, Kraemer K, Farrell M, Day N . Factors associated with alcohol use, depression, and their co-occurrence during pregnancy. Alcohol Clin Exp Res. 2008; 32(9):1543-51. PMC: 2746640. DOI: 10.1111/j.1530-0277.2008.00705.x. View

14.

. Committee Opinion No. 722: Marijuana Use During Pregnancy and Lactation. Obstet Gynecol. 2017; 130(4):e205-e209. DOI: 10.1097/AOG.0000000000002354. View

15.

Franks W, Crozier K, Penhale B . Women's mental health during pregnancy: A participatory qualitative study. Women Birth. 2017; 30(4):e179-e187. DOI: 10.1016/j.wombi.2016.11.007. View

16.

ElSohly M, Chandra S, Radwan M, Majumdar C, Church J . A Comprehensive Review of Cannabis Potency in the United States in the Last Decade. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021; 6(6):603-606. DOI: 10.1016/j.bpsc.2020.12.016. View

17.

Dunkel Schetter C . Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues. Annu Rev Psychol. 2010; 62:531-58. DOI: 10.1146/annurev.psych.031809.130727. View

18.

Bergink V, Kooistra L, Lambregtse-van den Berg M, Wijnen H, Bunevicius R, van Baar A . Validation of the Edinburgh Depression Scale during pregnancy. J Psychosom Res. 2011; 70(4):385-9. DOI: 10.1016/j.jpsychores.2010.07.008. View

19.

Simpson W, Glazer M, Michalski N, Steiner M, Frey B . Comparative efficacy of the generalized anxiety disorder 7-item scale and the Edinburgh Postnatal Depression Scale as screening tools for generalized anxiety disorder in pregnancy and the postpartum period. Can J Psychiatry. 2014; 59(8):434-40. PMC: 4143300. DOI: 10.1177/070674371405900806. View

20.

Page K, Murray-Krezan C, Leeman L, Carmody M, Stephen J, Bakhireva L . Prevalence of marijuana use in pregnant women with concurrent opioid use disorder or alcohol use in pregnancy. Addict Sci Clin Pract. 2022; 17(1):3. PMC: 8734065. DOI: 10.1186/s13722-021-00285-z. View