Pregnancy Related Maternal Anxiety and Adaptation

Maternal Anxiety and Pregnancy,Psychological Responses,Why Anxiety is Greater than Non Pregnant Females,Acceptance of Pregnancy,Anxiety and Newborn Parameters,Low Birth Weight Babies and Maternal Stress,Unwanted Pregnancies and Low Birth Weight,Anxiety Measures,Role of Society,Conclusion.

Maternal Anxiety and Pregnancy

    Pregnancy,
as a period of substantial biological and psychosocial change, can be expected
to raise anxiety about the future. Anxiety is the psychological consequence of
exposure to stressful circumstances that challenge one’s capacity to cope. 

    Patterns of maternal anxiety may be adaptive or maladaptive from psychosocial
and psychophysiological perspectives. Maladaptive psychosocial prenatal
responses have been associated with post portal maternal adaptive difficulty,
marital disturbance, and infant and childhood development problems.

Psychological Responses 

    Psychophysiological
responses to anxiety involve neuroendocrine pathways. The sympathetic autonomic
nervous system, through catecholamine release, may alter uterine contractile
activity in pregnancy and labor and, by arterial vasoconstriction, may restrict
uteroplacental perfusion and fetal growth. 

    Also, the
hypothalamic-pituitary-adrenal (HPA) axis and corticotropin releasing hormone
production during pregnancy may control the timing of birth and influence
preterm birth. Adrenocorticotropic hormone also is a sensitive indicator of
maternal psychological stress. 

    Another HPA axis pathway may alter immune system
response, rendering the expectant mother less resistant to infection. While
such dysregulation is associated with maladaptive responses, other factors can
modify stress responses.     

The magnitude and duration of the stressor, the timing
of a critical event, the genetic vulnerability of the mother and fetus, and
social environment factors, may foster homeostasis and offset dis regulation.

Why Anxiety is Greater than Non Pregnant Females

    In
general, pregnant women have higher anxiety in all trimesters of pregnancy than
nonpregnant women (Singh & Saxena, 1991). Studies of maternal anxiety cite
psychosocial factors as the most frequent and significant influences on
pregnancy adaptation, birth outcomes, and subsequent post portal
maternal/infant adaptation. 

    Two different and complementary conceptual
frame-works of maternal prenatal adaptation have been presented by Rubin (1975)
and by Lederman (1996). Rubin posited trimester tasks concerning binding-in and
binding-out of pregnancy.     

    Lederman identified seven dimensions of maternal
development based on studies of prenatal health outcomes and postpartum
adaptation:

Acceptance
of Pregnancy

    Planning and wanting the pregnancy, happiness, tolerance of
discomforts, ambivalence.

 

·       
Identification with a Motherhood Role: Motivation and preparation
for motherhood. Relationship to Mother: Availability of the gravida’s mother,
her (mother’s) reactions to the pregnancy, respect for the gravida’s autonomy,
willingness to reminisce; the gravida’s empathy with the mother. Relationship
to Husband/Partner: Mutual concern for each other’s needs as expectant parents;
effect of pregnancy on the relationship.

·       
Preparation for Labor: Practical steps; maternal thought processes.
Fears Pertaining to Pain, Helplessness, and Loss of Control in Labor: Stress,
pain, self-estimated coping ability. Concern about Well-Being of Self and
Infant in Labor: Regarding deviations from the norm. These seven dimensions are
measurable using questionnaire and interview instruments, both showing high
reliabilities for each dimension.

    Significant
differences have been found in the outcomes of pregnancy for women experiencing
high prenatal-state anxiety and psychosocial or developmental conflict. 

    In
several studies (summarized in Lederman, 1995a, 1995b, 1996), the personality
dimensions on adaptation to pregnancy showed that higher maternal anxiety in
pregnancy and labor were correlated with higher plasma catecholamines during
labor, decreased uterine contractility, fetal heart rate deceleration, and
prolonged laboratory. 

    Recently, results of another study (Lederman, Weis,
Brandon, &Mian, 2002) showed that anxiety, as measured by the different
personality dimensions, predicted length of gestation (preterm labor),
gestational age at first prenatal visit, and antepartal and laboratory
complications. 

    Of particular interest were findings that none of the
demographic dimensions, such as age, education, and income, when entered into a
multiple regression analysis with the personality dimensions, retained
predictive significance. 

    These novel results build on earlier findings,
suggesting that the mother’s psychosocial history and her perception of the
meaning, challenges, and expectations of pregnancy are of paramount importance
in the adaptation to pregnancy, and they carry greater weight than demographic
factors in predicting birth outcomes.

Anxiety and Newborn Parameters

    Although
they are conceptually and clinically related, research results suggested a
distinction may be warranted between preterm delivery and newborn birthweight. 

    Significant relationships have been reported between tween life-event stress
and infant birthweight, and between a measure of pregnancy-related anxiety
(adapted from Lederman’s dimension measures, 1996) and gestational age at
birth; both results occurred independent of subjects’ biomedical risk (Wadwha,
Sandman, Porto, Dunkel-Schetter, & Garite, 1993). 

    Socially stressful
factors, such as single marital status, little contact with neighbors (Peacock,
Bland, & Anderson, 1995), not cohabitating with a partner or having a
confidante, and highly stressful major life events (Nordentoft et al., 1996),
have been associated with pre-term delivery. 

    Paarlberg, Vingerhoets, pass
chier, Dekker, and van Geijn (1995) also concluded that the most consistent
finding in the literature was the relationship between preterm birth and taxing
situations.

Low Birth Weight Babies and Maternal Stress

    Low
birthweight appears to have a greater association with altered biophysical
states. Smoking, hypertension, prenatal hospitalization, and prior preterm
birth have been associated with low birthweight (Orr et al., 1996). 

    Paarlberg
and colleagues (1999) found that first-trimester smoking and maternal height,
weight, and educational level were significant risk factors for low birthweight.
MS Kramer (1998) found that the strongest predictors of intrauterine growth
restriction were smoking and low gestational weight gain. 

    Thus, prior studies
suggested that maternal anxiety (pregnancy specific anxiety, psychosocial
adaptive anxiety, and major life event stress) and maternal coping responses
have more associations with preterm labor, whereas chronic stress, smoking, and
other physical factors (height, weight, hypertension ) may be more consistently
related to infants that have restricted growth in utero or are low birthweight. 

    The aggregate of findings suggests different modes of preventive intervention
for the two disorders.

Unwanted Pregnancies and Low Birth Weight

    Decisions
regarding wontedness and acceptance of pregnancy remain relatively stable or
constant throughout pregnancy (Lederman, 1996). Not wanting pregnancy is
associated with inadequate maternal prenatal care (Albrecht, Miller, &
Clarke, 1994) and physical violence (Gazmararian et al., 1995). 

    Women who
report an unwanted pregnancy were more likely to have lower birthweight
newborns, higher infant mortality rates (Myhrman, 1988), a more than twofold
increased risk of neonatal death (Bustan & Coker, 1994), and children who
later developed psychopathology (Ward , 1991)

    Studies
of motherhood role identification indicate that maternal attachment and
parenting confidence showed consistent and stable responses across prenatal and
postpartum periods (Deutsch, Ruble, Fleming, Brooks-Gunn, & Stangor, 1988;
Fonagy, Steele, & Steele, 1991; Lederman, 1996 ). 

    Deutsch and colleagues
also found that the woman’s relationship with her mother during pregnancy was
strongly correlated with self-definition of her maternal role.

Anxiety Measures

    Kin
relationships of the gravida with her husband/partner and mother have
relationships to pregnancy outcomes. A lack of social stability, social
participation, and emotional and instrumental support increased the mother’s
likelihood of giving birth to a small-for-gestational-age infant
(Dejin-Karlsson et al., 2000). 

    As in the study by Lederman and colleagues (2002),
these results occurred independent of background, lifestyle, and biological
risk factors, attesting to the significance of kin relationships, particularly
the husband/partner relationship. 

    Lederman (1996) reported high
intercorrelations among the developmental dimensions in all trimesters,
indicating that early anxiety measures were stable predictors of later anxiety.
This suggested that prenatal assessment can identify women who would benefit
from early counseling.

Role of Society

    Socially
supportive community intervention during pregnancy may have near-term and
long-term beneficial effects for mother and child. A registered nurse home
visit program for African-American gravidas with inadequate social support
substantially reduced low birthweight (Norbeck, DeJoseph, & Smith, 1996). 

    Pregnant women who received social support from midwives had fewer
low-birthweight infants, and at a 7-year follow-up still showed significant
benefits for mothers and children (Oakley, Hickey, Rajan, & Rigby, 1996). 

    Another supportive prenatal nurse home-visitation program (Olds et al., 1998)
yielded beneficial maternal child results as much as 15 years later, including
improvement in women’s health behaviors and the quality of child caregiving.

Conclusion 

    In
summary, maternal anxiety and specific prenatal personality dimensions,
operating through neuroendocrine pathways, influence maternal and fetal/newborn
birth outcomes as well as longer-term outcomes. Many adverse outcomes may be
modified or prevented by supportive prenatal nurse visitation programs.