SUMMARY AND KEY ISSUES
In summary, there is substantial evidence that
anxiety, depression, and stress in pregnancy are
risk factors for adverse outcomes for mothers and
children. More specifically, anxiety in pregnancy is
associated with shorter gestation and has adverse
implications for fetal neurodevelopment and child
outcomes. Furthermore, anxiety about a particular
pregnancy seems to be especially potent. Finally,
chronic strain, exposure to racism, and depressive
symptoms in mothers during pregnancy are
associated with lower birth weight infants with
consequences for development as well. These
differential risk factors and related pathways to
PTB and LBW deserve further investigation.
Beyond this, women with high stress, anxiety,
and depressive symptoms in pregnancy are more
likely to be impaired during the postpartum period.
Postpartum affective disturbance and stress in turn
impair parenting quality and effectiveness [48].
Figure 1 summarizes the evidence that has been
briefly reviewed in a simple schematic with connections
in bold representing those with notably
stronger and more consistent evidence. This simple
diagram can be elaborated further to include associations
among the various types or forms of stress and
to include mediated pathways to birth outcomes.
For example, major life events or community catastrophes
can be hypothesized to increase pregnancy
anxiety, and long-term chronic strain to increase risk
of depression. The effects of chronic strain on LBW
via depression are also not depicted but are worthy of
further research. Together, the evidence and developing
consensus that biological and behavioral
mechanisms explain these findings lay the groundwork
for a next era of psychiatric and collaborative
interdisciplinary research on pregnancy.