A Review of the Effects of Anxiety During Pregnancy on Children’s Health

DOI: 10.5455/msm.2015.27.200-202
Received: 19 April 2015; Accepted: 05 June 2015

© 2015 Zohreh Shahhosseini, Mehdi Pourasghar, Alireza Khalilian, Fariba Salehi

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-
nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

REVIEW Mater Sociomed. 2015 Jun; 27(3): 200-202

A Review of the Effects of Anxiety During

Pregnancy on Children’s Health
Zohreh Shahhosseini1, Mehdi Pourasghar2, Alireza Khalilian3, Fariba Salehi4*

1
Department of Midwifery and Reproductive Health, Mazandaran University of Medical Sciences, Sari, Iran
2
Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran
3
Department of Biostatics, Mazandaran University of Medical Sciences, Sari, Iran
4
Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
Corresponding Author: Vesal street, Amir Mazandarani Boulevard, Mazandaran Province, Iran, Tel: +98-151-33367342, E-Mail:salehy.fariba@yahoo.com

ABSTRACT
Background: Although pregnancy is often portrayed as a time of great joy, that’s not the reality for all women. The adverse, long-term, stable,
and sometimes, irreparable effects of anxiety during pregnancy can change pregnancy into an agonizing and unpleasant event of women’s life
span. Aim: The aim of this study was to explore the adverse effects of anxiety in pregnancy on children’s health in order to promote child health.
Methods: In this narrative review the researchers searched in public databases like Google Scholar general search engine, and then more specific:
Science Direct, Scientific Information Database, Magiran, Irandoc, Pubmed, Scopus, Cochrane library, and Psych info using Medical Subject
Headings (MeSH) keywords: anxiety, maternal anxiety, pregnancy, pregnancy outcome, control and prevention restricted to English / Persian
language, during the 20 years ago. Then those articles written by renowned experts were selected. At first, a list of 60 papers generated from the
initial search. Then reviewers studied titles and abstracts and finally, quality assessment of full text studies was performed by two independent
reviewers. Researchers reviewed summary of all articles sought, ultimately used data from 25 full articles to compile this review paper. Results:
The findings were classified into four groups: Biological, Mental, Behavioral, and Medical effects of anxiety during pregnancy. Conclusions: The
effects of anxiety during pregnancy on offspring’s health are serious and thought-provoking to which the need for identifying and screening of
anxiety disorders in prenatal care is necessary.
Keywords: Anxiety, Pregnancy, Pregnancy outcome, Narrative review

1. INTRODUCTION A study suggested that the level of the heart rate variability in
Pregnancy is one of the most important events in women’s the offspring of anxious mothers be less than the control group
lives. Being pleasant, it is one of the most stressful events in a (12). Such children show more fear in dealing with everyday
woman’s life (1), as psychologists have cited, pregnancy as an events in their life. Mother’s anxiety, during pregnancy, is also
emotional crisis (2, 3). If this crisis is not properly managed associated with poor maternal- child interaction. In this way it’s
and controlled, it will turn into a prolonged crisis and will reported that anxiety and negative mood of mother has been
leave countless undesirable consequences on mother and her stated as one of the mechanisms of this problem (13).
baby (4-6). Prevalence of anxiety disorder during pregnancy, As regards high prevalence of anxiety and its serious conse-
in developed and developing countries are 10% and 25%, re- quences (3, 7) the researchers, in this study, have focused upon
spectively (4, 7, 8). the complications of mother’s anxiety during pregnancy, on
High levels of anxiety, during pregnancy, have adverse effect offspring, according to findings of related studies.
on mother and baby (3, 9, 10). Anxiety, in early pregnancy, re-
sults in loss of fetus and in the second and the third trimester 2. METHODOLOGY
leads to a decrease in birth weight and increased activity of the The current narrative review followed the five steps, which
Hypothalamus – Hypophysis–Adrenal axis (3, 4). It causes are: 1. identifying the research question; 2. Search methods for
a change in steroidogenes, destruction of social behavior and identifying relevant studies; 3. Study selection; 4. Charting
fertility rate in adulthood. Also anxiety during pregnancy is the data, collating, summarizing 5. Reporting the results (14).
accompanied by emotional problems, hyperactivity disorder, 2.1 Identifying the research question
decentralization and disturbance in cognitive development of What are the effects of anxiety during pregnancy on chil-
children (4, 11). dren’s health?

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 A Review of the Effects of Anxiety During Pregnancy on Children’s Health

2.2 Search methods for identifying relevant studies behavioral consequences including: infants’ responses to normal
The researchers searched in public databases like Google and standard sounds in the first nine months of infant’s life
Scholar general search engine, and then more specific: Science which is more irritable and nervous response (23, 25).
Direct, Scientific Information Database, Magiran, Irandoc, 4- Medical effects of anxiety during pregnancy
Pubmed, Scopus, Cochrane library, and Psych info using Findings show that children with anxious mothers face seri-
Medical Subject Headings (MeSH) keywords: anxiety, maternal ous illnesses both in childhood and adulthood such as Shortness
anxiety, pregnancy, pregnancy outcome, control and prevention. of breath, Rash; Asthma (20, 27), Coronary disease in adult-
2.3 Study selection hood and Reduction of heart rate variability in children(12). A
A list of 60 papers generated from the initial search. Then study suggests that endocrine disorders, to be significant as the
reviewers studied titles and abstracts. Finally, quality assess- result of increasing the activity of the Hypothalamic–Pituitary
ment of full text studies was performed by two independent –Adrenal axis in response to the high maternal anxiety. This
reviewers. Researchers reviewed summary of all articles sought, process in turn may affect Glucose metabolism and causing
ultimately data from 25 full articles to compile this review pa- Hyperglycemia in male offspring, although this relationship has
per were used. Researchers assessed for inclusion all titles and not been established in female children (28). In other words, the
abstracts without language limitations in English and Persian effects of prenatal stress on Glucose metabolism in adulthood
language during the 20 years ago. Then those articles written are related to sex (10). Other medical problems associated with
by renowned experts were selected. anxiety during pregnancy, are increase abnormalities such as
2.4 Charting the data, collating, summarizing cleft lip and cleft palate (29) .
Data extracted and were summarized in result section.
2.5 Reporting the results 4. DISCUSSION
Reporting data were four categories. Anxiety is one of the widespread health problems, especially
during pregnancy. Considering its high incidence and serious
3. RESULTS complications, no identification and screening occur in prena-
Findings from studies on the effects of anxiety during preg- tal care during pregnancy (30). According to the results, severe
nancy on children can be classified into four groups: Biological; anxiety has a significant impact on biological indicators of
Mental; Behavioral and Medical effects. newborn such as height, weight, and head circumference (6). In
1. Biological effects of anxiety during pregnancy this way it’s reported that chronic or extreme maternal anxiety
The biological effects of anxiety on children’s health were may also cause changes in the blood flow to the baby, making it
mentioned to be different. It is claimed there is a significant difficult to carry oxygen and other important nutrients to the
relationship between height of infant and maternal anxiety baby’s developing organs (31, 32). In addition, chronically or
in a way that in mothers with high levels of anxiety, the birth severely anxious mothers may feel overwhelmed and fatigued
height is shorter than birth height in non-anxious mothers (6, which might impact their diet and sleep habits and consistency
15). It is also reported that maternal anxiety has a significant of prenatal care. All of these factors may help explain how mater-
impact on birth weight (3, 10, 16), while in some other studies nal anxiety during pregnancy can have long-term effects on the
significant difference among fetus’s growth restriction, neonatal unborn child. The results of the studies in this reviewed article
Apgar score, birth weight, birth length; and head circumference are not related to biological indicators in a way that some are
among anxious and non-anxious women has not been reported repudiated. Hence it should be kept in mind as have been proved
(1, 9, 15, 17, 18). in many studies, there is a significant difference with regard to
2. Mental effects of anxiety during pregnancy these parameters between anxious and non-anxious mothers
According to the results, the high level of maternal anxiety which claims attention and focus for the health care providers.
has a significant relation with mental disorders, emotional Moderate-to-severe anxiety, during pregnancy, has a sig-
problems, lack of concentration and hyperactivity (4, 19, 20) nificant effect on children’s cognitive and psychiatric disorders,
and impaired cognitive development of children (4, 21). In this which are, sometimes, stable and seriously endanger the health
way it’s mentioned that increased stress hormones like Corti- of children (19-21). Hence, the results of studies in this paper
cotrophin particularly Cortisol and androgens which induce are coordinated, and make the problem more serious.
anxiety could lead to cognitive changes, changes in language Behaviorally, anxiety creates a lot of problems for children,
development, ability to classify the contents and speech in girls due to personal communication and social interaction, The in-
(4, 22, 23). Increase of these hormones has a significant relation creased activity of this core is associated with increased Cortisol
with gingerly in preschool boys too. The results of these studies (26), which is associated with reduced brain growth. The effect
indicate that extreme anxiety in pregnancy will be accompanied of cortisol is more associated with the growth of two sides of
with proliferation of too neuroblasts and also schizophrenia hippocampus, especially, the right side of hippocampus, in the
and dyslexia (22). first six months of infant’s life. Individual differences in response
3. Behavioral effects of anxiety during pregnancy to stressful events of life are related to the development of the
The results show that anxiety during pregnancy can lead to right part of hippocampus. Finally, a wide range of medical
prolonged crying in the neonatal period(24), irritability and problems associated with moderate- to- severe levels of anxiety
restlessness (25), individual differences in reaction to stressful is seen in children of this group of mothers that are consider-
life events (26); the weak interaction between mother–child able, sometimes remains lifelong and steady.
(13), and more fear in dealing with life events (12). The other ef- The evidences of some inconsistent studies provide the fact
fect of anxiety is a negative impact on children’s nervous system that further studies and researches in the field of the effects of
growth and development. This issue is associated with negative anxiety during pregnancy on the health of children is a serious

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A Review of the Effects of Anxiety During Pregnancy on Children’s Health

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