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Maternal Anxiety
Maternal anxiety during pregnancy has a signifiant effect on the health of the fetus. Maternal stress, anxiety, and depression alter maternal hormone levels and cause changes in fetal behavior, physiology, and biochemistry during pregnancy and after childbirth. Hormone levels affect the development of the fetus and its ability to self-regulate homeostasis within the uterus. Measurements of fetal heart rate (FHR) and fetal movement (FM) responses in utero indicate a strong maternal-fetal link.

Background Research
In the 1970s, minor psychological stressors led to several physiological fetal effects in research on pregnant monkeys. These effects included changes in FHR, blood pressure (BP), and arterial oxygenation. In other animal studies, stress levels were experimentally increased in rat fetuses. As adults, they showed delayed motor development, reduced explorative and adaptive behavior, anxiety in unfamiliar environments, impaired cognitive function, and changes in social and sexual behavior.

Past research on humans shows an association between maternal anxiety and obstetric abnormalities such as low birth weight and preterm births. Behavioral abnormalities such as a decreased fetal responsiveness to mock facial expressions, failure to show face and voice preferences, and longer habituation times are also observed.

Research Methods and Data Collection
Anxiety levels of mothers are measured with the Beck Depression Inventory and the Speilberger State-Trait Anxiety Inventory. Based on ratings, subjects are placed into either an anxiety disorders (AD) group or a depression group. Healthy participants without psychological disorders are placed into high, middle, and low anxiety groups. Participants are within their third trimester of pregnancy, ranging from 24 to 48 weeks gestation. Fetal behavior states are established in all fetuses of this age. Subjects are monitored for maternal heart rate (MHR), BP, respiration rate (RR), and skin conductance, which indicate a maternal stress response. The maternal sympathetic nervous system (SNS) changes MHR and skin conductance measurements during stress.

Cardiotocographs, fetal echocardiographs using a transabdominal Doppler transducer, and ultrasound examinations are used to detect FHR, variability in FHR, and FM in utero. Measurements of high-frequency HR variability determine the fetus’ ability to self-regulate during stress by autonomic reactions. A vibroacoustic stimulus device emits sound to the uterus and induces fetal stress, altering FHR and FM. Maternal stress is induced by the Stroop Color-Word Test and mental arithmetic tests.

Newborn health is measured by the Apgar test, which is scored on appearance, pulse, grimace, activity, and respiration ratings. The Bayley Scales of Infant Development assess motor skills, language skills and cognitive development of infants and toddlers.

Evidence
In comparison to fetuses of low anxiety mothers, fetuses of depressed women have significant HR increases during stress induced periods. Women with low anxiety have significant changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) under stressful conditions, but fetuses show no change in HR. FHR is independent of maternal stress responses. High anxiety groups have increased levels of placental corticotropin-releasing hormone (CRH) during periods of stress.

Newborns of stressed mothers demonstrate low scores on the Bayley and Apgar tests, poor adaptation to new environments, and increased problematic behavior at the age of eight months. As children, they show signs of hyperactivity, attention deficit, and aggression.

Biological Effects
The fetal biochemical profile mimics that of the mother during pregnancy. Anxiety leads to an increased level of maternal hormones, including CRH, adrenocorticotropic hormone (ACTH), cortisol, and chromogranin A (CgA). In the maternal neuroendocrine system, activation of the hypothalamic-pituitary-adrenal (HPA) axis increases adrenal hormone levels. This increase limits development of the fetal autonomic nervous system and the fetus’ ability to adjust to external stimuli. Excess secretion of hormones decrease uteroplacental perfusion which negatively impacts the function of the placenta and uterine blood flow. Stress leads to increases in smoking, alcohol consumption, drug use, loss of appetite, and weight loss, which also alter maternal hormone levels.

A fetus can sense maternal vasculature sounds in utero. Stress activation of the maternal sympathetic nervous system accelerates MHR and BP and signals the fetus. This mechanism involves a sensory response to stress rather than a hormonal one.

Treatments
The study of maternal anxiety helps guide decisions on the treatment of depression among pregnant women. The National Toxicology Program has researched the effect of medications such as fluoxetine (e.g. Prozac) on the fetus. Exposure to typical dosages during the third trimester results in poor neonatal adaption, including jitteriness, poor tone, weak or absent cry, and diminished pain. Alternative forms of depression treatment for pregnant women include massage therapy, exercise, meditation, and yoga.