Risk and Resilience

• Sedgl et al

  Despite the fall in teenage pregnancies in the UK, there is a wide disparity throughout the world, with Africa, South America and South Asia having the highest number.
• Nuffieldtrust.org

  Found there was a fall in teenage pregnancies in the UK from 1993-2020.
• Case study: Dutch famine (1994)

  In the famine 18000 people starved to death. In generations after the famine it was noted via conscription records found that there was a link to the famine and health issues.

  • EARLY: obesity, altered lipid profiles and cardiovascular disease.
  • MID: Reduced renal function.
  • LATE: Born small and low obesity as adults.

  This is caused by the 'Thrifty phenotype" caused infants conceived during the famine meant they were predisposed to putting on more weight after the famine ended.
• Barker (1980s): The "Thrifty" phenotype: 


  Found that low birth weight is associated with increased risk of death of Ischaemic heart disease.

  It's the way the body deals with stress and strain and adapts to it in future/ current generations.
• Case study: Thalidomide 


  Thalidomide was a drug which was used in a variety of conditions and was used in pregnant women in 1950s and 1960s. It caused birth defects in 2,000 UK babies, if including still born and miscarried babies would increase that to 10,000 babies in the UK.
• How many women smoke, continue to smoke while pregnant.

  50%
• What are the effects of prenatal tobacco exposure?

  Causes central nervous system and impairs fatal growth.
• Obel et al (2016)

  Prenatal risks e.g., smoking are associated with postnatal risks e.g., parent mental health issues and social adversity and as a result associations do not mean causations.
• Silventoinen et al (2022) 


  When using a sample of 10,527 monozygotic and dizygotic twins found that smoking is associated with education even when social backgrounds are controlled for. Education levels were lower in currently smoking twins compared to never smoking co-twins and higher among former smoking than among currently smoking co-twins.
• Fetal alcohol syndrome 


  First discovered in 1973, FAS is a liability which is most damaging in the first trimester when most people are unaware they are pregnant. The mechanisms behind it are harder to establish but it is associated with smoking and shows strong SES gradient. Fetal susceptibility related to low maternal BMI and chronic paternal alcohol use cause epigenetic alterations which increase susceptibility.
• Reid and Petrenko (2018)


  Across all domains of executive functioning and self-regulation are decreased in offspring with foetal alcohol syndrome.
• Smith et al (2017)


  Air pollution accounts fro 3% of low birth weight babies in London
• Sheffield et al (2018) 


  First study which linked air pollution and wellbeing in first year postpartum and the effect is strongest for black mothers. In addition only in stressed mothers do the effects of pollution show in infant's regulation.
• Lafortune et al (2021) 


  In natural disasters maternal stress increases.

  • The global impact causes longer gestational age and worse cognitive, motor, socio-emotional and behavioural outcomes in children.
  • Multifaceted e.g., level objective hardship (e.g., floods and storms) and severity of psychological distress.
• Thurston et al (2021)


  After natural disasters there's increased violence against women and girls in the aftermath
• Hales and Barker (2001): Fetal programming hypothesis (FPH)


  A hypothesis which argues that maternal stressors alongside inter-generational effects cause in-utero programming in the offspring causing a variety of outcomes including low birth weight, and metabolism and cardiovascular issues in the infant.

  
• Bennet (2004) 


  Prenatal maternal depression in the first trimester are similar to that of general female population however in the second and third trimester the rates double compared to the general female population.
• Field (2001)


  Prenatal depression is the strongest predictor of postnatal depression and is associated with growth delays, prematurity, disorganised sleep, decreased responsiveness, attentional, behavioural and emotional issues in adolescence (in offspring). Parent also shows confounding effects such as co-morbid anxiety, anger and stressful life events
• O'Donnel et al (2014) 


  Prenatal maternal distress doubles child mental illness risk at age 13 from 6% to 12%.
• Buss et al (2010) 


  Prenatal anxiety predicts altered grey matter volume in 6-9 year olds which makes offspring at increased risk neurodevelopmental issues and psychiatric issues.
• Cumulative stress model: 


  The dysregulation of physiological mediators cause later impairments in learning and behaviour including stress-related physical and mental illnesses.
• Match-mismatch model: 


  Mother's current and past experience influence physiological symptoms which 'cue' the foetus but the calibration can backfire if the environment does not match the calibration.
• Sandman, Davis and Glynn (2012)

  Mismatch theory explains why some infants thrive in spite of exposure to prenatal depression. Infants with concordant adversity had higher Mental developmental index and psychomotor developmental index scores suggest improved cognition and motor capabilities of these infants compared to post-natal only adversity group who has lower scores at most measured points of life.
• Limitations of pre-existing prenatal depression research:

  • Short follow up period leads to a danger of over-pathologising.
  • Are there similar patterns for mothers and father's prenatal depression.
  • Are there partner effects and how to we test parents separately?
  • Are there protective factors co-parents provide?
• Hughes et al (2019) New Mother's and Father's study (1): 


  Both parents had mental health measured and then externalising behaviours are measured at 2 years old. Externalising behaviours were mirrored by predicted externalising behaviours.

  Concluded that we should support Dad's in their transition into parenthood.

  Couple conflicts affect the 2yrs old which causes massively causing stress and anxiety and most notably in their behaviour.
• Yakubovich et al (2020):

  Sample of 2,128 women who reported not the frequency and the type of abuse they had suffered since aged 18.

  Found one-unit increase in cumulative exposure to deprivation associated with 62% increase in participant's frequency of experiencing IPV.
• Moderator 


  Affects strength and direction of the relationship.
• Mediator:


  Process through which variables are related.
• What are the two theroies which explain why neighbourhood disadvantage influences IPV?

  Social disoraganisation theory and Collective efficacy theory.
• Social disorganisation theory:

  Deprivation makes it increasingly more difficult to establish social ties which minimise violence. This happens by creating inhibitory environment and by steering women away from violent partners.
• Collective efficacy Theory: 


  Exposure to violence increases stress and vulnerability. A combination of individual risk (e.g., substance misuse or social isolation) and increased relational strain/ inhibited help-seeking behaviours).
• Devries et al (2010)

  Across 19 countries IPV prevalence ranges from 2-13.5%, making it as common of a condition for pregnant women as pre-eclampsia and gestational diabetes). IPV screening is not routine.
• Murray er al (2020)


  Reviewed 112 studies. Found there's 6 core pathways which impact foetus through the mother:

  • Stress and mental illness
  • Foetal attachment
  • Substance use
  • Nutritional intake
  • Antinatal health-care
  • Infection.
• WHO (2011)


  1 in 4 women in the UK encounter IPV at some point in their lives, which has negative consequences on them and their children (indirectly) e.g., children whose child substance abuse to block out the experiences, poor self-care and poor physical & mental health.
• Donovan et al (2016) 


  Pregnancy IPV doubles the risk of premature birth/ low birth weight. Longer-term psychosocial impacts include maternal stress. mental illness, foetal attachment, health related behaviours and infection.
• Huth-Bocks et al (2004)


  Mothers exposed to IPV in pregnancy were more likely to display 'disengaged' or 'distorted' foetal representations of their unborn child. Likely because IPV often triggers IPV leading mothers not to connect with their child in the months of pregnancy, making it more difficult to attach to said baby.
• Rahman et al (2012)


  Stigma of pregnancy-IPV can lead to delayed or cancelled antenatal appointments.
• Simanek and Meier (2015)


  Stress compromises immune functioning which increasing vulnerability to novel infections.
• Flinkkilä et al (2016)


  Infection in the second trimester is linked to neurodevelopment/ mental health problems in offspring including ADHD, Autism, Schizophrenia and mood disorders.
• O'Donnell and Meaney (2017)


  Maternal anxiety, depression and stress all influence neurodevelopment