Maternal Cognitions and Mother–Infant Interaction in Postnatal Depression and Generalized Anxiety Disorder Maternal perinatal mental health and offspring academic achievement at age 16: the mediating role of childhood executive function Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? Impact of maternal depression on infant nutritional status and illness: a cohort study. Antenatal maternal mental health as determinant of postpartum depression in a population based mother–child cohort (Rhea Study) in Crete, Greece Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis. Antenatal depression predicts depression in adolescent offspring: prospective longitudinal community-based study. The association of prenatal attachment and perinatal factors with pre- and postpartum depression in first-time mothers Maternal outcomes of a randomized controlled trial of a community-based support program for families of children with chronic illnesses. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Perinatal depression in a cohort study on Iranian women Development of a prenatal psychosocial screening tool for post-partum depression and anxiety. Screening for Symptoms of Postpartum Traumatic Stress in a Sample of Mothers with Preterm Infants Incidence of maternal and paternal depression in primary care: a cohort study using a primary care database. Postpartum Anxiety and Maternal-Infant Health Outcomes High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation. A prospective study of perinatal depression and trauma history in pregnant minority adolescents.
Postnatal depression and anxiety have been shown to increase the risk of disturbances in mother – child interaction and child development . Research into mechanisms has focused on genetics and maternal behavior ; maternal cognitions have received little attention . Our aim was to experimentally determine if worry and rumination in mothers with generalized anxiety disorder ( GAD ) and major depressive disorder ( MDD ) , diagnosed in the postnatal 6 months , interfered with maternal responsiveness to their 10-month old infants . Mothers ( N = 253 : GAD n = 90 ; MDD n = 57 ; control n = 106 ) and their infants were r and omized to either a worry/rumination prime ( WRP ) or a neutral prime ( NP ) ; mother – infant interactions were assessed before and after priming . Type of priming was a significant predictor of maternal cognitions , with WRP result ing in more negative thoughts , higher thought recurrence and more self-focus relative to NP across the entire sample . Interaction effects between group and priming were significant for two parenting variables : Compared with controls , WRP had a more negative impact on maternal responsiveness to infant vocalization for GAD , and to a lesser extent for MDD ; WRP led to decreased maternal vocalization for GAD . Also , mothers with GAD used stronger control after the NP than WRP , as well as compared with other groups , and overall post-priming , their children exhibited lower emotional tone and more withdrawal . Across the entire sample , WRP was associated with increased child vocalization relative to NP . This study demonstrated that disturbances in maternal cognitions , in the context of postnatal anxiety and to a lesser degree depression , play a significant role in mother – child interaction Background Elucidating risk pathways for under‐achieving at school can inform strategies to reduce the number of adolescents leaving school without passing grade s in core subjects . Maternal depression can compromise the quality of parental care and is associated with multiple negative child outcomes . However , only a few small studies have investigated the association between perinatal maternal depression and poor academic achievement in adolescence . The pathways to explain the risks are also unclear . Method Prospect i ve observational data from 5,801 parents and adolescents taking part in a large UK population cohort ( Avon‐Longitudinal‐ Study ‐of‐Parents‐ and ‐Children ) were used to test associations between  maternal and paternal depression and anxiety  in the perinatal period , executive function ( EF ) at age 8 , and academic achievement at the end of compulsory school at age 16 . Results Adolescents of postnatally depressed mothers were 1.5 times ( 1.19 , 1.94 , p = .001 ) as likely as adolescents of nondepressed mothers to fail to achieve a ‘ pass ’ grade in math ; antenatal anxiety was also an independent predictor of poor math . Disruption in different components of EF explained small but significant proportions of these associations : attentional control explained 16 % ( 4 % , 27 % , p < .001 ) of the association with postnatal depression , and working memory explained 17 % ( 13 % , 30 % , p = .003 ) of the association with antenatal anxiety . A similar pattern was seen for language grade s , but associations were confounded by maternal education . There was no evidence that paternal factors were independently associated with impaired child EF or adolescent exams . Conclusion Maternal postnatal depression and antenatal anxiety are risk factors for adolescents underachieving in math . Preventing , identifying , and treating maternal mental health in the perinatal period could , therefore , potentially increase adolescents ’ academic achievement . Different aspects of EF partially mediated these associations . Further work is needed , but if these pathways are causal , improving EF could reduce underachievement in math BACKGROUND Although anxiety disorders are documented in the literature for new mothers ( but less so for fathers ) , rates of postpartum caseness tend to include only those with depression when diagnostic interviews or self-report measures vali date d on such interviews are used . This methodology therefore underestimates the true percentage of women and men who experience significant psychological difficulties postpartum . This has implication s for assessment , treatment and screening for postnatal mood disorders . METHOD Two studies were conducted on a total of 408 women and 356 men expecting their first child . They were recruited antenatally , and interviewed at 6 weeks postpartum using the Diagnostic Interview Schedule . DSM-IV criteria were applied to determine the presence since birth of depression ( major or minor ) , panic disorder , acute adjustment disorder with anxiety ( meeting the criteria for generalised anxiety disorder except for the duration criterion ) , and phobia . RESULTS The inclusion of diagnostic assessment for panic disorder and acute adjustment disorder with anxiety increased the rates of caseness by between 57 and 100 % for mothers , and 31 - 130 % for fathers , over the rates for major or minor depression . Inclusion of assessment for phobia further increased the rates of disorder in both sample s. Couple concordance rates were between 6.6 and 11.1 % , with no significant difference between rates for depressive or depressive and anxious caseness . For women , a previous history of an anxiety disorder appears to be a greater risk factor for a postnatal mood disorder ( i.e. depression or anxiety ) than a history of a depressive disorder . CONCLUSIONS These results clearly show the need to assess for both depression and anxiety  in new and expectant parents , and we believe the term ' postnatal mood disorder ' ( PMD ) , rather than postnatal depression , more accurately reflects significant adjustment difficulties in new parents BACKGROUND The risk for emotional and behavioral problems is known to be high among children of depressed mothers , but little is known about the impact of prenatal and postnatal depression on the physical health of infants . OBJECTIVE To determine whether maternal depression is a risk factor for malnutrition and illness in infants living in a low-income country . DESIGN Prospect i ve cohort study . SETTING Rural community in Rawalpindi , Pakistan . PARTICIPANTS Six hundred thirty-two physically healthy women were assessed in their third trimester of pregnancy to obtain at birth a cohort of 160 infants of depressed mothers and 160 infants of psychologically well mothers . MAIN OUTCOME MEASURES All infants were weighed and measured at birth and at 2 , 6 , and 12 months of age , and they were monitored for episodes of diarrhea and acute respiratory infections . The mothers ' mental states were reassessed at 2 , 6 , and 12 months . Data were collected on potential confounders of infant outcomes , such as birth weight and socioeconomic status . RESULTS Infants of prenatally depressed mothers showed significantly more growth retardation than controls at all time points . The relative risks for being underweight ( weight-for-age z score of less than -2 ) were 4.0 ( 95 % confidence interval [ CI ] , 2.1 to 7.7 ) at 6 months of age and 2.6 ( 95 % CI , 1.7 to 4.1 ) at 12 months of age , and the relative risks for stunting ( length-for-age z score of less than -2 ) were 4.4 ( 95 % CI , 1.7 to 11.4 ) at 6 months of age and 2.5 ( 95 % CI , 1.6 to 4.0 ) at 12 months of age . The relative risk for 5 or more diarrheal episodes per year was 2.4 ( 95 % CI , 1.7 to 3.3 ) . Chronic depression carried a greater risk for poor outcome than episodic depression . The associations remained significant after adjustment for confounders by multivariate analyses . CONCLUSIONS Maternal depression in the prenatal and postnatal periods predicts poorer growth and higher risk of diarrhea in a community sample of infants . As depression can be identified relatively easily , it could be an important marker for a high-risk infant group . Early treatment of prenatal and postnatal depression could benefit not only the mother 's mental health but also the infant 's physical health and development Purpose Antenatal maternal mental health has been identified as an important determinant of postpartum depression ( PPD ) . We investigated the occurrence of depression both antenatally and postnatally and examined whether maternal trait anxiety and depression during pregnancy were associated with PPD at 8 weeks postpartum in a prospect i ve mother – child cohort ( Rhea Study ) in Crete , Greece . Methods 438 women completed the  Edinburgh Postnatal Depression Scale ( EPDS ) and the Trait subscale of the State-Trait Anxiety Inventory ( STAI-Trait ) question naires assessing antenatal depression and anxiety  , respectively , during the third trimester of pregnancy as well as the EPDS at 8 weeks postpartum . Results The prevalence of women with probable depression ( EPDS score ≥13 ) was 16.7 % at 28–32 weeks of pregnancy and 13.0 % at 8 weeks postpartum . A per 5 unit increase in the STAI-Trait subscale increased the odds for PPD by 70 % ( OR = 1.70 , 95 % CI 1.41 , 2.05 ) , whereas a per unit increase in EPDS during pregnancy increased the odds for PPD by 27 % ( OR = 1.27 , 95 % CI 1.19 , 1.36 ) . Conclusions Our findings suggest that antenatal maternal psychological well-being has a significant effect on PPD , which might have important implication s for early detection during pregnancy of women at risk for postpartum depression BACKGROUND Previous animal investigations link antenatal stress with a range of persistent behavioural abnormalities in the offspring . The current study examined if the effect was also found in humans through middle childhood . METHODS The current study is based on the Avon Longitudinal Study of Parents and Children ( ALSPAC ) , a prospect i ve , community-based study that has followed a cohort of women from pregnancy .  Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period . Children 's behavioural/emotional problems  were assessed by parent report at age 47 and 81 months . Information on obstetric and psychosocial factors was obtained at several points in pregnancy and the postnatal period . RESULTS Children whose mothers experienced high levels of anxiety in late pregnancy exhibited higher rates of behavioural/emotional problems at 81 months of age after controlling for obstetric risks , psychosocial disadvantage , and postnatal anxiety and depression ( for girls , OR = 1.91 , 95%CI = 1.26 - 2.89 ; for boys , OR = 2.16 , 95%CI = 1.41 - 3.30 ) . Furthermore , the effect at 81 months was comparable to what was previously obtained at 47 months , suggesting the kind of persistent effect proposed in the animal literature . CONCLUSIONS There is evidence that  antenatal stress/anxiety  has a programming effect on the fetus which lasts at least until middle childhood BACKGROUND Depression is familial . Evidence shows that untreated postnatal depression is associated with adverse outcomes for the child . Few studies have traced prospect ively the course of maternal depression through pregnancy , the postnatal period and the following 16 years in relation to adolescent offspring depression . METHOD The sample was recruited from two general practice antenatal clinics . Of 151 mother-child dyads followed from pregnancy to 16 years , information on the course of maternal depression and on depression in adolescent offspring was available for 127 ( 84 % ) . RESULTS Two-thirds ( 82/125 ) of the women had been depressed during the 17-year time period , with the majority ( 54/82 ) experiencing more than one episode . A third of the women were depressed in pregnancy ( 41/124 ) . Over half of these women ( 23/41 ) had consulted a doctor about their mental health prior to being pregnant and almost 90 % ( 35/39 ) had further episodes during the child 's lifetime . 14 % ( 18/127 ) of the adolescent offspring were diagnosed with a depressive disorder at 16 years . Every depressed adolescent had been exposed to maternal depression . The risk of depression for the 16-year-olds exposed to antenatal depression was 4.7 times greater than for offspring not so exposed . The effect of antenatal depression  was mediated by repeated exposure . LIMITATIONS The number of study participants is small and limited to an inner-city population . Only depression spectrum diagnoses in the adolescent offspring have been considered . CONCLUSIONS Detection of depression in pregnancy identifies mothers at risk of further depressive episodes and a group of children who are at risk of depression in adolescence Purpose This prospect i ve study investigated associations between prenatal attachment of adult first-time mothers to the unborn child , perinatal factors and levels of depression before and up to 18 months after delivery . Method Primiparas ( N = 161 ) without specific risk factors answered the following question naires during the last term of pregnancy ( t1 ) :  Edinburgh Postnatal Depression Scale ( EPDS ) , Maternal Antenatal Attachment Scale ( MAAS ) , question naire on the schema of the unborn child , and a question naire about the pregnancy .  Perinatal data were taken from the patients ’ files . The EPDS was answered 3 weeks ( t2 , N = 157 ) , 6 months ( t3 , N = 159 ) , and 18 months ( t4 , N = 132 ) postpartum . Results During pregnancy , 16.9 % of the women indicated mild depressive symptoms , and 7.5 % , medium to severe symptoms of depression . Mild symptoms of depression were found in 25.5 % at t2 , 10.1 % at t3 , and 12.2 % at t4 ; medium to severe symptoms were reported by 7.6 , 1.9 and 5.6 % , respectively . Women with low control during delivery ( emergency Caesarean ) showed a tendency for higher levels ( p = 0.067 ) of depression at t3 than women with elective Caesarean did . The quality of prenatal attachment to the unborn child correlated negatively with depressive symptoms at t1–t4 . Conclusions The closer the prenatal attachment of a mother to her unborn child , the less symptoms of depression she reports during the last term of pregnancy and postpartum . Therefore , promoting good mother – child attachment during pregnancy might influence the level of postpartum depression BACKGROUND Parents of children with chronic illnesses are at high risk for secondary mental health problems , such as anxiety and depression . OBJECTIVE To evaluate maternal outcomes of a support intervention for families of children with selected chronic illnesses . DESIGN A r and omized controlled clinical trial design with repeated measures 1 year apart . SETTING A community-based family support intervention linked to subspecialty and general pediatric clinics and practice s in a metropolitan area . PARTICIPANTS A population -based sample of 193 mothers of children aged 7 to 11 years ; the children were diagnosed as having diabetes , sickle cell anemia , cystic fibrosis , or moderate to severe asthma . About 15 % of the persons contacted refused to participate in the research , and 14 % of the families were lost to follow-up . INTERVENTION The 15-month intervention , the Family-to-Family Network , was design ed to enhance mothers ' mental health by linking mothers of school-aged children with selected chronic illnesses with mothers of older children with the same condition . The program included telephone contacts , face-to-face visits , and special family events . MAIN OUTCOME MEASURES Beck Depression Inventory score and the Psychiatric Symptom Index . RESULTS Maternal anxiety scores for participants in the experimental group decreased during the intervention period for all diagnostic groups and for the total group ; scores for the control group increased ( F = 5.07 , P = .03 ) . In multiple regression analyses , the intervention group was a significant predictor of posttest anxiety scores ( P = .03 ) . Effects were greater for mothers with high baseline anxiety ( P<.001 ) and for those who were themselves in poor health ( P<.01 ) . CONCLUSIONS A family support intervention can have beneficial effects on the mental health status of mothers of children with chronic illnesses . This type of intervention can be implemented in diverse pediatric setting OBJECTIVE To examine the hypothesis that the effects of postnatal depression on children 's behavioral/emotional problems are explained by antenatal maternal mood . METHOD The current study investigated this hypothesis in the Avon Longitudinal Study of Parents and Children , a prospect i ve , community-based study that has followed a cohort of women since pregnancy ( n = 7,144 ) who delivered their baby between April 1 , 1991 , and December 31 , 1992 .  Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period . Children 's behavioral/emotional problems were assessed by parent report at age 4 years . RESULTS After controlling for smoking , alcohol use , birth weight for gestational age , maternal age , child sex , and socioeconomic status , postnatal depression  at 8 weeks ( OR = 2.27 [ 1.55 - 3.31 ] ) and 8 months ( OR = 1.68 [ 1.12 - 2.54 ] ) was associated with children 's behavioral/emotional problems . Subsequent analyses that included antenatal maternal mood indicated that antenatal anxiety in late pregnancy and not antenatal depression was also independently associated with behavioral/emotional problems at age 4 ( OR = 1.72 [ 1.14 - 2.59 ] ) ; 8 week postnatal depression remained a significant predictor after antenatal maternal mood was statistically controlled for ( OR = 1.56 [ 1.04 - 2.32 ] ) . CONCLUSIONS  Antenatal anxiety and postnatal depression  represent separate risks for behavioral/emotional problems in children and act in an additive manner BACKGROUND : Childbearing years in the women ’s life are associated with the highest risk of depression . In this study depression in third trimester of pregnancy and after delivery was studied . Depressive symptom score and the proportion of mothers above a threshold were compared to indicate probable depressive disorder at each stage . METHODS : This prospect i ve cohort study was conducted in rural areas of Isfahan province of Iran from September 2007 to January 2008 . Subjects were all in their third trimester and followed up from the beginning of the study to 6 - 8 weeks postpartum . At all , 2156 pregnant women completed the self report question naires but 258 were excluded because they were incomplete and final analysis was done with 1898 sample s. At the final stage the sample size was decreased to 1291 . RESULTS : The prevalence of depression based on BDI score greater than 20 in last trimester of pregnancy , was 22.8 % and rate of depression based on EPD score greater than 12 between 6 to 8 weeks after delivery , was 26.3 % . Incidence of Post Partum Depression ( PPD ) in 6 to 8 weeks after delivery in those who were not clinical ly depressed during pregnancy was 20.1 % . Results showed that history of depression , unplanned pregnancy , being housewife and having 3 or more children had significant relation with ante partum depression . CONCLUSIONS : Two main risk factors for post partum depression are previous history of depression and depression during current pregnancy . It is important to assess these variables during pregnancy in order to facilitate timely identification of women at risk BACKGROUND Post-partum depression ( PPD ) is the most common complication of pregnancy in developed countries , affecting 10 - 15 % of new mothers . There has been a shift in thinking less in terms of PPD per se to a broader consideration of poor mental health , including anxiety after giving birth . Some risk factors for poor mental health in the post-partum period can be identified prenatally ; however prenatal screening tools developed to date have had poor sensitivity and specificity . The objective of this study was to develop a screening tool that identifies women at risk of distress , operationalized by elevated symptoms of depression and anxiety in the post-partum period using information collected in the prenatal period . METHODS Using data from the All Our Babies Study , a prospect i ve cohort study of pregnant women living in Calgary , Alberta ( N = 1578 ) , we developed an integer score-based prediction rule for the prevalence of PPD , as defined as scoring 10 or higher on the Edinburgh Postnatal Depression Scale ( EPDS ) at 4-months postpartum . RESULTS The best fit model included known risk factors for PPD : depression and stress in late pregnancy , history of abuse , and poor relationship quality with partner . Comparison of the screening tool with the EPDS in late pregnancy showed that our tool had significantly better performance for sensitivity . Further validation of our tool was seen in its utility for identifying elevated symptoms of postpartum anxiety . CONCLUSION This research heeds the call for further development and validation work using psychosocial factors identified prenatally for identifying poor mental health in the post-partum period There are no established screening criteria to help identify mothers of premature infants who are at risk for symptoms of emotional distress . The current study , using data obtained from recruitment and screening in preparation for a r and omized controlled trial , aim ed to identify potential risk factors associated with symptoms of depression , anxiety and posttraumatic stress in a sample of mothers with premature infants hospitalized in a neonatal intensive care unit . One hundred , thirty-five mothers of preterm infants born at 26–34 weeks of gestation completed three self-report measures : the Stanford Acute Stress Reaction Question naire , the Beck Depression Inventory ( 2nd ed . ) , and the Beck Anxiety Inventory  to determine their eligibility for inclusion in a treatment intervention study based on clinical cut-off scores for each measure . Maternal sociodemographic measures , including race , ethnicity , age , maternal pregnancy history , and measures of infant medical severity were not helpful in differentiating mothers who screened positive on one or more of the measures from those who screened negative . Programs to screen parents of premature infants for the presence of symptoms of posttraumatic stress , anxiety , and depression will need to adopt universal screening rather than profiling of potential high risk parents based on their sociodemographic characteristics or measures of their infant 's medical severity OBJECTIVE To examine incidence , trends , and correlates of  parental depression  in primary care from 0 to 12 years of child age . DESIGN Prospect i ve cohort study . SETTING Primary care records from more than 350 general practice s in The Health Improvement Network data base from 1993 to 2007 . PARTICIPANTS A total of 86 957 mother , father , and child triads identified in The Health Improvement Network data base by linking mothers and babies and then identifying an adult household man . Depressed parents were identified using Read code entries for depression and antidepressant prescriptions . MAIN EXPOSURES Child age , parental age at the birth , and area deprivation quintile . MAIN OUTCOME MEASURES Incidence rates for maternal and paternal episodes of depression . RESULTS Overall incidences of depression from the birth of the child up to age 12 years were 7.53 per 100 person-years for mothers and 2.69 per 100 person-years for fathers . Depression was highest in the first year post partum ( 13.93 and 3.56 per 100 person-years among mothers and fathers , respectively ) . By 12 years of child age , 39 % of mothers and 21 % of fathers had experienced an episode of depression . A history of depression , lower parental age at the birth of the child , and higher social deprivation were associated with a higher incidence of parental depression . CONCLUSIONS Parents are at highest risk for depression in the first year after the birth of their child . Parents with a history of depression , younger parents , and those from deprived areas are particularly vulnerable to depression . There is a need for appropriate recognition and management of  parental depression  in primary care OBJECTIVE : Postpartum anxiety screening does not typically occur , despite changes in life roles and responsibility after childbirth . We sought to determine the prevalence of postpartum anxiety during the maternity hospitalization and its associations with maternal and child outcomes . We further aim ed to compare correlates of anxiety with correlates of depression . METHODS : For a r and omized controlled trial of mothers with “ well ” newborns ≥34 weeks ’ gestation comparing 2 post – hospital discharge care models , mothers completed baseline in-person interviews during the postpartum stay and telephone surveys at 2 weeks , 2 months , and 6 months to assess health care use , breastfeeding duration , anxiety , and depression . All participants intended to breastfeed  . State anxiety scores ≥40 on the State Trait Anxiety Inventory ( STAI ) and depression scores ≥12 on the Edinburgh Postnatal Depression Survey ( EPDS ) were considered positive . RESULTS : A total of 192 ( 17 % ) of 1123 participating mothers had a positive baseline STAI ; 62 ( 6 % ) had a positive EPDS . Primiparity was associated with a positive STAI ( 20 % vs 15 % , P = .02 ) , but not a positive EPDS ( 4 % vs 7 % , P = .05 ) . Positive STAI scores were associated with cesarean delivery ( 22 % vs 15 % , P = .001 ) , reduced duration of breastfeeding ( P = .003 ) , and increased maternal , but not infant total unplanned health care utilization within 2 weeks of delivery ( P = .001 ) . Positive STAI scores occurred more frequently than positive EPDS scores at each assessment through 6 months postpartum . CONCLUSIONS : Postpartum state anxiety is a common , acute phenomenon during the maternity hospitalization that is associated with increased maternal health care utilization after discharge and reduced breastfeeding duration . State anxiety screening during the postpartum stay could improve these outcomes BACKGROUND Perinatal mood disorders affect up to 20 % of women in the United States . Little is known about how disorders in maternal mood may affect rates of breastfeeding . OBJECTIVE To determine the impact of prenatal depressive symptoms and high pregnancy-related anxiety on ( 1 ) prenatal intention to breastfeed and ( 2 ) breastfeeding initiation . METHODS We prospect ively followed 1436 pregnant women enrolled in the cohort study Project Viva . The main outcome measures were ( 1 ) mother 's second trimester self-report of intention to use all or mostly formula in the first week of life and ( 2 ) failure to initiate breastfeeding . We defined prenatal depressive symptoms as a second trimester Edinburgh Postpartum Depression Scale ( EPDS ) score of > or = 13 and high pregnancy-related anxiety as a " very much " response to three or more questions on a first trimester pregnancy anxiety scale . RESULTS Of the 1436 participants , 9 % ( n = 125 ) had prenatal depressive symptoms indicative of depression , and 10 % ( n = 141 ) reported high pregnancy-related anxiety ; 11 % ( n = 159 ) intended to give mostly or only formula in the first week of life , and 86 % ( n = 1242 ) initiated breastfeeding . In multivariate analyses , women with prenatal depressive symptoms ( OR 1.92 , 95 % CI 1.11 , 3.33 ) and high pregnancy-related anxiety ( OR 1.99 , 95 % CI 1.12 , 3.54 ) were roughly two times more likely than women without these mood disorders to plan to formula feed . However , neither prenatal depressive symptoms ( OR 1.06 , 95 % CI 0.61 , 1.84 ) nor high pregnancy-related anxiety ( OR 1.28 , 95 % CI 0.74 , 2.20 ) was associated with failure to initiate breastfeeding . CONCLUSIONS In a healthcare setting highly supportive of breastfeeding , women with prenatal depressive symptoms and possibly those with high pregnancy-related anxiety were less likely to plan prenatally to breastfeed , although this tendency did not translate into lower breastfeeding initiation rates OBJECTIVE Adolescent pregnancy is common and minority adolescents are at high risk . We sought the following : ( 1 ) to prospect ively assess prevalence of antenatal depression  ( AND ) and postpartum depression ( PPD ) in minority adolescents and ( 2 ) to examine the association of social support and adjustment , trauma , and stress on depression status . STUDY DESIGN A total of 212 pregnant adolescents were recruited from public prenatal clinics and administered a prospect i ve research survey during pregnancy and 6 weeks ' postpartum .  Depression was measured using the Edinburgh Postnatal Depression Scale .  Univariate , bivariate , and multivariable analyses were performed using logistic regression to assess predictors of AND and PPD . RESULTS In our cohort , 20 % screened positive for AND and 10 % for PPD . The strongest predictor of PPD was AND ( odds ratio [ OR ] , 4.89 ; P < .001 ) . Among adolescents with trauma history , there was a 5-fold increase ( OR , 5.01 ) in the odds of AND and a 4-fold increase ( OR , 3.76 ) in the odds of PPD . AND was associated with the adolescent 's poor social adjustment ( P < .001 ) , perceived maternal stress ( P < .001 ) , less social support ( P < .001 ) , and a less positive view of pregnancy ( P < .001 ) . PPD was significantly associated with primiparity ( P = .002 ) , poor social adjustment ( P < .001 ) , less social support and involvement of the baby 's father ( P < .001 ) , and less positive view of pregnancy ( P < .001 ) . CONCLUSION Significant independent risk factors for PPD include AND , view of pregnancy , and social support . Trauma history was highly prevalent and strongly predicted AND and PPD . Point prevalence decreased postpartum , and this may be due to transient increased social support following the birth , warranting longer follow-up and development of appropriate interventions in future work
The strongest evidence for an adverse effect of PMA exposure is in somatic and psychological outcomes ; the evidence for an effect of PMA on child development is inconclusive .
Several decades of research have focused on the impact of exposure to postnatal depression on children , while anxiety has been largely overlooked .
Estimates of the prevalence of postnatal maternal anxiety ( PMA ) range from 3 % to 43 % , suggesting PMA may be an important risk factor for adverse outcomes in children .
This review summarizes what is known about the effects of  PMA exposure on children and makes recommendations for future research .