ABSTRACT
The mother’s emotional state during pregnancy matters, not only for herself but also for the development of her fetus and future child. If the pregnant woman is stressed, anxious, or depressed, this increases the risk for her child having a range of emotional, behavioral, or physical problems later, although most children are not affected. Recent research has shown that many women are depressed or anxious during pregnancy because of the early trauma or adverse childhood experiences (ACEs), which they themselves have suffered. Such early trauma may even affect the fetus independent of the mother’s prenatal anxiety, stress, or depression. Many women also feel pregnancy specific anxiety, that is, anxiety related to the outcome of their pregnancy. We are starting to understand the biological mechanisms underlying such fetal programming, especially the role of the placenta, the HPA axis, inflammation and the immune system, and epigenetic changes. All this has significant implications for the clinical care of the obstetric patient such that psychological assessment, including trauma history, should be part of services as a routine matter, and the significant options for treatment – even preventative ones – are embedded in prenatal practices, either on site or as well-coordinated referrals often called ‘warm hand offs’. During pregnancy, more than one patient is present: the pregnant women and her future child. For centuries, medical practice has held this view with respect to the mother and child’s physical health; research strongly supports adopting this view for the women’s mental health and her child’s neurobehavioral development.
