ABSTRACT
Pregnancy is a time when women are busy preparing for the future and for their new addition to the family unit. However, this exciting time may be darkened with new or pre-existing depression. Numerous studies over the past decade have demonstrated that prenatal depression is much more common than previously thought, with incidence rates ranging from 13% to 20% of pregnant women (Andersson et al., 2006; Evans et al., 2001; Faisal-Cury and Rossi Menezes, 2007). Maternal depression and anxiety during pregnancy have been associated with preeclampsia (PE), premature delivery, fetal growth restriction, newborn irritability and increased infant/child behavioral problems (Gutteling et al., 2005; Kurki et al., 2000; Huizink et al., 2003; Alder et al., 2007; Zuckerman et al., 1990; Huot et al., 2004). Furthermore, the number of women using antidepressants (AD) during pregnancy has increased (Cooper et al., 2007). However, physiological changes related to both gestational depression and the medications used to treat it are poorly understood. Changes in affect (depression and anxiety) are associated with deleterious changes in the autonomic nervous system (ANS) function during pregnancy that may have serious consequences to the mother and the developing fetus (Bleil et al., 2008). Investigation of such physiological correlates of depression during pregnancy may help explain the negative sequelae and may lead to better treatment options. The measurement of heart rate variability (HRV) provides a non-invasive window into the role of the ANS in prenatal pathophysiology. This chapter outlines the effect of prenatal depression and anxiety on the ANS as measured by HRV indices. Section 25.2 identies factors that
CONTENTS
25.1 Introduction ........................................................................................................................ 479 25.2 Importance of Prenatal Maternal Well-Being ................................................................480 25.3 Physiological Changes Associated with Depression and Anxiety ............................. 481 25.4 HPA Axis ............................................................................................................................. 481 25.5 Measurement of the ANS in Pregnancy Using HRV ...................................................483 25.6 Assessment of Infants Exposed to Prenatal Depression and Anxiety.......................485 25.7 Our Work ............................................................................................................................ 487 25.8 Conclusions ......................................................................................................................... 493 Abbreviations .............................................................................................................................. 494 References ..................................................................................................................................... 494
describe the importance of a healthy expectant mother. Sections 25.3 and 25.4 deal with the physiological changes associated with both depression and anxiety. Sections 25.5 and 25.6 discuss HRV measurement in pregnant women and children. The latter part of this chapter presents some of our work.
