title: Anxiety disorders before birth and self-perceived distress during pregnancy: associations with maternal depression and obstetric, neonatal and early childhood outcomes.
abstract: BACKGROUND
  Maternal perinatal mental health has been shown to be associated with adverse consequences for the mother and the child. However, studies considering the effect of DSM-IV anxiety disorders beyond maternal self-perceived distress during pregnancy and its timing are lacking.
  
  
  OBJECTIVE
  To examine the role of maternal anxiety disorders with an onset before birth and self-perceived distress during pregnancy for unfavourable maternal, obstetric, neonatal and childhood outcomes.
  
  
  METHODS
  DSM-IV mental disorders and self-perceived distress of 992 mothers as well as obstetric, neonatal and childhood outcomes of their offspring were assessed in a cohort sampled from the community using the Munich-Composite International Diagnostic Interview. Logistic regression analyses revealed associations (odds ratios) between maternal anxiety disorders and self-perceived distress during pregnancy with maternal depression after birth and a range of obstetric, neonatal and childhood psychopathological outcomes.
  
  
  RESULTS
  Lifetime maternal anxiety disorders were related to offspring anxiety disorders, but not to offspring externalizing disorders. Analyses focussing on maternal DSM-IV anxiety disorders before birth yielded associations with incident depression after birth. In addition, self-perceived distress during pregnancy was associated with maternal depression after birth, preterm delivery, caesarean section, separation anxiety disorder, ADHD, and conduct disorder in offspring.
  
  
  CONCLUSIONS
  Findings confirm the transmission of anxiety disorders from mother to offspring. Apart from maternal anxiety, self-perceived distress during pregnancy also emerged as a putative risk factor for adverse outcomes. The finding that maternal anxiety disorders before birth yielded less consistent associations, suggests that self-perceived distress during pregnancy might be seen as a putative moderator/mediator in the familial transmission of anxiety.
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universitaet, Dresden, Germany. martini@psychologie.tu-dresden.de
authors.forename: Julia
authors.initials: J
authors.lastname: Martini
authors.forename: Susanne
authors.initials: S
authors.lastname: Knappe
authors.forename: Katja
authors.initials: K
authors.lastname: Beesdo-Baum
authors.forename: Roselind
authors.initials: R
authors.lastname: Lieb
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000209:etiology; D001034:Apgar Score; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000150:complications / Q000453:epidemiology*; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects / Q000523:psychology; D012307:Risk Factors; D012649:Self Concept; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology