title: Effects of depression, anxiety, self-esteem, and health behaviour on neonatal outcomes in a population-based Hungarian sample.
abstract: OBJECTIVE
  To investigate possible associations of maternal antenatal depression, anxiety and self-esteem with negative neonatal outcomes controlling for the effects of demographic covariates and health behaviour in a Hungarian sample.
  
  
  METHODS
  A population-based monitoring system was established in 10 districts of health visitors in Szombathely, Hungary, covering every woman registered as pregnant between February 1, 2008 and February 1 2009. Three hundred and seven expectant women in the early stage of their pregnancy were surveyed using the Short Form of Beck Depression Inventory for the measurement of depression and the Spielberger Trait-Anxiety Inventory for the measurement of anxiety. Self-esteem was evaluated by the Rosenberg's Self-Esteem Scale. At the end of the follow-up period, data on 261 mothers and their singleton neonates were available. The relationship between the explanatory and outcome variables (birth weight, length, chest circumference, gestational age, and 1- and 5-min Apgar score) was tested in girls and boys separately by multiple linear regression analysis (Forward method). Categorical variables were used as "dummy variables".
  
  
  RESULTS
  Maternal depression, anxiety and health behaviour did not show any association with neonatal outcomes. Higher level of maternal self-esteem was associated with higher birth weight and birth length in boys and higher birth length in girls. Maternal education positively correlated with birth length, gestational age and chest circumference in boys, and with birth length in girls. In girls, maternal socioeconomic status showed a positive association with birth weight and gestational age, while common law marriage had a negative effect on birth weight and chest circumference.
  
  
  CONCLUSIONS
  Lower level of maternal self-esteem possibly leads to a higher level of maternal stress which may reduce fetal growth via physiologic changes. Gender differences in associations between demographic factors and neonatal outcome measures indicate differences in fetal development between boys and girls.
authors.affiliation: Department of Health Visiting, Institute of Public Health, Recreation and Health Promotion, Faculty of Health Sciences, University of Pécs, Szombathely Campus, Hungary. btamas@etk.pte.hu
authors.forename: Tamás
authors.initials: T
authors.lastname: Bödecs
authors.forename: Boldizsár
authors.initials: B
authors.lastname: Horváth
authors.forename: Eniko
authors.initials: E
authors.lastname: Szilágyi
authors.forename: Xénia
authors.initials: X
authors.lastname: Gonda
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Rihmer
authors.forename: János
authors.initials: J
authors.lastname: Sándor
mesh_terms: D001008:Anxiety Disorders / Q000150:complications / Q000453:epidemiology; D001724:Birth Weight; D003863:Depression / Q000150:complications* / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012923:Social Class