Pregnancy as a period of risk, adaptation, and resilience for mothers and infants

“The scope of adversity includes childhood adversity, such as maltreatment and broader adverse childhood experiences (ACEs), which, in addition to maltreatment, include exposure to family/household dysfunction (i.e., parental divorce/ separation, domestic violence, substance use, mental illness, and incarceration; CDC,…”

“Furthermore, numerous epidemiological and observational studies demonstrate that small size at birth is predictive of a range of physical and mental health outcomes throughout the life span (Barker, Eriksson, Forsen, & Osmond, 2002; Davis, Buss, et al., 2011; Kim et al., 2014).”

“Depending on the nature, severity, and chronicity of the childhood adversity exposure, some pregnant women who were chronically maltreated may show hypocortisolism, a pattern observed in non-pregnant, chronically maltreated individuals (Gunnar & Quevedo, 2007; Yehuda et al., 2010).”

“Neurogenesis commences as early as 42 days after conception (Stiles & Jernigan, 2010) and by the end of the second trimester, 200 billion neurons have been produced (Bourgeois, 1997).”

“This hypothesis was generated largely based on studies of in-utero nutritional deprivation (Barker, 2002; Gluckman & Hanson, 2004).”

“Several recent meta-analyses provide strong evidence that prenatal maternal depression is associated with preterm birth (Grigoriadis et al., 2013; Grote et al., 2010) and low birth weight (Grote et al., 2010).”

“The Fetal Programming or Developmental Origins of Health and Disease (DOHaD) hypothesis posits that during sensitive Windows of fetal development, the environment can exert lasting influences on health and well-being across the life span (Barker, 1998).”

“Although more difficult to distinguish due to normative fears concerning pregnancy and childbirth, rates of prenatal anxiety also are higher compared to non-pregnant women (Dunkel Schetter & Tanner, 2012).”

“Cells migrate to their final destination where they begin to arborize and form dendritic branches (Sidman & Rakic, 1973).”

“Experiences during the prenatal period are critical for normative processes from the closing of the neural tube to development of circuits involved in sensory processing (Burton, Hempstock, & Jauniaux, 2001; Godfrey & Barker, 2001; Moon & Fifer, 2000).”

“In terms of proximal resources, social support during pregnancy is strongly associated with women’s prenatal mental health (Dunkel Schetter, Sagrestano, Feldman, & Killingsworth, 1996; Dunkel Schetter, 2011; Sperlich & Seng, 2008).”

“However, both increased and decreased connectivity have been observed in resting state and depending on the type of task that is used (Gee et al., 2013).”

“Furthermore, numerous epidemiological and observational studies demonstrate that small size at birth is predictive of a range of physical and mental health outcomes throughout the life span (Barker, Eriksson, Forsen, & Osmond, 2002; Davis, Buss, et al., 2011; Kim et al., 2014).”

“…and shows similar associations to outcomes than prospective assessments (e.g., Glynn et al., 2019), although associations between retrospectively reported adversity and outcomes may be impacted by contemporaneous factors (e.g., mental state, trait negativity, ongoing stress; Reuben et al., 2016).”

“Several recent meta-analyses provide strong evidence that prenatal maternal depression is associated with preterm birth (Grigoriadis et al., 2013; Grote et al., 2010) and low birth weight (Grote et al., 2010).”

“In lower-income samples, PTSD symptoms may be clinically elevated in as many as 18%–29% of pregnant women or more, particularly if women are high-risk due to childhood adversity and pregnancy complications (Narayan et al., 2017; Narayan, Atzl, et al., 2019; Yildiz, Ayers, & Phillips, 2017).”

“The hormone changes associated with gestation are linked to changes in neuronal structure, signaling, and neurogenesis (Keyser-Marcus et al., 2001; Shingo et al., 2003).”

“In terms of associations with stress physiology, following the 911 attacks, Yehuda et al. (2005) reported that mothers who developed PTSD had lower salivary cortisol levels, as did their infants.”

“Both hypercortisolism and hypocortisolism during pregnancy are associated with negative consequences for maternal and fetal well-being (Bowers & Yehuda, 2020; Davis et al., 2017; Davis & Sandman, 2010; Yehuda & Meaney, 2018).”

“This hypothesis was generated largely based on studies of in-utero nutritional deprivation (Barker, 2002; Gluckman & Hanson, 2004).”

“…with persisting consequences for both the mother and her offspring (Barker, Jaffee, Uher, & Maughan, 2011; Buss et al., 2012; Davis & Pfaff, 2014; Davis & Sandman, 2012; Korhonen, Luoma, Salmelin, & Tamminen, 2012; O’Donnell, Glover, Barker, & O’Connor, 2014; Sandman, Buss, Head, & Davis, 2015).”

“Additional prospective longitudinal studies have linked prenatal maternal anxiety to problems with attentional control through adolescence (Van den Bergh & Marcoen, 2004; Van den Bergh et al., 2005).”

“…problems and stress predict greater negative emotionality and fearful temperament in the offspring, assessed by both laboratory observation and maternal report (Blair, Glynn, Sandman, & Davis, 2011; Davis et al., 2004, 2007; Huot, Brennan, Stowe, Plotsky, & Walker, 2004; Rouse & Goodman, 2014).”

“During pregnancy, the maternal pituitary gland doubles in size, and cortisol levels increase 3-to 5-fold over gestation, achieving levels typically only seen in Cushing’s disease (Mastorakos & Ilias, 2003; Sandman et al., 2006).”

“The link between prenatal maternal mental health problems and offspring internalizing psychopathology is also apparent in young adulthood, as documented in several large cohort studies (Capron et al., 2015; Pearson et al., 2013; Plant, Pariante, Sharp, & Pawlby, 2015).”

“Downregulation of cortisol secretion, however, may increase risk that subsequent adversity will not be met with an effective stress response and may render individuals more susceptible to mental health problems, such as PTSD (Bowers & Yehuda, 2016; Pratchett & Yehuda, 2011).”

“…study, pregnant women’s higher numbers of reported benevolent childhood experiences (BCEs) involving supportive relationships and a positive and predictable quality of life were associated with fewer mental health problems and lower exposure to adversity during pregnancy (Narayan et al., 2018).”

“…mental health, evidence from studies of invitro fertilization or quasi-experimental natural disaster research suggests that environmental factors additionally contribute to the intergenerational transmission of mental health problems (Glynn et al., 2001; King & Laplante, 2005; Rice et al., 2009).”

“Fewer studies have evaluated the relation between maternal PTSD during pregnancy and child outcomes (Cook et al., 2018; Seng, Low, Sperlich, Ronis, & Liberzon, 2011).”

“…is a sensitive window when the fetus responds to nutritional deprivation with the development of a “thrifty phenotype” that promotes survival in an environment where food is scarce but is maladaptive and increases risk for metabolic disease when food is plentiful (Gluckman, Hanson & Pinal, 2005).”

“Like the toad, these adaptations are advantageous if the fetus is born preterm, but also may have long-term costs (Davis, Glynn, et al., 2011; Stout, Espel, Sandman, Glynn, & Davis, 2015).”

“…brain additionally is particularly susceptible to harm from teratogenic factors such as toxins, infection, maternal stress including prenatal mental health problems, and other environmental exposures (Davis, Head, Buss, & Sandman 2017; Davis et al., 2019; Kim et al., 2017; Madigan et al., 2018).”

“However, in contrast to the negative feedback at the level of the hypothalamus, cortisol stimulates the production of CRH from the placenta, similar to the role of cortisol in the amygdala (Robinson, Emanuel, Frim, & Majzoub, 1988).”

“…with persisting consequences for both the mother and her offspring (Barker, Jaffee, Uher, & Maughan, 2011; Buss et al., 2012; Davis & Pfaff, 2014; Davis & Sandman, 2012; Korhonen, Luoma, Salmelin, & Tamminen, 2012; O’Donnell, Glover, Barker, & O’Connor, 2014; Sandman, Buss, Head, & Davis, 2015).”

“Further, normative increases in pregnancy-related hormones (e.g., estrogen) not only predict maternal behavior, but experimental administration of them also elicits the onset of maternal behavior in virgin animals (Fahrbach & Pfaff, 1986; Numan, 2006; Numan, Rosenblatt, & Komisaruk, 1977).”

“Therefore, during pregnancy, there is a positive feedback loop whereby both maternal and fetal cortisol stimulate an increase in the production of CRH from the placenta (Sandman et al., 2006; Waffarn & Davis, 2012).”

“Synaptogenesis is present as early as the 16th gestational week, indicating communication between neurons (Bourgeois, Goldman-Rakic, & Rakic, 1994; Kostović, Judas, Rados, & Hrabac, 2002).”

“During pregnancy, the HPA axis response to a variety of different stressors diminishes (de Weerth & Buitelaar, 2005).”

“This toad has a fascinating adaptive response to adversity (Denver, 1997).”

“For other women, however, it might represent a period of increased risk, especially if the pregnancy is unplanned or the perpetrator questions the paternity (Chambliss, 2008; Jasinski, 2004; Narayan, Hagan, Cohodes, Rivera, & Lieberman, 2016).”

“Moreover, women who do not show the normative decrease in physiological and psychological stress responding during pregnancy are at increased risk for preterm delivery (Buss, Entringer, et al., 2009; Glynn, Dunkel Schetter, Hobel, & Sandman, 2008).”

“…problems and stress predict greater negative emotionality and fearful temperament in the offspring, assessed by both laboratory observation and maternal report (Blair, Glynn, Sandman, & Davis, 2011; Davis et al., 2004, 2007; Huot, Brennan, Stowe, Plotsky, & Walker, 2004; Rouse & Goodman, 2014).”

“Prenatal maternal stress and mental health problems are associated with persisting consequences for both the mother and her offspring (Barker, Jaffee, Uher, & Maughan, 2011; Buss et al., 2012; Davis & Pfaff, 2014; Davis & Sandman, 2012; Korhonen, Luoma, Salmelin, & Tamminen, 2012; O’Donnell,…”

“…mental health, evidence from studies of invitro fertilization or quasi-experimental natural disaster research suggests that environmental factors additionally contribute to the intergenerational transmission of mental health problems (Glynn et al., 2001; King & Laplante, 2005; Rice et al., 2009).”

“The endocrine profile in pregnancy also may impact maternal sensitivity to stressors, thereby contributing to vulnerability to mental health problems during the perinatal period (Glynn, Davis, & Sandman, 2013).”

“…with persisting consequences for both the mother and her offspring (Barker, Jaffee, Uher, & Maughan, 2011; Buss et al., 2012; Davis & Pfaff, 2014; Davis & Sandman, 2012; Korhonen, Luoma, Salmelin, & Tamminen, 2012; O’Donnell, Glover, Barker, & O’Connor, 2014; Sandman, Buss, Head, & Davis, 2015).”

“Additional prospective longitudinal studies have linked prenatal maternal anxiety to problems with attentional control through adolescence (Van den Bergh & Marcoen, 2004; Van den Bergh et al., 2005).”

“Further, childhood maltreatment also is associated with alterations in placental–fetal stress physiology, including significantly steeper increases in placental CRH across gestation (Buss et al., 2017; Moog et al., 2018).”

“Further, normative increases in pregnancy-related hormones (e.g., estrogen) not only predict maternal behavior, but experimental administration of them also elicits the onset of maternal behavior in virgin animals (Fahrbach & Pfaff, 1986; Numan, 2006; Numan, Rosenblatt, & Komisaruk, 1977).”

“McDonnell and Valentino (2016) found that maternal self-report of childhood adversity predicted both prenatal maternal depression symptoms and poorer infant socioemotional functioning, suggesting that prenatal factors may contribute to the link between maternal adversity and child outcomes.”

“…with persisting consequences for both the mother and her offspring (Barker, Jaffee, Uher, & Maughan, 2011; Buss et al., 2012; Davis & Pfaff, 2014; Davis & Sandman, 2012; Korhonen, Luoma, Salmelin, & Tamminen, 2012; O’Donnell, Glover, Barker, & O’Connor, 2014; Sandman, Buss, Head, & Davis, 2015).”

“Neurogenesis commences as early as 42 days after conception (Stiles & Jernigan, 2010) and by the end of the second trimester, 200 billion neurons have been produced (Bourgeois, 1997).”

“Consistent with observational human data, a mouse model of prenatal traumatic experiences showed that prenatal exposure caused an increase in anxiety-like behavior in the offspring (Osborne et al., 2018).”

“However, some investigators have documented that maternal PTSD during pregnancy predicts poorer infant birth outcomes, lower maternal–infant bonding, and higher levels of infant distress (Seng, 2002; Seng et al., 2013).”

“Depending on the nature, severity, and chronicity of the childhood adversity exposure, some pregnant women who were chronically maltreated may show hypocortisolism, a pattern observed in non-pregnant, chronically maltreated individuals (Gunnar & Quevedo, 2007; Yehuda et al., 2010).”

“…child and adolescent outcomes (Davis et al., 2018; de Weerth, 2018; Madigan et al., 2018; Robinson, Lahti-Pulkkinen, Heinonen, Reynolds, & Raikkonen, 2019; Sandman, Davis, Buss, & Glynn, 2011), we only briefly overview the links between prenatal maternal mental health and child outcomes here.”

“Experiences during the prenatal period are critical for normative processes from the closing of the neural tube to development of circuits involved in sensory processing (Burton, Hempstock, & Jauniaux, 2001; Godfrey & Barker, 2001; Moon & Fifer, 2000).”

“Prenatal hormone trajectories of the HPA and placental axis have been proposed to be one of the risk indicators for the development of postpartum depression (Glynn et al., 2013; Glynn & Sandman, 2014; Yim et al., 2009, 2010).”

“Further, childhood maltreatment also is associated with alterations in placental–fetal stress physiology, including significantly steeper increases in placental CRH across gestation (Buss et al., 2017; Moog et al., 2018).”

“For other women, however, it might represent a period of increased risk, especially if the pregnancy is unplanned or the perpetrator questions the paternity (Chambliss, 2008; Jasinski, 2004; Narayan, Hagan, Cohodes, Rivera, & Lieberman, 2016).”

“In one study, offspring were 3.4 times more likely to have a diagnosed depressive disorder at 18–25 years of age after accounting for postnatal maternal depression and sociodemographic risk factors (Plant et al., 2015).”

“…problems and stress predict greater negative emotionality and fearful temperament in the offspring, assessed by both laboratory observation and maternal report (Blair, Glynn, Sandman, & Davis, 2011; Davis et al., 2004, 2007; Huot, Brennan, Stowe, Plotsky, & Walker, 2004; Rouse & Goodman, 2014).”

“Experiences during the prenatal period are critical for normative processes from the closing of the neural tube to development of circuits involved in sensory processing (Burton, Hempstock, & Jauniaux, 2001; Godfrey & Barker, 2001; Moon & Fifer, 2000).”

“Of note, MomCare is particularly beneficial for women with histories of adversity (Grote, Zuckoff, Swartz, Bledsoe, & Geibel, 2007, 2015).”

“During the prenatal period the HPA axis plays a key role in regulation of fetal maturation and timing of delivery and directly impacts the maternal brain (Howland et al., 2017; Smith, Mesiano, & McGrath, 2002).”

“The CRH produced from the placenta is identical in structure and bioactivity to CRH produced from the hypothalamus (Goland, 1988).”

“During the prenatal period the HPA axis plays a key role in regulation of fetal maturation and timing of delivery and directly impacts the maternal brain (Howland et al., 2017; Smith, Mesiano, & McGrath, 2002).”

“Further in a sample of 907 dyads, Letourneau et al. (2019) showed that the relation between maternal ACEs and child internalizing and externalizing problems was partially mediated by prenatal maternal anxiety and depression.”

“The link between prenatal maternal mental health problems and offspring internalizing psychopathology is also apparent in young adulthood, as documented in several large cohort studies (Capron et al., 2015; Pearson et al., 2013; Plant, Pariante, Sharp, & Pawlby, 2015).”

“Furthermore, lower levels of salivary cortisol in infants were subsequently associated with higher levels of infants’ distress (Brand, Engel, Canfield, & Yehuda, 2006).”

“MomCare is a culturally-relevant, collaborative care intervention that provides brief IPT via approximately eight sessions after an initial engagement session (Grote et al., 2015).”

“For women with histories of childhood adversity, such as maltreatment and other interpersonal trauma in their families of origin, the pregnancy period can be a time when women are haunted by unresolved traumatic experiences (Lieberman, Díaz, & Van Horn, 2009; Narayan, Oliver Bucio, et al., 2016; Slade et al., 2009).”

“…are associated with persisting consequences for both the mother and her offspring (Barker, Jaffee, Uher, & Maughan, 2011; Buss et al., 2012; Davis & Pfaff, 2014; Davis & Sandman, 2012; Korhonen, Luoma, Salmelin, & Tamminen, 2012; O’Donnell, Glover, Barker, & O’Connor, 2014; Sandman, Buss,…”

“Moreover, like depression, maternal PTSD during pregnancy also is associated with shorter gestation and lower infant birth weight (Seng et al., 2011).”

“In a study by Posner et al. (2016), 6-week old infants exposed to prenatal maternal depression demonstrated increased inverse (i.e., increased negative) resting state functional connectivity between the amygdala and bilateral dorsal prefrontal cortex and ventromedial prefrontal cortex.”

“Interestingly, fetuses that go on to be delivered preterm display reduced connectional integrity as compared to age-matched fetuses who are delivered at term (Thomason et al., 2017).”

“…women may experience twice the rate of depression (up to 20% vs. 10%; Center for Disease Control and Prevention (CDC), 2019b), and low-income pregnant women may experience more than three-fold rates of depression (approximately 30% to 50% vs. 10%: Choi & Sikkema, 2016; Narayan et al., 2017).”

“Therefore, during pregnancy, there is a positive feedback loop whereby both maternal and fetal cortisol stimulate an increase in the production of CRH from the placenta (Sandman et al., 2006; Waffarn & Davis, 2012).”

“…in children’s stress responses and circadian HPA axis functioning from the neonatal period through adolescence (Davis, Glynn, Waffarn, & Sandman, 2011; Galbally, van Rossum, Watson, de Kloet, & Lewis, 2019; O’Donnell et al., 2013; Van den Bergh, Van Calster, Smits, Van Huffel, & Lagae, 2008).”

“For example, a mother’s report of more positive relationships with her parental figures and the presence of more affection during childhood were associated with fewer prenatal depression symptoms (Chung, Mathew, Elo, Coyne, & Culhane, 2008).”

“…mental health, evidence from studies of invitro fertilization or quasi-experimental natural disaster research suggests that environmental factors additionally contribute to the intergenerational transmission of mental health problems (Glynn et al., 2001; King & Laplante, 2005; Rice et al., 2009).”

“A robust non-human animal literature documents that the experience of pregnancy is associated with neurological changes in the mother that persist throughout her life span (see Glynn et al., 2018 for review).”

“Furthermore, studies that have covaried for women’s histories of childhood adversity and current stressful life events continue to find that the presence of high-quality social support is associated with benefits for women’s prenatal mental health (Racine et al., 2019; Séguin et al., 1995).”

“…with persisting consequences for both the mother and her offspring (Barker, Jaffee, Uher, & Maughan, 2011; Buss et al., 2012; Davis & Pfaff, 2014; Davis & Sandman, 2012; Korhonen, Luoma, Salmelin, & Tamminen, 2012; O’Donnell, Glover, Barker, & O’Connor, 2014; Sandman, Buss, Head, & Davis, 2015).”

“…linking maternal childhood and adulthood adversity to disruptions in stress physiology do not consider the preceding and often ongoing role of mental health problems during pregnancy, which may affect and be affected by altered stress physiology (Evans, Myers, & Monk, 2008; Yehuda & Meaney, 2018).”

“Downregulation of cortisol secretion, however, may increase risk that subsequent adversity will not be met with an effective stress response and may render individuals more susceptible to mental health problems, such as PTSD (Bowers & Yehuda, 2016; Pratchett & Yehuda, 2011).”

“Specifically, the more consistent the pre-and postnatal periods, the better infants performed on the Bayley Scale of Mental Development (Sandman, Davis, & Glynn, 2012).”

“Further, normative increases in pregnancy-related hormones (e.g., estrogen) not only predict maternal behavior, but experimental administration of them also elicits the onset of maternal behavior in virgin animals (Fahrbach & Pfaff, 1986; Numan, 2006; Numan, Rosenblatt, & Komisaruk, 1977).”

“Prenatal hormone trajectories of the HPA and placental axis have been proposed to be one of the risk indicators for the development of postpartum depression (Glynn et al., 2013; Glynn & Sandman, 2014; Yim et al., 2009, 2010).”

“However, these data are suggestive that early experiences shape developmental trajectories in ways that may be adaptive, but also increase risk for subsequent mental health problems (Tottenham, 2020).”

“Although many of these studies rely on retrospective reports of positive childhood which may be impacted by current mental health and other factors, there is evidence for convergence between prospective and retrospective reports (e.g., Glynn et al., 2019).”

“…may impact behavioral regulation, as elevated placental CRH in utero have been found to predict offspring’s increased internalizing problems (Davis et al., 2005; Howland et al., 2016) and may have persisting consequences for brain development during childhood (Curran, Sandman, Davis,…”

“In terms of proximal resources, social support during pregnancy is strongly associated with women’s prenatal mental health (Dunkel Schetter, Sagrestano, Feldman, & Killingsworth, 1996; Dunkel Schetter, 2011; Sperlich & Seng, 2008).”

“The hormone changes associated with gestation are linked to changes in neuronal structure, signaling, and neurogenesis (Keyser-Marcus et al., 2001; Shingo et al., 2003).”

“…prenatal mental health problem than depression and anxiety but an especially potent risk for women with childhood adversity, are also elevated in community samples of pregnant women compared to their non-pregnant counterparts (e.g., approximately 6%–8% compared to 4%–5%; Seng, Rauch, et al., 2010).”

“Both hypercortisolism and hypocortisolism during pregnancy are associated with negative consequences for maternal and fetal well-being (Bowers & Yehuda, 2020; Davis et al., 2017; Davis & Sandman, 2010; Yehuda & Meaney, 2018).”

“Moreover, women who do not show the normative decrease in physiological and psychological stress responding during pregnancy are at increased risk for preterm delivery (Buss, Entringer, et al., 2009; Glynn, Dunkel Schetter, Hobel, & Sandman, 2008).”

“Relying less on social support from previously maltreating caregivers is associated with a reduction in the risk of childhood maltreatment when babies were born, even among women who continued to have elevated depression (Easterbrooks, Chaudhuri, Bartlett, & Copeman, 2011).”

“Prenatal hormone trajectories of the HPA and placental axis have been proposed to be one of the risk indicators for the development of postpartum depression (Glynn et al., 2013; Glynn & Sandman, 2014; Yim et al., 2009, 2010).”

“The goal of the Care Project specifically is to test whether reducing maternal depression affects child developmental outcomes, as the long-term benefits to offspring following prenatal interventions delivered to women remain unknown (Davis et al., 2018; Garcia et al., 2019).”

“…brain additionally is particularly susceptible to harm from teratogenic factors such as toxins, infection, maternal stress including prenatal mental health problems, and other environmental exposures (Davis, Head, Buss, & Sandman 2017; Davis et al., 2019; Kim et al., 2017; Madigan et al., 2018).”

“These include associations with general cognitive function (Davis & Sandman, 2010) and perhaps more specifically with executive function (Buss, Davis, et al., 2009; Davis & Sandman, 2010).”

“…as elevated placental CRH in utero have been found to predict offspring’s increased internalizing problems (Davis et al., 2005; Howland et al., 2016) and may have persisting consequences for brain development during childhood (Curran, Sandman, Davis, Glynn, & Baram, 2017; Sandman et al., 2018).”

“…problems and stress predict greater negative emotionality and fearful temperament in the offspring, assessed by both laboratory observation and maternal report (Blair, Glynn, Sandman, & Davis, 2011; Davis et al., 2004, 2007; Huot, Brennan, Stowe, Plotsky, & Walker, 2004; Rouse & Goodman, 2014).”

“Both hypercortisolism and hypocortisolism during pregnancy are associated with negative consequences for maternal and fetal well-being (Bowers & Yehuda, 2020; Davis et al., 2017; Davis & Sandman, 2010; Yehuda & Meaney, 2018).”

“Like the toad, these adaptations are advantageous if the fetus is born preterm, but also may have long-term costs (Davis, Glynn, et al., 2011; Stout, Espel, Sandman, Glynn, & Davis, 2015).”

“Maternal report of childhood maltreatment is linked to elevations in hair cortisol concentrations during pregnancy (Schreier et al., 2015) and has been found to amplify the impact of women’s more proximal exposure to adulthood traumatic events prior to pregnancy on prenatal hair cortisol…”

“For instance, retrospective report of both family dysfunction and physical and emotional abuse, but not sexual abuse, was associated with psychosocial difficulties, including depression, anxiety, perceived stress, and other social risks, during pregnancy (Racine, Madigan, et al., 2018).”

“…humans as well as accelerated maturation (Class et al., 2008; Sandman et al., 2006; Swales et al., 2019), and these alterations may have adaptive advantages for survival; for example, stressed fetuses tend to have greater lung maturity when born preterm (Dunkel Schetter, 2009; Glynn et al., 2008).”

“…of adversity that may be previously unrecognized sources of mental health problems and stress, and then having the opportunity to connect to more formalized, tailored services and preventive interventions during pregnancy, depending on their needs and other priorities (Narayan et al., 2017, 2019).”

“…in children’s stress responses and circadian HPA axis functioning from the neonatal period through adolescence (Davis, Glynn, Waffarn, & Sandman, 2011; Galbally, van Rossum, Watson, de Kloet, & Lewis, 2019; O’Donnell et al., 2013; Van den Bergh, Van Calster, Smits, Van Huffel, & Lagae, 2008).”

“Furthermore, numerous epidemiological and observational studies demonstrate that small size at birth is predictive of a range of physical and mental health outcomes throughout the life span (Barker, Eriksson, Forsen, & Osmond, 2002; Davis, Buss, et al., 2011; Kim et al., 2014).”

“Finally, empirical evidence points to increased plasticity in the maternal as well as the fetal brain during the prenatal period (Davis et al., 2019; Glynn, 2010, 2012; Glynn, Davis, Sandman, & Goldberg, 2016).”

“Childhood adversity more broadly, and childhood maltreatment more specifically, is associated with elevated maternal mental health problems during pregnancy, such as elevated depression, anxiety, and PTSD symptoms (Choi & Sikkema, 2016; Racine, Zumwalt, McDonald, Tough, & Madigan, 2019; Seng, 2002).”

“…maltreatment is linked to elevations in hair cortisol concentrations during pregnancy (Schreier et al., 2015) and has been found to amplify the impact of women’s more proximal exposure to adulthood traumatic events prior to pregnancy on prenatal hair cortisol concentrations (Swales et al., 2018).”

“Prenatal stress exposure additionally increases risk for development of maternal anxiety and mood disorders (Slattery & Hillerer, 2016).”

“As there are many excellent reviews linking prenatal maternal psychological distress to infant, child and adolescent outcomes (Davis et al., 2018; de Weerth, 2018; Madigan et al., 2018; Robinson, Lahti-Pulkkinen, Heinonen, Reynolds, & Raikkonen, 2019; Sandman, Davis, Buss, & Glynn, 2011), we only…”

“…regulation, as elevated placental CRH in utero have been found to predict offspring’s increased internalizing problems (Davis et al., 2005; Howland et al., 2016) and may have persisting consequences for brain development during childhood (Curran, Sandman, Davis, Glynn, & Baram, 2017;…”

“The stress signal placental CRH is similarly associated with both shortened gestation and preterm birth in humans as well as accelerated maturation (Class et al., 2008; Sandman et al., 2006; Swales et al., 2019), and these alterations may have adaptive advantages for survival; for example, stressed…”

“Finally, empirical evidence points to increased plasticity in the maternal as well as the fetal brain during the prenatal period (Davis et al., 2019; Glynn, 2010, 2012; Glynn, Davis, Sandman, & Goldberg, 2016).”

“Prenatal hormone trajectories of the HPA and placental axis have been proposed to be one of the risk indicators for the development of postpartum depression (Glynn et al., 2013; Glynn & Sandman, 2014; Yim et al., 2009, 2010).”

“Higher levels of social support also predicted infants’ more effective cortisol reactivity following a stressor partially mediated by both lower levels of prenatal depression and more positive Mother×Infant interactions (Thomas, Letourneau, Bryce, Campbell, & Giesbrecht, 2017).”

“…as elevated placental CRH in utero have been found to predict offspring’s increased internalizing problems (Davis et al., 2005; Howland et al., 2016) and may have persisting consequences for brain development during childhood (Curran, Sandman, Davis, Glynn, & Baram, 2017; Sandman et al., 2018).”

“Placental CRH production in the maternal circulation increases 40-fold from the end of the first trimester to term (Sandman et al., 2006; Sandman, Glynn, & Davis, 2015).”

“Relatedly, prenatal maternal depression predicted problems with executive functioning and attention shifting at 4 years of age (El Marroun et al., 2017) as well as increased risk for an ADHD diagnosis during childhood (Clemens et al., 2015).”

“The placenta, a fetal organ, produces hormones including CRH in both the maternal and fetal systems (King, Nicholson, & Smith, 2001).”

“…from the father of the baby) were higher, the associations between infants’ negative temperament and their cortisol levels were attenuated, suggesting protective effects of both better prenatal mental health and greater social support (Luecken, MacKinnon, Jewell, Crnic, & Gonzales, 2015).”

“For women with histories of childhood adversity, such as maltreatment and other interpersonal trauma in their families of origin, the pregnancy period can be a time when women are haunted by unresolved traumatic experiences (Lieberman, Díaz, & Van Horn, 2009; Narayan, Oliver Bucio, et al., 2016; Slade et al., 2009).”

“…not only a window when the consequences of maternal adversity and resulting problems with mental health and stress physiology impact the fetus, but also a window of opportunity for resilience and intervention (Davis et al., 2018; Narayan et al., 2019; Sperlich & Seng, 2008; Yehuda & Meaney, 2018).”

“In terms of proximal resources, social support during pregnancy is strongly associated with women’s prenatal mental health (Dunkel Schetter, Sagrestano, Feldman, & Killingsworth, 1996; Dunkel Schetter, 2011; Sperlich & Seng, 2008).”

“In terms of specificity of adversity and prenatal mental health problems, studies have linked physical and psychological IPV victimization during pregnancy to women’s heighted levels of prenatal depression (Flanagan, Gordon, Moore, & Stuart, 2015).”

“In another study, infants born to women who were pregnant during and then developed PTSD in response to an earthquake in Wenchuan County of Sichuan Province in China showed impairments in cognitive development (Cai et al., 2017).”

“For other women, however, it might represent a period of increased risk, especially if the pregnancy is unplanned or the perpetrator questions the paternity (Chambliss, 2008; Jasinski, 2004; Narayan, Hagan, Cohodes, Rivera, & Lieberman, 2016).”

“…from the baby’s father and other counterparts, as well as greater availability of help in general, is associated with lower levels of anxiety and depression symptoms during pregnancy (Dunkel Schetter, 2011; River, Narayan, Atzl, Rivera, & Lieberman, 2020; Séguin, Potvin, Denis, & Loiselle, 1995).”

“…actually had poorer mental health and higher levels of stress during pregnancy if they self-reported high levels of support from partners but were rated by trained coders to actually have low levels of support based on their open-ended descriptions of partners (River, Narayan, Atzl et al., 2019).”

“During gestation, maternal physiology undergoes massive changes including transformations in stress physiology and immune function, both of which likely have implications for the maternal brain (Howland, Sandman, & Glynn, 2017; Noroña, Doom, Davis, & Gunnar, 2020).”

“…maltreatment is linked to elevations in hair cortisol concentrations during pregnancy (Schreier et al., 2015) and has been found to amplify the impact of women’s more proximal exposure to adulthood traumatic events prior to pregnancy on prenatal hair cortisol concentrations (Swales et al., 2018).”

“Both hypercortisolism and hypocortisolism during pregnancy are associated with negative consequences for maternal and fetal well-being (Bowers & Yehuda, 2020; Davis et al., 2017; Davis & Sandman, 2010; Yehuda & Meaney, 2018).”

“Infants’ regulatory skills are highly susceptible to alterations in the caregiving environment (Davis & Narayan, 2020; Gartstein & Skinner, 2018).”

“Higher maternal stress before conception and during pregnancy increases the risk for low birth weight, preterm birth, and offspring mental and physical health problems (Davis and Narayan, 2020; Keenan et al., 2018; Staneva et al., 2015; van den Bergh et al., 2020).”

“1 3 that pregnancy is an important life stage for development of future chronic disease risk not only for the fetus but also the mother [48], consideration of health risks associated with PFAS exposure during the prenatal period should be a priority and a method of sustained primordial prevention of chronic disease.”

“…health importance, as it indicates impairment not only in maternal psychological wellbeing, but also has robust long-term consequences for child mental health (Capron et al., 2015; Davis & Narayan, 2020; O ’ Donnell, Glover, Barker, & O ’ Connor, 2014; Plant, Pariante, Sharp, & Pawlby, 2015).”

“In particular, if women report high ACEs and low positive childhood experiences, assessing PCEs during pregnancy, adulthood, and parenthood may promote chances to provide resources and take preventive action before children are born (Davis & Narayan, 2020).”

“So far, only a limited number of studies have assessed SS longitudinally during pregnancy and postpartum in the same women, meaning that knowledge regarding the progression of SS trajectories during the entire peripartum period is limited (26, 27).”

“Psychosomatic Medicine, V 84 • 525-535 525 developmental trajectories (5).”

“Massive neurogenesis, neuronal migration to the cortex and synaptogenesis, among others, are crucial processes for a future brain healthy function (Davis and Narayan, 2020).”

“These findings also suggest that many individuals are capable of providing high quality parenting despite prior exposure to adversity and violence (14, 66, 97).”

“a resilience approach, one can shed light on this critically significant problem [10].”

“Pregnancy may be a sensitive window when individuals are particularly vulnerable to the long-reaching effects of ACEs (Davis & Narayan, 2020).”

“…Origins of Health and Disease (DOHaD) framework posits that maternal experiences of stress during pregnancy influence children’s developmental outcomes, including mental health [3], through both maternal-placental-fetal biological pathways and postnatal environmental differences [4–9].”

“The results showed that the most important factors related to depression or anxiety before delivery were a lack of a spouse or social support, a history of abuse or domestic violence, a personal history of psychological disorders, unintended pregnancy, traumatic life events, and high perceivable stress, the complicati…”

“Few studies have directly assessed processes that promote resilience following prenatal adversity (Atzl, Grande, Davis, & Narayan, 2019; Davis & Narayan, 2020; D ’ Anna-Hernandez & Rivera, 2014; Røsand, Slinning, Eberhard-Gran, Røysamb, & Tambs, 2011).”

“…suggests that offspring may be more vulnerable to the biopsychosocial sequelae of maternal trauma during the fetal period of development (Bouvette-Turcot et al., 2020; Bowers & Yehuda, 2016; Buss et al., 2017; Davis & Narayan, 2020; Keenan et al., 2018; Swales et al., 2018; Yehuda &Meaney, 2018).”

“M. Nevarez-Brewster et al. Developmental Cognitive Neuroscience 58 (2022) 101174 gestation maternal stress and sleep perturbations (Davis and Sandman, 2010; Okun et al., 2011).”

“This sensitivity is key to survival outside the womb, as it allows tailoring and adaptation to changing inputs (Entringer et al., 2015) in a manner that can have positive and negative implications for development and health across the lifecourse (Davis & Narayan, 2020).”

“…epigenetic changes and changes in maternal biological stress responses expose offspring to more maternal stress hormones in utero and thus potentiate neuroendocrine changes in childhood in both stress and non-stress conditions (Bowers & Yehuda, 2015; Davis & Narayan, 2020; Yehuda & Lerner, 2018).”

“It is well-known that pregnancy heralds a very special time with marked physiological and psychological change, during which maternal behaviors and exposures can yield lasting impacts on the health of the mother and fetus [3–5].”

“Experiences of stress and adversity, defined as experiences or conditions that threaten, or are perceived to threaten, physiological equilibrium (Loman & Gunnar, 2010; Weinstock, 2005), during sensitive periods of development may have especially enduring impacts on health (Davis & Narayan, 2020).”

“Pregnancy is a critical period in an individual’s life, during which exposure to environmental factors can have lasting health consequences [1].”

“Pregnant women in particular, are at a heightened risk of experiencing psychological distress [1], and complex psychological and physiological changes which occur during pregnancy can impart additional mental health vulnerabilities [2].”

“…emotion regulation; pregnancy; prenatal stress; respiratory sinus arrhythmia 1 INTRODUCTION In order to meet the incredible demands of fetal growth and development, pregnant women endure some of the most profound physiological changes in the female lifespan (Davis & Narayan, 2020; Schaffir, 2016).”

“Indeed, social support is “one of the most robust correlates of better maternal mental health” and is associated with lower depressive and anxiety symptoms among birthing parents across racial, ethnic, and income groups (Atzl et al., 2019; Davis & Narayan, 2020, p. 1632).”

“In addition, the psychological distress domain is usually mentioned as having the greatest impact on the OHRQoL because of the psychological changes that occur during this phase [32].”

“…difficulties in performing daily activities, failure to seek prenatal care, inadequate diet and use of harmful substances (drugs, tobacco, and alcohol), postpartum depression, complicated birth, preterm birth, increased risk of fetal growth restriction and low birth weight [2, 3, 20–23].”

“39 Elevated inflammatory and pro ‐ inflammatory biomarkers were observed when mothers experienced stress during the prenatal period.”

“They are highly susceptible to trauma and environmental toxins [42].”

“This sensitive period can be influenced by adversities, but it is also a time when positive factors can significantly impact the health and well-being of the pregnant woman and her offspring [125, 127–133].”

“Such changes include hormonal flux, growth of the placental organ, immunological and commensal microbial shifts, and a rapidly changing body to accommodate the growing fetus (Davis and Narayan, 2020; Glynn et al., 2018; Kazma et al., 2020).”

“It is clear that antenatal mental health plays a role in wellbeing for both mother and offspring, both individually and dyadically (Davis and Narayan, 2020; Ramey et al., 2015).”

“The pregnancy period is considered a window of opportunity to foster resilience and adaptation in mothers and their newborns [42].”

“Pregnancy marks a period of dynamic neurodevelopment, during which the developing fetus is particularly vulnerable to external influences (Davis & Narayan, 2020).”

“Body image theory and practice should be implemented by the inclusion of evidence-based clinical interventions to promote psychological well-being during the antenatal period [1].”

“…literature has extensively demonstrated that individuals exposed to such intense adverse conditions during developmental windows of heightened plasticity (Kim, 2016) may be susceptible to developing maladaptive stress responses and affective symptoms (Davis & Narayan, 2020; Pluess & Belsky, 2011).”

“This recommendation is complementary to the ones already given by experts, including attention to the beliefs and socio-emotional needs of women [7,11].”

“The prenatal period is a time of rapid development, during which the brain is particularly plastic and also sensitive to environmental influences (Davis and Narayan, 2020; Gyllenhammer et al., 2022).”

“The perinatal period provides opportunities to promote mental health and resilience of future parents and, consequently, prevent the intergenerational transmission of stress and psychopathology in the next generation [10].”

“Pregnancy provides opportunities to recognize and address crucial prenatal factors affecting early parent-child relationships and subsequent child development (e.g. Davis & Narayan, 2020).”

“As mentioned, during the pregnancy period childhood memories become more salient as mothers contemplate their experiences and consider how they would like to raise their child (Davis & Narayan, 2020).”

“Pregnancy is a natural physiological event, but the stress reactions it causes in the body are a process that affects all body systems and requires the physical, mental and social adaptation of the woman [1, 2].”

“High levels of resilience are likely to reduce perinatal stress, anxiety, and depression, as well as disrupt the intergenerational cycle of trauma for their infants [57, 98, 99].”

“During this vulnerable period, higher stress levels, however, increase the likelihood to suffer from psychological disorders such as maternal anxiety, and prenatal or postnatal depression (Davis & Narayan, 2020).”

“…and parenting, literature also suggests that mothers who experience stress and related mental health problems can enjoy secure attachments with their offspring and be responsive and supportive parents (Daryanani et al., 2016; Davis & Narayan, 2020; Greene et al., 2020; Jones-Mason et al., 2023).”

“Pregnancy and early postpartum are periods of substantial change and potential vulnerability to stress for the expectant individual and new parent (Coussons-Read, 2013; Davis and Narayan, 2020).”

“Preparing for motherhood is often viewed as a time of joy, anticipation, and personal transformation; however, pregnancy can also represent a period of heightened psychological vulnerability, due to a unique interplay of emotional, physical, and social stressors [1,2].”

“Increasing empirical [18] and clinical [19] recognition of the risks of intergenerational transmission of maternal adversity suggests that further study of ACEs is needed to appropriately intervene to improve maternal and child health.”

“Resilience is a positive psychological resource which can prevent mental disorders, and is a dynamic process that enables people at any stage of life to cope with adversity, bounce back after difficulties, manage unpleasant feelings, and adapt to change (5,15) .”

“These disorders can reduce a person ’ s resilience to adult stress and lead to disability in various aspects of their personal and social life (Davis and Narayan, 2020).”

“Health-related quality of life (HRQOL) is the term used to describe the health status as a crucial element of overall quality of life [3–5].”