Effects of maternal stress and anxiety during pregnancy on the fetus : review

Preterm delivery is one of the leading causes of neonatal and infant mortality and the leading cause of infant morbidity. It is responsible for more than 70% of neonatal deaths and nearly 50% of long-term neurologically disabled infants and children. All efforts should therefore be made to reduce these sad losses to women and their families and the sometimes preventable permanent neurological harm to children. Many pregnancies are complicated by psychosocial problems. In South Africa, women are exposed to many psychosocial stressors, including poverty and traumatic stress. South African women have some of the highest rates of antenatal depression in the world (up to 40% in comparison to international rates of 10-15%). Furthermore rates of intimate partner violence are high, with 30% of pregnant women reporting intimate partner violence in the last year. In the past, routine screening for these problems at antenatal visits, have been neglected. However, more recently, the American College of Obstetricians and Gynecologists has recommended that all pregnant women, regardless of social status, should have a psychosocial screening done once in each trimester. They recommended that the screening should include a wide range of psychosocial conditions, including depression, intimate partner violence and stress. In a plea for action to improve maternal health, Al-Saleh and Di Renzo recently referred to maternal stress as a cause of disability.