Tonsillectomy by means of plasma-mediated ablation: prospective, randomized, blinded comparison with monopolar electrosurgery. Maternal Cognitions and Mother–Infant Interaction in Postnatal Depression and Generalized Anxiety Disorder The impact of postnatal and concurrent maternal depression on child behaviour during the early school years. Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis. Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant responses to the still-face procedure. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect.
OBJECTIVE To compare plasma-mediated ablation ( PMA ) with monopolar electrosurgery ( MES ) for pediatric tonsillectomy . DESIGN Prospect i ve , r and omized , blinded study . SETTING Academic children 's hospital . PARTICIPANTS Thirty-four children , aged 4 to 7 years . INTERVENTIONS Tonsillectomy by means of PMA ( n = 17 ) or MES ( n = 17 ) . OUTCOME MEASURES We measured surgical efficacy , estimated blood loss , and surgical time during tonsillectomy and morphine use , immediate postoperative pain , and recovery scores after tonsillectomy . Parents recorded recovery of normal diet and activity and their own return to work for 10 days after surgery . Histopathologic evaluation of excised tonsils was performed . We review ed medical records and attempted follow-up telephone contact . RESULTS With no significant difference in blood loss compared with MES , PMA was effective for tonsillectomy . Performance of PMA took longer ( 24 vs 16 minutes ; P = .002 ) . Results of histopathologic evaluation showed less thermal injury with PMA than with MES ( P = .03 ) . Morphine consumption , pain , and recovery scores were equivalent between groups . We found no significant difference in recovery of normal diet and activity or parental return to work .  Patients undergoing PMA  had a greater number of perioperative complications than those undergoing MES , including 2 patients in the PMA group ( compared with none in the MES group ) who required unplanned admission for postoperative airway obstruction . CONCLUSIONS Plasma-mediated ablation for pediatric tonsillectomy result ed in less histopathologic thermal injury than MES , but did not show a statistically faster recovery to normal activity and diet or parental return to work . In addition , PMA took longer to perform , and had more complications . Therefore , PMA should not replace MES for pediatric tonsillectomy . The reduced thermal injury with PMA supports investigation into other means of using plasma ablation to treat tonsillar hypertrophy Postnatal depression and anxiety have been shown to increase the risk of disturbances in mother – child interaction and child development . Research into mechanisms has focused on genetics and maternal behavior ; maternal cognitions have received little attention . Our aim was to experimentally determine if worry and rumination in mothers with generalized anxiety disorder ( GAD ) and major depressive disorder ( MDD ) , diagnosed in the postnatal 6 months , interfered with maternal responsiveness to their 10-month old infants . Mothers ( N = 253 : GAD n = 90 ; MDD n = 57 ; control n = 106 ) and their infants were r and omized to either a worry/rumination prime ( WRP ) or a neutral prime ( NP ) ; mother – infant interactions were assessed before and after priming . Type of priming was a significant predictor of maternal cognitions , with WRP result ing in more negative thoughts , higher thought recurrence and more self-focus relative to NP across the entire sample . Interaction effects between group and priming were significant for two parenting variables : Compared with controls , WRP had a more negative impact on maternal responsiveness to infant vocalization for GAD , and to a lesser extent for MDD ; WRP led to decreased maternal vocalization for GAD . Also , mothers with GAD used stronger control after the NP than WRP , as well as compared with other groups , and overall post-priming , their children exhibited lower emotional tone and more withdrawal . Across the entire sample , WRP was associated with increased child vocalization relative to NP . This study demonstrated that disturbances in maternal cognitions , in the context of postnatal anxiety and to a lesser degree depression , play a significant role in mother – child interaction BACKGROUND This prospect i ve study explores the ongoing impact of early and subsequent maternal depression on offspring behaviour in the early school years . METHODS Seventy five mothers recruited into a longitudinal study were assessed for symptoms of depression when their children were 4 , 12 and 15 months , 4 years and later when the children were 6 - 8 years of age . Mothers , fathers , and school teachers were asked to report on children 's internalising and externalising behaviour problems . RESULTS Exposure to maternal depression during the first postpartum year was related to mother reports of child internalising and externalising problems in the early school years . Although depression in the first year predicted later internalising problems , effects for externalising behaviour problems were mediated by concurrent depression . Relations between concurrent maternal depression and externalising problems were confirmed by teacher ratings . Interestingly , the severity of symptoms at four months was significantly correlated with behaviour problems seven years later . LIMITATIONS Attrition over successive study contacts and therefore limited statistical power is acknowledged . Findings may be a conservative estimate of associations between maternal depression and later child behaviour problems . Also , the high prevalence of depressive symptomatology in the population from which the sample was drawn may limit the generalisability of results . CONCLUSIONS Findings confirm the importance of early identification and treatment for mothers with postnatal depression , given the likelihood of ongoing depression and relations with later child behaviour problems . From a practical point , severity of early symptoms may be a reliable index of those mothers and children at greatest risk BACKGROUND Previous animal investigations link antenatal stress with a range of persistent behavioural abnormalities in the offspring . The current study examined if the effect was also found in humans through middle childhood . METHODS The current study is based on the Avon Longitudinal Study of Parents and Children ( ALSPAC ) , a prospect i ve , community-based study that has followed a cohort of women from pregnancy .  Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period . Children 's behavioural/emotional problems  were assessed by parent report at age 47 and 81 months . Information on obstetric and psychosocial factors was obtained at several points in pregnancy and the postnatal period . RESULTS Children whose mothers experienced high levels of anxiety in late pregnancy exhibited higher rates of behavioural/emotional problems at 81 months of age after controlling for obstetric risks , psychosocial disadvantage , and postnatal anxiety and depression ( for girls , OR = 1.91 , 95%CI = 1.26 - 2.89 ; for boys , OR = 2.16 , 95%CI = 1.41 - 3.30 ) . Furthermore , the effect at 81 months was comparable to what was previously obtained at 47 months , suggesting the kind of persistent effect proposed in the animal literature . CONCLUSIONS There is evidence that  antenatal stress/anxiety  has a programming effect on the fetus which lasts at least until middle childhood Animal studies have demonstrated the interactive effects of prenatal stress exposure and postnatal rearing style on offspring capacity to manage stress . However , little is known about how parenting quality impacts the association between maternal prenatal anxiety and stress reactivity in human infants . This prospect i ve study examined the impact of prenatal anxiety disorder and maternal caregiving sensitivity on infants ' responses to a st and ardised interactive stressor ( still-face procedure ) .  Eighty-four women completed a clinical interview during pregnancy to assess anxiety symptoms meeting DSM-IV diagnostic criteria . At infant age 7 months , maternal sensitivity to infant distress and infant negative affect were observed and coded during the still-face procedure .  Maternal postnatal ( concurrent ) anxiety and depression were also assessed at this time . Results indicated a negative association between maternal sensitivity to infant distress and infant negative affect responses to the still-face procedure . An unexpected finding was a positive association between parity and infant reactivity . The main effect for sensitivity was qualified by a significant interaction , p<.05 , suggesting that the impact of sensitivity was particularly marked among infants of women who experienced an anxiety disorder during pregnancy . This finding is consistent with a cumulative risk model suggesting that maternal prenatal anxiety and quality of maternal care act in concert to shape infant outcomes OBJECTIVE To examine the hypothesis that the effects of postnatal depression on children 's behavioral/emotional problems are explained by antenatal maternal mood . METHOD The current study investigated this hypothesis in the Avon Longitudinal Study of Parents and Children , a prospect i ve , community-based study that has followed a cohort of women since pregnancy ( n = 7,144 ) who delivered their baby between April 1 , 1991 , and December 31 , 1992 .  Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period . Children 's behavioral/emotional problems were assessed by parent report at age 4 years . RESULTS After controlling for smoking , alcohol use , birth weight for gestational age , maternal age , child sex , and socioeconomic status , postnatal depression  at 8 weeks ( OR = 2.27 [ 1.55 - 3.31 ] ) and 8 months ( OR = 1.68 [ 1.12 - 2.54 ] ) was associated with children 's behavioral/emotional problems . Subsequent analyses that included antenatal maternal mood indicated that antenatal anxiety in late pregnancy and not antenatal depression was also independently associated with behavioral/emotional problems at age 4 ( OR = 1.72 [ 1.14 - 2.59 ] ) ; 8 week postnatal depression remained a significant predictor after antenatal maternal mood was statistically controlled for ( OR = 1.56 [ 1.04 - 2.32 ] ) . CONCLUSIONS  Antenatal anxiety and postnatal depression  represent separate risks for behavioral/emotional problems in children and act in an additive manner OBJECTIVE Moderate to heavy levels of prenatal alcohol exposure have been associated with alterations in child behavior , but limited data are available on adverse effects after low levels of exposure . The objective of this study was to evaluate the dose-response effect of prenatal alcohol exposure for adverse child behavior outcomes at 6 to 7 years of age . METHODS Beginning in 1986 , women attending the urban university-based maternity clinic were routinely screened at their first prenatal visit for alcohol and drug use by trained research assistants from the Fetal Alcohol Research Center . All women reporting alcohol consumption at conception of at least 0.5 oz absolute alcohol/day and a 5 % r and om sample of lower level drinkers and abstainers were invited to participate to be able to identify the associations between alcohol intake and child development . Maternal alcohol , cigarette , and illicit drug use were prospect ively assessed during pregnancy and postnatally . The independent variable in this study , prenatal alcohol exposure , was computed as the average absolute alcohol intake ( oz ) per day across pregnancy . At each prenatal visit , mothers were interviewed about alcohol use during the previous 2 weeks . Quantities and types of alcohol consumed were converted to fluid ounces of absolute alcohol and averaged across visits to generate a summary measure of alcohol exposure throughout pregnancy . Alcohol was initially used as a dichotomous variable comparing children with no prenatal alcohol exposure to children with any exposure . To evaluate the effects of different levels of exposure , the average absolute alcohol intake was relatively arbitrarily categorized into no , low ( > 0 but < 0.3 fl oz of absolute alcohol/day ) , and moderate/heavy ( > /=0.3 fl oz of absolute alcohol/day ) for the purpose of this study . Six years later , 665 families were contacted . Ninety-four percent agreed to testing . Exclusions included children who missed multiple test appointments , had major congenital malformations ( other than fetal alcohol syndrome ) , possessed an IQ > 2 st and ard deviations from the sample mean , or had incomplete data . The Achenbach Child Behavior Checklist ( CBCL ) was used to assess child behavior . The CBCL is a parent question naire applicable to children ages 4 to 16 years . It is widely used in the clinical assessment of children 's behavior problems and has been extensively used in research . Eight syndrome scales are further grouped into Externalizing or undercontrolled ( Aggressive and Delinquent ) behavior and Internalizing or overcontrolled ( Anxious/Depressed , Somatic Complaints , and Withdrawn ) behaviors . Three syndromes ( Social , Thought , and Attention Problems ) fit neither group . Higher scores are associated with more problem behaviors . Research assistants who were trained and blinded to exposure status independently interviewed the child and caretaker . Data were collected on a broad range of control variables known to influence childhood behavior and /or to be associated with prenatal alcohol exposure . These included perinatal factors of maternal age , education , cigarette , cocaine , and other substances of abuse and the gestational age of the baby . Postnatal factors studied included maternal psychopathology , continuing alcohol and drug use , family structure , socioeconomic status , children 's whole blood lead level , and exposure to violence . Data were collected only from black women as there was inadequate representation of other racial groups . STATISTICAL ANALYSES Statistical analyses were performed using the SPSS statistical package . Frequency distribution , cross-tabulation , odds ratio , and chi(2 ) tests were used for analyzing categorical data . Continuous data were analyzed using t tests , analyses of variance ( ANOVAs ) with posthoc tests , and regression analysis . RESULTS Testing was available for 501 parent-children dyads . Almost one fourth of the women denied alcohol use during pregnancy . Low levels of alcohol use were reported in 63.8 % and moderate/heavy use in 13 % of pregnancies . Increasing prenatal alcohol exposure was associated with lower birth weight and gestational age , higher lead levels , higher maternal age , and lower education level , prenatal exposure to cocaine and smoking , custody changes , lower socioeconomic status , and paternal drinking and drug use at the time of pregnancy . Children with any prenatal alcohol exposure were more likely to have higher CBCL scores on Externalizing ( Aggressive and Delinquent ) and Internalizing ( Anxious/Depressed and Withdrawn ) syndrome scales and the Total Problem Score . The odds ratio of scoring in the clinical range for Delinquent behavior was 3.2 ( 1.3 - 7.6 ) in children with any prenatal exposure to alcohol compared with nonexposed controls . The threshold dose was evaluated with the 3 prenatal alcohol exposure groups . One-way ANOVA revealed a significant between group difference for Externalizing ( Aggressive and Delinquent ) and the Total Problem Score . ( ABSTRACT TRUNCATED
The strongest evidence for an adverse effect of PMA exposure is in somatic and psychological outcomes ; the evidence for an effect of PMA on child development is inconclusive .
Several decades of research have focused on the impact of exposure to postnatal depression on children , while anxiety has been largely overlooked .
Estimates of the prevalence of postnatal maternal anxiety ( PMA ) range from 3 % to 43 % , suggesting PMA may be an important risk factor for adverse outcomes in children .
This review summarizes what is known about the effects of  PMA exposure on children and makes recommendations for future research .