Studies - Depression / Suicide / Mental Health

Abortion, Depression and the Impact on Later Children (2011, PNAS/ 2009, BN)

Study: Abortion, Depression and the Impact on Later Children

As a study finds brain changes in children whose mothers were depressed, we examine the research on abortion’s impact on subsequent children.

Recently, researchers at the University of Montreal found that children whose mothers were depressed had changes in their brains.
From the article at MedicalXpress.com:

    Researchers think that brains are sensitive to the quality of child care, according to a study that was directed by Dr. Sonia Lupien and her colleagues from the University of Montreal published today in the Proceedings of the National Academy of Sciences. The scientists worked with ten year old children whose mothers exhibited symptoms of depression throughout their lives, and discovered that the children’s amygdala, a part of the brain linked to emotional responses, was enlarged. …

    “Having enlarged amygdala could be protective and increase the probability of survival,” Lupien said. The amygdala may be protective through a mechanism that produces stress hormones known as glucocorticoids.

The researchers noted that the glucocorticoids levels of the children of depressed mothers who participated in this study increased significantly when they were presented with unfamiliar situations, indicating increased reactivity to stress in those children.

Adults who grew up in similar circumstances as these children show higher levels of glucocorticoids and a greater glucocorticoid reaction when participating in laboratory stress tests. “What would be the long term consequences of this increased reactivity to stress is unknown at this point.”

Enlarged amygdala have also been found in adopted children who were initially raised in orphanages, but not in children who were adopted early in life and by more affluent families, the authors said. They noted that “this strongly suggests that the brain may be highly responsive to the environment early in life.”

Studies Link Abortion to Depression in Women

While the study did not look at abortion, studies have found that women who have abortions are at higher risk for depression compared to women who continue the pregnancy — even when the pregnancy is unplanned. A British Medical Journal study found that compared to women who continued a first, unintended pregnancy, women who had a significantly higher risk of clinical depression as measured an average of eight years later.

In a New Zealand study headed by a pro-choice researcher, women who had abortions subsequently experienced higher rates of depression, substance abuse, anxiety disorders, and suicidal behavior than women who had not had abortions, even after controlling for pre-existing conditions. Approximately 42 percent of women with a history of abortion had experienced major depression in the last four years (nearly double the rate of women who had not been pregnant and 35 percent higher than those who carried to term).

And an analysis of a federally funded longitudinal study of American women revealed that, compared to women who gave birth, women who aborted were 65 percent more likely to be at risk of long-term clinical depression after controlling for age, race, education, marital status, history of divorce, income, and prior psychiatric state.[1]

Coping With Unwanted or Emotionally Distressing Abortions Can Impact Parenting

Research on abortion’s impact on parenting and on subsequent children does exist. For example, researchers using data for 4,844 children, collected through the National Longitudinal Survey of Youth, found that children whose mothers had abortions  had less supportive home environments (among 1 to 4 year olds) and more behavioral problems (among 5 to 9 year olds) than children of women without a history of abortion. The results held true even after controlling for maternal age, education, family income, the number of children in the home and maternal depression.[2]

The paper was co-written by Elliot Institute director Dr. David Reardon and published in The Journal of Child Psychology and Psychiatry. The authors wrote that although the results of the study were probably unprecedented, “they were not all that surprising when considered in light of previous research linking unresolved grief associated with other forms of perinatal loss, such as miscarriage and stillbirth, to compromised parenting.”

Lead author Dr. Priscilla Coleman of Bowling Green State University said that many women undergo abortions as the result of adverse circumstances or pressure from others, making the experience difficult to cope with if the woman was emotionally attached to the fetus or desired to carry the pregnancy to term.

“An abortion could become psychologically similar to other forms of pregnancy loss in some women,” she said.

Indeed, one survey found that 64 percent of American respondents who underwent abortions reported being pressured by others to do so, and a survey of women in post-abortion counseling groups found that more than 80 percent said they would have carried to term under better circumstances or with more support from those around them.

Ways Abortion May Impact Mother-Child Relationships

Coleman also authored a review of studies [http://www.theunchoice.com/News/parentingreview.htm] examining various types of prenatal loss and the effects on subsequent parenting. In the review, she concluded that abortion may be “particularly damaging to the parenting process.”[3]

The article, published in Current Women’s Health Reviews, looked at already published studies on miscarriage, induced abortion and adoption. It focused on psychological reactions to these various types of loss and discussed how they might affect a mother’s relationship with children born after the pregnancy loss.

The paper described a number of ways that a previous abortion can effect a woman’s relationship with her living children:

    * Increased depression and anxiety. Abortion has been linked to higher rates of maternal depression and anxiety before and after birth, which may effect the woman’s relationship with her children. In addition, depression is a common predictor for child abuse.
    * Sleep disorders and disturbances. Women who have had an abortion are more likely to experience sleep disorders compared to women who carry to term, and one survey found that many women attributed the sleep disorders to a past abortion. These sleep disturbances “could render the high energy demands of parenting more complicated.”
    * Substance abuse. Studies have found that women who had an abortion were more likely to engage in substance abuse, and also more likely to smoke or use drugs or alcohol while pregnant. Mothers who abuse drugs or alcohol are more likely to “engage in authoritarian and punitive parenting practices,” and parental substance abuse increases the risk that the children will suffer abuse or neglect.
    * Child abuse. Abortion has been associated with lower emotional support for one’s children and with a higher risk of child abuse and neglect.[1]

Abortion has also been linked in numerous studies to problems such as higher rates of suicide and various mental health disorders among women. While the review noted that not every woman may experience
psychological problems after abortion that will carry over into their personal relationships, “some women will have carryover effects into the parenting realm.”

“The best evidence regarding negative effects of abortion indicates that 20-30 percent will experience serious psychological problems,” Coleman wrote. “With 1.3 million U.S. abortions performed annually, a minimum of 130,000 new cases of abortion-related mental health problems appear each year.”

“A Profound Source of Suffering”

It is now known that women usually begin feeling maternal attachment in the early stages of pregnancy. Coleman noted that despite the increased responsibilities and stress involved in raising children, “numerous studies have documented positive psychological characteristics associated with motherhood including increases in life satisfaction, self-esteem, empathy, restraint, flexibility and resourcefulness in coping, and assertiveness.” Losing a child before or at birth, for any reason, however, “can be a profound source of suffering.”

While all forms of pregnancy loss can cause emotional distress that can impact future parenting, the available research indicates that emotional responses after induced abortion are more likely to go unresolved and to persist for a longer time period.

While “society understands that women who miscarry or relinquish a child through adoption may experience sadness and grief; however, grief after abortion … is not because abortion is not acknowledged by our culture as a human death experience,” and help to deal with the experience is usually not offered.

Further, many people see abortion as something “wanted” by the mother and don’t understand why a woman would experience distress afterward. Coleman pointed out, however, that having an abortion is “sometimes quite inconsistent with the woman’s true desires,” and many women, especially those who feel conflicted or didn’t want the abortion, do feel emotional distress afterwards.

“In many cases, women may suppress thoughts and emotions related to an abortion, because they have not been able to process and or/openly express negative emotions,” Coleman wrote, adding that the lack of acknowledgement and support after abortion gives the “covert message that others would rather not hear what we have to say, and this makes it difficult to even identify our reactions to our losses.”

~~~

Citations

1. More information and citations to these studies is available in the Recent Research booklet or in the Thomas W. Strahan Memorial Library at www.AbortionRisks.org.

2. PK Coleman, DC Reardon, JR Cougle, “The quality of caregiving environment and child development outcomes associated with maternal history of abortion using the NLSY data,” Journal of Child Psychology and Psychiatry, 43(6):743-757, 2002.

3. PK Coleman, “The Psychological Pain of Perinatal Loss and Subsequent Parenting Risks: Could Induced Abortion Be More Problematic Than Other Forms of Loss,” Current Women’s Health Issues 5: 88-99, 2009.
Noted in article — Review of Studies — http://www.theunchoice.com/News/parentingreview.htm
[August 15, 2011, "Children of depressed mothers have a different brain",
http://medicalxpress.com/news/2011-08-children-depressed-mothers-brain.html — NOTE: see article below;
Posted on August 17, 2011,  http://afterabortion.org/2011/abortion-depression-and-the-impact-on-later-children/

Children of Depressed Mothers have a Different Brain — http://medicalxpress.com/news/2011-08-children-depressed-mothers-brain.html

Researchers think that brains are sensitive to the quality of child care, according to a study that was directed by Dr. Sonia Lupien and her colleagues from the University of Montreal published today [15 August 2011] in the Proceedings of the National Academy of Sciences [http://www.medscape.com/viewarticle/748194?src=rss]. The scientists worked with ten year old children whose mothers exhibited symptoms of depression throughout their lives, and discovered that the children's amygdala, a part of the brain linked to emotional responses, was enlarged.

Similar changes, but of greater magnitude, have been found in the brains of adoptees initially raised in orphanages. Personalized attention to children's needs may be the key factor. "Other studies have shown that mothers feeling depressed were less sensitive to their children's needs and were more withdrawn and disengaged," explained Drs. Sophie Parent and Jean Séguin of the University of Montreal's, who followed the children over the years.

Scientists have established that the amygdala is involved in assigning emotional significance to information and events, and it contributes to the way we behave in response to potential risks. The need to learn about the safety or danger of new experiences may be greater in early life, when we know little about the world around us. Indeed, studies on other mammals, such as primates, show that the amygdala develops most rapidly shortly after birth. "We do not know if the enlargement that we have observed is the result of long-term exposure to lower quality care. But we show that growing up with a depressed mother is associated with enlarged amygdala."

"Having enlarged amygdala could be protective and increase the probability of survival," Lupien said. The amygdala may be protective through a mechanism that produces stress hormones known as glucocorticoids. The researchers noted that the glucocorticoids levels of the children of depressed mothers who participated in this study increased significantly when they were presented with unfamiliar situations, indicating increased reactivity to stress in those children. Adults who grew up in similar circumstances as these children show higher levels of glucocorticoids and a greater glucocorticoid reaction when participating in laboratory stress tests. "What would be the long term consequences of this increased reactivity to stress is unknown at this point."

Although this study cannot clarify the causes of enlarged amygdala, the researchers note that the adoption studies have also shown that children who were adopted earlier in life and into more affluent families than others did not have enlarged amygdala.

"This strongly suggests that the brain may be highly responsive to the environment during early development and confirms the importance of early intervention to help children facing adversity," Lupien said. "Initiatives such as prenatal and infancy nurse home visits and enriched day care environments could mitigate the effects of parental care on the developing brain." Séguin adds, "Future studies testing the effects of these preventive programs and observational studies involving children exposed to maternal depressive symptoms at different ages, and consequently for different lengths of time, should provide more insight into how this occurs, its long term consequences, and how it can be prevented."

More information: "Larger amygdala but no change in hippocampal volume in 10-year-old children exposed to maternal depressive symptomatology since birth", Proceedings of the National Academy of Sciences.

Related: http://www.pnas.org/content/early/2011/08/08/1105371108.abstract
Depressive symptoms in adolescents: associations with white matter — http://www.ncbi

.nlm.nih.gov/pmc/articles/PMC2269707/
[15 August 2011, http://medicalxpress.com/news/2011-08-children-depressed-mothers-brain.html ; www.pnas.org/cgi/doi/10.1073/pnas.1105371108 ]

Prenatal Psychosocial Stress Exposure Is Associated With Subsequent Working Memory Performance in Young Women
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862630/

Abstract
The aim of the present study was to examine the association between prenatal psychosocial stress exposure and subsequent prefrontal cortex-dependent working memory performance in human adults. Working memory performance was assessed using an item-recognition task under 10 mg hydrocortisone (cortisol) and placebo conditions in a sample of 32 healthy young women (mean age = 25 ± 4.34 years) whose mothers experienced a major negative life event during their pregnancy (Prenatal Stress, PS group), and in a comparison group of 27 healthy young women (mean age = 24 ± 3.4 years). The two groups did not differ in the placebo condition, however, subjects in the PS group showed longer reaction times after hydrocortisone administration compared with subjects in the comparison group (p = .02). These findings provide support for an association between prenatal stress exposure and the potential modulatory effect of cortisol on working memory performance in young adults, which may reflect compromised development of the prefrontal cortex in prenatal life.
 
The notion of developmental programming of adult health and disease is based on a large number of epidemiological studies across the world that have reported associations between markers of an individual’s birth phenotype, such as low birth weight or small body size, and subsequent risk of disease in adult life (Barker, 1998; Cannon, Jones, & Murray, 2002; Gluckman & Hanson, 2004a; Thompson, Syddall, Rodin, Osmond, & Barker, 2001).

There is emerging evidence that in humans, cognitive and intellectual performance also is affected by prenatal factors.

For example, very low birth weight children perform poorer in academic achievement tests (Finnstrom, Gaddlin, Leijon, Samuelsson, & Wadsby, 2003), and low birth weight is associated with lower scores on tests measuring language, spatial, fine motor, tactile, and attention abilities (Breslau, Chilcoat, DelDotto, Andreski, & Brown, 1996). In line with these results, higher birth weight was associated with better intelligence test scores at age 17 years (Seidman et al., 1992), and intrauterine growth restriction had an impact on spatial navigation at 6 years of age (Leitner, Heldman, Harel, & Pick, 2005).

It is unlikely that birth phenotypes, per se, play a causal role in increasing the risk for impairments in cognitive performance later in life. Instead, birth phenotypes more likely constitute a crude marker of developmental processes in intrauterine life that also may influence the structure and function of physiological systems that underlie health and disease risk in later life (Gluckman & Hanson, 2004b; Morley, Owens, Blair, & Dwyer, 2002).

The link between prenatal environment and adult health and disease may not necessarily be mediated via adverse birth outcomes, and measures of prenatal conditions may be more sensitive predictors of subsequent outcomes than birth size and weight at birth.

The association between prenatal factors and learning and memory has been reported very early in development.

Elevated levels of placental corticotrophin-releasing hormone (CRH) concentrations during the last trimester of gestation, potentially reflecting high levels of physiological stress, are associated with impaired fetal learning (Sandman, Wadhwa, Chicz-DeMet, Porto, & Garite, 1999).

A small but growing literature indicates that the consequences of prenatal maternal stress persist into the postpartum period (e.g., Entringer et al., 2008; Luoma et al., 2001; O’Connor, Heron, Golding, Beveridge, & Glover, 2002; Van den Bergh, Van Calster, Smits, Van Huffel, & Lagae, 2007).

Several recent prospective studies in humans have reported that prenatal adversity is associated with cognitive development (Buitelaar, Huizink, Mulder, de Medina, & Visser, 2003; Laplante, Brunet, Schmitz, Ciampi, & King, 2008). Moreover, studies in rodents and nonhuman primates also report that prenatal stress exposure influences postnatal cognitive performance (e.g., Kofman, 2002; Lemaire, Lamarque, Moal, Piazza, & Abrous, 2006; Szuran, Zimmermann, & Welzl, 1994; Vallee et al., 1999) and suggest underlying functional mechanisms may explain this association, including impairment of neurogenesis (Coe et al., 2003; Lemaire, Koehl, Le Moal, & Abrous, 2000), and long-term potentiation (Yaka, Salomon, Matzner, & Weinstock, 2007; Yang et al., 2007).

Many of these studies have examined hippocampal-dependent declarative memory because the hippocampus has been shown to be a prominent target for early adverse effects (e.g., Bremner, 2003; Driessen et al., 2000), and hippocampal dysfunction is believed to be involved in hypothalamic–pituitary–adrenal (HPA) axis dysregulation associated with adverse neonatal experience (Meaney et al., 1996).

Less work has been done with regard to the effects of early adversity (i.e., prenatal as well as early neonatal influences) on prefrontal-dependent working memory performance, which constitutes another important aspect of cognitive function. Working memory is the cognitive mechanism that underlies temporary storage and manipulation of limited amounts of information (Baddeley, 1986), allowing the brain to perform higher cognitive functions such as language, comprehension, and reasoning. The prefrontal cortex is known to develop later in terms of myelination and synaptic density (Yakovlev & Lecours, 1967). Because of its protracted development and the expression of glucocorticoid (GC) receptors (GRs; Teicher et al., 2003), the prefrontal cortex also may be prone to early insults. This is supported by a recent study in rats reporting an association between maternal stress during pregnancy and reductions of dendritic spine densities in the prefrontal cortex in the offspring (Murmu et al., 2006), and by several studies that found associations between early postnatal adverse experience and changes in the development of synaptic circuits in the prefrontal cortex of rodents (Helmeke, Ovtscharoff, Poeggel, & Braun, 2001; Helmeke, Poeggel, & Braun, 2001; Ovtscharoff & Braun, 2001; Poeggel et al., 2003).

In addition, studies that examined the effects of a different kind of prenatal adversity—prenatal alcohol exposure—found associations with frontal cortical volume reductions (Wass, Persutte, & Hobbins, 2001) and a decreased number of neurons in the medial prefrontal cortex (Mihalick, Crandall, Langlois, Krienke, & Dube, 2001). Effects of exogenous GC administration (Lupien, Gillin, & Hauger, 1999; Mizoguchi, Ishige, Takeda, Aburada, & Tabira, 2004), as well as acute psychosocial stress (Schoofs, Preuss, & Wolf, 2008) on working memory performance have been observed, and they are believed to be modulated by GRs.

In rodents, prenatal stress was associated with reduced hippocampal GR density (Barbazanges, Piazza, Le Moal, & Maccari, 1996; Maccari et al., 1995; Weinstock, Matlina, Maor, Rosen, & McEwen, 1992), and early neonatal adversity was associated with reduced hippocampal and frontal GR density (Ladd, Huot, Thrivikraman, Nemeroff, & Plotsky, 2004; Meaney et al., 1985).

Taken together, theses findings suggest that wo

rking memory function may be impaired by acute and early developmental stress exposure.

In some studies, differential effects of GC on memory performance in patient populations compared to healthy controls have been noted (Bremner, Vythilingam, Vermetten, Afzal, et al., 2004; Bremner, Vythilingam, Vermetten, Anderson, et al., 2004). Thus, these studies suggest that if there is a subtle vulnerability, small differences between groups may not emerge under basal conditions but may emerge only when there is a challenge imposed on the system.

Thus, the objective of the present study was to investigate in a double-blind, placebo-controlled, within-subject design in young adults (a) whether there is a general effect of prenatal psychosocial stress exposure on working memory performance (i.e., basal or placebo condition), and (b) whether the effects of prenatal stress on working memory are modulated by exogenous hydrocortisone administration…

Our results demonstrate an association in humans between maternal psychosocial stress exposure during pregnancy and subsequent working memory performance in the adult (female) offspring, potentially modulated by cortisol.

Young women who were exposed to prenatal stress exhibited an impaired performance under hydrocortisone treatment in a cognitive task that has been related to prefrontal cortex functioning, while they did not differ from a comparison group under basal (i.e., after placebo) condition. The observed changes are independent of birth weight and length of gestation, as well as postnatal factors including maternal care, exposure to traumatic events during childhood, and subjects’ present depression and neuroticism scores…

In conclusion, the present findings provide support for an impact of prenatal stress exposure on working memory performance in humans, which might reflect compromised development of the prefrontal cortex in prenatal life.
[Behav Neurosci. Author manuscript; available in PMC 2010 May 3; Published in final edited form as:
Behav Neurosci. 2009 August; 123(4): 886–893. doi:  10.1037/a0016265; PMCID: PMC2862630; NIHMSID: NIHMS188007 ;
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862630/ ]