Research Article PREGNANCY ANXIETY AND COMORBID DEPRESSION AND ANGER: EFFECTS ON THE FETUS AND NEONATE Tiffany Field, 1n Miguel Diego, 1 Maria Hernandez-Reif, 1 Saul Schanberg, 2 Cynthia Kuhn, 2 Regina Yando, 3 and Debra Bendell 4 One hundred sixty-six women were classified as experiencing high or low anxiety during the second trimester of pregnancy. The high anxiety women also had high scores on depression and anger scales. In a follow-up across pregnancy, the fetuses of the high anxiety women were noted to be more active and to experience growth delays. The high anxiety mothers’ high prenatal norepi- nephrine and low dopamine levels were followed by their neonates having low dopamine and serotonin levels. The high anxiety mothers’ newborns also had greater relative right frontal EEG activation and lower vagal tone. Finally, the newborns of high anxiety mothers spent more time in deep sleep and less time in quiet and active alert states and showed more state changes and less optimal performance on the Brazelton Neonatal Behavior Assessment Scale (motor maturity, autonomic stability and withdrawal). These data highlight the need for prenatal intervention for elevated anxiety symptoms during pregnancy. Depression and Anxiety 17:140–151, 2003. & 2003 Wiley-Liss, Inc. Key words: anxiety; depression; anger; fetus; newborn PREGNANCY ANXIETY AND COMORBID DEPRESSION AND ANGER EFFECTS ON THE FETUS AND NEONATE Prenatal anxiety ef fects on the fetus have been researched for decades [Glover et al., 1999]. More recently prenatal depression ef fects on the fetus and neonate have been reported [Lundy et al., 1999; Field et al., 2001]. Prenatal anger effects have received less attention. These feeling states are often confounded. Patients with depression very often report feeling anxious, without qualifying for a DSM ‘‘certified’’ anxiety disorder [American Psychiatric Association, 1994], and, vice versa, patients with an anxiety disorder regularly feel depressed, without suffering from a regular depression [Pini et al., 1997]. Patients with depression have been noted to score equally high on depression as on anxiety scales in at least two studies [Katz et al., 1989; Wetzler et al., 1990] and in one study, patients with major depression or dysthymia had even higher scores on anxiety scales than patients with anxiety disorders [Di Nardo and Barlow, 1990]. Aggression regulation disturbances are also a fre- quent component of mood disorders [Botsis et al., 1997]. The aggression is often turned inward, mani- festing itself as self-denigration or suicidality, or outward with symptoms such as anger attacks. Anger DEPRESSION AND ANXIETY 17:140–151 (2003) 1 Touch Research Institutes, University of Miami School of Medicine, Miami, Florida 2 Duke University School of Medicine, Durham, North Carolina 3 Harvard Medical School, Boston, Massachusetts 4 UCLA School of Medicine, Los Angeles, California Contract grant sponsor: NIMH; Contract grant number: MH 00331, MH 46586; Contract grant sponsor: Johnson and Johnson. n Correspondence to: Tiffany Field, PhD, Touch Research Institutes, University of Miami School of Medicine, Department of Pediatrics (D-820), PO Box 016820, Miami, FL 33101. E-mail: tfield@med.miami.edu. Received for publication 15 April 2002; Accepted 1 January 2002 Published online in Wiley InterScience (www.interscience.wiley. com). DOI. 10.1002/da.10071 & & 2003 WILEY-LISS, INC.