While
much more attention has been paid to postpartum de-pression, antepartum
depression also adversely affects preg-nancy outcome. Both antepartum anxiety
and depression have been associated with growth retardation and premature
birth, resulting in lower birth weights, but potential confounding fac-tors
have often not been adequately controlled for. Whether depression and other
psychological dysfunction cause poorer obstetric outcomes through poor
nutrition, substance abuse (including tobacco), poor adherence or no prenatal
care, and/ or physiological (hormonal, vascular) effects require further
investigation.
Psychological
factors are likely to affect fertility because fre-quency and timing of sexual
intercourse are important determi-nants of fertility. Nonconsummation,
avoidance of intercourse, vaginismus and psychogenic amenorrhea are
attributable to psychological origins. Psychogenic causes do not account for
most male impotence but may play a secondary role in many cases.
Whereas
some prospective data support psychological fac-tors influencing fertility in
the general population, psychological factors appear less potent in predicting
pregnancy outcome in couples receiving treatment for infertility. In general,
measures of stress, but not of psychopathology, have been associated with
infertility. This is a particularly complex subject for study be-cause it
involves potential psychological factors in both mem-bers of the couple and
interactions between them as well as their effects on sexual behavior and
fertility. Most psychological dis-tress seen in infertile couples is a result
of, rather than a cause of, infertility.
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