SUMMARY AND KEY ISSUES
In summary, there is substantial evidence that anxiety, depression, and stress in pregnancy are risk factors for adverse outcomes for mothers and children. More specifically, anxiety in pregnancy is associated with shorter gestation and has adverse implications for fetal neurodevelopment and child outcomes. Furthermore, anxiety about a particular pregnancy seems to be especially potent. Finally, chronic strain, exposure to racism, and depressive symptoms in mothers during pregnancy are associated with lower birth weight infants with consequences for development as well. These differential risk factors and related pathways to PTB and LBW deserve further investigation. Beyond this, women with high stress, anxiety, and depressive symptoms in pregnancy are more likely to be impaired during the postpartum period. Postpartum affective disturbance and stress in turn impair parenting quality and effectiveness [48]. Figure 1 summarizes the evidence that has been briefly reviewed in a simple schematic with connections in bold representing those with notably stronger and more consistent evidence. This simple diagram can be elaborated further to include associations among the various types or forms of stress and to include mediated pathways to birth outcomes. For example, major life events or community catastrophes can be hypothesized to increase pregnancy anxiety, and long-term chronic strain to increase risk of depression. The effects of chronic strain on LBW via depression are also not depicted but are worthy of further research. Together, the evidence and developing consensus that biological and behavioral mechanisms explain these findings lay the groundwork for a next era of psychiatric and collaborative interdisciplinary research on pregnancy.