Prenatal maternal stress programs infant stress regulation

Objective: Prenatal exposure to inappropriate levels of glucocorticoids (GCs) and maternal stress are putative mechanisms for the fetal programming of later health outcomes. The current investigation examined the influence of prenatal maternal cortisol and maternal psychosocial stress on infant physiological and behavioral responses to stress. Methods: The study sample comprised 116 women and their full term infants. Maternal plasma cortisol and report of stress, anxiety and depression were assessed at 15, 19, 25, 31 and 36 + weeks’ gestational age. Infant cortisol and behavioral responses to the painful stress of a heel‐stick blood draw were evaluated at 24 hours after birth. The association between prenatal maternal measures and infant cortisol and behavioral stress responses was examined using hierarchical linear growth curve modeling. Results: A larger infant cortisol response to the heel‐stick procedure was associated with exposure to elevated concentrations of maternal cortisol during the late second and third trimesters. Additionally, a slower rate of behavioral recovery from the painful stress of a heel‐stick blood draw was predicted by elevated levels of maternal cortisol early in pregnancy as well as prenatal maternal psychosocial stress throughout gestation. These associations could not be explained by mode of delivery, prenatal medical history, socioeconomic status or child race, sex or birth order. Conclusions: These data suggest that exposure to maternal cortisol and psychosocial stress exerts programming influences on the developing fetus with consequences for infant stress regulation.     

Pre-discharge anxiety among mothers of well newborns: prevalence and correlates

OBJECTIVE: To explore the prevalence and correlates of maternal postpartum anxiety. METHODS: 422 of 973 invited mothers (43%) were screened for anxiety before hospital discharge with the State-Trait Anxiety Inventory (STAI). Recent medical and social life events, stress, resiliency (mastery, social support, and marital satisfaction), length of stay, discharge readiness, anticipatory medical care, and history of psychiatric illness and depression were assessed by questionnaire and medical record review. RESULTS: 24.9% of mothers had moderate and 1% severe anxiety. Higher anxiety was observed among young, unmarried, primiparous mothers with male infants, and anxiety correlated with medical and negative social life events, stress, history of depression, and duration of postpartum stay. Inverse correlations were observed with maternal education and household income, pregnancy planning, prenatal class attendance, infant healthcare provider identification, and with all resiliency factors. In multivariate models, pre-discharge anxiety was significantly associated with medical life events and the maternal perception of perinatal stress, and negatively associated with mastery, marital satisfaction, and choice of infant healthcare provider. CONCLUSION: Moderate maternal anxiety is common prior to perinatal hospital discharge, especially among women with low mastery and marital satisfaction, stressful perinatal courses, and failure to identify an infant healthcare provider.     

Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant mental development

Background

Animal studies have shown that postnatal rearing style can modify the association between prenatal stress exposure and offspring neurodevelopmental outcomes. However, little is known about how parenting quality impacts the association between maternal prenatal anxiety and development in human infants.

Aim

This prospective study examined the impact of maternal prenatal anxiety disorder and maternal caregiving sensitivity on cognitive and psychomotor development in healthy, full-term, 7-month-old infants.

Measures

Women completed a clinical interview during the third trimester of pregnancy to assess anxiety symptoms meeting DSM-IV diagnostic criteria. At infant age 7 months, maternal sensitivity to infant distress and non-distress were observed and coded during the still-face procedure. Maternal postnatal (concurrent) anxiety and depression were also assessed at this time. Infant mental and psychomotor development was assessed at infant age 7 months using the Bayley Scales of Infant Development II.

Results

Analyses were based on 77 mother-infant dyads. Maternal sensitivity to infant distress moderated the association between maternal prenatal anxiety disorder and infant mental development, F (1, 77) = 5.70, p = .02. Whereas there was a significant positive association between sensitivity and mental development among infants whose mothers were anxious during pregnancy, sensitivity had little impact on mental development among infants of control (non-anxious) women. Results were independent of prenatal depression and postnatal anxiety and depression. A caregiving moderation effect was not found for infant psychomotor development, p > .10.

Conclusions

These findings are consistent with a cumulative risk model suggesting that maternal prenatal anxiety and quality of maternal care act in concert to shape infant outcomes.     

Prenatal mood disturbance predicts sleep problems in infancy and toddlerhood

BACKGROUND: Experimental animal data link prenatal stress with sleep disturbance in offspring, but the link in humans is unclear. AIMS: To investigate the link between prenatal maternal anxiety and depression and infant sleep disturbance from 6 to 30 months of age. STUDY DESIGN: Longitudinal prospective study of a large birth cohort from pregnancy to 30 months. Questionnaire measures of anxiety and depression were completed by mothers at 18 and 32 weeks gestation and at 8 weeks and 8 months postpartum. SUBJECTS: The ALSPAC cohort, a prospective community study of women in the UK who have been followed since pregnancy. OUTCOME MEASURES: Measures of total sleep time, number of awakenings, and broadly defined sleep problems were available on children at ages 6, 18, and 30 months. RESULTS: Reliable measures of total sleep time, nighttime awakenings, and sleep problems were identified at 6, 18, and 30 months. Higher levels of prenatal maternal anxiety and depression predicted more sleep problems at 18 and 30 months, after controlling for postnatal mood and obstetric and psychosocial covariates; the association was not restricted to clinical extremes. No link with total sleep time was observed. CONCLUSIONS: Mood disturbance in pregnancy has persisting effects on sleep problems in the child, a finding that is consistent with experimental animal research. The findings add to a growing literature showing that maternal prenatal stress, anxiety, and depression may have lasting effects on child development.     

Maternal eating disorders and infant feeding difficulties: maternal and child mediators in a longitudinal general population study

Background: Maternal eating disorders (ED) have been shown to increase the risk of feeding difficulties in the offspring. Very few studies, however, have investigated whether the effect of a maternal ED on childhood feeding is a direct effect or whether it can be ascribed to other child or maternal factors. We aimed to determine the role of maternal anxiety and depression in mediating the risk for feeding difficulties in infants of women with ED. Methods: A prospective study comparing women with lifetime ED (441) and without any lifetime psychiatric disorder (10,461) and their infants from the Avon Longitudinal Study of Parents and Children (ALSPAC). We investigated the effect of: maternal anxiety and depression in late pregnancy (32 weeks) and the post‐partum (8 weeks), child temperament and developmental status on infant feeding difficulties at 1 and 6 months. We also investigated the effect of active pregnancy ED symptoms. We tested 3 models and their fit to the data using structured equation modelling: a direct effect model, a fully mediational model and an integrated (partial meditational) model. Results: The integrated model including a direct effect of maternal lifetime ED on infant feeding and a mediational path via maternal distress (a latent variable combining anxiety and depression) fitted the data best. This also applied to maternal pregnancy ED symptoms. Feeding difficulties in turn increased maternal distress over time. Conclusions: Lifetime ED and active pregnancy ED increase the risk for infant feeding difficulties and do so via maternal distress (i.e., depression and anxiety). This has important implications for prevention and early intervention in relation to infant feeding difficulties, as well as for future research in the field.     

Parental depressive and anxiety symptoms during pregnancy and attention problems in children: a cross‐cohort consistency study

Background: Maternal depression and anxiety during pregnancy have been associated with offspring‐attention deficit problems. Aim: We explored possible intrauterine effects by comparing maternal and paternal symptoms during pregnancy, by investigating cross‐cohort consistency, and by investigating whether parental symptoms in early childhood may explain any observed intrauterine effect. Methods: This study was conducted in two cohorts (Generation R, n = 2,280 and ALSPAC, n = 3,442). Pregnant women and their partners completed questionnaires to assess symptoms of depression and anxiety. Child attention problems were measured in Generation R at age 3 with the Child Behavior Checklist, and in ALSPAC at age 4 with the Strengths and Difficulties Questionnaire. Results: In both cohorts, antenatal maternal symptoms of depression (Generation R: OR 1.23, 95% CI 1.05–1.43; ALSPAC: OR 1.33, 95% CI 1.19–1.48) and anxiety (Generation R: OR 1.24, 95% CI 1.06–1.46; ALSPAC: OR 1.32, 95% CI 1.19–1.47) were associated with a higher risk of child attention problems. In ALSPAC, paternal depression was also associated with a higher risk of child attention problems (OR 1.11, 95% CI 1.00–1.24). After adjusting for maternal symptoms after giving birth, antenatal maternal depression and anxiety were no longer associated with child attention problems in Generation R. Moreover, there was little statistical evidence that antenatal maternal and paternal depression and anxiety had a substantially different effect on attention problems of the child. Conclusions: The apparent intrauterine effect of maternal depression and anxiety on offspring‐behavioural problems may be partly explained by residual confounding. There was little evidence of a difference between the strength of associations of maternal and paternal symptoms during pregnancy with offspring‐attention problems. That maternal symptoms after childbirth were also associated with offspring‐behavioural problems may indicate a contribution of genetic influences to the association.     

Emotional stress in pregnancy predicts human infant reactivity

BACKGROUND: Infant distress to novelty at 4 months of life has previously been identified as an important predictor of longer term emotional development in childhood and adolescence. AIM: To investigate the relationship between prenatal stress and infant reactivity to unfamiliar visual, auditory and olfactory stimuli. STUDY DESIGN: Maternal emotional stress, life events and medical adversities during pregnancy and maternal personality characteristics were assessed by interview, questionnaire and patient charts at 2 weeks postnatal age. Postnatal maternal psychopathology was assessed at 2 weeks and 4 months postnatal age. Infant outcome was examined 4 months postnatally. SUBJECTS: 102 mother-infant pairs were recruited in local obstetric units, complete datasets were available for 96 mother-infant-pairs. OUTCOME MEASURE: Infant reactivity to unfamiliar stimuli was assessed when the infants were 4 months postnatal age. RESULTS: Maternal prenatal emotional stress was significantly associated with infant affective reactivity to novelty. Maternal postnatal psychopathology did not have an influence on affective infant reactivity. CONCLUSIONS: These data provide evidence for an impact of maternal emotional stress in pregnancy on early infant distress to novel stimuli, a behavioral trait whose stability throughout childhood and adolescence has previously been demonstrated.     

Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes

This position statement provides guidance for the monitoring, care, and follow-up of newborns exposed to selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in utero. Depression and anxiety are common during pregnancy and postpartum. While there are risks to taking medications during pregnancy, untreated or incompletely managed depression and anxiety also carry risks for the newborn. Poor neonatal adaptation syndrome (PNAS) occurs in one-third of newborns exposed to SSRIs or SNRIs in utero, and is generally mild and self-limiting. The low levels of SSRIs and SNRIs excreted in breast milk are compatible with breastfeeding. Persistent pulmonary hypertension of the newborn and congenital heart defects are rare associations of exposure to SSRIs or SNRIs in utero. There are inconsistencies in the literature regarding neurodevelopmental outcomes, specifically autism spectrum disorder and attention-deficit hyperactivity disorder. The inconsistencies likely relate to other factors (i.e., genetics, maternal depression, lifestyle, and comorbidities), rather than exposure to SSRIs or SNRIs in utero. Health care providers and parents should be reassured that PNAS is generally treatable with nonpharmacological measures, and that the risk of serious adverse effects from exposure to SSRIs or SNRIs in utero is low.     

Effects of mothers' prenatal psychiatric status and postnatal caregiving on infant biobehavioral regulation: can prenatal programming be modified?

BACKGROUND: Animal research suggests that antenatal stress exposure and postnatal rearing style act in concert to shape offspring biobehavioral outcomes. However, the combination of these maternally-mediated influences has not been studied in human infants. AIMS: To examine antenatal psychiatric status and maternal sensitivity in relation to 4-month-olds' autonomic regulation, HPA-axis functioning, and behavior. STUDY DESIGN: Prospective study of 47 pregnant women recruited from an urban hospital who completed questionnaire measures of anxiety and depression and underwent a psychiatric interview in the 2nd trimester. At 4 months postpartum, women again completed mood questionnaires and the mother-infant dyads participated in a 10-minute free-play session evaluated for maternal sensitivity. OUTCOME MEASURES: Baseline infant salivary cortisol and electrocardiogram (EKG) collected at the start of the 4-month sessions. Infant responsiveness and maternal report of temperament also were evaluated. RESULTS: Maternal sensitivity, but not antenatal psychiatric diagnosis, predicted greater levels of infant high frequency heart rate variability, after controlling for birth weight and age. Maternal sensitivity, but not psychiatric status, also predicted infant responsiveness. Maternal sensitivity modulated the effects of psychiatric illness on infant cortisol such that cortisol was low regardless of sensitivity for children of healthy women yet higher if the infant had insensitive versus sensitive caregiving when the mother had had an antenatal diagnosis. CONCLUSIONS: Biobehavioral adaptation, even that initiated in utero, is influenced by interactions with the social world. These findings support the compatibility of fetal programming and social-context models of infant biobehavioral development and have promising implications for pre and postnatal clinical intervention.     

Postpartum maternal moods and infant size predict performance on a national high school entrance examination

Background: In an earlier series of studies, we documented the effects of feeding practices and postnatal maternal mood on the growth and development of 226 Barbadian children during the first few months of life. In this report, we extend our earlier studies by examining predictive relationships between infant size, feeding practices and postpartum maternal moods and scores on a national high school examination, the Common Entrance Examination (CEE), at 11 to 12 years of age. Methods: Feeding practices, anthropometry, and maternal moods, using Zung depression and anxiety scales and a morale scale, were assessed at 7 weeks (n = 158), 3 months (n = 168), and 6 months (n = 209) postpartum. Background variables including sociodemographic and home environmental factors were also assessed during infancy. CEE scores on 169 of the children in the original study were obtained from the Ministry of Education of Barbados. Results: In our sample of 86 boys and 83 girls, we found that reduced infant lengths and weights at 3 and 6 months of age were predictive of lower CEE, especially math scores. Children who were smaller at these early ages had significantly lower scores on the examination than did larger children. Postpartum maternal moods, including reports of despair and anxiety, were also found to be significant predictors of lower CEE scores, especially English scores. However, breast‐feeding and other feeding practices were not directly associated with the CEE scores. Background variables, which significantly predicted lower CEE scores, included young maternal age at the time of her first pregnancy, more children in the home, less maternal education, and fewer home conveniences. Significant associations between infant anthropometry, maternal moods and CEE scores were all significant even when these background variables were controlled for. Conclusions: These findings have important implications for developing interventions early in life to improve academic test scores and future opportunities available to children in this setting.     

Prenatal maternal cortisol levels and infant behavior during the first 5 months

BACKGROUND AND AIMS: Research on both animals and humans is providing more and more evidence that prenatal factors can have long-term effects on development. Most human studies have examined the effects of prenatal stress on birth outcome (i.e. shorter pregnancies, smaller infants). The few studies that have looked at the infants' later development have found prenatal stress to be related to more difficult temperament, behavioral/emotional problems and poorer motor/cognitive development. In this paper, we have examined links between late pregnancy cortisol levels and infant behavior during the first 5 months of life. STUDY DESIGN AND SUBJECTS: Seventeen mothers and their healthy, full-term infants participated in this prospective, longitudinal study. The mothers' cortisol was determined in late pregnancy. The infants' behavior was videotaped during a series of bath sessions at the home: at 1, 3, 5, 7, 18 and 20 weeks of age. The mothers filled in temperament questionnaires (ICQ) in postnatal weeks 7 and 18. RESULTS AND CONCLUSIONS: The infants were divided into two groups based on their mothers' late pregnancy cortisol values: high and low prenatal cortisol groups. A trend was found for the high cortisol infants to be delivered earlier than the low cortisol group. Furthermore, the behavioral observations showed the higher prenatal cortisol group to display more crying, fussing and negative facial expressions. Supporting these findings, maternal reports on temperament also showed these infants to have more difficult behavior: they had higher scores on emotion and activity. The differences between the infants were strongest at the youngest ages (weeks 1-7).     

Maternal mental disorders in pregnancy and the puerperium and risks to infant health

Prenatal and postnatal period presents the highest prevalence of mental disorders in women’s lives and depression is the most frequent one, affecting approximately one in every five mothers. The aggravating factor here is that during this period psychiatric symptoms affect not only women’s health and well-being but may also interfere in the infant’s intra and extra-uterine development. Although the causes of the relationship between maternal mental disorders and possible risks to a child’s health and development remain unknown, it is suspected that these risks may be related to the use of psychotropic drugs during pregnancy, to substance abuse and the mother’s lifestyle. Moreover, after delivery, maternal mental disorders may also impair the ties of affection (bonding) with the newborn and the maternal capacity of caring in the post-partum period thus increasing the risk for infant infection and malnutrition, impaired child growth that is expressed in low weight and height for age, and even behavioral problems and vulnerability to presenting mental disorders in adulthood. Generally speaking, research on this theme can be divided into the type of mental disorder analyzed: studies that research minor mental disorders during pregnancy such as depression and anxiety find an association between these maternal disorders and obstetric complications such as prematurity and low birth weight, whereas studies that evaluate severe maternal mental disorders such as schizophrenia and bipolar disorder have found not only an association with general obstetric complications as well as with congenital malformations and perinatal mortality. Therefore, the success of infant growth care programs also depends on the mother’s mental well being. Such findings have led to the need for new public policies in the field of maternal-infant care geared toward the population of mothers. However, more research is necessary so as to confirm the association between all factors with greater scientific rigor.     

Anxiety disorders before birth and self-perceived distress during pregnancy: Associations with maternal depression and obstetric, neonatal and early childhood outcomes

Background

Maternal perinatal mental health has been shown to be associated with adverse consequences for the mother and the child. However, studies considering the effect of DSM-IV anxiety disorders beyond maternal self-perceived distress during pregnancy and its timing are lacking.

Aims

To examine the role of maternal anxiety disorders with an onset before birth and self-perceived distress during pregnancy for unfavourable maternal, obstetric, neonatal and childhood outcomes.

Study design

DSM-IV mental disorders and self-perceived distress of 992 mothers as well as obstetric, neonatal and childhood outcomes of their offspring were assessed in a cohort sampled from the community using the Munich-Composite International Diagnostic Interview. Logistic regression analyses revealed associations (odds ratios) between maternal anxiety disorders and self-perceived distress during pregnancy with maternal depression after birth and a range of obstetric, neonatal and childhood psychopathological outcomes.

Results

Lifetime maternal anxiety disorders were related to offspring anxiety disorders, but not to offspring externalizing disorders. Analyses focussing on maternal DSM-IV anxiety disorders before birth yielded associations with incident depression after birth. In addition, self-perceived distress during pregnancy was associated with maternal depression after birth, preterm delivery, caesarean section, separation anxiety disorder, ADHD, and conduct disorder in offspring.

Conclusion

Findings confirm the transmission of anxiety disorders from mother to offspring. Apart from maternal anxiety, self-perceived distress during pregnancy also emerged as a putative risk factor for adverse outcomes. The finding that maternal anxiety disorders before birth yielded less consistent associations, suggests that self-perceived distress during pregnancy might be seen as a putative moderator/mediator in the familial transmission of anxiety.     

Stress during pregnancy is associated with developmental outcome in infancy

BACKGROUND: Animal studies show that prenatal maternal stress may be related to cognitive impairments in offspring. Therefore, we examined whether psychological and endocrinologic measures of stress during human pregnancy predicted developmental outcome of the infant at 3 and 8 months. METHOD: Self-report data about daily hassles and pregnancy-specific anxiety and salivary cortisol levels were collected in 170 nulliparous women in early, mid- and late pregnancy in a prospective design, in which healthy infants born at term were followed up after birth. RESULTS: High levels of pregnancy-specific anxiety in mid-pregnancy predicted lower mental and motor developmental scores at 8 months (p < .05). High amounts of daily hassles in early pregnancy were associated with lower mental developmental scores at 8 months (p < .05). Early morning values of cortisol in late pregnancy were negatively related to both mental and motor development at 3 months (p < .05 and p < .005, respectively) and motor development at 8 months (p < .01). On average a decline of 8 points on the mental and motor development scale was found. All results were adjusted for a large number of covariates. CONCLUSION: Stress during pregnancy appears to be one of the determinants of delay in motor and mental development in infants of 8 months of age and may be a risk factor for later developmental problems. Further systematic follow-up of the present sample is needed to determine whether these delays are transient, persistent or even progressive.     

Effects of prenatal tobacco exposure on preschoolers' behavior

This is a longitudinal study of the relationship between prenatal tobacco exposure and the development of behavior problems in 672 children at the age of 3 years. Women from a prenatal clinic were interviewed about substance use at the end of each trimester of their pregnancy and at 3 years postpartum. Children were assessed at the age of 3 years with maternal ratings of behavior problems, activity, and attention. The prevalence of tobacco use was high in this cohort; 54.3% and 52.3% of the women smoked tobacco in the first and third trimesters of pregnancy, respectively. At 3 years postpartum, 61.6% of the women were smokers. There were significant effects of prenatal tobacco exposure on the children's behavior at age 3 years. Increases in scores on the Oppositional Behavior, Immaturity, Emotional Instability, Physical Aggression, and Activity scales and in the total score on the Toddler Behavior Checklist (TBC) were significantly associated with prenatal tobacco exposure. Smoking one pack of tobacco cigarettes per day during the third trimester of pregnancy was associated with an increase of 6 points in the total problem behavior score. Among the subscales of the TBC, tobacco exposure had the largest effect on oppositional behavior. Impulsivity and peer problems were associated with both prenatal and current tobacco exposure. Only current tobacco exposure predicted attention problems. Prenatal tobacco exposure had a significant negative effect on the development of behavior problems among preschoolers.     

Maternal depression and low maternal intelligence as risk factors for malnutrition in children: a community based case-control study from South India.

AIMS: To determine whether current and postpartum maternal depression and low maternal intelligence are risk factors for malnutrition in children. METHODS: In rural South India 72 children with malnutrition were identified from a central register; 72 controls were matched for age, gender, and residence. RESULTS: Major depression in the postpartum period (OR 5.0, 95% CI 1.0 to 24.0), current major depression (OR 3.2, 95% CI 1.1 to 9.5), and low maternal intelligence (OR 3.8, 95% CI 1.3 to 11.1) were associated with malnutrition in the child. Low birth weight (OR 2.9, 95% CI 1.2 to 6.8) was also significantly associated with infant malnutrition. Conditional logistic regression adjusting for all other determinants yielded the following results: major depression during the postpartum period (OR 7.8; 95% CI 1.6 to 38.51), current major depression (OR 3.1; 95% CI 0.9 to 9.7), low maternal intelligence (OR 4.6; 95% CI 1.5 to 14.1), and low birth weight (OR 2.7; 95% CI 2.5 to 6.8). The interactions between current maternal depression and low birth weight and between postpartum depression and low maternal intelligence were statistically significant. The level of maternal intelligence was associated with nutritional status. The severity of malnutrition was also significantly associated with major depression during the postpartum period and low maternal intelligence. CONCLUSION: There is evidence for an association between postpartum maternal depression, low maternal intelligence, and low birth weight with malnutrition in children aged 6-12 months.     

Maternal depression and low maternal intelligence as risk factors for malnutrition in children: a community based case-control study from South India

Aims: To determine whether current and postpartum maternal depression and low maternal intelligence are risk factors for malnutrition in children. Methods: In rural South India 72 children with malnutrition were identified from a central register; 72 controls were matched for age, gender, and residence. Results: Major depression in the postpartum period (OR 5.0, 95% CI 1.0 to 24.0), current major depression (OR 3.2, 95% CI 1.1 to 9.5), and low maternal intelligence (OR 3.8, 95% CI 1.3 to 11.1) were associated with malnutrition in the child. Low birth weight (OR 2.9, 95% CI 1.2 to 6.8) was also significantly associated with infant malnutrition. Conditional logistic regression adjusting for all other determinants yielded the following results: major depression during the postpartum period (OR 7.8; 95% CI 1.6 to 38.51), current major depression (OR 3.1; 95% CI 0.9 to 9.7), low maternal intelligence (OR 4.6; 95% CI 1.5 to 14.1), and low birth weight (OR 2.7; 95% CI 2.5 to 6.8). The interactions between current maternal depression and low birth weight and between postpartum depression and low maternal intelligence were statistically significant. The level of maternal intelligence was associated with nutritional status. The severity of malnutrition was also significantly associated with major depression during the postpartum period and low maternal intelligence. Conclusion: There is evidence for an association between postpartum maternal depression, low maternal intelligence, and low birth weight with malnutrition in children aged 6–12 months.     

Intimate partner violence and growth outcomes through infancy: A longitudinal investigation of multiple mediators in a South African birth cohort

Intimate partner violence (IPV) has been linked to poor fetal and infant growth. However, factors underlying this relationship are not well understood, particularly in the postnatal time period. In a South African cohort, we investigated (1) associations between IPV in pregnancy and growth at birth as well as postnatal IPV and child growth at 12 months and (2) whether maternal depression, tobacco or alcohol use or infant hospitalizations mediated IPV-growth relationships. Mothers were enrolled in pregnancy. Maternal IPV was measured during pregnancy and 10 weeks postpartum; depression, alcohol and tobacco use were measured during pregnancy and at 6 months postpartum. Child weight and length were measured at birth and 12 months and converted to z-scores for analysis. Linear regression and structural equation models investigated interrelationships between IPV and potential mediators of IPV-growth relationships. At birth, among 1,111 mother–infant pairs, maternal emotional and physical IPV were associated with reduced weight-for-age z-scores (WFAZ). Only physical IPV was associated with length-for-age z-scores (LFAZ) at birth. Antenatal maternal alcohol and tobacco use mediated IPV-growth relationships at birth. Postnatally, among 783 mother–infant pairs, emotional and physical IPV were associated with reduced WFAZ at 12 months. Only emotional IPV was associated with LFAZ at 12 months. Maternal tobacco use was a mediator postnatally. Findings highlight the role of physical and emotional IPV as risk factors for compromised fetal and infant growth. Findings underscore the importance of programmes to address interrelated risk factors for compromised infant growth, specifically IPV and substance use, which are prevalent in high-risk settings.     

A prospective study of maternal anxiety, perceived stress, and depressive symptoms in relation to infant cognitive development

Aim

Our objective was to examine the associations between maternal psychological health (trait anxiety, perceived stress, and depressive symptoms) during pregnancy or postpartum and infant visual, language, motor, and overall cognitive development.

Study Design and Methods

In the prospective Pregnancy, Infection, and Nutrition Study (2001-2006), central North Carolina women completed self-administered questionnaires during pregnancy to assess trait anxiety and depressive symptoms. An in-person interview assessed maternal perceived stress and depressive symptoms in the 4th postpartum month. Infant development was assessed at 12 months using the Mullen Scales of Early Learning (n = 358). Multiple linear regression with restricted cubic splines was used to examine potential non-linear associations between trait anxiety, perceived stress, and depressive symptoms in relation to Mullen sub-scales and Composite scores.

Results

Increasing maternal anxiety was associated with poorer overall cognition (adjusted β for Composite = − 0.2, 95% CI: −0.4, 0.0). Postpartum stress was positively associated with language development and general cognition (adjusted β for Expressive Language = 0.2, 95% CI: 0.0, 0.4; adjusted β for Composite = 0.3, 95% CI: 0.0, 0.6). Elevated depressive symptoms throughout pregnancy and postpartum were associated with better fine motor skills (adjusted β = 9.7, 95% CI: 3.9, 15.5). Anxiety, postpartum depressive symptoms and stress were associated with gross motor skills in a non-linear fashion, as were postpartum depressive symptoms and stress with expressive language.

Conclusions

Maternal trait anxiety, depressive symptoms and stress had little negative influence on infant cognitive development. In fact, moderate psychosocial distress may slightly accelerate motor development in particular, and some aspects of language.     

Maternal trait anxiety, depression and life event stress in pregnancy: relationships with infant temperament

AIMS: To assess whether links exist between maternal trait anxiety (STAI), perceived life event (LE) stress and depression (Edinburgh scale) and infant temperament. STUDY DESIGN AND SUBJECTS: Women in the third trimester of pregnancy returned psychological self-report questionnaires; infant temperament was evaluated at 4 and 6 months by maternal and paternal report, while depression (concurrent Edinburgh scale) was also assessed at four and six months. As data were returned inconsistently at 4 and 6 months, we combined these two time points for simplicity of reporting and optimisation of numbers. RESULTS: Univariate logistic regressions on 970 subjects indicated that the pregnancy STAI (>40) scores were associated with 2.56- and 1.57-fold increases (maternal and paternal, respectively), in the odds of "difficult" infant temperament at 4 or 6 months. Concurrent Edinburgh scores (OR of 3.06 and 2.64 for maternal reports, respectively) were also predictive of infant temperament. Age, education, income, marital status, obstetric complications, infant gender and prematurity were not predictive of infant temperament. In stepwise multiple logistic regression analyses, the antenatal trait STAI (odds ratio 1.96) significantly predicted maternal reports of "difficult" temperament at 4 or 6 months independent of both antenatal and postnatal depression scores. There were similar trends for paternal reports of "difficult" temperament but these were not significant. Antenatal depression and perceived LE stress were not predictive of temperament. Finally, women (N=14) reporting domestic violence (DV) in pregnancy had highly significant increased Edinburgh and STAI scores. CONCLUSIONS: Maternal trait anxiety was predictive of "difficult" infant temperament, independent of "concurrent" depression and key sociodemographic and obstetric risk factors. These findings, while needing replication using objective measures of infant temperament, suggest that antenatal psychological interventions aimed at minimising anxiety may optimize infant temperament outcomes. There may be some benefit in shaping specific interventions to women reporting specific risk factors such as DV or past abuse.