Biological embedding of perinatal social relationships in infant stress reactivity

Through a teratological lens: A narrative review of exposure to stress and drugs of abuse during pregnancy on neurodevelopment

Teratological research shows that both prenatal stress and prenatal substance exposure have a significant impact on neurodevelopmental outcomes in children. Using human research, the purpose of this narrative review is to explore the degree to which these exposures may represent complex prenatal and postnatal risks for the development of cognition and behavior in children. An understanding of the HPA axis and its function during pregnancy as well as the types and operationalization of prenatal stress provide a context for understanding the direct and indirect mechanisms by which prenatal stress affects brain and behavior development. In turn, prenatal substance exposure studies are evaluated for their importance in understanding variables that indicate a potential interaction with prenatal stress including reactivity to novelty, arousal, and stress reactivity during early childhood. The similarities and differences between prenatal stress exposure and prenatal substance exposure on neurodevelopmental outcomes including arousal and emotion regulation, cognition, behavior, stress reactivity, and risk for psychopathology are summarized. Further considerations for teratological studies of prenatal stress and/or substance exposure include identifying and addressing methodological challenges, embracing the complexity of pre-and postnatal environments in the research, and the importance of incorporating parenting and resilience into future studies.

Perinatal Predictors and Mediators of Attachment Patterns in Preschool Children: Exploration of Children's Contributions in Interactions with Mothers

Insecure and disorganized attachment patterns in children are linked to poor health outcomes over the lifespan. Attachment patterns may be predicted by variables that influence the quality of children's interactions with their primary caregivers/parents (usually mothers) such as prenatal and postnatal exposures and the children's own behaviours in interactions. The purposes of this exploratory study were to examine: (1) prenatal predictors of children's attachment patterns, and (2) postnatal mediators and moderators of associations between prenatal predictors and children's attachment patterns, with adjustment for relevant covariates. Mother-child dyads (n = 214) from the longitudinal Alberta Pregnancy Outcomes and Nutrition (APrON) cohort were studied using valid and reliable measures. Hayes' mediation analysis was employed to determine direct and indirect effects. Mothers' prenatal cortisol levels directly predicted disorganized (versus organized) child attachment in unadjusted models. Children's passivity (in adjusted models) and compulsivity (in unadjusted and adjusted models) in parent-child interactions mediated the pathway between mothers' prenatal cortisol levels and children's disorganized attachment patterns. Serial mediation analyses revealed that mothers' cortisol levels predicted their children's cortisol levels, which predicted children's compulsivity, and, ultimately, disorganized attachment in both unadjusted and adjusted models. No predictors were correlated with children's insecure (versus secure) attachment. This exploratory research suggests that prenatal exposure to mothers' cortisol levels and children's behavioural contributions to parent-child interaction quality should be considered in the genesis of children's attachment patterns, especially disorganization. Interventions focused on parent-child interactions could also focus on addressing children's behavioral contributions.

Longitudinal effects of maternal depressive and anxious symptomatology on child hair cortisol and cortisone from pregnancy to 5-years: The EDEN mother-child cohort

Exposure to maternal depressive and anxious symptomatology in utero and after birth can affect child outcomes. One proposed mechanism is through changes in child stress hormone levels, however current studies present inconsistent findings, and further research is needed to better understand the impact of maternal mental health on child stress response. This study aims to add to the limited literature by analysing longitudinal data ranging from 24 weeks amenorrhea to 5 years postpartum among 281 mother-child pairs from the French EDEN mother-child birth cohort. Hair cortisol and cortisone data were collected from children at four time points: birth, 1, 3, and 5 years. Mothers reported depressive symptomatology via the Center for Epidemiologic Studies Depression Scale (CES-D) (at 24-weeks amenorrhea, 3-, and 5-year follow-up), and the Edinburgh Postnatal Depression Scale (EPDS) (at 4, 8 and 12 months postpartum). Prenatal anxiety symptomatology was measured via the State Anxiety Inventory (STAI) at 24 weeks amenorrhea. Group-based trajectory modelling indicated a 1-cluster classification of longitudinal child hair cortisol, cortisone and cortisol-to-cortisone ratio, as analyses did not reveal a classification by subgroups representing different child profiles. After inverse probability weighting, small effects showed prenatal depressive symptomatology was significantly associated to higher levels of child hair cortisone at one year. Prenatal anxiety symptomatology was significantly linked to higher levels of child cortisol measured at birth and cortisone at birth and at 1 year. Postpartum depressive symptomatology at 8 months was related to higher levels of cortisone among 3-year-olds. These effects were not moderated by child sex or maternal socio-economic status. Further research is needed to understand why there are associations at some time points and not others to determine any potential buffering factors.

Social Support Buffers the Effects of Prenatal Depressed Mood: A Mixed-Methods Study

BACKGROUND: Women use various coping strategies to deal with stress and depression. These strategies are shaped by social contexts over the life course and may attenuate and/or exacerbate the physiologic effects of depression. AIMS: The purpose of this study was to determine whether coping strategies (active, disengaged, or social support coping) moderate depression-related diurnal cortisol dysregulation and to explore how social context influences women's use of coping. METHODS: This was a mixed-methods study of pregnant women (N = 65) during mid-pregnancy. Cortisol was measured in saliva collected during the waking hours of the day. Participants completed the Edinburgh Depression Scale and the Brief COPE. A subset of the sample participated in semistructured qualitative interviews (n = 20). RESULTS: Social support coping, but not active or disengaged coping, moderated end-of-day cortisol levels. Among depressed women, higher use of social support was associated with lower and more dynamic (i.e., less flat) diurnal cortisol rhythms. The qualitative findings revealed how complex social dynamics related to financial insecurity, lack of mutuality, and social identity affected women's use of and access to social support. CONCLUSION: These findings support theories of the stress-buffering effects of social support. Future research is needed to examine how social determinants affect access to social support, and how early life social experiences condition women's adaptive formation of social support coping strategies over the life course. Clinically, these findings underscore the value of relationship-centered nursing care for depressed women.

Maternal Early Life Adversity and Infant Stress Regulation: Intergenerational Associations and Mediation by Maternal Prenatal Mental Health

Early life adversity is a potent risk factor for poor mental health outcomes across the lifespan, including offspring vulnerability to psychopathology. Developmentally, the prenatal period is a sensitive window in which maternal early life experiences may influence offspring outcomes and demarcates a time when expectant mothers and offspring are more susceptible to stressful and salutary influences. This prenatal plasticity constituted the focus of the current study where we tested the association of maternal early life adversity with infant stress regulation through maternal prenatal internalizing symptoms and moderation by prenatal social support. Mother-infant dyads (n = 162) were followed prospectively and mothers completed assessments of social support and depressive and anxiety symptoms across pregnancy. Infants completed standardized stress paradigms at one month and six months. There were several key findings. First, maternal prenatal depressive symptoms significantly mediated predictions of infant cortisol reactivity to the heel stick at one month from maternal early life adversity: specifically, maternal early life adversity positively predicted depressive symptoms in pregnancy, which in turn predicted dampened infant cortisol reactivity. Second, prenatal social support did not significantly moderate predictions of depressive or anxiety symptoms in pregnancy from maternal early life adversity nor did it alter the associations of maternal depressive or anxiety symptoms with infant stress regulation. These results suggest that maternal prenatal mental health is a key mechanism by which maternal early life adverse experiences affect offspring risk for psychopathology. We discuss potential clinical and health implications of dysregulated infant cortisol reactivity with respect to lifespan development.

Addressing Adverse Childhood and Adult Experiences During Prenatal Care

Adverse childhood and adult experiences can affect health outcomes throughout life and across generations. The perinatal period offers a critical opportunity for obstetric clinicians to partner with patients to provide support and improve outcomes. This article draws on stakeholder input, expert opinion, and available evidence to provide recommendations for obstetric clinicians' inquiry about and response to pregnant patients' past and present adversity and trauma during prenatal care encounters. Trauma-informed care is a universal intervention that can proactively address adversity and trauma and support healing, even if a patient does not explicitly disclose past or present adversity. Inquiry about past and present adversity and trauma provides an avenue to offer support and to create individualized care plans. Preparatory steps to adopting a trauma-informed approach to prenatal care include initiating education and training for practice staff, prioritizing addressing racism and health disparities, and establishing patient safety and trust. Inquiry about adversity and trauma, as well as resilience factors, can be implemented gradually over time through open-ended questions, structured survey measures, or a combination of both techniques. A range of evidence-based educational resources, prevention and intervention programs, and community-based initiatives can be included within individualized care plans to improve perinatal health outcomes. These practices will be further developed and improved by increased clinical training and research, as well as through broad adoption of a trauma-informed approach and collaboration across specialty areas.

Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations

For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.

The Transition to Parenthood in Obstetrics: Enhancing Prenatal Care for Two Generation Impact

Obstetrics, the specialty overseeing infant and parent health before birth, could be expanded to address the inter-related areas of parents' prenatal impact on children's brain development and their own psychosocial needs during a time of immense change and neuroplasticity. Obstetrics is primed for the shift that is happening in pediatrics, which is moving from its traditional focus on physical health to a coordinated, whole child, two or multi-generation approach. Pediatric care now includes developmental screening, parenting education, parent coaching, access to developmental specialists, brain-building caregiving skills, linkages to community resources, and tiered interventions with psychologists. Drawing on decades of Developmental Origins of Health and Disease research highlighting the prenatal beginnings of future health and new studies on the transition to parenthood describing adult development from pregnancy to early postpartum, we propose that, similar to pediatrics, the integration of education and intervention strategies into the prenatal care ecosystem should be tested for its potential to improve child cognitive and social-emotional development and parental mental health. Pediatric care programs can serve as models of change for the systematic development, testing and, incorporation of new content into prenatal care as universal, first-tier treatment as well as evidenced-based, triaged interventions according to level of need. To promote optimal beginnings for the whole family, we propose an augmented prenatal care ecosystem that aligns with, and could build on, current major efforts to enhance perinatal care individualization through consideration of medical, social, and structural determinants of health.

The Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal study: cohort profile and key findings from the first three years

PURPOSE

The objectives of the ongoing Canadian longitudinal cohort called the Alberta Pregnancy Outcomes and Nutrition (APrON) study are to: (1) determine the relationship between maternal nutrient intake and status before, during, after pregnancy, and (a) maternal mental health, (b) pregnancy and birth outcomes, and (c) infant/child neurodevelopment and behavior; (2) identify maternal mental health and nutrient predictors of child behaviour; and (3) establish a DNA biobank to explore genomic predictors of children's neurodevelopment and behavior. The purpose of this paper is to describe the participants, measures, and key findings on maternal and paternal mental health, maternal nutrition, and child outcomes to when children are 3 years of age.

PARTICIPANTS

Participants included mothers and their children (n=2189) and mothers' partners (usually fathers; n=1325) from whom data were collected during the period from pregnancy to when children were 3 years of age, in Alberta, Canada. More than 88% of families have been retained to take part in completed data collection at 8 years of age.

FINDINGS TO DATE

Data comprise: questionnaires completed by pregnant women/mothers and their partners on mothers', fathers' and children's health; dietary interviews; clinical assessments; linkage to hospital obstetrical records; and biological samples such as DNA. Key findings on mental health, nutrition and child outcomes are presented. APrON women who consumed more selenium and omega-3 were less likely to develop symptoms of perinatal depression. Higher prenatal consumption of choline rich foods such as eggs and milk were recommended as was vitamin D supplementation for both mothers and children to meet guidelines. Couples in which both mothers and fathers were affected by perinatal depression reported lower incomes and higher maternal prenatal depressive symptoms and lower support from fathers postnatally and their children presented with the most behavioural problems. Maternal experiences of early adversity predicted increased likelihood of perinatal depression and anxiety and children's behavioural problems.

FUTURE PLANS

The APrON cohort offers a unique opportunity to advance understanding of the developmental origins of health and disease. There is a planned follow-up to collect data at 12 years of age.

Infant DNA methylation: an early indicator of intergenerational trauma?

Exposure to adverse childhood experiences (ACEs) increases risk for mental and physical health problems. Intergenerationally, mothers' ACEs predict children's health problems including neurodevelopmental and behavioural problems and poorer physical health. Theories of intergenerational trauma suggest that ACEs experienced in one generation negatively affect the health and well-being of future generations, with DNA methylation (DNAm) being one of several potential biological explanations. To begin exploring this hypothesis, we tested whether infant DNA methylation associated with intergenerational trauma. Secondary analysis employed data from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Subsample data were collected from mothers during pregnancy and postpartum on measures of distress, stress and ACEs and from infants at 3 months of age on DNAm from blood (n = 92) and buccal epithelial cells (BECs; n = 124; primarily nonoverlapping individuals between tissues). Blood and BECs were examined in separate analyses. Preliminary associations identified in blood and BECs suggest that infant DNAm patterns may relate to maternal ACEs. For the majority of ACE-related DNAm sites, neither maternal perinatal distress, nor maternal cortisol awakening response (CAR; a measure of hypothalamic-pituitary-adrenocortical axis function), substantially reduced associations between maternal ACEs and infant DNAm. However, accounting for maternal perinatal distress and cortisol substantially changed the effect of ACEs in a greater proportion of blood DNAm sites than BEC DNAm sites in the top ACEs-associated correlated methylated regions (CMRs), as well as across all CMRs and all remaining CpGs (that did not fall into CMRs). Possible DNAm patterns in infants, thus, might capture a signature of maternal intergenerational trauma, and this effect appears to be more dependent on maternal perinatal distress and CAR in blood relative to BECs.

Evolutionary Significance of the Neuroendocrine Stress Axis on Vertebrate Immunity and the Influence of the Microbiome on Early-Life Stress Regulation and Health Outcomes

Stress is broadly defined as the non-specific biological response to changes in homeostatic demands and is mediated by the evolutionarily conserved neuroendocrine networks of the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system. Activation of these networks results in transient release of glucocorticoids (cortisol) and catecholamines (epinephrine) into circulation, as well as activation of sympathetic fibers innervating end organs. These interventions thus regulate numerous physiological processes, including energy metabolism, cardiovascular physiology, and immunity, thereby adapting to cope with the perceived stressors. The developmental trajectory of the stress-axis is influenced by a number of factors, including the gut microbiome, which is the community of microbes that colonizes the gastrointestinal tract immediately following birth. The gut microbiome communicates with the brain through the production of metabolites and microbially derived signals, which are essential to human stress response network development. Ecological perturbations to the gut microbiome during early life may result in the alteration of signals implicated in developmental programming during this critical window, predisposing individuals to numerous diseases later in life. The vulnerability of stress response networks to maladaptive development has been exemplified through animal models determining a causal role for gut microbial ecosystems in HPA axis activity, stress reactivity, and brain development. In this review, we explore the evolutionary significance of the stress-axis system for health maintenance and review recent findings that connect early-life microbiome disturbances to alterations in the development of stress response networks.

Alteration in the psychologic status and family environment of pregnant women before and during the COVID-19 pandemic

Objective

To compare mental distress and COVID‐19‐related family environment changes among pregnant women before and during the pandemic.

Methods

In a survey‐based study in Lishui City, Zhejiang, China, pregnant women were recruited before (March–December, 2019; n = 2657) and during (January–August, 2020; n = 689) the COVID‐19 pandemic. They completed the Symptom Check List‐90 Revised (SCL90‐R) questionnaire and Pittsburgh Sleep Quality Index (PSQI), and were asked about their families via the Family Environment Scale (FES).

Results

Higher SCL90‐R scores of somatization (P = 0.003), depression (P = 0.043), anxiety (P = 0.041), hostility (P = 0.009), and others (P = 0.025) were reported by women during the COVID‐19 pandemic. Sleep disorder also occurred more frequently among pregnant women during the pandemic (P = 0.002). Social environmental characteristics of families showed impaired family cohesion, and increased levels of conflict and independence during the pandemic (all P < 0.05). The FES score for family cohesion was negatively related with obsessive–compulsive, depression, anxiety, and hostility symptoms, whereas that for conflict was positively related with these symptoms (all P < 0.001).

Conclusion

The mental health, sleep, and family environment of pregnant women was impaired during the COVID‐19 pandemic. Potential protective factors including increased social support might help to mitigate long‐lasting negative consequences.

The mental health and sleep of pregnant women was impaired during the COVID‐19 pandemic, and they experienced more stressful family events over the crisis.

Integrative Review of Early Life Adversity and Cortisol Regulation in Pregnancy

OBJECTIVE

To synthesize published findings on the relationship between early life adversity and hypothalamic-pituitary-adrenal axis cortisol parameters in pregnant women.

DATA SOURCES

We searched PubMed, CINAHL, and PsycINFO databases using variants and combinations of the keywords early life adversity, pregnancy, hypothalamic-pituitary-adrenal axis, and cortisol.

STUDY SELECTION

We selected articles that included pregnant participants, included measures of cortisol and early life adversity, were published in English in a peer-reviewed journal, and were of sufficient methodologic quality. Date of publication was unrestricted through May 2020.

DATA EXTRACTION

Twenty-five articles met the inclusion criteria and were evaluated for quality and risk of bias. Sources of cortisol included saliva, hair, plasma, and amniotic fluid.

DATA SYNTHESIS

We categorized findings according to four physiologically distinct cortisol output parameters: diurnal (daily pattern), phasic (in response to an acute stressor), tonic (baseline level), and pregnancy-related change. Preliminary evidence suggests that early adversity may be associated with elevated cortisol awakening response (diurnal) and blunted response to acute stressors (phasic), irrespective of other psychosocial symptoms or current stress. For women with high levels of current stress or psychological symptoms, early adversity was associated with higher baseline (tonic) cortisol levels.

CONCLUSION

Early life adversity in women is linked with alterations in cortisol regulation that are apparent during pregnancy. Researchers should examine how variations in each cortisol parameter differentially predict pregnancy health risk behaviors, maternal mental health, and neonatal health outcomes.

Pregnancy as a period of risk, adaptation, and resilience for mothers and infants

The pregnancy period represents a unique window of opportunity to identify risks to both the fetus and mother and to deter the intergenerational transmission of adversity and mental health problems. Although the maternal-fetal dyad is especially vulnerable to the effects of stress during pregnancy, less is known about how the dyad is also receptive to salutary, resilience-promoting influences. The present review adopts life span and intergenerational perspectives to review four key areas of research. The first part describes how pregnancy is a sensitive period for both the mother and fetus. In the second part, the focus is on antecedents of maternal prenatal risks pertaining to prenatal stress response systems and mental health. The third part then turns to elucidating how these alterations in prenatal stress physiology and mental health problems may affect infant and child outcomes. The fourth part underscores how pregnancy is also a time of heightened fetal receptivity to maternal and environmental signals, with profound implications for adaptation. This section also reviews empirical evidence of promotive and protective factors that buffer the mother and fetus from developmental and adaptational problems and covers a sample of rigorous evidence-based prenatal interventions that prevent maladaptation in the maternal-fetal dyad before babies are born. Finally, recommendations elaborate on how to further strengthen understanding of pregnancy as a period of multilevel risk and resilience, enhance comprehensive prenatal screening, and expand on prenatal interventions to promote maternal-fetal adaptation before birth.

Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic

BACKGROUND

Anxiety and depression symptoms in pregnancy typically affect between 10 and 25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm birth, postpartum depression, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond.

METHODS

We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social support.

RESULTS

We found substantially elevated anxiety and depression symptoms compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression and 57% reporting clinically relevant symptoms of anxiety. Higher symptoms of depression and anxiety were associated with more concern about threats of COVID-19 to the life of the mother and baby, as well as concerns about not getting the necessary prenatal care, relationship strain, and social isolation due to the COVID-19 pandemic. Higher levels of perceived social support and support effectiveness, as well as more physical activity, were associated with lower psychological symptoms.

CONCLUSION

This study shows concerningly elevated symptoms of anxiety and depression among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential protective factors include increased social support and exercise, as these were associated with lower symptoms and thus may help mitigate long-term negative outcomes.

Poverty, Caregiving, and HPA-Axis Activity in Early Childhood

The association between poverty and the activity of the hypothalamic pituitary adrenal (HPA) axis in early childhood is well established. Both ecological and transactional theories suggest that one way in which poverty may influence children's HPA-axis activity is through its effects on parents' behaviors, and over the past three decades a substantial literature has accumulated indicating that variations in these behaviors are associated with individual differences in young children's HPA-axis activity. More recent research suggests that non-parental caregiving behaviors are associated with HPA-axis activity in early childhood as well. Here we systematically review the literature on the association between both parental and non-parental caregiving behaviors in the context of poverty and the activity of the HPA-axis in early childhood. We conclude by noting commonalities across these two literatures and their implications for future research.

Salivary cortisol reactivity to psychological stressors in infancy: A meta-analysis

Measurement of salivary cortisol is a practical and non-invasive tool for studying stress reactivity to various types of stressors even in young infants. Whereas studies using physical stressors during the first months of life have found robust cortisol responses to painful stimuli, research with older infants using psychological stressors (e.g., parental separation) has produced mixed findings, limiting our understanding of potential developmental changes in cortisol reactivity across infancy. In the present study, we used meta-analysis to systematically investigate whether psychological stressor paradigms are associated with measurable cortisol responses in infants under 18 months of age and whether the magnitude of the responses is moderated by the type of psychological stressor (i.e., separation, frustration, novelty, or disruption of parental interaction), infant age, and other potential moderators. Across 47 studies (N = 4095, age range: 3-18 months), we found that commonly used psychological stressor paradigms are associated with a small (Hedges' g = .11) increase in salivary cortisol levels in typically developing infants. Stressor type moderated the effect sizes, and when effect sizes in each category were analyzed separately, only the separation studies were associated with a consistent increase in cortisol following the stressor. Age did not moderate the effect sizes either in the full set of studies or within the separate stressor types. These meta-analytic results indicate that the normative cortisol response to psychological stressors across infancy is small and emphasize the need for standardized stressor paradigms to assess cortisol responses systematically across infancy.

Improved Child Mental Health Following Brief Relationship Enhancement and Co-Parenting Interventions During the Transition to Parenthood

The transition to parenthood has been identified as a significant relationship stressor. Many couples report declines in relationship satisfaction and difficulty with individual stress and co-parenting-problems that have been associated with both child temperament as well as emotional and behavioral problems. Several parenting and relationship interventions have been developed to buffer against these difficulties. In the current study, we report secondary analyses of a randomized controlled trial of brief (6-hr) interventions that focused on improving either relationship satisfaction or co-parenting, delivered during pregnancy and the early postpartum period. In this trial, 90 opposite-sex couples (180 participants), who were pregnant with their first child, and were assessed as being at high risk for declines in relationship satisfaction, were randomized to receive either (1) a relationship intervention, (2) a co-parenting intervention, or (3) an information control. At 12 months postpartum, couples who received either the relationship or co-parenting intervention rated their infants as having lower negative emotionality and as having fewer externalizing symptoms compared to the information-only control. Lower externalizing symptoms at 12 months were, in turn, associated with reduced externalizing symptoms at 24 months postpartum. Whereas, lower ratings of child negative emotionality at 12 months were associated with reduced internalizing symptoms at 24 months postpartum. These results indicate that brief relationship or co-parenting interventions delivered during the transition to parenthood have secondary benefits for child mental health.

Maternal and paternal perinatal depressive symptoms associate with 2- and 3-year-old children's behaviour: findings from the APrON longitudinal study

BACKGROUND

Prenatal and postnatal depressive symptoms are common in expectant and new mothers and fathers. This study examined the association between four patterns of probable perinatal depression (mother depressed, father depressed, both depressed, neither depressed) in co-parenting mothers and fathers and their children's internalizing and externalizing behaviours at 24 and 36 months of age. The influence of sociodemographic, risk and protective factors was also examined.

METHODS

Depressive symptoms were measured during pregnancy and at 3 months postpartum and children's behaviour was assessed at 24 and 36 months of age. Families (n = 634) provided data on their children's internalizing (i.e. emotionally reactive, anxious/depressed, somatic complaints, withdrawn and total) and externalizing (i.e. attention problems, aggression and total) behaviour. Marginal models were employed to determine the relationship between children's behaviour over the two time points and the four patterns of probable parental depression. Sociodemographic variables as well as risk (stress) and protective (social support) factors were included in these models.

RESULTS

In the perinatal period 19.40% (n = 123) of mothers scored as probably depressed and 10.57% (n = 67) of fathers. In 6.31% (n = 40) of the participating families, both parents scored as probably depressed and in 63.72% (n = 404) neither parent scored as depressed. For children's emotionally reactive, withdrawn and total internalizing behaviours, both mothers' probable depression and mothers and fathers' co-occurring probable depression predicted higher scores, while for children's aggressive behaviour, attention problems, and total externalizing behaviours, only mothers' probable depression predicted higher scores, controlling for sociodemographic, risk and protective factors.

CONCLUSIONS

While probable perinatal depression in mothers predicted 2 and 3 year-old children's behavioural problems, co-occurrence of depression in mothers and fathers had an increased association with internalizing behavioural problems, after considering sociodemographic, risk and protective factors. Health care providers are encouraged to consider the whole family in preventing and treating perinatal depression.

Partner social support during pregnancy and the postpartum period and inflammation in 3-month-old infants

Prenatal social stress "programs" offspring immune activity in animal models, but how the prenatal social environment affects human offspring inflammation is not known. Here, we test associations between prenatal partner support quality, i.e. positive/helpful support, negative/upsetting support, and their interaction, and infant inflammatory markers. A sample of 113 women from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort were followed from early pregnancy to 3-months postpartum. Partner support quality was measured during pregnancy and the postpartum period. Three-month-old infant blood samples were assayed for inflammatory markers, i.e., adaptive immune markers IFNγ, IL12p70 and IL10. The prenatal positive-by-negative partner support interaction predicted infant IFNγ, IL12p70, and IL10, p's<.035, independent of covariates and postpartum partner support. When negative partner support was high, high positive support predicted higher infant IFNγ, IL12p70, and IL10. As such, partner support during pregnancy that is both highly negative/upsetting and also highly positive/helpful predicted adaptive immunity markers in infants at 3 months of age.

Malnutrition and depression in pregnancy and associations with child behaviour and cognitive function: a review of recent evidence on unique and joint effects 1

Accumulating studies suggest that prenatal experiences can shape a child's neurodevelopment. Malnutrition and depression occur in pregnancy relatively often and may affect child neurodevelopment independently as well as synergistically. We aimed to provide an overview of recent studies that have examined malnutrition and (or) depression in pregnancy and associations with child behavioural problems and cognitive function. We conducted a literature search in PubMed, using the following main search terms: "depression", "nutrition", "BMI", "pregnancy", "offspring", "cognition", and "behaviour". We included studies in human populations published from 2013 onwards. The literature search yielded 1531 articles, of which 55 were included in the current review. We presented the evidence on the associations between prenatal markers of nutritional status and (or) depression and child behaviour and (or) cognitive function. We additionally discussed interventions and mechanisms. Both malnutrition and depression in pregnancy are associated with increased externalizing behavioural problems and attentional deficits, and to some extent with poorer cognitive function in the child, but the evidence is not conclusive. Studies on synergistic effects of both factors on child behaviour and cognitive function are still scarce, and more research is needed. Potential shared mechanisms include the hypothalamic-pituitary-adrenal axis, the immune system, epigenetics, and oxidative stress.

Fetal programming of neuropsychiatric disorders by maternal pregnancy depression: a systematic mini review

BACKGROUND

Maternal depression complicates a large proportion of pregnancies. Current evidence shows numerous harmful effects on the offspring. Reviews, which include depression, concluded that stress has harmful effects on the offspring's outcomes neuro-cognitive development, temperament traits, and mental disorders.

OBJECTIVE

This mini review of recent studies, sought to narrow the scope of exposure and identify studies specifically assessing prenatal depression and offspring neuropsychiatric outcomes.

STUDY ELIGIBILITY CRITERIA

The review included longitudinal, cohort, cross-sectional, clinical, quasi-experimental, epidemiological, or intervention study designs published in English from 2014 to 2018.

PARTICIPANTS

Study populations included mother-child dyads, mother-father-child triads, mother-alternative caregiver-child triads, and family studies utilizing sibling comparisons.

METHODS

We searched PubMED and Web of Science. Study inclusion and data extraction were based on standardized templates. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS).

RESULTS

Thirteen studies examining neuropsychiatric outcomes were included. We judged the evidence to be moderate to high quality.

CONCLUSIONS

Our review supports that maternal prenatal depression is associated with neuropsychiatric adversities in children.

IMPLICATIONS

Future investigations should unravel the biological underpinnings and target timely interventions as early in pregnancy as possible to prevent offspring neuropsychiatric harms.

Social buffering of the maternal and infant HPA axes: Mediation and moderation in the intergenerational transmission of adverse childhood experiences

Supportive social relationships can reduce both psychological and physiological responses to stressful experiences. Recently, studies have also assessed the potential for social relationships to buffer the intergenerational transmission of stress. The majority of these studies, however, have focussed on social learning as a mechanism responsible for the intergenerational transmission of stress. Evidence of biological mechanisms is lacking. The objective of the current study was, therefore, to determine whether the association between maternal adverse childhood experiences (ACEs) and infant hypothalamic-pituitary-adrenal (HPA) axis function is mediated by maternal HPA axis function during pregnancy and moderated by social support. Data were from 243 mother-infant dyads enrolled in a prospective longitudinal cohort (the Alberta Pregnancy Outcomes and Nutrition Study). Maternal history of ACEs was retrospectively assessed while maternal perceived social support and salivary cortisol were assessed prospectively at 6-22 weeks gestation (Time 1) and 27-37 weeks gestation (Time 2), and infant cortisol reactivity to a laboratory stressor and maternal perceived social support were assessed at 5-10 months postnatal (Time 3). Results revealed that maternal HPA axis function during pregnancy mediated the effects of maternal ACEs on infant HPA axis reactivity, suggesting that the maternal HPA axis is a mechanism by which maternal early life stress is transmitted to offspring. Furthermore, social support in the prenatal and postnatal periods moderated the cascade from maternal ACEs to infant HPA axis reactivity. Specifically, prenatal social support moderated the association between ACEs and maternal HPA axis function during pregnancy, and postnatal social support moderated the association between maternal HPA axis function and infant cortisol reactivity. These findings highlight the social sensitivity of the HPA axis and suggest the utility of social relationships as an intervention target to reduce the effects of maternal early life stress on infant outcomes.

Hypothalamic-pituitary-adrenal axis and autonomic nervous system reactivity in children prenatally exposed to maternal depression: A systematic review of prospective studies

Depression is a common condition affecting up to 20% of all pregnant women, and is associated with subsequent developmental and behavioral problems in children, such as conduct disorder and ADHD. One proposed mechanism underlying these associations is modification of the fetal hypothalamic pituitary adrenal (HPA)-axis and the autonomic nervous system (ANS), resulting in altered responses to stress. This review examined the evidence regarding altered HPA-axis and ANS reactivity in children prenatally exposed to high maternal depressive symptoms. A systematic search was conducted in the electronic databases MEDLINE, EMBASE and PsycINFO, for studies published till 25 July 2017. A total of 13 studies comprising 2271 mother-infant dyads were included. None of the studies were suitable for meta-analysis. Risk of bias assessment showed low risk for four studies. Only three studies described an independent association between exposure to high maternal prenatal depressive symptoms and altered stress reactivity in children. There is limited evidence of an independent association between prenatal exposure to maternal depression and altered HPA or ANS reactivity in children.

Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex

Adverse childhood experiences (ACEs) of parents are associated with a variety of negative health outcomes in offspring. Little is known about the mechanisms by which ACEs are transmitted to the next generation. Given that maternal depression and anxiety are related to ACEs and negatively affect children's behaviour, these exposures may be pathways between maternal ACEs and child psychopathology. Child sex may modify these associations. Our objectives were to determine: (1) the association between ACEs and children's behaviour, (2) whether maternal symptoms of prenatal and postnatal depression and anxiety mediate the relationship between maternal ACEs and children's behaviour, and (3) whether these relationships are moderated by child sex. Pearson correlations and latent path analyses were undertaken using data from 907 children and their mothers enrolled the Alberta Pregnancy Outcomes and Nutrition study. Overall, maternal ACEs were associated with symptoms of anxiety and depression during the perinatal period, and externalizing problems in children. Furthermore, we observed indirect associations between maternal ACEs and children's internalizing and externalizing problems via maternal anxiety and depression. Sex differences were observed, with boys demonstrating greater vulnerability to the indirect effects of maternal ACEs via both anxiety and depression. Findings suggest that maternal mental health may be a mechanism by which maternal early life adversity is transmitted to children, especially boys. Further research is needed to determine if targeted interventions with women who have both high ACEs and mental health problems can prevent or ameliorate the effects of ACEs on children's behavioural psychopathology.