Prenatal and postnatal psychological symptoms of parents and family functioning: the impact on child emotional and behavioural problems

Mother-Infant Interaction and Maternal Postnatal Psychological Distress Associate with Child's Social-Emotional Development During Early Childhood: A FinnBrain Birth Cohort Study

We studied the effects of mother-infant interaction and maternal pre- and postnatal psychological distress on children's social-emotional problems and competences, as well as whether interaction quality moderates the association between distress and children's outcomes. Maternal pre- and postnatal psychological distress were measured using the SCL and EPDS questionnaires, whereas mother-infant interaction was measured when the child was 8 months old using the EA Scales. Children's social-emotional development was measured using the BITSEA questionnaire at 2 years old and using the SDQ questionnaire at 4 years old, where higher maternal structuring was associated with fewer social-emotional problems in children and higher maternal sensitivity was associated with greater social-emotional competence in children at 2 years old. Further, higher postnatal distress was found associated with greater social-emotional problems at 2 years old, though neither these effects nor moderating effects at 4 years old were observed after multiple-comparison corrections. Our findings support direct associations of both mother-infant interaction and maternal postnatal psychological distress with children's social-emotional development during toddlerhood.

"Association between perinatal mood disorders of parents and child health outcomes"

PURPOSE

Perinatal mood disorders affect both parents, impacting their children negatively. Little is known on the association between parental perinatal mood disorders and pediatric outcomes in Japan considering relevant covariates. Our objective was to investigate the association between paternal and maternal perinatal mood disorders and adverse physical and psychological child outcomes by the age of 36 months, adjusting for covariates such as the child's sex, age of parent at child's birth, perinatal mood disorders of the other parent, and perinatal antidepressant use.

METHODS

We identified parents in the JMDC Claims Database in Japan from 2012 to 2020. Perinatal mood disorders were defined using International Classification of Diseases, 10th codes for mood disorders during the perinatal period combined with psychiatric treatment codes. We evaluated the association between parental perinatal mood disorders and pediatric adverse outcomes by the age of 36 months using Cox proportional hazard models adjusted for the covariates.

RESULTS

Of the 116,423 father-mother-child triads, 2.8% of fathers and 2.3% of mothers had perinatal mood disorders. Paternal perinatal mood disorders were not significantly associated with adverse child outcomes. After adjusting for paternal perinatal mood disorders and antidepressant use, maternal perinatal mood disorders were associated with delayed motor development, language development disorders, autism spectrum disorders, and behavioral and emotional disorders (adjusted hazard ratio [95% confidence interval]: 1.65 [1.01-2.69], 2.26 [1.36-3.75], 4.16 [2.64-6.55], and 6.12 [1.35-27.81], respectively).

CONCLUSIONS

Paternal perinatal mood disorders were not associated with adverse child outcomes in this population. Maternal perinatal mood disorders were associated with multiple child outcomes.

Arterial Health Markers in Relation to Behavior and Cognitive Outcomes at School Age

BACKGROUND

Impaired arterial health is associated with a decline in cognitive function and psychopathology in adults. We hypothesized that these associations originate in early life. We examined the associations of blood pressure, common carotid artery intima media thickness, and carotid distensibility with behavior and cognitive outcomes during adolescence.

METHODS AND RESULTS

This study was embedded in the Dutch Generation R Study, a population-based prospective cohort study from early fetal life onwards. Blood pressure, carotid intima media thickness, and carotid distensibility were measured at the age of 10 years. At the age of 13 years, total, internalizing and externalizing problems and attention-deficit hyperactivity disorder symptoms were measured using the parent-reported Child Behavior Checklist (CBCL/6-18), autistic traits were assessed by the Social Responsiveness Scale, and IQ was assessed using the Wechsler Intelligence Scale for Children-Fifth Edition. A 1-SD score higher mean arterial pressure was associated with lower odds of internalizing problems (odds ratio [OR], 0.92 [95% CI, 0.85-0.99]). However, this association was nonsignificant after correction for multiple testing. Carotid intima media thickness and carotid distensibility were not associated with behavior and cognitive outcomes at 13 years old.

CONCLUSIONS

From our results, we cannot conclude that the associations of blood pressure, carotid intima media thickness, and carotid distensibility at age 10 years with behavior and cognitive outcomes are present in early adolescence. Further follow-up studies are needed to identify the critical ages for arterial health in relation to behavior and cognitive outcomes at older ages.

Prenatal stress and externalizing behaviors in childhood and adolescence: A systematic review and meta-analysis

Accumulating evidence suggests that psychological distress during pregnancy is linked to offspring risk for externalizing outcomes (e.g., reactive/aggressive behaviors, hyperactivity, and impulsivity). Effect sizes across studies have varied widely, however, due to differences in study design and methodology, including control for the confounding continuation of distress in the postnatal period. Clarifying these inconsistencies is necessary to guide the precision of prevention efforts and inform public health policies. A meta-analysis was conducted with 55 longitudinal studies to investigate the association between prenatal psychological distress (anxiety, depression, and perceived stress) and offspring externalizing behaviors. Results revealed a significant but small effect (r = .160) of prenatal distress on externalizing behaviors. The magnitude of the prenatal effect size remained largely unchanged after adjusting for postnatal distress (r = .159), implicating a unique effect of psychological distress during the prenatal period in the etiology of externalizing behaviors. Moderation tests showed that prenatal effects did not vary based on type and timing of psychological distress during pregnancy. Greater instability of distress from prenatal to postnatal periods predicted larger effects. Prenatal effects were comparable across most externalizing outcomes, consistent with the common comorbidity of externalizing spectrum disorders, although effects appeared smaller for nonaggressive rule-breaking (vs. aggressive) behaviors. Significant associations persisted across all developmental periods, appearing slightly larger in early childhood. We discuss these results in the context of developmental and psychobiological theories of externalizing behavior, offer preliminary clinical and public health implications, and highlight directions for future research including the need for longitudinal studies with more racially and socioeconomically diverse families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

"More Than Just a Manicure" Qualitative Experiences of Maternal Self-Care During COVID-19

Background

The COVID-19 pandemic presented families with novel challenges. Mothers were at particular risk for parental burnout, however, there is limited research on self-care behaviors to ameliorate it explicitly for mothers of young children (aged 3 and younger). Moreover, there has been little in-depth analysis on barriers to self-care and how mothers realistically implement it in their lives.

Methods

In this article, we explore influences on and barriers to self-care in mothers of young children during the COVID-19 pandemic. Using a content analysis approach, we used verbal testimony from mothers to create a coding framework and applied that framework to the sample (N = 717).

Results

Qualitative analyses revealed that beauty and personal care were the most utilized self-care acts. Two major barriers were lack of childcare and limited time. Social support was the most frequently reported asset to engaging in self-care. Participants noted that the pandemic significantly restricted their access to activities and social support.

Conclusions

These findings emphasize the need to encourage mothers to prioritize self-care and incorporate their support systems to facilitate engagement. These results can inform programming to increase self-care behaviors in mothers, particularly during times of high environmental stressors. Future research should examine how resources can be allocated toward barriers of self-care to reduce burnout and improve quality of life.

Maternal psychosocial stress during pregnancy and offspring neurobehavioral outcomes during early childhood in the Healthy Start Study

PURPOSE

We evaluate singular and combined effects of prenatal maternal depression and stress on early childhood neurobehavioral outcomes among 536 mother-child pairs.

METHODS

First, we used multivariable linear regression to investigate associations of women's Edinburgh Postnatal Depression Scale (EPDS) score and Perceived Stress Scale (PSS) score, separately, with offspring Child Behavior Checklist score. Next, to assess the combined effect of EPDS and PSS, we dichotomized each score at the fourth versus first to third quartiles and created a four-level variable comprising combinations of high and low depression and stress. Across all models, we accounted for household chaos, hubbub, and order scale (CHAOS) score, an indicator of the household environment associated with offspring behavioral outcomes.

RESULTS

Each one-unit increment in maternal EPDS and PSS scores corresponded with 0.75 (95% CI: 0.53, 0.96) and 0.72 (95% CI: 0.48, 0.95) units higher offspring total problems T-score, respectively. Children of women with high EPDS and PSS had highest T-scores for total problems. All associations remained materially unchanged after adjustment for CHAOS score.

CONCLUSIONS

Prenatal maternal depression and stress is associated with worse neurobehavioral outcomes among offspring, with the most unfavorable outcomes among children whose mothers had high scores for both EPDS and PSS.

Proximal Processes and Contextual Factors Associated with Early Socio-emotional Competence Development

There is growing interest in child socio-emotional competence from parents, educators, employers and policy makers, with emphasis on developing it as early as possible. The aim of the present study was to examine contextual and proximal factors that influence socio-emotional competence development across the first five years of a child's life. We used data from 3200 mothers and their children drawn mostly from four major data collection waves (antenatal, 9 months, 2 years and 4.5 years) of the population-based longitudinal study, Growing Up in New Zealand. Regression analyses were carried out to identify the predictors of socio-emotional competence after controlling for demographics and prior score(s) of socio-emotional competence. We found that specific maternal behaviours, such as playing games and playing with toys with children, singing songs or telling stories to them, reading books with them, having rules around viewing TV, DVDs and videos, and praising children have a positive effect on socio-emotional competence. Parental relationship warmth and less family stress at 9 months also made positive contributions to socio-emotional competence at 9 months and 2 years. In contrast, attending childcare and having more siblings at home negatively predicted socio-emotional competence at 9 months. Mother's unemployment, living in neighbourhoods perceived as negative and being in contact with family and social services were negatively associated with concurrent socio-emotional competence at 2 years. Overall, more and/or stronger contemporaneous effects were found suggesting that negative effects of contextual factors may not have lasting impact on socio-emotional competence. In addition, the results showed that maternal behaviours need to be practised regularly to have positive impact on child's socio-emotional development.

Differential effects of prenatal psychological distress and positive mental health on offspring socioemotional development from infancy to adolescence: a meta-analysis

The impact of prenatal maternal mental health on offspring socioemotional development is substantial and enduring. Existing literature primarily focuses on the effects of psychological distress during pregnancy, emphasizing adverse child outcomes. Recent studies, however, highlight the unique impact of positive maternal mental health on child outcomes. To elucidate the differential associations of maternal psychological distress and positive mental health during pregnancy with child outcomes, we conducted a systematic literature search and random-effects meta-analyses on studies investigating the associations of prenatal maternal mental health with child socioemotional development. Our analyses, comprising 74 studies with 321,966 mother-child dyads across 21 countries, revealed significant associations of prenatal psychological distress with both adverse and positive child socioemotional outcomes. Notably, the effect sizes for the association of psychological distress with positive child outcomes were smaller compared to adverse outcomes. Positive prenatal mental health, on the other hand, was significantly associated with positive socioemotional outcomes but not adverse outcomes. This meta-analysis highlights the independence of negative and positive prenatal mental health constructs and their distinct relationships with child socioemotional development. The findings underscore the importance of considering the positive spectrum of maternal mental health and developmental outcomes to enhance our understanding of prenatal influences on child development. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=335227, identifier CRD42022335227.

The effect of COVID-19 lockdowns on women's perinatal mental health: a systematic review

BACKGROUND

Risk factors for poor maternal perinatal mental health include a previous mental health diagnosis, reduced access to perinatal services, economic concerns and decreased levels of social support. Adverse maternal perinatal mental health can negatively influence the psychological wellbeing of infants. The outbreak of the COVID-19 pandemic presented an additional stressor. While literature on the impact of COVID-19 on perinatal mental health exists, no systematic review has focused specifically on maternal perinatal mental health during periods of COVID-19 lockdown.

AIMS

This systematic review explores how periods of COVID-19 lockdown impacted women's perinatal mental health.

METHODS

Searches of CINAHL, PsycARTICLES, PsycINFO, PubMed, Scopus and Web of Science were conducted for literature from 1st January 2020-25th May 2021. Quantitative, peer-reviewed, cross-sectional studies published in English with perinatal women as participants, and data collected during a period of lockdown, were included. Data was assessed for quality and narratively synthesized.

FINDINGS

Sixteen articles from nine countries met the inclusion criteria. COVID-19 lockdowns negatively impacted perinatal mental health. Risk factors for negative perinatal mental health noted in previous literature were confirmed. In addition, resilience, educational attainment, trimester, and ethnicity were identified as other variables which may influence mental health during perinatal periods experienced during lockdown. Understanding nuance in experience and harnessing intra and interpersonal support could advance options for intervention.

CONCLUSION

Developing resources for perinatal women that integrate informal sources of support may aid them when normal routine is challenged, and may mediate potential long-term impacts of poor perinatal maternal health on infants.

Impact of the Timing of Maternal Peripartum Depression on Infant Social and Emotional Development at 18 Months

The study assessed how the timing of maternal perinatal depressive symptoms affects infant socio-emotional characteristics at age 18 months. The study was a longitudinal cohort study that included six assessment points from the third trimester of pregnancy up to age 18 months (±1 month). Assessment of mothers included the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory, while assessments of infant included the Infant Toddler Social and Emotional Assessment (ITSEA) at 18 months. Mothers were categorized into one of the following groups: mothers who presented postnatal depression only (n = 19); mothers who presented both prenatal and postnatal depression (n = 14), and mothers who never showed perinatal depression symptoms (n = 38). Mothers who presented both prenatal and postnatal depression showed significantly higher levels of depressive score, reactivity to stress and level of anxiety trait compared to mothers of the two other groups. Infants of prenatally and postnatally depressed mothers had higher scores on the internalizing subscore of the ITSEA. The number of depression episodes during the study period was positively correlated with the externalizing and internalizing subscores of the ITSEA. These findings support the need to provide specific screening to identify women with prenatal depression.

Meta-analysis of diagnostic properties of the Whooley questions to identify depression in perinatal women

BACKGROUND

This study's objective was to assess the diagnostic properties of the Whooley questions in identifying depression among perinatal women according to previously published studies. We conducted a systematic review and meta-analysis of studies investigating the diagnostic accuracy of the Whooley questions in perinatal women.

METHODS

Nine databases were searched in October 2021. All primary studies evaluated the diagnostic properties of the Whooley questions compared with a diagnostic gold standard in women during the perinatal period or, if not identified as being in the perinatal stage within the study, women between 20 weeks' gestation to 4 weeks post-delivery. A bivariate mixed-effects meta-analysis was performed to estimate pooled diagnostic properties and measure heterogeneity. Meta-regression was conducted to evaluate factors contributing to heterogeneity.

RESULTS

Six studies were included in the review; five were used in the meta-analysis. The pooled sensitivity (95 % confidence interval) was 0.95 (0.81-0.99), pooled specificity was 0.60 (0.44-0.74), pooled positive likelihood ratio was 2.4 (1.6-3.4), pooled negative likelihood ratio was 0.09 (0.02-0.32), and pooled diagnostic odds ratio was 27 (7-106); heterogeneity was substantial (I² = 0.90, 0.81-1.00). Participant age and setting (community vs. hospital) significantly contributed to heterogeneity.

CONCLUSIONS

The Whooley questions have high sensitivity but moderate specificity for perinatal women. The Whooley questions are a short and acceptable tool for identifying depression in perinatal women. However, a potential risk exists of incorrectly identifying a high proportion of women as positive. Using the Whooley questions followed by a secondary case-finding tool could reduce the misdiagnosis risk.

Cost-effectiveness of mental health interventions during and after pregnancy: A systematic review

BACKGROUND

Mental health problems during and after pregnancy such as depression, anxiety, post-traumatic stress disorder (PTSD), or addiction are common and can have lifelong implications for both parents and offspring. This review investigates the cost-effectiveness of interventions tackling these problems, assesses the methodological quality of included studies, and indicates suggestions for further research.

METHODS

Thirteen databases were searched for economic evaluations of interventions related to antenatal, perinatal, and postnatal mental health conditions, published between 2000 and September 2021, in high-income countries.

RESULTS

Thirty-nine studies met all inclusion criteria. Interventions considered were screening programs, pharmacological treatments, and various forms of psychosocial and psychological support. Six studies reported that the intervention was cost-saving. Eighteen were cost-effective and seven likely to be cost-effective. Only six studies included health outcomes for the child; one study considered paternal health. The time horizon for which costs and consequences were considered was for most evaluations limited to 1 year (n = 18) or 2 years (n = 11) postpartum.

CONCLUSIONS

Given the importance of the subject, a relatively low number of studies have investigated the cost-effectiveness of interventions tackling mental health problems during and after pregnancy. The scant evidence available suggests good overall value for money. Likely, cost-effectiveness is underestimated as costly long-term consequences on offspring are systematically excluded. No evidence was found for several frequently occurring conditions. Further research is required to obtain reliable, long-term effectiveness data and to address the methodological challenges related to measuring all relevant health outcomes for all parties affected.

Associations between Maternal and Offspring Hair Cortisol Concentrations and Child Behavioral Symptoms in Mother-Child Pairs with Perinatal Mental Disorders

Maternal perinatal mental disorders (PMD) are associated with developmental and behavioral problems in children, probably mediated by the programming of the hypothalamic–pituitary–adrenal (HPA) axis. Increased cortisol concentrations during the antenatal and perinatal periods have been related to long-term effects on children’s behavior and stress response. We aimed to investigate the association of hair cortisol concentrations (HCC) between mothers, with (n = 16) and without PMD (n = 30), and their children, aged between 18 and 48 months. Participants were evaluated with a clinical interview and questionnaires for the Depression Anxiety Stress Scale and the Child Behavior Checklist for ages 1½–5. Maternal and child HCCs were compared between the two groups. Children of the PMD group had increased symptoms of attention deficit hyperactivity disorder. A positive linear association between maternal and child HCC was observed only in the total sample of mother–child dyads and the control group. In the PMD group, children’s HCCs were significantly associated with child anxiety/depression symptoms. Aggressive behavior and oppositional/defiant problems correlated significantly with children’s own HCCs, and their mother’s too. These findings suggest that a chronic dysregulation of maternal and child HPA axis and their associations in the PMD dyads may underlie the linkage among prolonged maternal stress, child behavioral/emotional problems and stress responses.

Maternal Psychological Problems During Pregnancy and Child Externalizing Problems: Moderated Mediation Model with Child Self-regulated Compliance and Polygenic Risk Scores for Aggression

A potential pathway underlying the association between prenatal exposure to maternal psychological problems and childhood externalizing problems is child self-regulation. This prospective study (N = 687) examined whether self-regulated compliance mediates the relation between maternal affective problems and hostility during pregnancy and childhood externalizing problems, and explored moderation by child polygenic risk scores for aggression and sex. Self-regulated compliance at age 3 was observed in mother-child interactions, and externalizing problems at age 6 were reported by mothers and teachers. Polygenic risk scores were calculated based on a genome-wide association study of aggressive behavior. Self-regulated compliance mediated the associations between maternal psychological problems and externalizing problems. Aggression PRS was associated with higher externalizing problems reported by mothers. No evidence was found of moderation by aggression PRS or sex. These findings support the hypothesis that maternal psychological problems during pregnancy might influence externalizing problems through early self-regulation, regardless of child genetic susceptibility or sex.

Fathers' Mental Health and Children's Aggressive Behaviour A Study Based on Data from the Norwegian Mother, Father and Child Cohort Study (MoBa)

The aim of the study was to examine the association between fathers' prenatal psychological distress and children's aggressive behaviour in terms of hitting others, and how children's age, gender and temperament affect this association. The study is based on data from 20,155 fathers and mothers from the Norwegian Mother, Father and Child Cohort Study (MoBa). Fathers and mothers completed questionnaires at 17 or 18 weeks of gestation and mothers at children's age 18 months, and 3 and 5 years. Fathers' prenatal psychological distress was assessed by the 5-item Symptom Checklist (SCL-5), and children's temperament by 12 items from the Emotionality Activity Sociability (EAS) Temperament Survey. Increasing prenatal psychological distress in fathers was associated with an increase of hitting from 18 months to 3 years of age in boys. Children's temperament did not affect the association between fathers' prenatal psychological distress and children's aggressive behaviour.

Prenatal mother-father cortisol linkage predicts infant executive functions at 24 months

The present study investigated associations between prenatal mother-father cortisol linkage and infant executive functions. Data come from an international sample (N = 358) of predominantly white and middle- to upper-class first-time parents. During late pregnancy, parents collected diurnal salivary cortisol samples and reported on levels of psychological stress. At 24 months, children completed a battery of executive function tasks. Parent cortisol linkage was operationalized as the time-dependent, within-dyad association between maternal and paternal diurnal cortisol. Results indicated that prenatal linkage was positively related to infant executive functions, suggesting that stronger mother-father cortisol linkage was associated with higher executive function scores. Additionally, this relation was moderated by paternal average cortisol levels such that executive function scores were lower when fathers had higher average cortisol levels and linkage was weak. This association suggests that elevated paternal cortisol amplifies the negative relation between lower cortisol linkage and lower infant executive function scores. Importantly, these findings were observed while controlling for observational measures of caregiving and self-report measures of psychosocial functioning and infant social-emotional behavior. These results suggest that prenatal linkage of mother's and father's stress physiology plays a potentially important part in programming and regulating infant neurocognitive development.

Protocol of a systematic review and network meta-analysis for the prevention and treatment of perinatal depression

INTRODUCTION

Perinatal depression is common and can often lead to adverse health outcomes for mother and child. Multiple pharmacological and non-pharmacological treatments have been evaluated against usual care or placebo controls in meta-analyses for preventing and treating perinatal depression compared. It is not yet established which of these candidate treatments might be the optimal approach for prevention or treatment.

METHODS AND ANALYSIS

A systematic review and Bayesian network meta-analyses will be conducted. Eight electronic databases shall be searched for randomised controlled trials that have evaluated the effectiveness of treatments for prevention and/or treatment of perinatal depression. Screening of articles shall be conducted by two reviewers independently. One network meta-analysis shall evaluate the effectiveness of interventions in preventing depression during the perinatal period. A second network meta-analysis shall compare the effectiveness of treatments for depression symptoms in women with perinatal depression. Bayesian 95% credible intervals shall be used to estimate the pooled mean effect size of each treatment, and surface under cumulative ranking area will be used to rank the treatments' effectiveness.

ETHICS AND DISSEMINATION

We shall report our findings so that healthcare providers can make informed decisions on what might be the optimal approach for addressing perinatal depression to prevent cases and improve outcomes in those suffering from depression through knowledge exchange workshops, international conference presentations and journal article publications.

PROSPERO REGISTRATION NUMBER

CRD42020200081.

Parental Prenatal Symptoms of Depression and Offspring Symptoms of ADHD: A Genetically Informed Intergenerational Study

Objective: The primary aim of the present study was to separate the direct effect of maternal prenatal depression on offspring ADHD from the passive transmission of genetic liability. Method: A children-of-twins and siblings design including 17,070 extended-family units participating in the Norwegian Mother and Child Cohort Study was used. Self-ratings were obtained from parents using the Symptom Checklist during pregnancy. Maternal ratings using Conner's Parent Rating Scale were obtained when the children were 5 years of age. Results: Genetic influences were important for explaining similarity between parents and offspring. There was also evidence for a maternal effect after accounting for genetic transmission (m = 0.06, 95% confidence interval [CI] = [0.02, 0.09]). Conclusion: Our results were consistent with hypotheses suggesting that maternal prenatal depression influences symptoms of ADHD in offspring. However, the effect was weak and a substantial portion of the association could be accounted for by shared genetic influences.

Postpartum depression and family function in Chinese women within 1 year after childbirth: A cross-sectional study

Family-related factors are reported to influence the development of postpartum depression (PPD), but limited studies have considered the role of family function in this condition. This study aimed to describe the proportion of people with probable or suspected PPD and to determine the relationships among PPD, family function, and obstetric factors. A cross-sectional study was conducted with 630 women who attended six integrated teaching and scientific research communities in Changsha, China. Instruments included the Edinburgh Postpartum Depression Scale and the Family Assessment Device (FAD). A multivariate logistic regression model was used to determine the risk factors of PPD. The prevalence of probable or suspected PPD was 37% in this sample. We found communication (odds ratio [OR] = 3.795, 95% confidence interval [CI] = 1.619-8.897), affective responsiveness (OR = 2.685, 95% CI = 1.642-4.301), role (OR = 2.483, 95% CI = 1.041-5.922), and general functioning (OR = 5.704，95% CI = 2.233-14.569) dimensions of FAD, and type of feeding (OR = 2.700, 95% CI = 1.285-5.671) influenced PPD in the context of Chinese culture. To decrease the prevalence of PPD, interventions such as health education programs and cognitive behavior therapy to strengthen family function are recommended among couples during and after pregnancy.

Social support buffers the effects of maternal prenatal stress on infants' unpredictability

OBJECTIVE

Exposure to stress in pregnancy has been shown to affect fetal development with short- and long-term physiological and behavioral consequences for the offspring. Although social support is known to lower perceived stress, no prior study has investigated the buffering role of social support in the context of prenatal stress effects on infant temperament. The aim of this study was to examine interactive effects of prenatal stress and social support on several dimensions of infant temperament at 9 months postpartum.

STUDY DESIGN

A total of 272 mothers completed the Perceived Stress Scale and the Perceived Social Support Scale in the 3rd trimester of pregnancy. Infant temperament was assessed by mothers at 9 months postpartum using the Infant Characteristics Questionnaire. Linear regression models were performed to assess the effects of perceived stress, social support, and their interaction on infant temperament.

RESULTS

Prenatal stress interacted with social support, such that prenatal stress increased infant unpredictability when social support was below -0.5 SD.

CONCLUSIONS

Prenatal stress was found to be a risk factor for infant temperamental unpredictability when combined with low social support perceived by the mother during pregnancy. Support of others, not previously examined in this context, can reduce the impact of prenatal stress.

The impact of maternal personality traits on behavioral problems in preschool-aged children: a population-based panel study in South Korea

The impact of maternal personality traits on offspring behavioral problems has not been well established. In our study, the association between maternal personality traits and behavioral problems in preschool-aged children was investigated. A total of 192 preschoolers with their mothers, who were part of a population-based panel study in South Korea, were included in the present study. Maternal personality traits were assessed by the Personality Assessment Inventory (PAI) when the children were 1 year old. The Child Behavior Checklist (CBCL) 1.5-5 was used to identify behavioral problems in the children at 4 and 5 years of age. Maternal personality (borderline, somatization) positively correlated with behavioral problems (externalizing, internalizing, and dysregulation) in children. Maternal paranoid personality trait correlated with children's internalizing and dysregulation behavioral problems. Multiple linear regressions showed that maternal borderline trait significantly predicted children's externalizing (B = 0.302, P = 0.001), internalizing (B = 0.211, P = 0.020), and dysregulation problems (B = 0.327, P < 0.001). Similarly, maternal somatization trait predicted children's internalizing problems (B = 0.291, P < 0.001). Maternal borderline and somatization traits showed association with children's behavioral problems. Psychological intervention and support for mothers with these personality traits may be helpful in raising children with behavioral problems.

The Prevalence of Psychological Symptoms in Pregnant Healthcare Workers (HCWs) and Pregnant Non-HCWs During the Early Stage of COVID-19 Pandemic in Chongqing, China

Background: Studies showed that healthcare workers (HCWs) and pregnant women bore the burden of mental problems during the coronavirus disease 2019 (COVID-19) pandemic. While, few studies have focused on the psychological impact of COVID-19 pandemic on pregnant women who work at healthcare settings. This study aimed to investigate and compare the prevalence difference of psychological symptoms between pregnant HCWs and pregnant non-HCWs during the early stage of COVID-19 pandemic in China. Methods: A cross-sectional online survey with anonymous structured questionnaires was conducted from February 15 to March 9, 2020. A total of 205 pregnant women in Chongqing, China were recruited. The mental health status was assessed using symptom checklist-90 (SCL-90). Results: Our sample was composed of 83 pregnant HCWs (mean age = 29.8) and 122 pregnant non-HCWs (mean age = 30.8). The results suggested the prevalence of psychological symptoms (the factor score ≥2) among all pregnant women ranged from 6.83% (psychosis symptoms) to 17.56% (obsessive-compulsive symptoms). Compared with pregnant non-HCWs, pregnant HCWs reported higher prevalence of psychological symptoms in 10 factors of SCL-90. After controlling the confounding variables, multiple logistic regression demonstrated that pregnant HCWs experienced higher prevalence of psychological symptoms of somatization (18.07 vs. 5.74%, p = 0.006, aOR = 4.52), anxiety disorders (16.87 vs. 6.56%, p = 0.016, aOR = 3.54), and hostility (24.10 vs. 10.66%, p = 0.027, aOR = 2.70) than those among pregnant non-HCW. Conclusion: Our study indicated that pregnant HCWs were more likely to suffer from mental health distress than pregnant non-HCWs during the early stage of COVID-19 pandemic. It is vital to implement targeted psychological interventions for pregnant women, especially for pregnant HCWs to cope with distress when facing the emerging infectious diseases.

Behavior Problems in Four-Year-Old Children from a Brazilian Birth Cohort

Abstract This study aimed to investigate the occurrence of behavior problems in 3750 four years old children from a birth cohort. Children were followed from birth to four years old through home visits, and questionnaires on child health and development and the Child Behavior Checklist 4-18/CBCL were applied. Prevalence rates were high (total problems 35.6%), particularly externalizing problems, which occurred in 44.4 % of children (48.3% girls; 40.6% boys; p < 0.001). Internalizing problems were less prevalent, occurring in 15.5 % of children (19.1% boys; 11.6% girls; p < 0.001). Regardless of sex, there was a higher prevalence of behavioral problems in children with younger siblings, whose mothers had less education and had no partner.

Effects of maternal and paternal postnatal depressive symptoms on infants' parasympathetic regulation in low-income, Mexican American families

Mothers and fathers are at elevated risk for developing depression during the first postnatal year, especially among families from marginalized communities. Although a number of studies demonstrate that exposure to maternal depressive symptoms can undermine infants' regulatory development, less is known about the extent to which paternal depressive symptoms may also contribute. The current study investigated whether maternal and paternal depressive symptoms were uniquely associated with infants' physiological regulation, and whether associations varied depending on infant sex. Participants included 90 low-income Mexican American families. Fathers and mothers self-reported their depressive symptoms when infants were 15 weeks old, and infants' resting parasympathetic activity (i.e., respiratory sinus arrhythmia [RSA]) was assessed at 6 and 24 weeks. Results indicated that, after controlling for infant 6-week RSA and depressive symptoms in the other parent, paternal depressive symptoms were associated with lower 24-week RSA for both girls and boys, but maternal depressive symptoms were only associated with lower 24-week RSA for boys. Findings highlight a potential mechanism through which the consequences of parent depressive symptoms may reverberate across generations, and suggest that considerations of both infants' and parents' sex may lend insight into how best to intervene.

A review and analysis of the components of potentially effective perinatal mental health interventions for infant development and mother-infant relationship outcomes

Children of mothers with serious mental health difficulties are at increased risk of developing mental health difficulties themselves in their own lifetime. Specialist interventions delivered in perinatal mental health services offer an opportunity to support the infant's development and long-term mental health. This review aimed to systematically evaluate the shared elements of successful perinatal mental health interventions that underpin improved outcomes for infants whose mothers experience perinatal mental health difficulties. Nine electronic databases were searched comprehensively for relevant controlled studies of perinatal mental health interventions, and a narrative synthesis undertaken to assess whether statistically significant benefits were noted. Sixteen studies, trialing 19 interventions, were analyzed using a narrative approach and grouped according to reported effectiveness. Eight interventions demonstrated significant improvements in infant outcomes and/or mother-infant relationship outcomes and were used to inform the analysis of the included interventions' components. While the interventions identified were diverse, there were common components which potentially underpin successful interventions for infants whose mothers are experiencing mental health difficulties, including: facilitation of positive Mother×Infant interactions; helping mothers to understand their infant's perspective or inner world; and the use of video feedback.

Interventions to Empower Adults with Eating Disorders and Their Partners around the Transition to Parenthood

The transition to parenthood is perceived as a stressful life event, when parents experience an immense change of their psychological focus and a reorientation of roles and responsibilities in the family system. This process may be even more challenging in the presence of a parental eating disorder history. This paper reviews the impact of parental eating disorders on the parents, the couple relationship, and their child during the perinatal period. A parental eating disorder is associated with more negative expectations of parental efficacy as well as specific difficulties in couple communication over the child's feeding, shape, and weight. Providers who better understand the effects of an eating disorder on parental functioning can more effectively intervene early on. We also present couple- or parent-based, empirically supported interventions for adults with eating disorders and their partners in the prenatal and postnatal periods: Uniting Couples in the treatment of Anorexia Nervosa (UCAN) and Uniting couples In the Treatment of Eating disorders (UNITE) both enhance recovery from the eating disorder through a couple-based intervention; the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) incorporates the support of partners, when appropriate; Parent-Based Prevention (PBP) focuses on improving parental functioning and reducing risk of negative parental and child outcomes. Finally, we discuss the clinical implications of addressing parental eating disorders and encourage more research on these families.

Preconception tests at advanced maternal age

Pregnancies at an advanced reproductive age are increasingly common. However, the safety of pregnancy remains a concern as maternal age is a recognized independent factor for various obstetric complications. Also, age is a risk factor for most systematic health problems and older women are more likely to enter into pregnancy with pre-existing conditions. At the moment there is no separate, structured guidance on preconception tests at advanced maternal age. However, the preconceptual period offers an ideal window to recognize and address underlying health issues, social issues and harmful lifestyle behaviours in order to optimize maternal health ultimately reducing infertility, perinatal morbidity and mortality. Preconception tests should be clinically relevant aiming to identify risk factors and address them to predict and prevent infertility and pregnancy complications. The importance of preconception care is magnified for women of advanced age for whom the risks are higher and the potential benefits greater.

Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort

Background

During pregnancy, about 10 to 20% of women experience depressive symptoms. Subclinical depression increases the risk of peripartum depression, maternal neuro-endocrine dysregulations, and adverse birth and infant outcomes. Current treatments often comprise face-to-face psychological or pharmacological treatments that may be too intensive for women with subclinical depression leading to drop-out and moderate effectiveness. Therefore, easily accessible, resilience enhancing and less stigmatizing interventions are needed to prevent the development of clinical depression. This paper describes the protocol of a prospective cohort study with an embedded randomized controlled trial (RCT) that aims to improve mental resilience in a sample of pregnant women through a self-help program based on the principles of Acceptance and Commitment Therapy (ACT). Maternal and offspring correlates of the trajectories of peripartum depressive symptoms will also be studied.

Methods

Pregnant women (≥ 18 years) receiving care in Dutch midwifery practices will participate in a prospective cohort study (n ~ 3500). Between 12 and 18 weeks of pregnancy, all women will be screened for depression with the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS score ≥ 11 will be evaluated with a structured clinical interview. Participants with subclinical depression (n = 290) will be randomized to a 9-week guided self-help ACT-training or to care as usual (CAU). Primary outcomes (depressive symptoms and resilience) and secondary outcomes (e.g. anxiety and PTSD, bonding, infant development) will be collected via online questionnaires at four prospective assessments around 20 weeks and 30 weeks gestation and at 6 weeks and 4 months postpartum. Maternal hair cortisol concentrations will be assessed in a subsample of women with a range of depressive symptoms (n = 300). The intervention’s feasibility will be assessed through qualitative interviews in a subsample of participants (n = 20).

Discussion

This is the first study to assess the effectiveness of an easy to administer intervention strategy to prevent adverse mental health effects through enhancing resilience in pregnant women with antepartum depressive symptomatology. This longitudinal study will provide insights into trajectories of peripartum depressive symptoms in relation to resilience, maternal cortisol, psychological outcomes, and infant developmental milestones.

Trial registration

Netherlands Trial Register (NTR), NL7499. Registered 5 February 2019.

Perinatal anxiety and depressive symptoms and perception of child behavior and temperament in early motherhood

The perinatal period is a vulnerable time for the development of psychopathology, particularly mood and anxiety disorders. In the study of maternal anxiety, important questions remain regarding the association between maternal anxiety symptoms and subsequent child outcomes. This study examined the association between depressive and anxiety symptoms, namely social anxiety, panic, and agoraphobia disorder symptoms during the perinatal period and maternal perception of child behavior, specifically different facets of development and temperament. Participants (N = 104) were recruited during pregnancy from a community sample. Participants completed clinician-administered and self-report measures of depressive and anxiety symptoms during the third trimester of pregnancy and at 16 months postpartum; child behavior and temperament outcomes were assessed at 16 months postpartum. Child development areas included gross and fine motor skills, language and problem-solving abilities, and personal/social skills. Child temperament domains included surgency, negative affectivity, and effortful control. Hierarchical multiple regression analyses demonstrated that elevated prenatal social anxiety symptoms significantly predicted more negative maternal report of child behavior across most measured domains. Elevated prenatal social anxiety and panic symptoms predicted more negative maternal report of child effortful control. Depressive and agoraphobia symptoms were not significant predictors of child outcomes. Elevated anxiety symptoms appear to have a distinct association with maternal report of child development and temperament. Considering the relative influence of anxiety symptoms, particularly social anxiety, on maternal report of child behavior and temperament can help to identify potential difficulties early on in mother-child interactions as well as inform interventions for women and their families.

Prenatal risk and physical aggression during the first years of life: The gender-specific role of inhibitory control

Prenatal risk and a lack of inhibitory control have consistently been related to the development of physical aggression in older children. This study examined whether inhibitory control mediated the relation between prenatal risk and aggression in infants and toddlers. The role of gender in this mediation model was also examined. The sample consisted of 161 mother-child dyads (83 boys). A prenatal cumulative risk score was created from a number of well-established risk factors including maternal psychopathology, substance use, and social and socioeconomic disadvantages. At 12 months, children performed an inhibitory control task. Physical aggression was assessed through maternal reports at 12 and 20 months of age. Results showed that higher prenatal risk was associated with more physical aggression. Inhibitory control mediated this association at both 12 and 20 months: higher prenatal risk was related to lower inhibitory control, which in turn led to higher aggression. At 20 months, gender moderated the mediation effect: the mediating role of inhibitory control was only found for girls. These results suggest that even before 2 years of age, inhibitory control is an important construct involved in the relation between prenatal risk and physical aggression.

Sad Dads and Troubled Tots: Protective Factors Related to the Stability of Paternal Depression and Early Childhood Internalizing Problems

The present study tested the moderating role of interparental relationship quality and child inhibitory control on the stability of paternal depression over time and associations between paternal depression and child internalizing problems in early childhood. Participants were a subsample (n = 166) of families from the Early Steps Multisite study, a longitudinal study of low-income parents and children. Interparental relationship quality (age 2) attenuated the association between paternal depressive symptoms at age 2 and paternal depressive symptoms at age 3. Both interparental relationship quality (age 3) and child inhibitory control (age 3) attenuated the association between paternal depressive symptoms (age 3) and age 4 child internalizing problems. Results suggest that high interparental relationship quality may be a protective factor in terms of lessening the stability of paternal depressive symptoms over time, as well as the association between paternal depression and later child internalizing problems. Similarly, high levels of inhibitory control may buffer children from the negative effects of paternal depression on the development of internalizing problems.

Aggressive behavior during toddlerhood: Interrelated effects of prenatal risk factors, negative affect, and cognition

Prenatal risk, temperamental negative affect, and specific cognitive abilities have all individually been identified as predictors of behavior problems during early childhood, but less is known about their interplay in relation to aggression during toddlerhood. This study examined the main and interaction effects of prenatal risk, negative affect, inhibitory control, attention, and vocabulary in the prediction of aggression in 150 children (75 boys). During pregnancy, a cumulative risk index was calculated based on the presence of 10 well-established maternal risk factors, such as prenatal substance use, maternal psychiatric disorder, and financial problems. Negative affect was measured at 6 and 20 months using maternal report. Child cognition was examined at 30 months using laboratory tasks for inhibitory control and attention, and a questionnaire was administered to assess vocabulary. In addition, mothers reported on their children's aggressive behavior at 30 months. Higher prenatal risk and negative affect at 20 months and, to a lesser extent, at 6 months were related to more aggression at 30 months. Poorer inhibitory control and, to a lesser extent, vocabulary at 30 months also predicted higher levels of aggressive behavior. Two-way interaction effects were found for cumulative risk and inhibitory control, negative affect (at 20 months) and inhibitory control, and negative affect (at 6 months) and vocabulary: aggressive behavior was most pronounced when combinations of high prenatal risk, high negative affect, and poor cognition were present. These results suggest that the impact of prenatal risk and child temperament depends in part on child's cognitive development during toddlerhood.

Negative impact of maternal antenatal depressive symptoms on neonate's behavioral characteristics

Prenatal maternal depression is associated with developmental disorders in offspring. However, the specific effects of the intensity of prenatal depressive symptoms on infant behavior remain poorly explored. The aim of this work is to explore the links between early neonatal behavior and maternal prenatal depressive symptoms, independently from maternal pre- and postnatal anxiety and early postnatal maternal depressive symptoms. Five hundred and ninety-eight women and their newborns from the MATQUID cohort were prospectively evaluated during the 8th month of pregnancy (T1) and at day 3 postpartum (T2). We analyzed the independent associations between neonates' behavior (Neonatal Behavioral Assessment Scale-NBAS) at T2 and the intensity of maternal prenatal depressive symptoms (CES-D), taking into account confounding factors including depressive symptoms at T2 and anxiety (T1 and T2). The presence of a major depressive episode (MDE) based on MINI at T1 was also studied, independently. Our results show a significant negative correlation between prenatal CES-D scores and NBAS scores on "habituation" (p = 0.0001), "orientation" (p = 0.015), "motor system" (p < 0.0001), "autonomic stability" (p < 0.0001) dimensions, independently of other variables, including pre/postnatal anxiety and postnatal depressive symptoms. A prenatal MDE was independently associated with lower scores on the "orientation" dimension (p = 0.005). This study reports a specific effect of prenatal depressive symptoms on newborn's behavior. These results highlight the crucial necessity for antenatal screening and adjusted treatments of maternal depressive symptoms and not only of MDE. Particular attention must be paid to infants of mothers presenting prenatal depressive symptoms to provide them with early developmental care when necessary.

Parenting Stress Plays a Mediating Role in the Prediction of Early Child Development from Both Parents' Perinatal Depressive Symptoms

Maternal postnatal depression has been associated with a broad range of developmental risk among children. However, there has been less focus on disentangling the effects of pre- and postnatal depressive symptoms, as well as examining the symptoms of both parents. This study aims to investigate the separate effects of pre- and postnatal depressive symptoms in mothers and fathers, and parents' differential effects on child social-emotional, cognitive, and language development at 18 months of age. Further, we investigate whether effects of depressive symptomatology on child outcomes are particularly strong when both parents evinced high symptom loads and whether parenting stress mediates associations between perinatal depressive symptoms and child developmental outcomes. The study used data from 1036 families participating in a community-based study from mid-pregnancy until 18 months postpartum. Depressive symptoms were assessed at seven time points (four prenatally). Within a structural equation framework, we found that parental perinatal depressive symptoms predicted child social-emotional functioning, specifically externalizing, internalizing, and dysregulation problems, as well as language developmental delay at 18 months. Controlling for postnatal symptoms we found no independent effect of prenatal depressive symptoms on any child outcomes. A differential effect was evident, linking maternal symptoms to social-emotional outcomes, and paternal symptoms to language outcomes. There was no evidence of stronger associations between depressive symptoms and child outcomes when both parents showed high symptom loads. However, parenting stress mediated most relations between parental depressive symptoms and child outcomes. Findings demonstrate the importance of including paternal depressive symptoms in both clinical and research contexts.

Cognitive Behavioral Therapy for Antenatal Depression in a Pilot Randomized Controlled Trial and Effects on Neurobiological, Behavioral and Cognitive Outcomes in Offspring 3-7 Years Postpartum: A Perspective Article on Study Findings, Limitations and Future Aims

PURPOSE OF ARTICLE

In a previous pilot randomized controlled trial including 54 pregnant women with depression, maternal mood improved after Cognitive Behavioural Therapy (CBT) compared to treatment as usual (TAU), showing medium to large effect sizes. The effect persisted up to 9 months postpartum, with infant outcomes also showing medium to large effects favoring CBT in various child domains. This perspective article summarizes the results of a follow-up that was performed approximately 5 years later in the same cohort, assessing the effects of antenatal Cognitive Behavioural Therapy for depression and anxiety on child buccal cell DNA-methylation, brain morphology, behavior and cognition.

FINDINGS

Children from the CBT group had overall lower DNA-methylation compared to children from the TAU group. Mean DNA-methylation of all NR3C1 promoter-associated probes did not differ significantly between the CBT and TAU groups. Children from the CBT group had a thicker right lateral occipital cortex and lingual gyrus. In the CBT group, Voxel-Based-Morphometry analysis identified one cluster showing increased gray matter concentration in the right medial temporal lobe, and fixel-based analysis revealed reduced fiber-bundle-cross-section in the Fornix, the Optical Tract, and the Stria Terminalis. No differences were observed in full-scale IQ or Total Problems Score. When the total of hypotheses tests in this study was considered, differences in DNA-methylation and brain measurements were no longer significant.

SUMMARY

Our explorative findings suggest that antenatal depression treatment decreases overall child DNA-methylation, increases cortical thickness, and decreases white matter fiber-bundle cross-section in regions involved in cognitive function and the stress response. Nevertheless, larger studies are warranted to confirm our preliminary conclusion that CBT in pregnancy alters neurobiological outcomes in children. Clinical relevance remains unclear as we found no effects of antenatal CBT on child behavior or cognition (yet).

The effects of paternal perinatal depression on socioemotional and behavioral development of children: A meta-analysis of prospective studies

A meta-analysis was conducted to analyze the literature concerning the effects of paternal perinatal depression (PPND) on socioemotional and behavioral development in children. We assessed the literature using searches in PubMed, Web of Science, the Cochrane Library, and Embase from inception to November 2019 and supplemented it by manual searches. Two authors independently selected the eligible studies and extracted data, and three authors assessed the quality of the studies. To explore the effects of PPND on a child's socioemotional and behavioral development, a random-effects meta-analysis was conducted, followed by the construction of a funnel plot. Nine studies were included for review. The pooled odds ratio (OR) of behavioral problems in children with PPND as compared to non-PPND was 1.209 (95% CI: 1.137-1.285), the pooled OR of emotional problems in children with PPND was 1.265 (95% CI: 1.180-1.356), and the pooled OR of social functions in children with PPND was OR=1.299 (95% CI: 0.972-1.736). PPND may play a significant role in adversely impacting the emotional and behavioral development in children during early childhood. Thus, interventions for PPND should be initiated to make up the negative effect of PPND on a child's emotional and behavioral development.

Antenatal determinants of early childhood talking delay and behavioural difficulties

The determinants of talking delay alone or its comorbidity with behavioural difficulties was examined in 5768 two-year-old members of the Growing Up in New Zealand longitudinal study. Using the MacArthur-Bates Communicative Development inventories and the total difficulties score from the preschool Strengths and Difficulties Questionnaire, a composite measure was created so that children were categorised as showing no language or behavioural concerns (72.5%), behavioural only difficulties (6.1%), language only difficulties (18.1%), and comorbid language and behavioural difficulties (3.3%). Analyses revealed that antenatal factors such as maternal perceived stress, inadequate folate intake, vitamin intake, alcohol consumption during the first trimester and maternal smoking all had a significant effect on child outcomes. In particular, low multivitamin intake and perceived stress during pregnancy were associated with coexisting language and behavioural difficulties. These findings support international research in showing that maternal factors during pregnancy are associated with developmental outcomes in the early childhood period, and demonstrate these associations within a NZ context. Interventions which address maternal stress management and health behaviours during pregnancy could be beneficial to offspring development.

Intergenerational transmission of depression: clinical observations and molecular mechanisms

Maternal mental illness can have a devastating effect during the perinatal period, and has a profound impact on the care that the baby receives and on the relationships that the baby forms. This review summarises clinical evidence showing the effects of perinatal depression on offspring physical and behavioural development, and on the transmission of psychopathology between generations. We then evaluate a number of factors which influence this relationship, such as genetic factors, the use of psychotropic medications during pregnancy, the timing within the perinatal period, the sex of the foetus, and exposure to maltreatment in childhood. Finally, we examine recent findings regarding the molecular mechanisms underpinning these clinical observations, and identify relevant epigenetic and biomarker changes in the glucocorticoid, oxytocin, oestrogen and immune systems, as key biological mediators of these clinical findings. By understanding these molecular mechanisms in more detail, we will be able to improve outcomes for both mothers and their offspring for generations.

Fetal and Infant Outcomes in the Offspring of Parents With Perinatal Mental Disorders: Earliest Influences

Mental illness is highly prevalent and runs in families. Mental disorders are considered to enhance the risk for the development of psychopathology in the offspring. This heightened risk is related to the separate and joint effects of inherited genetic vulnerabilities for psychopathology and environmental influences. The early years of life are suggested to be a key developmental phase in the intergenerational psychopathology transmission. Available evidence supports the idea that early exposure to parental psychopathology, during the pregnancy and first postpartum year, may be related to child psychological functioning beyond the postpartum period, up to adulthood years. This not only highlights the importance of intervening early to break the chain of intergenerational transmission of psychopathology but also raises the question of whether early interventions targeting parental mental disorders in this period may alleviate these prolonged adverse effects in the infant offspring. The current article focuses on the specific risk of psychopathology conveyed from mentally ill parents to the offspring during the pregnancy and first postpartum year. We first present a summary of the available evidence on the associations of parental perinatal mental illness with infant psychological outcomes at the behavioral, biological, and neurophysiological levels. Next, we address the effects of early interventions and discuss whether these may mitigate the early intergenerational transmission of risk for psychopathology. The summarized evidence supports the idea that psychopathology-related changes in parents' behavior and physiology in the perinatal period are related to behavioral, biological, and neurophysiological correlates of infant psychological functioning in this period. These alterations may constitute risk for later development of child and/or adult forms of psychopathology and thus for intergenerational transmission. Targeting psychopathology or mother-infant interactions in isolation in the postnatal period may not be sufficient to improve outcomes, whereas interventions targeting both maternal psychopathology and mother-infant interactions seem promising in alleviating the risk of early transmission.

Family Functioning and Psychological Health of Children with Mentally Ill Parents

Parental mental illness can be linked to reduced family functioning, which is associated with more conflicts, less adaptability and cohesion as well as a disorganized pattern of everyday planning. Concurrently, family functioning is an important moderator for the influence of parental mental disorders on the development of the children. Consequently, the current study addresses the correlation of family functioning in families with mentally ill parents and the psychological health of the children. The sample consists of 67 mentally ill parents. Both parents and therapists completed questionnaires related to family functioning and the psychological health of the children. Family functioning was rated as dysfunctional in 38% of the families. The psychological health of the children was classified as clinical or subclinical in 43% of the cases. 52% of the children were rated to have no psychological problems. In families with good family functioning, children were assessed to have less psychological problems than in families with poor functioning. Children outside the clinical range lived in families with good family functioning and vice versa. Significant positive correlations were found between the FB-A scales, the CBCL/4-18 syndrome scales and the CBCL/4–18 total score. Results indicate that family functioning and psychological health of children in families with mentally ill parents correlate closely and represent potential targets for future family interventions.

Prenatal Maternal Distress: A Risk Factor for Child Anxiety?

The deleterious association between various types of prenatal maternal psychological distress (PNMS, anxiety, depression, psychological distress, stress) and childhood anxiety symptomatology (internalizing behaviors, anxiety symptoms) has been established using both retrospective and prospective longitudinal studies across varied demographic cohorts and throughout development. Yet, the existing literature cannot claim maternal distress during pregnancy to be a specific risk factor for anxiety symptomatology, as studies utilizing such observational designs are unable to adequately account for confounding of potential genetic factors and the postnatal environment. In this review, we examine studies that attempt to minimize such confounding and thus disentangle the unique intrauterine exposure effect of varying types of PNMS on childhood anxiety symptomatology. Such methodologies include paternal versus maternal comparison studies, sibling comparisons, prenatal cross-fostering designs and timing of exposure studies (including disaster studies). Of the identified studies, findings indicate that prenatal maternal distress is likely to constitute a risk factor for anxiety symptomatology, although more studies are needed to replicate current findings in order to determine whether there are clear differences in effects across specific types of PNMS and for specific subpopulations. We review the methodological limitations and strengths of the literature prior to exploring avenues of future research and implications for theory and clinical practice.

Associations of Prenatal and Postnatal Maternal Depressive Symptoms with Offspring Cognition and Behavior in Mid-Childhood: A Prospective Cohort Study

Exposure to maternal depressive symptoms in the peri-pregnancy periods may be associated with poorer child development, but research is often limited to only maternal assessments of behavior and cognition. This study investigates the specific periods of prenatal and postnatal exposure to maternal depressive symptoms in association with child development using reports from teachers and mothers. This study is based on 1225 mother–child pairs from Project Viva, a prospective pre-birth cohort study. Mothers reported depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS) in mid-pregnancy as well as at 6 months and 12 months postpartum. Teachers and mothers reported child executive functions using the Behavioral Rating Inventory of Executive Function (BRIEF) and behavior using the Strengths and Difficulties Questionnaire (SDQ). Children completed the Kaufman Brief Intelligence Test (KBIT-2), the Wide Range Assessment of Visual Motor Abilities (WRAVMA), and the Visual Memory Index of the Wide Range Assessment of Memory and Learning (WRAML). We used multivariable linear regression models to examine associations of prenatal and postpartum depressive symptoms with outcomes. Many of the crude associations observed were attenuated after adjusting for demographic factors and maternal IQ, yet some remained significant. For example, high prenatal maternal depressive symptoms were associated with poorer scores on the BRIEF Behavior Regulation Index and some SDQ scales based on reports from teachers and mothers. High prenatal maternal depressive symptoms were associated with poorer behavioral development. Postpartum symptoms did not show strong associations with outcomes once we adjusted for the prenatal period.

Prenatal exposure to tobacco and marijuana and child autonomic regulation and reactivity: An analysis of indirect pathways via maternal psychopathology and parenting

We examined a conceptual model for the associations of prenatal exposure to tobacco (PTE) and marijuana with child reactivity/regulation at 16 months of age. We hypothesized that PTE would be associated with autonomic reactivity and regulation that these associations would be indirect via maternal anger/hostility, depression/stress, or harsh parenting assessed at 2 months and that these effects would be most pronounced among children exposed to both tobacco and marijuana (PTME). Participants were 247 dyads (81 PTE, 97 PTME, and 69 nonexposed) who were followed up at 2 (N = 247) and 16 months (N = 238) of child age. Results from model testing indicated an indirect association between PTME and autonomic functioning during the second year of life, which was mediated by harsh parenting during caregiver-infant interactions. This study fills an important gap in the literature on PTE, PTME, and autonomic regulation during the toddler years, highlighting the role of maternal parenting as important intervening variables.

A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fear of childbirth

BACKGROUND

Despite a sharp increase in the number of publications that report on treatment options for pregnancy-specific anxiety and fear of childbirth (PSA/FoB), no systematic review of nonpharmacological prenatal interventions for PSA/FoB has been published. Our team addressed this gap, as an important first step in developing guidelines and recommendations for the treatment of women with PSA/FoB.

METHODS

Two databases (PubMed and Mendeley) were searched, using a combination of 42 search terms. After removing duplicates, two authors independently assessed 208 abstracts. Sixteen studies met eligibility criteria, ie, the article reported on an intervention, educational component, or treatment regime for PSA/FoB during pregnancy, and included a control group. Independent quality assessments resulted in the retention of seven studies.

RESULTS

Six of seven included studies were randomized controlled trials (RCTs) and one a quasi-experimental study. Five studies received moderate quality ratings and two strong ratings. Five of seven studies reported significant changes in PSA/FoB, as a result of the intervention. Short individual psychotherapeutic interventions (1.5-5 hours) delivered by midwives or obstetricians were effective for women with elevated childbirth fear. Interventions that were effective for pregnant women with a range of different fear/anxiety levels were childbirth education at the hospital (2 hours), prenatal Hatha yoga (8 weeks), and an 8-week prenatal education course (16 hours).

CONCLUSIONS

Findings from this review can inform the development of treatment approaches to support pregnant women with PSA/FoB.

Identifying perinatal depression with case-finding instruments: a mixed-methods study (BaBY PaNDA – Born and Bred in Yorkshire PeriNatal Depression Diagnostic Accuracy)

Background

Perinatal depression is well recognised as a mental health condition but < 50% of cases are identified in routine practice. A case-finding strategy using the Whooley questions is currently recommended by the National Institute for Health and Care Excellence.

Objectives

To determine the diagnostic accuracy, acceptability and cost-effectiveness of the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to identify perinatal depression.

Design

A prospective diagnostic accuracy cohort study, with concurrent qualitative and economic evaluations.

Setting

Maternity services in England.

Participants

A total of 391 pregnant women.

Main outcome measures

Women completed the Whooley questions, EPDS and a diagnostic reference standard (Clinical Interview Schedule – Revised) during pregnancy (20 weeks) and postnatally (3–4 months). Qualitative interviews were conducted with health professionals (HPs) and a subsample of women.

Results

Diagnostic accuracy results: depression prevalence rates were 10.3% during pregnancy and 10.5% postnatally. The Whooley questions and EPDS (cut-off point of ≥ 10) performed reasonably well, with comparable sensitivity [pregnancy: Whooley questions 85.0%, 95% confidence interval (CI) 70.2% to 94.3%; EPDS 82.5%, 95% CI 67.2% to 92.7%; postnatally: Whooley questions 85.7%, 95% CI 69.7% to 95.2%; EPDS 82.9%, 95% CI 66.4% to 93.4%] and specificity (pregnancy: Whooley questions 83.7%, 95% CI 79.4% to 87.4%; EPDS 86.6%, 95% CI 82.5% to 90.0%; postnatally: Whooley questions 80.6%, 95% CI 75.7% to 84.9%; EPDS 87.6%, 95% CI 83.3% to 91.1%). Diagnostic accuracy of the EPDS (cut-off point of ≥ 13) was poor at both time points (pregnancy: sensitivity 45%, 95% CI 29.3% to 61.5%, and specificity 95.7%, 95% CI 93.0% to 97.6%; postnatally: sensitivity 62.9%, 95% CI 44.9% to 78.5%, and specificity 95.7%, 95% CI 92.7% to 97.7%). Qualitative evaluation: women and HPs were supportive of screening/case-finding for perinatal depression. The EPDS was preferred to the Whooley questions by women and HPs, mainly because of its ‘softer’ wording. Whooley question 1 was thought to be less acceptable, largely because of the terms ‘depressed’ and ‘hopeless’, leading to women not revealing their depressive symptoms. HPs identified a ‘patient-centred’ environment that focused on the mother and baby to promote discussion about mental health. Cost-effectiveness results: screening/case-finding using the Whooley questions or the EPDS alone was not the most cost-effective strategy. A two-stage strategy, ‘Whooley questions followed by the Patient Health Questionnaire’ (a measure assessing depression symptomatology), was the most cost-effective strategy in the range between £20,000 and £30,000 per quality-adjusted life-year in both the prenatal and postnatal decision models.

Limitations

Perinatal depression diagnosis was not cross-referenced with women’s medical records so the proportion of new cases identified is unknown. The clinical effectiveness and cost-effectiveness of screening/case-finding strategies was not assessed as part of a randomised controlled trial.

Conclusions

The Whooley questions and EPDS had acceptable sensitivity and specificity, but their use in practice might be limited by low predictive value and variation in their acceptability. A two-stage strategy was more cost-effective than single-stage strategies. Neither case-finding instrument met National Screening Committee criteria.

Future work

The yield of screening/case-finding should be established with reference to health-care records. The clinical effectiveness and cost-effectiveness of screening/case-finding for perinatal depression needs to be tested in a randomised controlled trial.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Demographic Predictors of Family Functioning and Its Change Over the First 5 Years Postpartum: Findings From the Healthy Beginnings Trial

There are very few longitudinal studies examining family functioning in early childhood. This was a prospective cohort study to identify maternal sociodemographic factors associated with family functioning over the first 5 years postpartum, using data from the Healthy Beginnings Trial. Family functioning was measured using the General Functioning Subscale of the McMaster Family Assessment Device. A total of 667 first-time mothers participated, of which 369 remained at 5 years. Family functioning did not change significantly over the 5 years. Mothers being Australian born, being employed, and having a partner were predictors for healthy family functioning. Targeting support for immigrants, low-income and single-mother families may therefore improve family functioning.