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Klimes-Dougan B, Papke V, Carosella KA, Wiglesworth A, Mirza SA, Espensen-Sturges TD, Meester C. Basal and reactive cortisol: A systematic literature review of offspring of parents with depressive and bipolar disorders. Neurosci Biobehav Rev 2022; 135:104528. [PMID: 35031342 DOI: 10.1016/j.neubiorev.2022.104528] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/19/2022]
Abstract
One of the most consistent biological findings in the study of affective disorders is that those with depression commonly show abnormal cortisol response, which suggests dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Children of parents with mood disorders offer the opportunity to explore the biological pathways that may confer risk for psychopathology. This review explores basal and reactive cortisol in the offspring of parents who are currently depressed or have had a history of a depressive or bipolar disorder. Using PRISMA guidelines, search terms yielded 2002 manuscripts. After screening, 87 of these manuscripts were included. Results from the literature suggest that while the degree and direction of dysregulation varies, offspring of a parent with depression tend to show elevations in both basal (particularly morning and evening) and reactive (tentatively for social stressors) cortisol levels. There were few studies focused on offspring of parents with bipolar disorder. This review also discusses implications and recommendations for future research regarding the HPA axis in the intergenerational transmission of depressive disorders.
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Affiliation(s)
- Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA.
| | - Victoria Papke
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
| | - Katherine A Carosella
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
| | - Andrea Wiglesworth
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
| | - Salahudeen A Mirza
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
| | - Tori D Espensen-Sturges
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
| | - Christina Meester
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
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2
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Puhakka IJA, Peltola MJ. Salivary cortisol reactivity to psychological stressors in infancy: A meta-analysis. Psychoneuroendocrinology 2020; 115:104603. [PMID: 32171123 DOI: 10.1016/j.psyneuen.2020.104603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/17/2020] [Accepted: 02/04/2020] [Indexed: 01/16/2023]
Abstract
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.
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Affiliation(s)
- Ilmari J A Puhakka
- Faculty of Education and Culture, Tampere University, Finland; Human Information Processing Laboratory, Psychology, Faculty of Social Sciences, Tampere University, 33014, Finland
| | - Mikko J Peltola
- Human Information Processing Laboratory, Psychology, Faculty of Social Sciences, Tampere University, 33014, Finland.
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3
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Biological embedding of maternal postpartum depressive symptoms: The potential role of cortisol and telomere length. Biol Psychol 2019; 150:107809. [PMID: 31734351 DOI: 10.1016/j.biopsycho.2019.107809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/15/2019] [Accepted: 11/04/2019] [Indexed: 12/29/2022]
Abstract
Although maternal postpartum depressive symptoms (PDS) are associated with child behavior problems, the underlying biological mechanisms are poorly understood. Thus, the current study focused on 193 healthy mother-child dyads and investigated child cortisol and telomere length as potential mediating factors. At 3 and 6 months postpartum, mothers reported on PDS. At age 6, children provided saliva and buccal swab samples. At age 10, mothers and children reported on child behavior problems. Structural equation modelling revealed (a) no association between PDS and child behavior problems and thus no possibility of mediation, but that (b) lower cortisol forecast more child-reported internalizing problems, and (c) shorter telomere length predicted more child-reported internalizing and externalizing problems. These findings raise mediational questions about the determinants of these biomarkers.
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Bleker LS, van Dammen L, Leeflang MMG, Limpens J, Roseboom TJ, de Rooij SR. Hypothalamic-pituitary-adrenal axis and autonomic nervous system reactivity in children prenatally exposed to maternal depression: A systematic review of prospective studies. Neurosci Biobehav Rev 2018; 117:243-252. [PMID: 30366609 DOI: 10.1016/j.neubiorev.2018.05.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Laura S Bleker
- Academic Medical Centre, Departments of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Lotte van Dammen
- University of Groningen - University Medical Centre Groningen, Department of Obstetrics and Gynaecology, 9713 GZ, Groningen, The Netherlands; University of Groningen - University Medical Centre Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Mariska M G Leeflang
- Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Academic Medical Centre, Department of Research Support - Medical Library, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Academic Medical Centre, Departments of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Susanne R de Rooij
- Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Koss KJ, Gunnar MR. Annual Research Review: Early adversity, the hypothalamic-pituitary-adrenocortical axis, and child psychopathology. J Child Psychol Psychiatry 2018; 59:327-346. [PMID: 28714126 PMCID: PMC5771995 DOI: 10.1111/jcpp.12784] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Research on early adversity, stress biology, and child development has grown exponentially in recent years. FINDINGS We review the current evidence for the hypothalamic-pituitary-adrenocortical (HPA) axis as a stress-mediating mechanism between various forms of childhood adversity and psychopathology. We begin with a review of the neurobiology of the axis and evidence for relations between early adversity-HPA axis activity and HPA axis activity-psychopathology, as well as discuss the role of regulatory mechanisms and sensitive periods in development. CONCLUSIONS We call attention to critical gaps in the literature to highlight next steps in this research including focus on developmental timing, sex differences, stress buffering, and epigenetic regulation. A better understanding of individual differences in the adversity-HPA axis-psychopathology associations will require continued work addressing how multiple biological and behavioral systems work in concert to shape development.
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Affiliation(s)
- Kalsea J. Koss
- Center for Research on Child Wellbeing, Office of Population Research, Department of Molecular Biology, Princeton, Princeton University, NJ, USA
| | - Megan R. Gunnar
- Center for Research on Child Wellbeing, Office of Population Research, Department of Molecular Biology, Princeton, Princeton University, NJ, USA
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Hay DF, van Goozen SHM, Mundy L, Phillips R, Roberts S, Meeuwsen M, Goodyer I, Perra O. If You Go Down to the Woods Today: Infants' Distress During a Teddy Bear's Picnic in Relation to Peer Relations and Later Emotional Problems. INFANCY 2017; 22:552-570. [PMID: 28757809 PMCID: PMC5507168 DOI: 10.1111/infa.12172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 10/12/2016] [Accepted: 10/15/2016] [Indexed: 11/27/2022]
Abstract
Infants' emotional reactions to an unusual event were assessed at a simulated birthday party during which two costumed characters enacted a Teddy Bear's Picnic. Two hundred and fifty-eight firstborn infants in a representative British community sample were observed at a mean age of 12.8 months in the presence of their parents and other participating families, in a laboratory sitting room decorated with balloons and banners. The picnic scenario was followed by free play with the other participating infants. At a mean of 36 months of age, mothers, fathers, and another informant who knew the child well completed the Child Behaviour Check List (CBCL). The majority of infants showed no vocal distress during the picnic scenario. A minority of infants expressed strong distress, which was correlated with elevated heart rate and production of cortisol. Infants who were not distressed were more likely to direct social behavior to their peers and especially likely to use physical force against peers. In comparison with strongly distressed and nondistressed infants, those who had shown mild distress during the picnic scenario were least likely to manifest later emotional problems. This pattern was particularly marked for boys. Taken together, the findings indicate that infants' strong distress during naturalistic encounters that are meant to be entertaining can suppress sociability and might indicate risk for subsequent emotional problems.
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Affiliation(s)
| | | | | | | | - Siwan Roberts
- Child and Adolescent Mental Health ServicesBetsi Cadwalladr Health Board
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Pratt M, Apter-Levi Y, Vakart A, Kanat-Maymon Y, Zagoory-Sharon O, Feldman R. Mother-child adrenocortical synchrony; Moderation by dyadic relational behavior. Horm Behav 2017; 89:167-175. [PMID: 28131596 DOI: 10.1016/j.yhbeh.2017.01.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/11/2016] [Accepted: 01/24/2017] [Indexed: 01/21/2023]
Abstract
Mother-child adrenocortical synchrony, the coupling of cortisol (CT) secretion in mother and child, has been associated with shared parent-child experiences and maladaptive familial contexts. Yet, few studies tested adrenocortical synchrony in diurnal CT patterns. Guided by the bio-behavioral synchrony model, we examined whether mother-child relational behavior and maternal psychopathology may moderate the degree of concordance between mother and child's diurnal CT. Ninety-seven mothers and their six-year old children participated in two groups; mothers diagnosed with major depression disorder (N=28) and non-depressed controls (N=69). Mother-child interactions were observed and coded for dyadic reciprocity and dyadic tension and diurnal cortisol was collected from mother and child over two consecutive weekend days. Concordance between maternal and child's diurnal CT was found, significant above and beyond time of measurement. Maternal depression, while associated with attenuated child diurnal CT variability, was unrelated to adrenocortical synchrony. Higher child diurnal CT production predicted a stronger linkage between maternal and child's diurnal CT, suggesting that greater child physiological stress is associated with increased susceptibility to the influences of maternal stress physiology. Mother-child reciprocity was related to lower adrenocortical synchrony. Findings suggest that higher adrenocortical synchrony is associated with greater physiological stress and less adaptive dyadic relational patterns. Results raise the possibility that diurnal adrenocortical synchrony taps a unique aspect of HPA-axis functioning whose role in the cross-generational transfer of stress physiology requires further research.
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Affiliation(s)
- Maayan Pratt
- Department of Psychology and the Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Yael Apter-Levi
- Department of Psychology and the Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Adam Vakart
- Department of Psychology and the Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Yaniv Kanat-Maymon
- Department of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Orna Zagoory-Sharon
- Department of Psychology and the Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Ruth Feldman
- Department of Psychology and the Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan, Israel; Yale University, Child Study Center, United States.
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Apter-Levi Y, Pratt M, Vakart A, Feldman M, Zagoory-Sharon O, Feldman R. Maternal depression across the first years of life compromises child psychosocial adjustment; relations to child HPA-axis functioning. Psychoneuroendocrinology 2016; 64:47-56. [PMID: 26610204 DOI: 10.1016/j.psyneuen.2015.11.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/05/2015] [Accepted: 11/07/2015] [Indexed: 11/25/2022]
Abstract
Maternal depression across the first years of life negatively impacts children's development. One pathway of vulnerability may involve functioning of the hypothalamic-pituitary-adrenal (HPA) axis. We utilize a community cohort of 1983 women with no comorbid risk repeatedly assessed for depression from birth to six years to form two groups; chronically depressed (N=40) and non-depressed (N=91) women. At six years, mother and child underwent psychiatric diagnosis, child salivary cortisol (CT) was assessed three times during a home-visit, mother-child interaction was videotaped, and child empathy was coded from behavioral paradigms. Latent Growth curve Model using Structural Equation Modeling (SEM) estimated the links between maternal depression and mother's negative parenting and three child outcomes; psychopathology, social withdrawal, and empathy as related to child CT baseline and variability. Depressed mothers displayed more negative parenting and their children showed more Axis-I psychopathology and social withdrawal. SEM analysis revealed that maternal depression was associated with reduced CT variability, which predicted higher child psychopathology and social withdrawal. Whereas all children exhibited similar initial levels of CT, children of controls reduced CT levels over time while children of depressed mothers maintained high, non-flexible levels. Mother negativity was related to lower initial CT levels, which predicted decreased empathy. Findings suggest that chronic maternal depression may compromise children's social-emotional adjustment by diminishing HPA-system flexibility as well as limiting the mother's capacity to provide attuned and predictable caregiving.
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Affiliation(s)
- Yael Apter-Levi
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Maayan Pratt
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Adam Vakart
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Michal Feldman
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Orna Zagoory-Sharon
- The Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Ruth Feldman
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel; The Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan 5290002, Israel.
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10
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Barry TJ, Murray L, Fearon RP, Moutsiana C, Cooper P, Goodyer IM, Herbert J, Halligan SL. Maternal postnatal depression predicts altered offspring biological stress reactivity in adulthood. Psychoneuroendocrinology 2015; 52:251-60. [PMID: 25544737 PMCID: PMC4309884 DOI: 10.1016/j.psyneuen.2014.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
Abstract
The offspring of depressed parents have been found to show elevated basal levels of the stress hormone cortisol. Whether heightened cortisol stress reactivity is also present in this group has yet to be clearly demonstrated. We tested whether postnatal maternal depression predicts subsequent increases in offspring biological sensitivity to social stress, as indexed by elevated cortisol reactivity. Participants (mean age 22.4-years) derived from a 22-year prospective longitudinal study of the offspring of mothers who had postnatal depression (PND group; n=38) and a control group (n=38). Salivary cortisol response to a social-evaluative threat (Trier Social Stress Test) was measured. Hierarchical linear modelling indicated that PND group offspring showed greater cortisol reactivity to the stress test than control group participants. Group differences were not explained by offspring depressive or anxiety symptoms, experiences of negative life events, elevated basal cortisol at age 13-years, subsequent exposure to maternal depression, or other key covariates. The findings indicate that the presence of early maternal depression can predict offspring biological sensitivity to social stress in adulthood, with potential implications for broader functioning.
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Affiliation(s)
- Tom J. Barry
- Centre for the Psychology of Learning and Experimental Psychopathology, University of Leuven, Tiensestraat 102, Leuven 3000, Belgium
| | - Lynne Murray
- School of Psychology and CLS, University of Reading, Reading RG6 6AL, UK,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - R.M. Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Christina Moutsiana
- Experimental Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - Peter Cooper
- School of Psychology and CLS, University of Reading, Reading RG6 6AL, UK,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Ian M. Goodyer
- Department of Psychiatry, Cambridge University, Cambridge CB2 2AH, UK
| | - Joe Herbert
- John van Geest Centre for Brain Repair, Department of Clinical Neuroscience, Cambridge University, Cambridge CB2 3BY, UK
| | - Sarah L. Halligan
- Department of Psychology, University of Bath, Bath BA2 7AY, UK,Corresponding author. Tel.: +44 1225 386636.
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Antenatal depression and children's developmental outcomes: potential mechanisms and treatment options. Eur Child Adolesc Psychiatry 2014; 23:957-71. [PMID: 25037152 DOI: 10.1007/s00787-014-0582-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/30/2014] [Indexed: 01/23/2023]
Abstract
During the last decade there has been increased recognition of the prevalence of antenatal depression as well as an expansion in research examining the impact of maternal mood during pregnancy on offspring development. The aim of this review was to summarise the theoretical underpinnings and empirical evidence regarding the impact of antenatal depression on children's developmental outcomes. Biological mechanisms hypothesised to account for an association between antenatal depression and adverse offspring outcomes are first identified including the functioning of the prenatal Hypothalamic Pituitary Adrenal (HPA) axis and epigenetic processes. A systematic literature search is then conducted of studies examining the impact of antenatal depression on child development. In general, studies examining associations between antenatal depression and offspring temperament, cognitive and emotional outcomes reveal either no effect of the prenatal environment or small effects that often attenuate following adjustment for other antenatal and postnatal risk factors. In contrast, an independent effect of antenatal depression on children's conduct problems and antisocial behaviour is a well-replicated finding. There is emerging evidence that exposure to depression during pregnancy impacts negatively on offspring biology, although the findings are complex and require replication. Psychological and pharmacological treatments of antenatal depression are then reviewed, considering whether antidepressant medication exerts harmful effects on the foetus. We close by proposing that antenatal depression is an early marker of a developmental cascade to future mental health problems for both mothers and offspring.
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