Effects of prenatal and postnatal maternal emotional stress on toddlers' cognitive and temperamental development

Mothers in stress: Hair cortisol of mothers living in marginalised Roma communities and the role of socioeconomic disadvantage

Roma living in marginalised communities are among the most disadvantaged groups in Slovakia. Socioeconomic disadvantage is associated with higher hair cortisol concentrations (HCC), including in parents. The aim of this study is therefore to assess differences in HCC, reflecting the levels of stress, between mothers living in MRCs and from the majority population, to assess the association of socioeconomic disadvantage with HCC, and whether disadvantage mediates the MRC/majority differences in HCC. Participants were mothers of children aged 15-18 months old living in MRCs (N=61) and from the Slovak majority population (N=90). During preventive paediatric visits, visits at community centres and home visits, hair samples and data by questionnaire were collected. HCC differed significantly between mothers living in MRCs and mothers from the majority population, with the mean HCC value being twice as high in mothers living in MRCs (22.98 (95% confidence interval, CI, 15.70-30.30) vs. 11.76 (8.34-15.20), p<0.05). HCC was significantly associated with education, household equipment and household overcrowding, but not with billing, socioeconomic stress and social support. The difference in HCC between mothers living in MRCs and mothers from the majority population was partially mediated by poor house equipment, such as no access to running water, no flushing toilet or no bathroom (the indirect effect of B=7.63 (95% CI: 2.12-13.92)). Practitioners and policymakers should be aware of high stress levels among mothers living in MRCs and aim at enhancing their living and housing conditions.

Prenatal stress impacts foetal neurodevelopment: Temporal windows of gestational vulnerability

Prenatal maternal stressors ranging in severity from everyday occurrences/hassles to the experience of traumatic events negatively impact neurodevelopment, increasing the risk for the onset of psychopathology in the offspring. Notably, the timing of prenatal stress exposure plays a critical role in determining the nature and severity of subsequent neurodevelopmental outcomes. In this review, we evaluate the empirical evidence regarding temporal windows of heightened vulnerability to prenatal stress with respect to motor, cognitive, language, and behavioural development in both human and animal studies. We also explore potential temporal windows whereby several mechanisms may mediate prenatal stress-induced neurodevelopmental effects, namely, excessive hypothalamic-pituitary-adrenal axis activity, altered serotonin signalling and sympathetic-adrenal-medullary system, changes in placental function, immune system dysregulation, and alterations of the gut microbiota. While broadly defined developmental windows are apparent for specific psychopathological outcomes, inconsistencies arise when more complex cognitive and behavioural outcomes are considered. Novel approaches to track molecular markers reflective of the underlying aetiologies throughout gestation to identify tractable biomolecular signatures corresponding to critical vulnerability periods are urgently required.

Maternal mental health mediates the effect of prenatal stress on infant temperament: The Harvey Mom Study

Prenatal maternal stress and mental health problems are known to increase risk for developmental psychopathology in offspring, yet pathways leading to risk or resiliency are poorly understood. In a quasi-experimental design, we prospectively examined associations between disaster-related prenatal stress, maternal mental health symptoms, and infant temperament outcomes. Mothers who were pregnant during Hurricane Harvey (N = 527) reported on objective hardships (e.g., loss of belongings or income, evacuation, home flooding) related to the storm and subsequent mental health symptoms (anxiety/depression, posttraumatic stress) across time. At a postpartum assessment, mothers reported on their infant's temperament (negative affect, positive affect, orienting/regulatory capacity). Greater objective hardship indirectly predicted higher levels of infant orienting/regulatory capacity through its association with increased maternal posttraumatic stress symptoms. Greater objective hardship also indirectly predicted higher levels of infant negative affect through its association with increased maternal anxiety/depression symptoms across time. Our findings suggest a psychological mechanism linking prenatal stress with specific temperamental characteristics via maternal mental health symptoms. Findings point to the importance of high-quality assessment and mental health services for vulnerable women and young children.

The impact of maternal mood and economic stress during Covid-19 pandemic on infant behaviour: Findings from the cross-sectional UK Covid-19 New Mum Study

The UK Covid-19 New Mum Study (cross-sectional study) recorded maternal experience during the early stages of the pandemic. Our previous analyses showed that the pandemic and 2020 national lockdown negatively impacted maternal mental health. Here, we describe changes in infant behaviour (crying and fussiness) reported by the mother during the Covid-19 pandemic compared to beforehand, and test whether these changes are associated with maternal variables (mental health, coping, financial insecurity, income and household support). We included only responses of mothers whose infants were born before the pandemic started (n = 2,031). Composite scores for maternal mental health and coping were obtained using principal components analysis. Multivariable logistic regression analysis was used to test whether maternal mood and coping and household financial stresses were associated with changes in infant behaviour considered negative (becoming fussier, crying more). Adjusting for confounders, the odds of the infant being fussier and crying more increased by 52% (OR = 1.52, 95% CI = 1.35;1.72) and 64% (OR = 1.64, 95% CI = 1.38;1.95), respectively, if the mother experienced poorer mental health. If the mother coped better and had more time to focus on her health and interests, the odds of these outcomes decreased by 27% (OR = 0.73, 95% CI = 0.65;0.83) and 23% (OR = 0.77, 95% CI = 0.65;0.91), respectively. Mothers who reported that, during the lockdown, household chores were more equally divided 'to a high extent' had 40% (OR = 0.60, 95% CI = 0.39;0.92) lower odds of reporting that their babies became fussier. Reporting major/moderate impact on food expenses was associated with the infant crying more (OR = 2.52, 95% CI = 1.16;5.50). Our results are consistent with previous studies showing that maternal wellbeing plays a significant role in children's behavioural changes during lockdowns. We need strategies to improve mental health and enable women to develop the skills to maintain resilience and reassure their children in challenging times.

Perinatal depression and infant and toddler neurodevelopment: A systematic review and meta-analysis

Many studies have focused on the effect of perinatal depression on neurodevelopment among children and adolescents. However, only a few studies have explored this relationship in infants and toddlers with inconsistent results. We performed a systematic review and meta-analysis to evaluate the association between perinatal depression and infant and toddler neurodevelopment during the first two postnatal years. Twenty-three studies were included in this meta-analysis. Perinatal depression was associated with poorer cognitive (Cohen's d = -0.19, SE= 0.06, 95% CI = -0.30 to -0.08), language (Cohen's d = -0.24, SE = 0.09, 95% CI = -0.40 to -0.07), and motor (Cohen's d = -0.15, SE = 0.05, 95% CI = -0.26 to -0.05) development. Subgroup analyses showed that the types of maternal depression (prenatal depression vs. postnatal depression), the method of measuring maternal depression (rating scale vs. diagnostic interview), and the time interval between assessment of exposure and outcome had an impact on the observed effect about neurodevelopment of infants and toddlers. In addition, the results of our study pointed to a stronger significant association between prenatal depression and cognitive, language, and motor delays in infants and toddlers, whereas the association between postnatal depression and cognitive, language, and motor delays in infants and toddlers was not statistically significant. In conclusion, this study provided convincing evidence that the perinatal window is a sensitive period for offspring neurodevelopment.

Maternal and Child Depressive Symptoms in a Sample of Low-income Families of Color: The Mediating Role of Child Adaptability

Maternal depressive symptoms are linked with child internalizing concerns, such as depressive symptoms. The impact that maternal depressive symptoms have on the onset and maintenance of child depressive symptoms might be especially salient in families of color who are low-income because of elevated rates of maternal depressive symptoms and environmental stressors in those populations. The relationship between maternal and child depressive symptoms might be partially explained by a child's capacity to flexibly respond to stressors in the environment, a construct known as adaptability. A simple mediation model was conducted with a sample of low-income, Black/African American and Latina mothers and their children (n = 128). Results suggested that child adaptability partially mediated the link between maternal and child depressive symptoms. We discussed how this study can inform research and practice that aim to assist low-income families of color with mental health needs.

Maximising the potential of Chinese birth cohort studies: a systematic review of mother-baby cohorts in mainland China

OBJECTIVES

There is now a growing interest in early-life influences on adult diseases in China. A number of birth cohorts have been established. This systematic review provided a better understanding of the development of mother-baby cohorts in China.

STUDY DESIGN

Systematic review.

METHODS

We conducted a systematic review for research or profile papers in English/Chinese that reported data from mother-baby cohorts in mainland China, with ≥1y follow-up after birth. We identified 315 papers, corresponding to 31 cohorts from 19 provinces/megacities.

RESULTS

All cohorts started in 1999-2017 (21 after 2010) and were set up with broad objectives or specific scientific focus. The baseline sample size varied, from <500 to >300,000 mothers. A majority of cohorts were initiated during pregnancy and followed children to <10y, only six to adolescence and none into adulthood. These cohorts mostly collected samples from mothers and babies, in addition to using interviews/questionnaires to collect information about pregnancy, birth and child health. Most cohorts were recruited from a single province/city. The large western region was understudied.

CONCLUSIONS

Mother-baby cohorts have developed rapidly in China, but usually with a short follow-up duration. Extending the follow-up of children and developing cross-cohort collaboration will increase the diversity, size and coverage of the sample, allow studying early influences on life-course health and identify targets for early intervention in the Chinese population.

Maternal prenatal and postnatal psychological distress trajectories and impact on cognitive development in 4-year-old children: the Japan Environment and Children's Study

Maternal prenatal and postnatal psychological distress, including depression and anxiety, may affect children's cognitive development. However, the findings have been inconsistent. We aimed to use the dataset from the Japan Environment and Children's Study, a nationwide prospective birth cohort study, to examine this association. We evaluated the relationship between the maternal six-item version of the Kessler Psychological Distress Scale (K6) scores and cognitive development among children aged 4 years. K6 was administered twice during pregnancy (M-T1; first half of pregnancy, M-T2; second half of pregnancy) and 1 year postpartum (C-1y). Cognitive development was assessed by trained testers, using the Kyoto Scale of Psychological Development 2001. Multiple regression analysis was performed with the group with a K6 score ≤ 4 for both M-T1 and M-T2 and C-1y as a reference. Records from 1,630 boys and 1,657 girls were analyzed. In the group with K6 scores ≥ 5 in both M-T1 and M-T2 and C-1Y groups, boys had significantly lower developmental quotients (DQ) in the language-social developmental (L-S) area (partial regression coefficient: -4.09, 95% confidence interval: -6.88 - -1.31), while girls did not differ significantly in DQ for the L-S area. Among boys and girls, those with K6 scores ≤ 4 at any one or two periods during M-T1, M-T2, or C-1y did not have significantly lower DQ for the L-S area. Persistent maternal psychological distress from the first half of pregnancy to 1 year postpartum had a disadvantageous association with verbal cognitive development in boys, but not in girls aged 4 years.

Longitudinal associations between paternal mental health and child behavior and cognition in middle childhood

Introduction

Paternal mental health has been associated with adverse consequences on offspring psychosocial development, and family environmental factors may partly explain those associations. To clarify this, we need comprehensive prospective studies, particularly in middle-childhood when the child enters school and is expected to make use of behavioral and cognitive skills as part of their interactions and learning.

Method

Using data from a sub-sample of the prospective 3D birth cohort study comprised of mother-father-child triads, and a follow-up of the parents and the children at 6-8 years of age (n = 61; 36 boys, 25 girls), we examined whether paternal anxious and depressive symptoms measured during the pregnancy period (i.e., prenatally) or concurrently when the child was assessed at 6-8 years old were associated with children's cognition/behavior.

Results

In contrast to our hypotheses, we found that greater prenatal paternal depressive symptoms predicted fewer child behavioral difficulties; and that greater concurrent childhood paternal depression or anxiety symptoms were associated with higher child full-scale IQ, controlling for the equivalent maternal mental health assessment and parental education. Father parenting perception did not mediate these associations, nor were they moderated by maternal mental health at the concurrent assessment, or paternal ratings of marital relationship quality.

Discussion

These findings suggest that higher symptoms of paternal mental health symptoms are associated with fewer child behavioral difficulties and higher cognitive performance in middle childhood. Potential clinical implications and future research directions are discussed.

Parental sensitivity modifies the associations between maternal prenatal stress exposure, autonomic nervous system functioning and infant temperament in a diverse, low-income sample

Evidence suggests that adversity experienced during fetal development may shape infant physiologic functioning and temperament. Parental sensitivity is associated with child stress regulation and may act as a buffer against risk for intergenerational health effects of pre- or postnatal adversity. Building upon prior evidence in a racially and ethnically diverse sample of infants (M infant age = 6.5 months) and women of low socioeconomic status, this study examined whether coded parenting sensitivity moderated the association between an objective measure of prenatal stress exposures (Stressful Life Events (SLE)) and infant parasympathetic (respiratory sinus arrhythmia; RSA) or sympathetic (pre-ejection period; PEP) nervous system functioning assessed during administration of the Still-Face-Paradigm (SFP) (n = 66), as well as maternal report of temperament (n = 154). Results showed that parental sensitivity moderated the associations between prenatal stress exposures and infant RSA reactivity, RSA recovery, PEP recovery, and temperamental negativity. Findings indicate that greater parental sensitivity is associated with lower infant autonomic nervous system reactivity and greater recovery from challenge. Results support the hypothesis that parental sensitivity buffers infants from the risk of prenatal stress exposure associations with offspring cross-system physiologic reactivity and regulation, potentially shaping trajectories of health and development and promoting resilience.

Association of maternal and paternal perinatal depression and anxiety with infant development: A longitudinal study

BACKGROUND

Maternal and paternal perinatal depression and anxiety are theorised to adversely impact infant development. Yet, few studies have assessed both mental health symptoms and clinical diagnoses within the one study. Moreover, research on fathers is limited. This study therefore aimed to examine the association between symptoms and diagnoses of maternal and paternal perinatal depression and anxiety with infant development.

METHOD

Data were from the Triple B Pregnancy Cohort Study. Participants included 1539 mothers and 793 partners. Depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale and Depression Anxiety Stress Scales. Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia were assessed using the Composite International Diagnostic Interview in trimester three. Infant development was assessed at 12-months using the Bayley Scales of Infant and Toddler Development.

RESULTS

Antepartum, maternal depressive and anxiety symptoms were associated with poorer infant social-emotional (d = -0.11, p = .025) and language development (d = -0.16, p = .001). At 8-weeks postpartum, maternal anxiety symptoms were associated with poorer overall development (d = -0.11, p = .030). No association was observed for clinical diagnoses in mothers, nor paternal depressive and anxiety symptoms or clinical diagnoses; albeit risk estimates were largely in the expected direction of adverse effects on infant development.

CONCLUSIONS

Evidence suggests that maternal perinatal depression and anxiety symptoms may adversely impact infant development. Effects were small but findings underscore the importance of prevention, early screening and intervention, alongside consideration of other risk factors during early critical periods.

Prenatal anxiety during the pandemic context is related to neurodevelopment of 6-month-old babies

Prenatal anxiety and depression in pandemic context could introduce changes in the fetal developmental trajectories that, ultimately, could alter the adaptive behaviors of the offspring, potentially affecting, for example, general neurodevelopment. The sample consisted of 105 mother-child dyads, recruited between March and May 2020. The dyads were evaluated longitudinally, prenatally and postnatally (6 months). The Pandemic Impact Questionnaire, the State-Trait Anxiety Inventory, and the Beck-II Depression Inventory were used to assess indicators of maternal anxiety and depression, respectively. Regarding the babies, their mothers responded to Age and Stages: 3, which assesses different dimensions of early neurodevelopment, in addition to a closed questionnaire to identify sociodemographic and maternal and child health variables. A series of mediation models were tested to examine the association between prenatal psychopathology/negative experiences of the pandemic and neurodevelopment. The results indicated that the negative experiences of the pandemic were indirectly associated with the socio-individual and fine motor neurodevelopment of the offspring, through maternal anxiety symptoms, during the third trimester, which functioned as a mediator.  Conclusions: This study provides evidence on the mediating effects of maternal anxiety on infant neurodevelopment in contexts of early adversity. It is important to point out the need to implement public health policies that allow a timely evaluation of neurodevelopmental variables during early childhood, which can implement early interventions to reduce the risks associated with these deficits. What is Known: • Effects of maternal mental health have been reported, effects on child neurodevelopment, in motor, cognitive, linguistic and socio-emotional dimensions. • Contexts of early adversity have been associated with maternal mental health and offspring development. What is New: • The context of pandemic adversity caused by COVID-19 is associated with motor and socio-individual neurodevelopment, mediated by maternal prenatal anxiety.

Mother-infant interaction and maternal postnatal psychological distress are associated with negative emotional reactivity among infants and toddlers- A FinnBrain Birth Cohort study

Studies have reported mixed findings regarding the effects of mother-infant interaction and maternal distress on children's negative emotional reactivity. In the current study (N = 134 and 107), we examined the effects of maternal Emotional Availability (sensitivity, structuring, non-intrusiveness and non-hostility) and maternal psychological distress on negative reactivity among children in the FinnBrain birth cohort study. In addition, the possible moderating effect of mother-infant interaction on the associations between maternal psychological distress and children's negative reactivity was examined. We used questionnaires to asses maternal psychological distress, observations of mother-infant interaction and observations as well maternal reports of child temperament to overcome the key limitations of many studies relying on single-method assessments. Our results showed that higher maternal sensitivity and structuring at 8 months of child's age were associated with lower mother-reported negative reactivity among children at 24 months. Higher maternal postnatal distress associated with higher parent-reported negative reactivity in children at 12 and 24 months of age when the effects of prenatal distress and the quality of mother-infant interaction were controlled for. Mother-infant interaction and maternal psychological distress did not associate with observations of child negative reactivity. We found no moderation effects of mother-infant interaction regarding the associations between maternal distress and children's negative emotional reactivity. Our findings reflect the importance of developing interventions to reduce the maternal distress symptoms while enhancing maternal sensitivity and structuring to prevent the possible harmful effects of these on child negative reactivity.

Associations between mother's depressive symptoms during pregnancy and newborn's brain functional connectivity

Depression during pregnancy is common and the prevalence further increased during the COVID pandemic. Recent findings have shown potential impact of antenatal depression on children's neurodevelopment and behavior, but the underlying mechanisms are unclear. Nor is it clear whether mild depressive symptoms among pregnant women would impact the developing brain. In this study, 40 healthy pregnant women had their depressive symptoms evaluated by the Beck Depression Inventory-II at ~12, ~24, and ~36 weeks of pregnancy, and their healthy full-term newborns underwent a brain MRI without sedation including resting-state fMRI for evaluation of functional connectivity development. The relationships between functional connectivities and maternal Beck Depression Inventory-II scores were evaluated by Spearman's rank partial correlation tests using appropriate multiple comparison correction with newborn's gender and gestational age at birth controlled. Significant negative correlations were identified between neonatal brain functional connectivity and mother's Beck Depression Inventory-II scores in the third trimester, but not in the first or second trimester. Higher depressive symptoms during the third trimester of pregnancy were associated with lower neonatal brain functional connectivity in the frontal lobe and between frontal/temporal lobe and occipital lobe, indicating a potential impact of maternal depressive symptoms on offspring brain development, even in the absence of clinical depression.

Differences in infant negative affectivity during the COVID-19 pandemic

This longitudinal study compared infant temperament rated at 3 months postpartum by 263 United-States-based women who gave birth during the COVID-19 pandemic and 72 who gave birth prior to the pandemic. All women completed questionnaires assessing perinatal mental health, social contact, and infant temperament. Mothers whose infants were born during the pandemic reported higher levels of infant negative affectivity as compared with mothers whose infants were born earlier (F(1, 324) = 18.28, p < .001), but did not differ in their ratings of surgency or effortful control. Maternal prenatal depressive symptoms, prenatal stress, and postpartum stress mediated differences in infant negative affectivity  between pandemic and pre-pandemic groups. Within the pandemic group, decreased postpartum social contact was associated with higher ratings of infant negative affectivity. These findings suggest that the pandemic has affected maternal perceptions of infant temperament, perinatal mental health, and social contact.

Association between prenatal maternal anxiety and/or stress and offspring's cognitive functioning: A meta-analysis

This meta-analysis examined the relationship between prenatal maternal stress and/or anxiety and the outcomes of children aged 3 months to 9 years. Of the 8754 studies published before June 2021 that were synthesized, 17 conducted in Western countries were included in the meta-analysis (Ntotal  = 23,307; Mmales 54%; Methnicity White 77%, Pacific 15%, African American/Black 10%, Middle Eastern 7%, Eastern 8%). Effect sizes ranged from -0.41 to 0.15. A weak negative association was found between prenatal stress and/or anxiety exposure and children's general intellectual development. Associations varied based on the type of exposure. Findings are limited to developed counties and cannot be generalized to low- and middle-income countries. Directions for maternal prenatal intervention and future studies are discussed.

Prospective associations between various prenatal exposures to maternal psychological stress and neurodevelopment in children within 24 months after birth

BACKGROUND

There is increasing evidence that prenatal exposure to maternal psychological distress may be a factor influencing offspring neurodevelopment, but stress type-dependent effects of maternal psychological distress on offspring neurodevelopment in early childhood have yet to be fully elucidated. Additionally, although positive maternal mental health exerts potential effects in protecting against adverse health outcomes, few investigators have considered the effects of positive maternal mental health on offspring neurodevelopment in early childhood.

AIMS

To determine the associations between various prenatal exposures to maternal psychological distress and positive life-event experiences and offspring neurodevelopment within 24 months of age.

METHODS

A total of 4412 mother-child dyads were recruited from the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC). Maternal perceived stress, negative life-event stress, positive life-event experiences around the time of conception (i.e., three months prior to and after conception) were assessed at 12-16 gestational weeks, and maternal anxiety and depressive symptoms were assessed at 32-36 gestational weeks. We measured children's neurodevelopment using the Ages and Stages Questionnaire, Third Edition (ASQ-3) at two, six, 12, and 24 months postnatally. We then exploited generalized linear models to estimate the associations between prenatal maternal psychological distress and positive life-event experiences and children's neurodevelopment at the above periods, and generalized linear mixed models were applied to assess the associations between maternal psychological distress and positive life-event experiences and suspected developmental delay (SDD) in children within 24 months after birth based on a longitudinal design.

RESULTS

Maternal perceived stress and negative life-event stress around the time of conception, and anxiety and depressive symptoms during late pregnancy were negatively associated with scores of children's neurodevelopment at two, six, 12, and 24 months of age; while maternal life-event experiences were positively associated with scores of children's neurodevelopment. Longitudinal analysis revealed that higher levels of maternal negative life-event stress and depressive symptoms augmented the risk of SDD in personal-social (OR = 1.435, 1.681). Mothers who experienced higher levels of positive life-event experiences exhibited a reduced risk of SDD in gross motor and personal-social domains (OR = 0.373, 0.350).

CONCLUSIONS

Prenatal exposure to maternal psychological distress is negatively associated with children's neurodevelopment in early childhood depending upon the type of distress. Maternal positive life-event experiences around the time of conception appeared to present potential benefits for child neurodevelopment.

Parental Mental Health and Parenting Behaviors Following Very Preterm Birth: Associations in Mothers and Fathers and Implications for Child Cognitive Outcome

OBJECTIVES

To investigate the longitudinal associations between parental mental health symptoms within 4 weeks of birth, parenting behaviors at 1 year, and child general cognitive ability at 4.5-5 years in a sample of children born very preterm (VP). This study also examined whether these associations differed based on level of family social risk.

METHODS

Participants were 143 children born <30 weeks' gestation and their parents. Within 4 weeks of birth, mothers' and fathers' depressive and anxiety symptoms were assessed using the Center for Epidemiologic Studies Depression Scale and Hospital Anxiety Depression Scale-Anxiety Subscale. Parents' sensitive and structuring parenting behaviors were assessed at 1 year using the Emotional Availability Scales. Child general cognitive ability was assessed at 4.5-5 years using the Wechsler Preschool & Primary Scale of Intelligence-Fourth Edition.

RESULTS

Higher maternal depressive symptoms were associated with lower levels of sensitive and structuring parenting behavior, while higher maternal anxiety symptoms were associated with higher levels of structuring parenting behavior. There was weak evidence for positive associations between mothers' sensitive parenting behavior and fathers' structuring parenting behavior and child general cognitive ability. There was also weak evidence for stronger associations between mothers' mental health symptoms, parenting behaviors, and child general cognitive ability, in families of higher compared with lower social risk.

CONCLUSIONS

Depressive and anxiety symptoms experienced by mothers in the initial weeks following VP birth can have long-term effects on their parenting behaviors. Enquiring about parents' mental health during their child's hospitalization in the neonatal intensive care unit is crucial.

Relations among Socioeconomic Status, Perceived Stress, and the Home Language Environment

While socioeconomic disparities in the home language environment have been well established, the mechanisms explaining these disparities are poorly understood. One plausible mechanism is heightened stress. The current study investigated whether maternal perceived stress was 1) associated with measures of the home language environment, and 2) mediated the relation between socioeconomic disparities and the home language environment. Data from three independent studies were analyzed, which together comprised 322 mother-child dyads. Two studies included mothers and their six- to twelve-month-old infants (N = 227). The third included mothers and their five- to nine-year-old children (N = 95). Mothers reported their educational attainment, income, and stress. Language Environment Analysis (LENA) measured the home language environment. As has been previously reported, socioeconomic disparities were observed in adult words and conversational turns. Stress did not mediate these associations, nor was it associated with adult words or conversational turns. Alternate mechanisms for future exploration are discussed.

Effect of Musical Stimulation on Placental Programming and Neurodevelopment Outcome of Preterm Infants: A Systematic Review

BACKGROUND

The fetal environment is modulated by the placenta, which integrates and transduces information from the maternal environment to the fetal developmental program and adapts rapidly to changes through epigenetic mechanisms that respond to internal (hereditary) and external (environmental and social) signals. Consequently, the fetus corrects the trajectory of own development. During the last trimester of gestation, plasticity shapes the fetal brain, and prematurity can alter the typical developmental trajectories. In this period, prevention through activity-inducing (e.g., music stimulation) interventions are currently tested. The purpose of this review is to describe the potentialities of music exposure on fetus, and on preterm newborns in the Neonatal Intensive Care Unit evaluating its influence on neurobehavioral development.

METHODS

Databases were searched from 2010 to 2022 for studies investigating mechanisms of placental epigenetic regulation and effects of music exposure on the fetus and pre-term neonates.

RESULTS

In this case, 28 selected papers were distributed into three research lines: studies on placental epigenetic regulation (13 papers), experimental studies of music stimulation on fetus or newborns (6 papers), and clinical studies on premature babies (9 papers). Placental epigenetic changes of the genes involved in the cortisol and serotonin response resulted associated with different neurobehavioral phenotypes in newborns. Prenatal music stimulation had positive effects on fetus, newborn, and pregnant mother while post-natal exposure affected the neurodevelopment of the preterm infants and parental interaction.

CONCLUSIONS

The results testify the relevance of environmental stimuli for brain development during the pre- and perinatal periods and the beneficial effects of musical stimulation that can handle the fetal programming and the main neurobehavioral disorders.

Prenatal stress self-help mindfulness intervention via social media: a randomized controlled trial

BACKGROUND

Prenatal stress is a pressing issue. However, there is a lack of robust evidence for psychosocial interventions to manage this problem.

AIMS

This study aimed to examine the effectiveness of a mindfulness-based intervention on reducing prenatal stress compared to participation in health education groups.

METHODS

A randomized controlled trial was conducted in a prenatal clinic of comprehensive tertiary care from April to October 2017. A total of 108 pregnant women were randomly assigned to an intervention or a control group. Participants completed self-report measures of depression, anxiety, perceived stress, fatigue, positive and negative affect, and mindfulness before, immediately after, and 15 weeks after the 4-week intervention period. Generalized estimating equations were used to analyze the intervention outcomes.

RESULTS

The results supported greater improvement in terms of perceived stress (Wald χ²=26.94, p<0.001), fatigue (Wald χ²=17.61, p<0.001), positive affect (Wald χ²=9.03, p = 0.011), negative affect (Wald χ²=11.37, p = 0.003), and mindfulness (Wald χ²=24.97, p<0.001) in the intervention group than in the control group.

CONCLUSIONS

The self-help mindfulness intervention decreased prenatal stress and negative affect and improved positive affect and mindfulness.

Maternal prenatal psychological distress and motor/cognitive development in two-year-old offspring: The Japan Environment and Children's Study

Maternal prenatal psychological distress, including depression and anxiety, may affect offspring's motor/cognitive development. However, research findings have been inconsistent. We used a dataset from the Japan Environment and Children's Study to evaluate associations between maternal six-item Kessler Psychological Distress Scale (K6) scores and motor/cognitive development among offspring at two years of age. Their offspring's motor/cognitive development was assessed using the Kyoto Scale of Psychological Development 2001. Records for 1859 male and 1817 female offspring were analyzed. The maternal K6 was administered twice during pregnancy: at a median of 14.6 weeks (M-T1) and 27.3 weeks (M-T2) of gestation. Multiple regression analysis was performed with the group with K6 scores ≤4 at both M-T1 and M-T2 as a reference. In the group with K6 scores ≥5 at both M-T1 and M-T2, male offspring had significantly lower developmental quotients (DQ) in the posture-motor area (partial regression coefficient [B]: -3.68, 95% confidence interval [CI]: -5.92 to -1.44) and language-social area (B: -1.93; 95%CI: -3.73 to -0.12), while female offspring had a lower DQ for the language-social area (B: -1.95; 95%CI: -3.73 to -0.17). In those with K6 scores ≥5 only at M-T1 or M-T2, male and female offspring did not differ significantly in DQ for any area. Continuous maternal psychological distress from the first to the second half of pregnancy was associated with lower motor and verbal cognitive development in male offspring and lower verbal cognitive development in female offspring at 2 years compared with the group without persistent maternal prenatal psychological distress.

The effect of the COVID-19 pandemic on infant development and maternal mental health in the first 2 years of life

We investigated how exogenous variation in exposure to the COVID-19 pandemic during the first year of life is related to infant development, maternal mental health, and perceived stress. Ninety-three socioeconomically diverse pregnant women were recruited before the pandemic to participate in a longitudinal study. Infants ranged in age at the beginning of lockdown (0-9.5 months old), thus experiencing different durations of pandemic exposure across the first year of life. The duration of pandemic exposure was not associated with family demographic characteristics, suggesting it captured exogenous variability. We tested associations between this exogenous variation in pandemic exposure and child and family outcomes. We also examined whether mother-reported disruptive life events were correlated with child and family outcomes. We found no association between duration of pandemic exposure in the first year of life and infant socioemotional problems, infant language development, or maternal mental health and perceived stress symptoms, at 12 or 24 months. However, we found that self-reported exposure to pandemic-related disruptive life events predicted greater maternal depression, anxiety, and perceived stress at 12 months, and greater depression and anxiety at 24 months. Socioeconomic status did not moderate these associations. These findings suggest cautious optimism for infants raised during this period.

Prenatal Programming of Behavior Problems via Second-by-Second Infant Emotion Dynamics

Fetal adaptations to prenatal maternal stress may confer high risk for childhood behavior problems, potentially operating via dynamic fluctuations in infants' emotions during mother-infant interactions. These fluctuations over time may give rise to behavior problems. Among a sample of 210 low-income mothers of Mexican origin and their 24-week-old infants, dynamic structural equation modeling was used to examine whether within-infant second-by-second emotion processes were predicted by maternal prenatal stress and predicted behavior problems at 36 and 54 months. The mean level around which infant negative affect fluctuated was related to prenatal stress, but not to childhood behavior problems. The volatility in infant negative affect, reflecting greater ebb and flow in infant negative affect during playful interaction, was predicted by prenatal stress and predicted enduring behavior problems in childhood. Results highlight a potential child-driven pathway linking prenatal exposure with childhood behavior problems via infant negative emotional volatility.

Maternal Distress during Pregnancy and the Postpartum Period: Underlying Mechanisms and Child's Developmental Outcomes-A Narrative Review

Maternal mental health may be considered a determining factor influencing fetal and child development. An essential factor with potentially negative consequences for a child's psychophysiological development is the presence of maternal distress during pregnancy and the postpartum period. The review is organized and presented to explore and describe the effects of anxiety, stress, and depression in pregnancy and the postpartum period on adverse child developmental outcomes. The neurobiology of maternal distress and the transmission mechanisms at the molecular level to the fetus and child are noted. In addition, the paper discusses the findings of longitudinal studies in which early child development is monitored concerning the presence of maternal distress in pregnancy and the postpartum period. This topic gained importance in the COVID-19 pandemic context, during which a higher frequency of maternal psychological disorders was observed. The need for further interdisciplinary research on the relationship between maternal mental health and fetal/child development was highlighted, especially on the biological mechanisms underlying the transmission of maternal distress to the (unborn) child, to achieve positive developmental outcomes and improve maternal and child well-being.

Dyadic Care Mobile Units: A Collaborative Midwifery and Pediatric Response to the COVID-19 Pandemic

Often dubbed the fourth trimester, the first 6 weeks of the postpartum period is a critical time that sets the stage for future health outcomes for both women and children. Leading maternal and child health advocates agree that intervention in the first 6 weeks of life is crucial. Although most new parents prioritize their newborn's well-care, many postpartum patients do not attend appointments for themselves, missing critical opportunities for identification and treatment of leading causes of maternal morbidity and mortality. Racial disparities in rates of postpartum complications highlight the increased importance of close postpartum follow-up for women of color. Barriers to attending routine postpartum visits were exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. Additionally, in traditional models of care, maternal-infant dyads experience fragmented care across multiple departments and patient care settings and only 1 to 2 routine visits for the postpartum patient. To address the challenges of providing in-person postpartum care during the COVID-19 pandemic in Boston, the Midwifery Service, and the Pediatrics Department of Boston Medical Center partnered to launch a mobile postpartum clinic that provided comprehensive, high-touch, dyadic care to postpartum patients and newborns in the first 6 weeks of life. Integrative mobile visits catered to the interplay of maternal and newborn health in the early postpartum period, providing an average of 3 visits to each dyad. This novel clinic concept addresses structural inequities by decreasing barriers to care and reimagines an ideal state of postpartum dyadic care with frequent visits addressing the complete needs of each postpartum patient and newborn. For more than 2 decades, maternal health advocates have been calling for change from health care birth systems to improve health care outcomes. This collaborative, interdepartmental initiative-conceived in the context of a pandemic-is an answer to that call.

Direct and indirect effects on child neurocognitive development when maternal cancer is diagnosed during pregnancy: What do we know so far?

Cancer during pregnancy threatens the lives of mother and foetus and its incidence is rising, making it an emerging medical challenge. Evidence on the direct impact of cancer therapies on neonatal outcomes resulted in general guidelines for maternal treatment that safeguards foetal development. Less focus has been placed on indirect factors, in pre- and postnatal periods, that may exert long-term impacts specifically on child neurocognition. Foetal development, in the context of maternal cancer during pregnancy, may be influenced directly by exposure to cancer diagnostics and (co-)treatment, or indirectly through maternal inflammation, malnutrition, hormonal fluctuations, prematurity, and psycho-biological stress. Maternal stress and insecure mother-infant bonding related to postpartum cancer treatment may further impact child cognitive-behavioural development. Understanding the independent and synergistic effects of the factors impacting neurocognitive development creates the opportunity to intervene during the oncological treatment to improve the child's long-term outcome, both by medical and psychosocial care and support.

Associations of Maternal Prenatal Stress and Depressive Symptoms With Childhood Neurobehavioral Outcomes in the ECHO Cohort of the NICHD Fetal Growth Studies: Fetal Growth Velocity as a Potential Mediator

OBJECTIVE

Maternal prenatal stress and mood symptoms are associated with risk for child psychopathology. Within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies (ECHO-FGS), a racially and ethnically diverse cohort, we studied associations between prenatal stress and depressive symptoms with child neurobehavior, and potential mediation by fetal growth velocity (FGV) in low-risk pregnancies.

METHOD

For 730 mother-child pairs, we had serial ultrasound measurements, self-reports of prenatal stress and depression, observations of child executive functions and motor skills from 4 to 8 years, and maternal reports of child psychiatric problems. We tested associations between prenatal stress and depressive symptoms with child neurobehavior in regression analyses, and associations with FGV in mixed effect models. Post hoc we tested severity of prenatal symptoms; FGV at 25th, 50th, and 75th percentiles; and moderation by biological sex and by race and ethnicity.

RESULTS

Prenatal stress and depressive symptoms were associated with child psychiatric problems, and prenatal depressive symptoms with decrements in executive functions and motor skills, especially in biological male children. Neither prenatal stress nor depressive symptoms were associated with FGV.

CONCLUSION

In one of the largest cohorts with observed child outcomes, and the first with broad representation of race and ethnicity in the United States, we found that prenatal stress and depressive symptoms were associated with greater reports of child psychiatric symptoms. Only prenatal depressive symptoms were associated with observed decrements in cognitive abilities, most significantly in biological male children. Stress during low-risk pregnancies may be less detrimental than theorized. There was no mediation by FGV. These findings support the need to attend to even small changes in prenatal distress, as these may have long-lasting implications.

Cell-type-specific epigenetic effects of early life stress on the brain

Early life stress (ELS) induces long-term phenotypic adaptations that contribute to increased vulnerability to a host of neuropsychiatric disorders. Epigenetic mechanisms, including DNA methylation, histone modifications and non-coding RNA, are a proposed link between environmental stressors, alterations in gene expression, and phenotypes. Epigenetic modifications play a primary role in shaping functional differences between cell types and can be modified by environmental perturbations, especially in early development. Together with contributions from genetic variation, epigenetic mechanisms orchestrate patterns of gene expression within specific cell types that contribute to phenotypic variation between individuals. To date, many studies have provided insights into epigenetic changes resulting from ELS. However, most of these studies have examined heterogenous brain tissue, despite evidence of cell-type-specific epigenetic modifications in phenotypes associated with ELS. In this review, we focus on rodent and human studies that have examined epigenetic modifications induced by ELS in select cell types isolated from the brain or associated with genes that have cell-type-restricted expression in neurons, microglia, astrocytes, and oligodendrocytes. Although significant challenges remain, future studies using these approaches can enable important mechanistic insight into the role of epigenetic variation in the effects of ELS on brain function.

Associations among stress and language and socioemotional development in a low-income sample

Stress has been linked with children's socioemotional problems and lower language scores, particularly among children raised in socioeconomically disadvantaged circumstances. Much of the work examining the relations among stress, language, and socioemotional functioning have relied on assessments of a single dimension of maternal stress. However, stress can stem from different sources, and people may appraise stressors differently. Taking a dimensional approach, this manuscript characterizes stress in multiple ways: as an overall composite; across the constructs of psychological appraisal vs. environmental stressors; and the independent contributions of a variety assessments. Data are from 548 mother-infant dyads (M = 13.14 months, SD = 2.11) who served as the control group for a poverty reduction clinical trial. Mothers completed questionnaires regarding the different types of stresses they may have experienced, as well as their children's language and socioemotional development. Results indicate that, collectively, higher maternal report of stress is associated with lower reports of children's socioemotional and language development. In addition, maternal psychological appraisals of stress were associated with both socioemotional and language development, whereas reports of environmental stressors were only associated with socioemotional development. Together, these findings suggest that maternal reports of stress are associated with lower maternal report of child development among low-income children.

Infant Developmental Outcomes: Influence of Prenatal Maternal-Fetal Attachment, Adult Attachment, Maternal Well-Being, and Perinatal Loss

Identification of prenatal characteristics that predict later infant development may afford opportunities for early intervention, potentially optimizing childhood development outcomes. The aim of the present study was to examine the effects of selected prenatal factors (maternal–fetal attachment, maternal adult attachment, maternal well-being, and previous perinatal loss) on later infant development. Pregnant women were recruited from two antenatal clinics at one tertiary hospital and asked to complete self-report questionnaires. The Bayley’s Scales of Infant and Toddler Development were then completed one to two years after their baby’s birth. Independent samples t-tests, correlational analyses, and multivariate linear regression models were conducted. Results from 40 dyads revealed that more favorable maternal–fetal attachment, more secure/less anxious maternal attachment, and higher maternal well-being predicted maternal reports of infant adaptive behavior regardless of previous perinatal loss. Infants of women without perinatal loss scored higher in external observer-rated cognitive development compared to infants of women with previous perinatal loss. While further research is required, findings indicate that a mother’s well-being and her relationship with her baby during pregnancy contributes to positive perceptions of her infant’s daily living skills. Supporting the parenting of women with perinatal loss is required to, in turn, promote optimal cognitive development in infants.

Perinatal and birth correlates of childhood irritability in Taiwan's national epidemiological study

BACKGROUND

Childhood irritability, characterized by low frustration tolerance and developmentally-inappropriate temper outbursts, is a transdiagnostic symptom in child psychiatry. Little is known regarding the influences of early experience and environmental exposure on irritability from a perinatal perspective. This study examined the associations between irritability and multiple perinatal and birth factors.

METHODS

Drawn Taiwan's National Epidemiological Study of Child Mental Disorders, 5124 children (2591 females) aged 7.7 to 14.6 years (mean 11.2 years) and their parents completed the Affective Reactivity Index, a well-established irritability measure. Parents completed a survey on parental, perinatal, and birth characteristics. Multiple linear regression models were performed to examine the associations between perinatal and birth characteristics and child irritability reported across informants.

RESULTS

Maternal smoking, vaginal bleeding, and pre-eclampsia during pregnancy and phototherapy for jaundice >3 days were associated with high irritability after adjusting for child's age, sex, and parental characteristics. Findings were consistent across parent- and child-rated irritability.

LIMITATIONS

Retrospective assessment of early exposures may be subject to recall bias despite previously-established validity and reliability. Longitudinal research with prospective assessments of early life exposures is recommended to confirm our findings. This exploratory approach of multiple survey items also precludes more in-depth assessments of perinatal risks for developing irritability.

CONCLUSIONS

This study provides novel evidence suggesting a perinatal link with irritability in a national sample of youths. Given that irritability predicts adverse mental health and life outcomes, identifying its perinatal and birth predictors may inform early etiology, guiding timely assessment and intervention.

Effects of prenatal exposures to air sulfur dioxide/nitrogen dioxide on toddler neurodevelopment and effect modification by ambient temperature

Emerging evidence suggests that prenatal exposure to ambient SO2 or NO2 induces fetal brain-damage. However, effects of prenatal exposure to SO2 or NO2 on toddler neurodevelopment and the effect-modification by ambient temperature remain unclear. Therefore, a prospective birth-cohort study was conducted from 2010 to 2012 in Shanghai, and 225 mother-child pairs were followed-up from mid-to-late pregnancy until 24-36 months postpartum. During the whole pregnancy, daily SO2/NO2 and temperature levels were obtained for each woman. Gesell-Development-Schedule was used to assess toddler neurodevelopment in the domains of gross-motor, fine-motor, adaptive-behavior, language and social-behavior. Distributed-lag-nonlinear-models simultaneously accounting for exposure-response and lag-response associations were applied to assess the impacts of prenatal SO2/NO2 exposure on neurodevelopment. Each 10-μg/m3 increase in weekly average SO2 concentrations had adverse associations with gross-motor in gestational-weeks 1-6, with adaptive-behavior in weeks 26-30, and with language in weeks 30-36 (developmental-quotient changes: - 1.17% to - 0.12%, P-values < 0.05). Each 10-μg/m3 increase in weekly average NO2 concentrations had adverse associations with gross-motor in gestational-weeks 33-36, with fine-motor in weeks 26-36 and with social-behavior in weeks 31-36 (developmental-quotient changes: - 0.91% to - 0.20%, P-values < 0.05). The cumulative effects for the whole pregnancy showed that each 10-μg/m3 increase in SO2 induced significant deficits in gross-motor and adaptive-behavior (developmental-quotient changes: - 4.71% and - 4.06%, respectively, P < 0.05). We found prenatal cumulative SO2 exposure induced more deficits in low temperature in language and adaptive-behavior than in high/moderate temperature. Thus, prenatal ambient SO2/NO2 exposure in specific time-windows (1st and 3rd trimesters for SO2; 3rd trimester for NO2) could impair toddler neurodevelopment and low temperature may aggravate the SO2-induced neurotoxicity.

Longitudinal association between maternal psychological stress during pregnancy and infant neurodevelopment: The moderating effects of responsive caregiving

BACKGROUND

Little is known regarding the role of responsive caregiving in the association between maternal psychological stress and child neurodevelopment. We, therefore, herein investigated the relationship between maternal psychological stress during pregnancy and children's neurodevelopment with modifications in responsive caregiving.

METHODS

A total of 3,603 mother-child pairs were recruited from the Shanghai Maternal-Child Pairs Cohort, and we assessed maternal psychological stress using the Life Events Scale for Pregnant Women (LESPW) during early and late pregnancy. Early neurodevelopment of infants at 6 and 12 months of age was also evaluated using the Age and Stage Questionnaire, Third Edition (ASQ-3). The 2-month-old infant nursing-care questionnaire was designed based on the Five Elements of Parenting Care Framework released by the World Health Organization (WHO) and used to evaluate the levels of early responsive caregiving for infants. Multivariate logistic regression analysis was then applied to determine the association between maternal psychological stress during pregnancy and child development.

RESULTS

The suspected developmental delay rate of infants aged 6 and 12 months ranged between 13.3% and 24.5%. After adjusting for confounders, we noted that high maternal subjective events stress during early pregnancy was associated with an increased risk of suspected developmental delay in problem-solving domains at 12 months of age [adjusted OR (aOR) = 1.51; 95% confidence interval (CI), 1.09-2.20]. High general negative objective events' stress during late pregnancy also constituted a risk factor for development in the personal-social domain at 12 months of age (aOR = 1.57; 95% CI, 1.13-2.19). Remarkably, we noted in infants with insufficient responsive caregiving that there were greater associations between the risk of general maternal negative objective events during late pregnancy and personal-social domain at 12 months of age (aOR = 2.06; 95% CI, 1.15-3.68). Similarly, there was a greater association between the risk for maternal subjective events during early pregnancy and problem-solving at 12 months of age (aOR = 1.55; 95% CI, 1.11-2.34).

CONCLUSIONS

Maternal psychological stress during pregnancy was predominantly associated with suspected developmental delay in infants at 6 and 12 months of age, and these associations were modified by early responsive caregiving.

The transdiagnostic origins of anxiety and depression during the pediatric period: Linking NIMH research domain criteria (RDoC) constructs to ecological systems

In the last decade, an abundance of research has utilized the National Institute of Mental Health (NIMH) research domain criteria (RDoC) framework to examine mechanisms underlying anxiety and depression in youth. However, relatively little work has examined how these mechanistic intrapersonal processes intersect with context during childhood and adolescence. The current paper covers reviews and meta-analyses that have linked RDoC-relevant constructs to ecological systems in internalizing problems in youth. Specifically, cognitive, biological, and affective factors within the RDoC framework were examined. Based on these reviews and some of the original empirical research they cover, we highlight the integral role of ecological factors to the RDoC framework in predicting onset and maintenance of internalizing problems in youth. Specific recommendations are provided for researchers using the RDoC framework to inform future research integrating ecological systems and development. We advocate for future research and research funding to focus on better integration of the environment and development into the RDoC framework.

Exposure and perception of PM2.5 pollution on the mental stress of pregnant women

Prenatal exposure to ambient PM_2.5 has been proved to be related to pregnant women's physical health and birth outcomes. However, the damage from air pollution on pregnant women's mental health has not been fully discussed. A case-control study was conducted to evaluate the effects of PM_2.5 exposure and risk perception on the mental stress of pregnant women. A total of 605 pregnant women, including 403 high symptoms of stress cases and 202 matched controls, were recruited from January 2018 to December 2018 in Nanjing, among which 313 high symptoms of stress cases and 144 matched controls were included in the analysis. Meaningfully high symptoms of anxiety were defined with a score of 6 points or greater on the phobic anxiety subscale of the Crown-Crisp index. We found that the PM_2.5 effect perceived by the case group was significantly higher than the control group, and the PM_2.5 exposure of the case group was also significantly higher than that of the control group. Binary logistic regression showed that for each increase in unit of PM_2.5 exposure, the risk of pregnant women suffering from high mental stress increased by 13.76% (95 %CI: 8.26-19.53%). Through path analysis modeling, we found that in the case group, perceived indoor attributions not only had a direct impact on mental stress (p < 0.001), but also played a key mediating role in the impact of average daily dose of PM_2.5 on mental stress (p < 0.001). The high level of mental stress is not only affected by objective exposure, but also by subjective perceptions in the case group. Considering the significant effect of PM_2.5 exposure on mental stress, pregnant women are recommended to spend appropriate amounts of time outdoors during clean air days. In addition, the mediating role of risk perception cannot be ignored. It is necessary to reassure pregnant women not to become overly concerned about the risk of PM_2.5 pollution and reduce their psychological burden.

Stress in pregnancy: Clinical and adaptive behavior of offspring following Superstorm Sandy

The current study investigated 304 children from a longitudinal project (the Stress in Pregnancy (SIP) Study) who were exposed and unexposed to Superstorm Sandy ("Sandy") in utero. They were prospectively followed from 2 to 6 years of age and their clinical and adaptive behaviors were assessed annually. Using a hierarchical linear model, the study found that in utero Sandy exposure was associated with greater clinical (anxiety, depression, and somatization) and lower adaptive behaviors (social skills and functional communication) at age 2 years. However, the trajectories were notably different between the two groups. Anxiety increased more rapidly among the exposed than unexposed group at ages 2-4, and depression increased only among the exposed. In contrast, social skills and functional communication were lower in exposed compared to unexposed children at age 2, but quickly increased and exceeded the capacities of unexposed children by age 3. The findings confirm that prenatal Sandy exposure is not only associated with an increase in anxiety, depression, and somatization in offspring, but also with greater adaptive skills as the children got older. Our study demonstrates that while children who have experienced stress in utero demonstrate elevated suboptimal clinical behaviors related to affective disorders, they nevertheless have the potential to learn adaptive skills.

A systematic review of the association between perinatal depression and cognitive development in infancy in low and middle-income countries

The association between perinatal depression and infant cognitive development has been well documented in research based in high-income contexts, but the literature regarding the same relationship in low and middle-income countries (LMICs) is less developed. The aim of this study is to systematically review what is known in this area in order to inform priorities for early intervention and future research in LMICs. The review protocol was pre-registered on Prospero (CRD42018108589) and relevant electronic databases were searched using a consistent set of keywords and 1473 articles were screened against the eligibility criteria. Sixteen articles were included in the review, seven focusing on the antenatal period, eight on the postnatal period, and one which included both. Five out of eight studies found a significant association between antenatal depression (d = .21-.93) and infant cognitive development, while four out of nine studies found a significant association with postnatal depression (d = .17-.47). Although the evidence suggests that LMICs should prioritise antenatal mental health care, many of the studies did not adequately isolate the effects of depression in each period. Furthermore, very few studies explored more complex interactions that may exist between perinatal depression and other relevant factors. More high-quality studies are needed in LMIC settings, driven by current theory, that test main effects and examine moderating or mediating pathways to cognitive development.

Maternal depressive symptoms and early childhood development: the role of mother-child interactions among mother-child dyads in rural areas of Central and Western China

Background

The associations among maternal depressive symptoms (MDS), mother–child interactions and early child development are poorly understood. This study aimed to explore the role of mother–child interactions on the associations between MDS and child development.

Methods

A cross-sectional study with a multistage sampling method was conducted in rural areas of Central and Western China. MDS, child development outcomes (communication, gross motor function, fine motor function, problem solving and personal social skills) and mother–child interactions were assessed by The Edinburgh Postpartum Depression Scale, the Chinese version of the Ages and Stages Questionnaires and the Multiple Indicator Cluster Surveys, respectively. Regression-based statistical mediation and moderation were conducted using the PROCESS macro for SPSS.

Results

A total of 2,548 participants (mothers: 1,274; children: 1,274) were included in our analyses. MDS was negatively associated with child development outcomes and mother–child interactions partly mediated these associations. The proportion of the mediating effect of mother–child interactions was 7.7% for communication, 8.2% for gross motor, 10.3% for fine motor, 10.1% for problem-solving and 9.5% for personal social domains. In addition, the interaction effects of MDS and mother–child interactions on the communication domain were significant (β = 0.070, 95% CI 0.016, 0.124; p = 0.011). The associations between MDS and child communication abilities were weaker at the high level (simple slope = −0.019, t =  − 0.458, p = 0.647) of mother–child interactions than at the mean level (simple slope = −0.089, t =  − 3.190, p = 0.002) and the low level (simple slope = −0.158, t =  − 4.231, p < 0.001). Similar moderating effects were not observed in the other child development outcomes.

Conclusion

Our results suggest the important role of mother–child interactions on the associations between MDS and early childhood development. Due to the cross-sectional design of this study, these associations require further investigation in prospective studies.

History of perinatal loss: A study of psychological outcomes in mothers and fathers after subsequent healthy birth

BACKGROUND

The loss of an expected child is a psychologically difficult and potentially traumatic life event. While most women will become pregnant again within a year following the loss, data are limited regarding the mental health of parents with a history of perinatal loss, especially in the period following the birth of a subsequent healthy child. This study, therefore, investigated the relation between perinatal loss and mothers' and fathers' psychological symptoms and parenting stress 6-months after the birth of a healthy child.

METHODS

A community sample of 92 mother-father dyads living in a Canadian city and having a 6-month-old biological infant were asked to complete questionnaires measuring their history of perinatal losses (55 parents reporting at least one loss) and their psychological symptoms and parenting stress.

RESULTS

Mothers and fathers who have experienced a perinatal loss reported more psychological symptoms and parenting stress. Mothers were more likely to report psychological symptoms and parenting stress compared to fathers, but the magnitude of the relation between perinatal losses and psychological outcomes were comparable for mothers and fathers.

LIMITATIONS

Limitations of the study include the use of a small community sample with low generalizability and low levels of psychological symptoms and stress.

CONCLUSIONS

The results suggest that the experience of a perinatal loss might have negative consequences on the psychological wellbeing of parents even after the birth of a healthy child.

Early Biomarkers and Intervention Programs for the Infant Exposed to Prenatal Stress

Functional development of affective and reward circuits, cognition and response inhibition later in life exhibits vulnerability periods during gestation and early childhood. Extensive evidence supports the model that exposure to stressors in the gestational period and early postnatal life increases an individual's susceptibility to future impairments of functional development. Recent versions of this model integrate epigenetic mechanisms of the developmental response. Their understanding will guide the future treatment of the associated neuropsychiatric disorders. A combination of non-invasively obtainable physiological signals and epigenetic biomarkers related to the principal systems of the stress response, the Hypothalamic-Pituitary axis (HPA) and the Autonomic Nervous System (ANS), are emerging as the key predictors of neurodevelopmental outcomes. Such electrophysiological and epigenetic biomarkers can prove to timely identify children benefiting most from early intervention programs. Such programs should ameliorate future disorders in otherwise healthy children. The recently developed Early Family-Centered Intervention Programs aim to influence the care and stimuli provided daily by the family and improving parent/child attachment, a key element for healthy socio-emotional adult life. Although frequently underestimated, such biomarker-guided early intervention strategy represents a crucial first step in the prevention of future neuropsychiatric problems and in reducing their personal and societal impact.

Exposures influencing the developing central autonomic nervous system

Autonomic nervous system function is critical for transition from in-utero to ex-utero life and is associated with neurodevelopmental and neuropsychiatric outcomes later in life. Adverse prenatal and neonatal conditions and exposures can impair or alter ANS development and, as a result, may also impact long-term neurodevelopmental outcomes. The objective of this article is to provide a broad overview of the impact of factors that are known to influence autonomic development during the fetal and early neonatal period, including maternal mood and stress during and after pregnancy, fetal growth restriction, congenital heart disease, toxic exposures, and preterm birth. We touch briefly on the typical development of the ANS, then delve into both in-utero and ex-utero maternal and fetal factors that may impact developmental trajectory of the ANS and, thus, have implications in transition and in long-term developmental outcomes. While many types of exposures and conditions have been shown to impact development of the autonomic nervous system, there is still much to be learned about the mechanisms underlying these influences. In the future, more advanced neuromonitoring tools will be required to better understand autonomic development and its influence on long-term neurodevelopmental and neuropsychological function, especially during the fetal period.

Association Between Maternal Perinatal Depression and Anxiety and Child and Adolescent Development: A Meta-analysis

IMPORTANCE

There is widespread interest in associations between maternal perinatal depression and anxiety and offspring development; however, to date, there has been no systematic, meta-analytic review on the long-term developmental outcomes spanning infancy through adolescence.

OBJECTIVE

To provide a comprehensive systematic review and meta-analysis of the extant literature on associations between maternal perinatal depression and anxiety and social-emotional, cognitive, language, motor, and adaptability outcomes in offspring during the first 18 years of life.

DATA SOURCES

Six databases were searched (CINAHL Complete, Cochrane Library, Embase, Informit, MEDLINE Complete, and PsycInfo) for all extant studies reporting associations between perinatal maternal mental health problems and offspring development to March 1, 2020.

STUDY SELECTION

Studies were included if they were published in English; had a human sample, quantitative data, a longitudinal design, and measures of perinatal depression and/or anxiety and social-emotional, cognitive, language, motor, and/or adaptability development in offspring; and investigated an association between perinatal depression or anxiety and childhood development.

DATA EXTRACTION AND SYNTHESIS

Of 27 212 articles identified, 191 were eligible for meta-analysis. Data were extracted by multiple independent observers and pooled using a fixed- or a random-effects model. A series of meta-regressions were also conducted. Data were analyzed from January 1, 2019, to March 15, 2020.

MAIN OUTCOMES AND MEASURES

Primary outcomes included social-emotional, cognitive, language, motor, and adaptability development in offspring during the first 18 years of life.

RESULTS

After screening, 191 unique studies were eligible for meta-analysis, with a combined sample of 195 751 unique mother-child dyads. Maternal perinatal depression and anxiety were associated with poorer offspring social-emotional (antenatal period, r = 0.21 [95% CI, 0.16-0.27]; postnatal period, r = 0.24 [95% CI, 0.19-0.28]), cognitive (antenatal period, r = -0.12 [95% CI, -0.19 to -0.05]; postnatal period, r = -0.25 [95% CI, -0.39 to -0.09]), language (antenatal period, r = -0.11 [95% CI, -0.20 to 0.02]; postnatal period, r = -0.22 [95% CI, -0.40 to 0.03]), motor (antenatal period, r = -0.07 [95% CI, -0.18 to 0.03]; postnatal period, r = -0.07 [95% CI, -0.16 to 0.03]), and adaptive behavior (antenatal period, r = -0.26 [95% CI, -0.39 to -0.12]) development. Findings extended beyond infancy, into childhood and adolescence. Meta-regressions confirmed the robustness of the results.

CONCLUSIONS AND RELEVANCE

Evidence suggests that perinatal depression and anxiety in mothers are adversely associated with offspring development and therefore are important targets for prevention and early intervention to support mothers transitioning into parenthood and the health and well-being of next-generation offspring.

In-utero stress and mode of conception: impact on regulation of imprinted genes, fetal development and future health

BACKGROUND

Genomic imprinting is an epigenetic gene regulatory mechanism; disruption of this process during early embryonic development can have major consequences on both fetal and placental development. The periconceptional period and intrauterine life are crucial for determining long-term susceptibility to diseases. Treatments and procedures in assisted reproductive technologies (ART) and adverse in-utero environments may modify the methylation levels of genomic imprinting regions, including insulin-like growth factor 2 (IGF2)/H19, mesoderm-specific transcript (MEST), and paternally expressed gene 10 (PEG10), affecting the development of the fetus. ART, maternal psychological stress, and gestational exposures to chemicals are common stressors suspected to alter global epigenetic patterns including imprinted genes.

OBJECTIVE AND RATIONALE

Our objective is to highlight the effect of conception mode and maternal psychological stress on fetal development. Specifically, we monitor fetal programming, regulation of imprinted genes, fetal growth, and long-term disease risk, using the imprinted genes IGF2/H19, MEST, and PEG10 as examples. The possible role of environmental chemicals in genomic imprinting is also discussed.

SEARCH METHODS

A PubMed search of articles published mostly from 2005 to 2019 was conducted using search terms IGF2/H19, MEST, PEG10, imprinted genes, DNA methylation, gene expression, and imprinting disorders (IDs). Studies focusing on maternal prenatal stress, psychological well-being, environmental chemicals, ART, and placental/fetal development were evaluated and included in this review.

OUTCOMES

IGF2/H19, MEST, and PEG10 imprinted genes have a broad developmental effect on fetal growth and birth weight variation. Their disruption is linked to pregnancy complications, metabolic disorders, cognitive impairment, and cancer. Adverse early environment has a major impact on the developing fetus, affecting mostly growth, the structure, and subsequent function of the hypothalamic-pituitary-adrenal axis and neurodevelopment. Extensive evidence suggests that the gestational environment has an impact on epigenetic patterns including imprinting, which can lead to adverse long-term outcomes in the offspring. Environmental stressors such as maternal prenatal psychological stress have been found to associate with altered DNA methylation patterns in placenta and to affect fetal development. Studies conducted during the past decades have suggested that ART pregnancies are at a higher risk for a number of complications such as birth defects and IDs. ART procedures involve multiple steps that are conducted during critical windows for imprinting establishment and maintenance, necessitating long-term evaluation of children conceived through ART. Exposure to environmental chemicals can affect placental imprinting and fetal growth both in humans and in experimental animals. Therefore, their role in imprinting should be better elucidated, considering the ubiquitous exposure to these chemicals.

WIDER IMPLICATIONS

Dysregulation of imprinted genes is a plausible mechanism linking stressors such as maternal psychological stress, conception using ART, and chemical exposures with fetal growth. It is expected that a greater understanding of the role of imprinted genes and their regulation in fetal development will provide insights for clinical prevention and management of growth and IDs. In a broader context, evidence connecting impaired imprinted gene function to common diseases such as cancer is increasing. This implies early regulation of imprinting may enable control of long-term human health, reducing the burden of disease in the population in years to come.

Postpartum maternal distress: a multidimensional illness requiring a multilevel, multidiscipline response

Australia's federal, state, territory and local governments all have responsibilities, often overlapping, for policy and delivery of primary mental health care to postpartum women. Identification and treatment of postpartum distress is carried out by a broad range of professionals from diverse disciplines. Although there is evidence to show that anxiety and stress are important aspects of postpartum distress, substantially greater emphasis has been given to identification and treatment of depression. In addition, relatively little attention has been given to incorporating positive and negative social experiences in healthcare policy and practice. This study aimed to extend the postpartum literature by: (1) comparing the levels of depression, anxiety and stress (i.e. distress indicators) in a non-clinical sample of postpartum mothers to those in the general non-clinical population; (2) comparing the prevalence of anxiety and stress to that of depression in postpartum mothers; and (3) examining the consequences of negative social exchange, alongside perceived social support, on postpartum distress indicators. A self-report survey was completed by 242 postpartum women assessing levels of perceived social support, frequency of negative social exchange and distress indicators. Postpartum mothers were found to have significantly higher depression, anxiety and stress than the general population, and had anxiety and stress levels that were similar in severity to depression. In addition, both negative social exchanges and perceived social support were found to be important for postpartum depression, anxiety and stress. These findings suggest that Australia's primary postpartum mental health care policy and practice guidelines, delivered through a broad range of professionals, may benefit from giving anxiety and stress equal weight to depression and by embracing the important effects, for good and for ill, of positive and negative social interactions.