Effects of prenatal stress on fetal and child development: A critical literature review

The role of prenatal stress and maternal trauma responses in predicting children's mental health during war

Background: The negative effects of prenatal stress on children's development and the buffering effects of maternal behaviour are well documented. However, specific maternal responses to trauma, particularly among families experiencing cumulative stressors during pregnancy and early childhood, remain less understood.Objective: This study investigated the interplay between prenatal stress in the context of the coronavirus disease 2019 (COVID-19) pandemic and consequent maternal trauma responses and children's difficulties in the context of war-related trauma.Methods: We recruited 318 pregnant women in Israel during the first wave of the COVID-19 pandemic (Time 1). Prenatal depression, anxiety, and COVID-related stress symptoms were assessed. When children were approximately 3.5 years old (SD = 0.02), the mothers were asked to report on parental responses related to the ongoing war and their child's emotional and behavioural difficulties (Time 2). Structural equation modelling was used to examine how maternal trauma responses mediate the association between prenatal stress-related mental health symptoms and children's difficulties during war.Results: Maternal prenatal depressive, anxious, and COVID-19-related stress symptoms predicted maladaptive maternal trauma responses during the war, which in turn were associated with increased emotional and behavioural problems in their children. Among the specific maternal trauma-related responses examined, cognitive avoidance and overprotectiveness were the only behavioural responses during the war significantly associated with children's difficulties.Conclusions: Our study highlights the impact of pandemic-related prenatal stress on maternal responses and children's difficulties during war, emphasizing the importance of identifying at-risk families as well as developing targeted interventions that mitigate negative parenting responses, particularly avoidance and overprotection.

Pregnancy-related anxiety modifies the effects of maternal exposure to organophosphate esters on preschoolers' behavioral development

Longitudinal associations with psychological factors modifying the effects of chemicals have not been sufficiently explored in epidemiologic studies. Our birth cohort study is the first to assess the associations between prenatal organophosphate ester (OPE) exposure and child behavior and to determine whether these associations change with pregnancy-related anxiety (PRA). Ultra-performance liquid chromatography‒tandem mass spectrometry (LC‒MS) was used to measure the tris(2-chloroethyl) phosphate (TCEP) and OPE metabolites in the 1st, 2nd and 3rd trimester urine samples. The evaluation of the behavioral development of children aged 4 years was based on the Chinese version of the Child Behavior Checklist (CBCL 1.5-5) from the main caregivers' reports. Two PRA groups (anxiety vs. nonanxiety) were identified using growth mixture models (GMMs). Generalized linear models (GLMs) and quantile-based g-computation (QGC) models were established to assess the effects of individual OPEs and a mixture of OPEs on preschoolers' behaviors stratified by PRA. Among the 1148 mother‒child pairs, GLMs revealed that, in the 1st trimester, children in the highest tertile of dibutyl phosphate (DBP) concentration presented remarkably greater behavioral problem scores than did those in the lowest tertile. First-trimester diphenyl phosphate (DPHP) was positively associated with internalizing problem scores, whereas bis(2-ethylhexyl) phosphate (BEHP) was negatively associated with behavioral problem scores. Third-trimester bis(1-chloro-2-propyl) phosphate (BCIPP) was associated with increased internalizing problem scores. Notably, positive associations between 1st trimester DBP, 2nd trimester DPHP and 3rd trimester BCIPP and behavioral problem scores were stronger among children of mothers with PRA. Using the QGC model, when the analysis was performed separately in the anxiety group, significant associations were found between the mixture of OPEs during the 3rd trimester and internalizing (β = 4.25, 95% CI: 0.24, 8.26) and total problem scores (β = 3.97, 95% CI: 0.64, 7.30). Prenatal OPE exposure may impair preschoolers' behavior, and this effect is potentially driven by PRA.

Maternal pre- and postnatal stress and maternal and infant gut microbiota features

BACKGROUND

Maternal stress can have short and long term adverse (mental) health effects for the mother and her child. Previous evidence suggests that the gut microbiota may be a potential mediator and moderator for the effects of stress via various pathways. This study explored the maternal microbiota trajectory during pregnancy as well as the association between pre- and postnatal maternal stress and features of the maternal and infant gut microbiota during and after pregnancy. In line with previous research, we hypothesized that maternal stress would be positively related to maternal and infant microbiota volatility and that infants of highly stressed mothers would show a relative increase in Proteobacteria and a relative decrease in Bifidobacterium.

METHODS

We collected maternal stool samples at 18 and 32 weeks of pregnancy and 8 months postpartum. Infant stools samples were obtained at 2, 6 and 12 weeks and 8 months postpartum. All samples were analyzed using shotgun metagenome sequencing. We also collected several measures of maternal stress (self-reported depression, anxiety, and stress, and hair cortisol and cortisone), most at the same time points as the microbiota samples.

RESULTS

Our data indicated that the maternal microbiota does not undergo drastic changes from the second to the third trimester of pregnancy but that the postpartum microbiota differs significantly from the prenatal microbiota. Furthermore, we identified associations between several stress measures and maternal and infant gut microbiota features at different time points including positive and negative associations with alpha diversity, beta diversity and individual microbial phyla and species relative abundances. Also, the maternal stress composite score, the perceived stress score and the log-ratio of hair cortisol and cortisone were all positively associated with infant microbiota volatility.

CONCLUSION

Our study provides evidence that maternal prenatal and postnatal stress is related to both the maternal and the infant microbiota. Collectively, this and previous studies indicate that maternal stress does not uniformly associate with most gut microbial features. Instead, the associations are highly time point specific. Regarding infant microbiota volatility, we have consistently found a positive association between stress and infant microbiota volatility. This warrants future research investigating this link in more depth.

Perinatal Mental Health Disorders and Resilience in Patients with Fetal Anomalies

OBJECTIVE

 Pregnant women face heightened vulnerability to mental health disorders (MHDs). There remains a lack of data during the antenatal period, particularly for high-risk subpopulations such as those with fetal anomalies. Understanding the psychological impact of women receiving a fetal anomaly diagnosis is crucial, as it can lead to MHDs. Additionally, maternal stress due to such diagnoses can have adverse effects on short- and long-term health outcomes for both the mother and the child. This study aimed to address the gap in knowledge regarding prenatal MHDs in women with fetal anomalies by characterizing maternal peripartum psychological health and identifying factors related to MHDs.

STUDY DESIGN

 Women diagnosed with fetal anomalies (N = 110) were recruited from a tertiary fetal care center and completed surveys assessing resilience, anxiety, depression, and posttraumatic stress symptoms (PTSs). Demographic characteristics were also collected and analyzed. Multiple regression analyses were conducted to explore associations between demographic variables and mental health outcomes.

RESULTS

 Participants endorsed elevated depressive symptoms (45%), anxiety (43%), and PTSs (39%). Private insurance and relationship status were positively associated, and resilience was negatively associated, with depression and anxiety levels. Maternal perception of diagnostic severity correlated with increased depressive symptoms and PTSs, whereas physician ratings of diagnostic severity did not.

CONCLUSION

 The findings underscore the prevalence of MHD among pregnant women with fetal anomalies and emphasize the importance of assessing maternal perception of severity in predicting mental health outcomes. Identifying risk factors like insurance status and relationship status suggests avenues for targeted screening and intervention. Multidisciplinary collaboration is essential for implementing effective strategies to address peripartum psychopathology related to fetal anomalies and improve overall maternal and fetal health.

KEY POINTS

· Pregnant women with fetal anomalies face poor mental health.. · Resilience is negatively related to poor mental health.. · Perception of severity impacts mental health symptoms..

Prenatal maternal stress: triangulating evidence for intrauterine exposure effects on birth and early childhood outcomes across multiple approaches

BACKGROUND

Maternal stress during pregnancy may impact offspring development via changes in the intrauterine environment. However, genetic and environmental factors shared between mothers and children might skew our understanding of this pathway. This study assesses whether prenatal maternal stress has causal links to offspring outcomes: birthweight, gestational age, or emotional and behavioral difficulties, triangulating across methods that account for various measured and unmeasured confounders.

METHODS

We used data from the Norwegian Mother, Father, and Child Cohort Study (MoBa), including maternal reports on prenatal stress at work, at home, and via stressful life events as exposures. Outcomes were children's birthweight and gestational age, from the Medical Birth Registry of Norway, and maternal reports on early offspring emotional and behavioral difficulties. We assessed associations using four approaches: sibling control analyses, gene-environment interaction analyses, intergenerational Mendelian randomization (MR), and negative control (i.e., postnatal stress) analyses.

RESULTS

Maternal prenatal stress was observationally associated with offspring lower birthweight (e.g., βwork = - 0.01 [95%CI: - 0.02, - 0.01]), earlier birth (e.g., βwork = - 0.04 [95%CI: - 0.04, - 0.03])), and more emotional (e.g., βevents = 0.08 [95%CI: 0.07, 0.09]) and behavioral difficulties (e.g., βrelationship = 0.08 [95%CI: 0.07, 0.09]) in the full sample (N = 112,784). However, sibling control analyses (N = 36,511) revealed substantial attenuation of all associations after accounting for familial factors. Gene-environment interaction models (N = 76,288) showed no clear evidence of moderation of associations by mothers' polygenic scores for traits linked to stress sensitivity. Intergenerational MR analyses (N = 29,288) showed no clear evidence of causal effects of maternal plasma cortisol on any offspring outcomes. Negative control exposure analyses revealed similar effect sizes whether exposures were measured prenatally or postnatally.

CONCLUSIONS

Our results indicate that links between prenatal maternal stress and variation in early offspring outcomes are more likely to be confounded than causal. While no observational study can rule out causality, the consistency of our findings across different approaches is striking. Other sources of prenatal stress or more extreme levels may represent intrauterine causal risk factors for offspring development. Nonetheless, our research contributes to identifying boundary conditions of the fetal programming and developmental origins of health and disease hypotheses, which may not be as universal as sometimes assumed.

[From generation to generation: mechanisms of risk transmission of parental mental illness in early childhood]

Growing up with a mentally ill parent is associated with multiple and far-reaching developmental risks for children. The intergenerational transmission of parental mental disorders is influenced by a variety of risk and protective factors as well as mediating mechanisms both on the part of the parents and children and in the social environment. The influence of parental psychopathology is particularly strong in the first years of life, but also affects development in childhood and adolescence and can have a lifelong negative impact on mental health. Due to the diverse and long-term effects on child development, the identification of transmission factors and the development of prevention and intervention strategies as early as possible are highly relevant in order to reduce the far-reaching negative consequences for the development of the offspring. Possible starting points for this include identified risk and protective factors as well as mediating mechanisms between parental psychopathology and child development. These factors and their effects on early child development are presented in this narrative review based on the current state of research. In addition, research gaps are identified and implications for the development of early interventions are discussed.

Prenatal Stress and Maternal Role in Neurodevelopment

This review summarizes recent findings on stress-related programming of brain development in utero, with an emphasis on situating findings within the mothers' broader psychosocial experiences. Meta-analyses of observational studies on prenatal stress exposure indicate the direction and size of effects on child neurodevelopment are heterogeneous across studies. Inspired by lifespan and topological frameworks of adversity, we conceptualize individual variation in mothers' lived experience during and prior to pregnancy as a key determinant of these heterogeneous effects across populations. We structure our review to discuss experiential categories that may uniquely shape the psychological and biological influence of stress on pregnant mothers and their developing children, including current socioeconomic resources, exposure to chronic and traumatic stressors, culture and historical trauma, and the contours of prenatal stress itself. We conclude by identifying next steps that hold potential to meaningfully advance the field of fetal programming.

The impact of maternal prenatal psychological distress on the development of epilepsy in offspring: The Japan Environment and Children's Study

The relationship between maternal prenatal psychological distress and epilepsy development in offspring has not yet been clarified. Herein, we used a dataset obtained from the Japan Environment and Children's Study, a nationwide birth cohort study, to evaluate the association between six-item Kessler Psychological Distress Scale (K6) scores and epilepsy among 1-3 years old. The data of 97,484 children were retrospectively analyzed. The K6 was administered to women twice: during the first half (M-T1) and second half (M-T2) of pregnancy. M-T1 ranged from 12.3-18.9 (median 15.1) weeks, and M-T2 ranged from 25.3-30.1 (median 27.4) weeks. Participants were divided into six groups based on K6 scores of two ranges (≤4 and ≥5) at M-T1 and M-T2. The numbers of children diagnosed with epilepsy at the ages of 1, 2, and 3 years were 89 (0.1%), 129 (0.2%), and 149 (0.2%), respectively. A maternal K6 score of ≥5 at both M-T1 and M-T2 was associated with epilepsy diagnosis ratios among 1-, 2-, and 3-year-old children in the univariate analysis. Moreover, multivariate analysis revealed that a maternal K6 score of ≥5 at both M-T1 and M-T2 was associated with epilepsy diagnosis ratios among 1-, 2-, and 3-year-olds. Continuous moderate-level maternal psychological distress from the first to the second half of pregnancy is associated with epilepsy among 1-, 2-, and 3-year-old children. Hence, environmental adjustments to promote relaxation such as mindfulness in pregnant women might be necessary.

Association between interpreter use and small for gestational age infants

BACKGROUND

Limited English proficiency is associated with worse health outcomes regardless of health literacy. Prior research suggests that using interpreter services for low English proficiency helps mitigate the language barrier, is associated with improved health outcomes, and patient satisfaction; however, obstetric and neonatal outcomes and pregnancy risks in this population are not well studied.

OBJECTIVES

The primary purpose of this study was to determine if low English proficiency is an independent risk factor for small for gestational age infants by utilizing interpreter use as a proxy for low English proficiency. Due to the known challenges in communication with a language barrier and discrimination against people whose first language is not English, we hypothesized that this could result in an increase in high risk conditions in pregnancy such as SGA. Our hypothesis was that the need for an interpreter would be associated with having small for gestational age infants.

STUDY DESIGN

We performed a retrospective cohort study at a single center using data between 1/1/2016 and 12/31/2021; we included singleton, live births ≥ 21 weeks gestation. We excluded multiple gestations, intrauterine fetal demise, and delivery < 21 weeks. The primary outcome was rate of small for gestational age. Small for gestational age was defined as birthweight < 10th percentile for gestational age using the 2018 Fenton newborn growth curve. Multivariable logistic regression was performed to control for confounding variables.

RESULTS

Of the 26,260 patients included in the study, 71.3% were non-Hispanic White, 9.5% were Hispanic/Latino, and 7.9% were non-Hispanic Black. Overall, 1,662 (6.3%) patients utilized an interpreter. Over half (58.0%) of patients requesting interpreter services were Hispanic. In unadjusted analyses, the rate of small for gestational age was not different between patients who used interpreter services (n=106, 6.4%) and those who did not (n=1612, 6.6 %), P=.779. After adjusting for race/ethnicity, gravidity, gestational age, private insurance, diabetes, hypertension, and prepregnancy body mass index, the use of interpreter services was associated with decreased odds of small for gestational age (aOR 0.67, 95% CI 0.53-0.84).

CONCLUSIONS

Our findings suggest that use of an interpreter is associated with a lower incidence of small for gestational age when controlling for patient characteristics and social determinants of health. Additional research is required to explore this association, but our results indicate that recognizing demographic risk factors and providing patients with social resources such as access to interpreter services may positively impact obstetric and neonatal outcomes.

Infant Temperament Is Associated With Milk Cortisol but Not With Maternal Childhood Trauma

Previous studies have suggested that maternal childhood trauma (MCT) may influence infant temperament, but the underlying physiological mechanisms remain unclear. This study sought to confirm the involvement of breast milk cortisol in the link between MCT and infant temperament. The study sample included 90 mother-infant dyads recruited from the urban Polish population. MCT was assessed based on the Early Life Stress Questionnaire (ELSQ) and infant temperamental factors (surgency/extraversion, negative affectivity, and orienting/regulation) using the Infant Behavior Questionnaire-Revised at 12 months of life. Cortisol was assayed in milk samples collected at 5 months of life using the ELISA method. Based on the ELSQ median, the sample was divided into low and high MCT groups. The ANCOVA models with milk cortisol as a covariant were run to check the effect of low versus high MCT on infant temperament. We found a positive association between milk cortisol and orienting/regulation. Surprisingly, the low and high MCT groups did not significantly differ in milk cortisol. Furthermore, we found that MCT was unrelated to any infant temperamental factor. While recent literature on the association between milk cortisol and infant temperament is inconsistent, our results suggest that high orienting/regulation might be an adaptation to adverse environments such as stress. Moreover, the infant's temperament appears to be more responsive to the current exposition to maternal stress than her experience of traumatic stress.

Thinking about the next generation: The case for a mentalization-informed approach to perinatal and intergenerational mental health

BACKGROUND

There has been substantial progress made across multiple disciplines to emphasize the importance of perinatal mental health both for parents and offspring. This focuses on what has been termed the 'First 1000 Days' from conception to the child's second birthday. We argue that our understanding of this issue can go further to create an intergenerational approach to mental health. Despite the existence of theoretical frameworks and practical approaches to implementation, there are gaps in the understanding of perinatal and intergenerational mental health including which psychological mechanisms are implicated in the transmission of risk and resilience within the perinatal period; and how to leverage these into treatment approaches.

AIMS AND METHODS

In this paper, we explore the potential for mentalization as a candidate psychological approach to intergenerational mental health.

RESULTS

We contextualize this issue in terms of the points of contact between mentalization and broader theoretical models such as the social determinants of health and the Developmental Origins of Health and Disease (DoHaD) model. Further, we provide an overview of the existing evidence base for the relevance of mentalization to perinatal mental health.

DISCUSSION

Finally, we sketch out an outline model for integrating mentalization into perinatal and intergenerational mental health, highlighting several areas of opportunity to develop research and practice from diverse geographies and demographics. Here, we suggest that integration of mentalization with other conceptual frameworks such as DoHaD can mutually enrich the understanding of each model, pointing the way towards more effective early and preventative interventions.

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

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

Does brain-derived neurotrophic factor play a role in the association between maternal prenatal mental health and neurodevelopment in 2-year-old children?

OBJECTIVE

To evaluate the role of brain-derived neurotrophic factor (BDNF)-a crucial modulator of neural development and plasticity-in the association between prenatal maternal anxiety, depression, and perceived stress and child neurodevelopment in a prospective cohort study.

METHODS

We included 526 eligible mother-child pairs from the Shanghai Birth Cohort in the study. Maternal mental health was assessed at mid-pregnancy using Zung's Self-Rating Anxiety Scale, Center for Epidemiologic Studies Depression Scale, and Perceived Stress Scale. The concentration of BDNF in cord blood was measured by ELISA. The offspring neurodevelopment at 24 months of age was assessed using the Bayley Scales. Linear and non-linear regression models were used.

RESULTS

The average cord blood BDNF levels were higher in female newborns and those born via vaginal delivery, full term, and normal birth weight. Prenatal maternal anxiety (β = -0.32; 95 % CI: -0.55, -0.09), depression (β = -0.30; 95 % CI: -0.52, -0.08), and perceived stress (β = -0.41; 95 % CI: -0.71, -0.12) scores were negatively associated with social-emotional performance at 24 months of age. However, no significant associations were found between prenatal maternal anxiety, depression, or perceived stress at mid-pregnancy and cord blood BDNF levels, as well as between cord blood BDNF levels and child neurodevelopment.

LIMITATIONS

Maternal mental health at different timepoints during pregnancy and generalizability of the results warrant further assessment.

CONCLUSIONS

Prenatal mental health was not associated with cord blood BDNF level and that BDNF may not be a mediator in the association between prenatal mental health and child neurodevelopment.

Neighborhood eviction trajectories and odds of moderate and serious psychological distress during pregnancy among African American women

African American mothers are unjustly burdened by both residential evictions and psychological distress. We quantified associations between trajectories of neighborhood evictions over time and the odds of moderate and serious psychological distress (MPD and SPD, respectively) during pregnancy among African American women. We linked publicly available data on neighborhood eviction filing and judgment rates to preconception and during-pregnancy addresses from the Life-course Influences on Fetal Environments (LIFE) Study (2009-2011; n = 808). Multinomial logistic regression-estimated odds of MPD and SPD during pregnancy that were associated with eviction filing and judgment rate trajectories incorporating preconception and during-pregnancy addresses (each categorized as low, medium, or high, with two 9-category trajectory measures). Psychological distress was measured with the Kessler Psychological Distress Scale (K6) (K6 scores 5-12 = MPD, and K6 scores ≥13 = SPD). MPD was reported in 60% of the sample and SPD in 8%. In adjusted models, higher neighborhood eviction filing and judgment rates, as compared with low/low rates, during the preconception and pregnancy periods were associated with 2- to 4-fold higher odds of both MPD and SPD during pregnancy among African American women. In future studies, researchers should identify mechanisms of these findings to inform timely community-based interventions and effective policy solutions to ensure the basic human right to housing for all. This article is part of a Special Collection on Mental Health.

Social support buffers the impact of pregnancy stress on perceptions of parent-infant closeness during the COVID-19 pandemic

Pregnant individuals and parents have experienced elevated mental health problems and stress during COVID-19. Stress during pregnancy can be harmful to the fetus and detrimental to the parent-child relationship. However, social support is known to act as a protective factor, buffering against the adverse effects of stress. The present study examined whether (1) prenatal stress during COVID-19 was associated with parent-infant closeness at 6 months postpartum, and (2) social support moderated the effect of prenatal stress on the parent-infant relationship. In total, 181 participants completed questionnaires during pregnancy and at 6 months postpartum. A hierarchical linear regression analysis was conducted to assess whether social support moderated the effect of stress during pregnancy on parent-infant closeness at 6 months postpartum. Results indicated a significant interaction between prenatal stress and social support on parents' perceptions of closeness with their infants at 6 months postpartum (β = .805, p = .029); parents who experienced high prenatal stress with high social support reported greater parent-infant closeness, compared to those who reported high levels of stress and low social support. Findings underscore the importance of social support in protecting the parent-infant relationship, particularly in times of high stress, such as during the COVID-19 pandemic.

Maternal lifetime stress and psychological functioning in pregnancy is associated with preschoolers' temperament: Exploring effect modification by race and ethnicity

BACKGROUND

Psychosocial stress and psychopathology frequently co-occur, with patterns differing by race and ethnicity. We used statistical mixtures methodology to examine associations between prenatal stress and child temperament in N = 382 racially and ethnically diverse maternal-child dyads to disentangle associations among maternal stressful life events, maternal psychological functioning in pregnancy, childhood neurobehavior, and maternal race and ethnicity.

METHODS

This study utilized data from a longitudinal pregnancy cohort, PRogramming of Intergenerational Stress Mechanisms (PRISM). Mothers completed the Lifetime Stressor Checklist-Revised, Edinburgh Postnatal Depression Scale, and Spielberger State-Trait Anxiety Scale during pregnancy. When their children were 3-5 years of age, they completed the Children's Behavior Questionnaire, which yields three temperament dimensions: Negative Affectivity (NA), Effortful Control (EC), and Surgency (S). We used weighted quantile sum regression to derive a weighted maternal stress index encompassing lifetime stress and depression and anxiety symptoms and examined associations between the resulting stress index and child temperament. Differential contributions of individual stress domains by race and ethnicity also were examined.

RESULTS

Mothers self-identified as Black/Black Hispanic (46.1 %), non-Black Hispanic (31.9 %), or non-Hispanic White (22 %). A higher maternal stress index was significantly associated with increased child NA (β = 0.72 95 % CI = 0.35, 1.10). Lifetime stress was the strongest contributor among Hispanic (36.7 %) and White (17.8 %) mothers, whereas depressive symptoms in pregnancy was the strongest contributor among Black (16.7 %) mothers.

CONCLUSION

Prenatal stress was most strongly associated with negative affectivity in early childhood. Consideration of multiple stress measures as a mixture accounted for differential contributions of individual stress domains by maternal race and ethnicity. These findings may help elucidate the etiology of racial/ethnic disparities in childhood neurobehavior.

A longitudinal study examining the associations between prenatal and postnatal maternal distress and toddler socioemotional developmental during the COVID-19 pandemic

Elevated psychological distress, experienced by pregnant women and parents, has been well-documented during the COVID-19 pandemic. Most research focuses on the first 6-months postpartum, with single or limited repeated measures of perinatal distress. The present longitudinal study examined how perinatal distress, experienced over nearly 2 years of the COVID-19 pandemic, impacted toddler socioemotional development. A sample of 304 participants participated during pregnancy, 6-weeks, 6-months, and 15-months postpartum. Mothers reported their depressive, anxiety, and stress symptoms, at each timepoint. Mother-reported toddler socioemotional functioning (using the Brief Infant-Toddler Social and Emotional Assessment) was measured at 15-months. Results of structural equation mediation models indicated that (1) higher prenatal distress was associated with elevated postpartum distress, from 6-weeks to 15-months postpartum; (2) associations between prenatal distress and toddler socioemotional problems became nonsignificant after accounting for postpartum distress; and (3) higher prenatal distress was indirectly associated with greater socioemotional problems, and specifically elevated externalizing problems, through higher maternal distress at 6 weeks and 15 months postpartum. Findings suggest that the continued experience of distress during the postpartum period plays an important role in child socioemotional development during the COVID-19 pandemic.

Infant microbes and metabolites point to childhood neurodevelopmental disorders

This study has followed a birth cohort for over 20 years to find factors associated with neurodevelopmental disorder (ND) diagnosis. Detailed, early-life longitudinal questionnaires captured infection and antibiotic events, stress, prenatal factors, family history, and more. Biomarkers including cord serum metabolome and lipidome, human leukocyte antigen (HLA) genotype, infant microbiota, and stool metabolome were assessed. Among the 16,440 Swedish children followed across time, 1,197 developed an ND. Significant associations emerged for future ND diagnosis in general and for specific ND subtypes, spanning intellectual disability, speech disorder, attention-deficit/hyperactivity disorder, and autism. This investigation revealed microbiome connections to future diagnosis as well as early emerging mood and gastrointestinal problems. The findings suggest links to immunodysregulation and metabolism, compounded by stress, early-life infection, and antibiotics. The convergence of infant biomarkers and risk factors in this prospective, longitudinal study on a large-scale population establishes a foundation for early-life prediction and intervention in neurodevelopment.

Combining the Antenatal Risk Questionnaire and the Edinburgh Postnatal Depression Scale in Early Pregnancy in Danish Antenatal Care-A Qualitative Descriptive Study

Pregnant women with a history of mental disorders, neglect, or low social support are at increased risk of mental health problems. It is crucial to identify psychosocial risk factors in early pregnancy to reduce the risk of short- and long-term health consequences for mother and child. The Antenatal Risk Questionnaire has been found acceptable as a psychosocial screening tool among pregnant women in Australia, but it has not been tested in a Scandinavian context. The aim of this study was to explore the experiences of pregnant women when using the Antenatal Risk Questionnaire and the Edinburgh Postnatal Depression Scale as part of a model to identify psychosocial vulnerabilities in pregnancy in Denmark. We conducted individual interviews (n = 18) and used thematic analysis. We identified two main themes: (1) Feeling heard and (2) An occasion for self-reflection. Overall, the pregnant women deemed the online ANRQ/EPDS acceptable as a screening tool. The screening model provided a feeling of being heard and provided an occasion for self-reflection about mental health challenges related to pregnancy and motherhood. However, some women expressed that the screening raised concerns and fear of the consequences of answering honestly. A non-judgmental, open, emphatic, and reassuring approach by clinicians may help reduce stigma.

Stress and Coping Strategies among Women in Late Motherhood

Background: The shifting reproductive age of women is reflected in European populations. Pregnancy in women older than 35 years is considered high-risk and can be an additional source of stress. The aim of this study was to assess the perceived stress of women experiencing late motherhood and the coping strategies used. Methods: The study was conducted in Poland by means of a diagnostic survey, using the COPE (Coping Orientation to Problems Experienced) Inventory, the Perceived Stress Scale (PSS), the Berlin Social Support Scales (BSSS), and a self-administered questionnaire. The study included 310 women who gave birth to their first child after the age of 35 and 313 respondents in a control group who gave birth before this age. Results: Based on the results, there were no statistically significant differences in feelings of stress among women who gave birth to their first child after the age of 35 (M = 18.33) compared to the control group (M = 18.14). However, statistically significant differences were observed regarding stress coping strategies. Conclusions: Women giving birth after the age of 35 were more likely to use strategies including active coping, planning, positive reformulation, acceptance, turning to religion, and seeking instrumental support.

The Role of Maternal Depression Symptoms and Maternal Attachment in Predicting Exclusive Breastfeeding: A Multisite Prospective Study

Background: Previous research shows that 61% of children younger than 6 months in low- and middle-income countries (LMICs) are not exclusively breastfed. Although data on the role of pre- and postnatal depression on breastfeeding exclusivity is mixed, fetomaternal attachment might foster breastfeeding exclusivity. Thus, we tested the potential mediating role of fetomaternal attachment and postnatal depression in the relationship between maternal prenatal depression and exclusive breastfeeding. Materials and Methods: Data were collected as part of a prospective, cross-cultural project, Evidence for Better Lives Study, which enrolled 1208 expectant mothers, in their third trimester of pregnancy across eight sites, from LMICs. Of the whole sample, 1185 women (mean age = 28.32, standard deviation [SD] = 5.77) completed Computer-Aided Personal Interviews on prenatal depressive symptoms, fetomaternal attachment, and socioeconomic status. A total of 1054 women provided follow-up data at 3-6 months after birth, about postnatal depressive symptoms, exclusive breastfeeding, and infant health indicators. Path analysis was used to assess parallel mediation. Results: In the whole sample, the effect of prenatal depression on breastfeeding exclusivity was completely mediated by postnatal depression, whereas fetomaternal attachment did not mediate the relationship. The full mediation effect was replicated individually in Pakistan and Sri Lanka. Conclusions: The study results indicate that prenatal depression symptoms contributed to the development of depressive symptoms after birth, negatively affecting the probability of exclusive breastfeeding. Future research should explore this in early prevention interventions, increasing the chances of healthy child development in LMICs. Considering the mixed results around the sites, it is important to better understand the relationship between maternal depression, fetomaternal attachment and breastfeeding behavior in each site's socio-cultural context.

Experience of discrimination reported during pregnancy and infant's emerging effortful control

Discrimination reported during pregnancy is associated with poorer offspring emotional outcomes. Links with effortful control have yet to be examined. This study investigated whether pregnant individuals' reports of lifetime racial/ethnic discrimination and everyday discrimination (including but not specific to race/ethnicity) reported during pregnancy were associated with offspring emerging effortful control at 6 months of age. Pregnant individuals (N = 174) and their offspring (93 female infants) participated. During pregnancy, participants completed two discrimination measures: (1) lifetime experience of racial/ethnic discrimination, and (2) everyday discrimination (not specific to race/ethnicity). Parents completed the Infant Behavior Questionnaire-Revised when infants were 6 months old to assess orienting/regulation, a measure of emerging effortful control. Analyses were conducted in a subsample with racially/ethnically marginalized participants and then everyday discrimination analyses were repeated in the full sample. For racially/ethnically marginalized participants, greater everyday discrimination (β = -.27, p = .01) but not greater lifetime experience of racial/ethnic discrimination (β = -.21, p = .06) was associated with poorer infant emerging effortful control. In the full sample, greater everyday discrimination was associated with poorer infant emerging effortful control (β = -.24, p = .002). Greater perceived stress, but not depressive symptoms, at 2 months postnatal mediated the association between everyday discrimination and emerging effortful control. Further research should examine additional biological and behavioral mechanisms by which discrimination reported during pregnancy may affect offspring emerging effortful control.

Prenatal hormone stress triggers embryonic cardiac hypertrophy outcome by ubiquitin-dependent degradation of mitochondrial mitofusin 2

Prenatal stress has been extensively documented as a contributing factor to adverse cardiac development and function in fetuses and infants. The release of glucocorticoids (GCs), identified as a significant stressor, may be a potential factor inducing cardiac hypertrophy. However, the underlying mechanism remains largely unknown. Herein, we discovered that corticosterone (CORT) overload induced cardiac hypertrophy in embryonic chicks and fetal mice in vivo, as well as enlarged cardiomyocytes in vitro. The impaired mitochondria dynamics were observed in CORT-exposed cardiomyocytes, accompanied by dysfunction in oxidative phosphorylation and ATP production. This phenomenon was found to be linked to decreased mitochondrial fusion protein mitofusin 2 (MFN2). Subsequently, we found that CORT facilitated the ubiquitin-proteasome-system-dependent degradation of MFN2 with an enhanced binding of appoptosin to MFN2, serving as the underlying cause. Collectively, our findings provide a comprehensive understanding of the mechanisms by which exposure to stress hormones induces cardiac hypertrophy in fetuses.

Stress is not so bad-cortisol level and psychological functioning after 8-week HIIT program during pregnancy: a randomized controlled trial

Background

Amid extensive pregnancy exercise research, the impact of High Intensity Interval Training (HIIT) on pregnant women's mental health is underexplored. Despite exercise benefits, it can trigger stress responses like elevated cortisol. This study fills the gap by investigating correlations between hair cortisol levels, mental health, and HIIT effects in pregnant women.

Methods

We conducted a randomized control trial among 38 Caucasian women in uncomplicated, singleton pregnancy (age 31.11 ± 4.03 years, 21.82 ± 4.30 week of gestation; mean ± SD). The experimental group comprised 22 women engaged in an 8-week high-intensity interval training program (HIIT). The comparative group consisted of 16 pregnant women undergoing an 8-week educational program (EDU). Before and after the interventions, all women were evaluated using the following tools: Hair cortisol level measurements, Beck Depression Inventory - II for depressive symptoms assessment, Childbirth Attitudes Questionnaire for childbirth fear measurement, 12-item Short Form Health Survey to gage health-related quality of life, International Physical Activity Questionnaire for physical activity level estimation, and a Progressive maximal exercise test to evaluate maternal exercise capacity.

Results

The key finding of our study reveals that women engaged in the HIIT intervention exhibited a distinct cortisol production pattern in contrast to the EDU group practicing standard moderate intensity physical activity. In the HIIT group, there was an increase in hair cortisol levels, while the EDU group showed a notable decrease. Remarkably, HIIT stimulated cortisol production without adversely impacting fear of childbirth and psychophysical condition during pregnancy. In fact, only the HIIT group showed a significant enhancement in mental health.

Conclusion

No links were discovered between hair cortisol levels and the severity of depressive symptoms, psychophysical well-being, or fear of childbirth. Hence, based on our research, employing cortisol levels during pregnancy as an indicator of negative stress or depression risk appears unwarranted.

Fetal CCL2 signaling mediates offspring social behavior and recapitulates effects of prenatal stress

Maternal stress during pregnancy is prevalent and associated with increased risk of neurodevelopmental disorders in the offspring. Maternal and offspring immune dysfunction has been implicated as a potential mechanism by which prenatal stress shapes offspring neurodevelopment; however, the impact of prenatal stress on the developing immune system has yet to be elucidated. Furthermore, there is evidence that the chemokine C-C motif chemokine ligand 2 (CCL2) plays a key role in mediating the behavioral sequelae of prenatal stress. Here, we use an established model of prenatal restraint stress in mice to investigate alterations in the fetal immune system, with a focus on CCL2. In the placenta, stress led to a reduction in CCL2 and Ccr2 expression with a concomitant decrease in leukocyte number. However, the fetal liver exhibited an inflammatory phenotype, with upregulation of Ccl2, Il6, and Lbp expression, along with an increase in pro-inflammatory Ly6CHi monocytes. Prenatal stress also disrupted chemokine signaling and increased the number of monocytes and microglia in the fetal brain. Furthermore, stress increased Il1b expression by fetal brain CD11b+ microglia and monocytes. Finally, intra-amniotic injections of recombinant mouse CCL2 partially recapitulated the social behavioral deficits in the adult offspring previously observed in the prenatal restraint stress model. Altogether, these data suggest that prenatal stress led to fetal inflammation, and that fetal CCL2 plays a role in shaping offspring social behavior.

Phenotypic Environmental Sensitivity and Mental Health During Pregnancy and Post Partum: Protocol for the Experiences of Pregnancy Longitudinal Cohort Study

BACKGROUND

Mental health problems during pregnancy and post partum are common and associated with negative short- and long-term impacts on pregnant individuals, obstetric outcomes, and child socioemotional development. Socio-environmental factors are important predictors of perinatal mental health, but the effects of the environment on mental health are heterogeneous. The differential susceptibility theory and the environmental sensitivity framework suggest that individuals differ in their degree of sensitivity to positive and negative environments, which can be captured by individual phenotypes such as temperament and personality. While there is strong evidence for these models in childhood, few studies examined them in adults, and they were not examined in pregnancy.

OBJECTIVE

The primary objective of the Experiences of Pregnancy study is to explore whether childhood and current environments are associated with mental health and well-being in pregnancy and whether these effects depend on individual sensitivity phenotypes (personality). This study also aims to gather important psychosocial and health data for potential secondary data analyses and integrative data analyses.

METHODS

We will conduct a longitudinal cohort study. The study was not registered elsewhere, other than this protocol. Participants will be recruited through social media advertisements linking to the study website, followed by an eligibility call on Zoom (Zoom Video Communications). Participants must be aged 18 years or older, currently residing in the United States as citizens or permanent residents, and currently planning to continue the pregnancy. A minimum of 512 participants will be recruited based on power analyses for the main objectives. Since the data will also be a resource for secondary analyses, up to 1000 participants will be recruited based on the available budget. Participants will be in their first trimester of pregnancy, and they will be followed at each trimester and once post partum. Data will be obtained through self-reported questionnaires assessing demographic factors; pregnancy-related factors; delivery, labor, and birth outcomes; early infant feeding; individual personality factors; childhood and current environments; mental health and well-being; attachment; and infant temperament. A series of measures were taken to safeguard the study from web robots and fraudulent participants, as well as to reduce legal and social risks for participants following Dobbs v. Jackson.

RESULTS

The study received ethics approval in April 2023 from the University of Oklahoma-Norman Campus Institutional Review Board. Recruitment occurred from May to August 2023, with 3 follow-ups occurring over 10 months.

CONCLUSIONS

The Experiences of Pregnancy study will extend theories of environmental sensitivity, mainly applied in children to the perinatal period. This will help better understand individual sensitivity factors associated with risk, resilience, plasticity, and receptivity to negative and positive environmental influences during pregnancy for pregnant individuals.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/49243.

Cumulative stress, PTSD, and emotion dysregulation during pregnancy and epigenetic age acceleration in Hispanic mothers and their newborn infants

Pregnancy can exacerbate or prompt the onset of stress-related disorders, such as post-traumatic stress disorder (PTSD). PTSD is associated with heightened stress responsivity and emotional dysregulation, as well as increased risk of chronic disorders and mortality. Further, maternal PTSD is associated with gestational epigenetic age acceleration in newborns, implicating the prenatal period as a developmental time period for the transmission of effects across generations. Here, we evaluated the associations between PTSD symptoms, maternal epigenetic age acceleration, and infant gestational epigenetic age acceleration in 89 maternal-neonatal dyads. Trauma-related experiences and PTSD symptoms in mothers were assessed during the third trimester of pregnancy. The MethylationEPIC array was used to generate DNA methylation data from maternal and neonatal saliva samples collected within 24 h of infant birth. Maternal epigenetic age acceleration was calculated using Horvath's multi-tissue clock, PhenoAge and GrimAge. Gestational epigenetic age was estimated using the Haftorn clock. Maternal cumulative past-year stress (GrimAge: p = 3.23e-04, PhenoAge: p = 9.92e-03), PTSD symptoms (GrimAge: p = 0.019), and difficulties in emotion regulation (GrimAge: p = 0.028) were associated with accelerated epigenetic age in mothers. Maternal PTSD symptoms were associated with lower gestational epigenetic age acceleration in neonates (p = 0.032). Overall, our results suggest that maternal cumulative past-year stress exposure and trauma-related symptoms may increase the risk for age-related problems in mothers and developmental problems in their newborns.

Maternal sleep disturbances during late pregnancy and child neuropsychological and behavioral development in early childhood

The present study aims to explore the association of maternal sleep disturbances during late pregnancy on child neuropsychological and behavioral development in preschool years. The study included 638 mother-child pairs from the prospective Rhea mother-child cohort in Crete, Greece. Information on antenatal sleep disturbances was collected through a computer-assisted interview. Children's neuropsychological and behavioral development was assessed using the McCarthy Scales of Children's Abilities (MSCA), the Attention-Deficit Hyperactivity Disorder Test (ADHDT), and the Strengths and Difficulties Questionnaire (SDQ). Multivariate analysis showed that maternal sleep duration less than 8 h was associated with reduced scores in the general cognitive scale (β = -2.28, 95% CI -4.54, -0.02, R2 = 0.417) and memory span (β = -3.24, 95% CI -5.72, -0.77, R2 = 0.304), while mild-severe daytime sleepiness was associated with reduced scores in the memory scale (β = -5.42, 95% CI -10.47, -0.37, R2 = 0.304), memory span (β = -5.44, 95% CI -10.68, -0.21, R2 = 0.304), nd functions of posterior cortex (β = -5.55, 95% CI -10.40, -0.70, R2 = 0.393) of MSCA. Snoring in late pregnancy was related to higher child hyperactivity scores in SDQ (β = 1.05, 95% CI 0.16, 1.95, R2 = 0.160). An interaction between child sex and maternal sleep duration in response to ADHD symptoms was also found (p for interaction < 0.05). Stratified analysis revealed increased hyperactivity, inattention, and ADHD total scores for girls of mothers with sleep duration less than 8 h. Maternal sleep disturbances during pregnancy may be associated with impaired child neuropsychological and behavioral development during the preschool years. Early detection and intervention is necessary to reduce sleep disturbances habits in pregnancy and improve child neurodevelopment.

Associations between maternal stress and infant resting brain activity among families residing in poverty in the U.S

Growing evidence suggests that maternal experiences of stress shape children's functional brain activity in the first years of life. Individuals living in poverty are more likely to experience stress from a variety of sources. However, it is unclear how stress is related to resting brain activity among children born into poverty. The present study examines whether infants born into households experiencing poverty show differences in brain activity associated with maternal reports of experiencing stress. The analytic sample comprised 247 mother-infant dyads who completed maternal questionnaires characterizing stress, and for whom recordings of infant resting brain activity were obtained at 1 year of age (M=12.93 months, SD=1.66; 50% female). Mothers (40% Black, non-Hispanic, 40% Hispanic, 12% White, non-Hispanic) who reported higher stress had infants who showed more resting brain activity in the lower end of the frequency spectrum (relative theta power) and less resting brain activity in the middle range of the frequency spectrum (relative alpha power). While statistically detectable at the whole-brain level, follow-up exploratory analyses revealed that these effects were most apparent in electrodes over frontal and parietal regions of the brain. These findings held after adjusting for a variety of potentially confounding variables. Altogether, the present study suggests that, among families experiencing low economic resources, maternal reports of stress are associated with differences in patterns of infant resting brain activity during the first year of life.

Intergenerational transmission of stress: Multi-domain stressors from maternal childhood and pregnancy predict children's mental health in a racially and socioeconomically diverse, multi-site cohort

PURPOSE

Despite growing recognition that unfortunately common maternal stress exposures in childhood and pregnancy may have intergenerational impacts on children's psychiatric health, studies rarely take a life course approach. With child psychopathology on the rise, the identification of modifiable risk factors is needed to promote maternal and child well-being. In this study, we examined associations of maternal exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE) with child mental health problems in a large, sociodemographically diverse sample.

METHODS

Participants were mother-child dyads in the ECHO-PATHWAYS consortium's harmonized data across three U.S. pregnancy cohorts. Women completed questionnaires regarding their own exposure to CTE and PSLE, and their 4-6-year-old child's mental health problems using the Child Behavior Checklist (CBCL). Regression analyses estimated associations between stressors and child total behavior problems, adjusting for confounders.

RESULTS

Among 1948 dyads (child age M = 5.13 (SD = 1.02) years; 38% Black, 44% White; 8.5% Hispanic), maternal history of CTE and PSLE were independently associated with children's psychopathology: higher CTE and PSLE counts were related to higher total problems ([ßCTE = 0.11, 95% CI [.06, .16]; ßSLE = 0.21, 95% CI [.14, 0.27]) and greater odds of clinical levels of problems (ORCTE = 1.41; 95% CI [1.12, 1.78]; ORPSLE = 1.36; 95% CI [1.23, 1.51]). Tests of interaction showed PSLEs were more strongly associated with child problems for each additional CTE experienced.

CONCLUSION

Findings confirm that maternal exposure to CTE and PSLE are independently associated with child mental health, and history of CTE exacerbates the risk associated with PSLE, highlighting intergenerational risk pathways for early psychopathology. Given the prevalence of these exposures, prevention and intervention programs that reduce childhood trauma and stress during pregnancy will likely positively impact women's and their children's health.

What risk factors for Developmental Language Disorder can tell us about the neurobiological mechanisms of language development

Language is a complex multidimensional cognitive system that is connected to many neurocognitive capacities. The development of language is therefore strongly intertwined with the development of these capacities and their neurobiological substrates. Consequently, language problems, for example those of children with Developmental Language Disorder (DLD), are explained by a variety of etiological pathways and each of these pathways will be associated with specific risk factors. In this review, we attempt to link previously described factors that may interfere with language development to putative underlying neurobiological mechanisms of language development, hoping to uncover openings for future therapeutical approaches or interventions that can help children to optimally develop their language skills.

Genome-wide neonatal epigenetic changes associated with maternal exposure to the COVID-19 pandemic

BACKGROUND

During gestation, stressors to the fetus, including viral exposure or maternal psychological distress, can fundamentally alter the neonatal epigenome, and may be associated with long-term impaired developmental outcomes. The impact of in utero exposure to the COVID-19 pandemic on the newborn epigenome has yet to be described.

METHODS

This study aimed to determine whether there are unique epigenetic signatures in newborns who experienced otherwise healthy pregnancies that occurred during the COVID-19 pandemic (Project RESCUE). The pre-pandemic control and pandemic cohorts (Project RESCUE) included in this study are part of a prospective observational and longitudinal cohort study that evaluates the impact of elevated prenatal maternal stress during the COVID-19 pandemic on early childhood neurodevelopment. Using buccal swabs collected at birth, differential DNA methylation analysis was performed using the Infinium MethylationEPIC arrays and linear regression analysis. Pathway analysis and gene ontology enrichment were performed on resultant gene lists.

RESULTS

Widespread differential methylation was found between neonates exposed in utero to the pandemic and pre-pandemic neonates. In contrast, there were no apparent epigenetic differences associated with maternal COVID-19 infection during pregnancy. Differential methylation was observed among genomic sites that underpin important neurological pathways that have been previously reported in the literature to be differentially methylated because of prenatal stress, such as NR3C1.

CONCLUSIONS

The present study reveals potential associations between exposure to the COVID-19 pandemic during pregnancy and subsequent changes in the newborn epigenome. While this finding warrants further investigation, it is a point that should be considered in any study assessing newborn DNA methylation studies obtained during this period, even in otherwise healthy pregnancies.

Maternal Perinatal Stress Trajectories and Negative Affect and Amygdala Development in Offspring

OBJECTIVE

Maternal psychological stress during pregnancy is a common risk factor for psychiatric disorders in offspring, but little is known about how heterogeneity of stress trajectories during pregnancy affect brain systems and behavioral phenotypes in infancy. This study was designed to address this gap in knowledge.

METHODS

Maternal anxiety, stress, and depression were assessed at multiple time points during pregnancy in two independent low-risk mother-infant cohorts (N=115 and N=2,156). Trajectories in maternal stress levels in relation to infant negative affect were examined in both cohorts. Neonatal amygdala resting-state functional connectivity MRI was examined in a subset of one cohort (N=60) to explore the potential relationship between maternal stress trajectories and brain systems in infants relevant to negative affect.

RESULTS

Four distinct trajectory clusters, characterized by changing patterns of stress over time, and two magnitude clusters, characterized by severity of stress, were identified in the original mother-infant cohort (N=115). The magnitude clusters were not associated with infant outcomes. The trajectory characterized by increasing stress in late pregnancy was associated with blunted development of infant negative affect. This relationship was replicated in the second, larger cohort (N=2,156). In addition, the trajectories that included increasing or peak maternal stress in late pregnancy were related to stronger neonatal amygdala functional connectivity to the anterior insula and the ventromedial prefrontal cortex in the exploratory analysis.

CONCLUSIONS

The trajectory of maternal stress appears to be important for offspring brain and behavioral development. Understanding heterogeneity in trajectories of maternal stress and their influence on infant brain and behavioral development is critical to developing targeted interventions.

Associations among maternal lifetime trauma, psychological symptoms in pregnancy, and infant stress reactivity and regulation

Maternal trauma has intergenerational implications, including worse birth outcomes, altered brain morphology, and poorer mental health. Research investigating intergenerational effects of maternal trauma on infant stress reactivity and regulation is limited. Maternal mental health during pregnancy may be a contributor: psychopathology is a sequela of trauma exposure and predictor of altered self-regulatory capacity in offspring of affected mothers. We assessed associations among maternal lifetime trauma and infant stress responsivity, mediated by psychological symptoms in pregnancy. Mothers reported lifetime trauma history and anxiety, depressive, and posttraumatic stress symptoms during pregnancy. At infant age 6 months, stress reactivity and regulation were assessed via maternal behavior ratings (Infant Behavior Questionnaire-Revised, IBQ-R) and behavioral (negative mood) and physiological (respiratory sinus arrhythmia, RSA) markers during a laboratory stressor (Still-Face Paradigm). Maternal trauma was directly associated with lower infant physiological regulation and indirectly associated with lower levels of both infant behavioral and physiological regulation via higher maternal anxiety during pregnancy. Maternal trauma was also indirectly associated with higher infant reactivity via higher maternal anxiety during pregnancy. Post hoc analyses indicated differential contributions of maternal prenatal versus postnatal anxiety to infant outcomes. Findings highlight potential contributory mechanisms toward maladaptive child stress response, which has been associated with poor behavioral, cognitive, and academic outcomes.

Rates of Preterm Birth and Low Birth Weight in an Adolescent Obstetric Clinic: Achieving Health Equity Through Trauma-Informed Care

Objectives

Adolescents who are pregnant and identify as Black are exposed to more societal harms that increase their and their offspring's risk for poor health outcomes. The Colorado Adolescent Maternity Program (CAMP) offers comprehensive, multidisciplinary (medical, behavioral health, nutrition, case management), trauma-informed obstetric care to pregnant adolescents to ensure the healthiest pregnancy and birth possible and pursue health equity. The present study aimed to examine ethnic and racial disparities in preterm birth and low birth weight before and after implementation of a trauma-informed model of care.

Methods

Participants were 847 pregnant adolescents (ages 12-22 years; 41% self-identified as Hispanic, 32% as non-Hispanic Black, 21% as non-Hispanic white) who received prenatal treatment-as-usual (TAU) or trauma-informed treatment. Demographic information, mental health symptoms, and birth outcomes were abstracted from medical records.

Results

Overall, findings provided support that implementation of a trauma-informed model of prenatal care led to equitable birth outcomes across racial and ethnic groups. Specifically, Black adolescents in the TAU group were more than twice as likely to deliver preterm or low birth weight infants compared with white and Hispanic adolescents. In the trauma-informed group, however, there were no statistical differences in birth outcomes across racial/ethnic groups, indicating an elimination of disparities in both preterm birth and low birth weight in this population. These more equitable birth outcomes occurred even in the context of adolescents of color having reported more severe depression symptoms postimplementation.

Conclusions

These findings provide evidence that a health system-level intervention, herein trauma-informed obstetric care for adolescents, can play a meaningful role in the reduction of racial disparities in birth outcomes.

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.

Prenatal stress and child externalizing behavior: effects of maternal perceived stress and cortisol are moderated by child sex

BACKGROUND

Externalizing behavior problems are related to social maladjustment. Evidence indicates associations between prenatal stress and child behavioral outcomes. It remains unclear how psychological distress vs. biological correlates of stress (cortisol) differentially predict externalizing behavior, and how their effects might differ as a function of child sex.

METHOD

108 pregnant women from the community collected salivary cortisol and reported their perceived stress during each trimester of pregnancy. At child age 9 years (M = 9.01, SD = 0.55), 70 mothers and children reported on child behavior. Structural equation modelling was used to analyze how cortisol levels and perceived stress during pregnancy predicted current child externalizing behavior, considering the moderating effect of child sex.

RESULTS

Perceived stress predicted higher externalizing behavior in boys (β = 0.42, p = 0.009) and lower externalizing behavior in girls (β = - 0.56, p = 0.014). Cortisol predicted lower externalizing behavior in boys (β = - 0.81, p < .001) and was not related to girls' externalizing behavior (β = 0.37, p = 0.200).

DISCUSSION/CONCLUSION

Prenatal stress affected externalizing behavior differently in girls vs. boys. These response patters in turn differed for indicators of psychological vs. biological maternal stress, encouraging an integrated approach. Findings indicate that perceived stress and cortisol may affect child development via different trajectories.

The role of prenatal violence exposure in the development of disparities in children's adiposity from birth to middle childhood

OBJECTIVE

This study examined whether women's exposure to multiple types of violence during childhood and pregnancy was associated with children's BMI trajectories and whether parenting quality moderated those associations.

METHODS

A cohort of 1288 women who gave birth between 2006 and 2011 self-reported their exposure to childhood traumatic events, intimate partner violence (IPV), and residential address (linked to geocoded index of violent crime) during pregnancy. Children's length/height and weight at birth and at age 1, 2, 3, 4 to 6, and 8 years were converted to BMI z scores. Observed mother-child interactions were behaviorally coded during a dyadic teaching task.

RESULTS

Covariate-adjusted growth mixture models identified three trajectories of children's BMI from birth to 8 years old: Low-Stable (17%), Moderate-Stable (59%), and High-Rising (22%). Children whose mothers experienced more types of IPV during pregnancy were more likely to be in the High-Rising than the Low-Stable (odds ratio [OR] = 2.62; 95% CI: 1.27-5.41) trajectory. Children whose mothers lived in higher crime neighborhoods were more likely to be in the High-Rising than the Low-Stable (OR = 1.11; 95% CI:1.03-1.17) or Moderate-Stable trajectories (OR = 1.08; CI: 1.03-1.13). Main effects of childhood traumatic events and moderation by parenting were not detected.

CONCLUSIONS

Maternal experiences of violence during pregnancy increase children's risk for developing overweight, highlighting intergenerational transmission of social adversity in children's health.

Maternal-infant bonding and partner support during pregnancy and postpartum: Associations with early child social-emotional development

The first 1000 days after conception are considered critical for healthy development and well-being throughout life. Fundamental to health practices during pregnancy and positive parenting after birth is the development of maternal-infant bonding. Previous research has demonstrated the importance of having an involved partner during pregnancy and in parenting for optimal maternal-infant bonding. The current study examined maternal-infant bonding and partner support during pregnancy and the postpartum period, and their associations with early child social-emotional development. A total of 227 women completed the Pre- and Postnatal Bonding Scale (PPBS) and Tilburg Pregnancy Distress Scale (TPDS) during pregnancy (32 weeks of gestation) and at 8 months postpartum, assessing maternal-infant bonding and partner support. Additionally, a questionnaire on social-emotional behavior of the Bayley Scales of Infant and Toddler Development was administered to mothers to measure child development at 2 years of age. Path analyses revealed an indirect positive effect of prenatal maternal-infant bonding on child social-emotional development through postnatal maternal-infant bonding, as well as mediating effects of pre- and postnatal maternal-infant bonding on the association between pre- and postnatal partner support and child social-emotional development. Our findings support the notion that an emotional connection from mother to child originates in pregnancy and that experiencing positive feelings towards the fetus promotes positive maternal-infant bonding after birth and social-emotional capacities of the child. Additionally, having a supportive partner during pregnancy and postpartum, might be essential for the development of optimal maternal-infant bonding.

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.

Intergenerational risk and resilience pathways from discrimination and acculturative stress to infant mental health

Preconception and prenatal stress impact fetal and infant development, and women of color are disproportionately exposed to sociocultural stressors like discrimination and acculturative stress. However, few studies examine links between mothers' exposure to these stressors and offspring mental health, or possible mitigating factors. Using linear regression, we tested associations between prenatally assessed maternal acculturative stress and discrimination on infant negative emotionality among 113 Latinx/Hispanic, Asian American, Black, and Multiethnic mothers and their children. Additionally, we tested interactions between stressors and potential pre- and postnatal resilience-promoting factors: community cohesion, social support, communalism, and parenting self-efficacy. Discrimination and acculturative stress were related to more infant negative emotionality at approximately 12 months old (M = 12.6, SD = .75). In contrast, maternal report of parenting self-efficacy when infants were 6 months old was related to lower levels of infant negative emotionality. Further, higher levels of parenting self-efficacy mitigated the relation between acculturative stress and negative emotionality. Preconception and prenatal exposure to sociocultural stress may be a risk factor for poor offspring mental health. Maternal and child health researchers, policymakers, and practitioners should prioritize further understanding these relations, reducing exposure to sociocultural stressors, and promoting resilience.

The impact of the war in Ukraine on the perinatal period: Perinatal mental health for refugee women (pmh-rw) protocol

Background

The aim of the Perinatal Mental Health for Refugee Women (PMH-RW) Project is to investigate the impact of the war on perinatal mental health: anxiety, post-traumatic stress, depression, and birth trauma symptoms. It will also evaluate the factors that serve as protective elements for the development of these potential diagnoses (such as personality traits, social support, sociodemographic characteristics, and access to medical/mental health services).

Method

An international observational cohort study with baseline data is being assessed in Ukraine (for internal refugees) and several European Countries (for external refugees). The study includes as participants both pregnant women and those who have recently given birth (with babies up to 1 year old). The assessment includes measures on depression (EPDS), anxiety (GAD-7), experiences during birth (City Birth Questionnaire), post-traumatic stress symptoms [Impact of events scale—revised (PTSD-R)], Personality (10-Item Personality Inventory-TIPI), and a questionnaire for socio-demographic data which also such social support.

Conclusion

This study will provide needed information for determining the impact of the Ukrainian Crisis on perinatal mental health by studying potential risk and protective factors. The data collected will be used to inform policymakers with useful information that can be used in the development of plans to protect and promote the mental health of the perinatal refugees impacted by this event. Also, it is our hope that data collected from this study will serve to plant the seeds for further research regarding the impact of the crisis in Ukraine on the offspring and to analyze how these events are affecting further generations.

Clinical Trial Registration

ClinicalTrials.gov, Identifier: NCT05654987.

Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action

Breast cancer is currently the most common cancer among women worldwide; in 15-25% of cases, patients are premenopausal at the time of diagnosis, and 50% of women desire pregnancy after cancer diagnosis. Motherhood after breast cancer involves complex psychological challenges with long-term consequences, though it is safely pursuable with adequate support. The purpose of this mini-review is to analyze the psychological implications surrounding pregnancy and motherhood after breast cancer and promote action in addressing the challenges that might affect women facing these life events.

The association between history of prenatal loss and maternal psychological state in a subsequent pregnancy: an ecological momentary assessment (EMA) study

BACKGROUND

Prenatal loss which occurs in approximately 20% of pregnancies represents a well-established risk factor for anxiety and affective disorders. In the current study, we examined whether a history of prenatal loss is associated with a subsequent pregnancy with maternal psychological state using ecological momentary assessment (EMA)-based measures of pregnancy-specific distress and mood in everyday life.

METHOD

This study was conducted in a cohort of N = 155 healthy pregnant women, of which N = 40 had a history of prenatal loss. An EMA protocol was used in early and late pregnancy to collect repeated measures of maternal stress and mood, on average eight times per day over a consecutive 4-day period. The association between a history of prenatal loss and psychological state was estimated using linear mixed models.

RESULTS

Compared to women who had not experienced a prior prenatal loss, women with a history of prenatal loss reported higher levels of pregnancy-specific distress in early as well as late pregnancy and also were more nervous and tired. Furthermore, in the comparison group pregnancy-specific distress decreased and mood improved from early to late pregnancy, whereas these changes across pregnancy were not evident in women in the prenatal loss group.

CONCLUSION

Our findings suggest that prenatal loss in a prior pregnancy is associated with a subsequent pregnancy with significantly higher stress and impaired mood levels in everyday life across gestation. These findings have important implications for designing EMA-based ambulatory, personalized interventions to reduce stress during pregnancy in this high-risk group.

Capturing the lived experiences of women with lymphoma in pregnancy: a qualitative study

Lymphoma in pregnancy is a rare and challenging diagnosis that complicates ∼1:6000 pregnancies; posing a series of unique therapeutic, social, and ethical challenges to the patient, her family, and the medical professionals involved. These difficulties are compounded by the paucity of real-world data on the management of LIP, and a lack of relevant support systems for women in this setting. We conducted a retrospective multicenter qualitative study, interviewing women aged ≥18 years of age diagnosed with Hodgkin (HL) or non-Hodgkin lymphoma (NHL) during pregnancy or within 12 months postpartum, between 1 January 2009 and 31 December 2020 from 13 Australasian sites. Semi-structured telephone interviews were conducted, recorded, and analyzed using QSR Int NVivo 12 Pro (March 2020, USA) to quantify salient themes. Of the 32 women interviewed, 20 (63%) were diagnosed during pregnancy (16, 34, and 13% in the 1st, 2nd, and 3rd trimesters, respectively), while 12 (37%) were diagnosed post-partum. Women recalled that their chief concerns at diagnosis were the welfare of their child (n = 13, 41%) and a fear of dying (n = 9, 28%). Perceived diagnostic delay attributed to pregnancy was reported by 41% of participants. Other key themes were communication, educational materials, psychosocial supports, and oncofertility issues. To our knowledge this is the first report capturing the lived experiences of survivors of lymphoma during pregnancy, affording a unique opportunity to consider the management, psychosocial supports, and delivery of care to meet the needs of these women.What is the NEW aspect of your work? To our knowledge, this is the first report capturing and analyzing the healthcare experiences of survivors of Lymphoma in Pregnancy (LIP).What is the CENTRAL finding of your work? Women valued clear and empathic communication, provision of tailored educational materials, access to psychosocial supports (particularly childcare and financial supports), and timely oncofertility management in their healthcare journey.What is (or could be) the SPECIFIC clinical relevance of your work? Women's personal accounts of positive and negative experiences of LIP care provide insights into their specific concerns and needs which can shape healthcare policy and development of a specific framework for managing and supporting patients with LIP (and other cancers).

A matter of habit? Stressful life events and cognitive flexibility in 15-month-olds

Exposure to chronic stress is associated with habitual learning in adults. We studied the origins of this association by examining the link between stressful life events and infant cognitive flexibility. The final sample consisted of N = 72 fifteen-month-old infants and their mothers. Mothers completed a survey on pre- and postnatal negative life events. To assess chronic stress physiologically, infant and maternal hair cortisol concentrations were determined for cortisol accumulation during the past 3 months. Each infant participated in two cognitive tasks in the laboratory. An instrumental learning task tested infants' ability to disengage from a habituated action when this action became ineffective (Seehagen et al., 2015). An age-adequate version of the A-not-B task tested infants' ability to find a toy at location B after repeatedly finding it at location A. Correlations between cortisol concentrations and postnatal negative life events (number, perceived impact) did not yield significance. Infant and maternal hair cortisol concentrations were not correlated. Infants' ability to shift to a new action in either task, controlled for acute stress, correlated neither with pre- and postnatal negative life events nor with cortisol concentrations. Taken together, these results indicate that the potential link between long-term stress exposure and cognitive flexibility might not be present in samples with low levels of psychosocial stress.

The impact of maternal depression, anxiety, and stress on early neurodevelopment in boys and girls

OBJECTIVE

To examine the effects of prenatal maternal depression, anxiety and stress, and postnatal depression on infant early neurodevelopment, and the sex dimorphism.

STUDY DESIGN

We used data from 3379 mother-infant pairs from the Shanghai Birth Cohort. Maternal mental health was assessed using the Center for Epidemiological Studies-Depression Scale, Zung Self-Rating Anxiety Scale, Perceived Stress Scale at mid-pregnancy, and the Edinburgh Postnatal Depression Scale at postpartum. Infant neurodevelopment was evaluated using the Ages & Stages Questionnaires and Bayley Scales at ages 6, 12, and 24 months, respectively. Linear mixed models and linear regression models were used.

RESULTS

Among 3379 mothers, 11.07 %, 5.42 %, and 34.85 % of women experienced depression, anxiety, and elevated stress, separately. As maternal prenatal mental scores increased per 1SD, infant social-emotional scores decreased -2.82 (-3.86, -1.79) vs -2.86 (-3.94, -1.79) for depression, -2.34 (-3.38, -1.31) vs -2.72 (-3.81, -1.64) for anxiety, and -2.55 (-3.60, -1.50) vs -3.41 (-4.48, -2.35) for stress among boys and girls at age 24 months, respectively. Associations were also observed on social-emotional and communication scores in boys and girls, and fine motor in girls at age 6 and 12 months. These associations were not observed for postpartum depression.

LIMITATION

Generalizability of the results to other population remains to be determined.

CONCLUSIONS

Prenatal maternal depression, anxiety, and stress were negatively associated with infant early neurodevelopment, which were not observed for postpartum depression. We underscore the importance of maternal prenatal mental health in optimizing infant neuropsychiatric development.

Preconception stress exposure from childhood to adolescence and birth outcomes: The impact of stress type, severity and consistency

The negative effects of prenatal stress on offspring health are well established, but there remains little understanding of the influence of stress prior to conception despite known effects on biological systems that are important for a healthy pregnancy. Furthermore, operational definitions of stress vary considerably, and exposure is often characterized via summed, ordinal scales of events. We hypothesized that type, severity, and consistency of preconception stress would be associated with birthweight and gestational age (GA) at birth. Data were drawn from a subsample of participants in the 21-year longitudinal Pittsburgh Girls Study (PGS, N = 2,450) that has followed women annually since childhood. Prior work in the PGS derived three domains of stress exposure between ages 7-17 years related to subsistence (e.g., resource strain, overcrowding), safety (e.g., community violence, inter-adult aggression), and caregiving (e.g., separation, maternal depression). We tested the effects of dimensions of preconception stress on birthweight and GA among offspring of 490 PGS participants who delivered at age 18 or older (n = 490; 76% Black, 20% White, 4% Multiracial). Our hypotheses were partially supported with results varying by stress type and severity and by infant sex. Severity of preconception exposure to subsistence stress was prospectively associated with lower offspring birthweight (B = -146.94, SE = 69.07, 95% CI = -282.66, -11.22). The association between severity of caregiving stress in childhood and adolescence and GA at birth was moderated by infant sex (B = 0.85, SE = .41, 95% CI = 0.04, 1.66), suggesting greater vulnerability to this type of stress for male compared to female infants. Exposure to safety stressors did not predict birth outcomes. Infants of Black compared with White mothers had lower birthweight in all models regardless of preconception stress type, severity or consistency. However, we observed no moderating effects of race on preconception stress-birth outcome associations. Demonstrating specificity of associations between preconception stress exposure and prenatal health has the potential to inform preventive interventions targeting profiles of exposure to optimize birth outcomes.

The Role of Prenatal Psychosocial Stress in the Associations of a Proinflammatory Diet in Pregnancy With Child Adiposity and Growth Trajectories

Importance

Prenatal psychosocial stress and nutrition may each program offspring adiposity, an important predictor of lifelong cardiometabolic health. Although increased stress and poor nutrition have been found to co-occur in pregnancy, little is known about their combined longitudinal associations in the offspring.

Objective

To investigate whether the associations of the Dietary Inflammatory Index (DII) with offspring adiposity differ by prenatal stress levels and whether these associations change with age.

Design, Setting, and Participants

Project Viva, a prospective prebirth cohort study of mother-child dyads in Massachusetts, included singleton children of mothers enrolled between April 1999 and July 2002, with follow-up visits at early childhood, midchildhood, and early adolescence. Data analysis was performed from October 31, 2020, to October 31, 2022.

Exposures

Food frequency-derived DII score in pregnancy was the exposure. Effect modifiers included stress-related measures in pregnancy; depressive symptoms assessed using the Edinburgh Postnatal Depression Scale (EPDS), dichotomized at scores greater than or equal to 13 vs less than 13; and census tract-level social vulnerability (overall Social Vulnerability Index and its 4 main subindices), dichotomized at the 75th percentile.

Main Outcomes and Measures

Overall adiposity, comprising sex- and age-standardized body mass index (BMI z), sum of subscapular and triceps skinfolds, fat mass index (FMI), and body fat percentage estimated using bioelectrical impedance analysis (BIA) and dual x-ray absorptiometry (DXA); and central adiposity, comprising waist circumference, ratio of subscapular to triceps skinfolds, and DXA-derived trunk FMI.

Results

Among 1060 mother-child dyads, mean (SD) maternal age was 32.6 (4.6) years, and 811 (77%) mothers were non-Hispanic White. Mean (SD) DII score was -2.7 (1.3) units, Social Vulnerability Index level was 38th (27th) percentile, and 8% of mothers had depressive symptoms. Mean (SD) age of the children was 3.3 (0.3) years at the early childhood visit, 7.9 (0.8) years at the midchildhood visit, and 13.2 (0.9) years at the early adolescence visit. In adjusted analyses, children born to mothers in the highest (vs lowest) quartile of DII had slower decrease in BMI z scores (β, 0.03 SD units/y; 95% CI, 0.01-0.05 SD units/y), and faster adiposity gain (eg, BIA total FMI β, 0.11 kg/m2/y; 95% CI, 0.03-0.19 kg/m2/y) over time. Associations of prenatal DII quartiles with childhood adiposity were stronger (eg, BIA total FMI quartile 4 vs quartile 1 change in β, 1.40 kg/m2; 95% CI, 0.21-2.59 kg/m2) among children of mothers with high vs low EPDS scores in pregnancy, although EPDS scores did not modify the change over time. Associations of prenatal DII with adiposity change over time, however, were greater among children whose mothers lived in neighborhoods with a high (BIA percentage body fat: β, 0.55% per year; 95% CI, 0.04%-1.07% per year) vs low (β, 0.13% per year; 95% CI, -0.20 to 0.46% per year), percentage of racial and ethnic minorities, and residents with limited English-language proficiency.

Conclusions and Relevance

The findings of this cohort study suggest that it may be useful to simultaneously evaluate prenatal diet and psychosocial stress in women as targets for interventions intended to prevent excess childhood adiposity.