Positive maternal mental health during pregnancy associated with specific forms of adaptive development in early childhood: Evidence from a longitudinal study

Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation

PURPOSE OF REVIEW

Perinatal mental health research provides an important perspective on neurobehavioral development. Here, we aim to review the association of maternal perinatal health with offspring neurodevelopment, providing an update on (self-)regulation problems, hypothesized mechanistic pathways, progress and challenges, and implications for mental health.

RECENT FINDINGS

(1) Meta-analyses confirm that maternal perinatal mental distress is associated with (self-)regulation problems which constitute cognitive, behavioral, and affective social-emotional problems, while exposure to positive parental mental health has a positive impact. However, effect sizes are small. (2) Hypothesized mechanistic pathways underlying this association are complex. Interactive and compensatory mechanisms across developmental time are neglected topics. (3) Progress has been made in multiexposure studies. However, challenges remain and these are shared by clinical, translational and public health sciences. (4) From a mental healthcare perspective, a multidisciplinary and system level approach employing developmentally-sensitive measures and timely treatment of (self-)regulation and coregulation problems in a dyadic caregiver-child and family level approach seems needed. The existing evidence-base is sparse.

SUMMARY

During the perinatal period, addressing vulnerable contexts and building resilient systems may promote neurobehavioral development. A pluralistic approach to research, taking a multidisciplinary approach to theoretical models and empirical investigation needs to be fostered.

Maternal asthma symptoms during pregnancy on child behaviour and executive function: A Bayesian phenomics approach

OBJECTIVE

Maternal history of inflammatory conditions has been linked to offspring developmental and behavioural outcomes. This phenomenon may be explained by the maternal immune activation (MIA) hypothesis, which posits that dysregulation of the gestational immune environment affects foetal neurodevelopment. The timing of inflammation is critical. We aimed to understand maternal asthma symptoms during pregnancy, in contrast with paternal asthma symptoms during the same period, on child behaviour problems and executive function in a population-based cohort.

METHODS

Data were obtained from 844 families from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort. Parent asthma symptoms during the prenatal period were reported. Asthma symptoms in children were reported longitudinally from two to five years old, while behavioural problems and executive functioning were obtained at seven years old. Parent and child measures were compared between mothers with and without prenatal asthma symptoms. Generalized linear and Bayesian phenomics models were used to determine the relation between parent or child asthma symptoms and child outcomes.

RESULTS

Children of mothers with prenatal asthma symptoms had greater behavioural and executive problems than controls (Cohen's d: 0.43-0.75; all p < 0.05). This association remained after adjustments for emerging asthma symptoms during the preschool years and fathers' asthma symptoms during the prenatal period. After adjusting for dependence between child outcomes, the Bayesian phenomics model showed that maternal prenatal asthma symptoms were associated with child internalising symptoms and higher-order executive function, while child asthma symptoms were associated with executive function skills. Paternal asthma symptoms during the prenatal period were not associated with child outcomes.

CONCLUSIONS

Associations between child outcomes and maternal but not paternal asthma symptoms during the prenatal period suggests a role for MIA. These findings need to be validated in larger samples, and further research may identify behavioural and cognitive profiles of children with exposure to MIA.

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

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

Positive maternal mental health attenuates the associations between prenatal stress and children's internalizing and externalizing symptoms

Positive maternal mental health can improve perceptions of stressful situations and promote the use of adaptive coping strategies. However, few studies have examined how positive maternal mental health affects children's development. The aims of this study were to examine the associations between positive maternal mental health and children's internalizing and externalizing symptoms, and to ascertain whether positive maternal mental health moderated the associations between prenatal stress and children's internalizing and externalizing symptoms. This study is based on the Norwegian Mother, Father, and Child Cohort Study (MoBa), and comprised 36,584 mother-child dyads. Prenatal stress was assessed using 41 self-reported items measured during pregnancy. Positive maternal mental health (self-efficacy, self-esteem, and enjoyment) was assessed by maternal report during pregnancy and postpartum. Child internalizing and externalizing symptoms were assessed by maternal report at age 5. Structural equation modeling was used for analysis. Maternal self-efficacy, self-esteem, and enjoyment were negatively associated with internalizing and externalizing symptoms in males and females. The association between prenatal stress and internalizing symptoms in males was stronger at low than at high levels of maternal self-esteem and enjoyment, whereas for females, the association was stronger at low than at high levels of maternal self-esteem and self-efficacy. This study provides evidence of associations between positive maternal mental health and children's mental health, and suggests that higher positive maternal mental health may buffer against the impacts of prenatal stress. Positive maternal mental health may represent an important intervention target to improve maternal-child well-being and foster intergenerational resilience.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Joint modelling of mental health markers through pregnancy: a Bayesian semi-parametric approach

Maternal depression and anxiety through pregnancy have lasting societal impacts. It is thus crucial to understand the trajectories of its progression from preconception to postnatal period, and the risk factors associated with it. Within the Bayesian framework, we propose to jointly model seven outcomes, of which two are physiological and five non-physiological indicators of maternal depression and anxiety over time. We model the former two by a Gaussian process and the latter by an autoregressive model, while imposing a multidimensional Dirichlet process prior on the subject-specific random effects to account for subject heterogeneity and induce clustering. The model allows for the inclusion of covariates through a regression term. Our findings reveal four distinct clusters of trajectories of the seven health outcomes, characterising women's mental health progression from before to after pregnancy. Importantly, our results caution against the loose use of hair corticosteroids as a biomarker, or even a causal factor, for pregnancy mental health progression. Additionally, the regression analysis reveals a range of preconception determinants and risk factors for depressive and anxiety symptoms during pregnancy.

Mid‐pregnancy and postpartum maternal mental health and infant sleep in the first year of life

Perinatal depression and anxiety are common and associated with sleep problems in the offspring. Depression and anxiety are commonly comorbid, yet often studied independently. Our study used an integrative measure of anxiety and depressive symptoms to examine the associations of maternal mental health (mid-pregnancy and postnatal) with infant sleep during the first year of life. A total of 797 mother-child dyads from the 'Growing Up in Singapore Towards healthy Outcome' cohort study provided infant sleep data at 3, 6, 9 and 12 months of age, using the caregiver reported Brief Infant Sleep Questionnaire. Maternal mental health was assessed at 26-28 weeks gestation and 3 months postpartum using the Edinburgh Postnatal Depression Scale, Beck Depression Inventory and State-Trait Anxiety Inventory. Bifactor modelling with the individual questionnaire items produced a general affect factor score that provided an integrated measure of anxiety and depressive symptoms. Linear mixed models were used to model the sleep outcomes, with adjustment for maternal age, education, parity, ethnicity, sex of the child and maternal sleep quality concurrent with maternal mental health assessment. We found that poorer mid-pregnancy, but not postpartum, maternal mental health was associated with longer wake after sleep onset duration across the first year of life (β = 49, 95% confidence interval 13-85 min). Poor maternal mental health during mid-pregnancy is linked to longer period of night awakening in the offspring during infancy. Interventions that aim to improve maternal antenatal mental health should examine infant sleep outcomes.

Cost-utility of a web-based intervention to promote maternal mental health among postpartum women presenting low risk for postpartum depression

OBJECTIVES

Web-based interventions for the promotion of maternal mental health could represent a cost-effective strategy to reduce the burden associated with perinatal mental illness. This study aimed to evaluate the cost-utility of Be a Mom, a self-guided web-based cognitive behavioral therapy intervention, compared with a waiting-list control.

METHODS

The economic evaluation alongside a randomized controlled trial was conducted from a societal perspective over a 14-month time frame. Postpartum women presenting low risk for postpartum depression were randomized to the intervention (n = 191) or control (n = 176) group and assessed at baseline, postintervention and 4 and 12 months after postintervention. Data regarding healthcare use, productive losses and quality-adjusted life years (QALYs) were collected and used to calculate incremental cost-effectiveness ratios (ICERs). Uncertainty was accounted for with nonparametric bootstrapping and sensitivity analyses.

RESULTS

At 14 months, and after accounting for a 3.5 percent discount rate, the intervention resulted in a yearly cost-saving of EUR 165.47 (-361.77, 28.51) and a QALY gain of 0.0064 (-0.0116, 0.0244). Bootstrapping results revealed a dominant ICER for the intervention group. Although results were statistically nonsignificant, cost-effectiveness acceptability curves showed that at a EUR 0 willingness to pay threshold, there is a 96 percent probability that the intervention is cost-effective when compared with the control group. The sensitivity analyses generally supported the acceptable likelihood of the intervention being more cost-effective than the control group.

CONCLUSIONS

From a societal perspective, the implementation of Be a Mom among low-risk postpartum women could be a cost-effective way to improve perinatal mental health.

Positive maternal mental health during pregnancy and mental and behavioral disorders in children: A prospective pregnancy cohort study

BACKGROUND

The role of positive maternal mental health during pregnancy in child mental health remains largely unknown. We investigated whether positive maternal mental health during pregnancy is associated with lower hazards of mental and behavioral disorders in children and mitigates the adverse effects of negative maternal mental health.

METHODS

Among 3,378 mother-child dyads of the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction study, mothers reported their positive mental health biweekly throughout pregnancy with the Positive and Negative Affect Schedule, the Spielberger State Anxiety Inventory Curiosity scale, and a visual analogue scale for social support, and negative mental health with the Center for Epidemiologic Studies Depression Scale. We extracted data on their mental and behavioral disorder diagnoses from a nationwide medical register. This register provided data on their children's mental and behavioral disorder diagnoses as well, from birth until 8.4-12.8 (Median = 10.2, Interquartile Range 9.7-10.8) years of age.

RESULTS

A positive maternal mental health composite score during pregnancy was associated with a lower hazard of any mental and behavioral disorder among all children [Hazard Ratio (HR) = 0.79, 95% Confidence Interval (CI) 0.71 - 0.87] and among children of mothers experiencing clinically relevant depressive symptoms during pregnancy [HR = 0.80, 95%CI 0.64 - 1.00] and/or mental and behavioral disorders before or during pregnancy [HR = 0.69, 95%CI 0.55-0.86]. These associations were independent of covariates.

CONCLUSIONS

Children whose mothers had more positive mental health during pregnancy were less likely to develop mental and behavioral disorders. Protective effects were seen also among children of mothers facing mental health adversities before or during pregnancy.

Discrimination and structural validity evaluation of Zung self-rating depression scale for pregnant women in China

PURPOSE

The applicability of the Zung self-rating depression scale (SDS) in pregnancy is unknown. We aimed to identify redundant items and evaluate the Zung SDS's structural validity.

METHOD

Two samples of pregnant women were invited from two districts in Shanghai (Yangpu sample, n = 6468 and Huangpu sample, n = 402). The Yangpu sample was randomly split into YGroup1/2/3. Item's properties were evaluated via the item response theory in YGroup1. Exploratory and confirmatory factor analyses were correspondingly executed in YGroup2 and YGroup3. Those items with discrimination parameter (α) lower than 0.65 or factor loading smaller than 0.4 were deleted from the scale. The final structure was validated in the Huangpu sample.

RESULTS

Items 4 (sleep), 7 (weight loss), 8 (constipation) and 9 (tachyarrhythmia) exhibited low discrimination power. Items 2 (diurnal variation), 5 (appetite), 10 (fatigue) and 19 (suicide idea) made a low contribution to all factors. A three-factor model was eventually constructed as cognitive (Items 14, 16, 17, 18 and 20), psychomotor (Items 6, 11 and 12) and affective (Items 1, 3, 13 and 15).

CONCLUSION

The Zung SDS needs modification before applied to pregnant women in China. The items describing the overlap symptoms of the physical change in pregnancy and mood disorder should be deleted.

The factor structure of the Edinburgh Postnatal Depression Scale among perinatal high-risk and community samples in London

Timely and accurate detection of perinatal mental health problems is essential for the wellbeing of both mother and child. Growing evidence has suggested that the Edinburgh Postnatal Depression Scale (EPDS) is not a unidimensional measure of perinatal depression, but can be used to screen for anxiety disorders. We aimed to assess the factor structure of the EPDS in 3 different groups of women: n = 266 pregnant women at high-risk of depression ("Perinatal Stress Study"), n = 471 pregnant women from a community sample, and n = 637 early postnatal women from a community sample ("developing Human Connectome Project"). Exploratory factor analysis (40% of each sample) and confirmatory factor analysis (60% of each sample) were performed. The relationship between EPDS scores and history of mental health concerns was investigated. Results suggested that a 3-factor model (depression, anxiety, and anhedonia) is the most appropriate across groups. The anxiety subscale (EPDS-3A) emerged consistently and was related to maternal history of anxiety disorders in the prenatal sample (W = 6861, p < 0.001). EPDS total score was related to history of mental health problems in both the prenatal (W = 12,185, p < 0.001) and postnatal samples (W = 30,044, p < 0.001). In both high-risk and community samples in the perinatal period, the EPDS appears to consist of depression, anxiety, and anhedonia subscales. A better understanding of the multifactorial structure of the EPDS can inform diagnosis and management of women in the prenatal and postnatal period. Further research is required to validate the EPDS-3A as a screening tool for anxiety.

Maternal depression trajectories and offspring positive attributes and social aptitudes at early adolescence: 2004 Pelotas birth cohort

There is growing evidence that adolescent positive attributes and social aptitudes are associated with beneficial outcomes, including higher educational attainment and lower risk of later psychiatric disorder. Although maternal depression is a well-known risk factor for a variety of offspring adverse outcomes, less is known on its repercussion on children's positive behavioral traits. This study aimed to evaluate the impact of maternal depression trajectories on offspring positive attributes and social aptitudes, testing sex-moderated models for the studied association. The 2004 Pelotas Birth Cohort is an ongoing cohort originally comprised by 4231 live births from Brazil. We included 3465 11-year-old adolescents (48.6% female; maternal self-reported skin color: 27.0% non-white). Maternal depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS) at all follow-ups. Adolescent positive attributes and social aptitudes were ascertained by specific subscales of Development and Well-Being Assessment (DAWBA). Multivariate linear regression was used to examine the effect of maternal depression trajectories on offspring's outcomes, adjusting for potential confounding variables. Moderation was assessed with interaction terms. Adolescents from mothers who presented high-chronic levels of depressive symptoms during offspring's life have lower scores of positive attributes and social aptitudes. Boys exposed to maternal depression during their lifetime are more affected than girls regarding positive attributes, but this sex difference was not observed for social aptitudes. Interventions targeting the promotion of adaptive behavioral traits may represent an effective way to buffer the adverse impact of maternal depression on offspring development, especially for vulnerable groups such as male adolescents.

Associations of physical activity, sedentary time, and physical fitness with mental health during pregnancy: The GESTAFIT project

PURPOSE

This study was aimed to analyze the associations of objectively measured physical activity (PA), sedentary time, and physical fitness with mental health in the early second trimester (16 ± 2 gestational weeks) of pregnancy.

METHODS

From 229 women initially contacted, 124 pregnant women participated in the present cross-sectional study. Data were collected between November 2015 and March 2017. The participants wore Actigraph GT3X+ Triaxial accelerometers for 9 consecutive days to objectively measure their PA levels and sedentary time. A performance-based test battery was used to measure physical fitness. Self-report questionnaires assessed psychological ill-being (i.e., negative affect, anxiety, and depression), and psychological well-being (i.e., emotional intelligence, resilience, and positive affect). Linear regression analyses were adjusted for age, educational level, accelerometer wear time, miscarriages, and low back pain.

RESULTS

Moderate-to-vigorous PA was negatively associated with depression (β = -0.222, adjusted R² = 0.050, p = 0.041). Higher levels of sedentary time were negatively associated with positive affect (β = -0.260, adjusted R² = 0.085, p = 0.017). Greater upper-body flexibility was positively associated with better emotional regulation (β = 0.195, adjusted R²= 0.030, p = 0.047). The remaining associations were not significant (all p > 0.05).

CONCLUSION

An active lifestyle characterized by higher levels of moderate-to-vigorous PA and lower levels of sedentary time during pregnancy might modestly improve the mental health of pregnant women. Although previous research has focused on the benefits of cardiorespiratory exercise, the present study shows that only upper-body flexibility is related to emotional regulation in early pregnant women. If the present findings are corroborated in further experimental research, physical exercise programs should focus on enhancing flexibility to promote improvements in emotional regulation during early second-trimester of pregnancy.

Income disparity in school readiness and the mediating role of perinatal maternal mental health: a longitudinal birth cohort study

AIMS

There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness.

METHODS

Prospective data from 505 mother-child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models.

RESULTS

Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 s.d. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034).

CONCLUSIONS

Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.

Be a Mom, a Web-Based Intervention to Promote Positive Mental Health Among Postpartum Women With Low Risk for Postpartum Depression: Exploring Psychological Mechanisms of Change

Background: This study explored whether Be a Mom, a brief and unguided cognitive behavioral web-based intervention, was effective in promoting psychological processes (self-compassion, psychological flexibility, emotion regulation) among low-risk postpartum women. Effects of Be a Mom in psychological processes compared with a control group were examined at post-intervention and at 4-months follow-up. Additionally, this work explored whether changes in psychological processes mediated improvements in positive mental health at postintervention. Methods: In total, 367 postpartum women presenting low risk for postpartum depression were randomly assigned to the intervention group (n = 191) or to a waiting-list control group (n = 176). Results: Compared with the control group, the intervention group reported significantly greater baseline to postintervention increases in self-compassion. No significant effects were found at the 4-month follow-up. Multilevel mediation showed that self-compassion improvements significantly mediated improvements in positive mental health among the intervention group. No significant results were found for psychological flexibility or emotion regulation. Conclusions: This study suggests that Be a Mom has the potential to cultivate self-compassion among low-risk postpartum women and that this may be a key mechanism for promoting positive mental health in this context. Clinical Trial Registration: www.clinicaltrials.gov, identifier: NCT04055974.

Maternal Prenatal Mood, Pregnancy-Specific Worries, and Early Child Psychopathology: Findings From the DREAM BIG Consortium

OBJECTIVE

Few studies have attempted to identify how distinct dimensions of maternal prenatal affective symptoms relate to offspring psychopathology. We defined latent dimensions of women's prenatal affective symptoms and pregnancy-specific worries to examine their association with early offspring psychopathology in three prenatal cohorts.

METHOD

Data were used from three cohorts of the DREAM-BIG consortium: Avon Longitudinal Study of Parents and Children (ALSPAC [N = 12,515]), Generation R (N = 6,803), and the Canadian prenatal cohort Maternal Adversity, Vulnerability, and Neurodevelopment (MAVAN [N = 578]). Maternal prenatal affective symptoms and pregnancy-specific worries were assessed using different measures in each cohort. Through confirmatory factor analyses, we determined whether comparable latent dimensions of prenatal maternal affective symptoms existed across the cohorts. We used structural equation models to examine cohort-specific associations between these dimensions and offspring psychopathology at 4 to 8 years of age (general psychopathology, specific internalizing and externalizing previously derived using confirmatory factor analyses). Cohort-based estimates were meta-analyzed using inverse variance-weighing.

RESULTS

Four prenatal maternal factors were similar in all cohorts: a general affective symptoms factor and three specific factors-an anxiety/depression factor, a somatic factor, and a pregnancy-specific worries factor. In meta-analyses, both the general affective symptoms factor and pregnancy-specific worries factor were independently associated with offspring general psychopathology. The general affective symptoms factor was further associated with offspring specific internalizing problems. There were no associations with specific externalizing problems.

CONCLUSION

These replicated findings of independent and adverse effects for prenatal general affective symptoms and pregnancy-specific worries on child mental health support the need for specific interventions in pregnancy.

Happiness in Pregnant African American Women: What Are the Biobehavioral Correlates?

The detrimental effects of prenatal stress on maternal-infant well-being have been well established and highlight increased concern for pregnant African American women. Research supports the notion that positive emotions may have a beneficial impact on the stress process and outcomes. However, the data have been largely restricted to non-African American pregnant women. This study's purpose was to examine potential relationships of both positive (happiness) and negative (stress, anxiety, and depressive symptoms) emotions and pro-inflammatory cytokines (interleukins-1β, -6, -8, -12, -17, tumor necrosis factor, and interferon-γ) in 72 pregnant African American women for a more complete picture of the stress process in this at-risk population. Results of this exploratory secondary data analysis show strong positive correlations between negative emotions and strong negative correlations between happiness and negative emotions. Interleukin-8 was positively correlated with negative emotions and negatively correlated with happiness. Results show mean ratings of negative emotions were higher than previously reported with more heterogeneous samples, while happiness ratings were in the moderate range. Findings suggest that pregnant African American women may experience higher stress and depressive symptoms than women in more heterogeneous samples. However, moderate levels of happiness might contribute to buffering the stress response.

Severity of nausea and vomiting in pregnancy and early childhood neurobehavioural outcomes: The Growing Up in Singapore Towards Healthy Outcomes study

BACKGROUND

Nausea and vomiting of pregnancy (NVP) affects 50 to 80 per cent of women. The existing literature has examined NVP from the perspective of the mother, and relatively less is known about offspring outcomes.

OBJECTIVES

To study the relationships of NVP with social-emotional, behavioural, and cognitive outcomes of the offspring in a multi-ethnic Asian cohort.

METHODS

In the Growing Up in Singapore Towards Healthy Outcomes prospective mother-offspring cohort study, mothers responded to a structured NVP questionnaire at 26-28 weeks' gestation (n = 1172) and participants with severe NVP were confirmed using medical records. Children underwent multiple neurodevelopmental assessments throughout childhood. We conducted multivariable regressions with post-estimation predictive margins to understand the associations of NVP with offspring neurobehavioural outcomes, which included 1-year Infant-Toddler Social and Emotional Assessment, 1.5-year Quantitative Checklist for Autism in Toddlers, 2-year Bayley Scales of Infant and Toddler Development, 2- and 4-year Child Behavior Checklist, and 4.5-year Kaufman Brief Intelligence Test. Analyses were adjusted for household income, birth variables, maternal mental health, and other relevant medical variables. Cohen's d effect sizes were calculated using standardised mean differences (μ_d ).

RESULTS

Mothers were categorised into no (n = 296, 25.3%), mild-moderate (n = 686, 58.5%), and severe NVP (n = 190, 16.2%), of whom 67 (5.7%) required admission. Compared to children of mothers who had no or mild-moderate NVP, children with exposure to severe NVP exhibited more externalising behaviours (μ_d 2.0, 95% CI 0.3, 3.6; Cohen's d = 0.33) and social communication difficulties before 2 years (μ_d 4.1, 95% Cl 0.1, 8.0; Cohen's d = 0.38), both externalising (μ_d 1.5, 95% CI 0.4, 2.6; Cohen's d = 0.43) and internalising behaviours at 2 years (μ_d 1.2, 95% CI 0.1, 2.2; Cohen's d = 0.35), and only internalising behaviours after 2 years (μ_d 1.1, 95% CI 0.4, 2.0; Cohen's d = 0.37).

CONCLUSIONS

Severe NVP is highly prevalent in this Asian cohort and may be adversely associated with multiple offspring neurobehavioural outcomes.

Perinatal emotional states: a comparative study between two cohorts recruited in a Mediterranean environment

Experiencing negative emotional states during pregnancy has been linked to adverse outcomes for mother and offspring. Our study aims were to compare the perinatal emotional states and obstetrical variables between pregnant women recruited in Spain (n = 202) and Italy (n = 103), and to investigate prenatal anxiety related factors. The study had two phases. In the 1^st phase (3^rd trimester of pregnancy), prenatal anxiety was assessed using the State-Trait Anxiety Inventory (STAI); other prenatal and sociodemographic variables were also collected. In the 2^nd phase (40 days postpartum), the STAI and the Edinburgh Postnatal Depression Scale were administered. Compared to the Spanish sample, the Italian sample presented higher STAI state and STAI factor 1 mean scores (22.5 vs. 18.6 and 10.0 vs. 7.2), shorter gestations (mean gestation weeks: 39.1 vs. 39.8), more unplanned pregnancies (31.1% vs. 16.4%), and more cesareans deliveries (42.5% vs. 16.0%). Low socioeconomic levels, younger ages, previous miscarriages and unplanned pregnancies were related to prenatal anxiety. Postpartum depression rates was 31.3% and there were no differences between countries. Our results suggested that it may be interesting in both countries to create a prenatal monitoring protocol that attaches more importance to emotional wellbeing both during pregnancy and in the long term.

Maternal influences on fetal brain development: The role of nutrition, infection and stress, and the potential for intergenerational consequences

An optimal early life environment is crucial for ensuring ideal neurodevelopmental outcomes. Brain development consists of a finely tuned series of spatially and temporally constrained events, which may be affected by exposure to a sub-optimal intra-uterine environment. Evidence suggests brain development may be particularly vulnerable to factors such as maternal nutrition, infection and stress during pregnancy. In this review, we discuss how maternal factors such as these can affect brain development and outcome in offspring, and we also identify evidence which suggests that the outcome can, in many cases, be stratified by socio-economic status (SES), with individuals in lower brackets typically having a worse outcome. We consider the relevant epidemiological evidence and draw parallels to mechanisms suggested by preclinical work where appropriate. We also discuss possible transgenerational effects of these maternal factors and the potential mechanisms involved. We conclude that modifiable factors such as maternal nutrition, infection and stress are important contributors to atypical brain development and that SES also likely has a key role.

Is positive mental health and the absence of mental illness the same? Factors associated with flourishing and the absence of depressive symptoms in postpartum women

OBJECTIVE

Exploring a wide range of factors associated with flourishing and with the absence of depressive symptoms among postpartum women.

METHODS

A sample of 661 postpartum women completed a set of questionnaires assessing sociodemographic and infant-related data, flourishing, psychological flexibility, self-compassion, resilience, and maternal confidence.

RESULTS

Younger infant age, higher levels of maternal confidence, and resilience increased the likelihood of flourishing. In turn, higher income, fewer problems with an infant's sleep, perceiving an infant's temperament as easy, and higher psychological flexibility increased the likelihood of not having depressive symptoms. Appraising the support received by others as good and having higher self-compassion increased the likelihood of both outcomes.

CONCLUSIONS

Our results support positive mental health and mental illness being related but distinct dimensions. Promoting positive mental health in the postpartum period should be an additional goal in public health care as it may efficiently complement the prevention of psychopathology.

Influence of Maternal Stress during Pregnancy on Child’s Neurodevelopment

(1) Background: High stress levels during pregnancy can affect the organogenesis and the foetus’ central nervous system maturation. The objective of this study was to determine whether a relationship between maternal stress during pregnancy and alterations in child neurodevelopment exists; (2) Methods: A bibliographical review was carried out following PRISMA Methodology and using Scopus, Web of Science and Cinahl databases. The research questions were made using PEO methodology (Participants, Exposition, Outcomes). Moreover, article quality was measured using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies; (3) Results: 22 articles that fit the inclusion criteria were selected. Different elements altered because of maternal stress during pregnancy could side with alterations in different areas of the neurodevelopment, such as cognitive development, motor development, behaviour, temperament, memory and learning abilities; (4) Conclusions: Although maternal stress can have an influence on children’s neurodevelopment, it is still unknown which are the specific elements related to this stress that can modify it negatively. Furthermore, future studies should evaluate whether a sex-specific association exists.

The role of interpersonal emotional regulation on maternal mental health

PURPOSE

Symptoms of depression and anxiety during the perinatal period have a negative impact on mothers and their developing children. A significant body of research has demonstrated an association between mental health and both individual and interpersonal emotion regulation. Yet, this association has not been studied during the perinatal period. The aim of this study was to explore the association between emotion regulation, maternal mental health, and interpersonal emotion regulation during the transition to motherhood in a sample of Chilean women.

METHODS

Women in their third trimester of pregnancy (n = 253) provided self-reports of emotion regulation and symptoms of depression and anxiety during pregnancy and three months postpartum. Additional self-reports of interpersonal emotion regulation were obtained from individuals who were identified as social support persons by these women. Results: Maternal emotion regulation contributed to maternal symptoms of depression and anxiety during pregnancy and after childbirth. The association between emotion regulation and maternal mental health was moderated by specific interpersonal emotion regulation strategies reported by the participant's social support persons. Strategies including modulating the emotional response, situation modification, attentional deployment and cognitive change, modified the association between poor regulation strategies and anxiety symptoms. Also, an infrequent use of these interpersonal emotion regulation strategies strengthened the association between these maternal emotional regulation difficulties and anxiety symptoms.

CONCLUSION

Our findings suggest that interpersonal emotional regulation strategies impact the association of maternal emotional regulation strategies and maternal emotional wellbeing.

Network Analyses of Maternal Pre- and Post-Partum Symptoms of Depression and Anxiety

BACKGROUND

Maternal mental health problems often develop prenatally and predict post-partum mental health. However, the circumstances before and following childbirth differ considerably. We currently lack an understanding of dynamic variation in the profiles of depressive and anxiety symptoms over the perinatal period.

METHODS

Depressive and anxiety symptoms were self-reported by 980 women at 26-week pregnancy and 3 months post-partum. We used network analysis of depressive and anxiety symptoms to investigate if the symptoms network changed during and after pregnancy. The pre- and post-partum depressive-anxiety symptom networks were assessed for changes in structure, unique symptom-symptom interactions, central and bridging symptoms. We also assessed if central symptoms had stronger predictive effect on offspring's developmental outcomes outcomes at birth and 24, 54, and 72 months old than non-central symptoms. Bridging symptoms between negative and positive mental health were also assessed.

RESULTS

Though the depressive-anxiety network structures were stable during and after pregnancy, the post-partum network was more strongly connected. The central depressive-anxiety symptoms were also different between prenatal and post-partum networks. During pregnancy, central symptoms were mostly related to feeling worthless or useless; after pregnancy, central symptoms were mostly related to feeling overwhelmed or being punished. Central symptoms during pregnancy were associated with poorer developmental outcomes for the child. Anxiety symptoms were strongest bridging symptoms during and after pregnancy. The interactions between negative and positive mental health symptoms were also different during and after pregnancy.

CONCLUSIONS

The differences between pre- and post-partum networks suggest that the presentation of maternal mental health problems varies over the peripartum period. This variation is not captured by traditional symptom scale scores. The bridging symptoms also suggest that anxiety symptoms may precede the development of maternal depression. Interventions and public health policies should thus be tailored to specific pre- and post-partum symptom profiles.

Be a Mom's Efficacy in Enhancing Positive Mental Health among Postpartum Women Presenting Low Risk for Postpartum Depression: Results from a Pilot Randomized Trial

In this study, we conducted a preliminary investigation of the efficacy of Be a Mom, a web-based self-guided intervention, in enhancing positive mental health among postpartum women at low risk for postpartum depression. Additionally, we examined Be a Mom’s efficacy regarding secondary outcomes as well as its acceptability and adherence. A total of 367 participants were randomly assigned to the Be a Mom group (n = 191) or to the waiting-list control group (n = 176) and completed baseline (T1) and postintervention (T2) assessments. The intervention group reported significant increases in positive mental health between T1 and T2 compared to the control group. Additionally, group effects were found for depressive and anxiety symptoms. A significantly higher proportion of participants in the Be a Mom group had an improvement trajectory (from not flourishing at T1 to flourishing at T2). A total of 62 (32.5%) women completed Be a Mom, and most would use it again if needed (n = 82/113; 72.6%). This study provides preliminary evidence of Be a Mom’s efficacy in increasing positive mental health among low-risk postpartum women. Our findings support mental health promotion strategies in the postpartum period and highlight the important role of web-based CBT interventions.

Maternal depression, anxiety, psychoticism and paranoid ideation have effects on developmental delay types of infants: A study with clinical infant-mother dyads

BACKGROUND

Developmental delay in infancy includes cognitive-language delay, fine motor delay, gross motor delay, and social-self help delay. Delay in one intellectual domain frequently effects the other areas of development; therefore, determining risk factors are essential. In this study, we evaluated the relationship between maternal psychiatric symptoms and developmental delay types of infants who have not a known risk factor and are expected to show healthy development but have some behavioral and developmental problems.

METHODS

The sample consisted of 79 infant-mother (26 girls, 53 boys) dyads who had been admitted to the Department of Child and Adolescent Psychiatry at Gulhane Research and Training Hospital over a one year period. Brief Infant-Toddler Social and Emotional Assessment Scale, Brief Symptom Inventory and Ankara Developmental Screening Inventory were used.

RESULTS

The most frequent developmental delay types were fine motor and social -self-help delay in this sample. For all developmentally delayed infants, maternal interpersonal sensitivity, and depression scores were higher than healthy developed ones. Logistic regression analyses revealed the risk factors: Higher maternal paranoid ideation increases the language-cognitive delay; maternal hostility and anxiety increase the gross motor delay; maternal psychoticism increases the social and self-help delay, and maternal depression increases the total development delay of infants.

CONCLUSION

Maternal depression, anxiety, psychoticism, and paranoid ideation are important risk factors for infants' developmental delay types and should be addressed while evaluating infant-mother dyads in clinical practice.

Positive Maternal Mental Health, Parenting, and Child Development

While maternal mental health is an important influence on child development, the existing literature focuses primarily on negative aspects of maternal mental health, particularly symptoms of depression, anxiety, or states of distress. We provide a review of the evidence on the potential importance of positive mental health for both mother and child. The evidence suggests that positive mental health is a distinct construct that is associated with improved birth outcomes and potentially with specific forms of parenting that promote both academic achievement and socioemotional function. We review studies that provide a plausible biological basis for the link between positive mental health and parenting, focusing on oxytocin-dopamine interactions. We caution that the evidence is largely preliminary and suggest directions for future research, noting the importance of identifying the operative dimensions of positive maternal mental health in relation to specific outcomes. We suggest that the inclusion of positive maternal mental health provides the potential for a more comprehensive understanding of parental influences on child development.

Biological embedding of experience: A primer on epigenetics

Biological embedding occurs when life experience alters biological processes to affect later life health and well-being. Although extensive correlative data exist supporting the notion that epigenetic mechanisms such as DNA methylation underlie biological embedding, causal data are lacking. We describe specific epigenetic mechanisms and their potential roles in the biological embedding of experience. We also consider the nuanced relationships between the genome, the epigenome, and gene expression. Our ability to connect biological embedding to the epigenetic landscape in its complexity is challenging and complicated by the influence of multiple factors. These include cell type, age, the timing of experience, sex, and DNA sequence. Recent advances in molecular profiling and epigenome editing, combined with the use of comparative animal and human longitudinal studies, should enable this field to transition from correlative to causal analyses.

Early environmental influences on the development of children's brain structure and function

The developing brain in utero and during the first years of life is highly vulnerable to environmental influences. Experiences occurring during this period permanently modify brain structure and function through epigenetic modifications (alterations of the DNA structure and chromatin function) and consequently affect the susceptibility to mental disorders. In this review, we describe evidence linking adverse environmental variation during early life (from the fetal period to childhood) and long-term changes in brain volume, microstructure, and connectivity, especially in amygdala and hippocampal regions. We also describe genetic variations that moderate the impact of adverse environmental conditions on child neurodevelopment, such as polymorphisms in brain-derived neurotrophic factor and catechol-O-methyltransferase genes, as well as genetic pathways related to glutamate and monoaminergic signaling. Lastly, we have depicted positive early life experiences that could benefit childhood neurodevelopment and reverse some detrimental effects of adversity in the offspring. WHAT THIS PAPER ADDS: Prenatal, peripartum, and postnatal adversities influence child behavior and neurodevelopment. Exposure to environmental enrichment and positive influences may revert these effects. Putative mechanisms involve alterations in neurotrophic factors and neurotransmitter systems. New tools/big data improved the understanding on how early adversity alters neurodevelopment. This permits better translation/application of the findings from animal models to humans.

Television viewing and child cognition in a longitudinal birth cohort in Singapore: the role of maternal factors

Background

Although infant media exposure has received attention for its implications on child development, upstream risk factors contributing to media exposure have rarely been explored. The study aim was to examine the relationship between maternal risk factors, infant television (TV) viewing, and later child cognition.

Methods

We used a prospective population-based birth cohort study, Growing Up in Singapore Towards healthy Outcomes (GUSTO), with 1247 pregnant mothers recruited in their first trimester. We first explored the relationship of infant TV exposure at 12 months and the composite IQ score at 4.5 years, as measured by the Kaufman Brief Intelligence Test, Second Edition (KBIT-2). Multivariable linear regressions were adjusted for maternal education, maternal mental health, child variables, birth parameters, and other relevant confounders. We then examined the associations of maternal risk factors with the amount of daily TV viewing of 12-month-old infants. Path analysis followed, to test a conceptual model designed a priori to test our hypotheses.

Results

The average amount of TV viewing at 12 months was 2.0 h/day (SD 1.9). TV viewing in hours per day was a significant exposure variable for composite IQ (ß = − 1.55; 95% CI: − 2.81 to − 0.28) and verbal IQ (ß = − 1.77; 95% CI: − 3.22 to − 0.32) at 4.5 years. Our path analysis demonstrated that lower maternal education and worse maternal mood (standardized ß = − 0.27 and 0.14, respectively, p < 0.01 for both variables) were both risk factors for more media exposure. This path analysis also showed that maternal mood and infant TV strongly mediated the relationship between maternal education and child cognition, with an exceptional model fit (CFI > 0.99, AIC 15249.82, RMSEA < 0.001).

Conclusion

Infant TV exposure has a negative association with later cognition. Lower maternal education and suboptimal maternal mental health are risk factors for greater television viewing. Paediatricians have a role in considering and addressing early risks that may encourage television viewing.

Infant Behavior and Competence Following Prenatal Exposure to a Natural Disaster: The QF2011 Queensland Flood Study

This study utilized a natural disaster to investigate the effects of prenatal maternal stress (PNMS) arising from exposure to a severe flood on maternally reported infant social-emotional and behavioral outcomes at 16 months, along with potential moderation by infant sex and gestational timing of flood exposure. Women pregnant during the Queensland floods in January 2011 completed measures of flood-related objective hardship and posttraumatic stress (PTS). At 16 months postpartum, mothers completed measures describing depressive symptoms and infant social-emotional and behavioral problems (n = 123) and competence (n = 125). Greater maternal PTS symptoms were associated with reduced infant competence. A sex difference in infant behavioral problems emerged at higher levels of maternal objective hardship and PTS; boys had significantly more behavioral problems than girls. Additionally, greater PTS was associated with more behavioral problems in boys; however, this effect was attenuated by adjustment for maternal depressive symptoms. No main effects or interactions with gestational timing were found. Findings highlight specificity in the relationships between PNMS components and infant outcomes and demonstrate that the effects of PNMS exposure on behavior may be evident as early as infancy. Implications for the support of families exposed to a natural disaster during pregnancy are discussed.

Prenatal Developmental Origins of Future Psychopathology: Mechanisms and Pathways

The developmental origins of health and disease hypothesis applied to neurodevelopmental outcomes asserts that the fetal origins of future development are relevant to mental health. There is a third pathway for the familial inheritance of risk for psychiatric illness beyond shared genes and the quality of parental care: the impact of pregnant women's distress-defined broadly to include perceived stress, life events, depression, and anxiety-on fetal and infant brain-behavior development. We discuss epidemiological and observational clinical data demonstrating that maternal distress is associated with children's increased risk for psychopathology: For example, high maternal anxiety is associated with a twofold increase in the risk of probable mental disorder in children. We review several biological systems hypothesized to be mechanisms by which maternal distress affects fetal and child brain and behavior development, as well as the clinical implications of studies of the developmental origins of health and disease that focus on maternal distress. Development and parenting begin before birth.

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

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

Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review

Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation (n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.