Maternal depressive symptoms and children's cognitive development: Does early childcare and child's sex matter?

The association between perinatal depressive symptoms and child neurodevelopment

BACKGROUND

Perinatal depression has been suggested to adversely impact child neurodevelopment. However, the complexity of the early childhood environment challenges conclusive findings.

OBJECTIVE

To evaluate whether there is an association between perinatal depressive symptoms and child intelligence quotient (IQ) at 5 years of age.

STUDY DESIGN

Secondary analysis of an ancillary study to a multicenter randomized trial of thyroxine therapy for pregnant individuals with subclinical hypothyroidism. Dyads of infants and birthing parent, with completed Center for Epidemiological Studies-Depression (CES-D) screens during pregnancy and postpartum and child neurodevelopment testing completed at five years of age (n=209) were included. CES-D screening was performed at 11-20 weeks, 34-38 weeks, and one-year postpartum. Depressive symptoms were categorized as antenatal (i.e., a positive screen at any point during pregnancy) or postpartum. The primary outcome was child IQ score < 85 at 5 years of age using the Wechsler Preschool and Primary Scale of Intelligence III (WPPSI-III) Full Scale test. Secondary outcomes included other assessments of childhood neurodevelopment. Bivariable analyses and multivariable logistic regressions were utilized.

RESULTS

Of the 209 birthing people included, 72 (34%) screened positive for depression during pregnancy and 32 (15%) screened positive one year postpartum. Children born to individuals with a positive antenatal depression screen had a higher odds of IQ < 85 at 5 years of age compared with children born to individuals with a CES-D < 16 (35% vs. 18%, OR 2.4, 95% CI 1.2-4.7). Similar findings were seen for children born to individuals with a positive postpartum depression screen (47% vs. 21%, OR 3.3, 95% CI 1.5-7.3). These associations did not persist in multivariable analyses that controlled for social determinants of health and clinical characteristics (adjusted odd ratio [aOR] 1.4, 95% CI 0.7-3.1; aOR 2.1, 95% CI 0.9-5.1, for antenatal and postpartum depressive symptoms, respectively). Similar findings were observed for other adverse neurodevelopmental outcomes.

CONCLUSIONS

Having a positive perinatal depression screen was not associated with child cognitive outcomes after controlling for covariates including social determinants of health.

Maternal postnatal depressive symptoms and early achievement of developmental milestones in infants and young children: A meta-analysis

Screening for social determinants of health, including maternal depression, is a recommended pediatric practice. However, the magnitude of association between maternal and child screening tools remains to be determined. The current study evaluated the association between maternal postnatal depressive symptoms and child developmental milestones, as well as moderators of these associations. A comprehensive search strategy was carried out in four databases (MEDLINE, EMBASE, APA PsycINFO, and Cochrane Central Register of Controlled Trials) from database inception to September 2022. Studies that examine postnatal depressive symptoms and associations with infant and early child (<6 years) achievement of developmental milestones were included. Data were extracted by two independent coders and a random-effects meta-analysis was used to estimate pooled effect sizes and test for moderators. A total of 38 non-overlapping studies (95,897 participants), all focused on maternal postnatal depression, met inclusion criteria. The pooled effect size for the association between postnatal depressive symptoms and early achievement of infant and child developmental milestones (N = 38; r = -.12; 95% CI = -.18, -.06) was small in magnitude. Child age at maternal depression measurement was a moderator, whereby effect sizes became greater for older children. Despite small effects, maternal postnatal depressive symptoms should be included in screening during routine well-child visits to enhance child development outcomes.

Maternal Mental Health in Pregnancy and Its Impact on Children's Cognitive Development at 18 Months, during the COVID-19 Pandemic (CONCEPTION Study)

BACKGROUND

The COVID-19 pandemic has significantly affected the mental health of pregnant persons.

OBJECTIVE

We aimed to evaluate the impact of maternal mental health and antidepressant use on children's cognitive development.

METHODS

We followed a cohort of children born during the COVID-19 pandemic. Maternal mental health was self-reported during pregnancy (Edinburgh Postnatal Depression Scale, General Anxiety Disorder-7, stress levels, and antidepressant use). The child's cognitive development was measured using the third edition of the Ages & Stages Questionnaires® (ASQ-3) at 18 months. Multivariate multinomial logistic regression models were built to assess the association between in utero exposure to maternal mental health and ASQ-3 domains: communication, gross motor, fine motor, problem-solving, and personal-social.

RESULTS

Overall, 472 children were included in our analyses. After adjusting for potential confounders, a need for further assessment in communication (adjusted odds ratio (aOR) 12.2, 95% confidence interval (CI) (1.60;92.4)), and for improvement in gross motricity (aOR 6.33, 95%CI (2.06;19.4)) were associated with in utero anxiety. The need for improvement in fine motricity (aOR 4.11, 95%CI (1.00; 16.90)) was associated with antidepressant exposure. In utero depression was associated with a decrease in the need for improvement in problem solving (aOR 0.48, 95%CI (0.24; 0.98)).

CONCLUSIONS

During the COVID-19 pandemic, maternal mental health appears to be associated with some aspects of children's cognitive development.

Longitudinal alterations in brain morphometry mediated the effects of bullying victimization on cognitive development in preadolescents

Bullying victimization is associated with a doubled risk of attempting suicide in adulthood. Two longitudinal brain morphometry studies identified the fusiform gyrus and putamen as vulnerable to bullying. No study identified how neural alterations may mediate the effect of bullying on cognition. We assessed participants with caregiver-reported bullying (N = 323) and matched non-bullied controls (N = 322) from the Adolescent Brain Cognitive Development Study dataset to identify changes in brain morphometry associated with ongoing bullying victimization over two years and determine whether such alterations mediated the effect of bullying on cognition. Bullied children (38.7% girls, 47.7% racial minorities, 9.88 ± 0.62 years at baseline) had poorer cognitive performance (P < 0.05), larger right hippocampus (P = 0.036), left entorhinal cortex, left superior parietal cortex, and right fusiform gyrus volumes (all P < 0.05), as well as larger surface areas in multiple other frontal, parietal, and occipital cortices. Thinner cortices were also found in the left hemisphere, particularly in the left temporal lobe, and right frontal region (all P < 0.05). Importantly, larger surface area in the fusiform cortices partially suppressed (12-16%), and thinner precentral cortices partially mitigated, (7%) the effect of bullying on cognition (P < 0.05). These findings highlight the negative impact of prolonged bullying victimization on brain morphometry and cognition.

Separation in Unity: Dialogical Transformation of Maternal Bond

The objective of this paper is to explore mothers' psychological adaptation related to separation from their newborn children immediately after birth. Mother and child separation has traditionally received attention from the child's perspective, but given that the bond is dyadic, the mother's wellbeing should also be considered. This qualitative study is based on interview data with mothers of premature infants. From the analysis, three themes emerged: concerns during pregnancy about premature birth; emotional strain caused by separation; and the need to protect and to be close to the newborn. Drawing on the perspectives of dialogical self theory and semiotic regulation model, the paper will focus on intra-psychological dynamics and will analyze the adaptation process in terms of I-positions. Based on the analysis, the maternal bond represents the integration of the I-position I-as-mother and My child, which is integrated during the pregnancy into the core of the self. It can be assumed that rupture of the self-continuity is activated by the birth of the child, which is then compounded if the child leaves. The maternal superordinate viewpoint (meta-I-position) directs a woman's behavior and allows for a sense of coherence under dynamic organization related to the birth of the child. The potential for psychological adaptation is presented as an ability to establish self-continuity.

Maternal depressive symptoms and children's academic performance: sex differences in the mediating role of school experiences

BACKGROUND

Maternal depressive symptoms (MDSs) are negatively associated with children's academic performance, with stronger effects sometimes reported in boys. However, few studies have tested the mechanisms of this association. We examined the mediating role of school engagement and peer victimization in this association and tested for sex differences.

METHODS

Participants were 1173 families from a population-based longitudinal Canadian study. MDSs were self-reported annually using the Centre for Epidemiologic Studies Depression Scale (child's age: 5 months to 5 years). Data on mediators (peer victimization, cognitive, behavioral, and emotional school engagement) were reported annually from ages 6-10 by multiple informants including children, parents, and teachers using items from validated scales. Mathematics, reading, and writing exam scores at age 12 were obtained from standardized exams administered by Québec's Ministry of Education and Teaching. Structural equation modeling was used to test mediation by school experiences in boys and girls.

RESULTS

Exposure to MDSs was negatively associated with mathematics, reading, and writing scores in girls and with mathematics only in boys. Cognitive and behavioral engagement significantly mediated the association between MDSs and mathematics, reading, and writing scores in girls. There were no significant mediators for boys.

CONCLUSIONS

Prevention and intervention strategies aiming to improve school engagement might be beneficial for daughters of mothers experiencing depressive symptoms. Further research is needed to replicate these findings and to identify the mechanisms explaining this association in boys.

Fetal sex-specific epigenetic associations with prenatal maternal depressive symptoms

Prenatal maternal mental health is a global health challenge with poorly defined biological mechanisms. We used maternal blood samples collected during the second trimester from a Singaporean longitudinal birth cohort study to examine the association between inter-individual genome-wide DNA methylation and prenatal maternal depressive symptoms. We found that (1) the maternal methylome was significantly associated with prenatal maternal depressive symptoms only in mothers with a female fetus; and (2) this sex-dependent association was observed in a comparable, UK-based birth cohort study. Qualitative analyses showed fetal sex-specific differences in genomic features of depression-related CpGs and genes mapped from these CpGs in mothers with female fetuses implicated in a depression-associated WNT/β-catenin signaling pathway. These same genes also showed enriched expression in brain regions linked to major depressive disorder. We also found similar female-specific associations with fetal-facing placenta methylome. Our fetal sex-specific findings provide evidence for maternal-fetal interactions as a mechanism for intergenerational transmission.

The Experience of Healthcare Professionals Providing Mental Health Services to Mothers with Postpartum Depression: A qualitative study

Objectives

This study aimed to describe the experience of healthcare professionals in providing mental health services to women with postpartum depression (PPD).

Methods

In this qualitative study, data were collected through semi-structured interviews with five physicians, five midwives and five psychologists from 14 urban healthcare centres in Kerman, Iran, from April 2019 to September 2019. Purposeful sampling was used to select the participants. Data were qualitatively analysed using a content analysis approach.

Results

Data analysis revealed the main theme of the study: ‘the long way ahead for comprehensive, integrated and responsive mental health services’. This theme included four categories: ‘postpartum depression challenges’, ‘social and personal factors’, ‘structural challenges’ and ‘need for change in mental health services’. The participants described that depression diagnosis is difficult due to insufficient knowledge among healthcare providers and the hidden signs of PPD. They also described how different factors such as economic and cultural factors, personality traits, a community’s lack of knowledge, negative attitude towards depression and limited family support might cause depression. Moreover, providing mental health services involves certain challenges, such as limited human resources, insufficient financial resources and incomplete or inefficient policy-making.

Conclusion

Although measures have been taken to provide mental health services, there are many challenges regarding providing mental health services to mothers. Therefore, serious measures should be taken to improve mental health services and re-define the existing measures. Informing the community, empowering the healthcare providers and attempting to change the community’s attitudes and beliefs can affect the mental healthcare of women with depression.

Neglecting Maternal Depression Compromises Child Health and Development Outcomes, and Violates Children's Rights in South Africa

The intention of the South African Children’s Act 38 of 2005 is to provide guarantees for the protection and promotion of optimum health and social outcomes for all children. These guarantees are the provision of basic nutrition, basic health care and social services, optimal family or parental care, as well as protection from maltreatment, neglect and abuse services. However, despite these guarantees, child and maternal mortality remain high in South Africa. The literature identifies maternal depression as a common factor that contributes to negative health and social outcomes for both mothers and their children. Despite the availability of easy-to-use tools, routine screening for maternal depression is not carried out in public health services, which is the source of services for the majority of women in South Africa. The results are that the mothers miss out on being diagnosed and treated for maternal depression, which results in negative child outcomes, such as malnutrition, as well as impacts on mental, social and physical health, and even death. The long-term impacts of untreated maternal depression include compromised child cognitive development, language acquisition and deviant behaviors and economic disadvantage in later life. The author concludes that the neglect of screening for, and treatment of maternal depression therefore violates the constitutional rights of the affected children, and goes against the spirit of the Constitution. The author recommends that maternal and child health services integrate routine screening for maternal depression, which will not only satisfy the Constitutional mandate, but also improve the health and developmental outcomes of the children and reduce child mortality.

Sex differences in the association between maternal depression and child and adolescent cognitive development: a systematic review and meta-analysis

BACKGROUND

Maternal depression is negatively associated with cognitive development across childhood and adolescence, with mixed evidence on whether this association differs in boys and girls. Herein, we performed a systematic review and meta-analysis of sex-specific estimates of the association between maternal depression and offspring cognitive outcomes.

METHOD

Seven databases (PubMed, EMBASE, PsycINFO, ERIC, CINAHL, Scopus, ProQuest) were searched for studies examining the longitudinal association between maternal depression and offspring (up to 18 years) cognitive outcomes. Studies were screened and included based on predetermined criteria by two independent reviewers (Cohen's κ = 0.76). We used random-effects models to conduct a meta-analysis and used meta-regression for subgroup analyses. The PROSPERO record for the study is CRD42020161001.

RESULTS

Twelve studies met inclusion criteria. Maternal depression was associated with poorer cognitive outcomes in boys [Hedges' g = -0.36 (95% CI -0.60 to -0.11)], but not in girls [-0.17 (-0.41 to 0.07)]. The association in boys varied as a function of the measure of depression used (b = -0.70, p = 0.005): when maternal depression was assessed via a diagnostic interview, boys [-0.84 (-1.23 to -0.44)] had poorer cognitive outcomes than when a rating scale was used [-0.16 (-0.36 to 0.04)].

CONCLUSIONS

This review and meta-analysis indicates that maternal depression is only significantly associated with cognitive outcomes in boys. Understanding the role of sex differences in the underlying mechanisms of this association can inform the development of targeted interventions to mitigate the negative effects of maternal depression on offspring cognitive outcomes.

MKK7 deficiency in mature neurons impairs parental behavior in mice

c‐Jun N‐terminal kinases (JNKs) are constitutively activated in mammalian brains and are indispensable for their development and neural functions. MKK7 is an upstream activator of all JNKs. However, whether the common JNK signaling pathway regulates the brain's control of social behavior remains unclear. Here, we show that female mice in which Mkk7 is deleted specifically in mature neurons (Mkk7^flox/floxSyn‐Cre mice) give birth to a normal number of pups but fail to raise them due to a defect in pup retrieval. To explore the mechanism underlying this abnormality, we performed comprehensive behavioral tests. Mkk7^flox/floxSyn‐Cre mice showed normal locomotor functions and cognitive ability but exhibited depression‐like behavior. cDNA microarray analysis of mutant brain revealed an altered gene expression pattern. Quantitative RT‐PCR analysis demonstrated that mRNA expression levels of genes related to neural signaling pathways and a calcium channel were significantly different from controls. In addition, loss of neural MKK7 had unexpected regulatory effects on gene expression patterns in oligodendrocytes. These findings indicate that MKK7 has an important role in regulating the gene expression patterns responsible for promoting normal social behavior and staving off depression.