Prenatal stress may have adverse effects on children’s mental health

Prenatal affective symptoms and stress may have a direct impact on children’s mental health, according to study findings published in Journal of the American Academy of Child & Adolescent Psychiatry.

“We already understood that the foundations for lifelong mental health are laid in the very first years of life, but we have further validated the idea that prenatal stress, the mother’s psychological well-being during pregnancy, is an important factor,” Ashley Wazana, MD, director of the Early Childhood Disorders Day Hospital at Jewish General Hospital in Montreal, said in a press release. “With data to support the impact of prenatal stress, we can look at protective measures that could help mothers to insulate their babies.”

Prior studies have provided insight into the underlying dimensions of maternal mood problems by focusing on the postnatal period and utilizing the widely used Edinburgh Postnatal Depression Scale (EPDS). Researchers suggested two or three underlying symptom dimensions distinguish items that represent anxiety from those that represent anhedonia or depression. However, Wazana and colleagues noted that important gaps remain in the literature, including the following:

• Most studies have not addressed the high correlation between symptom dimensions.

• It remains unknown whether the same symptom dimensions would emerge when measures other than the EPDS are used.

• There is limited evidence regarding whether these dimensions can be found in prenatal depression.

In the current study, the investigators defined latent dimensions of women’s pregnancy-specific worries and prenatal affective symptoms to examine their association with early offspring psychopathology. They collected data of three cohorts of the Developmental Research in Environmental Adversity, Mental Health, Biological Susceptibility and Gender (DREAM BIG) consortium of longitudinal pregnancy cohorts. The three cohorts were the Avon Longitudinal Study of Parents and Children (n = 12,515), Generation R (n = 6,803) and the Canadian prenatal cohort Maternal Adversity, Vulnerability and Neurodevelopment (n = 578).

Wazana and colleagues assessed maternal prenatal affective symptoms and pregnancy-specific worries using different measures in each cohort. They used confirmatory factor analyses to determine whether comparable latent dimensions of prenatal maternal affective symptoms existed across cohorts. Using structural equations models, they examined cohort-specific associations between offspring psychopathology, including general psychopathology and specific internalizing and externalizing problems, and latent dimensions at ages 4 to 8 years. Lastly, they used inverse variance-weighing in a meta-analysis of cohort-based estimates.

Results showed similarities among all cohorts regarding four prenatal maternal factors — a general affective symptoms factor, an anxiety/depression factor, a somatic factor and a pregnancy-specific worries factor. Meta-analyses revealed independent associations with offspring general psychopathology for the general affective symptoms factor and the pregnancy-specific worries factor. The researchers also observed an association between the general affective symptoms factor and offspring specific internalizing problems. They observed no associations with specific externalizing problems.

"We believe that mental health ought to be a fundamental part of prenatal health," Wazana said in the release. "Pregnancy is not a cocoon and stress can be an important factor in childhood mental health. We need to appreciate the importance of mental health needs across the lifespan, starting with pregnancy. We would like to see mothers have access to prenatal mental health resources, but, unfortunately, the wait time for such services can be longer than the gestation period." – by Joe Gramigna

Disclosure: One study author reports being a paid contributing author of the Achenbach System of Empirically Based Assessment. The other authors report no relevant financial disclosures.