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.
The first 1000 days of life are a critical period for neurodevelopment (Cusick and Georgieff, 2016; Schwarzenberg et al., 2018), and are sensitive to maternal factors and an adverse early environment (Suzuki, 2018). Mental disorders are an important contributor to the overall burden of 04disease in the world (Charlson et al., 2019). Perinatal mental illness was defined as maternal psychiatric disorders that existed before and persisting into pregnancy, or emerged during pregnancy, or in the postpartum period (O'Hara and Wisner, 2014). Depression affected 7.4–12.8 % (Bennett et al., 2004) of pregnant women, while anxiety affected 18.2–24.6 % (Dennis et al., 2017) of pregnant women. Prenatal maternal adversities might increase fetal corticoid levels by interrupting hypothalamic-pituitary-adrenal (HPA) axis, and “program” impaired fetal neural structures and functions (Bronson and Bale, 2016; Gluckman et al., 2010; O'Donnell and Meaney, 2017). Previous studies had reported that maternal perinatal mental illnesses, including single or combined depression (Rogers et al., 2020), anxiety (Rees et al., 2019) and perceived stress (Graignic-Philippe et al., 2014), were associated with adverse infant neurodevelopment in language (Rogers et al., 2020), cognitive (Wu et al., 2022), motor (Simcock et al., 2018), adaptive behavior (Rogers et al., 2020) or social-emotional (Porter et al., 2019) competences. However, the associations were less evident when comparing the types of prenatal and postpartum maternal mental problems with different domains of infant neurodevelopment domains (Burger et al., 2020). Most previous studies used self-report evaluation of child development and limited tools to take into account infant sex differences in early child development (Azak, 2012; Simcock et al., 2018) or possible mediation of postpartum depression in associations (Lahti et al., 2017), especially in low and middle income countries (LAMICs) (Burger et al., 2020).
Prenatal maternal mental problems were associated with less optimal infant early neurodevelopment including social-emotional, communication, cognition, and motor competences in the first 2 years, with strong effects on social-emotional development in both boys and girls. The sex modification effect appeared in the associations. Prenatal period is an important susceptible window for the effect of maternal depression on infant neurodevelopment. Postpartum depression had limited mediation and joint effects. This study underscores the importance of intervention in mothers' emotions during pregnancy to optimize child neuropsychiatric.