Key takeaways
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Researchers are gaining deeper insight into individual and combined impacts of maternal stress and depression during pregnancy on early childhood neurobehavioral outcomes.
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This study evaluated scores from validated, widely used assessments that were administered during early pregnancy visits and early childhood visits.
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Across all scenarios, high scores for both prenatal stress and depression were indicative of the least favorable neurobehavioral outcomes.
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Early screening and intervention for prenatal stress and depression can support long-term health outcomes for both mothers and children.
Research study background
Many studies have demonstrated that in utero exposure to maternal stress is associated with adverse neurobehavioral outcomes in children. However, most of this research focused on single assessments of psychosocial stress and didn’t account for the child’s home environment or represent a diverse population.
A multi-disciplinary team of experts from the Neuropsychology Program at Children's Hospital Colorado and the Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center on the University of Colorado Anschutz Medical Campus, sought to address these limitations and extend current literature. LEAD is focused on disrupting the intergenerational cycle of unfavorable health outcomes through research and impactful health practices.
“We know that what happens during pregnancy independently impacts the child not only during childhood but into adolescence and adulthood. With increasing recognition of the role of social and structural influences in shaping child health, research into how maternal social experiences, including how stress and mood during the prenatal period can literally “get under the skin” and shape multiple aspects of offspring health, is critically important.”
- WEI PERNG, PHD, MPH
As part of a LEAD’s Healthy Start Study (2010-2014), researchers analyzed data from 536 mother-child pairs and initially evaluated maternal nutrition's impact on cardiometabolic risk of offspring. Participants completed two widely used, validated emotional health assessments — the Edinburgh Postnatal Depression Scale (EPDS) and the Perceived Stress Scale (PSS) — at a research visit that took place during early pregnancy (less than 17 gestational weeks). They completed two additional assessments at an early childhood visit: the Child Behavior Checklist (CBCL) to screen for social, emotional and behavioral problems among offspring, and the Confusion, Hubbub, and Order Scale (CHAOS) questionnaire, which assesses the household environment.
Investigators first separately assessed associations of EDPS and PSS with six CBCL outcomes: total problems, internalizing behaviors, externalizing behaviors, anxious/depressed, anxiety problems and depressive problems. They then assessed the combined effect of both maternal prenatal assessments for high and low scores for depression and stress. Additionally, the CHOAS score was factored in for each scenario. They discovered that for every single-point increase in maternal EPDS and PSS scores, children's total problem scores rose by 0.72 or 0.75 points, respectively. This was indicative of adverse neurobehavioral outcomes. Further, the children of mothers with high EPDS and PSS scores had the highest total problem scores. These associations largely remained the same even after accounting for CHAOS scores.
Clinical implications
Clinicians should consider the relative ease of administering EDPS and PSS to screen for these common experiences during prenatal office visits. If prenatal stress or depression is identified, clinicians can offer pre-and post-natal resources such as supportive programs or therapy to benefit the long-term health of both mother and child. Further understanding of systemic and individual impacts on maternal stress will help identify the most vulnerable populations and guide targeted and community-level interventions.
Featured researchers
Greta Wilkening, PsyD, PhD
Director, Neuropsychology
Neuropsychology
Children’s Hospital Colorado
Professor
Pediatrics-Neurology
University of Colorado School of Medicine
Wei Perng PhD, MPH
Associate Professor of Epidemiology (with tenure), Associate Director of Research Training and Education at the Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center
Department of Epidemiology
University of Colorado School of Medicine
Dana Dabelea MD, PhD
Conrad M. Riley Endowed Professor, Director (LEAD Center)
Department of Epidemiology
University of Colorado School of Medicine
Satvinder Kaur Dhaliwal, PhD MPH
Epidemiologist
Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center
University of Colorado School of Medicine