Maternal depression and cortisol in pregnancy predict offspring emotional reactivity in the preschool period

The Interplay between Maternal Depression and ADHD Symptoms in Predicting Emotional and Attentional Functioning in Toddlerhood

Depression and ADHD frequently co-occur, presenting unique challenges such as difficulties in executive functioning and reduced quality of life. Both conditions are also associated with less optimal parenting behaviors. Despite the prevalence of this comorbidity, the combined effects of maternal depressive symptoms and ADHD on child development remain underexplored, particularly in early childhood, a critical period marked by heightened brain plasticity and reliance on external regulation. This study examines how maternal depression and ADHD symptoms jointly predict children's emotional and attentional development across the first two years of life. A sample of 156 mothers and children (51% boys) participated in a three-wave longitudinal study from pregnancy to two years postpartum. Maternal ADHD symptoms were reported during pregnancy, while depressive symptoms were reported at pregnancy, three months, and two years postpartum. At two years of age, child depressive symptoms were reported by mothers, and focused attention was observed during a structured play session. Findings revealed that the combination of high maternal ADHD and depressive symptoms in the perinatal period predicted the most significant difficulties in children at two years of age, including elevated depressive symptoms and reduced focused attention. Specifically, maternal depressive symptoms were associated with greater child depressive symptoms and lower focused attention only when maternal ADHD symptoms were elevated. These results highlight the compounding effects of maternal psychopathology on child development, emphasizing the importance of targeted support for children at heightened risk of emotional and cognitive impairments due to parental psychopathology.

Safety in treatment: Classical pharmacotherapeutics and new avenues for addressing maternal depression and anxiety during pregnancy

We aimed to review clinical research on the safety profiles of antidepressant drugs and associations with maternal depression and neonatal outcomes. We focused on neuroendocrine changes during pregnancy and their effects on antidepressant pharmacokinetics. Pregnancy-induced alterations in drug disposition and metabolism impacting mothers and their fetuses are discussed. We considered evidence for the risks of antidepressant use during pregnancy. Teratogenicity associated with ongoing treatment, new prescriptions during pregnancy, or pausing medication while pregnant was examined. The Food and Drug Administration advises caution regarding prenatal exposure to most drugs, including antidepressants, largely owing to a dearth of safety studies caused by the common exclusion of pregnant individuals in clinical trials. We contrasted findings on antidepressant use with the lack of treatment where detrimental effects to mothers and children are well researched. Overall, drug classes such as selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors appear to have limited adverse effects on fetal health and child development. In the face of an increasing prevalence of major mood and anxiety disorders, we assert that individuals should be counseled before and during pregnancy about the risks and benefits of antidepressant treatment given that withholding treatment has possible negative outcomes. Moreover, newer therapeutics, such as ketamine and κ-opioid receptor antagonists, warrant further investigation for use during pregnancy. SIGNIFICANCE STATEMENT: The safety of antidepressant use during pregnancy remains controversial owing to an incomplete understanding of how drug exposure affects fetal development, brain maturation, and behavior in offspring. This leaves pregnant people especially vulnerable, as pregnancy can be a highly stressful experience for many individuals, with stress being the biggest known risk factor for developing a mood or anxiety disorder. This review focuses on perinatal pharmacotherapy for treating mood and anxiety disorders, highlighting the current knowledge and gaps in our understanding of consequences of treatment.

Associations of gestational anxiety and depression with neonatal hair steroid levels

OBJECTIVE

To investigate the association prenatal maternal depression and anxiety may have on the levels of neonatal hair steroids (i.e. cortisol, cortisone, and the cortisol/cortisone ratio) at birth.

METHODS

Altogether, 271 mother-infant pairs derived from the Finnish Kuopio Birth Cohort Study were assessed for maternal depression and anxiety using the Edinburgh Postnatal Depression Scale (EPDS: EPDS-10 for depression, EPDS-3A for anxiety) during the first (T1) and third (T3) trimesters. The levels of cortisol and cortisone were determined from neonatal hair samples obtained at birth. Linear mixed models adjusted for sex, preterm birth, smoking during pregnancy, and gestational diabetes were used.

RESULTS

Neither T1 nor T3 EPDS-10 predicted the levels of neonatal hair steroids. T3 EPDS-3A (p = 0.012), but not T1 EPDS-3A, was linked to reduced neonatal hair cortisol levels. Neither T1 nor T3 EPDS-3A were significant predictors of neonate cortisone levels or cortisol/cortisone ratios.

CONCLUSION

Prenatal maternal anxiety, but not depression, may lead to pronounced alterations in some markers of fetal stress systems. Future research should further determine whether prenatal maternal symptoms of anxiety would form an optimal intervention target in order to attenuate fetal stress responses.

Sleep During Pregnancy and Offspring Outcomes From Infancy to Childhood: A Systematic Review

OBJECTIVE

Prenatal sleep problems have been previously linked to poor birth outcomes. However, much less is known about the associations between poor prenatal maternal sleep and offspring outcomes after birth. The purpose of this systematic review was to synthesize the findings linking prenatal maternal sleep health and offspring health and development during infancy and childhood.

METHODS

A total of 4650 nonduplicate articles were identified via PsycInfo and PubMed databases. After screening and full-text review, 34 articles met the inclusion criteria and were extracted for information.

RESULTS

The bulk of studies in this review (n = 19; 76.5%) were published between 2019 and 2024. Measures of prenatal sleep included sleep timing, quality, sleep disorders and/or symptoms of disorders, and daytime sleepiness. Offspring outcomes were categorized as follows: a) sleep health (e.g., nighttime sleep duration, night wakings), b) physical health (e.g., body mass index, hospitalizations), c) child developmental outcomes (e.g., global development, negative affect, executive functioning), and d) brain structure and function (e.g., brain volume, event-related potentials). Evidence consistently links poor prenatal sleep health to poorer offspring sleep, higher body mass index, higher prevalence of physical health conditions, poorer global development, and more behavioral problems. Emerging evidence also links prenatal sleep to differences in offspring brain structure and function.

CONCLUSIONS

Poor prenatal maternal sleep health may be an environmental signal that informs offspring health. Future studies are needed to fully understand the pervasive, intergenerational, and long-lasting effects of sleep across pregnancy.

Stress reactivity moderates the association between early experiences of unpredictability and emotional problems in adolescents

Researchers have documented that exposure to different kinds of psychosocial stressors can lead to emotional difficulties and, further, that heightened reactivity to stress can moderate these associations. Recently, investigators have distinguished among threat, deprivation, and unpredictability as different dimensions of early life stress (ELS). It is not clear, however, whether reactivity in specific stress response systems functions as a diathesis to lead to emotional difficulties following exposure to these dimensions of ELS. In this study (N = 154) we examined whether stress reactivity, assessed across different psychobiological systems during the Trier Social Stress Test, is a unitary or multidimensional construct, and if reactivity differentially moderates the associations between ELS dimensions and adolescents' susceptibility to emotional and behavioral problems two years later. A factor analysis conducted on stress reactivity measures yielded two factors: one composed of reactivity in heart rate, heart rate variability, and cortisol, and one composed of reactivity in skin conductance and self-reported mood. These two factors independently moderated the associations between early unpredictability and subsequent emotional problems. For each factor, the combination of higher unpredictability and higher stress reactivity predicted higher emotional problems; stress reactivity factors were not significant moderators of the effects of threat and deprivation. Our findings suggest that increased stress reactivity, assessed across several domains of functioning, functions as a diathesis that interacts with ELS characterized by unpredictability to predict subsequent mental health difficulties in adolescents and, further, that low stress reactivity buffers against mental health difficulties in adolescents who have experienced unpredictability early in life.

Maternal adverse childhood experiences and infant visual-limbic white matter development

BACKGROUND

Maternal adverse childhood experiences (ACEs) are robust predictors of mental health for both the exposed individual and the next generation; however, the pathway through which such intergenerational risk is conferred remains unknown. The current study evaluated the association between maternal ACEs and infant brain development, including an a priori focus on circuits implicated in emotional and sensory processing.

METHODS

The sample included 101 mother-infant dyads from a longitudinal study. Maternal ACEs were assessed with the Adverse Childhood Questionnaire dichotomized into low (0 or 1) and high (≥2) groups. White matter microstructure, as indexed by fractional anisotropy (FA), was assessed using structural magnetic resonance imaging in infants (41.6-46.0 weeks' postconceptional age) within a priori tracts (the cingulum, fornix, uncinate, inferior frontal occipital fasciculus, and inferior longitudinal fasciculus). Exploratory analyses were also conducted across the whole brain.

RESULTS

High maternal ACEs (≥2) were associated with decreased infant left inferior longitudinal fasciculus (ILF) FA (F(1,94) = 7.78, p < .006) relative to infants of low ACE mothers. No group difference was observed within the right ILF following correction for multiple comparisons (F(1,95) = 4.29, p < .041). Follow-up analyses within the left ILF demonstrated associations between high maternal ACEs and increased left radial diffusivity (F(1,95) = 5.10, p < .006). Exploratory analyses demonstrated preliminary support for differences in visual processing networks (e.g., optic tract) as well as additional circuits less frequently examined in the context of early life adversity exposure (e.g., corticothalamic tract).

CONCLUSIONS

Maternal ACEs predict neural circuit development of the inferior longitudinal fasciculus. Findings suggest that early developing sensory circuits within the infant brain are susceptible to maternal adverse childhood experiences and may have implications for the maturation of higher-order emotional and cognitive circuits.

Early life stress and iron metabolism in developmental psychoneuroimmunology

An estimated 250 million children face adverse health outcomes from early life exposure to severe or chronic social, economic, and nutritional adversity, highlighting/emphasizing the pressing concern about the link between ELS and long-term implications on mental and physical health. There is significant overlap between populations experiencing high levels of chronic stress and those experiencing iron deficiency, spotlighting the potential role of iron as a key mediator in this association. Iron, an essential micronutrient for brain development and immune function, is often depleted in stress conditions. Iron deficiency among the most common nutrient deficiencies in the world. Fetal and infant iron status may thus serve as a crucial intermediary between early chronic psychological stress and subsequent immune system changes to impact neurodevelopment. The review presents a hypothesized pathway between early life stress (ELS), iron deficiency, and neurodevelopment through the hypothalamic-pituitary-adrenocortical (HPA) axis and the IL-6-hepcidin axis. This hypothesis is derived from (1) evidence that stress impacts iron status (2) long-term neurodevelopmental outcomes that are shared by ELS and iron deficiency exposure, and (3) possible mechanisms for how iron may mediate the relation between ELS and iron deficiency through alterations in the developing immune system. The article concludes by proposing future research directions, emphasizing the need for rigorous studies to elucidate how stress and iron metabolism interact to modify the developing immune system. Understanding these mechanisms could open new avenues for improving human health and neurodevelopment for women and children globally, making it a timely and vital area of study in psychoneuroimmunology research.

Neonatal Hair Cortisol and Birth Outcomes: An Empirical Study and Meta-Analysis

OBJECTIVE

Prenatal stress physiology is often posited as a predictor of birth outcomes, including gestational age at birth and birthweight. However, research has predominantly relied on indicators in the maternal system, with few studies examining hormones of the fetal system. The current study focuses on fetal cortisol in the third trimester, as measured in neonatal hair, as a biological factor that might be associated with birth outcomes (gestational age at birth and birthweight). We report findings from two studies: a longitudinal cohort (Study 1), and a meta-analysis of the existing literature (Study 2).

METHODSSTUDY

Hair was collected for cortisol analysis from 168 neonates (55.95% female) shortly after birth. Gestational age at birth and birthweight were abstracted from medical records.

METHODSSTUDY

An exhaustive search of four databases was conducted, yielding 155 total studies for screening. Papers reporting neonatal hair cortisol (collection <2 weeks postpartum) and birth outcomes among human neonates were retained for analysis, including Study 1 results ( k = 9).

RESULTSSTUDY

Higher neonatal hair cortisol was related to longer gestation ( r = 0.28, p < .001) and higher birthweight, r = 0.16, p = .040. Sex did not moderate either association.

RESULTSSTUDY

Across the nine studies, higher neonatal hair cortisol predicted both longer gestation ( r = 0.35, p < .001, 95% confidence interval = 0.24-0.45) and higher birthweight ( r = 0.18, p = .001, 95% confidence interval = 0.07-0.28). Neonatal sex did not moderate these associations.

CONCLUSIONS

Fetal cortisol exposure in the third trimester plays a role in normative maturation of the fetus, and findings reveal that higher cortisol is associated with positive birth outcomes.

Maternal Adversity and Epigenetic Age Acceleration Predict Heightened Emotional Reactivity in Offspring: Implications for Intergenerational Transmission of Risk

Black American women are disproportionately exposed to adversities that may have an intergenerational impact on mental health. The present study examined whether maternal exposure to adversity and epigenetic age acceleration (EAA; a biomarker of stress exposure) predicts the socioemotional health of her offspring. During pregnancy, 180 Black American women self-reported experiences of childhood adversity and marginalization-related adversity (i.e., racial discrimination and gendered racial stress) and provided a blood sample for epigenetic assessment. At a three-year follow-up visit, women reported their offspring's emotional reactivity (an early indicator of psychopathology) via the CBCL/1.5-5. After adjusting for maternal education and offspring sex, results indicated that greater maternal experiences of childhood trauma (β = 0.21, SE(β) = 0.01; p = 0.01) and racial discrimination (β = 0.14, SE(β) = 0.07; p = 0.049) predicted greater offspring emotional reactivity, as did maternal EAA (β = 0.17, SE(β) = 0.09, p = 0.046). Our findings suggest that maternal EAA could serve as an early biomarker for intergenerational risk conferred by maternal adversity, and that 'maternal adversity' must be defined more broadly to include social marginalization, particularly for Black Americans.

Associations of prenatal maternal depressive symptoms with cord blood glucocorticoids and child hair cortisol levels in the project viva and the generation R cohorts: a prospective cohort study

BACKGROUND

Prior studies have reported conflicting results regarding the association of prenatal maternal depression with offspring cortisol levels. We examined associations of high levels of prenatal depressive symptoms with child cortisol biomarkers.

METHODS

In Project Viva (n = 925, Massachusetts USA), mothers reported their depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy, cord blood glucocorticoids were measured at delivery, and child hair cortisol levels were measured in mid-childhood (mean (SD) age: 7.8 (0.8) years) and early adolescence (mean (SD) age: 13.2 (0.9) years). In the Generation R Study (n = 1644, Rotterdam, The Netherlands), mothers reported depressive symptoms using the Brief Symptom Inventory (BSI) during pregnancy, and child hair cortisol was measured at a mean (SD) age of 6.0 (0.5) years. We used cutoffs of ≥ 13 for the EPDS and > 0.75 for the BSI to indicate high levels of prenatal depressive symptoms. We used multivariable linear regression models adjusted for child sex and age (at outcome), and maternal pre-pregnancy BMI, education, social support from friends/family, pregnancy smoking status, marital status, and household income to assess associations separately in each cohort. We also meta-analyzed childhood hair cortisol results from both cohorts.

RESULTS

8.0% and 5.1% of women respectively experienced high levels of prenatal depressive symptoms in Project Viva and the Generation R Study. We found no associations between high levels of maternal depressive symptoms during pregnancy and child cortisol biomarkers in either cohort.

CONCLUSIONS

The present study does not find support for the direct link between high levels of maternal depressive symptoms and offspring cortisol levels.

Increases in maternal depressive symptoms during pregnancy and infant cortisol reactivity: Mediation by placental corticotropin-releasing hormone

BACKGROUND

Maternal depressive symptoms in pregnancy may affect offspring health through prenatal programming of the hypothalamic-pituitary-adrenal (HPA) axis. The biological mechanisms that explain the associations between maternal prenatal depressive symptoms and offspring HPA axis regulation are not yet clear. This pre-registered investigation examines whether patterns of maternal depressive symptoms in pregnancy are associated with infant cortisol reactivity and whether this association is mediated by changes in placental corticotropin-releasing hormone (pCRH).

METHOD

A sample of 174 pregnant women completed assessments in early, mid, and late pregnancy that included standardized measures of depressive symptoms and blood samples for pCRH. Infant cortisol reactivity was assessed at 1 and 6 months of age.

RESULTS

Greater increases in maternal depressive symptoms in pregnancy were associated with higher cortisol infant cortisol reactivity at 1 and 6 months. Greater increases in maternal depressive symptoms in pregnancy were associated with greater increases in pCRH from early to late pregnancy which in turn were associated with higher infant cortisol reactivity.

CONCLUSIONS

Increases in maternal depressive symptoms and pCRH over pregnancy may contribute to higher infant cortisol reactivity. These findings help to elucidate the prenatal biopsychosocial processes contributing to offspring HPA axis regulation early in development.

The Interaction between Psychological Stress and Iron Status on Early-Life Neurodevelopmental Outcomes

This review presents evidence from animal and human studies demonstrating the possible connection and significant impact of poor iron status and psychological distress on neurocognitive development during pregnancy and the neonatal period, with implications for long-term cognition. Stress and iron deficiency are independently prevalent and thus are frequently comorbid. While iron deficiency and early-life stress independently contribute to long-term neurodevelopmental alterations, their combined effects remain underexplored. Psychological stress responses may engage similar pathways as infectious stress, which alters fundamental iron metabolism processes and cause functional tissue-level iron deficiency. Psychological stress, analogous to but to a lesser degree than infectious stress, activates the hypothalamic-pituitary-adrenocortical (HPA) axis and increases proinflammatory cytokines. Chronic or severe stress is associated with dysregulated HPA axis functioning and a proinflammatory state. This dysregulation may disrupt iron absorption and utilization, likely mediated by the IL-6 activation of hepcidin, a molecule that impedes iron absorption and redistributes total body iron. This narrative review highlights suggestive studies investigating the relationship between psychological stress and iron status and outlines hypothesized mechanistic pathways connecting psychological stress exposure and iron metabolism. We examine findings regarding the overlapping impacts of early stress exposure to iron deficiency and children's neurocognitive development. We propose that studying the influence of psychological stress on iron metabolism is crucial for comprehending neurocognitive development in children exposed to prenatal and early postnatal stressors and for children at risk of early iron insufficiency. We recommend future directions for dual-exposure studies exploring iron as a potential mediating pathway between early stress and offspring neurodevelopment, offering opportunities for targeted interventions.

Prenatal stress and child externalizing behavior: effects of maternal perceived stress and cortisol are moderated by child sex

BACKGROUND

Externalizing behavior problems are related to social maladjustment. Evidence indicates associations between prenatal stress and child behavioral outcomes. It remains unclear how psychological distress vs. biological correlates of stress (cortisol) differentially predict externalizing behavior, and how their effects might differ as a function of child sex.

METHOD

108 pregnant women from the community collected salivary cortisol and reported their perceived stress during each trimester of pregnancy. At child age 9 years (M = 9.01, SD = 0.55), 70 mothers and children reported on child behavior. Structural equation modelling was used to analyze how cortisol levels and perceived stress during pregnancy predicted current child externalizing behavior, considering the moderating effect of child sex.

RESULTS

Perceived stress predicted higher externalizing behavior in boys (β = 0.42, p = 0.009) and lower externalizing behavior in girls (β = - 0.56, p = 0.014). Cortisol predicted lower externalizing behavior in boys (β = - 0.81, p < .001) and was not related to girls' externalizing behavior (β = 0.37, p = 0.200).

DISCUSSION/CONCLUSION

Prenatal stress affected externalizing behavior differently in girls vs. boys. These response patters in turn differed for indicators of psychological vs. biological maternal stress, encouraging an integrated approach. Findings indicate that perceived stress and cortisol may affect child development via different trajectories.

Mother-infant interaction and maternal postnatal psychological distress are associated with negative emotional reactivity among infants and toddlers- A FinnBrain Birth Cohort study

Studies have reported mixed findings regarding the effects of mother-infant interaction and maternal distress on children's negative emotional reactivity. In the current study (N = 134 and 107), we examined the effects of maternal Emotional Availability (sensitivity, structuring, non-intrusiveness and non-hostility) and maternal psychological distress on negative reactivity among children in the FinnBrain birth cohort study. In addition, the possible moderating effect of mother-infant interaction on the associations between maternal psychological distress and children's negative reactivity was examined. We used questionnaires to asses maternal psychological distress, observations of mother-infant interaction and observations as well maternal reports of child temperament to overcome the key limitations of many studies relying on single-method assessments. Our results showed that higher maternal sensitivity and structuring at 8 months of child's age were associated with lower mother-reported negative reactivity among children at 24 months. Higher maternal postnatal distress associated with higher parent-reported negative reactivity in children at 12 and 24 months of age when the effects of prenatal distress and the quality of mother-infant interaction were controlled for. Mother-infant interaction and maternal psychological distress did not associate with observations of child negative reactivity. We found no moderation effects of mother-infant interaction regarding the associations between maternal distress and children's negative emotional reactivity. Our findings reflect the importance of developing interventions to reduce the maternal distress symptoms while enhancing maternal sensitivity and structuring to prevent the possible harmful effects of these on child negative reactivity.

Maternal Mental Health Care Matters: The Impact of Prenatal Depressive and Anxious Symptoms on Child Emotional and Behavioural Trajectories in the French EDEN Cohort

Few studies have investigated longitudinal trajectories of child socioemotional and behavioural development in relation to maternal prenatal mental health exposure or taken into consideration of the potential buffering effects of psychological intervention during pregnancy. Using data from 1135 mother-child dyads from the EDEN cohort from the general French population, Group-based trajectory modelling was used to model trajectories of behavioural and emotional characteristics measured at four timepoints via a parent-administered Strengths and Difficulties Questionnaire. Using propensity scores and inverse probability weighting to account for confounding factors, multinomial logistic regressions were used to quantify the associations with maternal symptoms of prenatal depression and anxiety. Stratified analyses were conducted by reporting psychologist and psychiatrist consultations during pregnancy. Compared to those without psychological problems, children of mothers with comorbid anxiety and depression retained a higher probability of following high and intermediate trajectories of emotional problems and a high trajectory of conduct problems throughout childhood. This increased risk was not present in the children of mothers who sought support through a prenatal psychologist or psychiatrist consultation. This article adds to a body of evidence underlining the importance of mental health care for expecting mothers.

Expectant parents' emotions evoked by pregnancy: A longitudinal dyadic analysis of couples in the Swedish Pregnancy Panel

RATIONALE

Holistic antenatal care requires knowledge of individuals' emotional response to pregnancy. Little is known about how a pregnant woman and her partner influence each other emotionally during a pregnancy.

OBJECTIVE

This study examines six discrete emotions that expectant couples experience during pregnancy, how these emotions change mid-to late-pregnancy, and whether the partners' emotional responses influence each other.

METHODS

A longitudinal dyadic study where pregnant women and their partners (1432 couples) rated the extent to which the pregnancy evoked joy, strength, security, worry, shame, and anger at pregnancy week 12-19, 22-24, and 36. Latent curve models with structured residuals identify levels of and change in these emotions over time, while accounting for between- and within-couple variance.

RESULTS

Pregnancy evoked mainly joy, strength, security, and worry, and lower levels of anger and shame. Pregnant women and partners felt similar levels of joy, strength, and security, but pregnant women felt more worry, shame, and anger. There was little to no mean-level change in all six measured emotions evoked by pregnancy (between-couple change), and no reciprocal effects between the partners (within-couple change).

CONCLUSIONS

Emotions in mid-pregnancy were also felt in late pregnancy. Furthermore, the pregnant woman and her partner have individual emotional trajectories. The results can assist healthcare professionals and researchers target interventions to expectant mothers and partners, specifically by understanding emotional response to pregnancy as a stable confound and by not approaching the couple as one emotional unit.

Evaluating depression and anxiety throughout pregnancy and after birth: impact of the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic presents unique social, economic, and psychological challenges for individuals globally. Thus, women who are pregnant face unprecedented mental health challenges.

OBJECTIVE

We sought to determine the impact of the pandemic on perinatal depression and anxiety in a longitudinal pregnancy cohort. We hypothesized increased depression and anxiety scores in women during pregnancy and after birth in the pandemic at all time points.

STUDY DESIGN

Participants were enrolled in the Ontario Birth Study, a pregnancy cohort embedded in clinical care at Mount Sinai Hospital, Toronto, Canada. Perinatal depression and anxiety were assessed using the 2-Item Patient Health Questionnaire and 2-Item Generalized Anxiety Disorder Questionnaire in early pregnancy, whereas the Edinburgh Postnatal Depression Scale and 2-Item Generalized Anxiety Disorder Questionnaire were used in late pregnancy and after birth. Logistic regression models were created to examine the association of the pandemic with clinically elevated mental health scores in the prepandemic group vs pandemic group while adjusting for covariates.

RESULTS

A total of 1159 survey responses from 649 participants between March 1, 2019, and February 28, 2021, were used to conduct this study. Participants were assessed in early pregnancy (n=416), in late pregnancy (n=373), and after birth (n=370). Responses received on or before February 29, 2020, were considered the “prepandemic” responses, whereas responses after the aforementioned date were considered the “pandemic” responses. Mean rank scores of depression and anxiety were significantly higher in the pandemic group (P=.02 and P=.003, respectively) in the postpartum period. There was no significant association between pandemic time and antenatal scores. However, postnatally, mothers were 2.6 times more likely to score ≥13 on the Edinburgh Postnatal Depression Scale during the pandemic than before the pandemic (95% confidence interval, 1.2–5.7; P=.02). Adjustment for ethnicity and income strengthened this association as the odds ratio increased to 3.3 (95% confidence interval, 1.4–8.0; P=.007).

CONCLUSION

Pandemic-associated increases in depression and anxiety scores were confined to the postpartum period, highlighting a need for increased screening and interventions for perinatal mood and anxiety disorders postnatally as this pandemic continues.

Basal and reactive cortisol: A systematic literature review of offspring of parents with depressive and bipolar disorders

One of the most consistent biological findings in the study of affective disorders is that those with depression commonly show abnormal cortisol response, which suggests dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Children of parents with mood disorders offer the opportunity to explore the biological pathways that may confer risk for psychopathology. This review explores basal and reactive cortisol in the offspring of parents who are currently depressed or have had a history of a depressive or bipolar disorder. Using PRISMA guidelines, search terms yielded 2002 manuscripts. After screening, 87 of these manuscripts were included. Results from the literature suggest that while the degree and direction of dysregulation varies, offspring of a parent with depression tend to show elevations in both basal (particularly morning and evening) and reactive (tentatively for social stressors) cortisol levels. There were few studies focused on offspring of parents with bipolar disorder. This review also discusses implications and recommendations for future research regarding the HPA axis in the intergenerational transmission of depressive disorders.

Inflammatory modulation of the associations between prenatal maternal depression and neonatal brain

Inflammatory signaling has a role in sensing intrauterine environment, which may be moderators in altering fetal brain development upon maternal environment. This study integrated cytokine transcriptome of post-mortem fetal brains, neonatal brain imaging and genetic variants (n = 161) to examine whether cytokines are candidates for modulating the relationship between prenatal maternal depression and fetal brain development. This study obtained the transcriptome data of 208 cytokine genes in 12 fetal brain regions from the BrainSpan database. We also included 161 mother-child dyads with prenatal maternal depressive symptoms assessed at 26 weeks of gestation, cytokine genotype data extracted from umbilical cord specimens, and neonatal brain images from a longitudinal prospective birth cohort. We revealed that 22 cytokine genes are expressed in specific brain regions in utero, whose variants have roles in modulating the effects of the prenatal environment on the accelerated fetal development of the hippocampus, auditory, parietal, orbitofrontal, and dorsal prefrontal cortex. Neonates high in the genetic expression score (GES) of TNFRSF19 and IL17RB showed a larger right hippocampal volume, high in the GES of BMPR1B showed the thicker thickness of the sensorimotor cortex, and high in the GES of IL1RAP and CXCR4 demonstrated the thicker thickness of the dorsal and orbital prefrontal cortex in relation with greater prenatal maternal depressive symptoms. Our findings suggest that in humans, the cytokine genes are expressed in a brain region-specific manner in utero and may have potential roles in modulating the fetal development of the corresponding brain regions in response to the maternal environment.

School-age social behavior and pragmatic language ability in children with prenatal serotonin reuptake inhibitor exposure

Studies examining associations between fetal serotonin reuptake inhibitor (SRI) exposure and child autism spectrum disorder (ASD) diagnoses or delayed language remain mixed and rarely prospectively follow children or employ gold-standard assessments. We prospectively followed a cohort of mother-child dyads from pregnancy through early elementary school (N = 178), and obtained maternal and alternate-caregiver ratings of behaviors related to ASD (N = 137), as well as direct, gold-standard assessments of child ASD symptoms and pragmatic language among dyads who experienced prenatal depression and either took SRIs or were medication free during pregnancy (N = 44). Prenatal SRI exposure was related to maternal ratings of ASD-related behaviors (β = 0.24 95% confidence interval; CI [0.07, 0.48]), and, among boys, alternative caregiver ratings (males-only β = 0.28 95% CI [0.02, 0.55], females-only β = -0.21 95% CI [-0.63, 0.08]). However, results of our direct assessments suggest an association between SRI exposure and reduced pragmatic language scores (β = -0.27, 95% CI [-0.53, -0.01], but not ASD (Autism Diagnostic Observation Schedule β = 0.14 95% CI [-0.15, 0.41]; Social Responsiveness Scale β = 0.08 95% CI [-0.25, 0.40]). These discrepancies point to issues regarding how ASD is assessed, and the possibility that SRIs may be more strongly associated with language or other broader behaviors that coincide with ASD. Larger prospective studies that incorporate thorough, gold-standard assessments of ASD, language, and other ASD-related behaviors are needed.

Maternal Depressive Symptoms During Pregnancy and Brain Age in Young Adult Offspring: Findings from a Prenatal Birth Cohort

Maternal depression during pregnancy is associated with elevated risk of anxiety and depression in offspring, but the mechanisms are incompletely understood. Here we conducted a neuroimaging follow-up of a prenatal birth cohort from the European Longitudinal Study of Pregnancy and Childhood (n = 131; 53% women, age 23–24) to test whether deviations from age-normative structural brain development in young adulthood may partially underlie this link. Structural brain age was calculated based on previously published neuroanatomical age prediction models using cortical thickness maps from healthy controls aged 6–89. Brain age gap was computed as the difference between chronological and structural brain age. Participants also completed self-report measures of anxiety and mood dysregulation. Further, mothers of a subset of participants (n = 103, 54% women) answered a self-report questionnaire in 1990–1992 about depressive symptoms during pregnancy. Higher exposure to maternal depressive symptoms in utero showed a linear relationship with elevated brain age gap, which showed a quadratic relationship with anxiety and mood dysregulation in the young adult offspring. Our findings suggest that exposure to maternal depressive symptoms in utero may be associated with accelerated brain maturation and that deviations from age-normative structural brain development in either direction predict more anxiety and dysregulated mood in young adulthood.

Neural correlates of emotion processing predict resilience in youth at familial risk for mood disorders

Aberrant face emotion processing has been demonstrated in youth with and at a familial risk for bipolar and major depressive disorders. However, the neurobiological factors related to emotion processing that underlie resilience from youth-onset mood disorders are not well understood. Functional magnetic resonance imaging data during an implicit emotion processing task were collected at baseline from a sample of 50 youth, ages 8-17, who were healthy but also familially at high risk for either bipolar disorder or major depressive disorder, and 24 healthy controls with no family history of psychopathology (HCL). Participants were reevaluated 3 years later and classified into three groups for analysis: high-risk youth who converted to a psychiatric diagnosis (CVT; N = 23), high-risk youth who were resilient from developing any psychopathology (RES; N = 27), and HCL youth (N = 24) who remained healthy at follow-up. For happy > calm faces, the CVT and RES groups had significantly lower activation in the left inferior parietal lobe (IPL), while the RES group had lower activation in the right supramarginal gyrus. For fear > calm faces, the RES group had lower activation in the right precuneus and inferior frontal gyrus (IFG) compared to the CVT group. Connectivity analyses revealed the RES group exhibited higher left IPL connectivity with visual cortical regions for happy > calm faces, and higher IFG connectivity with frontal, temporal, and limbic regions for fear > calm faces. These connectivities were correlated with improvements in prosocial behaviors and global functioning. Our findings suggest that differential activation and connectivity in the IPL, IFG, and precuneus in response to emotional stimuli may represent distinct resilience and risk markers for youth-onset mood disorders.

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.

Does Prenatal Maternal Distress Contribute to Sex Differences in Child Psychopathology?

PURPOSE OF REVIEW

Prenatal maternal psychological distress is an established risk factor for the development of psychopathology in offspring. The purpose of this review is to evaluate whether sex differences in fetal responses to maternal distress contribute to sex differences in subsequent psychopathology.

RECENT FINDINGS

Male and female fetuses respond differently to stress signals. We review recent evidence that demonstrates a sex-specific pattern of association between prenatal maternal distress and pathways associated with risk for psychopathology including offspring hypothalamic pituitary adrenocortical (HPA) axis regulation, brain development, and negative emotionality. Prenatal maternal distress exerts sex-specific consequences on the fetus. These differences may contribute to the well-established sex differences in psychopathology and in particular to greater female vulnerability to develop internalizing problems.

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.