Prenatal maternal stress, child internalizing and externalizing symptoms, and the moderating role of parenting: findings from the Norwegian mother, father, and child cohort study

Predicting 5-year-olds mental health at birth: development and internal validation of a multivariable model using the prospective ELFE birth cohort

We developed and internally validated a multivariable model to be used in the perinatal period, to predict 5-year-olds mental health, using the ELFE prospective French multicentre birth cohort (n=9768). Twenty-six candidate predictors were used, spanning pre-pregnancy maternal health, pregnancy-specific-experiences, birth factors and sociodemographic risk (maternal age, education, relationship, migrancy and family income). The Strengths and Difficulties Questionnaire total score at 5-years, dichotomised at the recommended cut-off (16), was the outcome. Least Absolute Shrinkage and Selector Operator followed by bootstrapping was used. High and low-risk was classified by ≥8% risk-threshold score. Stability of the model at population- and individual-level and model performance across groups of interest (sex, sociodemographic risk and neonatal intensive care admissions) was also examined. 10 variables (total number pregnancy-specific experiences, sociodemographic risk, maternal pre-existing hypertension and psychological difficulties, gravidity, maternal mental health problems in a previous pregnancy, smoking and alcohol use in current pregnancy, how labour started and infant sex) with a C-statistic of 0.67; 95%CI (0.64-0.69) predicted mental health. The positive and negative predictive value were 12% & 95.4% respectively, leading to 78.8% of children correctly classified. Model performance was similar across groups of interest but increased for children (born ≥33-weeks-gestation) with neonatal admissions (AUC 0.78; 95%CI (0.69-0.87)). This model is most useful for identifying low-risk children. Applying this model in a tiered preventative intervention framework could be beneficial with those predicted to be high-risk receiving further screening to determine the level of intervention required. External validation and implementation research are required before considering its use in practice.

Prenatal stress, epigenetically-assessed glucocorticoid exposure at birth, and child psychiatric symptoms: A prospective, multi-cohort study

BACKGROUND

Recent work suggests that DNA methylation can be used as a proxy of fetal glucocorticoid exposure (MPS-GC), showing associations with maternal psychopathology during pregnancy. However, it is unknown whether the MPS-GC may act as a marker for broader prenatal stress and whether it partially mediates associations of prenatal stress with child internalizing and externalizing symptoms.

METHODS

Using harmonized data from three prospective birth cohorts (Npooled = 6086), we examined whether a cumulative measure of prenatal stress, and its individual stress domains, associate with the MPS-GC in cord blood at birth. Next, we examined (i) whether the MPS-GC at birth associates with child psychiatric symptoms, (ii) whether this association is moderated by postnatal stress, and (iii) whether the effect of prenatal stress on child psychiatric symptoms is partially mediated by the MPS-GC at birth.

RESULTS

Our meta-analysis revealed no significant associations between the MPS-GC at birth and prenatal stress or the individual stress domains. Moreover, the MPS-GC did not significantly associate with later child internalizing or externalizing symptoms, and there were no moderating effects of postnatal stress. Additionally, while prenatal stress significantly associated with child psychiatric symptoms, we found no partial mediation via the MPS-GC at birth.

CONCLUSIONS

We did not find support that the MPS-GC in cord blood reliably proxies prenatal stress, associates with child psychiatric risk, or partially mediates the associations between prenatal stress and psychiatric risk.

Low neurocognitive performance and problematic contexts: interaction influences in predicting adolescent externalizing behaviors within a community sample

Research has identified neurocognitive and contextual risk factors of externalizing behaviors. However, fewer studies have examined the interaction among neurocognitive and other risk factors in predicting externalizing behaviors. The goal of the current study was to examine the relation between neurocognitive and contextual factors in predicting externalizing behaviors in a community sample of adolescents. Participants were 84 adolescents, aged 11-17 (M = 13.39, SD = 1.82), recruited as part of a larger study. Separate moderated multiple regression models were utilized in which neurocognitive variables (intellectual functioning, short-term memory/attention, disinhibition) were added as predictors and contextual variables (family dysfunction and parental depression, anxiety, and stress) were added as moderators in step 1, and their interaction was added in step 2. Externalizing behaviors served as criterion variables (hyperactivity/impulsivity and oppositional defiant disorder symptom severity, reactive and proactive aggression). Overall, results suggest that higher levels of problematic contextual factors exacerbate the significant negative associations among neurocognitive functioning and externalizing behaviors. Importantly, this pattern was shown across neurocognitive domains and contextual factors. Findings suggest that contextual factors should be targeted for the treatment or prevention of youth externalizing behaviors, particularly for adolescents with neurocognitive vulnerabilities.

Prenatal maternal stress: triangulating evidence for intrauterine exposure effects on birth and early childhood outcomes across multiple approaches

BACKGROUND

Maternal stress during pregnancy may impact offspring development via changes in the intrauterine environment. However, genetic and environmental factors shared between mothers and children might skew our understanding of this pathway. This study assesses whether prenatal maternal stress has causal links to offspring outcomes: birthweight, gestational age, or emotional and behavioral difficulties, triangulating across methods that account for various measured and unmeasured confounders.

METHODS

We used data from the Norwegian Mother, Father, and Child Cohort Study (MoBa), including maternal reports on prenatal stress at work, at home, and via stressful life events as exposures. Outcomes were children's birthweight and gestational age, from the Medical Birth Registry of Norway, and maternal reports on early offspring emotional and behavioral difficulties. We assessed associations using four approaches: sibling control analyses, gene-environment interaction analyses, intergenerational Mendelian randomization (MR), and negative control (i.e., postnatal stress) analyses.

RESULTS

Maternal prenatal stress was observationally associated with offspring lower birthweight (e.g., βwork = - 0.01 [95%CI: - 0.02, - 0.01]), earlier birth (e.g., βwork = - 0.04 [95%CI: - 0.04, - 0.03])), and more emotional (e.g., βevents = 0.08 [95%CI: 0.07, 0.09]) and behavioral difficulties (e.g., βrelationship = 0.08 [95%CI: 0.07, 0.09]) in the full sample (N = 112,784). However, sibling control analyses (N = 36,511) revealed substantial attenuation of all associations after accounting for familial factors. Gene-environment interaction models (N = 76,288) showed no clear evidence of moderation of associations by mothers' polygenic scores for traits linked to stress sensitivity. Intergenerational MR analyses (N = 29,288) showed no clear evidence of causal effects of maternal plasma cortisol on any offspring outcomes. Negative control exposure analyses revealed similar effect sizes whether exposures were measured prenatally or postnatally.

CONCLUSIONS

Our results indicate that links between prenatal maternal stress and variation in early offspring outcomes are more likely to be confounded than causal. While no observational study can rule out causality, the consistency of our findings across different approaches is striking. Other sources of prenatal stress or more extreme levels may represent intrauterine causal risk factors for offspring development. Nonetheless, our research contributes to identifying boundary conditions of the fetal programming and developmental origins of health and disease hypotheses, which may not be as universal as sometimes assumed.

[The study of the behavioral reactions and duration of ultrasonic vocalization in rats from females stressed during pregnancy]

OBJECTIVE

To study the psycho-emotional state and its relationship to the duration of ultrasonic vocalization in the offspring of rats with physiological and stress-complicated pregnancy.

MATERIAL AND METHODS

The experiments were performed on the offspring (n=120) of rats with physiological pregnancy and the offspring of animals stressed during the entire gestation period (21-23 days). Study animals were divided into the following groups: 1 - intact - males and females (n=52) born to healthy rats; 2 - stress - males and females (n=68) born to rats that underwent stress during pregnancy.

At the age of 17 days, the total vocalization duration (at 50 kHz) was recorded in rats. To assess the psycho-emotional state of the offspring, the open field and elevated plus maze tests were performed at 22 days, marble burying at 35 days, and Porsolt forced swimming test at 47 days. To assess cognitive function in the offspring, short-term working memory was examined in the recognition of a new object test at 35 days and long-term memory in the conditioned passive avoidance reflex test at the age of 47 days.

RESULTS

The results of the open field and elevated plus maze tests indicated that the offspring of females stressed during pregnancy showed anxious behavior. In addition, animals from stressed rats exhibited compulsive and depressive behaviors in the marble burying and Porsolt forced swimming tests. The offspring of stressed rats showed impaired reproduction of the memory traces in the conditioned passive avoidance reflex test.

CONCLUSION

In the offspring of females stressed during pregnancy, anxious, compulsive, and depressive behavior is observed, accompanied by an increase in the duration of ultrasonic vocalization at 50 kHz.

Perinatal Factors and Their Association with Early-Adulthood Suicidal Behavior in a Brazilian Birth Cohort

BACKGROUND

The objectives of this study were to investigate the relationship between perinatal risk factors and suicidal ideation and attempts in young adults in Pelotas, Brazil.

METHODS

The data were collected from the 1993 Pelotas Birth Cohort study. Every pregnant woman who gave birth in one of the hospitals in Pelotas Brazil in 1993 was invited to participate in the study. The current study uses perinatal data collected in 1993, and follow-ups at ages 18 and 22. The primary outcome was lifetime suicide attempts with past month suicide ideation a secondary outcome. The association between perinatal predictors and suicidal ideation or lifetime suicide attempts was investigated using hierarchical logistic regression.

FINDINGS

There was an analytic sample size of 3493. The perinatal factors association with lifetime suicide attempts were sex (OR = 2.25 CI: 1.76-2.89), paternal education at birth (OR = 0.60, 95%CI: 0.36-0.99), maternal education (9-11 years OR = 2.81, 95%CI: 1.41-5.59, & 0-8 years OR = 2.21, 95%CI: 1.07-4.58), support from friends or neighbors at birth (OR = 0.36 95%CI: 0.17-0.77), and maternal smoking during pregnancy (OR = 1.41, 95%CI: 1.10-1.79). Patterns of associations were broadly similar with suicidal ideation. Interactions between sex and the perinatal factors paternal education, maternal education, smoking and support from friends were assessed and found to be not significant.

CONCLUSION

Several factors during the perinatal period are associated with risk of lifetime suicide attempts and ideation in young adults in Brazil. Early-life factors associated with suicide-related concerns in early adulthood were similar to those observed in studies from high-income settings.

The Association Between Prenatal Maternal Stress and Adolescent Affective Outcomes is Mediated by Childhood Maltreatment and Adolescent Behavioral Inhibition System Sensitivity

Prenatal maternal stress is linked to offspring outcomes; however, there is little research on adolescents, behavioral, transdiagnostic outcomes, or the mechanisms through which relations operate. We examined, in N = 268 adolescents (Mage = 15.31 years; SD = 1.063; 57.8% boys) whether prenatal maternal stress is associated with adolescent affective outcomes; whether this association is mediated, serially, by childhood home atmosphere and adolescent behavioral inhibition system (BIS) sensitivity; and whether mediational effects are moderated by adolescent attention-deficit/hyperactivity disorder or maternal internalizing symptomology. Prenatal maternal daily stress and major life events were associated with adolescent outcomes through childhood negative atmosphere/neglect and BIS sensitivity, with no evidence of moderation. Results have implications regarding the effect of prenatal maternal stress on offspring outcomes and regarding corresponding sensitive periods.

Prenatal stress and gestational epigenetic age: No evidence of associations based on a large prospective multi-cohort study

Psychological stress during pregnancy is known to have a range of long-lasting negative consequences on the development and health of offspring. Here, we tested whether a measure of prenatal early-life stress was associated with a biomarker of physiological development at birth, namely epigenetic gestational age, using foetal cord-blood DNA-methylation data. Longitudinal cohorts from the Netherlands (Generation R Study [Generation R], n = 1,396), the UK (British Avon Longitudinal Study of Parents and Children [ALSPAC], n = 642), and Norway (Mother, Father and Child Cohort Study [MoBa], n1 = 1,212 and n2 = 678) provided data on prenatal maternal stress and genome-wide DNA methylation from cord blood and were meta-analysed (pooled n = 3,928). Measures of epigenetic age acceleration were calculated using three different gestational epigenetic clocks: "Bohlin", "EPIC overlap" and "Knight". Prenatal stress exposure, examined as an overall cumulative score, was not significantly associated with epigenetically-estimated gestational age acceleration or deceleration in any of the clocks, based on the results of the pooled meta-analysis or those of the individual cohorts. No significant associations were identified with specific domains of prenatal stress exposure, including negative life events, contextual (socio-economic) stressors, parental risks (e.g., maternal psychopathology) and interpersonal risks (e.g., family conflict). Further, no significant associations were identified when analyses were stratified by sex. Overall, we find little support that prenatal psychosocial stress is associated with variation in epigenetic age at birth within the general paediatric population.

Early risk for child externalising symptoms: Examining genetic, prenatal, temperamental and parental influences

This study utilized the Early Growth and Development Study (N = 561 adoptive children; 57.2% male, 55.3% White), a study of children adopted at birth, to examine heritable (birth parent psychopathology) and prenatal risk (prenatal maternal distress and smoking during pregnancy), infant negative affectivity, adoptive parent over-reactivity and warmth as independent predictors of childhood externalizing symptoms. The current study evaluated if: (1) infant negative affectivity and over-reactive parenting are candidate mediators for the effects of heritable and prenatal risk on externalizing symptoms and (2) parental warmth weakens the influence of heritable risk, prenatal risk, negative affectivity, and over-reactive parenting on externalizing symptoms. There were main effects of heritable risk, infant negative affectivity, and over-reactive parenting on child externalizing symptoms. The study found no support for the hypothesized mediation and moderation effects, suggesting that targeting parental over-reactivity rather than warmth would be more effective in reducing risk for childhood externalizing symptoms.

Prenatal maternal negative life events associated with child emotional and behavioral problems in the French EDEN cohort

INTRODUCTION

Prenatal negative life events (NLEs) have been linked to adverse health outcomes in children. However, few studies examine this relationship during late childhood using trajectory analyses. Additionally, the impact of specific NLEs domains on child development remains unclear. This study aims to longitudinally explore the association between NLEs (cumulative score and specific NLEs domains) and child outcomes from birth to late childhood.

METHODS

1135 mother-child pairs from the French EDEN cohort were followed from 24 to 28 weeks of pregnancy up to 11 years of age. Maternal self-reports of prenatal NLEs were collected immediately after birth, then analyzed as a cumulative score and by NLEs domain. Children's emotional and behavioral symptoms were assessed at 4 timepoints through the Strengths and Difficulties Questionnaire.

RESULTS

Children of mothers exposed to ≥3 NLEs were more likely to follow trajectories of high levels of peer relationship problems (aOR [95 % CI] = 5.69 [1.74-18.69]), emotional symptoms (aOR [95 % CI] = 3.05 [1.08-8.63]), and conduct problems (aOR [95 %] = 3.53 [1.20-10.42]). Among the domains of NLEs, only events related to housing, finance, and living conditions were significantly associated with high emotional and behavioral difficulties trajectories (aOR [95%CI] = 2.71[1.26-5.81]).

LIMITATIONS

Potential attrition bias due to a higher dropout rate for children experiencing early indications of emotional and behavioral difficulties.

CONCLUSION

Findings support the relationship between prenatal NLEs and child outcomes, underscoring the importance of assessing prenatal stressors across life domains to identify mothers who might be in need of support.

Multiple Risk in Pregnancy- Prenatal Risk Constellations and Mother-Infant Interactions, Parenting Stress, and Child Externalizing and Internalizing Behaviors: A Prospective Longitudinal Cohort Study from Pregnancy to 18 Months Postpartum

Multiple risk is associated with adverse developmental outcomes across domains. However, as risk factors tend to cluster, it is important to investigate formation of risk constellations, and how they relate to child and parental outcomes. By means of latent class analysis patterns of prenatal risk factors were identified, and relations to interactional quality, parenting stress, and child internalizing and externalizing behaviors were investigated. An array of prenatal risk factors was assessed in 1036 Norwegian pregnant women participating in a prospective longitudinal community-based study, Little in Norway. Mother-infant interactions were videotaped and scored with the Early Relational Health Screen (ERHS) at 12 months. The Parenting Stress Index (PSI) and Infant-Toddler Social and Emotional Assessment (ITSEA) were administered at 18 months. First, we analyzed response patterns to prenatal risks to identify number and characteristics of latent classes. Second, we investigated whether latent class membership could predict mother-child interactional quality, parenting stress, and child internalizing and externalizing behavior after the child was born. Results revealed three prenatal risk constellations: broad risk (7.52%), mental health risk (21.62%) and low-risk (70.86%). Membership in the broad risk group predicted lower scores on interactional quality, while membership in the mental health risk group predicted less favorable scores on all outcome measures. Prenatal risks clustered together in specific risk constellations that differentially related to parent, child and interactional outcomes.

Associations between prenatal maternal stress, maternal inflammation during pregnancy, and children's internalizing and externalizing symptoms throughout childhood

BACKGROUND

Maternal immune activation is a potential mechanism underlying associations between maternal stress during pregnancy and offspring mental health problems. This study examined associations between prenatal maternal stress, maternal inflammation during pregnancy, and children's internalizing and externalizing symptoms from 3 to 10 years of age, and whether maternal inflammation mediated the associations between prenatal maternal stress and children's internalizing and externalizing symptoms.

METHODS

This study comprised 4,902 mother-child dyads in the Generation R study. Prenatal maternal stress was assessed using self-reported data collected during pregnancy and analyzed as a latent variable consisting of four stress domains. Maternal inflammation during pregnancy was assessed using serum concentrations of C-reactive protein (CRP) measured at a median of 13.5 weeks' gestation. Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist (CBCL) by maternal report at ages 3 years, 5 years, and 10 years; paternal-reported CBCL data were also available at 3 years and 10 years.

RESULTS

Prenatal maternal stress was associated with maternal-reported internalizing and externalizing symptoms of the child at 3, 5, and 10 years of age, and with paternal-reported internalizing and externalizing symptoms at 3 and 10 years. Prenatal maternal stress was associated with maternal CRP concentrations prior to, but not after, covariate adjustment. Maternal CRP concentrations during pregnancy were associated with paternal-reported internalizing symptoms of offspring at 10 years of age prior to, but not after, covariate adjustment. There was no evidence that CRP concentrations mediated the associations between prenatal maternal stress and children's internalizing or externalizing symptoms.

CONCLUSIONS

Maternal stress during pregnancy is associated with higher levels of internalizing and externalizing symptoms in children, but this association is not because of differences in maternal immune activation linked to maternal stress. Replication of these findings in other cohorts is required; examination of other biomarkers or variation in immune activity during pregnancy would also benefit from further exploration.

Intergenerational risk and resilience pathways from discrimination and acculturative stress to infant mental health

Preconception and prenatal stress impact fetal and infant development, and women of color are disproportionately exposed to sociocultural stressors like discrimination and acculturative stress. However, few studies examine links between mothers' exposure to these stressors and offspring mental health, or possible mitigating factors. Using linear regression, we tested associations between prenatally assessed maternal acculturative stress and discrimination on infant negative emotionality among 113 Latinx/Hispanic, Asian American, Black, and Multiethnic mothers and their children. Additionally, we tested interactions between stressors and potential pre- and postnatal resilience-promoting factors: community cohesion, social support, communalism, and parenting self-efficacy. Discrimination and acculturative stress were related to more infant negative emotionality at approximately 12 months old (M = 12.6, SD = .75). In contrast, maternal report of parenting self-efficacy when infants were 6 months old was related to lower levels of infant negative emotionality. Further, higher levels of parenting self-efficacy mitigated the relation between acculturative stress and negative emotionality. Preconception and prenatal exposure to sociocultural stress may be a risk factor for poor offspring mental health. Maternal and child health researchers, policymakers, and practitioners should prioritize further understanding these relations, reducing exposure to sociocultural stressors, and promoting resilience.

A Multi-Cohort Examination of the Independent Contributions of Maternal Childhood Adversity and Pregnancy Stressors to the Prediction of Children's Anxiety and Depression

Women's social experiences can have long-term implications for their offspring's health, but little is known about the potential independent contributions of multiple periods of stress exposures over time. This study examined associations of maternal exposure to adversity in childhood and pregnancy with children's anxiety and depression symptoms in a large, sociodemographically diverse sample. Participants were 1389 mother-child dyads (child age M = 8.83 years; SD = 0.66; 42% Black, 42% White; 6% Hispanic) in the ECHO-PATHWAYS Consortium's three U.S. pregnancy cohorts. Women reported their exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE). Children self-reported on their symptoms of anxiety and depression at age 8-9 years. Regression analyses estimated associations between maternal stressors and children's internalizing problems, adjusting for confounders, and examined child sex as a modifier. Exploratory interaction analyses examined whether geospatially-linked postnatal neighborhood quality buffered effects. In adjusted models, PSLE counts positively predicted levels of children's anxiety and depression symptoms ([ßAnxiety=0.08, 95%CI [0.02, 0.13]; ßDepression=0.09, 95%CI [0.03, 0.14]); no significant associations were observed with CTE. Each additional PSLE increased odds of clinically significant anxiety symptoms by 9% (95%CI [0.02, 0.17]). Neither sex nor neighborhood quality moderated relations. Maternal stressors during pregnancy appear to have associations with middle childhood anxiety and depression across diverse sociodemographic contexts, whereas maternal history of childhood adversity may not. Effects appear comparable for boys and girls. Policies and programs addressing prevention of childhood internalizing symptoms may benefit from considering prenatal origins and the potential two-generation impact of pregnancy stress prevention and intervention.

Mapping gene by early life stress interactions on child subcortical brain structures: A genome-wide prospective study

Background

Although it is well-established that both genetics and the environment influence brain development, they are typically examined separately. Here, we aimed to prospectively investigate the interactive effects of genetic variants-from a genome-wide approach-and early life stress (ELS) on child subcortical brain structures, and their association with subsequent mental health problems.

Method

Primary analyses were conducted using data from the Generation R Study (N = 2257), including genotype and cumulative prenatal and postnatal ELS scores (encompassing life events, contextual risk, parental risk, interpersonal risk, direct victimisation). Neuroimaging data were collected at age 10 years, including intracranial and subcortical brain volumes (accumbens, amygdala, caudate, hippocampus, pallidum, putamen, thalamus). Genome-wide association and genome-wide-by-environment interaction analyses (GWEIS, run separately for prenatal/postnatal ELS) were conducted for eight brain outcomes (i.e., 24 genome-wide analyses) in the Generation R Study (discovery). Polygenic scores (PGS) using the resulting weights were calculated in an independent (target) cohort (adolescent brain cognitive development Study; N = 10,751), to validate associations with corresponding subcortical volumes and examine links to later mother-reported internalising and externalising problems.

Results

One GWEIS-prenatal stress locus was associated with caudate volume (rs139505895, mapping onto PRSS12 and NDST3) and two GWEIS-postnatal stress loci with the accumbens (rs2397823 and rs3130008, mapping onto CUTA, SYNGAP1, and TABP). Functional annotation revealed that these genes play a role in neuronal plasticity and synaptic function, and have been implicated in neuro-developmental phenotypes, for example, intellectual disability, autism, and schizophrenia. None of these associations survived a more stringent correction for multiple testing across all analysis sets. In the validation sample, all PGSgenotype were associated with their respective brain volumes, but no PGSGxE associated with any subcortical volume. None of the PGS associated with internalising or externalising problems.

Conclusions

This study lends novel suggestive insights into gene-environment interplay on the developing brain as well as pointing to promising candidate loci for future replication and mechanistic studies.

Maternal stress, child behavior and the promotive role of older siblings

BACKGROUND

In the first years of their lives, children develop the cognitive, social and emotional skills that will provide the foundations for their lifelong health and achievements. To increase their life prospects and reduce the long-term effects of early aversive conditions, it is therefore crucial to understand the risk factors that negatively affect child development and the factors that are instead beneficial. In this study, we tested (i) the effects of different social and environmental stressors on maternal stress levels, (ii) the dynamic relationship between maternal stress and child behavior problems during development, and (iii) the potential promotive (i.e. main) or protective (i.e. buffering) effect of siblings on child behavior problems during development.

METHODS

We used longitudinal data from 373 mother-child pairs (188 daughters, 185 sons) from pregnancy until 10 years of age. We assessed maternal stress and child behavior problems (internalizing and externalizing) with validated questionnaires, and then used linear mixed models, generalized linear mixed models and longitudinal cross-lagged models to analyze the data.

RESULTS

Our results showed that higher maternal stress levels were predicted by socio-environmental stressors (i.e. the lack of sufficient social areas in the neighborhood). Moreover, prenatal maternal stress reliably predicted the occurrence of behavior problems during childhood. Finally, the presence of older siblings had a promotive function, by reducing the likelihood that children developed externalizing problems.

CONCLUSIONS

Overall, our results confirm the negative effects that maternal stress during pregnancy may have on the offspring, and suggest an important main effect of older siblings in promoting a positive child development.