Pre- and Post-Natal Maternal Depressive Symptoms in Relation with Infant Frontal Function, Connectivity, and Behaviors

Antidepressant effects of activation of infralimbic cortex via upregulation of BDNF and β-catenin in an estradiol withdrawal model

RATIONALE

Clinical and preclinical studies have demonstrated that estradiol withdrawal after delivery is one of important factors involved in the pathogenesis of postpartum depression (PPD). The infralimbic cortex (IL) is related to anxiety and mood disorders. Whether IL neurons mediate PPD is still unclear.

OBJECTIVES

This study was to observe the antidepressant effect and expression of BDNF and β-catenin in IL by allopregnanolone (ALLO) treatment or the selective activation or inhibition of IL neurons using a chemogenetic approach in a pseudopregnancy model of PPD.

METHODS

Administration of estradiol combined with progesterone and the abrupt withdrawal of estradiol simulated the pregnancy and early postpartum periods to induce depression in ovariectomized rats. The relative expression levels of β-catenin and BDNF were observed by western blotting.

RESULTS

Immobility time was significantly increased in the forced swim test and open-arm movement was reduced in the elevated plus maze test in the estradiol-withdrawn rats. After ALLO treatment, the immobility time were lower and open-arm traveling times higher than those of the estradiol-withdrawn rats. Meanwhile, the expression level of BDNF or β-catenin in the IL was reduced significantly in estradiol-withdrawn rats, which was prevented by treatment with ALLO. The hM3Dq chemogenetic activation of pyramidal neurons in the IL reversed the immobility and open-arm travel time trends in the estradiol-withdrawal rat model, but chemogenetic inhibition of IL neurons failed to affect this. Upregulated BDNF and β-catenin expression and increased c-Fos in the basolateral amygdala were found following IL neuron excitation in model rats.

CONCLUSIONS

Our results demonstrated that pseudopregnancy and estradiol withdrawal produced depressive-like behavior and anxiety. ALLO treatment or specific excitement of IL pyramidal neurons relieved abnormal behaviors and upregulated BDNF and β-catenin expression in the IL in the PPD model, suggesting that hypofunction of IL neurons may be involved in the pathogenesis of PPD.

The effect of prenatal maternal distress on offspring brain development: A systematic review

BACKGROUND

Prenatal maternal distress can negatively affect pregnancy outcomes, yet its impact on the offspring's brain structure and function remains unclear. This systematic review summarizes the available literature on the relationship between prenatal maternal distress and brain development in fetuses and infants up to 12 months of age.

METHODS

We searched Central, Embase, MEDLINE, PsycINFO, and PSYNDEXplus for studies published between database inception and December 2023. Studies were included if prenatal maternal anxiety, stress, and/or depression was assessed, neuroimaging was used to examine the offspring, and the offspring's brain was imaged within the first year of life. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-II.

RESULTS

Out of the 1516 studies retrieved, 71 met our inclusion criteria. Although the studies varied greatly in their methodology, the results generally pointed to structural and functional aberrations in the limbic system, prefrontal cortex, and insula in fetuses and infants prenatally exposed to maternal distress.

CONCLUSIONS

The hippocampus, amygdala, and prefrontal cortex have a high density of glucocorticoid receptors, which play a key role in adapting to stressors and maintaining stress-related homeostasis. We thus conclude that in utero exposure to maternal distress prompts these brain regions to adapt by undergoing structural and functional changes, with the consequence that these alterations increase the risk for developing a neuropsychiatric illness later on. Future research should investigate the effect of providing psychological support for pregnant women on the offspring's early brain development.

Wife-Mother Role Conflict at the Critical Child-Rearing Stage: A Machine-Learning Approach to Identify What and How Matters in Maternal Depression Symptoms in China

Maternal depression (MD) was one of the most prevalent psychiatric problems worldwide. However, it easily remains untreated and misses the best time to prevent the emergence or worsening of major depressive symptoms due to under-observed stigma and the lack of effective screening tools. Thus, this study aims to develop and validate a machine learning-based MD symptoms prediction model integrating more observable and objective factors to early detect and monitor MD risk. A cross-sectional study was conducted in 10 community vaccination centers in Wenzhou, China, and a total of 1099 mothers were surveyed by using purposive sampling. A questionnaire containing questions regarding socio-demographic variables, psychophysiological variables, wife role-related variables, and mother role-related variables was used to collect data. A framework of data preprocessing, feature selection, and model evaluation was implemented to develop an optimal risk prediction model. Results demonstrated that the XG-Boost algorithm provided robust performance with the highest AUC and well-balanced sensitivity and specificity (AUC = 0.90, sensitivity = 0.74, specificity = 0.90). Furthermore, the causal mediation analysis indicated that wife-mother role conflict positively predicted MD symptoms, and it also exerted influence on mothers suffering through the mediation of anxiety and insomnia. Findings from the present study may help guide the development of MD screening tools to early detect and provide the modifiable risk factor information for timely tailored prevention.

Telehealth Care for Perinatal Depression in Immigrant and Refugee Women: A Scoping Review

Immigrant and refugee women have higher rates of perinatal depression compared to native-born women. Innovative telehealth interventions provide opportunities for prevention and treatment of perinatal depression. However, little is known about telehealth for perinatal immigrant and refugee women with depression. The aims of this scoping review were to identify available literature addressing the use of telehealth care for perinatal depression in immigrant and refugee women, and to determine the content, mode of delivery, and outcomes of telehealth care when provided for this population. A systematic literature search from 2000 to July 2023 was conducted in six databases and grey literature. The initial search resulted in 988 articles which were screened for their titles and abstracts. Eighty-one full-text articles were reviewed, yielding five articles included in this review. One quantitative study (a feasibility descriptive study), three qualitative studies, and a commentary supported the user satisfaction and potential effectiveness of telehealth care, delivered via telephone and text messaging, in improving perinatal depression symptoms. This review revealed a dearth of data-based studies on the outcomes of telehealth care for perinatal depression among immigrant and refugee women. Collaboration among researchers, healthcare providers, and technology engineers is required to improve telehealth care for this population.

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.

Preschoolers' emotion reactivity and regulation: Links with maternal psychological distress and child behavior problems

Maladaptive offspring emotion regulation has been identified as one pathway linking maternal and child psychological well-being in school-aged children. Whether such a pathway is present earlier in life still remains unclear. The present study investigated the role of preschoolers' emotion reactivity and regulation in the association between maternal psychological distress and child internalizing and externalizing problems. Children's emotion reactivity and regulation were assessed through both observed behavior and physiology. At 42 months of age, children (n = 251; 128 girls) completed a fear induction task during which their heart-rate variability was assessed and their behavior was monitored, and maternal self-reports on depressive mood and anxiety were collected. At 48 months mothers and fathers reported on their children's internalizing and externalizing problems. Higher maternal depressive mood was associated with lower child fear-related reactivity and regulation, as indexed by heart-rate variability. The latter mediated the association between higher maternal depressive mood and higher preschoolers' externalizing problems. Overall, our findings support the role of preschoolers' emotion reactivity and regulation in the relationship between maternal psychological distress and children's socio-emotional difficulties. This role may also depend on the discrete emotion to which children react or seek to regulate as, here, we only assessed fear-related reactivity and regulation.

Postpartum depression literacy in Chinese perinatal women: a cross-sectional study

Background

Postpartum depression literacy is a specific mental health literacy that can help perinatal women identify, manage, and prevent postpartum depression. However, the current status and associated factors of postpartum depression literacy among Chinese perinatal women are still unclear. This study investigated postpartum depression literacy and its associated factors among this group.

Methods

A cross-sectional survey was conducted involving 386 cases of perinatal women using the convenience sampling method. Participants completed four questionnaires to evaluate their general characteristics, postpartum depression literacy, perceived social support, and general self-efficacy. The SPSS 24.0 software was used for descriptive statistical analysis, univariate analysis, and multivariate analysis.

Results

The total PoDLiS score was (3.56 ± 0.32). The factors that composed the final multiple regression equation included planned pregnancy condition (β = -0.137, p = 0.003), education (β = 0.127, p < 0.001), history of depression (β = -0.271, p < 0.001), social support (β = 0.0012, p < 0.001), self-efficacy (β = 0.030, p < 0.001), and complications (β = -0.0191, p = 0.0019). They accounted for 32.8% of the total postpartum depression literacy variation (R² = 0.328, F = 24.518, p < 0.001).

Conclusion

The findings of this study improved our understanding of perinatal women's postpartum depression literacy and its associated factors. Women with low postpartum depression literacy urgently need to be identified. Comprehensive nursing intervention measures should be taken from six dimensions of mental health literacy, social support, and self-efficacy to improve the postpartum depression literacy of perinatal women.

Knowledge, Attitude and Perceptions Around Perinatal Mental Health Among Doctors in an Obstetrics and Gynaecology Academic Department in Singapore

Background Frontline healthcare professionals who provide regular care to women in the antenatal and postnatal period play a critical role in the early detection and management of maternal perinatal mental health (PMH). This study aimed to assess the knowledge, attitudes, and perceptions of doctors around perinatal mental health in an obstetrics and gynaecology (O&G) department in Singapore. Methods Using an online survey, data was collected from 55 doctors who participated in the Doctor's Knowledge, Attitudes and Perceptions of Perinatal Mental Health (I-DOC) study. The survey questions assessed the knowledge, attitudes, perceptions and practices in relation to PMH among doctors in the O&G specialty. Descriptive data was presented as means and standard deviations (SDs), or frequency and percentages. Results Out of the 55 doctors, more than half (60.0%) were not aware of the adverse impacts of poor PMH; 83.7% of doctors were not confident in providing PMH advice and 65.5% did not routinely screen patients for PMH disorders. There was a lower percentage of doctors (10.9% vs. 34.5%, p<0.001) who discussed PMH issues in the antenatal period compared to the postnatal period and this was statistically significant. Majority of doctors (98.2%) agreed that having standardised PMH guidelines will be useful. All doctors agreed on the benefits of having PMH guidelines, education and routine screening for patients. Conclusion There is inadequate PMH literacy among O&G doctors and lack of emphasis on antenatal PMH disorder. The findings highlighted the need for increased education and development of perinatal mental health guidelines.

Maternal perinatal depression and child brain structure at 2-3 years in a South African birth cohort study

Maternal perinatal depression is associated with risk of adverse child developmental outcomes and differences in offspring brain structure. Evidence from low- and middle-income countries is lacking as is an investigation of antenatal, postnatal, and persistent depression in the same sample. In a South African birth cohort, we investigated the effect of antenatal and postpartum maternal depressive symptoms on offspring brain structure at 2-3 years of age. Magnetic resonance imaging was performed, extracting cortical thickness and surface areas in frontal cortex regions of interest and subcortical volumes using FreeSurfer software. Maternal depressive symptoms were measured using the Edinburgh Postpartum Depression Scale and the Beck Depression Inventory II antenatally and at 6-10 weeks, 6 months, 12 months, and 18 months postpartum and analyzed dichotomously and continuously. Linear regressions were used controlling for child age, sex, intracranial volume, maternal education, age, smoking, alcohol use and HIV. 146 children were included with 38 (37%) exposed to depressive symptoms antenatally and 44 (35%) exposed postnatally. Of these, 16 (13%) were exposed to both. Postpartum, but not antenatal, depressive symptoms were associated with smaller amygdala volumes in children (B = -74.73, p = 0.01). Persistent maternal depressive symptoms across pregnancy and postpartum were also independently associated with smaller amygdala volumes (B = -78.61, p = 0.047). Differences in amygdala volumes among children exposed to postnatal as well as persistent maternal depressive symptomatology underscore the importance of identifying women at-risk for depression during the entire perinatal period.

Associations Between Infant Screen Use, Electroencephalography Markers, and Cognitive Outcomes

Importance

Research evidence is mounting for the association between infant screen use and negative cognitive outcomes related to attention and executive functions. The nature, timing, and persistence of screen time exposure on neural functions are currently unknown. Electroencephalography (EEG) permits elucidation of the neural correlates associated with cognitive impairments.

Objective

To examine the associations between infant screen time, EEG markers, and school-age cognitive outcomes using mediation analysis with structural equation modeling.

Design, Setting, and Participants

This prospective maternal-child dyad cohort study included participants from the population-based study Growing Up in Singapore Toward Healthy Outcomes (GUSTO). Pregnant mothers were enrolled in their first trimester from June 2009 through December 2010. A subset of children who completed neurodevelopmental visits at ages 12 months and 9 years had EEG performed at age 18 months. Data were reported from 3 time points at ages 12 months, 18 months, and 9 years. Mediation analyses were used to investigate how neural correlates were involved in the paths from infant screen time to the latent construct of attention and executive functioning. Data for this study were collected from November 2010 to March 2020 and were analyzed between October 2021 and May 2022.

Exposures

Parent-reported screen time at age 12 months.

Main Outcomes and Measures

Power spectral density from EEG was collected at age 18 months. Child attention and executive functions were measured with teacher-reported questionnaires and objective laboratory-based tasks at age 9 years.

Results

In this sample of 437 children, the mean (SD) age at follow-up was 8.84 (0.07) years, and 227 children (51.9%) were male. The mean (SD) amount of daily screen time at age 12 months was 2.01 (1.86) hours. Screen time at age 12 months contributed to multiple 9-year attention and executive functioning measures (η2, 0.03-0.16; Cohen d, 0.35-0.87). A subset of 157 children had EEG performed at age 18 months; EEG relative theta power and theta/beta ratio at the frontocentral and parietal regions showed a graded correlation with 12-month screen use (r = 0.35-0.37). In the structural equation model accounting for household income, frontocentral and parietal theta/beta ratios partially mediated the association between infant screen time and executive functioning at school age (exposure-mediator β, 0.41; 95% CI, 0.22 to 0.59; mediator-outcome β, -0.38; 95% CI, -0.64 to -0.11), forming an indirect path that accounted for 39.4% of the association.

Conclusions and Relevance

In this study, infant screen use was associated with altered cortical EEG activity before age 2 years; the identified EEG markers mediated the association between infant screen time and executive functions. Further efforts are urgently needed to distinguish the direct association of infant screen use compared with family factors that predispose early screen use on executive function impairments.

Auditory Mismatch Responses to Emotional Stimuli in 3-Year-Olds in Relation to Prenatal Maternal Depression Symptoms

Maternal depression symptoms are common in pregnant women and can have negative effects on offspring’s emotional development. This study investigated the association between prenatal maternal depression symptoms (assessed with the Edinburgh Postnatal Depression Scale at 24 weeks of gestation) and auditory perception of emotional stimuli in 3-year-olds (n = 58) from the FinnBrain Birth Cohort Study. Using electroencephalography (EEG), we examined mismatch responses for happy, sad, and angry sounds presented among neutral stimuli. A positive association between maternal depression symptoms and the emotional mismatch responses in an early time window (80–120 ms) was found, indicating that brain responses of children of mothers with depressive symptoms were weaker to happy sounds, though the results did not survive Bonferroni correction. There were no clear associations in the sad and angry emotional categories. Our results tentatively support that the 3-year-old children of mothers with depression symptoms may be less sensitive to automatically detect happy sounds compared to children whose mothers do not display symptoms of depression.

Antenatal Depression as a Stunting Risk Factor: A Systematic Review

BACKGROUND: Depression during pregnancy is often found and ignored even though depression has a negative impact not only on the mother but also on the fetus to adulthood. Stunting is a problem of lack of nutritional status that begins during pregnancy. AIM: The purpose of this article is to systematically identify the description and relationship between depression during pregnancy and stunting in children. METHOD: The approach used is the systematic review method to search articles. Articles were identified from 2010-2020 by conducting a literature search with the keywords "antenatal depression" OR "prenatal depression" OR "depression during pregnancy" and "stunting" in the electronic databases dataset by Sciencedirect, Pubmed Research Gate, and Google Scholar. RESULTS: The search results found 1875 articles selected into 20 journal articles that match the inclusion criteria. CONCLUSION: The results found that depression during pregnancy correlated with risk factors for stunting. As a preventive measure, health workers, especially midwives, can provide psychological care in antenatal care by considering these factors.

Prenatal depression exposure alters white matter integrity and neurodevelopment in early childhood

Prenatal exposure to maternal depression increases the risk for onset of emotional and behavioral disorders in children. We investigated the effects of exposure to prenatal depression on white matter microstructural integrity at birth and at 2-3 years, and associated neurodevelopment. Diffusion-weighted images were acquired for children of the Drakenstein Child Health Study at 2-4 weeks postpartum (n=70, 47% boys) and at 2-3 years of age (n=60, 58% boys). Tract-Based Spatial Statistics was used to compare, using an ROI based approach, diffusion tensor metrics across groups defined by presence (>19 on Beck's Depression Inventory and/or >12 on the Edinburgh Postnatal Depression Scale) or absence (below depression thresholds) of depression, and associations with neurodevelopmental measures at age 2-3 years were determined. We did not detect group differences in white matter integrity at neonatal age, but at 2-3 years, children in the exposed group demonstrated higher fractional anisotropy, and lower mean and radial diffusivity in association tracts compared to controls. This was notable in the sagittal stratum (radial diffusivity: p<0.01). Altered white matter integrity metrics were also observed in projection tracts, including the corona radiata, which associated with cognitive and motor outcomes in exposed 2-3-year-olds (p<0.05). Our findings of widespread white matter alterations in 2-3-year-old children with prenatal exposure to depression are consistent with previous findings, as well as with neuroimaging findings in adults with major depression. Further, we identified novel associations of altered white matter integrity with cognitive development in depression-exposed children, suggesting that these neuroimaging findings may have early functional impact.

Subthreshold psychiatric symptoms as potential predictors of postpartum depression

The authors' purpose in the present study is to examine the role of subthreshold mental disorders as predictors of Postpartum Depression (PPD). 110 pregnancy women were evaluated as follow: the General 5-Spectrum Measure at 26 weeks of gestation; the Edinburgh Postnatal Depression Scale at 3/6 months after delivery. Only 4.5% of the sample developed PPD at 3/6 months after delivery. Agoraphobia/panic, depressed mood, social anxiety and eating problems relate positively to PPD at 3/6 months. Early identification of symptoms that could indicate the development of future mood problems in the mother is of crucial importance for mental health and prevention.

A Narrative Review of Methodological Considerations in Magnetic Resonance Imaging of Offspring Brain Development and the Influence of Parenting

Parenting has been robustly associated with offspring psychosocial development, and these effects are likely reflected in brain development. This hypothesis is being tested with increasingly rigorous methods and the use of magnetic resonance imaging, a powerful tool for characterizing human brain structure and function. The objective of this narrative review was to examine methodological issues in this field that impact the conclusions that can be drawn and to identify future directions in this field. Studies included were those that examined associations between parenting and offspring brain structure or function. Results show four thematic features in this literature that impact the hypotheses that can be tested, and the conclusions drawn. The first theme is a limited body of studies including repeated sampling of offspring brain structure and function, and therefore an over-reliance on cross-sectional or retrospective associations. The second involves a focus on extremes in early life caregiving, limiting generalizability. The third involves the nature of parenting assessment, predominantly parent- or child-report instead of observational measures which may be more ecologically valid measures of parenting. A closely related fourth consideration is the examination of detrimental versus positive parenting behaviors. While studies with one or more of these thematic limitations provide valuable information, future study design should consider addressing these limitations to determine how parenting shapes offspring brain development.

Internalizing problems are associated with oral health-related quality of life in early childhood: Outcomes from an Asian multi-ethnic prospective birth cohort

Oral health status ideally warrants for a holistic biopsychosocial approach to health and wellness. Little is known about the impact of behavioral problems on oral health-related quality of life (OHRQoL) in children due to the paucity of studies in early childhood, particularly in Asian multi-ethnic populations. This study evaluated the relationship between early child's socioemotional factors and OHRQoL, as well as its association with orofacial pain (OFP) and early childhood caries (ECC) in the Asian GUSTO birth cohort. Mother-child dyads were postnatally assessed at 3 time points. The Child Behavior Checklist (CBCL) was used to assess the child's socioemotional and behavioral problems at age 4-4.5 years together with other validated questionnaires to evaluate maternal anxiety and depression. ECC detection was performed at age 5, and OHRQoL (primary) and OFP (secondary) outcomes were assessed at age 6 from a total of 555 mother-child dyads. After a univariate regression analysis was performed to identify potential predictors and confounders, a multivariate regression model was run with predisposing factors (CBCL internalization and externalization problems, OFP, ECC) and adjusted for confounders (maternal psychosocial states, maternal education) to determine associations with OHRQoL. Results showed an association between CBCL internalization scores and poorer OHRQoL (RR = 1.03, p = 0.033, 95% CI 1.01 to 1.05), although the limited risk ratio may not have a practical applicability in psychosocially healthy children, alike the majority of those evaluated in this cohort. The average OHRQoL overall score among children with OFP was 2.39 times more than those without OFP (OR = 2.39, p < 0.001, 95% CI 2.00 to 2.86). Thus, in early childhood, OFP, and to lesser extent internalizing behaviors, may negatively impact OHRQoL. This study therefore highlights the complex relationship between OHRQoL and its predisposing socioemotional and somatic pain factors, and demands further investigations in clinically relevant populations.

Language Proficiency and Migrant-Native Disparities in Postpartum Depressive Symptoms

Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants’ language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21–2.19)), intermediate (aOR 1.68 (95% CI 1.16–2.42)), and limited (aOR 2.55 (95% CI 1.64–3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.

Antenatal maternal anxiety modulates the BOLD response in 20-year-old men during endogenous cognitive control

Evidence is building for an association between the level of anxiety experienced by a mother during pregnancy and offspring cognition and structural and functional brain correlates. The current study uses fMRI to examine the association between prenatal exposure to maternal anxiety and brain activity associated with endogenous versus exogenous cognitive control in 20-year-old males. Endogenous cognitive control refers to the ability to generate control over decisions, strategies, conflicting information and so on, from within oneself without external signals, while exogenous control is triggered by external signals. In line with previous results of this long-term follow-up study we found that 20-year-olds of mothers reporting high levels of anxiety during weeks 12-22 of pregnancy exhibited a different pattern of decision making in a Gambling paradigm requiring endogenous cognitive control, compared to adults of mothers reporting low to average levels of anxiety. Moreover, the blood oxygenation level dependent (BOLD) response in a number of prefrontal cortical areas was modulated by the level of antenatal maternal anxiety. In particular, a number of right lateralized clusters including inferior frontal junction, that were modulated in the adults of mothers reporting low to average levels of anxiety during pregnancy by a task manipulation of cognitive control, were not modulated by this manipulation in the adults of mothers reporting high levels of anxiety during pregnancy. These differences in brain functional correlates provide a neurobiological underpinning for the hypothesis of an association between exposure to maternal anxiety in the prenatal life period and a deficit in endogenous cognitive control in early adulthood.

Longitudinal studies examining the impact of prenatal and subsequent episodes of maternal depression on offspring antisocial behaviour

Maternal depression is associated with adverse child outcomes including antisocial behaviour (ASB). Prospective longitudinal studies have focused on the timing and cumulative exposure to maternal depression to further delineate the association and mechanisms of effect. The objective of this systematic review was to synthesise and evaluate the findings of longitudinal studies of maternal depression and offspring antisocial behaviour. Three databases were searched (Psychinfo, Web of Science, and Medline). Twenty of 5936 studies met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme criteria [Critical Appraisal Skills Programme (2017) CASP (cohort observation checklist). https://casp-uk.net/wpcontent/uploads/2018/01/CASP-Cohort-Study-Checklist.pdf ]. Results of individual studies were highly varied, using diverse analytical approaches and not all studies explored the independent effects of different episodes. Only three studies examined hypothesised mechanisms. Prenatal, postnatal, and later episodes of depression were all predictive of antisocial outcomes. One particular time period of depression exposure did not emerge as more predictive of offspring ASB than another. However, measures of maternal depression after the perinatal period were limited and typically included a one-off assessment of mothers' depressive symptoms that was concurrent to the assessment of offspring ASB. When cumulative exposure to maternal depression and specific timing effects were measured within the same study it was cumulative exposure that conferred the greatest risk for offspring ASB-particularly when this exposure began during the perinatal period. Findings are discussed in terms of limitations in the literature and highlight the need for future research to examine the biological and environmental mechanisms that underpin associations between maternal depression and offspring antisocial behaviour during different stages of development.

Maternal Vitamin D and its Role in Determining Fetal Origins of Mental Health

There is evidence that mental health disorders may have roots in fetal life and are associated with deficiencies in various micronutrients, including vitamin D. During pregnancy, vitamin D balance is influenced by an increase in maternal calcitriol and a substantial increase in maternal Vitamin D Binding Protein concentrations. In the early stages of life, vitamin D is necessary to mediate numerous brain processes such as proliferation, apoptosis, and neurotransmission. Furthermore, Vitamin D has a recognized anti-inflammatory activity that normally suppresses inflammation. Increased activation of hypothalamo-pituitary-adrenal axis (HPA) and inflammation during gestation may influence maternal health and fetal neurodevelopment during and beyond pregnancy. A deficit of Vitamin D and maternal stressful events during gestation, such as perinatal depression, could influence the efficacy of the immune system altering its activity. Vitamin D deficiency during gestation associated with a reduction in fetal brain development has been widely described and correlated with alteration in the production of the brain-derived neurotrophic factor. To this regard, many studies highlights that low maternal vitamin D dosage during gestation has been related to a significantly greater risk to develop schizophrenia and other severe mental illnesses in later life. The objective of this paper is a comprehensive overview of maternal vitamin D balance in determining the fetal origins of mental health with some references to the link between vitamin D levels, inflammatory responses to stress and mental disorders in adult life.

Different types of low back pain in relation to pre- and post-natal maternal depressive symptoms

Background

Low back pain (LBP) is a common musculoskeletal problem during pregnancy, with an estimated prevalence ranging from 30–78% (Mota MJ et al. J Back Musculoskelet Rehabil 28(2):351-7,2015 and Abebe E et al. J Med Sc Tech 3(3). 37-44,2014). Women reporting LBP are at increased risk of developing perinatal depression. Pregnancy-related LBP is highly heterogeneous and can be divided into lumbar pain (LP), posterior pelvic pain (PPP), and combined pain (CP). Therefore, the purpose of this study was to investigate the associations between LBP and perinatal depressive symptoms.

Methods

This was a retrospective case-control study conducted from January 2016 to April 2019. A total of 484 pregnant women were enrolled in this study: a case group of 242 pregnant women who were diagnosed with LBP and an age-matched control group of 242 pregnant women without LBP. The Edinburgh Postnatal Depression Scale (EPDS), LBP characteristics, and questionnaires about pregnancy that included demographic, parity, work, comorbidity, and previous pregnancy data were completed and compared between the case group and the control group.

Results

A total of 68 of 242 (28.1%) women experienced PPP, 142 (58.7%) had lumbar pain(LP), and 32 (13.2%) had combined pain. Furthermore, 26.5% of women with prenatal depression in the LP subgroup remained depressed 6 months postnatally, while the percentages for women in the PPP subgroup and CP subgroup were just 10.6% and 15.6%, respectively. The percentage of women who recovered anytime between delivery and six months postnatally in the PPP subgroup was significantly higher than that in the LP subgroup (31.7% vs. 14.7%, P < 0.001).

Conclusions

There is a difference in the prevalence of prenatal, postnatal, and perinatal depressive symptoms among pregnant women with different types of LBP. It is necessary to screen prenatal and postnatal depression separately and differentiate the types of LBP during pregnancy. Attention to these factors may help to outline better management strategies to improve maternal health.

Associations between stress exposure and new mothers' brain responses to infant cry sounds

Exposure to severe stress has been linked to negative postpartum outcomes among new mothers including mood disorders and harsh parenting. Non-human animal studies show that stress exposure disrupts the normative adaptation of the maternal brain, thus identifying a neurobiological mechanism by which stress can lead to negative maternal outcomes. However, little is known about the impact of stress exposure on the maternal brain response to infant cues in human mothers. We examined the association of stress exposure with brain response to infant cries and maternal behaviors, in a socioeconomically diverse (low- and middle-income) sample of first-time mothers (N=53). Exposure to stress across socioeconomic, environmental, and psychosocial domains was associated with reduced brain response to infant cry sounds in several regions, including the right insula/inferior frontal gyrus and superior temporal gyrus. Reduced activation in these regions was further associated with lower maternal sensitivity observed during a mother-infant interaction. The findings demonstrate that higher levels of stress exposure may be associated with reduced brain response to an infant’s cry in regions that are important for emotional and social information processing, and that reduced brain responses may further be associated with increased difficulties in developing positive mother-infant relationships.

The influence of maternal anxiety and depression symptoms on fNIRS brain responses to emotional faces in 5- and 7-month-old infants

Greater relative right (versus left) frontal cortical activation to emotional faces as measured with alpha power in the electroencephalogram (EEG), has been considered a promising neural marker of increased vulnerability to psychopathology and emotional disorders. We set out to explore multichannel fNIRS as a tool to investigate infants' frontal asymmetry responses (hypothesizing greater right versus left frontal cortex activation) to emotional faces as influenced by maternal anxiety and depression symptoms during the postnatal period. We also explored activation differences in fronto-temporal regions associated with facial emotion processing. Ninety-one typically developing 5- and 7-month-old infants were shown photographs of women portraying happy, fearful and angry expressions. Hemodynamic brain responses were analyzed over two frontopolar and seven bilateral cortical regions subdivided into frontal, temporal and parietal areas, defined by age-appropriate MRI templates. Infants of mothers reporting higher negative affect had greater oxyhemoglobin (oxyHb) activation across all emotions over the left inferior frontal gyrus, a region implicated in emotional communication. Follow-up analyses indicated that associations were driven by maternal depression, but not anxiety symptoms. Overall, we found no support for greater right versus left frontal cortex activation in association with maternal negative affect. Findings point to the potential utility of fNIRS as a method for identifying altered neural substrates associated with exposure to maternal depression in infancy.

Advanced neuroimaging: A window into the neural correlates of fetal programming related to prenatal exposure to maternal depression and SSRIs

Fetal programming is a conceptual framework whereby the in utero environment shapes the offspring's neurodevelopment. Maternal depression and treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy are common prenatal exposures that affect critical early life developmental programming processes. Prenatal depression and SSRIs both have been reported to increase the risks for preterm birth, low birth weight, and are associated with behavioral disturbances across the early life span. However, not all exposures lead to adverse developmental outcomes and distinguishing how each exposure contributes to variations in development remains challenging. Advances in neuroimaging, using MR and EEG, offer novel insights into central processes that might reveal the neural correlates of fetal programming. This review focuses on emerging findings from neuroimaging studies reflecting early brain functional and structural development associated with prenatal exposure to maternal depression and SSRI antidepressants. Suggestions for future research directions that use neuroimaging as a tool to advancing our understanding of the early origins of developmental plasticity are offered.

Prenatal symptoms of anxiety and depression associated with sex differences in both maternal perceptions of one year old infant temperament and researcher observed infant characteristics

BACKGROUND

Sex differences in the behaviour of children exposed to prenatal maternal depression and anxiety have been reported. This study compared depression and anxiety symptoms reported by mothers at term with maternal perceptions of one year old male and female infant temperament and with researcher observed infant characteristics, identifying differences for males and females with both approaches.

METHODS

Infant behaviour and temperament was assessed via maternally completed questionnaires including Infant Behavioural Questionnaire Revised - Short form and by researcher administered subcomponents of Laboratory Temperament Assessment Battery and Bayley Scales of Infant Development III.

RESULTS

For female infants, higher prenatal scores for depression and anxiety were associated with maternal perceptions of lower bonding, higher aggression and negativity, and lower soothability (n = 67 mother-infant dyads). In the laboratory assessment, intensity of escape was the only female infant factor significantly associated with maternal mood (n = 41). For male infants, there was minimal association between prenatal mood scores and maternal perceptions (n = 46) whereas in the laboratory assessment (n = 35) depression scores were associated with expressive language, facial interest and facial fear while anxiety scores were associated with expressive and receptive language, parent behaviour and facial fear.

LIMITATIONS

Findings may be restricted to a single ethnicity or mode of delivery. Fewer infants attended the infant assessment. A laboratory setting may mask symptomatology in females.

CONCLUSIONS

Atypical maternal perceptions may present a barrier to the early identification of male infants impacted by maternal depression and anxiety.

When Fathers Begin to Falter: A Comprehensive Review on Paternal Perinatal Depression

The transition to parenthood is considered to be a major life transition that can increase the vulnerability to parental depressive disorders, including paternal perinatal depression (PPND). Although it is known that many fathers experience anxiety and depression during the perinatal period, PPND is a recent diagnostic entity and there are not enough published studies on it. Accordingly, its prevalence and epidemiology are still not well defined, although the majority of studies agree that PPND is less frequent than maternal perinatal depression and postpartum depression. Nevertheless, PPND is different from maternal perinatal mental health disorders, usually, fathers have less severe symptoms, and mood alterations are often in comorbidity with other affective disorders. Despite the absence of DSM-5 diagnostic criteria and the fluctuation of prevalence rates, clinical symptoms have been defined. The main symptoms are mood alterations and anxiety, followed by behavioral disturbances and concerns about the progress of pregnancy and the child’s health. Moreover, PPND negatively impacts on family functioning, on couples’ relationships, and on family members’ well-being. The aim of this paper is to present an overview of the current understandings on PPND and the potential screening, prevention, and treatment options.

Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 2): Qualitative Study

Background

Social support is known to reduce risks of postnatal depression (PND) and improve maternal emotional well-being. However, the Asian cultural context is often neglected when appraising maternal needs and mothers’ preferences for social support. While many preventive efforts have experimented with technology, professionals, and paraprofessionals in providing social support to mothers in need, most studies determined the effectiveness of their interventions through quantitative measurements of maternal outcomes. Experiences and feedback from both participants and administrators are rarely discussed, especially in an Asian setting.

Objective

The goal of the research was to evaluate the postnatal experiences of Asian mothers at risk of PND and the perceptions of peer volunteers regarding a technology-based peer-support intervention program (PIP).

Methods

A qualitative semistructured interview was conducted with 20 Asian mothers at risk of depression (10 from the control group and 10 from the intervention group) and 19 peer volunteers from a randomized controlled trial. The PIP included weekly correspondence between peer volunteers and mothers through any telecommunication means over 4 weeks. All interviews were approximately 30 to 60 minutes long, audiotaped, transcribed verbatim, and analyzed using thematic analysis. Study findings were reported according to the Consolidated Standards of Reporting Trials checklist.

Results

Two overarching themes comprising five subthemes were generated: postnatal experience (a bouncy ride, a way forward) and evaluation of the PIP (valuable, flexible, and supportive program; building blocks of a good relationship; and lessons learned and the road ahead). Mothers from both the control and interventions groups were generally satisfied with hospital care and the support received from family. They also shared similar breastfeeding challenges and needs for more informed decisions and follow-up support from the hospital. However, mothers who received the PIP tended to have more positive outlooks of their birth experiences. Overall, peer volunteers and mothers involved in the PIP found the PIP useful and expressed satisfaction with the program’s flexibility. They also shared their personal takeaways, the qualities of their friendships, and the need for extended correspondence time and recommended outreach to non–at-risk mothers.

Conclusions

The positive endorsement of the PIP by peer volunteers and mothers suggests the success of the PIP in maintaining positive maternal emotional well-being during the postpartum period. With the help of technology, hospitals can easily provide additional peer support to at-risk mothers in addition to existing standard care offered to these mothers.

Trial Registration

ISRCTN Registry ISRCTN14864807; http://www.isrctn.com/ISRCTN14864807

International Registered Report Identifier (IRRID)

RR2-10.2196/resprot.9416

Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 1): Randomized Controlled Trial

Background

The frenzy of postbirth events often takes a toll on mothers’ mental well-being, leaving them susceptible to postpartum psychological disorders such as postnatal depression (PND). Social support has been found to be effective in restoring the emotional well-being of new mothers. Therefore, mothers need to be supported during the crucial postpartum period to buffer the negative after effects of childbirth and to promote healthier maternal well-being.

Objective

This study aimed to evaluate the effectiveness of a technology-based peer-support intervention program (PIP) on maternal outcomes during the early postpartum period.

Methods

A randomized, parallel-armed controlled trial was conducted. The study recruited 138 mothers (69 in intervention group, 69 in control group) at risk of PND from a tertiary hospital in Singapore. To support these mothers, 20 peer volunteers were recruited by word of mouth and trained by a psychiatrist in social support skills before the intervention commenced. The 4-week–long intervention included a weekly follow-up with a peer volunteer through phone calls or text messages. The intervention group received peer support in addition to the standard care offered by the hospital. The control group only received postnatal standard care. Maternal outcomes (PND, postnatal anxiety [PNA], loneliness, and perceived social support) were measured with reliable and valid instruments. Data were collected immediately postpartum, at 1 month postpartum and at 3 months postpartum. The general linear model was used to compare the groups for postpartum percentage changes in the outcome variables at first and third months, and the linear mixed model was used to compare the trend over the study period.

Results

There was a statistically significant difference in Edinburgh Postnatal Depression Scale scores (d=–2.11; 95% CI −4.0 to −0.3; P=.03) between the intervention and control groups at 3 months postpartum after adjusting for covariates. The intervention group had a significant change over time compared with the control group.

Conclusions

The technology-based PIP was found to be effective in reducing the risk of PND among new mothers and showed a generally positive trend in reducing PNA and loneliness and increasing perceived social support. This study highlights the importance of training paraprofessionals to provide needed support for new mothers postpartum. A further long-term evaluation of the PIP on maternal and family outcomes and its cost-effectiveness is needed to inform clinical practices.

Trial Registration

ISRCTN Registry ISRCTN14864807; https://www.isrctn.com/ISRCTN14864807

International Registered Report Identifier (IRRID)

RR2-10.2196/resprot.9416

Effects of Maternal Psychopathology and Education Level on Neurocognitive Development in Infants of Adolescent Mothers Living in Poverty in Brazil

BACKGROUND

Adolescent motherhood remains common in developing countries and is associated with risk factors that adversely impact infant neurodevelopment, including poverty, low maternal education, and increased maternal psychopathology. Yet, no published work has assessed how these factors affect early brain development in developing countries.

METHODS

This pilot study examined effects of maternal psychopathology and education on early neurocognitive development in a sample of adolescent mothers (N = 50, final n = 31) and their infants living in poverty in São Paulo, Brazil. Maternal symptoms of anxiety, depression, and attention-deficit/hyperactivity disorder and education level were assessed during pregnancy. Infant neurocognitive development was assessed at 6 months of age, with oscillatory power and functional connectivity in the theta (4-6 Hz), alpha (6-9 Hz), and gamma (30-50 Hz) frequencies derived from resting-state electroencephalography; temperament (negative affect, attention, and regulation); and cognitive, language, and motor skills. Cluster-based permutation testing and graph-theoretical methods were used to identify alterations in oscillatory power and connectivity that were associated with maternal psychopathology and education. Correlations between power and connectivity alterations were examined in relation to infants' overt cognitive behavioral abilities.

RESULTS

Increased maternal anxiety and lower maternal education were associated with weaker oscillatory connectivity in alpha-range networks. Infants with the weakest connectivity in the alpha network associated with maternal anxiety also showed the lowest cognitive ability. Greater maternal anxiety and attention-deficit/hyperactivity disorder were associated with increased absolute and relative theta power.

CONCLUSIONS

Our findings highlight the importance of addressing maternal psychopathology and improving education in poor adolescent mothers to prevent negative effects on infant neurodevelopment.

Maternal sensitivity predicts anterior hippocampal functional networks in early childhood

Maternal care influences child hippocampal development. The hippocampus is functionally organized along an anterior-posterior axis. Little is known with regards to the extent maternal care shapes offspring anterior and posterior hippocampal (aHPC, pHPC) functional networks. This study examined maternal behavior, especially maternal sensitivity, at 6 months postpartum in relation to aHPC and pHPC functional networks of children at age 4 and 6 years. Maternal sensitivity was assessed at 6 months via the "Maternal Behavior Q Sort (MBQS) mini for video". Subsequently, 61 and 76 children underwent resting-state functional magnetic resonance imaging (rs-fMRI), respectively, at 4 and 6 years of age. We found that maternal sensitivity assessed at 6 months postpartum was associated with the right aHPC functional networks in children at both 4 and 6 years of age. At age 4 years, maternal sensitivity was associated positively with the right aHPC's functional connectivity with the sensorimotor network and negatively with the aHPC's functional connectivity with the top-down cognitive control network. At 6 years of age, maternal sensitivity was linked positively with the right aHPC's functional connectivity with the visual-processing network. Our findings suggested that maternal sensitivity in infancy has a long-term impact on the anterior hippocampal functional network in preschool children, implicating a potential role of maternal care in shaping child brain development in early life.

Infant Behavior and Competence Following Prenatal Exposure to a Natural Disaster: The QF2011 Queensland Flood Study

This study utilized a natural disaster to investigate the effects of prenatal maternal stress (PNMS) arising from exposure to a severe flood on maternally reported infant social-emotional and behavioral outcomes at 16 months, along with potential moderation by infant sex and gestational timing of flood exposure. Women pregnant during the Queensland floods in January 2011 completed measures of flood-related objective hardship and posttraumatic stress (PTS). At 16 months postpartum, mothers completed measures describing depressive symptoms and infant social-emotional and behavioral problems (n = 123) and competence (n = 125). Greater maternal PTS symptoms were associated with reduced infant competence. A sex difference in infant behavioral problems emerged at higher levels of maternal objective hardship and PTS; boys had significantly more behavioral problems than girls. Additionally, greater PTS was associated with more behavioral problems in boys; however, this effect was attenuated by adjustment for maternal depressive symptoms. No main effects or interactions with gestational timing were found. Findings highlight specificity in the relationships between PNMS components and infant outcomes and demonstrate that the effects of PNMS exposure on behavior may be evident as early as infancy. Implications for the support of families exposed to a natural disaster during pregnancy are discussed.

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.

Prenatal maternal anxiety and children's brain structure and function: A systematic review of neuroimaging studies

BACKGROUND

Maternal anxiety disorders are common during pregnancy and postpartum, and are associated with increased behaviour problems and risk of mental health difficulties in children. Understanding alterations in brain structure and function associated with maternal anxiety may help elucidate potential mechanisms via which high maternal anxiety could affect children.

METHODS

We conducted a systematic review of extant research studying the associations between prenatal anxiety and children's brain structure and function, as assessed through neuroimaging. Data were gathered in accordance with the PRISMA review guidelines.

RESULTS

Ten articles were identified, and all found a significant association between antenatal maternal anxiety and child neurodevelopment. Studies vary considerably in their methods with five studies employing electroencephalography (EEG), one using magnetoencephalography (MEG), and the rest employing magnetic resonance imaging (MRI).

LIMITATIONS

The heterogeneity of neuroimaging techniques undertaken by the reviewed studies precluded a meta-analysis from being performed. The applicability of this systematic review to clinical practice is also limited given that the studies examined children across a wide age range (neonates to 17 years).

CONCLUSIONS

From early infancy to late adolescence, findings suggest alterations of brain structure and function in frontal, temporal, and limbic areas in children born to mothers who experienced prenatal anxiety. These brain abnormalities may underlie associations between prenatal anxiety and children's behaviour, though more research incorporating neuroimaging and behavioural data is necessary to determine this.

Prenatal stress and the developing brain: Risks for neurodevelopmental disorders

The prenatal period is increasingly considered as a crucial target for the primary prevention of neurodevelopmental and psychiatric disorders. Understanding their pathophysiological mechanisms remains a great challenge. Our review reveals new insights from prenatal brain development research, involving (epi)genetic research, neuroscience, recent imaging techniques, physical modeling, and computational simulation studies. Studies examining the effect of prenatal exposure to maternal distress on offspring brain development, using brain imaging techniques, reveal effects at birth and up into adulthood. Structural and functional changes are observed in several brain regions including the prefrontal, parietal, and temporal lobes, as well as the cerebellum, hippocampus, and amygdala. Furthermore, alterations are seen in functional connectivity of amygdalar-thalamus networks and in intrinsic brain networks, including default mode and attentional networks. The observed changes underlie offspring behavioral, cognitive, emotional development, and susceptibility to neurodevelopmental and psychiatric disorders. It is concluded that used brain measures have not yet been validated with regard to sensitivity, specificity, accuracy, or robustness in predicting neurodevelopmental and psychiatric disorders. Therefore, more prospective long-term longitudinal follow-up studies starting early in pregnancy should be carried out, in order to examine brain developmental measures as mediators in mediating the link between prenatal stress and offspring behavioral, cognitive, and emotional problems and susceptibility for disorders.

Sex Differences in Vulnerability to Prenatal Stress: a Review of the Recent Literature

PURPOSE OF REVIEW

To evaluate the degree to which recent studies provide evidence that the effects of prenatal maternal stress (PNMS) on child health outcomes vary depending on the child's biological sex. In this review, we used a broad definition of stress, including negative life events, psychological stress, and established stress biomarkers. We identified 50 peer-reviewed articles (published January 2015-December 2017) meeting the inclusion criteria.

RECENT FINDINGS

Most articles (k = 35) found evidence of either sex-specific associations (significant in one sex but not the other) or significant PNMSxstress interactions for at least one child health outcome. Evidence for sex-dependent effects was strongest in the group of studies evaluating child neural/nervous system development and temperament as outcomes. There is sufficient evidence of sex-dependent associations to recommend that researchers always consider the potential role of child sex in PNMS programming studies and report descriptive statistics for study outcomes stratified by child biological sex.

Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis

This review aims to examine the prevalence and incidence of postpartum depression among healthy mothers without prior history of depression including postpartum depression and who gave birth to healthy full-term infants. A systematic search of ClinicalTrials.gov, CINAHL, EMBASE, PsycINFO, and PubMed was performed for English articles from the inception of the database to November 2017, as well as a manual search of the reference lists of the included articles, and an expert panel was consulted. Across 15,895 articles, 58 articles (N = 37,294 women) were included in the review. The incidence of postpartum depression was 12% [95% CI 0.04-0.20] while the overall prevalence of depression was 17% [95% CI 0.15-0.20] among healthy mothers without a prior history of depression. Prevalence was similar regardless of the type of diagnostic tool used; however, there were statistical differences in the prevalence between different geographical regions, with the Middle-East having the highest prevalence (26%, 95% CI 0.13-0.39) and Europe having the lowest (8%, 95% CI 0.05-0.11). There was no statistical difference in prevalence between different screening time points, but an increasing prevalence was observed beyond six months postpartum. Intervention studies often neglect healthy mothers. This review reports a similar prevalence rate of postpartum depression among mothers without history of depression when compared to mothers with history of depression. Thus, future studies should place equal emphasis on this neglected group of mothers so that targeted interventions and follow-ups can be introduced at appropriate time points.

Alterations in Resting-State Networks Following In Utero Selective Serotonin Reuptake Inhibitor Exposure in the Neonatal Brain

BACKGROUND

Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression during pregnancy. SSRIs cross the placenta, inhibit serotonin reuptake, and thereby are thought to alter central fetal serotonin signaling. Both prenatal maternal mood disturbances and in utero SSRI exposure have been associated with altered fetal and infant behavior. Resting-state functional magnetic resonance imaging has identified resting-state networks (RSNs) in newborns, reflecting functional capacity of auditory and visual networks and providing opportunities to examine early experiences effects on neurodevelopment. We sought to examine the effect of in utero SSRI exposure on neonatal RSN functional organization. We hypothesized that prenatal SSRI exposure would be associated with alterations in neonatal RSNs compared with healthy control infants and infants exposed to mothers with depression.

METHODS

Clinician-rated Hamilton Depression Rating Scale and self-reported Pregnancy Experiences Scale were completed during the third trimester. Control (n = 17), maternal depression-exposed (Hamilton Depression Rating Scale ≥8 without SSRI exposure, n = 16), and SSRI-exposed (n = 20) 6-day-old neonates underwent resting-state functional magnetic resonance imaging. Independent component analysis was used as a data-driven approach to extract 22 RSNs.

RESULTS

SSRI-exposed neonates had higher connectivity in a putative auditory RSN compared with depressed-only (p = .01) and control (p = .02) infants (corrected for multiple comparisons), controlling for sex, age at the magnetic resonance imaging, and Pregnancy Experiences Scale score.

CONCLUSIONS

Hyperconnectivity in auditory RSN in neonates with in utero SSRI exposure relative to neonates of depressed but not pharmacologically treated mothers and control infants may offer an insight into the functional organization origins of shifts in language perception and altered language development, previously reported in infants and children with prenatal SSRI exposure.

Maternal depressive symptoms are negatively associated with child growth and development: Evidence from rural India

Maternal depression has been suggested as a risk factor for both poor child growth and development in many low‐ and middle‐income countries, but the validity of many studies is hindered by small sample sizes, varying cut‐offs used in depression diagnostics, and incomplete control of confounding factors. This study examines the association between maternal depressive symptoms (MDSs) and child physical growth and cognitive development in Madhya Pradesh, India, where poverty, malnutrition, and poor mental health coexist. Data were from a baseline household survey (n = 2,934) of a randomized controlled trial assessing an early childhood development programme. Multivariate linear and logistic regression analyses were conducted, adjusting for socio‐economic factors to avoid confounding the association of mental health and child outcomes. MDS (measured using the Center for Epidemiologic Studies Short Depression Scale) was categorized as low, medium, and high in 47%, 42%, and 10% of mothers, respectively. The prevalence of child developmental delay ranged from 16% to 27% for various development domains. Compared with children of mothers with low MDS, those of high MDS mothers had lower height‐for‐age, weight‐for‐age, and weight‐for‐height z‐scores (0.22, 0.21, and 0.15, respectively), a higher rate of stunting and underweight (~1.5 times), and higher rate of developmental delay (partial adjusted odds ratio ranged from 1.3–1.8 for different development domains and fully adjusted odds ratio = 1.4 for fine motor). Our results—that MDS is significantly associated with both child undernutrition and development delay—add to the call for practical interventions to address maternal depression to simultaneously address multiple outcomes for both women and children.

Developmental Connectomics from Infancy through Early Childhood

The human brain undergoes rapid growth in both structure and function from infancy through early childhood, and this significantly influences cognitive and behavioral development in later life. A newly emerging research framework, developmental connectomics, provides unprecedented opportunities for exploring the developing brain through non-invasive mapping of structural and functional connectivity patterns. Within this framework, we review recent neuroimaging and neurophysiological studies investigating connectome development from 20 postmenstrual weeks to 5 years of age. Specifically, we highlight five fundamental principles of brain network development during the critical first years of life, emphasizing strengthened segregation/integration balance, a remarkable hierarchical order from primary to higher-order regions, unparalleled structural and functional maturations, substantial individual variability, and high vulnerability to risk factors and developmental disorders.

The Nexus Between Nutrition and Early Childhood Development

This article looks at both nutrition and early childhood stimulation interventions as part of an integrated life cycle approach to development. We build on recent systematic reviews of child development, which are comprehensive in regard to what is currently known about outcomes reported in key studies. We then focus particularly on implementation, scaling, and economic returns, drawing mainly on experience in low- and middle-income countries where undernutrition and poor child development remain significant public health challenges with implications across the life course.

Influences of prenatal and postnatal maternal depression on amygdala volume and microstructure in young children

Maternal depressive symptoms influence neurodevelopment in the offspring. Such effects may appear to be gender-dependent. The present study examined contributions of prenatal and postnatal maternal depressive symptoms to the volume and microstructure of the amygdala in 4.5-year-old boys and girls. Prenatal maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) at 26 weeks of gestation. Postnatal maternal depression was assessed at 3 months using the EPDS and at 1, 2, 3 and 4.5 years using the Beck's Depression Inventory-II. Structural magnetic resonance imaging and diffusion tensor imaging were performed with 4.5-year-old children to extract the volume and fractional anisotropy (FA) values of the amygdala. Our results showed that greater prenatal maternal depressive symptoms were associated with larger right amygdala volume in girls, but not in boys. Increased postnatal maternal depressive symptoms were associated with higher right amygdala FA in the overall sample and girls, but not in boys. These results support the role of variation in right amygdala structure in transmission of maternal depression to the offspring, particularly to girls. The differential effects of prenatal and postnatal maternal depressive symptoms on the volume and FA of the right amygdala suggest the importance of the timing of exposure to maternal depressive symptoms in brain development of girls. This further underscores the need for intervention targeting both prenatal and postnatal maternal depression to girls in preventing adverse child outcomes.

Infant frontal EEG asymmetry in relation with postnatal maternal depression and parenting behavior

Right frontal electroencephalogram (EEG) asymmetry associates with negative affect and depressed mood, which, among children, are predicted by maternal depression and poor parenting. This study examined associations of maternal depression and maternal sensitivity with infant frontal EEG asymmetry based on 111 mother-6-month-infant dyads. There were no significant effects of postnatal maternal depression or maternal sensitivity, or their interaction, on infant EEG frontal asymmetry. However, in a subsample for which the infant spent at least 50% of his/her day time hours with his/her mother, both lower maternal sensitivity and higher maternal depression predicted greater relative right frontal EEG asymmetry. Our study further showed that greater relative right frontal EEG asymmetry of 6-month-old infants predicted their greater negative emotionality at 12 months of age. Our study suggested that among infants with sufficient postnatal maternal exposure, both maternal sensitivity and mental health are important influences on early brain development.

Prenatal Depression Risk Factors, Developmental Effects and Interventions: A Review

This narrative review based on a literature search in PubMed and PsycInfo on the two terms prenatal and antenatal depression includes empirical studies, reviews and meta-analyses that have been published during the last 5 years on risk factors, developmental effects and interventions for prenatal depression. Risk factor studies that met criteria feature demographic measures (lower socioeconomic status, less education, non-marital status, non-employment, less social support and health locus of control, unintended pregnancy, partner violence and history of child abuse) and physiological variables (cortisol, amylase, and pro-inflammatory cytokines and intrauterine artery resistance). The negative effects include postpartum depression, paternal depression, and prematurity and low birth weight. Negative effects on infants include greater right frontal EEG, amygdala connectivity, cortical thinning and more difficult temperament. In childhood, externalizing and internalizing problems have been reported. The data on prenatal antidepressants (specifically SSRIs) reveal negative effects including internalizing problems as well as a greater risk for autism spectrum disorder. Prenatal interventions that have been effective include interpersonal psychotherapy, peer support, massage therapy, yoga, tai chi, and aerobic exercise. Potential underlying mechanisms are discussed as well as methodological limitations including homogeneity of samples and lack of randomization to intervention groups. Despite these limitations, the literature highlights the need for prenatal depression screening and intervention.