Background
This study determined whether parental mental health and emotional experiences during the prenatal period were linked to infant developmental outcomes through the Ages and Stages Questionnaire (ASQ-3) at 8−10 months.
Methods
Participants included 133 individuals who were living in the US and were pregnant or had given birth within 6 months prior to enrollment. Respondents were majority White with high education and income levels. Online surveys were administered from May 2020 to September 2021; follow-up surveys were administered from November 2020 to August 2022.
Results
Parent generalized anxiety symptoms were positively associated with infant communication (β = 0.34, 95% CI [0.15, 1.76], p < 0.05), while parent-fetal bonding was positively associated with infant communication (β = 0.20, 95% CI [0.05, 0.76], p < 0.05) and personal-social performance (β = 0.20, 95% CI [0.04, 0.74], p < 0.05). COVID-19-related worry was negatively associated with infant communication (β = −0.30, 95% CI [−0.75, −0.12], p < 0.05) and fine motor performance (β = −0.25, 95% CI [−0.66, −0.03], p < 0.05).
Conclusion
Parent mental health and emotional experiences may contribute to infant developmental outcomes in high risk conditions such as a pandemic.
Impact statement
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Maternal SARS-CoV-2 infection has been evaluated in relation to child outcomes, however, parent psychosocial experiences should not be overlooked when considering pandemic risks to child development.
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Specific prenatal mental health and pandemic-related emotional experiences are associated with infant developmental performance, as assessed by the Ages and Stages. Questionnaire (ASQ-3) at 8 to 10 months old.
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Findings indicate that parental prenatal anxiety and emotional experiences from the pandemic should be assessed when evaluating child developmental delays.
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Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Manti, S. et al. Effects of vertical transmission of respiratory viruses to the offspring. Front. Immunol. 13, 853009 (2022).
Hu, Y. J., Wake, M. & Saffery, R. Clarifying the sweeping consequences of COVID-19 in pregnant women, newborns, and children with existing cohorts. JAMA Pediatr. 175, 117–118 (2021).
Arthurs, A. L., Jankovic-Karasoulos, T. & Roberts, C. T. COVID-19 in pregnancy: what we know from the first year of the pandemic. Biochim. Biophys. Acta Mol. Basis Dis. 1867, 166248 (2021).
Kotlyar, A. M. et al. Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 224, 35–53.e3 (2021).
Jeganathan, K. & Paul, A. B. Vertical transmission of SARS-CoV-2: a systematic review. Obstet. Med. 15, 91–98 (2022).
Wei, S. Q., Bilodeau-Bertrand, M., Liu, S. & Auger, N. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ 193, E540–E548 (2021).
Kong, L. et al. Association of preeclampsia and perinatal complications with offspring neurodevelopmental and psychiatric disorders. JAMA Netw. Open 5, e2145719 (2022).
Iyengar, U., Jaiprakash, B., Haitsuka, H. & Kim, S. One year into the pandemic: a systematic review of perinatal mental health outcomes during COVID-19. Front. Psychiatry 12, 674194 (2021).
Liu, C. H. & Tronick, E. Re-conceptualising prenatal life stressors in predicting post-partum depression: cumulative-, specific-, and domain-specific approaches to calculating risk. Paediatr. Perinat. Epidemiol. 27, 481–490 (2013).
Liu, C. H., Phan, J., Yasui, M. & Doan, S. Prenatal life events, maternal employment, and postpartum depression across a diverse population in New York City. Community Ment. Health J. 54, 410–419 (2018).
Liu, C. H., Erdei, C. & Mittal, L. Risk factors for depression, anxiety, and PTSD symptoms in perinatal women during the COVID-19 Pandemic. Psychiatry Res. 295, 113552 (2021).
Mughal, M. K., Ginn, C. S., Magill-Evans, J. & Benzies, K. M. Parenting stress and development of late preterm infants at 4 months corrected age. Res. Nurs. Health 40, 414–423 (2017).
Van den Bergh, B. R. H. et al. Prenatal developmental origins of behavior and mental health: the influence of maternal stress in pregnancy. Neurosci. Biobehav Rev. 117, 26–64 (2020).
Desplats, P. A. Perinatal programming of neurodevelopment: epigenetic mechanisms and the prenatal shaping of the brain. in perinatol programming of neurodevelopment. (ed. Antonelli M. C) (Springer, 2015).
Chan, J. C., Nugent, B. M. & Bale, T. L. Parental advisory: maternal and paternal stress can impact offspring neurodevelopment. Biol. Psychiatry 83, 886–894 (2018).
Jensen Peña, C., Monk, C. & Champagne, F. A. Epigenetic effects of prenatal stress on 11β-hydroxysteroid dehydrogenase-2 in the placenta and fetal brain. PloS One 7, e39791 (2012).
Koutra, K. et al. Antenatal and postnatal maternal mental health as determinants of infant neurodevelopment at 18 months of age in a mother-child cohort (Rhea Study) in Crete, Greece. Soc. Psychiatry Psychiatr. Epidemiol. 48, 1335–1345 (2013).
Zhang, W. et al. Prenatal depression and infant temperament: the moderating role of placental gene expression. Infancy 23, 211–231 (2018).
Babineau, V. et al. Prenatal depression and 5-HTTLPR interact to predict dysregulation from 3 to 36 months-a differential susceptibility model. J. Child Psychol. Psychiatry 56, 21–29 (2015).
Madigan, S. et al. A meta-analysis of maternal prenatal depression and anxiety on child socioemotional development. J. Am. Acad. Child Adolesc. Psychiatry 57, 645–657.e8 (2018).
Korja, R., Nolvi, S., Grant, K. A. & McMahon, C. The relations between maternal prenatal anxiety or stress and child’s early negative reactivity or self-regulation: a systematic review. Child Psychiatry Hum. Dev. 48, 851–869 (2017).
Tarabulsy, G. M. et al. Meta-analytic findings of the relation between maternal prenatal stress and anxiety and child cognitive outcome. J. Dev. Behav. Pediatr. 35, 38–43 (2014).
Koire, A., Mittal, L., Erdei, C. & Liu, C. H. Maternal-fetal bonding during the COVID-19 pandemic. BMC Pregnancy Childbirth 21, 846 (2021).
Branjerdporn, G., Meredith, P., Strong, J. & Garcia, J. Associations between maternal-foetal attachment and infant developmental outcomes: a systematic review. Matern. Child Health J. 21, 540–553 (2017).
Petri, E. et al. Maternal-foetal attachment independently predicts the quality of maternal-infant bonding and post-partum psychopathology. J. Matern. Fetal Neonatal Med. J. 31, 3153–3159 (2018).
Alhusen, J. L., Gross, D., Hayat, M. J., Woods, A. B. & Sharps, P. W. The influence of maternal-fetal attachment and health practices on neonatal outcomes in low-income, urban women. Res. Nurs. Health 35, 112–120 (2012).
Alhusen, J. L., Hayat, M. J. & Gross, D. A longitudinal study of maternal attachment and infant developmental outcomes. Arch. Women’s Ment. Health 16, 521–529 (2013).
Arguz Cildir, D., Ozbek, A., Topuzoglu, A., Orcin, E. & Janbakhishov, C. E. Association of prenatal attachment and early childhood emotional, behavioral, and developmental characteristics: a longitudinal study. Infant Ment. Health J. 41, 517–529 (2020).
Le Bas, G. et al. The role of antenatal and postnatal maternal bonding in infant development. J. Am. Acad. Child Adolesc. Psychiatry 61, 820–829.e1 (2022).
Ji, E. K. et al. Effects of ultrasound on maternal-fetal bonding: a comparison of two- and three-dimensional imaging. J. Int Soc. Ultrasound Obstet. Gynecol. 25, 473–477 (2005).
Chudleigh, T. Scanning for pleasure. Ultrasound Obstet. Gynecol. 14, 369–371 (1999).
Provenzi, L. et al. Prenatal maternal stress during the COVID-19 pandemic and infant regulatory capacity at 3 months: a longitudinal study. Dev. Psychopathol. 35, 35–43 (2023).
Wang, Y. et al. Impact of Covid-19 in pregnancy on mother’s psychological status and infant’s neurobehavioral development: a longitudinal cohort study in China. BMC Med .18, 347 (2020).
Ayed, A. et al. Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait. BMC Pregnancy Childbirth 20, 754 (2020).
Schonhaut, L., Armijo, I., Schönstedt, M., Alvarez, J. & Cordero, M. Validity of the ages and stages questionnaires in term and preterm infants. Pediatrics 131, e1468–e1474 (2013).
Pisoni, C. et al. Risk and protective factors in maternal-fetal attachment development. Early Hum. Dev. 90, S45–S46 (2014).
Radloff, L. S. The CES-D Scale: a self-report depression scale for research in the general population. 1. accessed 7 Nov 2023. https://doi.org/10.1177/014662167700100306 (1977).
Gaynes et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes: summary. In: AHRQ Evidence Report Summaries. Agency for Healthcare Research and Quality (US); accessed 7 Nov 2023. https://www.ncbi.nlm.nih.gov/books/NBK11838/ (2005).
Heller, H. M., Draisma, S. & Honig, A. Construct validity and responsiveness of instruments measuring depression and anxiety in pregnancy: a comparison of EPDS, HADS-A and CES-D. Int. J. Environ. Res. Public Health 19, 7563 (2022).
Spitzer, R. L., Kroenke, K., Williams, J. B. W. & Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch. Intern. Med. 166, 1092–1097 (2006).
Löwe, B. et al. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Med. Care 46, 266–274 (2008).
Simpson, W., Glazer, M., Michalski, N., Steiner, M. & Frey, B. N. Comparative efficacy of the generalized anxiety disorder 7-item scale and the Edinburgh Postnatal Depression Scale as screening tools for generalized anxiety disorder in pregnancy and the postpartum period. Can. J. Psychiatry Rev. Can. Psychiatr. 59, 434–440 (2014).
Cranley, M. S. Development of a tool for the measurement of maternal attachment during pregnancy. Nurs. Res. 30, 281–284 (1981).
Liu, C. H., Giallo, R., Doan, S. N., Seidman, L. J. & Tronick, E. Racial and ethnic differences in prenatal life stress and postpartum depression symptoms. Arch. Psychiatr. Nurs. 30, 7–12 (2016).
Dindo, L. et al. A randomized controlled trial for symptoms of anxiety and depression: effects of a 1-day acceptance and commitment training workshop. Ann. Clin. Psychiatry J. Am. Acad. Clin. Psychiatr. 33, 258–269 (2021).
Hyun, S., Hahm, H. C., Wong, G. T. F., Zhang, E. & Liu, C. H. Psychological correlates of poor sleep quality among U.S. young adults during the COVID-19 pandemic. Sleep. Med. 78, 51–56 (2021).
Prigerson, H. G. et al. Inventory of complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res. 59, 65–79 (1995).
Liu, C. H., Stevens, C., Conrad, R. C. & Hahm, H. C. Evidence for elevated psychiatric distress, poor sleep, and quality of life concerns during the COVID-19 pandemic among U.S. young adults with suspected and reported psychiatric diagnoses. Psychiatry Res. 292, 113345 (2020).
Squires, J., Twombly, E., Bricker, D., Potter, L. ASQ®-3 User’s Guide. Paul H. Brookes Pub; accessed 7 Nov 2023. https://products.brookespublishing.com/ASQ-3-Users-Guide-P571.aspx (2009).
Agarwal, P. K. et al. Concurrent validity of the ages and stages questionnaires with Bayley Scales of Infant Development-III at 2 years - Singapore cohort study. Pediatr. Neonatol. 65, 48–54 (2024).
Sheldrick, R. C., Marakovitz, S., Garfinkel, D., Carter, A. S. & Perrin, E. C. Comparative accuracy of developmental screening questionnaires. JAMA Pediatr. 174, 366–374 (2020).
Shreffler, K. M., Spierling, T. N., Jespersen, J. E. & Tiemeyer, S. Pregnancy intendedness, maternal-fetal bonding, and postnatal maternal-infant bonding. Infant. Ment. Health J. 42, 362–373 (2021).
McMahon, C., Camberis, A. L., Berry, S. & Gibson, F. Maternal mind-mindedness: Relations with maternal-fetal attachment and stability in the first two years of life: Findings from an Australian prospective study. Infant Ment. Health J. 37, 17–28 (2016).
Bernier, A., Tarabulsy, G. M., Cyr, C. & Matte-Gagné, C. Further evidence for the multidimensional nature of maternal sensitivity: differential links with child socioemotional functioning at preschool age. Infancy 26, 238–247 (2021).
Shuffrey, L. C. et al. Association of birth during the COVID-19 pandemic with neurodevelopmental status at 6 months in infants with and without in utero exposure to maternal SARS-CoV-2 infection. JAMA Pediatr. 176, e215563 (2022).
Firestein, M. R. et al. Assessment of neurodevelopment in infants with and without exposure to asymptomatic or mild maternal SARS-CoV-2 infection during pregnancy. JAMA Netw. Open 6, e237396 (2023).
Gete, S., Calderon-Margalit, R., Grotto, I. & Ornoy, A. A comparison of the effects of maternal anxiety and depression on child development. Eur. J. Public Health 29, ckz185.275 (2019).
Quintigliano, M., Trentini, C., Fortunato, A., Lauriola, M. & Speranza, A. M. Role of parental attachment styles in moderating interaction between parenting stress and perceived infant characteristics. Front. Psychol. 12, 730086 https://www.frontiersin.org/articles/10.3389/fpsyg.2021.730086.
Shao, S. S. et al. [A cohort study of maternal pregnancy-related anxiety at different trimesters and infants’ neurobehavioral development]. Zhonghua Yu Fang Yi Xue Za Zhi 55, 177–183 (2021).
Lin, H. C. et al. Maternal self-efficacy buffers the effects of COVID-19-related experiences on postpartum parenting stress. J. Obstet. Gynecol. Neonatal Nurs. 51, 177–194 (2022).
Huang, P. et al. Association between the COVID-19 pandemic and infant neurodevelopment: a comparison before and during COVID-19. Front. Pediatr. 9, 662165 (2021).
Gur, R. E. et al. The disproportionate burden of the COVID-19 pandemic among pregnant black women. Psychiatry Res. 293, 113475 (2020).
Liu, C. H. & Tronick, E. Prevalence and predictors of maternal postpartum depressed mood and anhedonia by race and ethnicity. Epidemiol. Psychiatr. Sci. 23, 201–209 (2013).
Liu, C. H., Koire, A., Erdei, C. & Mittal, L. Subjective social status, COVID-19 health worries, and mental health symptoms in perinatal women. SSM - Popul. Health 18, 101116 (2022).
Liu, C. H., Snidman, N., Kagan, J. & Tronick, E. Effect of maternal distress on perceptions of infant behavior may differ in Chinese-American and European-American mothers and infants. J. Dev. Behav. Pediatr. 41, 212–220 (2020).
Liu, C. H. & Doan, S. N. Psychosocial stress contagion in children and families during the COVID-19 pandemic. Clin. Pediatr. 59, 853–855 (2020).
Erdei, C. & Liu, C. H. The downstream effects of COVID-19: a call for supporting family wellbeing in the NICU. J. Perinatol. 40, 1283–1285 (2020).
Acknowledgements
We are grateful to Finneas G.T. Wong and Emily Zhang for the initial set up and data collection of this project.
Funding
This research was supported by Family Health and Resiliency Fund and the Weinberg and Barton Families.
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CL, AK, CE provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. CL, AK, CM, LM, JR, and CE drafted the article or revised it critically for important intellectual content. CL provided final approval of the version to be published.
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Liu, C.H., Koire, A., Ma, C. et al. Prenatal mental health and emotional experiences during the pandemic: associations with infant neurodevelopment screening results. Pediatr Res 96, 237–244 (2024). https://doi.org/10.1038/s41390-024-03100-y
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DOI: https://doi.org/10.1038/s41390-024-03100-y