Maternal Perinatal Depression โ€“ Impact on Infant and Child Development

Ellen Waxler, Kelsie Thelen, Maria Muzik
European Psychiatric Review, 2011;4(1):41-47
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Abstract

Perinatal maternal depression is very common (it affects 10โ€“15% of women), and has detrimental and potentially long-lasting effects on infant and child development. This paper reviews the current state of knowledge of the effects of prenatal maternal depression on foetal development, mediated by foetal exposure to maternal stress hormones. We also discuss the effects of mothersโ€™ postpartum depression on infant temperament and emotion regulation, the development of infant stress systems, and infant attachment patterns, and we review the long-term sequelae for child development. We discuss the impact of suboptimal parenting secondary to perinatal depression and highlight the interaction of parenting and child genetic risk in predicting adverse developmental outcomes. Finally, we discuss interventions aiming to interrupt cycles of mother-to-child risk transmission.
Keywords
Perinatal maternal depression, foetal development, infancy, risk transmission, child problems, caregiving, developmental psychopathology
Disclosure The authors have no conflicts of interest to declare.
Received: February 14, 2011 Accepted March 03, 2011
Correspondence: Maria Muzik, Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109, US. E: muzik@med.umich.edu

Prevalence studies indicate that one in five women in the US experience an episode of major depressive disorder (MDD) during their lifetime1 and illness onset is most commonly seen between ages 20 and 40, the prime age range for childbearing.2 Studies have shown that 10 to 16% of pregnant or postpartum women are depressed, and even more women experience subsyndromal depressive symptoms that are frequently overlooked.3,4 In general, more childcare stress, more life stress, and social support deficits commonly co-occur with entry to motherhood, and are among the top predictors of postpartum depression.5 Additional risk factors include family history or own prior history of depression,6 history of past or current abuse,7 history of co-morbid conditions (e.g. substance use, severe anxiety or medical health problems),8 and finally psychosocial stressors, such as financial or occupational problems, absence of supportive relationships, or ambivalence about the pregnancy.9

If left untreated, perinatal depression can have adverse effects on the course of pregnancy (e.g. preterm birth),10 as well as infant and young child outcomes.11 Transmission of risk for mental illness from mother to child could be the result of several mechanisms, including foetal stress exposure in utero, inheritance of risk genes, and exposure to less optimal maternal parenting secondary to mental illness, along with possible interactive effects and moderating factors such as timing of maternal depression and child characteristics.

Negative birth outcomes are associated most strongly with depression symptoms in the second and third trimesters12 via in utero stress exposure. Antenatal depression leads to alterations in the motherโ€™s neuroendocrine stress regulation (showing elevated cortisol levels)13 and decreased uterine blood flow,14 which may contribute to premature delivery, low birth weight, and pre-eclampsia.15,16 Postpartum depression can disrupt sensitive caregiving, leading to adverse child outcomes.11 The impact of poor parenting on child outcomes is moderated by child genetics such that infants with genetic risk are more susceptible to negative outcomes.17 Maternal perinatal depression has been found in the literature to negatively affect infant temperament and emotion regulation,18 development of neuroendocrine stress systems,19โ€“21 and attachment security.22,23 Subsequently, suboptimal infantsโ€™ biological and socio-emotional development may carry forward and negatively impact young childrenโ€™s physical and mental health as well.24

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