Maternal–Foetal Medicine
Maternal Perinatal Depression – Impact on Infant and Child Development Ellen Waxler,1
Kelsie Thelen,2 and Maria Muzik3
1. Clinical Subjects Coordinator, Department of Psychiatry, and Graduate Student in Clinical Psychology, University of Michigan; 2. Clinical Subjects Coordinator, Department of Psychiatry, University of Michigan, and Graduate Student in Social Work, Boston University; 3. Assistant Professor, Department of Psychiatry, and Assistant Research Scientist, Center for Human Growth and Development, University of Michigan
Abstract
Perinatal maternal depression is very common (it affects 10–15% 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 mothers’ post-partum 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, care-giving, developmental psychopathology
Disclosure: The authors have no conflicts of interest to declare. Received: 14 February 2011 Accepted: 3 March 2011 Citation: European Obstetrics & Gynaecology, 2012;7(1):25–31 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
Studies have shown
that 10 to 16 % of pregnant or post-partum 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 post-partum depression.5
history of depression,6
Additional risk factors include family history or own prior 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., pre-term birth)10 child outcomes.11
as well as infant and young
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 mother’s neuroendocrine stress regulation (showing elevated cortisol
© TOUCH BRIEFINGS 2012
levels)13
and illness onset is most commonly seen between the ages of 20 and 40, the prime age range for childbearing.2
and decreased uterine blood flow,14
which may contribute
to premature delivery, low birth weight and pre-eclampsia.15,16 Post-partum depression can disrupt sensitive care-giving, 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 neuroendocrine stress systems19–21
development of and attachment security.22,23
Subsequently, suboptimal infants’ biological and socioemotional development may carry forward and negatively impact young children’s physical and mental health as well.24
In the following sections, we elaborate on current research on the effects of maternal perinatal depression on foetal and infant development, the mechanisms of risk transmission from mother to child and adverse long-term child outcomes described in the literature. We also briefly touch on the role of perinatal interventions delivered to depressed mothers in ameliorating risk transmission.
Antenatal Depression – Impact on the Foetus and Neonate
Stress and depression during pregnancy lead, via activation of the maternal hypothalamic–pituitary–adrenal (HPA) stress axis, to increases in circulating maternal stress hormones, cortisol and placental corticotropin-releasing hormone (CRH), thus exposing the developing foetus to these stress hormones.25
The HPA axis is the final
pathway activated by stress signals: neurons in the hypothalamus synthesise and secrete corticotrophin-releasing hormones (CRHs)
25
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