The Role of maternal depressive and anxiety symptoms in maternal cognitive processing during pregnancy and infant attentional processing of emotional faces at the age of eight months - the FinnBrain birth cohort study

Maternal pre- and postnatal depressive and anxiety symptoms are common. These symptoms of distress are known to adversely impact both maternal adaptations to motherhood as well as child development. Currently, little is known about the associations between maternal prenatal distress and cognitive functions, while maternal cognitive functions, especially executive functions are closely related to maternal parenting. Moreover, little is known about the role of maternal preand postnatal symptoms of distress in shaping the development of an infant’s cognitive attention mechanisms, and more specifically, face processing. Finally, the moderating role of child sex on the pre- and early postnatal influences of maternal distress on infant attention development has been rarely explored. The aims of this study were: 1) to compare maternal cognitive functioning during pregnancy between two different test methods using a traditional paper-and-pencil test and a computerized neuropsychological test battery (Study I), and further, to study the associations between maternal self-reported prenatal depressive and anxiety (i.e., both general anxiety and pregnancy-related anxiety) symptoms and cognitive functions (Study II); and 2) to explore the associations between maternal pre- and postnatal depressive and general anxiety symptoms and an 8-month-old infant’s attention to social-emotional signals conveyed through faces (Studies III and IV). The participants for this study were mothers and infants and members of the FinnBrain Birth Cohort Study. The results showed that the cognitive test methods correlated non-significantly or only modestly depending on the cognitive domain. Maternal prenatal symptoms of depression- and pregnancyrelated anxiety, but not general anxiety, predicted the number of errors made in a visual maze task demanding planning and updating of visuo-spatial working memory. Both maternal decreasing and increasing depressive symptoms from the pre- to postnatal period versus consistently low symptoms were associated with enhanced infant processing of threat (i.e., fearful faces) in relation to other facial expressions, and this effect was similar for boys and girls. Maternal pre- and postnatal anxiety symptoms were differently associated with infant attention patterns, with sex-differences in the associations. Maternal prenatal anxiety, but not postnatal, associated with a heightened bias for threat for all infants. Maternal postnatal anxiety symptoms, in turn, associated with the overall disengagement probability from faces to distractors differently for boys and girls. Boys, in relation to maternal symptoms, disengaged their attention more often from faces to distractors and girls less often disengaged. In conclusion, these findings suggest that maternal symptoms of depression and anxiety during the pre- and early postnatal periods, even if at sub-clinical level, relate to cognitive processing both in mothers themselves and in their infants. Some effects on infants may be sex-specific.Äidin masennus- ja ahdistusoireiden yhteys hänen kognitiivisiin toimintoihinsa raskausaikana sekä 8-kuukauden ikäisen vauvan kasvojenilmeisiin suuntautuvaan tarkkaavaisuuteen – FinnBrain-syntymäkohorttitutkimus Äidin raskausajan masennus- ja ahdistusoireet ovat yleisiä. Näiden stressioireiden on havaittu vaikuttavan haitallisesti sekä äidin valmistautumiseen vanhemmuuteen että lapsen kehitykseen. Vasta vähän tiedetään äidin raskausajan stressioireiden ja kognitiivisen suoriutumisen välisistä yhteyksistä, vaikka äidin kognitiivisilla toiminnoilla, erityisesti toiminnanohjauksella, tiedetään olevan keskeinen yhteys vanhempana toimimiseen. Vähän tiedetään myös siitä, miten äidin raskausajan ja synnytyksen jälkeiset oireet voivat muokata lapsen kognitiivisten tarkkaavaisuusmekanismien kehitystä, ja erityisesti kasvojenilmeisiin suuntautuvaa tarkkaavaisuutta. Lisäksi vauvan sukupuolen merkitystä äidin kokemien stressioireiden ja tarkkaavaisuuden kehityksen välillä ei ole juurikaan tutkittu. Tämän väitöskirjan tavoitteena oli: 1) verrata äidin raskaudenaikaista kognitiivista suoriutumista kahden eri testimenetelmän välillä, perinteisessä kynä-paperi –testissä sekä tietokoneistetussa neuropsykologisessa testipatterissa (tutkimus I), ja lisäksi tarkastella äidin raskausaikana itseraportoimien masennus- ja ahdistusoireiden (ml. yleinen ja raskausspesifi ahdistus) ja kognitiivisten toimintojen välisiä yhteyksiä (tutkimus II), sekä 2) tarkastella äidin raskausaikana sekä synnytyksen jälkeen raportoimien masennus- ja ahdistusoireiden ja 8-kuukauden ikäisen vauvan kasvojenilmeisiin suuntautuvan tarkkaavaisuuden välisiä yhteyksiä (tutkimukset III ja IV). Tutkittavat olivat äitejä ja vauvoja, jotka ovat mukana FinnBrainsyntymäkohorttitutkimuksessa. Kahden kognitiivisen testin eri osien välillä havaittiin ei-merkitseviä tai vain kohtalaisia yhteyksiä. Äidin masennusoireet ja raskausspesifi ahdistuneisuus, mutta ei yleinen ahdistuneisuus, ennustivat korkeampaa virheiden määrää näönvaraisessa sokkelotehtävässä, joka edellyttää suunnittelukykyä ja visuo-spatiaalisen työmuistin päivittämistä. Sekä äidin laskevat että nousevat masennusoireet alkuraskaudesta kuusi kuukautta synnytyksen jälkeen (vs. tasaisen matalat oireet) olivat yhteydessä vauvan voimakkaampaan tarkkaavaisuuden suuntautumiseen uhkaärsykkeisiin (pelokkaat kasvot) verrattuna muihin kasvojenilmeisiin, lapsen sukupuolesta riippumatta. Äidin raskausajan ja synnytyksen jälkeiset ahdistuneisuusoireet olivat eri tavoin yhteydessä vauvan tarkkaavaisuusprosesseihin, osin eri tavoin tyttö- ja poikavauvoilla. Äidin raskausajan ahdistusoireet olivat yhteydessä vauvan voimakkaampaan tarkkaavaisuuden suuntautumiseen uhkaärsykkeisiin sekä pojilla että tytöillä. Äidin synnytyksen jälkeiset ahdistusoireet olivat pojilla yhteydessä suurempaan todennäköisyyteen siirtää tarkkaavaisuus kasvoista häiriöärsykkeeseen ja tytöillä vähäisempään todennäköisyyteen siirtää katse pois kasvoista. Yhteenvetona voidaan todeta, että äidin raskausajan ja synnytyksen jälkeisen ajan masennus- ja ahdistusoireet ovat yhteydessä hänen omaan sekä vauvan kognitiiviseen prosessointiin. Lapseen liittyviä vaikutuksia voi ohjata myös vauvan sukupuoli

Maternal Executive Functioning, Emotional Availability and Psychological Distress During Toddlerhood: A FinnBrain Birth Cohort Study

Executive functioning (EF) is one of the building blocks in parental caregiving behavior, and contextual variables have been reported to moderate the link between EF and caregiving behavior. Although psychological distress due to various factors is prevalent during early parenthood and is negatively associated with adult EF, it is not known whether psychological distress influences the maternal EF/caregiving link. This study explored the association between maternal EF and caregiving behavior (more specifically, Emotional Availability/EA), and whether single and cumulative maternal psychological distress domains moderated the EF/EA association in a general population sample of 137 Finnish birth cohort mothers with 2.5-year-old children. EF was measured with a composite of five computerized Cogstate tasks, EA with the Emotional Availability Scales, and three psychological distress domains with self-report questionnaires (depression: EPDS, anxiety: SCL-90, insomnia: AIS). Better EF was significantly associated with more positive, sensitive caregiving, but this association was no longer significant when controlling for education level. Neither individual nor cumulative distress domains moderated the EF/EA association significantly, although the observed moderation effects were in the expected direction. These findings suggest that EF should be recognized alongside socioemotional factors as variables that are associated with parental caregiving behavior during toddlerhood. Furthermore, if the non-significant moderation results are replicated, they indicate that mothers in community samples are not at great risk for psychological distress that would compromise their capacity to utilize their EF while caring for their child. Further studies are needed to confirm these findings, as well as to examine these associations among fathers and in samples that have higher levels of chronic stressors. Studies with more diverse samples in terms of distress levels and EF performance would provide further insight into early childhood parenting and its risk factors

Behavioral regulatory problems are associated with a lower attentional bias to fearful faces during infancy

To investigate the role of early regulatory problems (RP), such as problems in feeding, sleeping, and calming down during later development, the association between parent‐reported RP at 3 months (no‐RP, n = 110; RP, n = 66) and attention to emotional faces at 8 months was studied. Eight‐month‐old infants had a strong tendency to look at faces and to specifically fearful faces, and the individual variance in this tendency was assessed with eye tracking using a face‐distractor paradigm. The early RPs were related to a lower attention bias to fearful faces compared to happy and neutral faces after controlling for temperamental negative affectivity. This suggests that early RPs are related to the processing of emotional information later during infancy.</p

The Connection and Development of Unpredictability and Sensitivity in Maternal Care Across Early Childhood

Both patterns of maternal sensory signals and sensitive care have shown to be crucial elements shaping child development. However, research concerning these aspects of maternal care has focused mainly on maternal sensitivity with fewer studies evaluating the impact of patterns of maternal behaviors and changes in these indices across infancy and childhood. The aims of this study were to explore how maternal unpredictability of sensory signals and sensitivity develop and associate with each other from infancy to toddlerhood and whether elevated maternal depressive and anxiety symptoms relate to maternal unpredictable signals and sensitivity in toddlerhood. The study population consisted of 356 mother–child dyads assessed at 30 months; a subset of 103 mother–child dyads additionally participated in 8 months assessment. Maternal unpredictability and sensitivity were assessed from video-recorded free-play episodes at 8 and 30 months. Maternal depressive and anxiety symptoms were assessed with questionnaires at gestational weeks 14, 24, 34 and 3, 6, 12, and 24 months. Mean level of mothers’ unpredictability decreased on average whereas sensitivity did not change between infancy and toddlerhood. Both maternal unpredictability and sensitivity showed moderate level of individual stability from infancy to toddlerhood and these two measures were modestly correlated within each age. Elevated maternal depressive and anxiety symptoms were not related to unpredictability but related to lower maternal sensitivity in toddlerhood. These results identify unpredictable sensory signals as a characteristic of parental care that is independent of standard quality measures and suggest that it may be less influenced by maternal depressive and anxiety symptoms.</p

Maternal Executive Functioning, Emotional Availability and Psychological Distress During Toddlerhood: A FinnBrain Birth Cohort Study

Executive functioning (EF) is one of the building blocks in parental caregiving behavior, and contextual variables have been reported to moderate the link between EF and caregiving behavior. Although psychological distress due to various factors is prevalent during early parenthood and is negatively associated with adult EF, it is not known whether psychological distress influences the maternal EF/caregiving link. This study explored the association between maternal EF and caregiving behavior (more specifically, Emotional Availability/EA), and whether single and cumulative maternal psychological distress domains moderated the EF/EA association in a general population sample of 137 Finnish birth cohort mothers with 2.5-year-old children. EF was measured with a composite of five computerized Cogstate tasks, EA with the Emotional Availability Scales, and three psychological distress domains with self-report questionnaires (depression: EPDS, anxiety: SCL-90, insomnia: AIS). Better EF was significantly associated with more positive, sensitive caregiving, but this association was no longer significant when controlling for education level. Neither individual nor cumulative distress domains moderated the EF/EA association significantly, although the observed moderation effects were in the expected direction. These findings suggest that EF should be recognized alongside socioemotional factors as variables that are associated with parental caregiving behavior during toddlerhood. Furthermore, if the non-significant moderation results are replicated, they indicate that mothers in community samples are not at great risk for psychological distress that would compromise their capacity to utilize their EF while caring for their child. Further studies are needed to confirm these findings, as well as to examine these associations among fathers and in samples that have higher levels of chronic stressors. Studies with more diverse samples in terms of distress levels and EF performance would provide further insight into early childhood parenting and its risk factors.</p

Infant Sex Moderates the Effects of Maternal Pre- and Postnatal Stress on Executive Functioning at 8 Months of Age

Previous studies report that early life stress, including maternal pre- and postnatal stress, has adverse effects on cognitive development and that these associations might be sex-specific. However, no studies exist on early life stress and infant executive functioning (EF). The aim of this study was to examine the relationship between maternal pre- and postnatal stress and infant EF, and whether these associations are moderated by infant sex. Maternal prenatal depressive, general anxiety, and pregnancy-specific anxiety symptoms were measured three times, and postnatal depressive and general anxiety symptoms were measured 6 months postpartum. Infant EF was assessed with a modified A-not-B task 8 months postpartum (N = 214). Maternal postnatal general anxiety predicted poorer EF in girls in comparison with boys. Moreover, there was a trend toward an interaction between prenatal anxiety and infant sex such that prenatal anxiety predicted infant EF differently in girls and in boys. No association was found between depressive symptoms or pregnancy-specific anxiety symptoms and infant EF. These findings suggest that maternal anxiety may have sex-specific effects on early EF and that pre- and postnatal stress may differently affect infant EF/cognitive development. The implications of these findings and important future directions are discussed.</p

Trajectories of maternal pre- and postnatal anxiety and depressive symptoms and infant fear: Moderation by infant sex

BackgroundPrior work has examined the links between pre- and postnatal maternal distress and infant negative affectivity; however, there is little understanding about how the continuity of infant exposure to pre- and postnatal maternal distress relates to infant development. This study investigated the continuity of maternal pre- and postnatal depressive and anxiety symptoms and their relations with infant fear among 391 mother-infant dyads. An additional aim was to consider infant sex as a moderating factor.MethodsMaternal anxiety and depressive symptoms were measured during gestational weeks 14, 24 and 34 and 3 and 6 months postpartum. Subsequently, infant fear was measured using mother reports (IBQ-R) at 6 months and in a laboratory setting (Lab-TAB Masks episode) at 8 months. Using growth mixture modeling, a three-class model describing the course of maternal symptoms across pregnancy and the early postnatal period was identified, consisting of mothers with “Consistently Low Distress”, “Prenatal-Only Distress”, and “Consistently High Distress”.ResultsInfant girls exposed to prenatal-only maternal distress were higher in observed fear than infant boys exposed to prenatal-only distress. Infant girls exposed to consistently high distress also showed lower observed fear than their counterparts exposed to prenatal-only maternal distress.LimitationsThe main limitation of the study is the relatively small group size within the Consistently High subgroup.ConclusionsThe findings suggest that girls might be particularly sensitive to maternal distress, and that prenatal-only and continuous distress exposure are differentially related to female infant fear.</p

Maternal prenatal psychological distress associates with offspring early-life wheezing - FinnBrain Birth Cohort

Background: Exposure to prenatal maternal psychological distress may contribute to the development of childhood atopic disorders. Little is known about the importance of distress severity and its duration for the risk. Our aim was to investigate how chronic maternal depressive and anxiety symptoms across gestation influence the risk of wheezing and eczema at child age 24 months.Methods: The study population was drawn from the FinnBrain Birth Cohort Study, including 1305 mother-infant dyads followed across gestation until the child age of 24 months when the outcomes were mother-reported wheezing ever and doctor-diagnosed eczema. To investigate the risk of wheezing phenotypes, wheezing with and without eczema was separated. Maternal distress was assessed with the Edinburgh Postnatal Depression Scale for depressive and the Symptom Checklist-90 for anxiety symptoms three times during pregnancy, and the chronicity was demonstrated using symptom trajectories composed by latent growth mixture modeling.Results: Of the children, 219/1305 (17%) had wheezing ever and 285/1276 (22%) had eczema. Risk of wheezing ever was elevated with maternal consistently high depressive symptoms (adjusted odds ratio 2.74; 95% confidence interval 1.37-5.50) or moderate and increasing anxiety symptoms (1.94; 1.06-3.54, respectively). Similarly, wheezing without eczema was associated with consistently high depressive (3.60; 1.63-7.94, respectively) and moderate and increasing anxiety symptoms (2.43; 1.21-4.91, respectively).Conclusions: Maternal chronic psychological distress across gestation was associated with toddler wheezing and especially wheezing without other atopic features (eczema). This finding supports the theory of intrauterine programming effect by maternal psychological distress on offspring immune system and respiratory morbidity.</p

Associations between observed and reported infant negative affectivity, fear and self-regulation, and early communicative development-Evidence from the FinnBrain Birth Cohort Study

Self-regulation and language are intertwined abilities, but the nature of their relations in early childhood when both skills are still emerging is insufficiently understood. Our knowledge of the relations between early negative affectivity and preverbal and verbal communicative development is still limited. Further, observed and reported temperament capture how aspects of temperament operate in different settings but are rarely used in parallel in studies examining early language. During the period of rapid development, longitudinal studies are needed to identify early risk factors for delayed communicative development. We studied relations between aspects of emerging self-regulation and negative affectivity using both observations at 8 months and mother-reports at 6 and 12 months, and communicative development measured by gesturing and vocabulary at 14 and vocabulary at 30 months in 183 children. Mother-reported self-regulation was related to a higher use of communicative gestures and observed self-regulation by gaze aversion to poorer receptive and expressive vocabulary at 14 months, but neither was significantly associated with vocabulary at 30 months. We found little evidence for associations between negative affectivity and fear in infancy and communicative development. Our findings highlight different aspects of self-regulation as both potential risk and protective factors for communicative development. Mixed results indicate a need for a more detailed examination of different strategies of self-regulation in different conditions and developmental stages to yield a deeper understanding of the relations between self-regulation in infancy and communicative development

Unpredictable maternal sensory signals in caregiving behavior are associated with child effortful control

Emerging evidence suggests that exposure to unpredictable patterns of maternal sensory signals during infancy is associated with child neurodevelopment, including poorer effortful control. However, longitudinal effects on child development and possible sex differences are understudied. The aims of the present study were to explore whether exposure to unpredictable maternal sensory signals during infancy is related to child effortful control at 5 years of age and whether child sex moderates these associations. In addition, we examined how exposure to very high vs. low/moderate unpredictability using categorical cut-offs is related to child effortful control. Participants (133 mother–child pairs, all Caucasian) were drawn from the FinnBrain Birth Cohort Study in Finland. Maternal sensory signals (auditory, visual, tactile) were coded from the 10-min free-play episode on a moment-on-moment basis using Observer XT 11 (Noldus), and the unpredictability of maternal sensory signals was characterized as the entropy rate when the infant was 8 months of age. Child effortful control was assessed via mother reports using the Child Behavior Questionnaire very short form (CBQ-VSF) when the child was 5 years old. Correlational analyses showed that higher unpredictability of maternal sensory signals had a modest association with children’s poorer effortful control at 5 years of age. Notably, the linear regression model showed that child sex moderated these associations, as higher exposure to unpredictable maternal sensory signals was related to poorer effortful control among males, but not among females. Moreover, the general linear model showed that exposure to very high unpredictability was associated with poorer child effortful control at 5 years of age and remained significant when adjusted for possible confounding factors. These results are in line with previous findings and suggest that the unpredictability of maternal sensory signals is potentially an important aspect of early caregiving behavior associated with the development of child effortful control.</p