Stressful pregnancies linked to behavioural problems in children

Findings from a number of studies suggest that there is an association between mothers who had stressful pregnancies and behavioural problems in their children. In the first study conducted in a developing country, PAUL G. RAMCHANDANI, LINDA RICHTER, SHANE NORRIS AND ALAN STEIN set out to examine whether maternal prenatal stress is associated with an increased risk of subsequent child behavioural problems in a developing country.

Predictors of postnatal depression in an urban South African cohort

Background: Postnatal depression can have a significant impact on both maternal and child health. There have been very few studies undertaken in the developing world to identify women at risk of postnatal depression. The present study aimed to investigate risk factors for the occurrence of postnatal depression in urban South African women. Method: A large prospective population cohort study identified antenatal risk factors for postnatal depression in Soweto, Johannesburg, South Africa. One thousand and thirty-five women were interviewed in the antenatal period and subsequently completed the Pitt Depression Questionnaire in the postnatal period. Results: 170/1035 (16.4%) women were probable cases of postnatal depression. The strongest independent predictors of postnatal depression were exposure to extreme societal stressors (witnessing a violent crime/danger of being killed) (adjusted Odds Ratio 2.468 (95% Confidence Interval 1.509, 4.037)) and reporting difficulties with their partner (adjusted OR 1.645 (1.088, 2.488)). Limitations: There was some loss of the sample during follow-up (35.1%), which was to be expected given the turbulent nature of the study setting. The measures were questionnaires administered by interview. Conclusion: Postnatal depression is common in women in developing world settings, such as this part of Southern Africa. Although some of the risk factors for postnatal depression were similar to those identified in studies in developed nations, some important differences exist, most notably antenatal exposure to extreme societal stressors. This study shows that it is possible to identify women at risk during pregnancy in a developing world setting.

Prenatal depression, fetal neurobehavior, and infant temperament: novel insights on early neurodevelopment from a socioeconomically disadvantaged Indian cohort

This article extends the research focusing on the early origins of psychopathology into the prenatal period, by exploring the association between maternal prenatal depression and offspring (fetal and infant) neurobehavior. The sample is recruited from a rural population in South India where women in the third trimester of pregnancy were assessed for depression and the heart rate responses of their fetuses to extrinsically applied vibroacoustic stimuli were studied. At 2 months postbirth, infant temperament and cortisol responsivity to immunization were assessed. The association between maternal prenatal depression and fetal responsivity to vibroacoustic stimulation, and infant responsivity to immunization, was U shaped with higher levels of responsivity noted in the offspring of mothers with very high and very low depression scores, and lower levels noted in the offspring of mothers with moderate depression scores. Maternal prenatal depression was not associated with infant temperament. The findings highlight the importance of environmental influences in the developmental origins of neurobehavior, suggesting that such differences, not evident at baseline, may emerge upon exposure to stressors. The study also emphasizes the need for further investigation in low- and middle-income contexts by providing preliminary evidence of the differing patterns of association observed between high- and low-income populations

Maternal postnatal depression and children's growth and behaviour during the early years of life: exploring the interaction between physical and mental health

Objective: To assess the association between maternal postnatal depression and child behaviour problems and child growth at age 2 years. Methods: This was a longitudinal birth cohort study in Johannesburg, South Africa. Primary analysis on the 'Birth to Twenty' cohort was performed for the association between maternal postnatal depression and child behaviour problems (n=1035) and growth (n=891) at age 2 and subgroup analyses (n=635) were carried out to assess the role of poor child growth in this association. Main outcome measures were the association between maternal postpartum depression (measured at 6 months postnatally using the Pitt depression inventory) and child behaviour problems (Richman child behaviour scale) and child growth at age 2 years. Results: Maternal postnatal depression was significantly associated with child behaviour problems at age 2, independent of socioeconomic status (?=0.353, p value=0.015). There was some evidence that children of depressed mothers were also at increased risk for having stunted growth, compared to non-depressed mothers (OR 1.61 (95% CI 1.02 to 2.56). The association between postnatal depression and child behavioural problems was significantly mediated by the stunted growth of the child (?=0.294, p value=0.111). Conclusions: Maternal postnatal depression is associated with later child behaviour problems independent of the socioeconomic status of the family. This association is mediated by the child's growth, demonstrating the importance of considering a child's physical and mental health together.

Low birthweight and subsequent emotional and behavioural outcomes in 12-year-old children in Soweto, South Africa: findings from Birth to Twenty

Background. The fetal origins hypothesis suggests that an adverse prenatal environment, indexed by low birthweight (LBW), may increase the risk of developing later disease. Recently the hypothesis has been extended to psychological outcomes, especially depression. The aim of this analysis was to test, for the first time in a developing country setting, the association between LBW and psychological symptoms, in Soweto, South Africa. Methods. A sample of 1029 children was drawn from Birth to Twenty, a longitudinal cohort followed from pregnancy to young adulthood. This sample completed the Youth Self Report at age 12 years, a validated psychological measure of behavioural and emotional adjustment. Scores were compared between LBW (<2500 g) and normal birthweight children using multivariate analysis with adjustment for potential birth and life events confounding factors. Results. No associations were found between LBW and total [adjusted odds ratio (OR) 1.09, 95% confidence interval (CI) 0.69-1.74], internalizing (adjusted OR 0.81, 95% CI 0.52-1.28) or externalizing profiles (adjusted OR 0.81, 95% CI 0.49-1.36). The only difference detected was for the internalizing sub-profile of Somatic Complaints (adjusted OR 2.02, 95% CI 1.21-3.38), which on subgroup analysis was greatest among females. Conclusions. We found no convincing evidence of an association between LBW and emotional and behavioural outcomes in 12-year olds in this sample in urban South Africa. To our knowledge, this is the first published assessment of this association in a developing world context.

Postnatal depressive symptoms and child psychological develoment at 10 years: a prospective study of longitudinal data from the South African Birth to Twenty cohort

In high-income countries, maternal postnatal depression is associated with adverse outcomes in the child. However, few studies have investigated this relation in countries of low and middle income. Furthermore, to our knowledge, no studies have followed up cohorts into later childhood. We aimed to investigate whether maternal depression 6 months after birth is associated with psychological difficulties in a socioeconomically disadvantaged South African cohort of children at age 10 years. Birth to Twenty is a prospective, longitudinal, birth-cohort study based in the Soweto area of Johannesburg, South Africa. Mothers and children in this cohort have been followed up at time points ranging from before birth to age 10 years. Maternal mood was measured at 6 months with the Pitt depression inventory and at 10 years with the Centre for Epidemiologic Studies depression scale (CES-D). Child psychological functioning was assessed at 10 years with the South African child assessment schedule (SACAS). Our primary outcome was psychological development of children at age 10 years, measured by total score on the SACAS. Secondary outcomes were scores on externalising and internalising subscales of the SACAS. We used t tests to compare psychological outcomes between children whose mother had postnatal depression at 6 months and those whose mother did not have postnatal depression. We examined associations between maternal postnatal depression and child psychological outcomes by multivariate linear-regression analysis, adjusting for socioeconomic status and maternal depression at 10 years, and we used logistic regression to provide odds ratios for associations identified by linear regression. 1866 mothers completed the Pitt depression inventory 6 months after the birth of their child; of these, 453 (24%) had symptoms of postnatal depression. At the 10-year assessment, 1012 mothers completed the CES-D questionnaire, of whom 747 (74%) were judged to have depression. Sociodemographic characteristics did not differ between mothers with and without depression at both 6 months and 10 years. After adjusting for socioeconomic status and maternal depression at 10 years, children whose mothers had postnatal depression at 6 months were more than twice as likely to have significant psychological difficulties 10 years later compared with children whose mothers did not have postnatal depression at 6 months (adjusted odds ratio 2?26, 95% CI 1?23-4?16). Maternal postnatal depression is associated with adverse psychological outcomes in children up to 10 years later in countries of low and middle income. In view of the increased prevalence of postnatal depression in these settings, this finding has important implications for policy and interventions for children and their mothers.

Maternal depression and foetal responses to novel stimuli: Insights from a socio-economically disadvantaged Indian cohort

Maternal stress during pregnancy has pervasive effects on stress responsivity in children. This study is the first to test the hypothesis that maternal prenatal depression, as observed in South India, may be associated with how foetuses respond to a potentially stressful stimulus. We employed measures of foetal heart rate at baseline, during exposure to a vibroacoustic stimulus, and post-stimulation, to study patterns of response and recovery in 133 third trimester foetuses of depressed and non-depressed mothers. We show that the association between maternal depression and foetal stress responsivity is U-shaped with foetuses of mothers with high and low depression scores demonstrating elevated responses, and poorer recovery, than foetuses of mothers with moderate levels. The right amount of intra-uterine stimulation is important in conditioning foetuses towards optimal regulation of their stress response. Our results imply that, in certain environmental contexts, exposure to moderate amounts of intra-uterine stress may facilitate this process