Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 8, pp 1335–1345 | Cite as

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

  • Katerina KoutraEmail author
  • Leda Chatzi
  • Manolis Bagkeris
  • Maria Vassilaki
  • Panos Bitsios
  • Manolis Kogevinas
Original Paper
First Online:

Abstract

Purpose

A growing body of evidence links poor maternal mental health with negative outcomes on early child development. We examined the effect of antenatal and postnatal maternal mental health on infant neurodevelopment at age 18 months in a population-based mother–child cohort (Rhea Study) in Crete, Greece.

Methods

Self-reported measures of maternal depression (EPDS), trait anxiety (STAI-Trait) and personality traits (EPQ-R) were assessed in a sample of women during pregnancy and at 8 weeks postpartum (n = 223). An additional sample of 247 mothers also completed the EPDS scale at 8 weeks postpartum (n = 470). Neurodevelopment at 18 months was assessed with the use of Bayley Scales of Infant and Toddler Development (3rd edition).

Results

Multivariable linear regression models adjusted for confounders revealed that antenatal depressive symptoms (EPDS ≥ 13) were associated with decrease in cognitive development independently of postnatal depression. High trait anxiety and extraversion were associated with decrease and increase, respectively, in social–emotional development. Also, high trait anxiety and neuroticism had a positive effect on infants’ expressive communication. Finally, postpartum depressive symptoms (EPDS ≥ 13) were associated with decrease in cognitive and fine motor development independently of antenatal depression.

Conclusions

These findings suggest that antenatal and postnatal maternal psychological well-being has important consequences on early child neurodevelopment.

Keywords

Antenatal maternal mental health Postpartum depression Infant neurodevelopment 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

Rhea cohort was supported by European projects (EU FP6-2003-Food-3-A NewGeneris, EU FP6. STREP HiWATE, EU FP7 ENV.2007.1.2.2.2. Project No 211250 Escape, EU FP7-2008-ENV-1.2.1.4 EnviroGenoMarkers, EU FP7-HEALTH-2009- single-stage CHICOS, EU FP7 ENV.2008.1.2.1.6. Proposal No 226285 ENRIECO); and by the Greek Ministry of Health (Program of Prevention of obesity and neurodevelopmental disorders in preschool children, in Heraklion district, Crete, Greece: 2011–2014). We are grateful to all those who participated in the study especially the mothers and their infants, the psychologists who assisted in infants’ neurodevelopmental assessment and the whole Rhea team for their contribution and understanding. We also acknowledge Raquel Garcia Esteban, Barcelona, for conducting the standardisation of Bayley’s scores.

Conflict of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    Field T (2011) Prenatal depression effects on early development: a review. Infant Behav Dev 34(1):1–14PubMedCrossRefGoogle Scholar
  2. 2.
    Bergman K, Sarkar P, Glover V, O’Connor TG (2010) Maternal prenatal cortisol and infant cognitive development: moderation by infant-mother attachment. Biol Psychiatry 67(11):1026–1032PubMedCrossRefGoogle Scholar
  3. 3.
    Davis EP, Sandman CA (2010) The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development. Child Dev 81(1):131–148PubMedCrossRefGoogle Scholar
  4. 4.
    O’Donnell K, O’Connor TG, Glover V (2009) Prenatal stress and neurodevelopment of the child: focus on the HPA axis and role of the placenta. Dev Neurosci 31(4):285–292PubMedCrossRefGoogle Scholar
  5. 5.
    O’Connor TG, Heron J, Golding J, Beveridge M, Glover V (2002) Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years: report from the Avon longitudinal study of parents and children. Br J Psychiatry 180:502–508PubMedCrossRefGoogle Scholar
  6. 6.
    Evans J, Heron J, Francomb H, Oke S, Golding J (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323(7307):257–260PubMedCrossRefGoogle Scholar
  7. 7.
    Murray L, Hipwell A, Hooper R, Stein A, Cooper P (1996) The cognitive development of 5-year-old children of postnatally depressed mothers. J Child Psychol Psychiatry 37(8):927–935PubMedCrossRefGoogle Scholar
  8. 8.
    Grace SL, Evindar A, Stewart DE (2003) The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health 6(4):263–274PubMedCrossRefGoogle Scholar
  9. 9.
    McMahon C, Trapolini T, Barnett B (2008) Maternal state of mind regarding attachment predicts persistence of postnatal depression in the preschool years. J Affect Disord 107(1–3):199–203PubMedCrossRefGoogle Scholar
  10. 10.
    Hay DF, Pawlby S, Sharp D, Asten P, Mills A, Kumar R (2001) Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. J Child Psychol Psychiatry 42(7):871–889PubMedCrossRefGoogle Scholar
  11. 11.
    Brennan PA, Hammen C, Andersen MJ, Bor W, Najman JM, Williams GM (2000) Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5. Dev Psychol 36(6):759–766PubMedCrossRefGoogle Scholar
  12. 12.
    Cornish AM, McMahon CA, Ungerer JA, Barnett B, Kowalenko N, Tennant C (2005) Postnatal depression and infant cognitive and motor development in the second postnatal year: the impact of depression chronicity and infant gender. Infant Behav Dev 28(4):407–417CrossRefGoogle Scholar
  13. 13.
    Evans J, Melotti R, Heron J, Ramchandani P, Wiles N, Murray L, Stein A (2012) The timing of maternal depressive symptoms and child cognitive development: a longitudinal study. J Child Psychol Psychiatry 53(6):632–640PubMedCrossRefGoogle Scholar
  14. 14.
    Deave T, Heron J, Evans J, Emond A (2008) The impact of maternal depression in pregnancy on early child development. BJOG 115(8):1043–1051PubMedCrossRefGoogle Scholar
  15. 15.
    Hay DF, Pawlby S, Waters CS, Perra O, Sharp D (2010) Mothers’ antenatal depression and their children’s antisocial outcomes. Child Dev 81(1):149–165PubMedCrossRefGoogle Scholar
  16. 16.
    Huizink AC, Robles de Medina PG, Mulder EJ, Visser GH, Buitelaar JK (2003) Stress during pregnancy is associated with developmental outcome in infancy. J Child Psychol Psychiatry 44(6):810–818PubMedCrossRefGoogle Scholar
  17. 17.
    DiPietro JA, Novak MF, Costigan KA, Atella LD, Reusing SP (2006) Maternal psychological distress during pregnancy in relation to child development at age two. Child Dev 77(3):573–587PubMedCrossRefGoogle Scholar
  18. 18.
    Chatzi L, Plana E, Daraki V, Karakosta P, Alegkakis D, Tsatsanis C, Kafatos A, Koutis A, Kogevinas M (2009) Metabolic syndrome in early pregnancy and risk of preterm birth. Am J Epidemiol 170(7):829–836PubMedCrossRefGoogle Scholar
  19. 19.
    Koutra K, Chatzi L, Roumeliotaki T, Vassilaki M, Giannakopoulou E, Batsos C, Koutis A, Kogevinas M (2012) Socio-demographic determinants of infant neurodevelopment at 18 months of age: mother-child cohort (Rhea Study) in Crete. Greece. Infant Behav Dev 35(1):48–59CrossRefGoogle Scholar
  20. 20.
    Spielberger C, Gorsuch R, Lushene R, Vagg P, Jacobs G (1970) Manual for the state: trait anxiety inventory. Consulting Psychologists Press, Palo AltoGoogle Scholar
  21. 21.
    Liakos A, Yannitsi S (1984) Reliability and validity of the modified Greek version of the Spielberger state: Trait Anxiety Inventory. Encephalos 21:71–76Google Scholar
  22. 22.
    Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item edinburgh postnatal depression scale. Br J Psychiatry 150:782–786PubMedCrossRefGoogle Scholar
  23. 23.
    Murray L, Carothers AD (1990) The validation of the EPDS on a community sample. Br J Psychiatry 157:288–290PubMedCrossRefGoogle Scholar
  24. 24.
    Leonardou AA, Zervas YM, Papageorgiou CC, Marks MN, Tsartsara EC, Antsaklis A, Christodoulou GN, Soldatos CR (2009) Validation of the Edinburgh postnatal depression scale and prevalence of postnatal depression at 2 months postpartum in a sample of Greek mothers. J Reprod Infant Psyc 27(1):28–39CrossRefGoogle Scholar
  25. 25.
    Vivilaki VG, Dafermos V, Kogevinas M, Bitsios P, Lionis C (2009) The Edinburgh postnatal depression scale: translation and validation for a greek sample. BMC Public Health 9:329PubMedCrossRefGoogle Scholar
  26. 26.
    Chatzi L, Melaki V, Sarri K, Apostolaki I, Roumeliotaki T, Georgiou V, Vassilaki M, Koutis A, Bitsios P, Kogevinas M (2011) Dietary patterns during pregnancy and the risk of postpartum depression: the mother-child ‘Rhea’ cohort in Crete, Greece. Public Health Nutr 14(9):1663–1670PubMedCrossRefGoogle Scholar
  27. 27.
    Eysenck HJ, Eysenck SBG (1991) Manual of the Eysenck personality scales. Hodder & Stoughton, LondonGoogle Scholar
  28. 28.
    Bayley N (2006) Bayley scales of infant and toddler development, 3rd edn. PsychCorp Harcourt Assessment Inc, San AntonioGoogle Scholar
  29. 29.
    Royston P, Wright E (1998) A method for estimating age-specific reference intervals (‘normal ranges’) based on fractional polynomials and exponential transformation. J R Stat Soc Series A Stat Soc 161(1):79–101CrossRefGoogle Scholar
  30. 30.
    Papaioannou A, Patelarou E, Chatzi L, Koutis A, Kafatos A, Kogevinas M (2008) Use of healthcare services and risk factors among pregnant women in Crete. Int J Gynaecol Obstet 103(3):253–255PubMedCrossRefGoogle Scholar
  31. 31.
    Dinas K, Mavromatidis G, Dovas D, Giannoulis C, Tantanasis T, Loufopoulos A, Tzafettas J (2008) Current caesarean delivery rates and indications in a major public hospital in northern Greece. Aust N Z J Obstet Gynaecol 48(2):142–146PubMedCrossRefGoogle Scholar
  32. 32.
    Sutter-Dallay AL, Murray L, Dequae-Merchadou L, Glatigny-Dallay E, Bourgeois ML, Verdoux H (2011) A prospective longitudinal study of the impact of early postnatal versus chronic maternal depressive symptoms on child development. Eur Psychiatry 26(8):484–489PubMedCrossRefGoogle Scholar
  33. 33.
    Rich-Edwards JW, Mohllajee AP, Kleinman K, Hacker MR, Majzoub J, Wright RJ, Gillman MW (2008) Elevated midpregnancy corticotropin-releasing hormone is associated with prenatal, but not postpartum, maternal depression. J Clin Endocrinol Metab 93(5):1946–1951PubMedCrossRefGoogle Scholar
  34. 34.
    Mulder EJ, Robles de Medina PG, Huizink AC, Van den Bergh BR, Buitelaar JK, Visser GH (2002) Prenatal maternal stress: effects on pregnancy and the (unborn) child. Early Hum Dev 70(1–2):3–14PubMedCrossRefGoogle Scholar
  35. 35.
    Ronsaville DS, Municchi G, Laney C, Cizza G, Meyer SE, Haim A, Radke-Yarrow M, Chrousos G, Gold PW, Martinez PE (2006) Maternal and environmental factors influence the hypothalamic-pituitary-adrenal axis response to corticotropin-releasing hormone infusion in offspring of mothers with or without mood disorders. Dev Psychopathol 18(1):173–194PubMedCrossRefGoogle Scholar
  36. 36.
    Pajulo M, Savonlahti E, Sourander A, Helenius H, Piha J (2001) Antenatal depression, substance dependency and social support. J Affect Disord 65(1):9–17PubMedCrossRefGoogle Scholar
  37. 37.
    Zhu SH, Valbo A (2002) Depression and smoking during pregnancy. Addict Behav 27(4):649–658PubMedCrossRefGoogle Scholar
  38. 38.
    Conroy S, Marks MN, Schacht R, Davies HA, Moran P (2010) The impact of maternal depression and personality disorder on early infant care. Soc Psychiatry Psychiatr Epidemiol 45(3):285–292PubMedCrossRefGoogle Scholar
  39. 39.
    Kurstjens S, Wolke D (2001) Effects of maternal depression on cognitive development of children over the first 7 years of life. J Child Psychol Psychiatry 42(5):623–636PubMedCrossRefGoogle Scholar
  40. 40.
    Mensah FK, Kiernan KE (2010) Parents’ mental health and children’s cognitive and social development: families in England in the Millennium Cohort Study. Soc Psychiatry Psychiatr Epidemiol 45(11):1023–1035PubMedCrossRefGoogle Scholar
  41. 41.
    Austin MP, Hadzi-Pavlovic D, Leader L, Saint K, Parker G (2005) Maternal trait anxiety, depression and life event stress in pregnancy: relationships with infant temperament. Early Hum Dev 81(2):183–190PubMedCrossRefGoogle Scholar
  42. 42.
    Gutteling BM, de Weerth C, Willemsen-Swinkels SH, Huizink AC, Mulder EJ, Visser GH, Buitelaar JK (2005) The effects of prenatal stress on temperament and problem behavior of 27-month-old toddlers. Eur Child Adolesc Psychiatry 14(1):41–51PubMedCrossRefGoogle Scholar
  43. 43.
    Laible D (2006) Maternal emotional expressiveness and attachment security: links to representations of relationships and social behavior. Merrill-Palmer Q 52:645–670CrossRefGoogle Scholar
  44. 44.
    Costa PT, McCrae RR (1980) Influence of extraversion and neuroticism on subjective well-being: happy and unhappy people. J Pers Soc Psychol 38(4):668–678PubMedCrossRefGoogle Scholar
  45. 45.
    Goldberg D (2001) Vulnerability factors for common mental illnesses. Brit J Psychiat 178:S69–S71CrossRefGoogle Scholar
  46. 46.
    Jacobs N, van Os J, Derom C, Thiery E, Delespaul P, Wichers M (2011) Neuroticism explained? From a non-informative vulnerability marker to informative person-context interactions in the realm of daily life. Br J Clin Psychol 50(1):19–32PubMedCrossRefGoogle Scholar
  47. 47.
    Chatzi L, Koutra K, Vassilaki M, Vardiampasis A, Georgiou V, Koutis A, Lionis C, Bitsios P, Kogevinas M (2012) Maternal personality traits and risk of preterm birth and fetal growth restriction. Eur Psychiatry. doi: 10.1016/j.eurpsy.2011.11.006
  48. 48.
    Caspi A, Roberts BW, Shiner RL (2005) Personality development: stability and change. Annu Rev Psychol 56:453–484PubMedCrossRefGoogle Scholar
  49. 49.
    Pluess M, Bolten M, Pirke KM, Hellhammer D (2010) Maternal trait anxiety, emotional distress, and salivary cortisol in pregnancy. Biol Psychol 83(3):169–175PubMedCrossRefGoogle Scholar
  50. 50.
    Guxens M, Mendez MA, Molto-Puigmarti C, Julvez J, Garcia-Esteban R, Forns J, Ferrer M, Vrijheid M, Lopez-Sabater MC, Sunyer J (2011) Breastfeeding, long-chain polyunsaturated fatty acids in colostrum, and infant mental development. Pediatrics 128(4):880–889CrossRefGoogle Scholar
  51. 51.
    Thompson WM, Harris B, Lazarus J, Richards C (1998) A comparison of the performance of rating scales used in the diagnosis of postnatal depression. Acta Psychiatr Scand 98(3):224–227PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Katerina Koutra
    • 1
    • 2
    Email author
  • Leda Chatzi
    • 1
  • Manolis Bagkeris
    • 1
  • Maria Vassilaki
    • 1
  • Panos Bitsios
    • 2
  • Manolis Kogevinas
    • 3
    • 4
    • 5
    • 6
  1. 1.Department of Social Medicine, Faculty of MedicineUniversity of CreteHeraklionGreece
  2. 2.Department of Psychiatry and Behavioral Sciences, Faculty of MedicineUniversity of CreteHeraklionGreece
  3. 3.National School of Public HealthAthensGreece
  4. 4.Centre for Research in Environmental Epidemiology (CREAL)BarcelonaSpain
  5. 5.Municipal Institute of Medical ResearchBarcelonaSpain
  6. 6.CIBER Epidemiologia y Salud Pública (CIBERESP)GranadaSpain

Personalised recommendations

Cite article

Buy options