Child Psychiatry & Human Development

, Volume 43, Issue 5, pp 683–714 | Cite as

Prenatal and Postpartum Maternal Psychological Distress and Infant Development: A Systematic Review

  • Dawn Kingston
  • Suzanne Tough
  • Heather Whitfield
Review Paper


Infant development plays a foundational role in optimal child development and health. Some studies have demonstrated an association between maternal psychological distress and infant outcomes, although the main emphasis has been on postpartum depression and infant-maternal attachment. Prevention and early intervention strategies would benefit from an understanding of the influence of both prenatal and postpartum maternal distress on a broader spectrum of infant developmental outcomes. We conducted a systematic review of studies assessing the effect of prenatal and postpartum maternal psychological distress on five aspects of infant development: global; cognitive; behavioral; socio-emotional; and psychomotor. These findings suggest that prenatal distress can have an adverse effect on cognitive, behavioral, and psychomotor development, and that postpartum distress contributes to cognitive and socio-emotional development.


Infant development Maternal psychological distress Systematic review Maternal psychosocial care 


  1. 1.
    Hertzman C (1998) The case for child development as a determinant of health. Can J Public Health 89(Suppl 1):S14–S21PubMedGoogle Scholar
  2. 2.
    Hertzman C (2009) The state of child development in Canada: are we moving toward, or away from, equity from the start? Paediatr Child Health 14:673–676PubMedGoogle Scholar
  3. 3.
    Williams R, Hertzman C (2009) Promises, promises. Paediatr Child Health 14:649–650PubMedGoogle Scholar
  4. 4.
    Marmot M (2010) Fair society, healthy lives. Department of Health, LondonGoogle Scholar
  5. 5.
    Commission on Social Determinants of Health (2008) Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. World Health Organization, GenevaGoogle Scholar
  6. 6.
    Priest SR, Austin MP, Barnett BB, Buist A (2008) A psychosocial risk assessment model (PRAM) for use with pregnant and postpartum women in primary care settings. Arch Womens Ment Health 11:307–317PubMedCrossRefGoogle Scholar
  7. 7.
    Woods SM, Melville JL, Guo Y, Fan MY, Gavin A (2010) Psychosocial stress during pregnancy. Am J Obstet Gynecol 202:61–67PubMedCrossRefGoogle Scholar
  8. 8.
    Austin MP, Tully L, Parker G (2007) Examining the relationship between antenatal anxiety and postnatal depression. J Affect Disord 101:169–174PubMedCrossRefGoogle Scholar
  9. 9.
    Beeghly M, Weinberg MK, Olson KL, Kernan H, Riley J, Tronick EZ (2002) Stability and change in level of maternal depressive symptomatology during the first postpartum year. J Affect Disord 71:169–180PubMedCrossRefGoogle Scholar
  10. 10.
    Horwitz SM, Briggs-Gowan MJ, Storfer-Isser A, Carter AS (2009) Persistence of maternal depressive symptoms throughout the early years of childhood. J Womens Health 18:637–645CrossRefGoogle Scholar
  11. 11.
    Auerbach JG, Atzaba-Poria N, Berger A, Landau R (2004) Emerging developmental pathways to ADHD: possible path markers in early infancy. Neural Plastic 11:29–43CrossRefGoogle Scholar
  12. 12.
    Olsen EM, Houmann T, Christiansen E, Landorph SL, Heering K, Kaas-Nielsen S, Samberg V, Lichtenberg A, Jorgensen T, Skovgaard AM (2008) Predictors (0–10 months) of psychopathology at age 1 1/2 years—a general population study in The Copenhagen Child Cohort. J Child Psychol Psychiatr Allied Discip 49:553–562CrossRefGoogle Scholar
  13. 13.
    Skovgaard AM, Olsen EM, Christiansen E, Houmann T, Landorph SL, Jorgensen T, and Study Group (2008) Predictors (0–10 months) of psychopathology at age 1 1/2 years—a general population study in The Copenhagen Child Cohort. J Child Psychol Psychiatr Allied Discip 49:553–562CrossRefGoogle Scholar
  14. 14.
    Bergman K, Sarkar P, Glover V, O’Connor TG (2010) Maternal prenatal cortisol and infant cognitive development: moderation by infant-mother attachment. Biol Psychiatr 67:1026–1032CrossRefGoogle Scholar
  15. 15.
    Urizar GG Jr, Munoz RF (2011) Impact of a prenatal cognitive-behavioral stress management intervention on salivary cortisol levels in low-income mothers and their infants. Psychoneuroendocrinology 36:1480–1494PubMedCrossRefGoogle Scholar
  16. 16.
    Poobalan AS, Aucott LS, Ross L, Smith WC, Helms PJ, Williams JH (2007) Effects of treating postnatal depression on mother-infant interaction and child development: systematic review. Br J Psychiatr 191:378–386CrossRefGoogle Scholar
  17. 17.
    Cohen J (1988) Statistical power analysis for the behavioral sciences 2nd ed. Lawrence Erlbaum, New JerseyGoogle Scholar
  18. 18.
    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012PubMedCrossRefGoogle Scholar
  19. 19.
    Punamaki R-L, Repokari L, Vilska S, Poikkeus P, Tiitinen A, Sinkkonen J, Tulppala M (2006) Maternal mental health and medical predictors of infant developmental and health problems from pregnancy to one year: does former infertility matter? Infant Behav Dev 29:230–242PubMedCrossRefGoogle Scholar
  20. 20.
    Slykerman RF, Thompson JM, Clark PM, Becroft DM, Robinson E, Pryor JE, Wild CJ, Mitchell EA (2007) Determinants of developmental delay in infants aged 12 months. Paediatr Perinat Epidemiol 21:121–128PubMedCrossRefGoogle Scholar
  21. 21.
    Brouwers EPM, van Baar AL, Pop VJM (2001) Maternal anxiety during pregnancy and subsequent infant development. Infant Behav Dev 24:95–106CrossRefGoogle Scholar
  22. 22.
    Hernandez-Martinez C, Arija V, Balaguer A, Cavalle P, Canals J (2008) Do the emotional states of pregnant women affect neonatal behavior? Early Human Dev 84:745–750CrossRefGoogle Scholar
  23. 23.
    Buitelaar JK, Huizink AC, Mulder EJ, de Medina PG, Visser GH (2003) Prenatal stress and cognitive development and temperament in infants. Neurobiol Aging 24:S53–S60PubMedCrossRefGoogle Scholar
  24. 24.
    Murray L (1992) The impact of postnatal depression on infant development. J Child Psychol Psychiatr 33:543–561CrossRefGoogle Scholar
  25. 25.
    Reilly S, Eadie P, Bavin EL, Wake M, Prior M, Williams J, Bretherton L, Barrett Y, Ukoumunne OC (2006) Growth of infant communication between 8 and 12 months: a population study. J Paediatr Child Health 42:764–770PubMedCrossRefGoogle Scholar
  26. 26.
    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 28:407–417CrossRefGoogle Scholar
  27. 27.
    Kaspers AG, Rep A, Ganzevoort W, Wolf H, de Vries JI, van Wassenaer AG, PETRA investigators (2009) No association between maternal psychological symptoms and infant outcome after pregnancy complicated by early-onset hypertensive disorders. Acta Paediatr 98:298–303PubMedCrossRefGoogle Scholar
  28. 28.
    Beckwith L, Howard J, Espinosa M, Tyler R (1999) Psychopathology, mother-child interaction, and infant development: substance-abusing mothers and their offspring. Dev Psychopathol 11:715–725PubMedCrossRefGoogle Scholar
  29. 29.
    Albertsson-Karlgren U, Bohlin G, Hagekull B, Nettelbladt P (2000) Mental disease postpartum—sociability, stranger wariness and mother’s reports of approach-withdrawal behavior in infants at ten months. Nord J Psychiatr 54:235–241CrossRefGoogle Scholar
  30. 30.
    Feldman R, Granat A, Pariente C, Kanety H, Kuint J, Gilboa-Schechtman E (2009) Maternal depression and anxiety across the postpartum year and infant social engagement, fear regulation, and stress reactivity. J Am Acad Child Adolesc Psychiatr 48:919–927CrossRefGoogle Scholar
  31. 31.
    Murray L, Cooper P, Creswell C, Schofield E, Sack C (2007) The effects of maternal social phobia on mother-infant interactions and infant social responsiveness. J Child Psychol Psychiatr Allied Discip 48:45–52CrossRefGoogle Scholar
  32. 32.
    Matthey S, Guedeney A, Starakis N, Barnett B (2005) Assessing the social behavior of infants: use of the ADBB scale and relationship to mother’s mood. Infant Ment Health J 26:442–458CrossRefGoogle Scholar
  33. 33.
    Ellman LM, Schetter CD, Hobel CJ, Chicz-Demet A, Glynn LM, Sandman CA (2008) Timing of fetal exposure to stress hormones: effects on newborn physical and neuromuscular maturation. Dev Psychobiol 50:232–241PubMedCrossRefGoogle Scholar
  34. 34.
    Field T, Diego M, Hernandez-Reif M, Salman F, Schanberg S, Kuhn C, Yando R, Bendell D (2002) Prenatal anger effects on the fetus and neonate. J Obstet Gynaecol 22:260PubMedCrossRefGoogle Scholar
  35. 35.
    Field T, Diego M, Hernandez-Reif M (2008) Prenatal dysthymia versus major depression effects on the neonate. Infant Behav Dev 31:190–193PubMedCrossRefGoogle Scholar
  36. 36.
    van Batenburg-Eddes T, de Groot L, Huizink AC, Steegers EAP, Hofman A, Jaddoe VWV, Verhulst FC, Tiemeier H (2009) Maternal symptoms of anxiety during pregnancy affect infant neuromotor development: the generation R study. Dev Neuropsychol 34:476–493PubMedCrossRefGoogle Scholar
  37. 37.
    American College of Obstetricians and Gynecologists (2006) ACOG committee opinion no. 343: psychosocial risk factors, perinatal screening and intervention. Obstetr Gynecol 108:469–477CrossRefGoogle Scholar
  38. 38.
    Austin MP (2003) Psychosocial assessment and management of depression and anxiety in pregnancy. Key aspects of antenatal care for general practice. Aust Fam Physician 32:119–126PubMedGoogle Scholar
  39. 39.
    Howard LM, Goss C, Leese M, Appleby L, Thornicroft G (2004) The psychosocial outcome of pregnancy in women with psychotic disorders. Schizophr Res 71:49–60PubMedCrossRefGoogle Scholar
  40. 40.
    Woolhouse H, Brown S, Krastev A, Perlen S, Gunn J (2009) Seeking help for anxiety and depression after childbirth: results of the maternal health study. Arch Womens Ment Health 12:75–83PubMedCrossRefGoogle Scholar
  41. 41.
    Beeghly M, Weinberg MK, Olson KL, Kernan H, Riley J, Tronick EZ (2002) Stability and change in level of maternal depressive symtomatology during the first postpartum year. J Affect Disord 71:169–180PubMedCrossRefGoogle Scholar
  42. 42.
    Cardone IA, Kim JJ, Gordon TE, Gordon SM, Silver RK (2006) Psychosocial assessment by phone for high-scoring patients taking the Edinburgh Postnatal Depression Scale: communication pathways and strategies. Arch Women’s Ment Health 9:87–94CrossRefGoogle Scholar
  43. 43.
    Carroll JC, Reid AJ, Biringer A, Midmer D, Glazier RH, Wilson L et al (2005) Effectiveness of the Antenatal Psychosocial Health Assessment (ALPHA) form in detecting psychosocial concerns: a randomized controlled trial. CMAJ 173:253–259PubMedCrossRefGoogle Scholar
  44. 44.
    Reid AJ, Biringer A, Carroll JD, Midmer D, Wilson LM, Chalmers B et al (1998) Using the ALPHA form in practice to assess antenatal psychosocial health. Antenatal Psychosocial Health Assessment. CMAJ 159:677–684PubMedGoogle Scholar
  45. 45.
    McLennan JD, Offord DR (2002) Should postpartum depression be targeted to improved child mental health? J Am Acad Child Adolesc Psychiatr 41:28–35CrossRefGoogle Scholar
  46. 46.
    Buist A, Condon J, Brooks J, Speelman C, Milgrom J, Hayes B et al (2006) Acceptability of routine screening for perinatal depression. J Affect Disord 93:233–237PubMedCrossRefGoogle Scholar
  47. 47.
    Matthey S, White T, Phillips J, Taouk R, Chee TT, Barnett B (2005) Acceptability of routine antenatal psychosocial assessments to women from English and non-English speaking backgrounds. Arch Womens Ment Health 8:171–180PubMedCrossRefGoogle Scholar
  48. 48.
    Tough SC, Siever JE, Leew S, Johnston DW, Benzies K, Clark D (2008) Maternal mental health predicts risk of developmental problems at 3 years of age: follow up of a community based trial. BMC Pregnancy Childbirth 8:16PubMedCrossRefGoogle Scholar
  49. 49.
    Simpson GA, Cohen RA, Bloom B, Blumberg SJ (2009) The impact of children’s emotional and behavioral difficulties on their lives and their use of mental health services. Paediatr Perinatal Epidemiol 23:472–481CrossRefGoogle Scholar
  50. 50.
    Waddell C, Hua JM, McEwan K, Garland O, Peters R (2007) Preventing mental disorders in children. Can J Public Health 98:174–178PubMedGoogle Scholar
  51. 51.
    Hertzman C, Boyce T (2010) How experience gets under the skin to create gradients in developmental health. Annu Rev Public Health 31:329–347PubMedCrossRefGoogle Scholar
  52. 52.
    Brooks-Gunn J, Duncan G (1997) The effects of poverty on children. Child Poverty 7:55–71Google Scholar
  53. 53.
    Currie ML, Rademacher R (2004) The pediatrician’s role in recognizing and intervening in postpartum depression. Pediatr Clin N Am 51:785–801CrossRefGoogle Scholar
  54. 54.
    Brugha TS, Morrell CJ, Slade P, Walters SJ (2011) Universal prevention of depression in women postnatally. Psychol Med 41:739–748PubMedCrossRefGoogle Scholar
  55. 55.
    Le HN, Perry DF, Sheng X (2009) Using the internet to screen for postpartum depression. Matern Child Health J 13:213–221PubMedCrossRefGoogle Scholar
  56. 56.
    Achenbach TM (1991) Manual for the child behavior check list. University of Vermont, VermontGoogle Scholar
  57. 57.
    Austin MP (2004) Antenatal screening and early intervention for “perinatal” distress, depression and anxiety: where to from here? Arch Women’s Ment Health 7:1–6CrossRefGoogle Scholar
  58. 58.
    Austin MP, Reilly N, Milgrom J, Barnett B (2010) A national approach to perinatal mental health in Australia: exercising caution in the roll-out of a public health initiative. Med J Aust 192:111PubMedGoogle Scholar
  59. 59.
    Keon SW (2009) Early childhood education and care: Canada’s challenges and next steps. Paediatr Child Health 14:660–661PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Dawn Kingston
    • 1
  • Suzanne Tough
    • 2
  • Heather Whitfield
    • 3
  1. 1.Faculty of Nursing, Rm 5-258 Edmonton Clinic Health AcademyUniversity of AlbertaEdmontonCanada
  2. 2.Faculty of Paediatrics and Community Health Sciences, Centre for Child, Family, and Community ResearchUniversity of CalgaryCalgaryCanada
  3. 3.McMaster UniversityHamiltonCanada

Personalised recommendations