Maternal Depression and Child Growth in Developing Countries: A Focus on the Postnatal Period

  • Kristen M. Hurley
  • Pamela J. Surkan
  • Maureen M. Black


The prevalence of maternal depression and infant malnutrition is high in developing countries. Maternal depression can interfere with parenting behaviors and may negatively impact infant nutrition and growth. This review examines studies that look at the relationship between maternal depression and infant growth. A literature search was conducted in PubMed. Articles published that examined associations between maternal mental health, depression, and infant growth (ages 0–36 months) in developing countries were reviewed and summarized. Fifteen publications described 16 studies that met the above review criteria. Of these studies, nine examined the associations between maternal depression and infant growth and seven examined general maternal mental health symptoms and infant growth. Almost all studies of maternal depression/depressive symptoms found an association with poor infant growth (eight out of nine). Likewise, the majority of studies of general mental health symptoms and poor infant growth (five out of seven) reported a significant association. The review suggests that the relation between maternal depression and poor infant growth occurs at extremes of nutrition (e.g., underweight, stunting, or wasting) rather than along the nutrition continuum. Most publications examined relations with growth problems at the extremes; and nearly all (11/12) of these reported significant associations between maternal depression/mental health problems and some form of severe malnutrition (e.g., underweight, stunting, or wasting).  Findings from two of the three publications that examined either mild malnutrition or growth along a continuum (e.g., weight-for-age or length-for-age on a continuous scale) reported no significant associations between maternal depression/depressive symptoms and growth. Inclusion of covariates in multivariable models generally attenuated the associations, emphasizing that there are many diverse determinants of maternal depression and infant growth. Only 3 of the 16 studies were longitudinal. The current review suggests that an association exists between maternal depression/depressive symptoms and poor infant growth in developing countries, especially when nutrition problems are severe (e.g., underweight, stunting, or wasting). Additional research is needed to better understand the relations between maternal depression/depressive symptoms and poor infant growth.


Depressive Symptom Maternal Depression Postpartum Depression Common Mental Disorder Maternal Depressive Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Center for Epidemiologic Studies Depression Scale


Common mental disorders


Structured Clinical Interview – Non-patient Version for the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised


Structured Clinical Interview – Patient Version for the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised


Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition


Edinburgh Postnatal Depression Scale




Height-for-age z-score


International Classification of Diseases, 10th revision


Polyunsaturated fatty acids


Adult Psychiatric Morbidity Questionnaire


Schedules for Clinical Assessment in Neuropsychiatry


Structured Clinical Interview – Non-patient Version for DSM-III-R


Self-Reporting Questionnaire – 20 items




Weight-for-age z-score


Weight-for-age z-score


World Health Organization


  1. Aboud FE, Shafique S, Akhter S. A responsive feeding intervention increases children’s self-feeding and maternal responsiveness but not weight gain. J Nutr. 2009;109:1738–43.Google Scholar
  2. Adewuya AO, Ola BO, Aloba OO, Mapayi BM, Okeniyi JAO. Impact of postnatal depression on infants’ growth in Nigeria. J Affect Disord. 2008;108:191–3.PubMedCrossRefGoogle Scholar
  3. Ahmad I, Kahn M. Risk factors associated with post-natal depression in Pakistani women. Pakistan Journal of Social and Clinical Psychology. 2005;3:41–50.Google Scholar
  4. Anoop S, Saravanan B, Joseph A, Cherian A, Jacob KS. Maternal depression and low maternal intelligence as risk factors for malnutrition in children: a community based case-control study from South India. Arch Dis Child. 2004;89:325–9.PubMedCrossRefGoogle Scholar
  5. Appleton KM, Rogers PJ, Ness AR. Is there a role for n–3 long-chain polyunsaturated fatty acids in the regulation of mood and behaviour? A review of the evidence to date from epidemiological studies, clinical studies and intervention trials. Nutr Res Rev. 2008;21:13–41.PubMedCrossRefGoogle Scholar
  6. Baker-Henningham H, Powell CA, Walker S, Grantham-Mcgregor SM. Mothers of undernourished Jamaican children have poorer psychosocial functioning and this is associated with stimulation provided in the home. Eur J Clin Nutr. 2003;57:786–92.PubMedCrossRefGoogle Scholar
  7. Beard JL, Hendricks MK, Perez EM, Murray-Kolb LE, Berg A, Vernon-Feagans L, Irlam J, Isaacs W, Sive A, Tomlinson M. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135:267–72.PubMedGoogle Scholar
  8. Black MM, Hurley KM. Helping children develop healthy eating habits. In: Tremblay RE, Barr RG, Peters R, editors. Encyclopedia on early childhood development. Montreal, QC: Centre of Excellence for Early Childhood Development; 2008.Google Scholar
  9. Black MM, Hutcheson JJ, Dubowitz H, Berenson-Howard J. Parenting style and developmental status among children with nonorganic failure to thrive. Pediatr Psychol. 1994;19:689–707.CrossRefGoogle Scholar
  10. Black MM, Baqui AH, Zaman K, Mcnary SW, Le K, Arifeen SE, Hamadani JD, Parveen M, Yunus M, Black RE. Depressive symptoms among rural Bangladeshi mothers: implications for infant development. J Child Psychol Psychiatry. 2007;48:764–72.PubMedCrossRefGoogle Scholar
  11. Black MM, Walker SP, Wachs TD, Ukuer N, Gardner JM, Grantham-Mcgregor SM, Lozoff B, Engle PL, Cabral De Mello M. Policies to reduce undernutrition include child development. Lancet. 2008a;371:454–5.PubMedCrossRefGoogle Scholar
  12. Black RE, Allen LH, Bhutto ZA, Caufield LE, De Onis M, Ezzati M, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008b;371:243–60.PubMedCrossRefGoogle Scholar
  13. Black MM, Baqui AH, Zaman K, Arifeen SE, Black RE. Maternal depressive symptoms and infant growth in rural Bangladesh. Am J Clin Nutr. 2009;89:51S–957S.Google Scholar
  14. Carvalhaes MA, Benicio MH. Mother’s ability of childcare and children malnutrition. Rev Saude Publica. 2002;36:188–97.PubMedCrossRefGoogle Scholar
  15. Cooper PJ, Landman M, Tomlinson M, Molteno C, Swartz L, Murray L. Impact of a mother-infant intervention in an indigent peri-urban South African context: pilot study. Br J Psychiatr. 2002;180:76–81.CrossRefGoogle Scholar
  16. Dearden KA, Hilton S, Bentley ME, Caulfield LE, Wilde C, Ha PB, Marsh D. Caregiver verbal encouragement increases food acceptance among Vietnamese toddlers. J Nutr. 2009;139:1387–92.PubMedCrossRefGoogle Scholar
  17. De Miranda CT, Turecki G, Mari JDJ, Andreoli SB, Marcolim MA, Goihman S, Puccini R, Strom BL, Berlin JA. Mental health of the mothers of malnourished children. Int J Epidemiol. 1996;25:128–33.PubMedCrossRefGoogle Scholar
  18. Dennis C-L, Mcqueen K. The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics. 2009;123:e736–51.PubMedCrossRefGoogle Scholar
  19. Digirolamo AM, Ramirez-Zea M. Role of zinc in maternal and child mental health. Am J Clin Nutr. 2009;89:940S–5S.PubMedCrossRefGoogle Scholar
  20. Fuggle P, Glover L, Khan F, Haydon K. Screening for postnatal depression in Bengali women: preliminary observations from using a translated version of the Edinburgh Postnatal Depression Scale (EPDS). J Reprod Infant Psychol. 2002;20:71–82.CrossRefGoogle Scholar
  21. Glover V, Onozawa K, Hodgkinson A. Benefits of infant massage for mothers with postnatal depression. Semin Neonatol. 2002;7:495–500.PubMedCrossRefGoogle Scholar
  22. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B; International Child Development Steering Group. Lancet. 2007;369:60–70.PubMedCrossRefGoogle Scholar
  23. Harpham T, Huttly S, De Silva MJ, Abramsky T. Maternal mental health and child nutritional status in four developing countries. J Epidemiol Community Health. 2005;59:1060–4.PubMedCrossRefGoogle Scholar
  24. Hurley KM, Caulfield LE, Sacco LM, Costigan KA, Dipietro JA. Psychosocial influences in dietary patterns during pregnancy. J Am Diet Assoc. 2005;105:963–6.PubMedCrossRefGoogle Scholar
  25. Hurley KM, Black MM, Papas MA, Caufield LE. Maternal symptoms of stress, depression, and anxiety are related to nonresponsive feeding styles in a statewide sample of WIC participants. J Nutr. 2008;138:799–805.PubMedGoogle Scholar
  26. Husain N, Creed F, Tomenson B. Depression and social stress in Pakistan. Psychol Med. 2000;30:395–402.PubMedCrossRefGoogle Scholar
  27. Kazi A, Fatmi Z, Hatcher J, Kadir MM, Niaz U, Wasserman GA. Social environment and depression among pregnant women in urban areas of Pakistan: importance of social relations. Soc Sci Med. 2006;63:1466–76.PubMedCrossRefGoogle Scholar
  28. Leung BMY, Kaplan BJ. Perinatal Depression: prevalence, risks, and the nutrition: a review of the literature. J Am Diet Assoc. 2009;109:1566–75.PubMedCrossRefGoogle Scholar
  29. Lovejoy MC, Graczyk PA, O’hare E, Neuman G. Maternal depression and parenting behavior: A meta-analytic review. Clin Psychol Rev. 2000;20:561–92.PubMedCrossRefGoogle Scholar
  30. Malphurs JE, Raag T, Field T, Pickens J, Pelaez-Nogueras M. Touch by intrusive and withdrawn mothers with depressive symptoms. Early Development and Parenting. Early Dev Parenting. 1996;5:111–5.CrossRefGoogle Scholar
  31. Mcgrath JM, Records K, Rice M. Maternal depression and infant temperament characteristics. Infant Behav Dev. 2008;31:71–80.PubMedCrossRefGoogle Scholar
  32. McLearn KT, Minkovitz CS, Strobino DM, Marks E, Hou W. Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices. Arch Pediatr Adolesc Med. 2006;160:279–84.PubMedCrossRefGoogle Scholar
  33. Mcnamara RK, Carlson SE. Role of omega-3 fatty acids in brain development and function: potential implications for the pathogenesis and prevention of psychopathology. Prostaglandins Leukot Essent Fatty Acids. 2006;75:329–49.PubMedCrossRefGoogle Scholar
  34. Murray CJ, Lopez AD. The global burden of disease. Cambridge, MA: Harvard University Press; 1996.Google Scholar
  35. NRC-IOM. Depression in parents, parenting, and children: opportunities to improve identification, treatment, and prevention. Committee on depression, parenting practices, and the healthy development of children, board on children, youth, and families, division on behavioral and social sciences and education., Washington, DC: The National Academies of Press; 2009.Google Scholar
  36. Patel V, Desouza N, Rodrigues M. Postnatal depression and infant growth and development in low income countries: a cohort study from Goa, India. Arch Dis Child. 2003;88:34–7.PubMedCrossRefGoogle Scholar
  37. Patel V, Rahman A, Jacob KS, Hughes M. Effect of maternal mental health on infant growth in low income countries: new evidence from South Asia. BMJ. 2004;328:820–3.PubMedCrossRefGoogle Scholar
  38. Patel V, Araya R, Chatterjee S, Chisholm D, Cohen A, De Silva M, Hosman C, Mcguire H, Rojas G, Van Ommeren M. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet. 2007;370:991–1005.PubMedCrossRefGoogle Scholar
  39. Patel V, Garrison P, de Jesus Mari J, Minas H, Prince M, Saxena S; Advisory group of the Movement for Global Mental Health. The Lancet’s series on global mental health. Lancet. 2008;372:1354–7.PubMedCrossRefGoogle Scholar
  40. Paulson JF, Dauber S, Leiferman JA. Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics. 2006;118:659–68.PubMedCrossRefGoogle Scholar
  41. Perez EM, Hendricks MK, Beard JL, Murray-Kolb LE, Berg A, Tomlinson M, Irlam J, Isaacs W, Njengele T, Sive A, Vernon-Feagans L. Mother-infant interactions and infant development are altered by maternal iron deficiency anemia. J Nutr. 2005;135:850–5.PubMedGoogle Scholar
  42. Petterson SM, Albers AB. Effects of poverty and maternal depression on early child development. Child Dev. 2001;72:1794–813.PubMedCrossRefGoogle Scholar
  43. Popkin BM. An overview on the nutrition transition and its health implications: the Bellagio meeting. Public Health Nutr. 2002;5:93–103.PubMedGoogle Scholar
  44. Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R. Impact of maternal depression on infant nutritional status and illness: A Cohort Study. Arch Gen Psychiatr. 2004a;61:946–52.PubMedCrossRefGoogle Scholar
  45. Rahman A, Lovel H, Bunn J, Iqbal Z, Harrington R. Mothers’ mental health and infant growth: a case-control study from Rawalpindi, Pakistan. Child Care Health Dev. 2004b;30:21–7.PubMedCrossRefGoogle Scholar
  46. Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet. 2008a;13:902–9.CrossRefGoogle Scholar
  47. Rahman A, Patel V, Maselko J. Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices. Arch Pediatr Adolesc Med. 2008b;160:279–84.Google Scholar
  48. Riolo SA, Nguyen TA, Greden JF, King CA. Prevalence of depression by race/ethnicity: Findings from the National Health and Nutrition Examination Survey III. Am J Public Health. 2005;95:998–1000.PubMedCrossRefGoogle Scholar
  49. Shah A. Social, political, economic and environmental issues that affect us all–poverty facts and stats. Global Issues. Accessed at: (2009).
  50. Spitzer RL, Williams JB, Gibbon M, First MB. The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatr. 1992;49:624–9.PubMedCrossRefGoogle Scholar
  51. Stewart RC, Bunn J, Vokhiwa M, Umar E, Kauye F, Fitzgerald M, Tomenson B, Rahman A, Creed F. Common mental disorder and associated factors amongst women with young infants in rural Malawi. Soc Psychiatr Psychiatr Epidemiol. 2010;45:551–9.Google Scholar
  52. Surkan PJ, Ryan LM, Carvalho Vieira LM, Berkman LF, Peterson KE. Maternal social and psychological conditions and physical growth in low-income children in Piauí, Northeast Brazil. Soc Sci Med. 2007;64:375–88.PubMedCrossRefGoogle Scholar
  53. Surkan PJ, Kawachi I, Peterson KE. Childhood overweight and maternal depressive symptoms. J Epidemiol Community Health. 2008a;62:e11.PubMedCrossRefGoogle Scholar
  54. Surkan PJ, Kawachi I, Ryan LM, Berkman LF, Carvalho Vieira LM, Peterson KE. Maternal depressive symptoms, parenting self-efficacy, and child growth. Am J Public Health. 2008b;98:125–32.PubMedCrossRefGoogle Scholar
  55. Tomlinson M, Cooper P, Murray L. The mother-infant relationship and infant attachment in a South African peri-urban settlement. Child Dev. 2005;76:1044–54.PubMedCrossRefGoogle Scholar
  56. Tomlinson M, Cooper PJ, Stein A, Swartz L, Molteno C. Post-partum depression and infant growth in a South African peri-urban settlement. Child Care Health Dev. 2006;32:81–6.PubMedCrossRefGoogle Scholar
  57. Tronick E, Reck C. Infants of depressed mothers. Harv Rev Psychiatr. 2009;17:147–56.CrossRefGoogle Scholar
  58. van den Boom DC, Hoeksma JB. The effect of infant irritability on mother-infant interaction: A growth-curve analysis. Dev Psychol. 1995;31:197.CrossRefGoogle Scholar
  59. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371:340–57.PubMedCrossRefGoogle Scholar
  60. Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010 Mar;125:e473–80.PubMedCrossRefGoogle Scholar
  61. Wachs TD, Black MM, Engle PL. Maternal Depression: A global threat to children’s health, development, and behavior and to human rights. Matern Depress: Child Dev Perspect. 2009;3:51–9.CrossRefGoogle Scholar
  62. WHO. Mental Health Atlas. Geneva: Department of Mental Health and Substance Abuse. 2005.Google Scholar
  63. Wojcik J, Dudek D, Schlegal-Zawadzka M, Grabowska M, Marcinek A, Florek E. Antepartum/postpartum depressive symptoms and serum zinc and magnesium levels. Pharmacol Rep. 2006;58:571–6.PubMedGoogle Scholar
  64. Wolf AW, De Andraca I, Lozoff B. Maternal depression in three Latin American samples. Soc Psychiatry Psychiatr Epidemiol. 2002;37:169–76.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Kristen M. Hurley
    • 1
  • Pamela J. Surkan
    • 2
  • Maureen M. Black
    • 1
  1. 1.Department of PediatricsUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

Personalised recommendations