Skip to main content

Advertisement

SpringerLink
Log in

Prenatal Depressive Symptoms and Toddler Behavior Problems: The Role of Maternal Sensitivity and Child Sex

  • Original Article
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

Abstract

Increasing evidence suggests that maternal depression during pregnancy is associated with child behavioral outcomes even after accounting for later maternal depression. The purpose of this study was to examine various mechanisms, including maternal sensitivity, neonatal problems, and concurrent maternal depression, that might explain the association between prenatal maternal depressive symptoms and toddler behavior problems. Young, low income, African American mothers (n = 196) were interviewed during pregnancy and at 24-months postpartum, medical records were collected at the birth, and mother–child interactions were video-recorded at 24 months. Path analyses revealed that the association between prenatal depression and toddler behavior problems was mediated by maternal sensitivity and maternal depressive symptoms at 24 months. No evidence was found for a mediating effect of neonatal problems. Path models examining sex differences suggested that different mediating factors may be important for boys and girls, with boys being particularly susceptible to the effects of maternal sensitivity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Goodman SH, Gotlib IH (2002) Children of depressed parents: mechanisms of risk and implications for treatment. American Psychological Association, Washington

    Book  Google Scholar 

  2. Betts KS, Williams GM, Najman JM, Alati R (2014) The relationship between maternal depressive, anxious, and stress symptoms during pregnancy and adult offspring behavioral and emotional problems. Depress Anxiety 31:9–18

    Article  PubMed  Google Scholar 

  3. Hay DF, Pawlby S, Waters CS, Perra O, Sharp D (2010) Mothers’ antenatal depression and their children’s antisocial outcomes. Child Dev 81:149–165

    Article  PubMed  Google Scholar 

  4. Leis JA, Heron J, Stuart EA, Mendelson T (2014) Associations between maternal mental health and child emotional and behavioral problems: does prenatal mental health matter? J Abnorm Child Psychol 42:161–171

    Article  PubMed  Google Scholar 

  5. O’Donnell KJ, Glover G, Barker ED, O’Connor TG (2014) The persisting effect of maternal mood in pregnancy on childhood psychopathology. Dev Psychopathol 26:393–403

    Article  PubMed  Google Scholar 

  6. Field T (2011) Prenatal depression effects on early development: a review. Infant Behav Dev 34:1–14

    Article  PubMed  Google Scholar 

  7. Goodman SH, Gotlib IH (1999) Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev 106:458–490

    Article  PubMed  Google Scholar 

  8. Pearson RM, Melotti R, Heron J, Joinson C, Stein A, Ramchandani PG, Evans J (2012) Disruption to the development of maternal responsiveness? The impact of prenatal depression on mother–infant interactions. Infant Behav Dev 35:613–626

    Article  PubMed  Google Scholar 

  9. Talge NM, Neal C, Glover V (2007) Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? J Child Psychol Psychiatry 48:245–261

    Article  PubMed  Google Scholar 

  10. Wadhwa PD (2005) Psychoneuroendocrine processes in human pregnancy influence fetal development and health. Psychoneuroendocrinology 30:724–743

    Article  Google Scholar 

  11. Buss C, Davis EP, Muftuler LT, Head K, Sandman CA (2010) High pregnancy anxiety during mid-gestation is associated with decreased gray matter density in 6–9-year-old children. Psychoneuroendocrinology 35:141–153

    Article  PubMed  PubMed Central  Google Scholar 

  12. Khashan AS, Everard C, McCowan LME, Dekker G, Moss-Morris R, Baker PN et al (2014) Second-trimester maternal distress increases the risk of small for gestational age. Psychol Med 44:2799–2810

    Article  PubMed  Google Scholar 

  13. Accortt EE, Cheadle ACD, Dunkel-Schetter C (2014) Prenatal depression and adverse birth outcomes: an updated systematic review. Matern Child Health J 19:1306–1337

    Article  Google Scholar 

  14. Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis C-L, Koren G et al (2013) The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry 74:e321–e341

    Article  PubMed  Google Scholar 

  15. Zuckerman B, Bauchner H, Parker S, Cabral H (1990) Maternal depressive symptoms during pregnancy, and newborn irritability. J Dev Behav Pediatr 11:190–194

    Article  PubMed  Google Scholar 

  16. Arpi E, Ferrari F (2013) Preterm birth and behaviour problems in infants and preschool-age children: a review of the recent literature. Dev Med Child Neurol 55:788–796

    Article  PubMed  Google Scholar 

  17. Aarnoudse-Moens CSH, Weisglas-Kuperus N, van Goudoever JB, Oosterlaan J (2009) Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics 124:717–728

    Article  PubMed  Google Scholar 

  18. Canals J, Esparó G, Fernández-Ballart JD (2006) Neonatal behaviour characteristics and psychological problems at 6 years. Acta Paediatr 95:1412–1417

    Article  PubMed  Google Scholar 

  19. Ohgi S, Takahashi T, Nugent JK, Arisawa K, Akiyama T (2003) Neonatal behavioral characteristics and later behavioral problems. Clin Pediatr 42:679–686

    Article  Google Scholar 

  20. Halligan SL, Cooper PJ, Fearon P, Wheeler SL, Crosby M, Murray L (2013) The longitudinal development of emotion regulation capacities in children at risk for externalizing disorders. Dev Psychopathol 25:391–406

    Article  PubMed  Google Scholar 

  21. Bakermans-Kranenburg MJ, van Ijzendoorn MH, Juffer F (2008) Less is more: meta-analytic arguments for the use of sensitivity-focused interventions. In: Juffer F, Bakermans-Kranenburg MJ, van Ijzendoorn MH (eds) Promoting positive parenting: an attachment-based intervention. Taylor & Francis Group/Lawrence Erlbaum Associates, New York, pp 59–74

    Google Scholar 

  22. Kok R, Linting M, Bakermans-Kranenburg MJ, van Ijzendoorn MH, Jaddoe VWV, Hofman A et al (2013) Maternal sensitivity and internalizing problems: evidence from two longitudinal studies in early childhood. Child Psychiatry Hum Dev 44:751–765

    Article  PubMed  Google Scholar 

  23. Tronick E, Reck C (2009) Infants of depressed mothers. Harv Rev Psychiatry 17:147–156

    Article  PubMed  Google Scholar 

  24. Field T, Healy BT, Goldstein S, Guthertz M (1990) Behavior-state matching and synchrony in mother–infant interactions of nondepressed versus depressed dyads. Dev Psychol 26:7–14

    Article  Google Scholar 

  25. Feng X, Shaw DS, Kovacs M, Lane T, O’Rourke FE, Alarcon JH (2008) Emotion regulation in preschoolers: the roles of behavioral inhibition, maternal affective behavior, and maternal depression. J Child Psychol Psychiatry 49:132–141

    PubMed  Google Scholar 

  26. Tronick E, Gianino A (1986) Interactive mismatch and repair: challenges to the coping infant. Zero Three 5:1–6

    Google Scholar 

  27. Pearson RM, Cooper RM, Pentok-Voak IS, Lightman SL, Evans J (2010) Depressive symptoms in early pregnancy disrupt attentional processing of infant emotion. Psychol Med 40:621–631

    Article  PubMed  Google Scholar 

  28. Heron J, O’Connor TG, Evans J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80:65–73

    Article  PubMed  Google Scholar 

  29. O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry 8:37–54

    Article  Google Scholar 

  30. Carter AS, Garrity-Rokous FE, Chazan-Cohen R, Little C, Briggs-Gowan MJ (2001) Maternal depression and comorbidity: predicting early parenting, attachment security, and toddler social-emotional problems and competencies. J Am Acad Child Adolesc Psychiatry 40:18–26

    Article  PubMed  Google Scholar 

  31. Loomans EM, van der Stelt O, van Eijsden M, Gemke RJBJ, Vrijkotte TGM, Van den Bergh BRH (2012) High levels of antenatal maternal anxiety are associated with altered cognitive control in five-year-old children. Dev Psychobiol 54:441–450

    Article  PubMed  Google Scholar 

  32. Elsmén E, Steen M, Hellström-Westas L (2004) Sex and gender differences in newborn infants: why are boys at increased risk? J Mens Health Gender 1:303–311

    Article  Google Scholar 

  33. Stevenson DK, Verter J, Fanaroff AA, Oh W, Ehrenkranz RA, Shankaran S et al (2000) Sex differences in outcomes of very low birthweight infants: the newborn male disadvantage. Arch Dis Child Fetal Neonatal Ed 83:F182–F185

    Article  PubMed  PubMed Central  Google Scholar 

  34. Boatella-Costa E, Costas-Moragas C, Botet-Mussons F, Fornieles-Deu A, De Cáceres-Zurita ML (2007) Behavioral gender differences in the neonatal period according to the Brazelton scale. Early Hum Dev 83:91–97

    Article  PubMed  Google Scholar 

  35. Gerardin P, Wendland J, Bodeau N, Galin A, Bialobos S, Tordjman S (2011) Depression during pregnancy: is the developmental impact earlier in boys? A prospective case-control study. J Clin Psychiatry 72:378–387

    Article  PubMed  Google Scholar 

  36. Tronick EZ, Weinberg MK (2000) Gender differences and their relation to maternal depression. In: Johnson SL, Hayes AM, Field TM, Schneiderman N, McCabe PM (eds) Stress, coping, and depression. Lawrence Erlbaum Associates Publishers, Mahwah, pp 23–34

    Google Scholar 

  37. Hummel AC, Kiel EJ (2015) Maternal depressive symptoms, maternal behavior, and toddler internalizing outcomes: a moderated mediation model. Child Psychiatry Hum Dev 46:21–33

    Article  PubMed  PubMed Central  Google Scholar 

  38. Chang H, Olson SL, Sameroff AJ, Sexton HR (2011) Child effortful control as a mediator of parenting practices on externalizing behavior: evidence for a sex-differentiated pathway across the transition from preschool to school. J Abnorm Child Psychol 39:71–81

    Article  PubMed  PubMed Central  Google Scholar 

  39. Tung I, Li JJ, Lee SS (2012) Child sex moderates the association between negative parenting and childhood conduct problems. Aggress Behav 38:239–251

    Article  PubMed  Google Scholar 

  40. Edwards RC, Thullen MJ, Isarowong N, Shiu CS, Henson L, Hans SL (2012) Supportive relationships and the trajectory of depressive symptoms among young, African American mothers. J Fam Psychol 26:585–594

    Article  PubMed  Google Scholar 

  41. Berlin LJ, Brady-Smith C, Brooks-Gunn J (2002) Links between childbearing age and observed maternal behaviors with 14-month-olds in the Early Head Start Research and Evaluation Project. Infant Ment Health J 23:104–129

    Article  Google Scholar 

  42. Harden KP, Lynch SK, Turkheimer E, Emery RE, D’Onofrio BM, Slutske WS et al (2007) A behavior genetic investigation of adolescent motherhood and offspring mental health problems. J Abnorm Psychol 116:667–683

    Article  PubMed  PubMed Central  Google Scholar 

  43. Wakschlag LS, Gordon RA, Lahey BB, Loeber R, Green SM, Leventhal BL (2000) Maternal age at first birth and boys’ risk for conduct disorder. J Res Adolesc 10:417–441

    Article  Google Scholar 

  44. Hans SL, Thullen M, Henson LG, Lee H, Edwards RC, Bernstein VJ (2013) Promoting positive mother-infant relationships: a randomized trial of community doula support for young mothers. Inf Mental Hlth J 34:446–457

    Article  Google Scholar 

  45. Radloff LS (1977) The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  46. Lewinsohn PM, Hops H, Roberts RE, Seeley JR (1992) Adolescent psychopathology: prevalence, comorbidity, and psychosocial correlates. Verhaltenstherpie 2:132–139

    Article  Google Scholar 

  47. Hobel CJ, Hyvarinen MA, Okada DM, Oh W (1973) Prenatal and intrapartum high-risk screening, I: prediction of the high-risk neonate. Am J Obstet Gynecol 117:1–9

    Article  PubMed  Google Scholar 

  48. Strobino DM, Baruffi G (1984) Evaluation of a measure of neonatal morbidity. Med Care 22:818–826

    Article  PubMed  Google Scholar 

  49. Bernstein VJ, Percansky, C, Hans, SL (1987) Screening for social-emotional impairment in infants born to teenage mothers. Paper presented at the Meetings of the Society for Research in Child Development, Baltimore, MD

  50. Bernstein VJ, Hans SL (1994) Predicting the developmental outcome of two-year-old children born exposed to methadone: impact of social-environmental risk factors. J Clin Child Psychol 23:349–359

    Article  Google Scholar 

  51. Wakschlag LS, Hans SL (1999) Relation of maternal responsiveness during infancy to the development of behavior problems in high-risk youths. Dev Psychol 35:569–579

    Article  PubMed  Google Scholar 

  52. Briggs-Gowan M, Carter AS (2005) ITSEA BITSEA: the infant toddler and brief infant-toddler social emotional assessment. PsychCorp, San Antonio

    Google Scholar 

  53. Briggs-Gowan MJ, Carter AS, Irwin JR, Wachtel K, Cicchetti DV (2004) The brief infant-toddler social and emotional assessment: screening for social-emotional problems and delays in competence. J Pediatr Psychol 29:143–155

    Article  PubMed  Google Scholar 

  54. Briggs-Gowan MJ, Carter AS, McCarthy K, Augustyn M, Caronna E, Clark R (2013) Clinical validity of a brief measure of early childhood social-emotional/behavioral problems. J Pediatr Psychol 38:577–587

    Article  PubMed  PubMed Central  Google Scholar 

  55. StataCorp (2013) Stata statistical software: release 13. Statacorp, College Station

    Google Scholar 

  56. Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6:1–55

    Article  Google Scholar 

  57. MacKinnon DP, Fairchild AJ, Fritz MS (2007) Mediation analyses. Annu Rev Psychol 58:593–694

    Article  PubMed  PubMed Central  Google Scholar 

  58. Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40:879–891

    Article  PubMed  Google Scholar 

  59. Siddiqui A, Hägglöf B (2000) Does maternal prenatal attachment predict postnatal mother–infant interaction? Early Hum Dev 59:13–25

    Article  PubMed  Google Scholar 

  60. McFarland J, Salisbury AL, Battle CL, Hawes K, Halloran K, Lester BM (2011) Major depressive disorder during pregnancy and emotional attachment to the fetus. Arch Womens Ment Health 14:425–434

    Article  PubMed  PubMed Central  Google Scholar 

  61. Lau JYF, Eley TC (2010) The genetics of mood disorders. Annu Rev Clin Psychol 6:313–337

    Article  PubMed  Google Scholar 

  62. Weinberg MK, Olson KL, Beeghly M, Tronick EZ (2006) Making up is hard to do, especially for mothers with high levels of depressive symptoms and their infant sons. J Child Psychol Psychiatry 47:670–683

    Article  PubMed  Google Scholar 

  63. Bocknek EL, Brophy-Herb HE, Banerjee M (2009) Effects of parental supportiveness on toddlers’ emotion regulation over the first three years of life in a low-income African American sample. Infant Ment Health J 30:452–476

    Article  Google Scholar 

  64. Nelson JA, Leerkes EM, O’Brien M, Calkins SD, Marcovitch S (2012) African American and European American mothers’ beliefs about negative emotions and emotion socialization practices. Parent Sci Pract 12:22–41

    Article  PubMed  PubMed Central  Google Scholar 

  65. Rouse MH, Goodman SH (2014) Perinatal depression influences on infant negative affectivity: timing, severity, and co-morbid anxiety. Infant Behav Dev 37:739–751

    Article  PubMed  PubMed Central  Google Scholar 

  66. de Bruijn ATCE, van Bakel HJA, van Baar AL (2009) Sex differences in the relation between prenatal maternal emotional complaints and child outcome. Early Hum Dev 85:319–324

    Article  PubMed  Google Scholar 

  67. Hammen C (2002) Context of stress in families of children with depressed parents. In: Goodman SH, Gotlib IH (eds) Children of depressed parents: mechanisms of risk and implications for treatment. American Psychological Association, Washington, pp 175–199

    Chapter  Google Scholar 

  68. Grote NK, Swartz HA, Geibel SL, Zuckoff A, Houck PR, Frank E (2009) A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatr Serv 60:313–321

    Article  PubMed  PubMed Central  Google Scholar 

  69. Shaw DS, Connell A, Dishion TA, Wilson MN, Gardner F (2009) Improvements in maternal depression as a mediator of intervention effects on early childhood problem behavior. Dev Psychopathol 21:417–439

    Article  PubMed  PubMed Central  Google Scholar 

  70. Rackett P, Holmes BM (2010) Enhancing the attachment relationship: a prenatal perspective. Educ Child Psychol 27:33–50

    Google Scholar 

  71. Kersten-Alvarez LE, Hosman CMH, Riksen-Walraven JM, van Doesum KTM, Hoefnagels C (2011) Which preventative interventions effectively enhance depressed mothers’ sensitivity? A meta-analysis. Infant Ment Health J 32:362–376

    Article  Google Scholar 

  72. Mayers HA, Hager-Budny M, Buckner EB (2008) The chance for children teen parent–infant project: results of a pilot intervention for teen mothers and their infants in inner city high schools. Infant Ment Health J 29:320–342

    Article  Google Scholar 

Download references

Acknowledgments

This study was supported by Grant R40MC 00203 from the United States Maternal and Child Health Bureau and through funding from the Irving B. Harris Foundation. We would like to thank Linda Henson for her leadership in the project, the dedicated research team who collected data and coded video recordings, including Cynthia Lashley, Brenda Copley, Laura Walton, Bianca Pullen, and Matthew Thullen, and the young mothers who participated in the study.

Author information

Authors and Affiliations

  1. School of Social Service Administration, The University of Chicago, 969 E. 60th Street, Chicago, IL, 60637, USA

    Renee C. Edwards & Sydney L. Hans

Authors
  1. Renee C. Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sydney L. Hans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Renee C. Edwards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Edwards, R.C., Hans, S.L. Prenatal Depressive Symptoms and Toddler Behavior Problems: The Role of Maternal Sensitivity and Child Sex. Child Psychiatry Hum Dev 47, 696–707 (2016). https://doi.org/10.1007/s10578-015-0603-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-015-0603-6

Keywords

Search

Navigation