Association between prenatal maternal anxiety and/or stress and offspring's cognitive functioning: A meta‐analysis

Abstract

This meta‐analysis examined the relationship between prenatal maternal stress and/or anxiety and the outcomes of children aged 3 months to 9 years. Of the 8754 studies published before June 2021 that were synthesized, 17 conducted in Western countries were included in the meta‐analysis (Ntotal = 23,307; Mmales 54%; Methnicity White 77%, Pacific 15%, African American/Black 10%, Middle Eastern 7%, Eastern 8%). Effect sizes ranged from −0.41 to 0.15. A weak negative association was found between prenatal stress and/or anxiety exposure and children's general intellectual development. Associations varied based on the type of exposure. Findings are limited to developed counties and cannot be generalized to low‐ and middle‐income countries. Directions for maternal prenatal intervention and future studies are discussed.

Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation

“…Recent meta-analyses have found associations between in utero exposure to maternal distress and (self-)regulation problems at the cognitive, behavioral and social-emotional level, that is, for: (i) postpartum bonding problems [with depression ( r = 0.20 to 0.25), anxiety ( r = 0.16), stress ( r = 0.15) and preconception stress ( r = −0.17)] [62]; (ii) internalizing problems in infancy (associated with maternal internalizing ( r = 0.17) as well as with paternal internalizing problems ( r = 0.13) [63]; (iii) cognitive problems in infancy and childhood , for example, cognitive problems (neonates–60 months) ( r = −0.05) [64], lower executive function (6 months–9 years ( r = 0.07) [65], lower general cognitive ability (3 months- 9 years) (effect sizes between −0.041 to 0.15) [66]; (iv) social-emotional and behavioral problems including emotional dysregulation, aggressive behavior, internalizing and externalizing problems) in infancy and childhood ( r = 0.16) (2 months–8.5 years) [67 ▪▪ ]; (v) negative socio-emotional and cognitive outcome from infancy to late adolescence : social-emotional problems (2 months–17 years) (OR = 1.66), more so in depression than anxiety [68]; motor ( r = −0.07), cognitive ( r = −0.12), language ( r = −0.11), social-emotional ( r = 0.21), and adaptive behavior ( r = −0.26) (4 weeks–17 years) [69]; poorer cognitive outcomes only for boys (infancy to 18 years) [boys; Hedges’ g = −0.36, girls: Hedges’ g : = −0.17) and outcome was poorer when a diagnostic interview was used compared to the use of a rating scale [70]. (vi) Finally, one meta-analysis included psychopathological outcome : increased risk of both ASD (pooled OR 1.64) and ADHD (pooled OR 1.72) was confirmed in a meta-analysis including 2–27 year old offspring [71].…”

Timing Sensitivity of Prenatal Cortisol Exposure and Neurocognitive Development

“…Strong evidence for sex moderating associations between prenatal stress exposure and cognitive outcomes from animal models (Glover & Hill, 2012) does not seem to extend to humans. In fact, a recent meta-analysis of 22 studies observed a modest negative association between maternal stress and anxiety (a proxy for HPA axis physiology) and cognitive outcomes but did not observe any moderation by sex (Delagneau et al, 2023). Further research that incorporates prenatal sex steroids and other plausible explanations for sex moderation is needed to advance this line of research in humans.…”

Screen Time and Developmental Performance Among Children at 1-3 Years of Age in the Japan Environment and Children’s Study

“…We replicated and extended the study of Madigan et al with a larger sample size, at a slightly early age, and with differential cultural backgrounds. Maternal prenatal or postpartum stress and child’s sex may be associated with cognitive functioning and behavioral problems in children . Detecting interactions is crucial for public health if maternal stress influences the fetal or children’s environment.…”

“…Maternal prenatal or postpartum stress and child’s sex may be associated with cognitive functioning and behavioral problems in children. 21 , 22 , 23 , 24 , 25 , 26 Detecting interactions is crucial for public health if maternal stress influences the fetal or children’s environment.…”