Association of maternal depression and anxiety with toddler social-emotional and cognitive development in South Africa: a prospective cohort study

Abstract

ObjectiveA robust literature has identified associations between prenatal maternal depression and adverse child social-emotional and cognitive outcomes. The majority of prior research is from high-income countries despite increased reporting of perinatal depression in low/middle-income countries (LMICs). Additionally, despite the comorbidity between depression and anxiety, few prior studies have examined their joint impact on child neurodevelopment. The objective of the current analysis was to examine associations between prenatal maternal depression and anxiety with child social-emotional and cognitive development in a cohort from the Western Cape Province of South Africa.DesignPrenatal maternal depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory Scale at 20–24 weeks’ gestation. Child neurobehaviour was assessed at age 3 using the Brief Infant-Toddler Social Emotional Assessment and the Bayley Scales of Infant Development III Screening Test (BSID-III ST). We used linear regression models to examine the independent and joint association between prenatal maternal depression, anxiety and child developmental outcomes.ResultsParticipants consisted of 600 maternal-infant dyads (274 females; gestational age at birth: 38.89 weeks±2.03). Children born to mothers with both prenatal depression and trait anxiety had higher social-emotional problems (mean difference: 4.66; 95% CI 3.43 to 5.90) compared with children born to mothers with no prenatal depression or trait anxiety, each condition alone, or compared with mothers with depression and state anxiety. Additionally, children born to mothers with prenatal maternal depression and trait anxiety had the greatest reduction in mean cognitive scores on the BSID-III ST (mean difference: −1.04; 95% CI −1.99 to –0.08).ConclusionsThe observed association between comorbid prenatal maternal depression and chronic anxiety with subsequent child social-emotional and cognitive development underscores the need for targeting mental health support among perinatal women in LMICs to improve long-term child neurobehavioural outcomes.

Prenatal maternal stress: triangulating evidence for intrauterine exposure effects on birth and early childhood outcomes across multiple approaches

“…While many of the studies originate from Europe, North America, and Australia, similar ndings have been reported in other regions (13,(21)(22)(23)(24)(25). In one South African study, three-year-old children born to mothers experiencing both depression and anxiety during pregnancy faced a higher risk of emotional di culties compared to their counterparts born to mothers experiencing only one of these issues; children born to mothers without these symptoms were found to be at the lowest risk (22). Overall, across different data sources and populations, the evidence for an observational association between maternal prenatal stress and offspring outcomes is quite consistent(26).…”

“…For example, one US study that analyzed data from three different pregnancy cohorts found a relationship between maternal stress during pregnancy and emotional issues in offspring observed at ages 8 to 9 years (15). While many of the studies originate from Europe, North America, and Australia, similar ndings have been reported in other regions (13,(21)(22)(23)(24)(25). In one South African study, three-year-old children born to mothers experiencing both depression and anxiety during pregnancy faced a higher risk of emotional di culties compared to their counterparts born to mothers experiencing only one of these issues; children born to mothers without these symptoms were found to be at the lowest risk (22).…”

Associations of adverse maternal experiences and diabetes on postnatal maternal depression and child social-emotional outcomes in a South African community cohort

“…Between April 2018 and March of 2020, participants were recruited from the Bishop Lavis community at their Health Center or the Diabetes Clinic in Tygerberg Academic Hospital in the Western Cape Province, South Africa. This study was built on existing collaborations with the university through the Safe Passage Study [19]. Results from the Safe Passage study revealed high rates of depression and anxiety within the population: 55% of mothers had a prenatal Edinburgh postnatal depression score (EPDS) � 13 and 19.17% of mothers had a State-Trait Anxiety Inventory (STAI) � 40 [19].…”

“…This study was built on existing collaborations with the university through the Safe Passage Study [19]. Results from the Safe Passage study revealed high rates of depression and anxiety within the population: 55% of mothers had a prenatal Edinburgh postnatal depression score (EPDS) � 13 and 19.17% of mothers had a State-Trait Anxiety Inventory (STAI) � 40 [19].…”