Associations Between Maternal Stressful Life Events and Perceived Distress during Pregnancy and Child Mental Health at Age 4

Abstract

Accumulating evidence suggests that maternal exposure to objectively stressful events and subjective distress during pregnancy may have intergenerational impacts on children’s mental health, yet evidence is limited. In a multisite longitudinal cohort (N = 454), we used multi-variable linear regression models to evaluate the predictive value of exposure to stressful events and perceived distress in pregnancy for children’s internalizing problems, externalizing problems, and adaptive skills at age 4. We also explored two- and three-way interactions between stressful events, distress, and child sex. Both objective and subjective maternal stress independently predicted children’s behavior, with more stressful events and higher distress predicting more internalizing and externalizing problems and worse adaptability; stress types did not significantly interact. There was some evidence that more stressful events predicted higher externalizing behaviors only for girls. Three-way interactions were not significant. The current findings highlight the importance of considering the type of stress measurement being used (e.g., counts of objective event exposure or subjective perceptions), suggest prenatal stress effects may be transdiagnostic, and meet calls for rigor and reproducibility by confirming these independent main effects in a relatively large group of families across multiple U.S. regions. Results point to adversity prevention having a two-generation impact and that pre- and postnatal family-focused intervention targets may help curb the rising rates of children’s mental health problems.

A Multi-Cohort Examination of the Independent Contributions of Maternal Childhood Adversity and Pregnancy Stressors to the Prediction of Children’s Anxiety and Depression

“…Though this body of work is compelling, with some exceptions, most studies have focused on outcomes in young children and relied on parent reports, raising concerns about time-limited programming effects and potential rater bias in tested associations (De Los Reyes et al, 2015). In addition, despite evidence that maternal exposure to major life events during pregnancy is associated with child outcomes, even after adjusting for maternal subjective ratings of psychological distress during pregnancy (Rudd et al, 2022), most studies have relied on maternal self-report of subjective distress rather than more objective accounts of stressor exposures.…”

Intergenerational Transmission of Effects of Women's Stressors During Pregnancy: Child Psychopathology and the Protective Role of Parenting

“…There is some evidence that boys might be more likely to develop externalizing problems during childhood within the context of maternal prenatal stress ( 40 , 48 , 49 ). Yet, findings here are still mixed, and fewer studies have examined these potential sex differences in early childhood, when externalizing problems are less sex differentiated ( 43 , 47 , 50 ).…”

“…There is evidence regarding differential sex effects of maternal stress on offspring psychopathology; however, to date these findings have been quite mixed—necessitating additional inquiry ( 17 , 33 , 40 – 43 ). This is particularly important to examine in outcomes with well-established sex differences, such as externalizing behavior problems during childhood.…”

Cohort profile: the ECHO prenatal and early childhood pathways to health consortium (ECHO-PATHWAYS)

“…In ECHO-PATHWAYS analyses focused on the TIDES cohort, we found that prenatal phthalate exposure was associated with child behaviours as well as social responsiveness at age 4–6 in a sex-specific manner, indicating that phthalates may have sex-specific impacts on child behaviour and development 65. Additional work in TIDES demonstrated that maternal stressful life events and distress during pregnancy were associated with more child behaviour problems and lower levels of adaptive functioning 66. Since GAPPS-PW had been a closed cohort, no child health data was available until ECHO-PATHWAYS began and therefore no child health analyses using extant data could be leveraged within this cohort.…”

“… 65 Additional work in TIDES demonstrated that maternal stressful life events and distress during pregnancy were associated with more child behaviour problems and lower levels of adaptive functioning. 66 Since GAPPS-PW had been a closed cohort, no child health data was available until ECHO-PATHWAYS began and therefore no child health analyses using extant data could be leveraged within this cohort. Currently, GAPPS-PW has collected data on over 600 ECHO-PATHWAYS participants, and consortium analyses including these data are ongoing.…”