Perinatal Maternal Mental Health, Fetal Programming and Child Development

Abstract

Maternal mental disorders over pregnancy show a clear influence on child development. This review is focused on the possible mechanisms by which maternal mental disorders influence fetal development via programming effects. This field is complex since mental health symptoms during pregnancy vary in type, timing and severity and maternal psychological distress is often accompanied by higher rates of smoking, alcohol use, poor diet and lifestyle. Studies are now beginning to examine fetal programming mechanisms, originally identified within the DOHaD framework, to examine how maternal mental disorders impact fetal development. Such mechanisms include hormonal priming effects such as elevated maternal glucocorticoids, alteration of placental function and perfusion, and epigenetic mechanisms. To date, mostly high prevalence mental disorders such as depression and anxiety have been investigated, but few studies employ diagnostic measures, and there is very little research examining the impact of maternal mental disorders such as schizophrenia, bipolar disorder, eating disorders and personality disorders on fetal development. The next wave of longitudinal studies need to focus on specific hypotheses driven by plausible biological mechanisms for fetal programming and follow children for a sufficient period in order to examine the early manifestations of developmental vulnerability. Intervention studies can then be targeted to altering these mechanisms of intergenerational transmission once identified.

Mood symptoms in pregnant and postpartum women with bipolar disorder: a naturalistic study

“…Both groups of pregnant women with BD (treated and untreated with pharmacotherapy) have a greater risk for multiple adverse reproductive events (cesarean delivery, preterm birth, and infants with microcephaly, small for gestational age, and with neonatal hypoglycemia) compared to women without BD . Evolving research on the association between adversity during pregnancy (fetal programming) and life‐long health has highlighted the risks of uncontrolled disease . To contribute information on the course of BD and the impact of pharmacotherapy on symptom expression across childbearing, we conducted a prospective study of a community cohort of pregnant women with BD.…”

“…14,15 Evolving research on the association between adversity during pregnancy (fetal programming) and life-long health has highlighted the risks of uncontrolled disease. 16,17 To contribute information on the course of BD and the impact of pharmacotherapy on symptom expression across childbearing, we conducted a prospective study of a community cohort of pregnant women with BD. We characterized symptoms of depression and mania throughout pregnancy and the first year after birth and compared symptom levels of psychotropic-treated women to those of nonpsychotropic-treated women.…”

Early adversity and psychiatric symptoms – a prospective study on Ethiopian mothers and their children

“…There is a need for more longitudinal studies and also those including covariates that may affect the relationship between maternal mental health in pregnancy and foetal development [3, 8]. Some prospective studies have been conducted, applying a foetal developmental programming framework, and these report of an association between maternal mood (distress, depression and anxiety) during the perinatal period and an increased risk of psychiatric symptoms in the children.…”

Depression and parenting: the need for improved intervention models

“…A systematic review including 43 studies found a range of outcomes from emotional, physiological, cognitive and hormonal (10). Given the vulnerability of the fetal period it is not surprising that pregnancy is emerging as a key area of interest in this literature (11,12).…”