Prenatal exposure to a natural disaster and early development of psychiatric disorders during the preschool years: stress in pregnancy study

Abstract

Background Growing evidence shows an association between in utero exposure to natural disasters and child behavioral problems, but we still know little about the development of specific psychopathology in preschool‐aged children. Methods Preschool children (n = 163, mean age = 3.19, 85.5% racial and ethnic minorities) and their parents (n = 151) were evaluated annually at ages 2–5 to assess the emergence of psychopathology using the Preschool Age Psychopathological Assessment (PAPA), a parent‐report structured diagnostic interview developed for preschool‐age children. Sixty‐six (40.5%) children were exposed to Sandy Storm (SS) in utero and 97 (59.5%) were not. Survival analysis evaluated patterns of onset and estimated cumulative risks of psychopathology among exposed and unexposed children, in total and by sex. Analyses were controlled for the severity of objective and subjective SS‐related stress, concurrent family stress, and demographic and psychosocial confounders, such as maternal age, race, SES, maternal substance use, and normative prenatal stress. Results Exposure to SS in utero was associated with a substantial increase in depressive disorders (Hazard Ratio (HR) = 16.9, p = .030), anxiety disorders (HR = 5.1, p < .0001), and attention‐deficit/disruptive behavioral disorders (HR = 3.4, p = .02). Diagnostic rates were elevated for generalized anxiety disorder (GAD; HR = 8.5, p = .004), attention‐deficit/hyperactivity disorder (ADHD; HR = 5.5, p = .01), oppositional‐defiant disorder (ODD; HR = 3.8, p = .05), and separation‐anxiety disorder (SAD; HR = 3.5, p = .001). Males had distinctively elevated risks for attention‐deficit/disruptive behavioral disorders (HR = 7.8, p = .02), including ADHD, CD, and ODD, whereas females had elevated risks for anxiety disorders (HR = 10.0, p < .0001), phobia (HR = 2.8, p = .02) and depressive disorders (HR = 30.0, p = .03), including SAD, GAD, and dysthymia. Conclusions The findings demonstrate that in utero exposure to a major weather‐related disaster (SS) was associated with increased risk for psychopathology in children and provided evidence of distinct psychopathological outcomes as a function of sex. More attention is needed to understand specific parent, child, and environmental factors which account for this increased risk, and to develop mitigation strategies.

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

“…The fetal programming hypothesis(2-4) and DOHaD are often implicitly accepted in the literature on prenatal exposures and are used to explain the effects of a range of prenatal exposures on a range of offspring's physical and psychological outcomes (14,(101)(102)(103). The mechanism has strong support for certain outcomes, such as fetal alcohol syndrome (101,104) where prenatal alcohol exposure is a clear cause.…”

The Impact of COVID-19 Related Distress on Antenatal Depression in Australia

“…Maternity care is ultimately one of the most early and important points of intervention for the population’s physical and mental health across the lifespan. Studies in other extreme examples such as those following children of mothers that were pregnant during natural disasters have shown disturbingly high levels of internalizing and externalizing problems such as ADHD, depression, and anxiety, as well as poorer language and cognitive development in the children that were exposed to natural disasters in-utero [ 59 , 60 , 61 ]. Environmental stress is known to impact the long-term health of a developing fetus through a number of mechanisms including epigenetics (changes to developmental programming) and shortening of telomeres (an important protective component at the end of chromosomes) [ 58 ].…”

The clinical implications of climate change for mental health

“…Case-control study 86 RR, relative risk; CI, confidence interval; IRR, incidence rate ratio; OR, odds ratio; HR, hazard ratio.…”