Prenatal maternal stress, child internalizing and externalizing symptoms, and the moderating role of parenting: findings from the Norwegian mother, father, and child cohort study

Abstract

Background Few studies have examined how parenting influences the associations between prenatal maternal stress and children's mental health. The objectives of this study were to examine the sex-specific associations between prenatal maternal stress and child internalizing and externalizing symptoms, and to assess the moderating effects of parenting behaviors on these associations. Methods This study is based on 15 963 mother–child dyads from the Norwegian Mother, Father, and Child Cohort Study (MoBa). A broad measure of prenatal maternal stress was constructed using 41 self-reported items measured during pregnancy. Three parenting behaviors (positive parenting, inconsistent discipline, and positive involvement) were assessed by maternal report at child age 5 years. Child symptoms of internalizing and externalizing disorders (depression, anxiety, attention-deficit hyperactivity disorder, conduct disorder, and oppositional-defiant disorder) were assessed by maternal report at age 8. Analyses were conducted using structural equation modeling techniques. Results Prenatal maternal stress was associated with child internalizing and externalizing symptoms at age 8; associations with externalizing symptoms differed by sex. Associations between prenatal maternal stress and child depression, and conduct disorder and oppositional-defiant disorder in males, became stronger as levels of inconsistent discipline increased. Associations between prenatal maternal stress and symptoms of attention-deficit hyperactivity disorder in females were attenuated as levels of parental involvement increased. Conclusions This study confirms associations between prenatal maternal stress and children's mental health outcomes, and demonstrates that these associations may be modified by parenting behaviors. Parenting may represent an important intervention target for improving mental health outcomes in children exposed to prenatal stress.

Intergenerational risk and resilience pathways from discrimination and acculturative stress to infant mental health

“…Lastly, because a number of DoHAD findings have suggested that vulnerabilities to prenatal stress are sex-differentiated (Braithwaite et al, 2017;Clayborne et al, 2021;Glynn & Sandman, 2012;Hicks et al, 2019;McLaughlin et al, 2021;Rosa et al, 2019;Sandman et al, 2013;Sharp et al, 2015), we tested the interaction of stressor X sex in a fourth step. All continuous variables contributing to interaction terms were centered prior to analysis.…”

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

“…Major stress exposures can directly impact maternal mental and physical health during pregnancy (Dayan et al, 2010;László et al, 2013) and indirectly impact a range of offspring outcomes in childhood, including externalizing problems, internalizing problems, and physical illness (Bush et al, 2020;Van den Bergh et al, 2020). In closer examination of links with childhood internalizing problems, maternal exposure to stress during pregnancy, ranging from perceived psychosocial distress to severe exogenous environmental events such as floods, has been associated with increased risk of offspring anxiety and depression (Clayborne et al, 2021;Hentges et al, 2019;McLean et al, 2018). 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).…”

“…Recent examinations have reported that maternal childhood adversity (Rowell & Neal-Barnett, 2022) and stress during pregnancy (Clayborne et al, 2021;Hentges et al, 2019) are each associated, as separate predictors, with children's increased risk for internalizing problems, suggesting that there may be intergenerational transmission of risk and pointing to the potential value of better understanding these associations. While a long line of literature has demonstrated prenatal origins of child mental and physical health, very few studies have simultaneously examined maternal stress exposures during and prior to pregnancy.…”

Mapping gene by early life stress interactions on child subcortical brain structures: A genome‐wide prospective study

“…Dichotomised risks were summed to create domain scores, and domain scores were subsequently summed and standardised within periods to obtain prenatal and postnatal ELS scores. These ELS scores are based on earlier studies, have been used in multiple cohorts, and have been found to prospectively associate with mental health and cognitive outcomes (Cecil et al., 2014; Clayborne et al., 2021; Rijlaarsdam et al., 2016; Schuurmans et al., 2022). In ABCD, ELS measures were retrospectively assessed when the child was on overage 9 years, including both prenatal and postnatal exposures.…”