Maternal Psychosocial Distress During Pregnancy and Child Behavior Outcomes Open Access

Brand, Sarah Rosen (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/sj139222d?locale=en
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Abstract

Abstract
Maternal Psychosocial Distress During Pregnancy and Child Behavior Outcomes
By Sarah Rosen Brand, M.A.
Background: Prenatal depression, anxiety, and stress have all been shown to be associated with adverse child behavioral outcomes. The current study used advanced statistical modeling to examine the impact of maternal distress during pregnancy on internalizing and externalizing problems in young children, as well as the potential mediating and moderating effects of biological, psychological, and social factors on the maternal distress-child behavior problem relationship. Methods: Women who had participated in a prospective study on maternal mood during pregnancy completed questionnaires about their child's behavior and their current mood when the child was between 1.5 and 9 years old. Maternal distress during pregnancy was constructed as a latent variable, based on a combination of self-report and clinician rated measures collected throughout the course of pregnancy. Results: Maternal distress during pregnancy was significantly associated with child behavior problems. This association was moderated by maternal social support during pregnancy. Infant baseline cortisol was also associated with child internalizing problems, but it did not act as a mediator between prenatal maternal distress and child outcome. In contrast, maternal symptoms concurrent with child behavior ratings fully mediated the maternal distress-child behavior problem relationship. Conclusions: This study extends the research on the impact of prenatal maternal distress by conceptualizing distress in a more multi-informant, comprehensive manner. The findings are discussed with regard to clinical implications and future research directions.

ACKNOWLEDGEMENTS
I am so grateful to my parents, friends, and family for their love and support. None of this would have been possible without them. I would like to express my deepest gratitude to my advisor, Dr. Patricia Brennan, for her excellent guidance, caring, patience, and mentoring over the last five years. Without Dr. Brennan, I would not have completed graduate school. I would like to thank my committee members, Dr. Craighead, Dr. Nowicki, Dr. Nygaard, and Dr. Smith, for their guidance and support throughout this process. I would also like to thank Dr. Stowe, Dr. Newport, Mrs. Knight for their assistance with this project over the last four years. It is because of them and the staff at the Emory Women's Mental Health Program that this project was possible. I would like to thank Dr. Stacy Ryan, Dr. Patrick Sylver, Dr. Mandy Allen, Dr. Katrina Johnson, Dr. Jamie LaPrairie Beale, Julia Schechter, and Julie Carrol, for their wonderful support, ideas, and humor in the Brennan Lab. Finally, I would like to thank my parents and brothers for their constant encouragement. I would especially like to thank my grandmother, Patricia Brand, who has been a wonderful inspiration.

Table of Contents

TABLE OF CONTENTS

Introduction……………………………………………………………………………………….1

Effects of maternal psychological distress on the developing fetus……………………....2
Fetal programming hypothesis…………………………………………………………….3
Potential pathways of transmission………………………………………………………..4
Maternal psychological distress during pregnancy and child behavior outcomes………...5
Mediators and moderators of the relationship between maternal prenatal distress and
child behavior…………………………………………………………………………….11
Potential confounds……………………………………………………………………....17
Rationale for the current study…………………………………………………………...19

Method………………………………………………………………………………………..….20

Overview…………………………………………………………………………...…… 20
Inclusion/exclusion criteria ……………………………………………………………...21
Participants……………………………………………………………………………….21
Procedures………………………………………………………………………………. 22
Operational definitions…………………………………………………………………...23
Measures ……………………………………………………………………………….. 24

Data Analysis…………………………………………………………………………………….29

Results……………………………………………………………………………………………31

Discussion………………………………………………………………………………………..36

Significance of Antenatal Factors………………………………………………………. 41
Limitations of the Current Study………………………………………………………...43
Strengths of the Current Study …………………………………………………………..44
Clinical Implications …………………………………………………………………….46
Future Directions ……………………………………………………………………......47
Conclusions ……………………………………………………………………………...48

References………………………………………………………………………………………..50

Tables………………………………………………………………………………………….…61

Figures……………………………………………………………………………………………70

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