Maternal Psychosocial Distress During Pregnancy and Child Behavior Outcomes Public
Brand, Sarah Rosen (2011)
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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