Maternal Prenatal Distress and Child Cognitive Outcomes During the Preschool Years Open Access

Schechter, Julia Corwin (2015)

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Background: A great deal of animal research as well as available human research suggests that psychological distress experienced by the mother during gestation is associated with later neurodevelopmental deficits in offspring. However, most research investigating the outcomes associated with prenatal stress in humans has been conducted during infancy, leaving many questions unanswered regarding the long term effects of prenatal distress on child neurocognitive development. The current study examined the impact of maternal distress during pregnancy on neurocognitive outcomes in preschool age children, as well as potential mediators and moderators of this risk pathway. Specifically, children's hypothalamic-pituitary-adrenal axis functioning (i.e., cortisol reactivity) was examined as a mediator and parenting behaviors were examined as moderators.

Methods: Mother-child dyads (N=162) were recruited from a longitudinal cohort of women who had previously participated in a study on maternal mood during pregnancy. 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. During a follow-up visit, information was collected regarding mother's symptomatology since the child's birth and children's neurocognitive abilities. In addition, cortisol reactivity was assessed via saliva samples before and after a stressor task, and parenting behaviors were recorded during a parent-child interaction.

Results: Maternal prenatal distress significantly predicted to children's lower general cognitive and expressive language abilities. This relationship was moderated by parent positive engagement such that the relationship was strongest for children whose mothers exhibited low levels of positive engagement and was not significant for mothers who exhibited high levels of positive engagement. Children's cortisol reactivity was not found to be a mediator.

Conclusions: Prenatal maternal distress, measured in a multi-informant, comprehensive manner predicts to lower cognitive functioning in preschool aged children, particularly when mothers display low levels of positive parenting. The findings are discussed with regard to clinical implications and future research directions.

Table of Contents

Introduction. 1

Prenatal distress. 2

Prenatal distress and the fetus. 3

Prenatal distress and the neonatal period and infancy. 3

Prenatal distress and preschool outcomes. 7

The fetal programming hypothesis. 11

The hypothalamic-pituitary-adrenal axis. 13

Prenatal distress and the HPA axis. 14

HPA axis functioning and cognitive outcome. 18

Parenting. 20

Postnatal distress. 23

Rationale for the proposed study. 24

Hypotheses. 25

Method. 26

Participants. 26

Procedure. 27

Measures. 28

Determining confounds. 33

Results. 34

Discussion. 41

Prenatal distress and neurocognitive abilities. 41

HPA axis as a mediator. 43

Parenting as a moderator. 46

Study limitations. 50

Study strengths. 52

Clinical implications. 53

Future directions. 55

Conclusion. 56

References. 58

Tables. 68

Figures. 78

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