Impact of maternal wellbeing in pregnancy on child development

1
Impact of maternal well-being in pregnancy on
child development

• Dr Toity Deave
• Centre for Child Adolescent Health
• University of the West of England, Bristol
• Dr Jon Heron, ALSPAC1
• Dr Jonathan Evans, Unit of Psychiatry1
• Professor Alan Emond, Centre for Child
  Adolescent Health1.
• 1 University of Bristol.

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Background

• Depression is common in pregnancy (Evans et al,
  2001)
• Antenatal depression is associated with early
  childhood cognitive development in
  socio-economically deprived families (Deave,
  2005)
• Maternal anxiety in pregnancy increases emotional
  and behavioural problems in early childhood
  (OConnor et al., 2002)
• Hormonal levels in early pregnancy influence
  foetal brain development (HPA axis)
• (de Weerth et al, 2005 Van den Bergh et
  al, 2005)

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Study objectives
1. To estimate the impact of mothers
depression during pregnancy on child development
at 18 months of age, independent of postnatal
depression. 2. To test whether there is a
dose-response association between mothers
depression during pregnancy and child development
at 18 months of age.  
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Methods 1

• Study population
• Based on the Avon Longitudinal Study of Parents
  and
• Children (ALSPAC) longitudinal,
  prospective,
• community-based study of women, their
  partners, and
• index child (www.alspac.bris.ac.uk).
• Total of 14 663 women were recruited.
• Baseline data
• socio-demographic, family details
• pregnant woman, partner
• between 12-32 weeks gestation
• through postal questionnaires.

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Methods 2
Exposure measure Maternal risk of depression was
assessed using the Edinburgh Postnatal Depression
Scale (EPDSgt12) Derived variables antenatal
only, postpartum only risk of depression
Outcome measure Modified Denver Developmental
Screening Test (modified DDST) Analysis Descriptiv
e statistics and frequencies, bivariable tests of
association multivariable regression analyses
(STATA version 8)..
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Demographic characteristics
Complete antenatal depression data
(N11098) Expecting first child n4833 (44)
Average age 28 years (range 15-44) Attained
Olevels/equivalent n7090 (64) No partner
n227 (2) Partner employed n8341 (89)
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Results 2

• Child development (modified DDST) ( N10125)
• 9 (n893) developmentally delayed
• Antenatal depression (EPDSgt12) (N11098)
• 14 (n1520) once (18/40 or 32/40)
• 7 (n779) twice (18/40 and 32/40)
• Experienced no depression during study
• period (AN or PN) 75 (n6978)

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Levels of depression during pregnancy and in the
postpartum
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Associations of antenatal risk of depression and
modified DDST (N9244)
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Adjusted associations of antenatal depression and
modified DDST with postpartum depression entered
into the model
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Strengths

• Prospective longitudinal design large community
  sample
• Study population was broadly representative of
  the population of the United Kingdom at time of
  recruitment
• Many potential confounding variables controlled
  for in the analysis.

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Limitations

• Depressed women less likely to take part
• Maternal mood may confound the completion of the
  modified DDST
• Data relied on parental report

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Generalisability

• Large, community-based population sample
  followed-up for 18/12, 80-90 participation
• Prevalence of both antenatal and postpartum
  depression similar to other studies
• Findings broadly consistent with earlier studies
• Findings partially explained by biological
  studies maternal stress during pregnancy can
  influence the developing foetus

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Conclusions

• Different courses of development for children of
  mothers who experienced persistent depression
  during pregnancy
• Concurs with previous studies importance of
  depression and anxiety in pregnancy and
  depression in the postpartum period
• Evidence that antenatal psychological health is
  important for optimal child development,
  independent of postpartum health
• Suggests there is evidence that programmes to
  improve maternal well-being in pregnancy might be
  beneficial

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THANK YOU

• Dr Toity Deave
• Centre for Child Adolescent Health
• University of the West of England, Bristol
• toity.deave_at_uwe.ac.uk
• Dr Jon Heron, ALSPAC1
• Dr Jonathan Evans, Unit of Psychiatry1
• Professor Alan Emond, Centre for Child
  Adolescent Health1.
• 1 University of Bristol.

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Associations of antenatal risk of depression and
modified DDST (N9244)