Review
Prenatal depression effects on early development: A review

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Abstract

This review of recent research on prenatal depression suggests that it is a strong predictor of postpartum depression and is more common than postpartum depression. Prenatal depression has been associated with excessive activity and growth delays in the fetus as well as prematurity, low birthweight, disorganized sleep and less responsiveness to stimulation in the neonate. Infants of depressed mothers have difficult temperament, and later in development attentional, emotional and behavioral problems have been noted during childhood and adolescence, as well as chronic illnesses in adulthood. Several variables have confounded the effects of prenatal depression including comorbid anxiety and anger as well as stressful life events. Potential mediating variables are low prenatal maternal dopamine and serotonin levels and elevated cortisol and norepinephrine. The associated intrauterine artery resistance may limit blood flow, oxygen and nutrients to the fetus. Some studies also suggest the heritability of developmental problems for the children of prenatally depressed mothers, including ADHD and antisocial behavior. Multivariate, longitudinal research is needed to disentangle these confounding and mediating variables.

Research highlights

▶ Research on prenatal depression suggests that it is a strong predictor of postpartum depression. ▶ Prenatal depression has been associated with excessive activity, growth delays and prematurity. ▶ Infants of depressed mothers have difficult temperament and attentional, emotional and behavioral problems later in life.

Section snippets

Overview

Postpartum depression has received significant attention in the literature for its negative effects on child development (Field, 1998, Murray and Cooper, 1997). In contrast, there are very few prenatal depression effects studies, even though discussions of these effects date back to the time of Hippocrates (Huizink, Mulder, & Buitelaar, 2004). Some have speculated that prenatal depression was not recognized because depressed mood was the expected correlate of normal hormonal changes such as

Prevalence of prenatal depression

Prenatal depression, referred to as antenatal depression in many parts of the world, has ranged in incidence/prevalence from 6% to 38% in the published literature. These figures have varied by the state or country where the research occurred and the type of reporting. For example, in one study from the U.S., groups were separated by those women who experienced depression only during the antepartum period (that figure being a very low 6%) versus chronic depression (7%) and postpartum depression

Prenatal depression as a predictor of postpartum depression

Antenatal depression has been noted to significantly predict postpartum depression. For example, in one study, antenatal depression along with a prior history of depression and a low level of partner support were the strongest predictors of postnatal depression (Milgrom et al., 2008). Similarly, in another study, women who had antenatal depression were significantly more likely to be depressed postnatally (Edwards et al., 2008). In still another study, both antenatal anxiety and depression

Prenatal depression effects on the fetus

In one of the first studies on prenatal depression effects on the fetus, our group showed that fetuses of depressed mothers spent a significantly greater percentage of time being active (44% vs. 28%) (Dieter et al., 2001) (see Fig. 1). A stepwise regression suggested that 29% of the variance in fetal activity was explained by prenatal depression scale scores, with anxiety scale scores adding 6% to that variance to total 35% of the variance. In a similar study, behavior and heart rate

Early interactions and temperament

At 3–6 months, the infants of prenatally depressed mothers showed less negative responding to their mother's noncontingent and still-face behavior, suggesting that they were more accustomed to this behavior in their mothers (Field et al., 2009a). The less responsive behavior of the depressed mothers was further compounded by their comorbid mood states of anger and anxiety and their difficult interaction styles including withdrawn or intrusive interaction styles (Field et al., 2009a). The

Physiological measures in infants and children

In several studies on prenatal depression effects on neonatal outcome, we have reported lower vagal tone (which is associated with lesser attentiveness) and greater relative right frontal EEG activation (which is associated with withdrawal behavior) (Field et al., 2004b; see Field & Diego, 2008 for a review). In all of this research, the depressed women had lower vagal tone and greater relative right frontal EEG activation. Their infants, in turn, mimicked these physiological profiles. In

Health and immune function

Prenatally depressed women have poorer self-reported health and functioning than their non-depressed counterparts. This has been demonstrated in one of our studies in which a greater incidence of prenatally depressed women reported the use of antibiotics (Field et al., 2004b). In another study, using self-report measures, health problems were noted in prenatally depressed women along with limited functional status (activities of daily living) (Orr, Blazer, James, & Reiter 2007). These women had

Comorbid anxiety and developmental outcomes

Anxiety is often comorbid with depression. In many studies those born to women who have experienced comorbid depression and anxiety are at particularly high risk for later developmental and social-emotional problems (Field et al., 2004a, Wadhwa, 2005). Women with high depression and anxiety scores are more likely to deliver preterm infants who are small for gestational age and, in turn, have other developmental problems. For example, in one study, depression and anxiety scores obtained during

Summary

In summary, maternal prenatal depression is the strongest predictor of postpartum depression and is believed to be more common than postpartum depression. Prenatal depression has been associated with excessive activity and growth delays in the fetus as well as prematurity, low birthweight, disorganized sleep and less responsiveness to stimulation in the neonate. Infants of depressed mothers have difficult temperament, and attentional, emotional and behavioral problems have been noted in

Acknowledgements

This research was supported by a Merit Award (MH # 46586), NIH grants (AT#00370 and HD#056036) and Senior Research Scientist Awards (MH#00331 and AT#0011585) and a March of Dimes Grant (#12-FY03-48) to Tiffany Field and funding from Johnson and Johnson Pediatric Institute to the Touch Research Institute

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