Acta Pædiatrica ISSN 0803-5253
REGULAR ARTICLE
Maternal stress during pregnancy is associated with moderate to severe depression in 11-year-old children Rebecca F Slykerman ([email protected])1, John Thompson2, Karen Waldie3, Rinki Murphy4, Clare Wall5, Edwin A Mitchell2 1.Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand 2.Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand 3.School of Psychology, University of Auckland, Auckland, New Zealand 4.Department of Medicine, University of Auckland, Auckland, New Zealand 5.Department of Nutrition, University of Auckland, Auckland, New Zealand
Keywords Child depression, Maternal stress during pregnancy, Risk factors Correspondence Dr Rebecca Slykerman, Starship Children’s Hospital, Auckland District Health Board, Private Bag 92024, Auckland 1124, New Zealand. Tel: +6421-715-969 | Fax: +649-307-8926 | Email: [email protected] Received 30 April 2014; revised 29 June 2014; accepted 20 August 2014. DOI:10.1111/apa.12787
ABSTRACT Aim: Maternal stress during pregnancy has been associated with negative outcomes in children. We examined the risk factors for symptoms of depression in 11-year-old children, including the interaction between birthweight and other variables. Methods: We collected maternal, obstetric and demographic information from birth through to the age of 11. Approximately, half of the 609 children were born small-forgestational-age (SGA). Information collected at 3.5 and 7 years of age included intelligence testing and parent-reported behavioural and emotional development. At 11 years of age, the children completed the Center for Epidemiological Studies Depression Scale for Children. Multivariable logistic regression analysis examined the relationship between selfreported symptoms of moderate to severe depression at the age of 11 and explanatory variables. Results: Symptoms of moderate to severe depression were related to increasing maternal stress during pregnancy, young maternal age, lower intelligence test scores at 7-years-old and being bullied at school in the previous 6 months. There was also a significant interaction between maternal stress in pregnancy and symptoms of depression in 11-yearold children born SGA. Conclusion: Increasing maternal stress during pregnancy was associated with increased risk of symptoms of moderate to severe depression in 11-year-old children, especially those who were born SGA.
INTRODUCTION Depression in children or adolescents is a problem that has been shown to have a negative impact on later psychological wellbeing (1) and on physical health (2). Various risk factors for depression have been reported, including female sex, being bullied and poor family relationships (3,4). Investigation of the relationship between low birthweight in both preterm and full-term infants, and subsequent behavioural difficulties and depression, has shown mixed results. Some studies have found that low birthweight is significantly associated with negative emotional and behavioural outcomes (5,6), while others have not (7). More recently, it has been proposed that low birthweight in conjunction with other risk factors, such as female sex, may Abbreviations ABC, Auckland Birthweight Collaborative Study; ADHD, Attention Deficit Hyperactivity Disorder; AGA, Appropriate-for-Gestational-Age; IQ, Intelligence Quotient; SDQ, Strengths and Difficulties Questionnaire; SGA, Small-for-Gestational-Age.
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better predict risk of depression rather than birthweight alone (8). As the Barker hypothesis suggested that events in foetal life are related to health outcomes in adulthood, a growing amount of research has examined this relationship (9). Maternal depression, anxiety and increased stress during
Key notes
Maternal stress during pregnancy has been associated with negative outcomes in children. We found that symptoms of moderate to severe depression at 11 years of age were associated with increasing maternal stress during pregnancy, young maternal age, lower intelligence test scores at seven and being bullied at school. Increasing maternal stress during pregnancy was associated with increased risk of symptoms of moderate to severe depression in 11-year-old children, especially those born SGA.
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2015 104, pp. 68–74
Slykerman et al.
pregnancy have been associated with negative outcomes in offspring in some studies (10), but not all (11). Prenatal maternal stress has been linked to increased foetal activity, decreased foetal weight estimates and low birthweight (12). Children of mothers who reported antenatal stress and anxiety have also been shown to have an increased risk of attention deficit hyperactivity disorder (ADHD) symptoms (13), reduced cognitive test scores as preschoolers and increased risk of behavioural and emotional problems in childhood (14). The aim of this study was to investigate risk factors for symptoms of depression in 11-year-old children, including antenatal, obstetric and environmental factors and the effect of being born small-for-gestational-age (SGA). A further aim was to examine whether children born SGA interacted with antenatal and postnatal factors to increase the risk of symptoms of depression in children.
METHOD Participants The study participants were selected at birth between October 1995 and November 1997. They were selected over the entire time period from the Auckland District Health Board and from October 1995 to August 1997 from the Waitemata District Health Board. All SGA infants (≤10th percentile for gestation and sex) and a random selection of appropriate-for-gestational-age infants (AGA) were selected for during the study. The numbers in each group were approximately equal. Infants were excluded from the study if they were not resident and born in the designated study regions, were preterm (
REGULAR ARTICLE
Maternal stress during pregnancy is associated with moderate to severe depression in 11-year-old children Rebecca F Slykerman ([email protected])1, John Thompson2, Karen Waldie3, Rinki Murphy4, Clare Wall5, Edwin A Mitchell2 1.Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand 2.Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand 3.School of Psychology, University of Auckland, Auckland, New Zealand 4.Department of Medicine, University of Auckland, Auckland, New Zealand 5.Department of Nutrition, University of Auckland, Auckland, New Zealand
Keywords Child depression, Maternal stress during pregnancy, Risk factors Correspondence Dr Rebecca Slykerman, Starship Children’s Hospital, Auckland District Health Board, Private Bag 92024, Auckland 1124, New Zealand. Tel: +6421-715-969 | Fax: +649-307-8926 | Email: [email protected] Received 30 April 2014; revised 29 June 2014; accepted 20 August 2014. DOI:10.1111/apa.12787
ABSTRACT Aim: Maternal stress during pregnancy has been associated with negative outcomes in children. We examined the risk factors for symptoms of depression in 11-year-old children, including the interaction between birthweight and other variables. Methods: We collected maternal, obstetric and demographic information from birth through to the age of 11. Approximately, half of the 609 children were born small-forgestational-age (SGA). Information collected at 3.5 and 7 years of age included intelligence testing and parent-reported behavioural and emotional development. At 11 years of age, the children completed the Center for Epidemiological Studies Depression Scale for Children. Multivariable logistic regression analysis examined the relationship between selfreported symptoms of moderate to severe depression at the age of 11 and explanatory variables. Results: Symptoms of moderate to severe depression were related to increasing maternal stress during pregnancy, young maternal age, lower intelligence test scores at 7-years-old and being bullied at school in the previous 6 months. There was also a significant interaction between maternal stress in pregnancy and symptoms of depression in 11-yearold children born SGA. Conclusion: Increasing maternal stress during pregnancy was associated with increased risk of symptoms of moderate to severe depression in 11-year-old children, especially those who were born SGA.
INTRODUCTION Depression in children or adolescents is a problem that has been shown to have a negative impact on later psychological wellbeing (1) and on physical health (2). Various risk factors for depression have been reported, including female sex, being bullied and poor family relationships (3,4). Investigation of the relationship between low birthweight in both preterm and full-term infants, and subsequent behavioural difficulties and depression, has shown mixed results. Some studies have found that low birthweight is significantly associated with negative emotional and behavioural outcomes (5,6), while others have not (7). More recently, it has been proposed that low birthweight in conjunction with other risk factors, such as female sex, may Abbreviations ABC, Auckland Birthweight Collaborative Study; ADHD, Attention Deficit Hyperactivity Disorder; AGA, Appropriate-for-Gestational-Age; IQ, Intelligence Quotient; SDQ, Strengths and Difficulties Questionnaire; SGA, Small-for-Gestational-Age.
68
better predict risk of depression rather than birthweight alone (8). As the Barker hypothesis suggested that events in foetal life are related to health outcomes in adulthood, a growing amount of research has examined this relationship (9). Maternal depression, anxiety and increased stress during
Key notes
Maternal stress during pregnancy has been associated with negative outcomes in children. We found that symptoms of moderate to severe depression at 11 years of age were associated with increasing maternal stress during pregnancy, young maternal age, lower intelligence test scores at seven and being bullied at school. Increasing maternal stress during pregnancy was associated with increased risk of symptoms of moderate to severe depression in 11-year-old children, especially those born SGA.
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2015 104, pp. 68–74
Slykerman et al.
pregnancy have been associated with negative outcomes in offspring in some studies (10), but not all (11). Prenatal maternal stress has been linked to increased foetal activity, decreased foetal weight estimates and low birthweight (12). Children of mothers who reported antenatal stress and anxiety have also been shown to have an increased risk of attention deficit hyperactivity disorder (ADHD) symptoms (13), reduced cognitive test scores as preschoolers and increased risk of behavioural and emotional problems in childhood (14). The aim of this study was to investigate risk factors for symptoms of depression in 11-year-old children, including antenatal, obstetric and environmental factors and the effect of being born small-for-gestational-age (SGA). A further aim was to examine whether children born SGA interacted with antenatal and postnatal factors to increase the risk of symptoms of depression in children.
METHOD Participants The study participants were selected at birth between October 1995 and November 1997. They were selected over the entire time period from the Auckland District Health Board and from October 1995 to August 1997 from the Waitemata District Health Board. All SGA infants (≤10th percentile for gestation and sex) and a random selection of appropriate-for-gestational-age infants (AGA) were selected for during the study. The numbers in each group were approximately equal. Infants were excluded from the study if they were not resident and born in the designated study regions, were preterm (
