The association between perinatal maternal mental health during the COVID-19 pandemic and offspring neurodevelopment at 24 months of age

Background

Prenatal anxiety and depression have been linked to adverse childhood neurodevelopment, potentially through cortisol-induced epigenetic changes. Postpartum depression is also associated with neurodevelopmental delays, possibly via altered parental attachment. While prenatal and postpartum mental health may be correlated, their relative and independent impacts on offspring neurodevelopment remain unclear. This study examines the effects of prenatal and postpartum anxiety and/or depression on neurodevelopmental delay at 24 months.

Methods

In a nationwide prospective cohort from the “Assessing the Safety of Pregnancy in the Coronavirus Pandemic” study, prenatal anxiety (GAD-7), prenatal depression (PHQ-9), and six-week postpartum depression (EPDS) were assessed. Childhood neurodevelopment was measured using the Ages and Stages Questionnaire, 3rd edition (ASQ-3). Logistic regression tested associations between moderate-to-severe maternal anxiety/depression and neurodevelopmental delay, adjusting for participant age, education, household income, and residential density. Alcohol, nicotine, anxiety/depression medication use during pregnancy, and preterm birth were considered as moderators/mediators.

Results

Offspring of participants experiencing both prenatal and postpartum moderate-to-severe anxiety or depression (N = 62) had a higher risk of neurodevelopmental delay at 24 months compared to those who experienced neither (N = 1060) with an adjusted risk ratio of 1.88 (p < 0.001). While delay risk was higher in offspring of those with only prenatal (N = 218) or postpartum (N = 45) anxiety/depression, these were not statistically significant.

Conclusion

Having both moderate-to-severe prenatal and postpartum anxiety or depression independently increased the risk of developmental delay at 24 months, even after adjusting for confounders. Further research is needed to explore underlying mechanisms linking maternal mental health and fetal neurodevelopment.