Antenatal maternal anxiety is associated with problem behaviour at age five
Introduction
The idea that the basis for a good health and development in later life is formed in the very early stages of development has a long history [1]. Recently, programming influences of maternal distress during pregnancy on long-term behavioural and cognitive development of the offspring have received increased interest (for reviews see [2], [3], [4]).
In prospective studies that were focussed on long-term behavioural outcome, evidence was found for an association between antenatal maternal distress and a higher prevalence of problem behaviour in the offspring. For example, pre-school aged children (47 months old) of mothers who scored in the top 15% of the scale used to measure anxiety at 32 weeks gestation, were more than twice as likely to have behavioural problems. In the same cohort, high levels of antenatal anxiety in late gestation were related to a twofold increase in overall problem behaviour at 81 months of age [5], [6]. In addition, anxiety in early gestation (12 to 22 weeks) was related to hyperactivity, externalising problems and self-reported anxiety in 8 and 9 year olds [7]. In line with these findings, exposure to stress during pregnancy (strongest effects in 10th week of gestation) was found to be associated with symptoms of ADHD particularly in boys that were assessed at the age of 7 [8]. Antenatal programming of offspring behaviour has even been shown to persist well into adolescence. Antenatal maternal anxiety in early pregnancy (12 to 22 weeks) was associated with depressive symptoms in girls at the age of 15 [9] and mothers' antenatal depression significantly predicted antisocial behaviour in their offspring at age 16 [10].
So far, most of these previous studies that have investigated the association between antenatal anxiety and child behaviour are based on maternal reports [5], [6] or composite scores (mother + teacher) [7], [8] of child behaviour. However, considerable debate in literature exists about inconsistencies in reports on child behaviour among different informants [11]. These disparities between informants might be due (at least partially) to inherent differences in experiences that these informants share with the children; for example the home environment versus the classroom [12]. In addition, evidence is accumulating for the influence of parental psychopathology on cross-informant discrepancies [13], [14], [15], [16]. To sum up, although evidence concerning the association between maternal negative emotions during pregnancy with long-term behavioural outcome is accumulating, these findings were based on maternal ratings of child behaviour. Therefore, the aim of the present study was to investigate the association between antenatal maternal anxiety and problem behaviour in children at age five using both maternal as well as the child's primary school teacher's ratings of child behaviour.
In addition, we aimed to examine the moderating role of the child's sex in the association between antenatal anxiety and children's problem behaviour. Results from animal studies have indicated sex differences in the programming effects of antenatal maternal stress or anxiety [17]. In humans, antenatal anxiety or stress during pregnancy was associated with cognitive impairments [18], [19], [20], ADHD symptoms and externalising problems [7], [8] in boys and with more emotional symptoms, conduct problems [5], [6] and self-reported depressive symptoms [9] in girls. Hence, both male and female offspring seem at risk for these antenatal programming effects, although in each sex these effects seem to be represented in different outcomes.
In sum, the first aim of the current study was to investigate the relation between antenatal maternal anxiety and children's behaviour at age five. An important addition to the existing body of literature was the use of mother as well as teacher reports on child behaviour. Furthermore, because of our large community based, non-clinical sample, we were able to test the moderating effect of the child's sex. We expected higher levels of antenatal maternal anxiety to be associated with more overall problem behaviour and more externalising problems in boys and with more internalising problems (emotional symptoms) in girls.
Section snippets
Sample
The current study is part of the Amsterdam Born Children and their Development (ABCD) study, a large community based birth cohort. Extensive information about the cohort and procedures regarding data collection is provided elsewhere [21]. In short, between January 2003 and March 2004 12,373 pregnant women were approached to participate in the study via their obstetric care provider and a questionnaire covering socio-demographic, obstetric, life-style and psychosocial conditions was sent to
Cross-informant agreement
Bivariate correlations between mother and teacher ratings were r = .40 (overall problem score), r = .29 (emotional symptoms), r = .29 (conduct problems), r = .43 (hyperactivity/inattention), r = .32 (peer relationship problems), and r = .23 (pro-social behaviour) (all p's < .01).
Antenatal anxiety and children's behaviour rated by mother
Analyses revealed a significant interaction between antenatal anxiety and the child's sex F(1, 4372) = 4,34, p = .04, in children's overall problem behaviour when child behaviour was rated by the mother. In boys, antenatal maternal
Discussion
Results in the current study provided support for the hypothesis that antenatal anxiety is related to children's problem behaviour and are in accordance with a foetal programming perspective [29]. Current results corroborate findings from previous comparable studies, which have reported adverse effects of antenatal anxiety on child behaviour [5], [6], [7], [8], [9], [10], [19], [20], [30]. Children of mothers who reported higher levels of anxiety during their pregnancy showed more overall
Conflict of interest statement
None declared.
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