A Developmental Cascade from Prenatal Stress to Child Internalizing and Externalizing Problems

Abstract

Objective This study utilized a developmental cascade approach to test alternative theories about the underlying mechanisms behind the association of maternal prenatal stress and child psychopathology. The fetal programming hypothesis suggests that prenatal stress affects fetal structural and physiological systems responsible for individual differences in child temperament, which further increases risk for internalizing and externalizing problems. Interpersonal models of stress transmission suggest that maternal stress influences child mental health via early parenting behaviors. We also examined a continuation of stress hypothesis, in which prenatal stress predicts child mental health via the continuation of maternal stress in the postpartum period. Methods Participants were 1,992 mother–child pairs drawn from a prospective pregnancy cohort. Mothers reported on their perceived stress, anxiety, and depression during pregnancy and at 4-month postpartum. Birthweight was assessed via medical records of birthweight. At 4-month postpartum, hostile-reactive parenting behaviors were assessed. Child temperamental negative affect was measured at age 3. Child internalizing and externalizing problems were assessed at age 5. Results Prenatal stress was associated with both internalizing and externalizing problems via postnatal stress and child temperament. Prenatal stress was also associated with externalizing behaviors via increased hostile-reactive parenting. After accounting for postnatal factors, prenatal stress continued to have a direct effect on child internalizing, but not externalizing, symptoms. Conclusion Results provide support for the fetal programming, interpersonal stress transmission, and continuation of stress models. Findings highlight the need for prenatal preventative programs that continue into the early postnatal period, targeting maternal stress and parenting behaviors.

Pregnancy as a period of risk, adaptation, and resilience for mothers and infants

“…The link between prenatal maternal mental health problems, stress, and child negative emotionality persists throughout childhood and is associated with the development of children's internalizing problems (Davis & Sandman, 2012; Howland, Sandman, Glynn, Crippen, & Davis, 2016). A recent prospective study with close to 2,000 mother–child dyads measured maternal stress, anxiety, and depression both during pregnancy and postnatally and showed that prenatal distress predicted child negative emotionality at 3 years and internalizing problems at 5 years after covarying postnatal maternal mental health (Hentges, Graham, Plamondon, Tough, & Madigan, 2019). Prenatal maternal stress, anxiety, and depression also predicted elevated depressive symptoms in adolescence assessed by both maternal report and child self-report (Davis et al, 2019; O'Donnell et al, 2014).…”

Associations between infant and toddler regulatory problems, childhood co‐developing internalising and externalising trajectories, and adolescent depression, psychotic and borderline personality disorder symptoms

“…However, co‐occurring and/or persistent RPs can increase the risk of internalising and externalising symptoms and mental disorders across childhood and adolescence (Bilgin et al., ; Cook et al., ; Hemmi, Wolke, & Schneider, ; Hyde, O'Callaghan, Bor, Williams, & Najman, ; Toffol et al., ; Winsper & Wolke, ). The cascade model of development describes how early risk predictors can cumulatively influence maladaptive outcomes over time (Hentges, Graham, Plamondon, Tough, & Madigan, ). The ‘cascade’ represents the extent to which differences in emotion or behaviour maximally affect the next most proximate phase of development, which in turn affects the following stage, and so on (Hyde et al., ).…”

Prenatal Relocation Stress Enhances Resilience Under Challenge in Infant Rhesus Macaques

“…Intriguingly although our cross-fostered sample size was small, the notable behavioral consequences were identical across both groups, demonstrating the independence Prior research suggests that prenatal stress is a risk factor for behavioral dysregulation and problematic outcomes in animal and human health (Schneider et al, 1992(Schneider et al, , 2002Coe et al, 2003;Gutteling et al, 2005;Ruiz and Avant, 2005;Pryce et al, 2011). In studies conducted on human children, prenatal stress has been linked with both internalizing and externalizing behavior dysregulation (Betts et al, 2014;MacKinnon et al, 2018;Hentges et al, 2019). Moreover, multiple studies have shown a link between prenatal stress and signs of internalizing behavior at an early age.…”

“…The consequences of prenatal stress on infant development are diverse (Clarke and Schneider, 1993;Gutteling et al, 2005;DiPietro et al, 2006;Hartman et al, 2018). Some studies have shown prenatal stress leads to internalizing outcomes (negative affect, poor soothability, anxiety; Gutteling et al, 2005;Hentges et al, 2019), some to externalizing outcomes (impulsivity, poor self control; Gutteling et al, 2005;Betts et al, 2014;MacKinnon et al, 2018), and still others, to resilient outcomes (advanced cognitive development and stress resistance; Fujioka et al, 2001;DiPietro et al, 2006). We observed that offspring of mothers that were relocated for an average of 9 days over an average of 1.5 relocations during pregnancy were more active, confident, and willing to engage with novelty, and exhibited lower post-stress cortisol during a moderately stressful social separation at 90-120 days of age.…”

“…Moreover, multiple studies have shown a link between prenatal stress and signs of internalizing behavior at an early age. Internalizing behaviors include negative affect, anxiety, depression, and withdrawn behavior (Gutteling et al, 2005;Hentges et al, 2019). For example, in a study measuring the effects of prenatal stress on 6-month-old human infants, prenatal stress and anxiety were found to predict higher levels of negative emotional affect thus increasing the risk for later internalizing behavior (Nolvi et al, 2016).…”