Postpartum maternal mental health is associated with cognitive development of HIV-exposed infants in Zimbabwe: a cross-sectional study

Abstract

This study examines the cognitive profiles of infants born to HIV positive mothers in Zimbabwe. Caregivers with HIV exposed infants delivered in 30 clinics in two areas of Zimbabwe were recruited to the study. Of the 574 study participants, 562 caregiver-infant dyads with a biological HIV +ve mother and infant aged 0-24 months were interviewed. All infants were tested by a trained administrator for cognitive development on the Mullen Scales of Early Learning (MSEL). The Edinburgh Postnatal Depression Scale and Parental Stress Index-Short Form were completed by the mothers together with infant and caregiver socioeconomic characteristics. Linear regression models were used to relate cognitive development scores to maternal stress scores, maternal depression scores and infant HIV status adjusting for infant and caregiver characteristics, as well as socioeconomic factors. Higher maternal depression scores were associated with lower overall infant cognitive scores (adjusted mean difference (aMD) = -0.28; CI 95%:-0.50 to -0.06; p = 0.01) and in the expressive language (aMD = -0.14; CI 95%:-0.27 to -0.01; p = 0.04), fine motor skills (aMD = -0.17; CI 95%: -0.33 to -0.01; p = 0.03), gross motor (aMD = -0.22; CI 95%:-0.40 to -0.04; p = 0.02), and visual reception (aMD = -0.22; CI 95%:-0.40 to -0.05; p = 0.01) domains. Higher maternal stress was associated with poorer overall infant cognitive scores (aMD = -0.11; CI 95%:-0.20 to -0.02; p = 0.02) and in the specific domains of expressive language (aMD = -0.07; CI 95%:-0.12 to -0.01; p = 0.01), gross motor skills (aMD = -0.12; CI 95%:-0.18 to -0.05; p < 0.01) and visual reception (aMD = -0.09; CI 95%:-0.16 to -0.02; p = 0.02). Comparisons between the small number of HIV positive infants (n = 16) and the HEU infants (n = 381) showed the latter to have higher mean gross motor scores (50.3 vs. 40.6; p = 0.01). There was no evidence of difference by HIV status in the other MSEL domains or overall mean cognitive scores. Our findings demonstrate the association between maternal mood and stress levels and child cognitive functioning, particularly in expressive language and visual reception development. Although cross sectional data cannot shed light on the direction of this association, the study suggests that interventions to address maternal stress and depression symptoms may prove to be beneficial.

Effects of Maternal Suicidal Ideation on Child Cognitive Development: A Longitudinal Analysis

“…Similar to previous studies, maternal mental health was negatively associated with child development in the language and visual domains [13,14]. It may be that mental health burdens and stress distract mothers from parenting and child stimulation reducing visual and verbal interactions and may affect the crucial child development steps.…”

In Utero HIV Exposure and the Early Nutritional Environment Influence Infant Neurodevelopment: Findings from an Evidenced Review and Meta-Analysis

“…Low socioeconomic status is also a known risk factor for poorer cognitive development [88] and is particularly important to consider in the context of HIV infection given the overlaps between HIV/AIDS and economic and food insecurity [9]. Lastly, poor maternal mental health during the pre-and postnatal periods may adversely influence infant neurodevelopmental outcomes [89], and among women living with HIV specifically, depression and mental health vulnerabilities are especially prevalent [90] and have shown to associate with infant health outcomes [91].…”

Caries experience and oral health related quality of life in a cohort of Ugandan HIV-1 exposed uninfected children compared with a matched cohort of HIV unexposed uninfected children

“…Thus, HEU children seem to be disadvantaged with respect to birth outcomes such as preterm birth, linear growth, metabolism, adaptive and innate immune systems; and increased infectious morbidity [24]. In addition to direct exposure in utero and during delivery, mothers with HIV-1 can also affect the health situation of their children indirectly through poverty, caregiver insufficiency, unemployment, illness and bereavement [25]. Previous studies have shown that compared to HEU children, children with HIV infection have more negative impacts on their quality of life [26][27][28].…”