Mom’s Depression Leaves Kids at Risk for Developmental Delay
— Early childhood appears to be the time of greatest vulnerability
by Elizabeth Hlavinka, Staff Writer, MedPage Today August 17, 2020
Canadian children whose mothers had depression were more likely to be developmentally vulnerable upon entering the school system, researchers reported.
Among 52,103 mom-child pairs, kids exposed to maternal depression within their first 5 years of life had a 17% greater risk of scoring in the bottom 10% on at least one developmental domain in kindergarten compared with children who were not exposed to maternal depression (adjusted relative ratio 1.17, 95% CI 1.11-1.23), reported Elizabeth Wall-Wieler, PhD, of Stanford University, and colleagues.
This risk was greatest when exposure to maternal depression occurred between 4 and 5 years, and before a child’s first birthday, the team wrote in Pediatrics.
“While exposure to maternal depression at any point in early childhood had a negative effect on most aspects of early childhood development, we found that the largest effect tended to be if exposure was immediately before school entry,” Wall-Wieler told MedPage Today in an email.
One in eight women are diagnosed with postpartum depression, according to CDC data. In one longitudinal analysis of mothers, the prevalence of depression increased from 6% in the first 2 years after giving birth to 9% when children were 10 years old.
Many fathers — between 2% and 25% — experience postpartum depression too, but there is less research on what effect paternal experience has on children’s development.
Overall, 70% of children exposed to maternal depression in this study did not show developmental vulnerability.
That “speaks to the resilience of children and serves as a reminder that adverse outcomes are in no way inevitable,” commented Stephanie Klees Goeglein, MD, MS, and Yvette E. Yatchmink, MD, PhD, both of Brown University, in an accompanying editorial.
Prenatal depression is actually more common than postpartum depression and may influence early child development through hormones passed from mom to baby in pregnancy. Because prenatal depression was not accounted for in this data, it may be an “unexplored contributor to the developmental vulnerability of the children in the sample,” Goeglein and Yatchmink said.
Other potential confounders include paternal or partners’ depression, and whether mothers were treated for their condition. Up to 85% of women with postpartum depression go untreated, so the prevalence of developmentally vulnerable children in this study may in fact be underestimated, Goeglein and Yatchmink noted.
The editorialists, who called maternal depression a “public health crisis,” pointed out the disproportionate rate at which low-income women experience maternal depression and called for integrated behavioral health and pediatric interventions that are “culturally sensitive and inclusive of vulnerable populations such as communities of color, immigrants, and those struggling with homelessness.”
The study linked population data from Manitoba, Canada, to physician and pharmaceutical claims, as well as data from the Early Developmental Instrument (EDI) screens performed in the latter half of kindergarten. The data were adjusted for maternal education, social isolation, marital status, and drug/alcohol/tobacco use in pregnancy. It was also adjusted for children’s birth weight, order, sex, gestational age, and family neighborhood.
Most moms were between 25 and 34 years old (77.6%), and 21.1% did not complete high school. Ten percent were unmarried and 16.5% smoked in pregnancy. The cohort was about evenly distributed across five income quintiles.
In total, 19.1% of mothers were diagnosed with depression between their children’s birth and fifth birthday. Maternal depression was more common later in the child’s life, with 7% of women diagnosed within the first year after giving birth and 9.1% diagnosed between a child’s fourth and fifth birthday.
Depressed moms were more likely to be younger than 25 at the time of their first childbirth, be unmarried or low-income, and to have smoked or used drugs or alcohol during pregnancy, although these differences were accounted for in the analysis, the authors noted.
Maternal depression was associated with specific developmental domains within the EDI scale, including social competence (aRR 1.28, 95% CI 1.20-1.38), physical health and well-being (aRR 1.28, 95% CI 1.20–1.36), and emotional maturity (aRR 1.27, 95% CI 1.18–1.36), according to the study.
In contrast, maternal depression was not associated with language and cognitive development in children, researchers reported.
“In our study, developmental vulnerability was defined as a child scoring in the lowest 10% on a particular developmental domain,” Wall-Wieler explained. “[S]coring low on physical health may indicate that the child has poor motor skills, whereas scoring low on emotional maturity may indicate that the child is hyperactive or anxious.”
In a subgroup analyses of 836 sibling pairs, children whose mothers had depression within their first 5 years of life had an elevated risk of social competence deficits (aRR 1.74, 95% CI 1.26–2.38) and emotional maturity (aRR 1.48, 95% CI 1.09–2.01) compared with sisters who were not exposed to maternal depression in early childhood, Wall-Wieler and co-authors reported.
The study did not account for the severity of maternal depression or time to treatment, which is a limitation, the researchers noted, adding that the study also lacked information on fathers and parenting styles.
- Elizabeth Hlavinka covers clinical news, features, and investigative pieces for MedPage Today. She also produces episodes for the Anamnesis podcast. Follow
The authors did not report any disclosures.
Primary Source: Pediatrics
Secondary Source: Pediatrics