Maternal Anxiety During and After Pregnancy: Effects on Child Internalizing Behaviour

Research Article

Ann Depress Anxiety. 2014;1(7): 1031.

Maternal Anxiety During and After Pregnancy: Effects on Child Internalizing Behaviour

Sue K Adams1*, Jennifer F. Daly1 and Kathleen N Morgan2

1Department of Human Development and Family Studies, University of Rhode Island, USA

2Department of Psychology, Wheaton College (MA), USA

*Corresponding author: Sue K Adams, Department of Human Development and Family Studies, University of Rhode Island, Transition Center 208, 2 Lower College Road, Kingston, RI 02881USA

Received: September 30, 2014; Accepted: November 03, 2014; Published: November 14, 2014

Abstract

Background: Anxiety during pregnancy can have significant effects on both a developing fetus and long-term developmental outcomes. In animal and human models, prenatal anxiety has been associated with characteristics of inhibited temperament in infants, which may be a precursor to later anxiety disorders. This pilot study examined if maternal report of anxiety during pregnancy differentially explained preschool-aged children’s internalizing behaviour over and above a mother’s trait anxiety. In addition, using multi-reporter methodology, the study examined if maternal anxiety during pregnancy predicted multiple reporters’ ratings of child internalizing behaviour.

Method: Participants in this pilot study included preschool-aged children, their mothers, and teachers. Retrospective maternal anxiety during pregnancy, current maternal anxiety and multi-reporter ratings of children’s internalizing behaviour were assessed.

Results: In a sample of 46 mothers, their preschool children, and the children’s teachers, hierarchical multiple regression analyses indicated that after controlling for a mother’s current level of anxiety, maternal anxiety during pregnancy significantly predicted children’s internalizing behaviour as reported by their mothers, but not as reported by teachers or other observers.

Conclusion: The prenatal environment may have a significant effect on child internalizing over time. Findings also suggest that mothers may be the most reliable reporters of child behaviour because of an overarching knowledge of the child’s behaviour across contexts.

Introduction

Pregnancy is often perceived as an exciting milestone in a woman’s life. For many women, however, it is also a time wrought with concerns about their child’s and family’s health and well-being [1,2]. In fact, expectant mothers appear to be especially vulnerable to anxiety [3,4]. Occurrences of clinical-level anxiety in this population are found to be high when compared to rate estimates of anxiety in non-pregnant fertile women [4], with as many as 54% of pregnant women reporting elevated levels of anxiety in at least one of three prenatal assessments [3].

Anxiety during pregnancy is associated with a number of prenatal and perinatal complications, the putative mechanism for which is excessive cortisol secretion in the mother and disruption of the developing hypothalamic-pituitary-adrenal axis in the fetus [5]. The resulting consequences can include an increased risk for lower birth weights [6] more frequent premature delivery [7,8], and less optimal performance on the Brazelton Neonatal Behaviour Assessment Scale [9]. In addition, prenatal anxiety can alter the developmental trajectory of infants and children, resulting in children that are more irritable or difficult to soothe [10,11]. Children of mothers who were gestationally stressed have also been shown to exhibit behaviourally inhibited temperaments [12] that increase their risk for anxiety disorders later in life [13,14]. Given the high prevalence of anxiety disorders during pregnancy, exploring the short- and long-term effects of prenatal anxiety on the developing fetus is judicious.

The role of the prenatal and postnatal environments on development

Studies of prenatal anxiety and perinatal fetal outcomes in nonhuman animal models have the advantage of a level of control that is not easily duplicated in human studies. In these studies, researchers have identified a causal relation between prenatal stress and behavioural effects in nonhuman primate and rodent infants including behavioural inhibition when placed in social situations [15], impaired motor skills [16], reduced exploratory behaviour [17], and reduced social play [18]. Clarke and Schneider [19] examined the effects of prenatal stress on the postnatal stress responses of juvenile rhesus monkeys and found that prenatally-stressed subjects exhibited less normal social behaviour (i.e., proximity, contact) and more abnormal social behaviour (i.e., mutual clinging) than controls, suggesting that exposure to stress in utero may have a long-term effect on offspring behavioural reactivity, producing offspring with an intensified response to stress.

Correlational studies in human populations have yielded similar results. For instance, Coplan, O’Neil, and Arbeau [12] investigated whether maternal trait and state anxiety during pregnancy would differentially predict temperament in human infants. Researchers found that antenatal state anxiety measured during the third trimester of pregnancy predicted less positive infant affect and a lower attention span at three months of age. High levels of cortisol in pregnant women at 30-32 weeks gestation has also been shown to be significantly related to greater infant negative reactivity at 2 months old and predictive of infant temperament as assessed by a measure of infant negative reactivity [20].

It is also important to note that the postnatal environment may play a significant role in the transmission and development of anxious temperament in infants, children, and adolescents. For instance, the process of breastfeeding transmits glucocorticoids, such as cortisol, from mother to infant [21]. Breastfed infants whose mothers had elevated cortisol levels have demonstrated increased fearful behaviour and negative temperaments [21,22], and these patterns are not found in formula-fed infants [22]. Additionally, with regard to the link between behavioural inhibition and anxiety disorders later in life, Chronis-Tuscano and colleagues [13] conducted a longitudinal study examining temperament and anxiety in 126 infants and their mothers. Results revealed that mothers who reported stable and consistent behavioural inhibition over their children’s involvement in the study had a significantly higher likelihood of having adolescents diagnosed with anxiety disorders [13]. Not only does anxiety interfere with a child’s social and emotional development, but it is the most prevalent psychiatric disorder among children and adolescents [23] and often persists into adulthood causing individuals significant impairment across multiple domains of life [24,25].

Issues related to single and multi-method reporting

A limitation of many studies is the issue of single reporter bias [26], a methodological concern that arises in numerous empirical investigations of children’s behaviour. The problematic nature of single reporter designs is grounded in a substantial literature indicating that social and emotional behaviours, such as internalizing, frequently exhibit variation across situational contexts [27]. One methodological approach to remedy this dilemma has been the use of multiple reporters to assess the target behaviour. However, while the intuitive benefits of a multiple reporter approach are easily grasped, the use of multiple reporters to assess social and emotional behaviours introduces its own unique set of problems. Assessments of target behaviour often differ across reporters [28], and research has yet to resolve the debate as to which individuals (e.g. parent, teacher, trained observers or child) are the most accurate reporters of child anxiety [29].

In a seminal, meta-analytic study, Achenbach and colleagues [28] investigated the consistency of multiple reporters of behavioural and emotional problems of children and adolescents. While they found fairly high correlations among similar reporters (e.g., parent pairs), the mean correlation among different reporters was low (e.g., parent/teacher). The investigators report that each class of reporter differentially contributes to the variance of target variables, arguing that target variables differ across contexts, rather than that certain types of reporters offer less valid or reliable reports. Yet others have suggested that parents are the most reliable reporters of externalizing behaviours and children the most reliable reporters of internalizing behaviours [27]. In young children, however, it has been hypothesized that children are more likely to share worries and concerns with their parents, resulting in parents as the most reliable reporter of internalizing symptoms [30]. Further exploration is warranted to determine the specific nature and contribution of the different reporters (e.g., parents, teachers, objective observers) on child internalizing behaviours.

The current study

The purpose of this study was two-fold. First, we aimed to examine if maternal report of anxiety during pregnancy differentially explains preschool-aged children’s internalizing behaviour over and above a mother’s trait anxiety. Second, using multi-reporter methodology, we aimed to examine if maternal anxiety during pregnancy would predict multiple reporters’ perceptions of child internalizing behaviour. It was hypothesized that after controlling for a mother’s current level of anxiety, maternal anxiety during pregnancy would significantly predict children’s internalizing behaviour as reported by the mother, teacher, and observer ratings (Figure 1).