Maternal depression during pregnancy and children's physical development

Abstract

Prenatal maternal psychological distress, particularly depression, has been increasingly recognized as a factor that influences fetal growth; however, its impact on early childhood development remains less well understood. The present study investigated the association between prenatal depression and children's growth trajectories, as well as the odds of overweight and obesity from 1 to 36 months, while also accounting for maternal anxiety and stress. We analyzed data from 4710 mother-child dyads in the Jiangsu Birth Cohort, assessing maternal psychological distress across trimesters and categorizing participants into groups with mild, moderate, and severe depressive symptomatology. Children's weight-for-length z-scores (WLZ) were used to assess overweight/obesity prevalence, and growth patterns were identified through trajectory models. The results from the generalized estimating equations analysis showed that greater depressive symptomatology during pregnancy was associated with a 28% to 41% increase in the odds of childhood overweight/obesity across all three trimesters, compared with mild depressive symptomatology. We identified five distinct WLZ growth trajectory patterns, and found that mothers with greater depressive symptomatology were 39%-47% more likely to have children who followed a very-high-stable growth trajectory, compared with mothers with mild depressive symptomatology. These findings highlight the significant impact of prenatal depression on adverse growth patterns and childhood overweight/obesity, underscoring the need for early intervention.

Keywords

prenatal distress / children / overweight and obesity / cohort study

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 82373581 to Yuan Lin).

Acknowledgments

We are grateful to all the participants of the Jiangsu Birth Cohort and to everyone involved in the data collection process.

Additional information

The online version contains supplementary material available at http://www.jbr-pub.org.cn/article/doi/10.7555/JBR.39.20250164?pageType=en.

References

[1] Zhang X, Liu J, Ni Y, et al. Global prevalence of overweight and obesity in children and adolescents: A systematic review and meta-analysis[J]. JAMA Pediatr, 2024, 178(8): 800-813. doi: 10.1001/jamapediatrics.2024.1576

[2] Pan X, Wang L, Pan A. Epidemiology and determinants of obesity in China[J]. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392. doi: 10.1016/S2213-8587(21)00045-0

[3] Simmonds M, Llewellyn A, Owen CG, et al. Predicting adult obesity from childhood obesity: A systematic review and meta-analysis[J]. Obes Rev, 2016, 17(2): 95-107. doi: 10.1111/obr.12334

[4] Chung ST, Krenek A, Magge SN. Childhood obesity and cardiovascular disease risk[J]. Curr Atheroscler Rep, 2023, 25(7): 405-415. doi: 10.1007/s11883-023-01111-4

[5] Salama M, Balagopal B, Fennoy I, et al. Childhood obesity, diabetes, and cardiovascular disease risk[J]. J Clin Endocrinol Metab, 2023, 108(12): 3051-3066. doi: 10.1210/clinem/dgad361

[6] Howard LM, Molyneaux E, Dennis CL, et al. Non-psychotic mental disorders in the perinatal period[J]. Lancet, 2014, 384(9956): 1775-1788. doi: 10.1016/S0140-6736(14)61276-9

[7] Barker DJP. The origins of the developmental origins theory[J]. J Intern Med, 2007, 261(5): 412-417. doi: 10.1111/j.1365-2796.2007.01809.x

[8] Lamichhane N, Olsen NJ, Mortensen EL, et al. Associations between maternal stress during pregnancy and offspring obesity risk later in life—a systematic literature review[J]. Obes Rev, 2020, 21(2): e12951. doi: 10.1111/obr.12951

[9] Rogers A, Obst S, Teague SJ, et al. Association between maternal perinatal depression and anxiety and child and adolescent development: A meta-analysis[J]. JAMA Pediatr, 2020, 174(11): 1082-1092. doi: 10.1001/jamapediatrics.2020.2910

[10] Zhang L, Li P, Ge Q, et al. Maternal prenatal depressive symptoms and fetal growth during the critical rapid growth stage[J]. JAMA Netw Open, 2023, 6(12): e2346018. doi: 10.1001/jamanetworkopen.2023.46018

[11] Henrichs J, Schenk JJ, Roza SJ, et al. Maternal psychological distress and fetal growth trajectories: The Generation R Study[J]. Psychol Med, 2010, 40(4): 633-643. doi: 10.1017/S0033291709990894

[12] Liu G, Dancause KN, Elgbeili G, et al. Disaster-related prenatal maternal stress explains increasing amounts of variance in body composition through childhood and adolescence: Project Ice Storm[J]. Environ Res, 2016, 150: 1-7. doi: 10.1016/j.envres.2016.04.039

[13] Nawa N, Black MM, Araya R, et al. Pre- and post-natal maternal anxiety and early childhood weight gain[J]. J Affect Disord, 2019, 257: 136-142. doi: 10.1016/j.jad.2019.06.068

[14] Zhou J, Zhang S, Teng Y, et al. Maternal pregnancy-related anxiety and children's physical growth: The Ma'anshan birth cohort study[J]. BMC Pregnancy Childbirth, 2023, 23(1): 384. doi: 10.1186/s12884-023-05711-5

[15] Leppert B, Junge KM, Röder S, et al. Early maternal perceived stress and children's BMI: Longitudinal impact and influencing factors[J]. BMC Public Health, 2018, 18(1): 1211. doi: 10.1186/s12889-018-6110-5

[16] Song M. Trajectory analysis in obesity epidemiology: A promising life course approach[J]. Curr Opin Endocr Metab Res, 2019, 4: 37-41. doi: 10.1016/j.coemr.2018.08.002

[17] Du J, Lin Y, Xia Y, et al. Cohort profile: The Jiangsu Birth Cohort[J]. Int J Epidemiol, 2023, 52(6): e354-e363. doi: 10.1093/ije/dyad139

[18] Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress[J]. J Health Soc Behav, 1983, 24(4): 385-396. doi: 10.2307/2136404

[19] Zung WWK. A rating instrument for anxiety disorders[J]. Psychosomatics, 1971, 12(6): 371-379. doi: 10.1016/S0033-3182(71)71479-0

[20] Radloff LS. The CES-D scale: A self-report depression scale for research in the general population[J]. Appl Psychol Meas, 1977, 1(3): 385-401. doi: 10.1177/014662167700100306

[21] WHO Multicentre Growth Reference Study Group, de Onis M. WHO Child Growth Standards based on length/height, weight and age[J]. Acta Paediatr Suppl, 2006, 95(S450): 76-85. doi: 10.1111/j.1651-2227.2006.tb02378.x

[22] Lee JH, Herzog TA, Meade CD, et al. The use of GEE for analyzing longitudinal binomial data: a primer using data from a tobacco intervention[J]. Addict Behav, 2007, 32(1): 187-193. doi: 10.1016/j.addbeh.2006.03.030

[23] Roddy Mitchell A, Gordon H, Lindquist A, et al. Prevalence of perinatal depression in low- and middle-income countries: a systematic review and meta-analysis[J]. JAMA Psychiatry, 2023, 80(5): 425-431. doi: 10.1001/jamapsychiatry.2023.0069

[24] Eichler J, Schmidt R, Poulain T, et al. Maternal depressive symptoms and stress during pregnancy as predictors of gestational age at birth and standardized body mass index from birth up to 2 years of age[J]. BMC Pregnancy Childbirth, 2021, 21(1): 635. doi: 10.1186/s12884-021-04111-x

[25] Rudd KL, Zhao Q, Lisha NE, et al. The role of prenatal violence exposure in the development of disparities in children's adiposity from birth to middle childhood[J]. Obesity (Silver Spring), 2023, 31(8): 2119-2128. doi: 10.1002/oby.23794

[26] Bräuner EV, Lim YH, Koch T, et al. Sex-dependent associations between maternal prenatal stressful life events, BMI trajectories and obesity risk in offspring: The Raine Study[J]. Compr Psychoneuroendocrinol, 2021, 7: 100066. doi: 10.1016/j.cpnec.2021.100066

[27] Mueller BR, Bale TL. Impact of prenatal stress on long term body weight is dependent on timing and maternal sensitivity[J]. Physiol Behav, 2006, 88(4-5): 605-614. doi: 10.1016/j.physbeh.2006.05.019

[28] Gao Y, Luo J, Zhang Y, et al. Prenatal exposure to per- and polyfluoroalkyl substances and child growth trajectories in the first two years[J]. Environ Health Perspect, 2022, 130(3): 037006. doi: 10.1289/EHP9875

[29] Yang M, Chen Z, Cao Z, et al. Prenatal exposure to phthalates and child growth trajectories in the first 24 months of life[J]. Sci Total Environ, 2023, 898: 165518. doi: 10.1016/j.scitotenv.2023.165518

[30] Lobel M, Cannella DL, Graham JE, et al. Pregnancy-specific stress, prenatal health behaviors, and birth outcomes[J]. Health Psychol, 2008, 27(5): 604-615. doi: 10.1037/a0013242

[31] Gilles M, Otto H, Wolf IAC, et al. Maternal hypothalamus-pituitary-adrenal (HPA) system activity and stress during pregnancy: effects on gestational age and infant's anthropometric measures at birth[J]. Psychoneuroendocrinology, 2018, 94: 152-161. doi: 10.1016/j.psyneuen.2018.04.022

[32] de Weerth C, Buitelaar JK. Physiological stress reactivity in human pregnancy—a review[J]. Neurosci Biobehav Rev, 2005, 29(2): 295-312. doi: 10.1016/j.neubiorev.2004.10.005

[33] Weinstock M. The potential influence of maternal stress hormones on development and mental health of the offspring[J]. Brain Behav Immun, 2005, 19(4): 296-308. doi: 10.1016/j.bbi.2004.09.006

[34] Dieckmann L, Czamara D. Epigenetics of prenatal stress in humans: The current research landscape[J]. Clin Epigenetics, 2024, 16(1): 20. doi: 10.1186/s13148-024-01635-9

[35] Rahman A, Fisher J, Bower P, et al. Interventions for common perinatal mental disorders in women in low- and middle-income countries: A systematic review and meta-analysis[J]. Bull World Health Organ, 2013, 91(8): 593-601 I. doi: 10.2471/BLT.12.109819