July 30, 2007

Anxiety, Depression and Stress During Pregnancy Results in Sensitive Children, Mental Health Problems


A new research study out of the University of Rochester Medical School indicates that a mother's mental stress during pregnancy (caused by depression and anxiety) results in a greater risk that infants and toddlers will not sleep well during the first few years of life, and also results in increased risk of behavioral and mental health problems in these children. The study results were published this month in the academic journal called Early Human Development.

These results confirm earlier related research we've reported on that have linked stress during pregnancy with increased risk of mental health and behavioral problems, as well as lower birth weights, and higher risk of anxiety and depression and emotional regulation problems in the child as a baby and later in life. Pregnancy stresses have also been linked to increased risk of schizophrenia.

Additionally, researchers we've talked to say that this is a good example of how nature and nurture can interact in predisposing individuals and families to mental illness. A child born to a mother who already suffers from depression or anxiety may pass her stress on to the child which can have significant short and long terms implications. In the short term the exposure to stress during pregnancy can result in a child who seems more sensitive to its environment, who has more difficulty sleeping and cries more, than a child of a less-stressed mother. This "fussy" baby could further increases the stress experienced by the parents and put them in a negative mindset when trying to help the child, because they are sleep deprived and even more stressed. This makes the parents less able to provide the care and nurturing that research shows results in the most mentally healthy child in the long term. This type of scenario demonstrates how mental illness can impact families across multiple generations, but at the same time its not anyone's "fault"; this is, after all, new research that nobody could have know about previously, and the parents are likely trying hard to do the best they can given the situation. This type of research does, however, also highlight the importance of the mental health of the parents prior to pregnancy and the necessity for treatment of any anxiety or depression via self-help by good books or software, or via professional psychologists or psychiatrists, prior to pregnancy. There are many effective treatments today for anxiety, depression and stress - so there is no need for people to go untreated.

While this new research study finding presents itself as important news to tired new moms and dads – for whom a soundly sleeping child spells out well-deserved respite – it may carry even more value for babies. For them, sleep ranks as one of the most highly regarded indexes of healthy development, and plays a critical role in consolidating memory and facilitating learning, regulating metabolism and appetite, promoting good moods and sustaining both cardiovascular health and a vigorous immune function.

"We’ve long known that child’s sleep is vital to his or her growth, but the origins of problems affecting it remained unclear. Now, we have evidence that these patterns may be set early on, perhaps even before birth,” said lead author Thomas O’Connor, Ph.D., associate professor of Psychiatry at the University of Rochester Medical Center. "This is another piece in the unfolding mystery of just how much the prenatal environment may shape a child’s health and development for years to come."

The survey-based study, part of the Avon Longitudinal Study of Parents and Children (ALSPAC), assessed pregnant women living in Avon, England, who were due to give birth in a 21-month window. More than 14,000 women – an estimated 85 to 90 percent of those eligible – responded to questionnaires that gauged how depressed or anxious they were at multiple points early on in, late in, and after their pregnancy. Later on, the women were then asked to report on their child’s sleep habits at 6, 18 and 30 months, detailing how long the child slept (a consolidated daytime and nighttime total), how often the child awoke, and if he or she exhibited any of seven common forms of sleep problems, such as having nightmares, refusing to go to bed or having trouble falling asleep.

Surprisingly, babies born to mothers classified as anxious or depressed while pregnant dozed just as long as their unstressed-pregnancy counterparts – about 12 hours.

However, this sleep was less sweet; children born to mothers who were depressed or anxious during pregnancy experienced more sleep problems. For instance, mothers classified as clinically anxious 18 weeks into pregnancy, compared to their non-anxious counterparts, were about 40 percent more likely to have an 18-month-old who refused to go to bed, woke early, and kept crawling out of bed. The child’s rocky relationship with sleep often persisted until he or she was 30 months old.

A similar effect was found in children born to mothers who were depressed during pregnancy.

These prenatal mood disturbances worked as reliable predictors of children’s sleep problems even when investigators controlled data for other factors already linked with poor sleep quality in children, including a mother’s level of postnatal anxiety or depression, her smoking habit, or her social class.

“This problematic sleep is notable; it may be part of the reason why mood-disturbed pregnancies are linked to children’s behavioral disorders, like depression, hyperactivity and anxiety, later on down the road,” O’Connor said. “It remains to be seen if the sleep problems we witnessed may play an active, causal role in priming the path for these children’s emotional and cognitive problems in later life, or if both conditions merely fall out of the same stressful pregnancies.”

Related studies now show that stress, which is associated with increased exposure stress hormones, like cortisol, may disrupt a child’s formation of a bundle of nerve cells in the brain – called the suprachiasmatic nucleus – which act as a signaling system that tune’s body’s internal clock. This signaling system helps to properly regulate daily rhythms of waking, sleeping, even hunger – that is, if its formation has not been disrupted.

This could explain why sound sleep doesn’t come easily to kids whose signaling systems may not be properly calibrated, O’Connor said. However, more research is needed to monitor this signaling pathway more closely, watching for biological hints as to why sleep and behavioral disturbances so often crop up together.

In the meantime, pregnant women concerned about how their own mood-disturbance may harm their unborn baby’s sleeping habits, development and emotional health may want to consider psychological treatment, O’Connor said. Several evidence-based therapies exist, and unlike medication, none of them are suspect in the least for causing adverse effects to baby.

“Given prenatally, psychological interventions could instill a whole host of benefits that may carry-over to the child,” O’Connor said.

The ALSPAC study, part of the WHO-initiated European Longitudinal Study of Pregnancy and Childhood, is funded by the Wellcome Trust, the National Institutes of Health and the United Kingdom’s Department of Health, Department of the Environment, and Medical Research Council.

Science Journal Summary: Prenatal mood disturbance predicts sleep problems in infancy and toddlerhood

Related Reading:
Stress and Pregnancy - The Importance of Low Stress in Brain Development and Mental Illness Prevention

How to Lower Stress, Anxiety, Worry and Depression Before Pregnancy

The Long-term Impact of Stress During Childhood on Brain Development


I did an informal poll of mothers - did they feel stressed, anxious or depressed during pregnancy.

Mostly they laughed - to live, to breathe, to work, take care of a family, go shopping, clean house... or even to be bored with nothing to do - all causes some stress and anxiety. But they didn't feel any abnormal stresses or anxiety. They all have a good life, good family, cushy jobs and were very happy to be pregnant. They were... "content". But depressed? No - actually none were depressed.

Then I looked at how many of us had children who had poor sleep or other problems as babies. Just two. I found it interesting that in both cases the mothers did get sick while they were pregnant. Hmm... A stressor? Maybe - but not a "mental" one.

Then we looked at how many of the kids had an LD, autistic-spectrum, ADHD, etc... Wow - a big jump there to barely a family left unscathed without at least 1 in 3 kids affected.

Then... what about growing up to have a "mental" problem? A few. Scattered. To mothers who had been sick, others who had not been. Mothers who had other kids without problems, Mothers who worked outside the home, mothers who had not...

All wanted to be mothers. All had been happy. None had depression or any stress or anxiety other that what everyone else living has (some, because of their wealth probably had a lot less than most others).

I am not going anywhere with this. Just sharing some observations.

Observations about the multitude of mothers who are mentally healthy with loved babies who end up with children who are mentally healthy as well, but get illnesses affecting their brain anyway.


Posted by: Naomi at August 1, 2007 07:47 AM

I'm concerned for my daughter-in-law. She is pregnant with their second child and is still nursing the 2+ yr old who has not even started potty training. Schizophrenia runs in her mother's side of the family. Her maternal grandfather was severly schizophrenic and is her only maternal uncle. She does not let the 2 yr old out of her sight to play with other children. The child spends almost all of her time inside at home. My daughter-in-law is frequently vomiting and says she cannot eat anything because it doesn't agree with her but she asked me to get her a cheeseburger from McDonalds and canned refried beans and Mexican shredded cheese (which did not make her sick). She became irrational when I took time off work to spare her some rest time and took the 2yr old with me and my daughter to a mall to play and to just walk around because it was too hot to go to the zoo. The daughter-in-law felt she had "lost control" of her child because I didn't make these plans well in advance. I didn't make the plans ahead of time because we didn't know what the weather would be. She even called my son who was on a business trip on the East coast to tell him how upset she was. He called me long distance and was very unhappy with the whole situation. Am I right to be concerned for my daughter-in-law and the 2yr old as well as for my son?

Posted by: Diane at August 1, 2007 12:36 PM

I feel like all this research just seems so obvious. But I am disappointed when every article I read places so much emphasis on the mother alone being responsible for her emotional well being. She should have a network of loving and respectful people (for example THE FATHER) surrounding her to eliminate any and all stress from her pregnancy.

Posted by: marissposa at February 10, 2008 02:15 AM

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