Background: Maternal mental health problems represent one of the most common complications of the prenatal and postnatal periods, with 13-25% of women experiencing stress, depression, or anxiety. As many as 50% of women with prenatal distress continue to experience symptoms into their child’s early years. Historically, the main focus has been limited to the impact of postpartum depression on maternal-child attachment. The purpose of this study was to determine the association between prenatal and postnatal maternal mental health and five domains of child development (cognitive, socio-emotional, behavioural, psychomotor, global) from birth to age 8.
Methods: This systematic review included cohort or case-control studies in which: 1) the exposure was any form of maternal mental health problem identified in pregnancy or to 1-year postpartum; 2) the outcome was a measure of global, behavioural, psychomotor, cognitive, or socio-emotional development in children from birth to age 8; 3) publication was between January, 1990 and July, 2013; 4) participants were recruited from developed countries. A university-based librarian constructed the search strategy to identify articles from CINAHL, Embase, ERIC, PsychInfo, and Medline. Reference lists of included articles were hand-searched, as well as relevant topical journals. Titles and abstracts of all articles were reviewed independently for inclusion by two reviewers. Quality appraisal was conducted by 2 independent reviewers using the Scottish Intercollegiate Guideline Network (SIGN) templates for cohort and case-control studies. Disagreements regarding inclusion or quality of articles were resolved by consensus. Data extraction was completed by 1 reviewer using a standardized abstraction form.
Results: 17932 articles were examined, with 66 being included. Significant associations were found between maternal mental health and the majority of developmental domains in infants (4/5), toddlers (5/5), and school-age children (4/5); among preschoolers, maternal mental health was associated with global and cognitive development. Prenatal maternal mental health was consistently negatively associated with most developmental domains in infants, toddlers, preschoolers, and school-age children, whereas postnatal maternal mental health was associated with half. We did not observe a trend in specificity with regard to the type of maternal mental health problem and child outcome.
Conclusions: The results support a paradigm shift from a historical focus on postpartum depression to a framework that considers a broader range of maternal mental health problems across the prenatal and postnatal periods. Next steps should involve investigating the effectiveness of early identification and treatment of maternal mental health problems during pregnancy on child outcomes.