Maternal Depression During Pregnancy and the Postnatal Period Risks and Possible Mechanisms for Offspring Depression at Age 18 Years

Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, England.
JAMA Psychiatry (Impact Factor: 12.01). 10/2013; 70(12). DOI: 10.1001/jamapsychiatry.2013.2163
Source: PubMed


IMPORTANCE Some small studies suggest that maternal postnatal depression is a risk factor for offspring adolescent depression. However, to our knowledge, no large cohort studies have addressed this issue. Furthermore, only 1 small study has examined the association between antenatal depression and later offspring depression. Understanding these associations is important to inform prevention. OBJECTIVE To investigate the hypothesis that there are independent associations between antenatal and postnatal depression with offspring depression and that the risk pathways are different, such that the risk is moderated by disadvantage (low maternal education) with postnatal depression but not with antenatal depression. DESIGN, SETTING, AND PARTICIPANTS Prospective investigation of associations between symptoms of antenatal and postnatal parental depression with offspring depression at age 18 years in a UK community-based birth cohort (Avon Longitudinal Study of Parents and Children) with data from more than 4500 parents and their adolescent offspring. MAIN OUTCOMES AND MEASURES Diagnosis of offspring aged 18 years with major depression using the International Classification of Diseases, 10th Revision. RESULTS Antenatal depression was an independent risk factor. Offspring were 1.28 times (95% CI, 1.08-1.51; P = .003) more likely to have depression at age 18 years for each standard deviation increase in maternal depression score antenatally, independent of later maternal depression. Postnatal depression was also a risk factor for mothers with low education, with offspring 1.26 times (95% CI, 1.06-1.50; P = .01) more likely to have depression for each standard deviation increase in postnatal depression score. However, for more educated mothers, there was little association (odds ratio, 1.09; 95% CI, 0.88-1.36; P = .42). Analyses found that maternal education moderated the effects of postnatal but not antenatal depression. Paternal depression antenatally was not associated with offspring depression, while postnatally, paternal depression showed a similar pattern to maternal depression. CONCLUSIONS AND RELEVANCE The findings suggest that treating maternal depression antenatally could prevent offspring depression during adulthood and that prioritizing less advantaged mothers postnatally may be most effective.

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Available from: Daphne Kounali, Sep 04, 2014
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    • "Of importance, irritability symptoms are associated with child anxiety/depressive symptoms and conduct problems (Dougherty et al., 2013; Krieger et al., 2013; Stringaris & Goodman , 2009b) and at present, we cannot be certain whether the association between irritability symptoms and adolescent depressive symptoms is better accounted for by these other more well-established pathways of anxiety/depressive symptoms and conduct problems. With regard to early family risk factors, maternal depressive symptoms (pre-and postnatal) are robust and well researched risks for offspring depressive symptoms in adolescence (Pawlby, Hay, Sharp, Waters, & O'Keane, 2009; Pearson et al., 2013) and may act as a common antecedent of the three pathways outlined above (i.e. Irritability Symptoms; Anxiety/Depressive Symptoms; and Conduct Problems ; Cents et al., 2013; Leis, Heron, Stuart, & Mendelson, 2014; Mars et al., 2012). "
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    ABSTRACT: The authors tested three possible pathways linking prenatal maternal depressive symptoms to adolescent depressive symptoms. These pathways went through childhood Irritability Symptoms, Anxiety/Depressive Symptoms or Conduct Problems. Data were collected from 3,963 mother-child pairs participating in the Avon Longitudinal Study of Parents and Children. Measures include maternal depressive symptoms (pre- and postnatal); toddler temperament (2 years); childhood (7-13 years) irritability symptoms, anxiety/depressive symptoms, conduct problems, and adolescent depressive symptoms (16 years). Irritability Symptoms: This pathway linked sequentially - prenatal maternal depressive symptoms, toddler temperament (high perceived intensity and low perceived adaptability), childhood irritability symptoms, and adolescent depressive symptoms. Anxiety/Depressive symptoms: This pathway linked sequentially - prenatal maternal depressive symptoms, toddler temperament (negative perceived mood), childhood anxiety/depressive symptoms, and adolescent depressive symptoms. Childhood conduct problems were not associated with adolescent depressive symptoms, above and beyond irritability symptoms and anxiety/depressive symptoms. Results suggest evidence for two distinct developmental pathways to adolescent depressive symptoms that involve specific early and midchildhood features. © 2015 Association for Child and Adolescent Mental Health.
    Journal of Child Psychology and Psychiatry 02/2015; DOI:10.1111/jcpp.12395 · 6.46 Impact Factor
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    • "It is possible that it is not depressive symptomatology per se but other factors, including socioeconomic status (van Doesum et al., 2007) and personality pathology (Conroy et al., 2010) that may be more closely related to the depressed mother's capacity for sensitive behavior. The fact that prenatal depressive symptoms were associated with maternal sensitivity is consistent with a growing literature on the independent effects of prenatal depression, even controlling for subsequent depressive episodes, on the mother–infant relationship and long-term developmental outcomes (Field, 2011; Hayes et al., 2012; Pearson et al., 2013). Another limitation involves our measure of psychosocial stress, which includes both concurrent and past stressors. "
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    ABSTRACT: The hormone oxytocin (OT) is of particular interest in the study of childbearing women, as it has a role in the onset and course of labor and breastfeeding. Recent research has linked OT to maternal caregiving behavior towards her infant, and to postpartum depressive symptomatology. There is also evidence that psychosocial adversity affects the oxytocin system. The present study investigated the relationship of endogenous OT in women during pregnancy and at 8weeks postpartum to psychosocial stress, maternal symptoms of depression, and maternal sensitive behavior. It was hypothesized that OT would mediate the effects of maternal depressive symptoms on maternal interactive behavior. We also tested the hypothesis that psychosocial stress would moderate the relationship between OT and maternal depressive symptoms and sensitive behavior. A community sample of 287 women was assessed at 12-14 weeks gestation, 32-34 weeks gestation, and 7-9 weeks postpartum. We measured plasma OT, maternal symptoms of depression and psychosocial stress. At the postpartum home visit, maternal behavior in interaction with the infant was videotaped, and then coded to assess sensitivity. In the sample as a whole, OT was not related to maternal depressive symptoms or to sensitive maternal behavior. However, among women who reported high levels of psychosocial stress, higher levels of plasma OT were associated with fewer depressive symptoms and more sensitive maternal behavior. These results suggest that endogenous OT may act as a buffer against the deleterious effects of stress, thereby protecting high risk women from developing depressive symptoms and promoting more sensitive maternal interactive behavior.
    Hormones and Behavior 06/2014; 66(2). DOI:10.1016/j.yhbeh.2014.06.014 · 4.63 Impact Factor
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    • "Offspring who had been exposed both to maternal depression in utero and to childhood maltreatment were 3.2 times more likely than those exposed to neither, to have a diagnosis of a depressive disorder at 11 and/or 16 years. In contrast, children who were exposed only to maternal antenatal depression or to childhood maltreatment were no more at risk of having depression Pearson et al. (2013) 8,937 Maternal antenatal depression was measured at 18 and 32 weeks of pregnancy using the EPDS "
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    ABSTRACT: Exposure to adverse experiences in early life increases the risk of depression during adulthood. Recent findings have highlighted that exposure of a fetus to an adverse intrauterine environment may also have implications for later offspring depression. This review considers the status of the evidence for these associations and the potential mechanisms underlying prenatal developmental risks for later depression, addressing the challenging possibility that environmental predisposition to depression may begin before birth.
    Journal of Developmental Origins of Health and Disease 06/2014; 5(05):1-12. DOI:10.1017/S2040174414000324 · 0.75 Impact Factor
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