Pregnancy stress and its link to child behavioural problems

Stress, anxiety or depression are becoming increasingly prevalent across the world due to a multitude of factors. Though research has long suggested a link between mothers’ mental health during pregnancy and children’s externalising behaviours, many previous studies have not disentangled the impact of parents’ psychological distress. Research published by the American Psychological Association last week in the journal Psychological Bulletin, has reiterated that children of mothers experiencing high stress, anxiety, or depression during pregnancy may have a greater risk of mental health and behaviour issues throughout childhood and adolescence.
The study, analysing data from 55 studies with over 45,000 participants, links maternal distress during pregnancy to children’s externalising behaviours, such as attention deficit hyperactivity disorder (ADHD) symptoms and aggression. Importantly, this effect persists even when postnatal psychological distress is considered. Externalising behaviours - which include physical aggression, disobeying rules, cheating, stealing, and destruction of property - are common among children but can be experienced into adulthood. The latest findings emphasise the need for accessible mental health care and support during pregnancy to prevent childhood behaviour problems.
The study spanned various age groups, with the strongest effect observed in early childhood, but it persisted through middle childhood and adolescence. “Our research suggests that psychological distress during the pregnancy period has a small but persistent effect on children’s risk for aggressive, disinhibited and impulsive behaviours,” said study author Irene Tung, PhD, of California State University Dominguez Hills.
The findings are consistent with theories that suggest that exposure to stress hormones in utero can affect children’s brain development, according to the researchers. “These findings add to the evidence that providing widely accessible mental healthcare and support during pregnancy may be a critical step to help prevent childhood behaviour problems.” All the 55 studies measured women’s psychological distress during pregnancy (including stress, depression or anxiety) and then later measured their children’s externalising behaviours.
Overall, the researchers found that women who reported more anxiety, depression or stress while pregnant were more likely to have children with more ADHD symptoms or who exhibited more difficulties with aggressive or hostile behaviour, as reported by parents or teachers. In the current study, the researchers only included research in which mothers’ psychological distress was measured both during and after pregnancy. They found that even after controlling for later (postnatal) psychological distress, distress during pregnancy in particular increased children’s risk of developing externalising problems.
The effect held true regardless of whether the children were boys or girls and for children in early childhood (ages 2-5), middle childhood (6-12) and adolescence (13-18), though the effect was strongest in early childhood. The findings are consistent with theories that suggest that exposure to stress hormones in utero can affect children’s brain development, according to the researchers.
Future research should focus on increasing diversity to understand the cultural and socioeconomic variables that affect prenatal stress and to develop effective interventions, according to Tung. “Understanding how psychological distress during pregnancy impacts underrepresented families is key to developing equitable public health policies and interventions,” she said.
Tung and her colleagues are now conducting two studies focused on understanding the types of support and resources that promote resilience and recovery from stress during pregnancy, particularly for families facing health inequities. The goal is to help inform culturally inclusive preventive interventions during pregnancy to help support early mental health resilience and well-being for parents and their children.
Future research aims to address diversity and cultural factors in prenatal stress, enabling equitable public health policies and interventions.