High levels of maternal stress during pregnancy linked to children's behavior problems

"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 behaviors," said study author Irene Tung, PhD, of California State University Dominguez Hills. "These findings add to the evidence that providing widely accessible mental health care and support during pregnancy may be a critical step to help prevent childhood behavior problems."

Tung and her colleagues analyzed data from 55 studies with more than 45,000 total participants. All the studies measured women's psychological distress during pregnancy (including stress, depression or anxiety) and then later measured their children's "externalizing behaviors" -- mental health symptoms directed outward, such as attention deficit hyperactivity disorder or aggression.

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 behavior, as reported by parents or teachers.

The research was published in the journal Psychological Bulletin.

Research has long suggested a link between mothers' mental health during pregnancy and children's externalizing behaviors. However, many previous studies have not disentangled the effects of stress, anxiety or depression during pregnancy from the effects of parents' psychological distress after a child is born.

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 externalizing problems.

The effect held true regardless of whether the children were boys or girls. And it held true 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.

"Most existing research has focused on white, middle-class and higher educated samples. But experiences of racism, economic disparities and lack of health care access are known contributors to stress during pregnancy. Understanding how psychological distress during pregnancy impacts underrepresented families is key to developing equitable public health policies and interventions," she said.

She 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.