Maternal depression during early pregnancy associated with impaired child executive functioning at 4 to 5 years of age: AJOG
Maternal depression is a serious condition that affects up
to 1 in 7 pregnancies. Despite evidence linking maternal depression to
pregnancy complications and adverse fetal outcomes, there remain large gaps in
its identification and treatment. More work is needed to define the specific
timing and severity of depression that most urgently requires intervention,
where feasible, to protect maternal health and the developing fetus.
A study by Levitan RD et al aimed to examine whether the
timing and severity of maternal depression and/or anxiety during pregnancy
affect child executive functioning at age 4.5 years. Executive functioning in
the preschool years is a strong predictor of both school readiness and longterm
quality of life.
This longitudinal observational pregnancy cohort study
included a sample of 323 mother-child dyads taking part in the Ontario Birth
Study, an open pregnancy cohort in Toronto, Ontario, Canada. Maternal symptoms
of depression and anxiety were assessed at 12 to 16 and 28 to 32 weeks of
gestation and at the time of child testing at age 4.5 years using the 4-item
Patient Health Questionnaire. Child executive functioning was measured during a
home visit using standardized computerized administration of the Flanker test
(a measure of attention) and the Dimensional Change Card Sort (a measure of
cognitive flexibility). Posthoc general linear models were used to assess
whether maternal depression severity categories (no symptom, mild symptoms, or
probable major depressive disorder) were helpful in identifying children at
risk.
Across all children, after controlling for potential
confounds, greater maternal depressive symptoms at weeks 12 to 16 weeks of
gestation predicted worse performance on both the Flanker test (DR2 ¼0.058; P<
.001) and the Dimensional Change Card Sort (P=.018). Posthoc general linear
modeling further demonstrated that the children of mothers meeting the
screening criteria for major depression in early pregnancy scored 11.3% lower
on the Flanker test and 9.8% lower on the Dimensional Change Card Sort than the
children of mothers without maternal depressive symptoms in early pregnancy.
Mild depressive symptoms had no significant effect on executive function
scores. There was no significant effect of anxiety symptoms or maternal
antidepressant use in early pregnancy or pandemic conditions or maternal
symptoms in later pregnancy or at the time of child testing on either the
Flanker or Dimensional Change Card Sort results.
This study demonstrated that fetal exposure to maternal
major depression, but not milder forms of depression, at 12 to 16 weeks of
gestation is associated with impaired executive functioning in the preschool
years.
The current findings suggest that maternal major depression
during early pregnancy may have a particularly deleterious effect on the fetal
brain circuitry necessary for child executive functioning. This emphasizes an
urgent need to improve the recognition and treatment of major depression,
particularly in early pregnancy, to limit its negative effects on child
cognitive development. Possible treatments include both antidepressant
medications and cognitive behavior therapy, which now has proven efficacy for
antenatal depression per se.
This study demonstrated that fetal exposure to maternal
major depression, but not milder forms of depression, at 12 to 16 weeks of
gestation is associated with impaired executive functioning in the preschool
years. Child executive functioning is crucial for school readiness and predicts
long-term quality of life. This emphasizes an urgent need to improve the
recognition and treatment of maternal major depression, particularly in early
pregnancy, to limit its negative effects on the patient and on child cognitive
development.
