University of Calgary PRISM: University of Calgary's Digital Repository Arts Arts Research & Publications 2019-05 A Developmental Cascade from Prenatal Stress to Child Internalizing and Externalizing Problems Hentges, Rochelle F.; Graham, Susan; Plamondon, André R.; Tough, Suzanne C.; Madigan, Sheri L. Oxford University Press on behalf of the Society for Pediatric Psychology : Journal of Pediatric Psychology Hentges, R. F., Graham, S. A., Plamondon, A. R., Tough, S. C., & Madigan, S. L. (2019). A Developmental Cascade from Prenatal Stress to Child Internalizing and Externalizing Problems. "Journal of Pediatric Psychology", 2019, 1-11. http://dx.doi.org/10.1093/jpepsy/jsz044 http://hdl.handle.net/1880/111910 journal article https://creativecommons.org/licenses/by/4.0 Unless otherwise indicated, this material is protected by copyright and has been made available with authorization from the copyright owner. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca Journal of Pediatric Psychology, 2019, 1–11 doi: 10.1093/jpepsy/jsz044 Original Research Article Downloaded from https://academic.oup.com/jpepsy/advance-article-abstract/doi/10.1093/jpepsy/jsz044/5511639 by University of Calgary user on 13 June 2019 A Developmental Cascade from Prenatal Stress to Child Internalizing and Externalizing Problems 1,2 1,2 Rochelle F. Hentges, PHD, Susan A. Graham, PHD, 3,4 2,5,6 Andre Plamondon, PHD, Suzanne Tough, PHD, and 1,2 Sheri Madigan PHD 1Department of Psychology, University of Calgary, 2Owerko Centre, Alberta Children’s Hospital Research Institute, 3Department des fondements et pratiques en education, Universite Laval, 4Applied Psychology and Human Development, University of Toronto, 5Department of Community Health Sciences, University of Calgary and, 6Department of Pediatrics, University of Calgary All correspondence concerning this article should be addressed to Rochelle Hentges, PhD, Owerko Centre, Third Floor—CDC Building, c/o 2500 University Dr. N.W., Calgary, Alberta T2N 1N4, Canada. E-mail: [email protected] Received October 31, 2018; revisions received May 7, 2019; accepted May 10, 2019 Abstract Objective: This study utilized a developmental cascade approach to test alternative theories about the underlying mechanisms behind the association of maternal prenatal stress and child psychopa- thology. The fetal programming hypothesis suggests that prenatal stress affects fetal structural and physiological systems responsible for individual differences in child temperament, which fur- ther increases risk for internalizing and externalizing problems. Interpersonal models of stress transmission suggest that maternal stress influences child mental health via early parenting behav- iors. We also examined a continuation of stress hypothesis, in which prenatal stress predicts child mental health via the continuation of maternal stress in the postpartum period. Methods: Participants were 1,992 mother–child pairs drawn from a prospective pregnancy cohort. Mothers reported on their perceived stress, anxiety, and depression during pregnancy and at 4-month post- partum. Birthweight was assessed via medical records of birthweight. At 4-month postpartum, hostile-reactive parenting behaviors were assessed. Child temperamental negative affect was mea- sured at age 3. Child internalizing and externalizing problems were assessed at age 5. Results: Prenatal stress was associated with both internalizing and externalizing problems via postnatal stress and child temperament. Prenatal stress was also associated with externalizing behaviors via increased hostile-reactive parenting. After accounting for postnatal factors, prenatal stress contin- ued to have a direct effect on child internalizing, but not externalizing, symptoms. Conclusion: Results provide support for the fetal programming, interpersonal stress transmission, and continu- ation of stress models. Findings highlight the need for prenatal preventative programs that continue into the early postnatal period, targeting maternal stress and parenting behaviors. Key words: developmental psychopathology; fetal programming; mental health; prenatal stress. Introduction role in promoting children’s health and well-being. A robust literature within developmental science sug- However, recent advancements in research have sug- gests that the early social environment plays a critical gested that the developmental origins of health and VC The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: [email protected] 1 2 Hentges, Graham, Plamondon, Tough, and Madigan disease (DOHaD) can be traced back to events that oc- development through its spillover onto early parent– cur even before birth (Gillman, 2005). For example, infant interactions and relations (Hammen, Shih, & when rodents are exposed to stressors (e.g., electric Brennan, 2004). For example, Hammen et al. (2004) shocks, forced swim tests) during pregnancy, their off- found that the association between maternal depres- spring exhibit maladjusted behaviors, including anxi- sion and child depression at age 15 years was entirely Downloaded from https://academic.oup.com/jpepsy/advance-article-abstract/doi/10.1093/jpepsy/jsz044/5511639 by University of Calgary user on 13 June 2019 ety and depressive behaviors, heightened emotional mediated by family and interpersonal stress effects and physiological stress reactivity, and aggression (e.g., parenting). However, much of this research has (Abe et al., 2007; Eaton, Edmonds, Henry, Snellgrove, been conducted with mothers experiencing postnatal & Sloman, 2015). These findings have been replicated depression or anxiety, thus it’s unclear whether the in observational research with humans. For example, same mechanisms underlie the link between prenatal maternal perceived stress, anxiety, and depression dur- stress and child mental health. To our knowledge, ing the prenatal period have been associated with in- only two studies have examined how prenatal stress creased risk of attention-deficit hyperactivity disorder and maternal mental health impact postnatal parent- (ADHD), depression, and behavior problems ing, with mixed results. Belsky, Ruttle, Boyce, (Madigan et al., 2018; Rodriguez & Bohlin, 2005), Armstrong, & Essex (2015) found that prenatal ma- with some indications that prenatal stress might even ternal stress, defined as a composite of depression, increase the risk for more severe psychotic disorders, marital conflict, and financial stress, did not predict such as schizophrenia (Van Os & Selten, 1998). negative parenting during infancy, whereas Lereya and Wolke (2013) found that prenatal anxiety and de- A Search for Intermediary Factors: Two Proposed pression predicted higher maternal hostile and puni- Models tive parenting during preschool. Parents who are A critical next step is to move beyond cataloguing unable to control their own negative emotional reac- these associations and toward identifying intermediary tions are further proposed to engender child problems mechanisms that explain why and how prenatal stress in regulating their own behaviors (i.e., externalizing influences later child mental health. In examining the problems) and emotions (i.e., internalizing problems; underlying mechanisms, researchers often cite the fetal Grusec & Davidov, 2010). programming hypothesis, which postulates that expo- A notable limitation of the current body of research sure to events or stressors during gestation (e.g., is that most studies tend to examine the association heightened maternal anxiety) “programmes persisting between prenatal stress on either neonatal physiology changes in a range of metabolic, physiological, and and health outcomes (e.g., birth weight), or child tem- structural parameters,” which impact fetal neural de- perament, or child mental health outcomes. velopment and regulatory capabilities (Barker, 1995, Accordingly, there is a significant lack of longitudinal p. 171; O’Donnell, O’Connor, & Glover, 2009). One research that examines how these complementary pro- such “structural parameter” is fetal growth and size. cesses unfold over time. Through a developmental cas- Accordingly, prenatal stress has been associated with cade approach, the primary aim of this article is to a higher risk of prematurity and low birthweight examine the potential downstream consequences of (Bussie`res et al., 2015; Grote et al., 2010). In addition, prenatal stress on child mental health through a longi- research has suggested that prenatal stress alters the tudinal series of proposed underlying mechanisms. An physiological structure of the growing fetus, thereby advantage of a developmental cascade model is that it increases the likelihood of infants and toddlers show- allows for the examination of how early predictors cu- ing greater temperamental negative emotional reactiv- mulatively influence a developmental outcome (e.g., ity (Davis et al., 2004; Madigan et al., 2018), defined child mental health) over time through multiple pro- as early emerging, biologically based individual differ- cesses and systems (Masten & Cicchetti, 2010). Not ences in negative affect, such as anger, fear, and sad- only is this a more holistic approach to examining