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The impact of maternal depression and prenatal antidepressant exposure on child development : consideration of internal and external contextual factors

University of British Columbia

One in five women experience a depressive episode during pregnancy, with up to one in ten being treated with antidepressants. Despite an overall adverse developmental effect related to exposure to maternal depression and antidepressants during pregnancy, not all children are equally affected. Moreover, critical yet unanswered questions remain regarding the potential developmental risks and benefits of antidepressant treatment during pregnancy. The purpose of this thesis was to study the association between maternal depression and prenatal antidepressant exposure and child developmental outcomes while considering the role of key contextual factors that may influence these associations. Depression severity, patterns of depressive symptoms over time, and underlying genetic risk were investigated for their role in influencing child outcomes. Small yet consistent associations were found between prenatal antidepressant exposure and vulnerability for anxiety and lower physical independence at kindergarten age, after stringently adjusting for confounding by maternal mental health. Genetic differences were found to underlay associations between prenatal maternal depression symptom levels and genome-wide differences in DNA methylation at age 18 years. Looking longitudinally, increasing maternal depression symptoms across the first three postpartum years were associated with worse child behavioral problems and executive functions at ages three and six years; a pattern of decreasing maternal depression symptoms over the same time period, despite initially higher depressive symptoms during pregnancy, was associated with no impairments. Collectively, the findings presented herein help explain the heterogeneity of child outcomes that are observed in relation to early developmental exposure to maternal depression and its treatment with antidepressants. This thesis highlights the impact of factors underlying and related to maternal mental health on children’s developmental outcomes, and suggest that investments made to improve maternal depression have the potential to benefit the health of both mothers and their children.

Text

2019-07-02

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/70857

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/