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Abstract

Background Prenatal depression affects 9-22% of pregnancies and has been associated with altered fetal development and adverse pregnancy and labour outcomes, and preconception mental health may reveal important differences in the type of fetal exposure to depression (i.e. chronic continuous depression may differ from incidental depression). This thesis used population-based data to examine associations between prenatal depression and preconception mental health and developmental vulnerability (falling in the bottom 10% of children) measured by the Early Development Instrument (EDI). Methods First, we examined all live births in British Columbia, Canada between January 01, 2001, and December 31, 2012 with valid follow-up data on the Early Development Instrument until December 31, 2018. Logistic regression models were used to estimate unadjusted and adjusted odds ratios of developmental vulnerability for all EDI subscales among those with and without diagnostic codes for depression during pregnancy, and conditional logistic regression models were run within the same birth parent. The second aim restricted to people diagnosed with depression during pregnancy and used depression and anxiety (DEP-ANX) diagnostic codes from 3 years preconception to date of conception to build three exposure groups: 1) No history of depression (incidental depression during the pregnancy), 2) Episodic (depression in some but not all periods pre-conception), and 3) Chronic (depression across multiple preconception periods). Logistic regression models were run to examine the associations between these three exposure groups and developmental vulnerability. Results Prenatal depression was significantly associated with increased odds for developmental vulnerability on physical health and well-being, social competence, language and cognitive development, and emotional maturity domains. No significant associations were found in our matched sibling pairs analysis. Children born to a pregnant person with chronic prenatal DEP-ANX preconception were at higher risk for developmental vulnerability particularly on the social competence, emotional maturity, and physical health and well-being domains compared to children born to a pregnant person with incident depression during pregnancy. Conclusion Fetal exposure to prenatal depression may influence physical health and well-being, language and cognition, and socio-emotional development in ways that predispose to childhood developmental vulnerability on these domains, and preconception mental health may play a role.