Positive maternal mental health during pregnancy associated with specific forms of adaptive development in early childhood

摘要

Background: The quality of prenatal maternal mental health, from psychological stress, depressive symptoms, to anxiety and other non-psychotic mental disorders profoundly affects fetal neu-rodevelopment. Despite the compelling evidence for the broad influence of maternal emotional well-being, the existing literature focuses almost exclusively on the effects of stress or symptoms of depression or anxiety, and does therefore not capture the full range of mental well-being. Health is a continuum that is not defined by merely an absence of illness or disability. Positive mental health has been shown to be a distinct construct from absence of symptoms of mental illnesses which predicts future mental and physical health. Despite the evidence for the influence of positive mental well-being on health there is, to our knowledge, no research examining the possible effects of positive antenatal mental health on the development of the offspring. While large-scale birth-cohort studies emphasize the importance of maternal mental health problems, measures of positive mental health in the study design are rarely considered. While such measures are used to screen for symptoms of mental disorders, it may nevertheless be possible to detect aspects of positive mental health through latent variable modelling. Methods: This study was part of a prospective birth cohort study, Growing Up in Singapore Towards Healthy Outcomes (GUSTO). The sample (n = 1066) included women who conceived naturally, did not have any medical conditions before or during pregnancy, and gave birth to full-term babies with normal birth weight. Three mental health measures (i.e., Beck Depression Inventory II [BDI-II], State-Trait Anxiety Inventory [STAI] & Edinburgh Postnatal Depression Scale [EPDS]) were administered during 26-week pregnancy during the participants' clinic visit. The responses to the measures' items were used in bifactor latent modelling. Mothers rated their child on the Infant Toddler Socio-Emotional Assessment (ITESA) questionnaire at 12-months-old and the Quantitative Checklist for Autism in Toddlers (QChat) at 18-months-old. At 24-month, and the Bayley Scales of Infant and Toddler Development third edition (Bayley) was used to assess the child's development in the domains of cognition, language, motor skills, socio-emotional behaviors and adaptability. Results: A seven-factor bi-factor model best fitted the data. This included a general factor and six sub-factors. Two of the sub-factors were related to positive mental health — Positive Mood (FD = 0.94; ωH = .51; H = 0.87) and Positive Self (FD = 0.89; ωH = .43; H=0.65). The reliability indices suggest that positive mental health construct can be reliably extracted from screening tools for depression and anxiety. A heatmap illustrates the significant association of positive antenatal mental health with some behaviors in children, specifically those associated with sociability, communication and parentally-rated competence. Conclusion: In conclusion, this study demonstrates the feasibility of using common psychiatric disorders screening tools to examine the effect of positive mental health. Moreover, the effects of positive mental health are likely to be specific and different from the lack of mental disorders. A deeper understanding of positive mental health will allow for more comprehensive understanding of fetal and child development.