The impact of intrauterine exposures on neurodevelopmental outcomes in 8–10 year old children within a disadvantaged population

Abstract

Introduction: Intrauterine exposures can have lasting impacts on offspring neurodevelopment. The aim of this thesis was to investigate the associations of antenatal depression and pregnancy complications on child cognitive and mental health at 8–10 years of age. Method: This is a follow-up study of the SCreening fOr Pregnancy Endpoints (SCOPE) cohort. During pregnancy, women completed a number of questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS) at 15 weeks’ and 20 weeks’ gestation, and pregnancy complications recorded. Women were contacted 8–10 years after delivery for assessment of their child’s neurodevelopment. Cognitive testing utilised five tests from the Cambridge Neuropsychological Test Automated Battery, focusing on executive function, memory and reaction time. Mothers completed the Depression, Anxiety and Stress Scale (DASS-42) to assess their own mental health, and the Spence Children’s Anxiety Scale (SCAS) and the Child Anxiety Life Interference Scale (CALIS) to assess their child’s anxiety. Children completed the SCAS and CALIS questionnaires along with the Center for Epidemiological Studies Depression scale for Children (CES-DC). Results: Data were available for 273 mother-child pairs. Thirty-eight mothers scored ≥13 on the EPDS and were classed as having high antenatal depression, with the remainder classed as having low antenatal depression. For children of the high antenatal depression group, both the parent and to a lesser extent the child report, demonstrated increased likelihood of anxiety symptoms and anxiety interference. Children in this group were also at increased risk of errors on learning memory and spatial working memory task, and longer motor movement times. There were no differences in any other reaction time measures, delayed memory measures, or executive functioning or in risk of child self-reported depression symptoms between the groups. Next, groups were assigned based on the presence of one of the five major complications of pregnancy; preeclampsia (PE; n=38), small for gestational age (SGA; n=34), preterm birth (PTB; n=26), gestational diabetes mellitus (GDM; n=22) and gestational hypertension (GH; n=20) and developmental outcomes compared with controls (n=166). Children born following PE and/or SGA were most vulnerable to cognitive deficits, with poorer performance on executive functioning and memory tasks. Children born following GDM had better learning memory performance compared to controls. Children born SGA or after GH had longer movement and reaction times, respectively. Children born after PE reported higher anxiety and anxiety interference. Children born SGA were at increased risk of reporting anxiety interference. Interestingly, children born preterm had decreased likelihood of self-reported anxiety symptoms, while children born after GDM were at decreased risk of anxiety interference, including anxiety interference outside the home. Exposure to pregnancy complications had no effect on child depressive symptoms. Conclusion: Maternal antenatal depression and pregnancy complications are associated with neurodevelopmental outcomes in 8–10-year-old children. This has lifelong implications, reducing future job opportunities and socioeconomic success. Similarly, poor mental health in childhood and adolescence is associated with increased risk of long-term mental health problems. Recognition of factors that contribute to deficits in cognition and mental health provides opportunities for early interventions to improve long-term health and social outcomes.