Prenatal Parental Stress Linked to Behaviour Problems in Toddlers

Expectant parents' emotional struggles predict emotional and behavioral problems in 2-year-olds, new research shows. The same study reveals, for the first time, that couple conflict helps explain emotional problems in very young children.

The team of researchers - from the Universities of Cambridge, Birmingham, New York, and Leiden - say their findings highlight a pressing need for greater support for couples before, during and after pregnancy to improve outcomes for children. The study is the first to examine the influence of both mothers' and fathers' wellbeing before and after birth on children's adjustment at 14 and 24 months of age.

Lead author, Professor Claire Hughes from Cambridge's Centre for Family Research, said: "For too long, the experiences of first-time dads have either been sidelined or treated in isolation from that of mums. This needs to change because difficulties in children's early relationships with both mothers and fathers can have long-term effects.

"We have already shared our findings with the NCT (National Childbirth Trust) and we encourage the NHS and other organizations to reconsider the support they offer."

The study, published today in Development & Psychopathology, drew on the experiences of 438 first-time expectant mothers and fathers who were followed up at 4, 14 and 24 months after birth. These parents were recruited in the East of England, New York State and the Netherlands.

The researchers found that the prenatal wellbeing of first-time mothers had a direct impact on the behavior of their children by the time they were two years old. Mothers who suffered from stress and anxiety in the prenatal period were more likely to see their child display behavioral problems such as temper tantrums, restlessness, and spitefulness.

The researchers also found that two-year-olds were more likely to exhibit emotional problems - including being worried, unhappy and tearful; scaring easily, or being clingy in new situations - if their parents had been having early postnatal relationship problems. These ranged from a general lack of happiness in the relationship to rows and other kinds of conflict.

Hughes says: "Our findings highlight the need for earlier and more effective support for couples to prepare them better for the transition to parenthood."

Links between child outcomes and parental wellbeing have been shown in other studies, but this is the first to involve couples, track parental wellbeing in both parents over an extended period of time, and focus on child behavior in the first two years of life. While there is growing evidence for the importance of mental health support for expectant and new mothers, this study highlights the need to extend this support to expectant fathers and to go beyond individual well-being to consider the quality of new mothers' and fathers' couple relationships.

The researchers acknowledge that genetic factors are likely to play a role but they accounted for parents' mental health difficulties prior to their first pregnancy and after their child's birth. Co-author Dr. Rory Devine, a developmental psychologist at the University of Birmingham, says "Our data demonstrate that mental health problems during pregnancy have a unique impact on children's behavior problems."

Using standardized questionnaires and in-person interviews, participating mothers and fathers reported on their symptoms of anxiety and depression in the third trimester of pregnancy and when their child was 4, 14 and 24 months old. At each of these visits, parents also completed standardized questionnaire measures of couple relationship quality and children's emotions and behavior.

Hughes says: "There has been an assumption that it's really difficult to get dads involved in research like this. But our study draws on a relatively large sample and is unique because both parents answered the same questions at every stage, which enabled us to make direct comparisons."

The research is part of an ongoing project examining the wellbeing and influence of new mothers and fathers. In a closely linked study, published in Archives of Women's Mental Health in July 2019, the team found that fathers share in traumatic memories of birth with their partners far more than has previously been recognized. This study compared the wellbeing of parents in the third trimester of pregnancy with that when their child was four months old.

Co-author, Dr. Sarah Foley, also from Cambridge's Centre for Family Research said: "If mum has a difficult birth, that can be a potentially traumatic experience for dads".

"What both studies show is that we need to make antenatal support much more inclusive and give first-time mums and dads the tools they need to communicate with each other and better prepare them for this major transition. With resources stretched, parents are missing out on the support they need."