What are the neurodevelopmental risks of infants with mothers who have postpartum depression (PPD)?

From the Guidelines

Infants of mothers with postpartum depression are at risk of neurodevelopmental problems, but the risk is largely attributed to the mother's depressive disorder itself rather than antidepressant exposure during pregnancy. The current evidence suggests that intrauterine antidepressant exposure does not substantially increase the risk for concerning neurodevelopmental problems such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) 1. However, children born to women with depressive disorders are exposed to several other risk factors, including disrupted mother-infant interactions, which can lead to delayed cognitive development, language acquisition difficulties, behavioral problems, and emotional regulation challenges.

Key Considerations

• The research to date provides reassurance that antidepressant use during pregnancy does not substantially increase the risk for neurodevelopmental problems 1.
• The risk of neurodevelopmental problems is largely attributed to the mother's depressive disorder itself, rather than antidepressant exposure during pregnancy 1.
• Disrupted mother-infant interactions, reduced sensitivity, responsiveness, and positive engagement with the baby can lead to reduced quality and frequency of stimulating interactions crucial for healthy brain development.
• Early intervention, including maternal mental health treatment, enhancing mother-infant interactions, and providing additional supportive care for the infant, is critical to mitigate these developmental risks.

Recommendations for Clinical Practice

• Routine screening for depression in pregnant women using validated self-report screening measures, such as the Patient Health Questionnaire, the Hospital Anxiety and Depression Scale, and the Edinburgh Postnatal Depression Scale, is recommended 1.
• A stepped approach to treatment of depression during pregnancy, including monitoring, exercise, social support, and evidence-based treatment, such as cognitive therapy and antidepressants, should be considered 1.
• Women with a history of severe suicide attempts or severe depression who have previously experienced symptom reduction with antidepressant treatment may respond better to antidepressants than psychotherapy 1.

From the Research

Neurodevelopmental Risks of Infants with Mothers who have Postpartum Depression (PPD)

• Infants of mothers with PPD are at risk for various developmental, psychosocial, and physical challenges 2.
• PPD can affect maternal and child health across the life course and predispose future generations to a myriad of challenges 2.
• Maternal postpartum depression is associated with an increased risk for developing depressive symptoms in women, which can impair mother-infant interactions and affect child development 3.
• Depressed mothers often display less attachment, sensitivity, and more harsh or disrupted parenting behaviors, which may contribute to reports of adverse child outcomes in children of depressed mothers 3.
• Perinatal depression is associated with increased risk for wide-ranging adverse child development effects that can affect infant and early childhood mental health 4.

Risk Factors for PPD

• Depression during current and previous pregnancy, and problems with current delivery are strong predicting risk factors for PPD 5.
• Length of stay in the neonatal intensive care unit (NICU) is also a risk factor, with the odds of PPD risks increasing initially, then leveling off, and then decreasing after 31 days 5.
• Racial and ethnic minorities, immigrant and refugee populations, and mothers in rural locations are also at higher risk for PPD 2.

Interventions and Management Strategies

• Early identification and treatment of perinatal depression are critical to ensure optimal infant development and the child's future mental health 4.
• Interventions focused on the mother-infant relationship and dyadic interaction may be required to address the potential effect of maternal depression on the child 4.
• Trauma-informed care is suggested at individual and organizational levels, leading to better care for those with and without previous trauma exposure 2.
• Increasing PPD symptom awareness, screening for PPD, and connections with resources should begin during prenatal visits 2.