Adverse Prenatal Factors May Lead to Psychiatric Concerns in Children

Prenatal care for a pregnant person is critical for the healthy development of the baby. But harmful exposures, some of which can happen before someone even knows they're expecting, can increase their child’s risk of cognitive brain development issues.

According to a recent study published in PLoS ONE, a child who had at least two of six adverse prenatal exposures is more likely to struggle with issues ranging from anxiety to attention difficulties.

The Study

Researchers at Massachusetts General Hospital studied 7,898 non-adopted, unrelated children ages 9 to 10 years old. They also examined an additional 696 sibling pairs. The children came from 21 communities across the United States. Surveys from the Adolescent Brain and Cognitive Development (ABCD) Study were used to examine adverse prenatal exposures.

The results were scored on the Child Behavior Checklist (CBCL), which is designed to detect emotional and behavioral problems in youth. Six primary exposures were pinpointed: unplanned pregnancy; maternal alcohol, tobacco, or marijuana use very early in pregnancy; pregnancy complications; and birth complications.

“Prenatal events can have a lifelong impact on a baby’s health, including brain health. Stressful events, exposure to toxins, or lack of prenatal care can lead to complications and health risks for a baby after being born,” explains Amy Morin, psychotherapist, and editor-in-chief of Verywell Mind.

When a child had more than one of these adverse prenatal exposures, the results were notable.

“None of the individual factors alone made a significant difference. However, with two potential exposures the odds of showing changes in psychopathology was present. These difficulties in behavior were linear with each added exposure that was measured. This could reach up to a three-and-a-half times increase in symptoms,” states Dr. Thomas G. Burns, PsyD, ABPP, Practice Director for the Neuropsychology Program at Children’s Healthcare of Atlanta. 

Dr. Burns also noted that some factors, such as unplanned pregnancy, are common. “The factors that we would worry more about are the ones with chronic use,” such as drugs and alcohol.

Strengths and Weaknesses

The results of the study put more information about healthcare in the hands of pregnant women and their doctors. That can have a far-reaching positive impact.

“This study can help people understand that prenatal care goes beyond taking vitamins,” says Morin. “Maternal stress affects a baby’s genes and development. When a mother has a lot of stress hormones in her body, it leaves an imprint on the fetus—or even causes things to develop differently."

While the findings are notable, the study places a lot of emphasis on factors predating the child’s birth, which could be a point of contention.

“A weakness of this study is that people will complain that other things have happened to those kids in the 8 or 9 years since they were born. A kid may have had a traumatic event, and (now) has behavioral problems. It may have nothing to do with the smoking or the alcohol they were exposed to,” Dr. Burns notes.

In spite of this potential weakness, the study was able to use other sampling methods to bolster its findings.

“What I thought was creative is they took the siblings of all these kids and compared it to a sibling group, so that they would have had kids in a similar environment. And the kids that were exposed to those factors still had more psychological issues than the kids that weren’t. I think that was pretty strong. I think it was a good study for that reason,” explains Dr. Burns.

Offering Hope

If there is a question about exposure a child may have experienced, it’s good to know what to look for.

“Being aware of a child’s history and development are extremely important as we have demonstrated that early intervention can be very helpful in mitigating any early issues,” Dr. Burns notes. 

“It is very important for mothers and fathers to recognize the impact that various events or exposure can have on a child. While many children may be resilient to one exposure, as the various exposures increase, the behavioral issues will also be more likely to surface,” he advises.

Morin echoes this sentiment. “It’s also important to talk about addressing stressful events. Anything from unplanned pregnancy to stress over income can affect a baby’s future.”

Educating pregnant mothers about their physical and emotional health, as well as the health of their baby, is a pivotal step in placing a child on a successful, healthy path.