217 - Associations between Adverse Parental Mental Health and Infant Temperament

Publication Number: 3209.217

Kennedi Williams, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Ivy Gleason, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Mary Akel, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jiafeng Li, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Madeline Meirhaeghe, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Samantha P.. Gottlieb, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Estefania Espinosa, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Elizabeth S.. Norton, Northwestern University, Evanston, IL, United States; Lauren S.. Wakschlag, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Stephanie A.. Fisher, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Leena B. Mithal, Ann and Robert H. Lurie Children's Hospital of Chicago / Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Tonia Branche, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Adverse parental mental health has been linked to greater infant irritability and low positive affect. However, prior findings, derived from patient populations with limited diversity, are inconsistent in the early infancy period when behavioral regulation rapidly emerges.

Objective: To evaluate the association of prenatal and postpartum mental health in the birthing parent and infant temperament.

Design/Methods: The Chicago Perinatal Origins of Disease (CPOD) cohort is an observational study of pregnant people and their infants. Exposures were self-reported anxiety and depressive symptoms in the birthing parent, assessed by the Generalized Anxiety Disorder-7 (GAD-7; no-to-minimal, < 5 vs. mild or greater, ≥5) and Patient Health Questionnaire-9 (PHQ-9; no-to-minimal, < 5 vs. mild or greater ≥5) at 8-28 (V1) and 26-38 (V3) weeks’ gestational age, and 4-8 weeks postpartum (V5). Antenatal anxiety and depression diagnoses were abstracted from medical records. The primary outcome was infant irritability, assessed by the Multidimensional Assessment Profile-Temper Loss Scale (MAPS-TL) at 4-8 weeks and 4-6 months (after the typical period for colic). Linear regression models evaluated the association between parental mental health and infant temperament, adjusted for parental age, household income, infant sex, and parity.

Results: Of 133 eligible participants, 17% and 28% self-identified as Black or Hispanic, respectively, and had a median (IQR) age of 32 years (29.0, 35.0) at enrollment (Table 1). Mild or greater (vs. no-to-minimal) parental anxiety symptoms at V1, V3, and V5 were associated with higher infant MAPS-TL scores at 4-8 weeks (p < 0.001, Table 2), as were elevated depressive symptoms at all timepoints (p≤0.002). Greater anxiety and/or depressive symptoms at V1 (p < 0.001) and V5 (p < 0.05), and greater prenatal depressive symptoms at V3 (p=0.008), were associated with higher infant MAPS-TL scores at 4-6 months of life (Table 3). An antenatal medical diagnosis of anxiety was associated with infant irritability at 4-8 weeks (p=0.04) and 4-6 months (p=0.004). An antenatal diagnosis of depression was associated with irritability at 4-6 months (p=0.04).

Conclusion(s): In the racially and socioeconomically diverse CPOD cohort, prenatal and postpartum anxiety/depressive symptoms and/or diagnoses are associated with greater irritability across early infancy, notably beyond the typical period of fussiness and colic. Our findings highlight the importance of birthing parent mental health for infant behavioral regulation, though whether these associations persist in childhood requires further study.

Table 1. Cohort characteristics
PAS 2026_Maternal MH & Infant Temperament_Table 1.pdfContinuous variables are presented as median (IQR), and categorical variables as frequency (%).

Table 2: Association of prenatal and postnatal anxiety or depressive symptoms and antenatal anxiety or depression diagnoses with infant irritability (MAPS-TL) at 4-8 weeks of postnatal life
PAS 2026_Maternal MH & Infant Temperament_Table 2.pdfAbbreviations: Generalized Anxiety Disorder-7 (GAD7), Patient Health Questionnaire-9 (PHQ9), Multidimensional Assessment Profile Temper Loss Scale (MAPS-TL, assessed as a continuous measure), Confidence interval (CI)

1. Anxiety symptoms, assessed by the GAD-7, were categorized as no-to-minimal (score < 5) versus mild-or greater (score ≥ 5). Depressive symptoms, assessed by the PHQ-9, were categorized as no-or-minimal (score < 5) versus mild or greater (score ≥ 5). Antenatal medical diagnoses were abstracted from the medical record.

2. Adjusted for participant age, household income, infant sex, and parity

3. Bolded values denote p-value significance at p<0.05.

4. Visit 3 occurred at least 8 weeks after completion of Visit 1.

Table 3: Association of prenatal and postnatal anxiety or depressive symptoms and antenatal anxiety or depression diagnoses with infant irritability (MAP-DB) at 4-6 months of postnatal life
PAS 2026_Maternal MH & Infant Temperament_Table 3.pdfAbbreviations: Generalized Anxiety Disorder-7 (GAD7), Patient Health Questionnaire-9 (PHQ9), Multidimensional Assessment Profile Temper Loss Scale (MAPS-TL, assessed as a continuous measure), Confidence interval (CI)

1. Anxiety symptoms, assessed by the GAD-7, were categorized as no-to-minimal (score < 5) versus mild or greater (score ≥ 5). Depressive symptoms, assessed by the PHQ-9, were categorized as no-to-minimal (score < 5) versus mild or greater (score ≥ 5). Antenatal medical diagnoses were abstracted from the medical record.

2. Adjusted for participant age, household income, infant sex, and parity

3. Bolded values denote p-value significance at p<0.05.

4. Visit 3 occurred at least 8 weeks after completion of Visit 1.