128 - Educational outcomes in children exposed to maternal mental disorders during pregnancy: A within-family sibling comparison analysis

Publication Number: 1118.128

Evelyn Lee, University of Sydney, ST LEONARDS, New South Wales, Australia; Sithum Munasinghe, Western Sydney University, Penrith, New South Wales, Australia; Helen Soenong, UNSW, Sydney, New South Wales, Australia; Ju Lee Oei, Mater Research, Brisbane, Queensland, Australia

Background: In-utero exposure to maternal mental disorders has been associated with an increased risk of adverse cognitive outcomes among offspring. However, the causality of the association remains unclear as unmeasured familial confounders may influence maternal exposure and offspring cognitive development. This has implications on preventive intervention strategies.

Objective: We examined the educational performance of Australian children aged 8-9 years who were exposed to maternal mental disorders during pregnancy.

Design/Methods: All live births from 2001-2013 in New South Wales, Australia from the routinely collected perinatal data collection was linked with the National Assessment Program: Literacy and Numeracy to enumerate educational outcomes, and the Admitted Patient Data collection to identify maternal mental disorders during pregnancy.

The full cohort analyses included 247,130 mother-offspring pairs. The sibling comparison analyses involved 4,007 sibling-pairs where the firstborn (unexposed) sibling was discordant for in-utero exposure to maternal mental disorder to account for unmeasured familial, maternal intrauterine and genetic confounding.

Results: Over the study period, 4,581 children (1.8%) were exposed to maternal mental disorders during pregnancy. Among exposed children, half were male (50.3%), one-fifth lived in the lowest socioeconomic quintiles (21.6%), and 7.6% had mothers identified as Aboriginal and/or Torres Strait Islander. Exposed children were more likely to be born < 37 weeks of gestation (15.7%), low birth weight (12.7%), have lower 5-minute Apgar scores (3.0%) and require resuscitation at birth (43.4%).

In the full cohort analyses, prenatal exposure to mental disorders was associated with a higher likelihood of performing below the benchmark across academic domains at ages 8-9 years (risk ratio RR=1.63 95%CI 1.50-1.77) with the strongest association observed for spelling followed by language, numeracy and writing, after adjusting for key covariates.

However, in sibling comparison analysis, we found that this association was substantially attenuated for poor academic results (RR 0.83 95%CI 0.72-0.95).

Conclusion(s): This study provides novel evidence that poorer academic outcomes among children exposed to maternal mental disorders during pregnancy likely reflect unmeasured familial and environment factors shared within families rather than direct intrauterine effect.

Interventions to improve educational outcomes for affected children may therefore benefit from a broader family and social context approach rather than focusing only on maternal mental health during pregnancy.