Cognitive Impairment and

Psychopathology in Children
with Moms who had
Postpartum Depression
Shawn Jin
MS3
11/6/2017
 Definitions

Dyad- mother and child pair

PPD- MDD within 4 weeks of birth (APA definition)
~10% of mothers
Symptoms same as MDD but could manifest as:
Lack of interest in caring for baby
Infancidal ideation
Guilt of not caring enough for the child

Postpartum Unipolar Major Depression: Epidemiology, Clinical Features, Assessment, and Diagnosis - UpToDate. Accessed November 4, 2017.
https://www.uptodate.com/contents/postpartum-unipolar-major-depression-epidemiology-clinical-features-assessment-and-
diagnosis?source=search_result&search=postpartum%20depression&selectedTitle=1~116.
Areas affected by PPD in
Children
Cognition
Executive functioning
Intelligence
Language and development
Anxiety
ODD/CD
ADHD
 Cognition

Longitudinal study with 137 dyads, 28 of which had PPD

Screened for depression at 4 month PP
Assessed infant cognitive function at 16 months
Infants exposed to PPD vs Infants unexposed to PPD
(mean difference = 5.22, 95% CI: [10.19, 0.25]) at 16
months

McManus, Beth M., and Julie Poehlmann. Parentchild Interaction, Maternal Depressive Symptoms and Preterm Infant
Cognitive Function. Infant Behavior and Development 35, no. 3 (June 1, 2012): 48998.
https://doi.org/10.1016/j.infbeh.2012.04.005.
 Executive Function(EF)

EF= attention switching, working memory, processing

speed, attentional control, selective attention
n = 5,801 Dyads in England between 1991-1992
10% of mothers were diagnosed with PPD
PPD caused significant deficits in:
Attention switching .044 (.01, .089) (P=.05),
Attentional control .11 (.03, .19) (P=.006)
Processing speed .05(.02-.07) (P=.001)

Pearson, Rebecca M., Marc H. Bornstein, Miguel Cordero, Gaia Scerif, Liam Mahedy, Jonathan Evans, Abu Abioye, and Alan Stein. Maternal
Perinatal Mental Health and Offspring Academic Achievement at Age 16: The Mediating Role of Childhood Executive Function. Journal of
Child Psychology and Psychiatry, and Allied Disciplines 57, no. 4 (April 2016): 491501. https://doi.org/10.1111/jcpp.12483.
 Intelligence (IQ)

171 dyads total, 42(24.6%) dyads had PPD in longitudinal

study
Measures adolescent IQ in presence/absence of initial
PPD
Significant effect on boy adolescent IQ
Depressed moms adolescent boys scored 23 points
lower on IQ than well moms adolescent boys (P=.001)
No significant difference in IQ between exposed and
unexposed adolescent girls

Hay, Dale F., Susan Pawlby, Cerith S. Waters, and Deborah Sharp. Antepartum and Postpartum Exposure to Maternal Depression: Different
Effects on Different Adolescent Outcomes. Journal of Child Psychology and Psychiatry 49, no. 10 (October 1, 2008): 107988.
https://doi.org/10.1111/j.1469-7610.2008.01959.x.
 Language Development

296 dyads in a longitudinal study,

21 (7.1%) dyads developed PPD
Using Bayley Scales of Infant Development III to assess
language at 1 year mark
Poor language development significantly correlated with
length of PPD. 3.00 (5.15; 0.82) (P=.007)

Quevedo, L. A., R. A. Silva, R. Godoy, K. Jansen, M. B. Matos, K. A. Tavares Pinheiro, and R. T. Pinheiro. The Impact of Maternal
Post-Partum Depression on the Language Development of Children at 12 Months. Child: Care, Health and Development 38, no. 3
(May 1, 2012): 42024. https://doi.org/10.1111/j.1365-2214.2011.01251.x.
 Anxiety & Depression

96 dyads, 41 (42.7%) had PPD

Longitudinal study for 13 years
PPD exposed children significantly have higher rates of
adolescent anxiety compared to unexposed
children(OR = 3.56, 95% CI = 1.0811.71;
Wald = 4.36, df = 1, P = 0.037)
PPD exposed children significantly have higher rates of
adolescent depression compared to unexposed children
(OR = 3.78, 95% CI = 0.9614.9;
Wald = 3.60, df = 1, P = 0.058)

Halligan, Sarah L., Lynne Murray, Carla Martins, and Peter J. Cooper. Maternal Depression and Psychiatric Outcomes in
Adolescent Offspring: A 13-Year Longitudinal Study. Journal of Affective Disorders 97, no. 1 (January 1, 2007): 14554.
https://doi.org/10.1016/j.jad.2006.06.010.
 Anxiety & Depression

Halligan, Sarah L., Lynne Murray, Carla Martins, and Peter J. Cooper. Maternal Depression and Psychiatric Outcomes in
Adolescent Offspring: A 13-Year Longitudinal Study. Journal of Affective Disorders 97, no. 1 (January 1, 2007): 14554.
https://doi.org/10.1016/j.jad.2006.06.010.
 Depression

N = 8937 dyads total, of which 664 (7.3%) had PPD

Longitudinal study measuring adolescent depression at
age 18
Significantly increased odds of having MDD as
adolescent for those exposed to PPD than those who are
not [OR 1.67, 95% CI 1.1 to 2.6, p=0.026)]
Found more PPD in those who have lower education

Pearson, Rebecca M., Jonathan Evans, Daphne Kounali, Glyn Lewis, Jon Heron, Paul G. Ramchandani, Tom G. OConnor, and Alan Stein.
Maternal Depression During Pregnancy and the Postnatal Period: Risks and Possible Mechanisms for Offspring Depression at Age 18 Years.
JAMA Psychiatry 70, no. 12 (December 1, 2013): 131219. https://doi.org/10.1001/jamapsychiatry.2013.2163.
 ODD/CD

691 dyads, 177 (25.6%) with PPD in longitudinal study

Measures outcome at 10 years of age for externalizing
behaviors (Aggression, ODD)
At age 10, Children of moms with PPD significantly have
higher chance of having externalizing behaviors.
OR:1.92, 95%CI(1.083.43)

Verkuijl, Nienke E, Linda Richter, Shane A Norris, Alan Stein, Bilal Avan, and Paul G Ramchandani. Postnatal Depressive Symptoms
and Child Psychological Development at 10 Years: A Prospective Study of Longitudinal Data from the South African Birth to Twenty
Cohort. The Lancet Psychiatry 1, no. 6 (November 1, 2014): 45460. https://doi.org/10.1016/S2215-0366(14)70361-X.
 ADHD

N=2057 dyads in Quebec province

Assessed for ADHD symptoms at 5 month and 8 year old,
while measuring for PPD
PPD exposed significantly scored higher on assessment
scale for ADHD compared to unexposed OR(1.35;
95%CI[1.18-1.54]).

Galra, Cdric, Sylvana M. Ct, Manuel P. Bouvard, Jean-Baptiste Pingault, Maria Melchior, Grgory Michel, Michel Boivin, and
Richard E. Tremblay. Early Risk Factors for Hyperactivity-Impulsivity and Inattention Trajectories From Age 17 Months to 8 Years.
Archives of General Psychiatry 68, no. 12 (December 5, 2011): 126775. https://doi.org/10.1001/archgenpsychiatry.2011.138.
Summary & My Conclusion

PPD exposure has significant correlation to later

cognitive impairments and psychopathologies in children
not only within infancy, but also to adolescents and
adult hood.
Very important to screen mothers and to support
mothers to minimize PPD.
 What the Experts Recommend:

USPSTF: suggest screening all postpartum women for

depression when services are in place to ensure
appropriate diagnosis, treatment, and follow-up (Grade
B)
ACOG: recommends that clinicians screen patients at
least once during the perinatal period for depression
and anxiety symptoms using a standardized, validated
tool.
APA: Encourage universal screening of pregnant and
new mothers for depression. The perinatal period is
one of increased connection with healthcare systems for
most women, and an opportune time to screen for the
symptoms of depression.

https://www.acog.org/Resources-And-Publications/Committee-
https://www.uspreventiveservicestaskforce.org/Page/Document/Recomme Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-
ndationStatementFinal/depression-in-adults-screening1 Depression http://www.apa.org/advocacy/health/postpartum.pdf
References
Galra, Cdric, Sylvana M. Ct, Manuel P. Bouvard, Jean-Baptiste Pingault, Maria Melchior, Grgory Michel, Michel Boivin,
and Richard E. Tremblay. Early Risk Factors for Hyperactivity-Impulsivity and Inattention Trajectories From Age 17 Months to
8 Years. Archives of General Psychiatry 68, no. 12 (December 5, 2011): 126775.
https://doi.org/10.1001/archgenpsychiatry.2011.138.

Halligan, Sarah L., Lynne Murray, Carla Martins, and Peter J. Cooper. Maternal Depression and Psychiatric Outcomes in
Adolescent Offspring: A 13-Year Longitudinal Study. Journal of Affective Disorders 97, no. 1 (January 1, 2007): 14554.
https://doi.org/10.1016/j.jad.2006.06.010.

Hay, Dale F., Susan Pawlby, Cerith S. Waters, and Deborah Sharp. Antepartum and Postpartum Exposure to Maternal
Depression: Different Effects on Different Adolescent Outcomes. Journal of Child Psychology and Psychiatry 49, no. 10
(October 1, 2008): 107988. https://doi.org/10.1111/j.1469-7610.2008.01959.x.

McManus, Beth M., and Julie Poehlmann. Parentchild Interaction, Maternal Depressive Symptoms and Preterm Infant
Cognitive Function. Infant Behavior and Development 35, no. 3 (June 1, 2012): 48998.
https://doi.org/10.1016/j.infbeh.2012.04.005.

Pearson, Rebecca M., Marc H. Bornstein, Miguel Cordero, Gaia Scerif, Liam Mahedy, Jonathan Evans, Abu Abioye, and Alan
Stein. Maternal Perinatal Mental Health and Offspring Academic Achievement at Age 16: The Mediating Role of Childhood
Executive Function. Journal of Child Psychology and Psychiatry, and Allied Disciplines 57, no. 4 (April 2016): 491501.
https://doi.org/10.1111/jcpp.12483.

Pearson, Rebecca M., Jonathan Evans, Daphne Kounali, Glyn Lewis, Jon Heron, Paul G. Ramchandani, Tom G. OConnor, and
Alan Stein. Maternal Depression During Pregnancy and the Postnatal Period: Risks and Possible Mechanisms for Offspring
Depression at Age 18 Years. JAMA Psychiatry 70, no. 12 (December 1, 2013): 131219.
https://doi.org/10.1001/jamapsychiatry.2013.2163.

Postpartum Unipolar Major Depression: Epidemiology, Clinical Features, Assessment, and Diagnosis - UpToDate. Accessed
November 4, 2017. https://www.uptodate.com/contents/postpartum-unipolar-major-depression-epidemiology-clinical-
features-assessment-and-diagnosis?source=search_result&search=postpartum%20depression&selectedTitle=1~116.

Quevedo, L. A., R. A. Silva, R. Godoy, K. Jansen, M. B. Matos, K. A. Tavares Pinheiro, and R. T. Pinheiro. The Impact of
Maternal Post-Partum Depression on the Language Development of Children at 12 Months. Child: Care, Health and
Development 38, no. 3 (May 1, 2012): 42024. https://doi.org/10.1111/j.1365-2214.2011.01251.x.

Verkuijl, Nienke E, Linda Richter, Shane A Norris, Alan Stein, Bilal Avan, and Paul G Ramchandani. Postnatal Depressive
Symptoms and Child Psychological Development at 10 Years: A Prospective Study of Longitudinal Data from the South African
Birth to Twenty Cohort. The Lancet Psychiatry 1, no. 6 (November 1, 2014): 45460. https://doi.org/10.1016/S2215-
0366(14)70361-X.
Thank you!
 Questions?

https://s-media-cache-ak0.pinimg.com/originals/1c/09/6e/1c096eb0dfd292b73b2a7f1c4f994c9c.jpg