Viewpoint - Maternal mental health and the child

A mother's mental health problems can affect a child's development, suggests Dr Linda Miller.

The risk of teratogenicity is a major concern for women on medication for long-term mental illness.

Lithium, carbamazepine and sodium valproate are all known to be a significant risk for the fetus.

Ideally, prenatal counselling and adjustments to medication should be made under specialist care.

Research suggests that many women stop their medication when they discover that they are pregnant, which increases the risk of relapse.

An increased level of fetal monitoring throughout the pregnancy reduces anxiety and facilitates an early detection of anomalies.

Depression in pregnancy

Babies born to mothers who have suffered depression during their pregnancy are more likely to be small for dates or premature.

Eating disorders

Anorexia in pregnancy can sometimes result in the fetus being deprived of adequate nutrition.

Some women with eating disorders practise 'anorexia by proxy', giving their baby weak, diluted feeds as they perceive normal feeds to be too strong.

The children often exhibit anorexic behaviour, such as excessive fussiness about food types, from an early age.

OCD

Women with obsessive compulsive disorder (OCD) might find it difficult to adapt to pregnancy, and have high expectations of the birth.

If things do not go exactly as planned they might blame themselves or the child. This can have a detrimental effect on bonding.

Postnatal mental health conditions are common because new mothers can begin to feel vulnerable.

Postnatal depression

Maternal depression in the first year of a child's life can have a profound effect on their future development.

A study in Colorado in the US found that depressed mothers' speech failed to encourage 'associative learning' in their two- to six-month-old babies, compared to controls.

Behavioural problems and poorer vocabulary scores in five-year-olds were found to be proportional to the duration and severity of maternal depression.

Recent depressive symptoms were more common in those families with behavioural problems.

A Cambridge study of interactions between mothers and babies at two months found depressed mothers were less sensitively attuned to the infant, more negating of infant experience and less affirming. Disturbed interactions were predictive of poor infant cognitive function at 18 months.

Researchers at Reading University found that the content and social patterning of five-year-olds' play at school and the likelihood of behavioural problems was predicted by maternal postnatal depression.

This confirmed that maternal depression in the first few months could affect psychological adjustment of the child in the long term.

Maternal eating disorders

A questionnaire found a strong, specific correlation between childhood behavioural problems relating to food and maternal eating disorder. Video studies of meals have confirmed conflicts. Improving maternal responsiveness to infant cues helped. Other studies have shown that mothers with eating disorders exerted more verbal control over their children.

In a prospective study, these mothers were much more concerned than controls with the weight of their two-year-old daughter. At five years, the children had greater negative affect. Overall affected children have difficulty forming normal attachments.

They have problems forming relationships in later life. Children of depressed mothers often cling to a substitute mother figure or anyone showing kindness. They are more likely to experience an excessive sense of loss at any stage.

Treating postnatal depression does not seem to have much impact on the abnormal maternal infant interaction, but teaching the mother infant massage has a significant effect. Behavioural interventions that manage sleep problems have a significant effect on maternal mood.

Maternal psychosis

Children whose mothers have suffered from psychosis are said to be less likely to suffer from under-stimulation than those with a family history of depression. Safety is the main concern for the neonate, but the condition responds to treatment in a safe environment.

These families often come to the attention of social services - when the episode presents immediately post-natally or in cases of pre-existing psychosis during the pregnancy - to ensure that safety concerns are acted on promptly.

Many children whose mothers had psychosis attribute their parent's behaviour to themselves. It is often only when they reach school age and encounter peers and their parents that they realise their parent's behaviour is different.

Children will often blame themselves at this stage. Many suffer developmental problems in their teens. They are also genetically predisposed to developing mental illness.

- Dr Miller is a GP in London

KEY POINTS

- Lithium, carbamazepine and sodium valproate are all known to be a significant risk for the fetus.

- Many women stop their medication when they discover that they are pregnant, with the risk of relapse.

- Babies born to mothers who have suffered depression during pregnancy are more likely to be small for dates or born prematurely.

- Anorexia in pregnancy can result in the fetus being deprived of adequate nutrition.

- Women with OCD may find it very difficult to adapt to pregnancy.

- Depressed mothers were less sensitively attuned to the infant.

- Children of psychotic mothers attribute their parents' behaviour to themselves.

- Mothers with eating disorders exerted more verbal control over their children.

REFERENCES

- Dr Gillian Wainscott. Maternal Mental Health and The Child. CHS course Hammersmith Hospital 25 Sept, 2002

- Williams J, Myson V, Steward S et al. Self-discontinuation of Antiepileptic Medication in Pregnancy: Detection by Hair Analysis. Epilepsia 2002; 43: 824-31

- Kaplan P S et al. Child-directed speech produced by mothers with symptoms of depression fails to promote associative learning in four-month-old infants. Child Dev 1999; 70 (3): 560-70

- Brennan P A et al. Chronicity, severity, and timing of maternal depressive symptoms: relationship with child outcomes at age five. Developmental Psychology 2000; 36 (6): 759-66

- Murray L et al. The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome. Child Dev 1996; 67 (5): 2,512-26

- Murray L. The socio-emotional development of five-year-old children of post-natally depressed mothers. J Child Psychol Psych1999;40 (8): 1,259-71

- Whelan E, Cooper P. The association between childhood feeding problems and maternal eating disorder; a community study. J Psychol Med 2000; 30(1): 69-77

- Stein et al. Influence of Psychiatric disorder on the controlling behaviour of mothers with one-year-old infants. A study of women with maternal eating disorder, postnatal depression and a healthy comparison group. Br J Psychiatry 2001; 179: 157-62

- Stein A, Woolley H and McPherson K. Conflict between mothers with eating disorders and their infant during mealtimes. Br J Psychiatry 1999; 175: 455-61

- Agras S et al. Prospective study of the influence of eating disordered mothers on their children. Int J Eating Dis 1999; 25(3): 253-62

- Onozawa K et al. Infant massage improves mother infant interaction for mothers with postnatal depression. J Affect Disord 2001; 63(1-3): 201-7

- Hiscock H, Wake M Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ 2002; 324: 1,062-5.

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