Child Behavior May Be Programmed During Pregnancy

Yael Waknine

July 16, 2004

July 16, 2004 — Maternal anxiety during the first 12 to 22 weeks of pregnancy is associated with enhanced susceptibility of the child to disorders such as attention deficit/hyperactivity disorder (ADHD), according to results of a prospective study published in a recent issue of Child Development. The study lends support to the hypothesis of maternal-fetal programming.

"It is recognized that both genetic and non-genetic factors play an etiological role in commonly diagnosed childhood disorders, such as ADHD, externalizing problems, and internalizing problems, write Bea R. H. Van den Bergh and Alfons Marcoen, from the Catholic University of Leuven in Belgium. "It has long...been known that neurodevelopmental impairments seen in some of these disorders...are caused by the deleterious effect of prenatal factors on developmental processes of the brain."

According to the authors, the "fetal programming hypothesis" states that disturbing factors during sensitive periods of in-utero development can program the set-points of a variety of systems in the fetus. The set-points constrain the adaptive plasticity of the child to their environment, resulting in maladaptive physiology and a predisposition to disease or disorder.

To evaluate this theory, investigators collected anxiety-level data from 71 normal primipara mothers via questionnaires throughout their pregnancies. When the 72 children were aged eight or nine years, their mothers, a teacher, and an impartial observer completed questionnaires measuring each child's attention and hyperactivity, acting-out behavior, and anxiety level.

Hierarchical multiple regression analysis showed that maternal anxiety during pregnancy explained 22%, 15%, and 9% of the variance in cross-situational ADHD symptoms, externalizing problems, and self-reported anxiety, respectively.

Maternal anxiety during the first 12 to 22 weeks of pregnancy was a significant independent predictor, while factors such as the child's sex, parents' educational level, smoking during pregnancy, birth weight, and postnatal maternal anxiety were not.

"The present study yielded some of the strongest indirect evidence available today, that antenatal maternal anxiety may contribute to the 'shaping' of alteration in the child's neurobehavioral development — and, hence enhance the susceptibility for childhood disorders — by programming some set-points in early developing brain structure-function relationships," the authors comment.

"Converging evidence from other studies in identifying specific 'programming windows' during gestation could give the impetus to develop prevention, intervention, and support programs for highly anxious pregnant women," the authors suggest. "These programs could include stress reduction instructions and behavioral treatments to reduce anxiety and neuroendocrine reactions to stress from early gestation on."

The authors report no pertinent financial disclosures.

Child Dev. 2004;75:4

Reviewed by Gary D. Vogin, MD

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