Impact on maternal mental health on infants development: A narrative review

ABSTRACT

Mental health problems among expectant mothers and new mothers are important yet neglected health problems that significantly raise maternal and child morbidity and death in India. The mental health and well-being of parents have an impact on the growth and development of their children. Maternal depression during pregnancy and after delivery reduces the chance that a child survives since it signals that the baby will grow slowly and have a higher chance of developing diarrhea. More specifically, depression, one of the most common causes of disease-related limitation in women, not only impacts the women but also has an adverse effect on their children. This may impair a mother’s capacity to care for her children, increasing the possibility that the kids will suffer from sickness, malnutrition, delayed development, and mental problems that could linger into adulthood. Reduced child growth has adverse effects on short-term and long-term effects on non-communicable illness risks, learning capacity, working ability, academic achievement, brain development, and non-communicable disease risks.

Introduction

Combating maternal mental health has gained importance and significance across the globe because it is a global public health issue. The World Health Organization reports that approximately 10% of pregnant women and 13% of new mothers experience an emotional condition, often depression.[1] Mothers are the primary caretakers for infants, regardless of work or marital status. Therefore, any factor that affects a woman impacts her child, resulting in an impact on public health.[2] About 20% of females are likely to experience a mental health disorder either during their pregnancy or within the initial year following childbirth.[3] Malnutrition has an effect on all countries in some form.[4] According to the World Health Organization, about 10% of pregnant women and 13% of new moms suffer from a mental health problem, often depression, which has a negative impact on both their ability to function and the health and physical development of their children.[5] The mother’s mental health has a negative impact on the development and growth of the child as well.[6] Undernutrition has effects that go beyond the rate of physical development in individuals. Undernutrition not only hampers physical growth but also increases the risk of mortality and diseases. Additionally, it can have adverse effects on both mental and physical abilities.[4] Maternal mental health issues, including pre- and postpartum depression, significantly increase the likelihood of development challenges in infants and young children, in contrast to those whose mothers do not experience depression.[5] This may affect mothers’ capability to care for their children, increasing the risk of illness, malnutrition, delayed growth, and potential behavioral problems as an adult.[6]

Additionally, mental health problems like depression and anxiety after giving birth are related to reduced emotional involvement, neglect, and jealousy, which impact the care of the infant. Mental illnesses like depression and anxiety during pregnancy are linked to inadequate prenatal attention, low birth weight, and early delivery.[5] The majority of mental health conditions go untreated while many symptoms, like sleeplessness or easy irritation, are inherent to motherhood and can go neglected.[7] Women’s mental well-being may suffer throughout pregnancy and the initial year after giving birth. Mothers with mental health conditions are more at risk due to social and cultural issues, especially in developing countries. Factors such as poverty, excessive stress, domestic or gender-based violence, unplanned pregnancy, adolescent pregnancy, situations of emergencies and conflicts, emergencies, and a lack of social support are some of the factors that have been related to this illness. If the woman already has a mental health issue, especially if a sudden pregnancy is involved, this could result in significant sadness, substance addiction, and suicidal thoughts.[8] In addition to indirect factors such as anemia, malaria, and cardiovascular disease, the most prevalent initial causes of maternal impairment and death include excessive bleeding, infection, high blood pressure, botched abortion, and obstructed labor.[9] Mothers are most often affected by depression and anxiety, and the number of suicides among those with severe cases is rising daily.[6]

Newborn babies are extremely vulnerable to their environment and the level of care they receive. They are also particularly sensitive to the mental well-being of their mothers. Therefore, infants are prone to being influenced by the presence of mental disorders in their mothers. When a mother experiences long-lasting or severe mental illness, as well as affect important aspects of infant care such as breastfeeding.[10] The concept that an expecting mother’s emotions may affect the health of her unborn child is commonly accepted. Children require social and behavioral change strategies, such as community-level advice, discussion, media involvement, and influence, to promote the consumption of readily available, affordable, healthy foods. This is true, especially in those who are marginalized. Because women who are malnourished are more likely to give birth to children who are malnourished, UNICEF promotes extra nutrition schemes for teenage girls, pregnant women, and mothers who breastfeed.[11]

Methodology

A comprehensive literature search was conducted on the topic ‘Impact of maternal mental health on infants development’ using databases like Pub Med, Google Scholar, Web of Science, Relevant reports of WHO, United Nations of Children’s Education Funds, and others. The goal was to create a change and raise knowledge and understanding among the public. We recorded 34 articles that contained the keywords like maternal mental health, depression, postnatal, mother’s health, and infant development.

Why maternal mental health is affected?

Violence and abuse

Violence and assault, as well as mental, physical, and sexual assault, have a severe impact on women’s well-being and health. Post-traumatic stress disorder (PTSD), suicidal thoughts or attempts at solving the problem anxiety, depression, and addiction to drugs or alcohol are a few signs like this.[12] For women to have their physical and mental health, they must feel secure and understood. Women’s physical, emotional, and sexual abuse have a severe effect on their health and well-being. This can involve PTSD, thoughts of suicide or actions, anxiety, depression, and the misuse of alcohol or drugs.[13]

Discrimination based on sexuality or gender identity

Women who identify as bisexual, lesbian, or with another sexuality experience higher rates of anxiety and depression than women who identify as heterosexual. These women are more likely to commit suicide or damage themselves if they experience prejudice, exclusion, bullying, or abuse. Lack of support from friends and family can significantly increase the likelihood of acquiring mental health problems. Transgender women and other gender variant people have been found to have significant rates of despair, anxiety, and suicide risk because of support issues, marginalization, and discrimination.[12]

Alcoholic spouses and intimate partner violence

Students who use alcohol or drugs can have serious consequences for themselves and those around them. Many persons who struggle with substance misuse are unaware of the connection between their drug use and behavioral changes or deterioration. The fact that substance use disorders frequently co-occur with other mental health diseases such as severe depression, eating disorders, and attention-deficit/hyperactivity disorder makes this difficulty much more difficult.[13] Most of the women of regular drinkers also reported suffering intimate relationship violence, which had a serious negative impact on their mental health. Five of the seven respondents (5/7) who discussed suicide attempts or suicidal thoughts were intimate relationship violence victims. Children were abused by drunken fathers in other families as well. None of the women mentioned getting assistance for coping with an alcoholic spouse or abuse from an intimate relationship.

Relationship status

Anxiety and despair are more prevalent among women who have lost a loved one, divorced, or gone through a similar life event. After a breakup, it’s common to feel angry, depressed, or as though your customary pleasures are no longer enjoyable. When these feelings persist and begin to interfere with your daily life, it’s time to get help and talk to someone.[14]

Cycle of mental and physical changes of women

Several risk factors are linked to depression during pregnancy. Inadequate prenatal and postnatal care, poor nutrition, stressful life events like poverty, gender-based violence (the separation of sons and daughters, a conservatism in thinking), and polygamy (desiring dowry), as well as a history of psychiatric disorders (hereditary), complications from prior births, events that occurred during pregnancy, such as previous miscarriages, and earlier delivery methods, such as surgical delivery or earlier ways, are a few of them. In addition to these, factors like gender, marital status, weight, whether or not a pregnancy was intended, history of stillbirths, prior encounters with protracted labor, and level of social support should be taken into account.[15] The growth of the fetus as well as labor and delivery are dependent on the neuro-hormone cortex, which is linked to stress. A minor change in this hormone during the early stages of pregnancy can initiate a series of events that modify the fetal response system, which then affects growth and development [Tables 1 and 2].[16]

Table 1.

Postnatal mental health issues[8] – Baby blues,[17] Insomnia,[18] Stress[19]

Name	Stage	Cause	Symptoms
Anxiety	Moderate	1) They worry that their child is hungry 2) Child is usually fussy making the mother lose confidence	Restless,
Depression	Severe	Failure to bond with the baby, early weaning because of medical conditions	Gloomy, dark circles, loss of interest, loneliness
Baby blues[17]	Immediately after childbirth	Hormonal changes, rapid fall in estrogen	Fatigue, nervousness, crying spells, oversensitivity, appetite loss, confusion
Insomnia[18]	Moderate	Physical postpartum changes like breast enlargement, hunger (increased nutritional needs) because of breastfeeding and night sweats. Melatonin release is altered	Sadness, dark circles, pale skin, muscle weakness, backache
Stress[19]	Moderate	Bodily changes; Difficult birth experience; Exposing their breasts to other people while breastfeeding, lack of sleep, less milk supply causes them to be stressed, difficulty taking care of the baby with their partner, and financial woes	Irritable, moody, let-down reflex or milk-ejection reflex

Table 2.

Neonatal Mental Health By Birth[25] – Cognitive development,[26] Attention-deficit,[27] Vestibular disorders,[28] Reflex problems,[29] Feeding Problems (gastroesophageal reflex)[30]

	Neonatal mental health problems by birth	Attitude
1)	Cognitive development[26]	Gag reflex problem, eye blinking, furiously suction problems
2)	Attention-deficit[27]	If we snap our fingers, the child won’t notice
3)	Vestibular disorders[28]	The child is not able to hear and comprehend commands
4)	Reflex problems[29]	Symmetric tonic neck reflex positive; Babinski reflex positive; Asymmetric tonic neck reflex positive; Sucking reflex negative
5	Feeding problems (gastroesophageal reflex)[30]	Choking, coughing, and throwing up when feeding

Discussion

Postnatal mental health issues

Studies have focused greater focus on women’s mental health in the postpartum time than in the antepartum phase. Postpartum depression (PPD) is thought to affect 12 to 16 percent of women, according to current statistics. Quick or ongoing postpartum depression and anxiety are both possible. Postnatal discomfort is recognized to be associated with several psychosocial risk factors, just like antenatal distress.

Postpartum depression

The most prevalent maternal mental health problem that moms worldwide suffer is depression. Although many women go through several stages of depression throughout their lives, postpartum depression is the most common variety. A risk factor for later maternal mental health issues as well as behavioral and emotional issues in young children is postpartum depression in mothers.[20] Symptoms of this maternal mental health disorder include sadness, irritability, restlessness, impatience, fatigue, insomnia, intrusive thoughts, or the inability to stay focused. Pregnancy is a period characterized by heightened physical and emotional sensitivity that can potentially increase the risk or intensity of symptoms of depression.[21] PPD has multiple causes, but healthcare professionals believe that the decrease in the hormones progesterone and estrogen after childbirth and the rise in pressures, in general, all over maternity and the postpartum period are the main ones. PPD is curable and the risk of severe depression can be decreased with adequate treatment for mental illness.

Anxiety disorders

Anxiety disorders, which include agitation, a racing heart, difficulty sleeping, and excessive concern, are other common disorders affecting both parents’ mental health.[22] This is often defined as strong or extreme concern and fear regarding everyday occurrences. Some moms go through this because they are worried for the safety of their kids or for other reasons unrelated to becoming a mother. Increased anxiety can affect a parent’s judgment, ability to evaluate specific circumstances, and other parenting functions, regardless of the cause.

Obsessive-compulsive disorder

Obsessive-compulsive disorder is defined as a pattern of unwanted thoughts, anxieties, and obsessions that cause someone to engage, in particular, compulsions that interfere with day-to-day activities and are frequently made worse by elevated levels of stress. The condition may be felt by a parent who is now in charge of a defenceless child due to their desire to protect the child from harm. It could result in constant cleaning routines, monotonous speech or behavior, compulsive thoughts, mental obsessions, and more.[7]

Post-traumatic stress disorder

Post-traumatic stress disorder is another mental health condition that affects mothers frequently in the United States. PTSD can result from a variety of events, but moms who had a traumatic childbirth experience are more likely to have the condition. Cortisol and other stress-related chemicals can be released during pregnancy. Otherwise known as birth trauma, this form of PTSD is often a result of fear experienced during childbirth that harm will come to you or your child or the realization of those fears (high-risk births).

Postpartum Psychosis

Postpartum psychosis can occur in the initial two weeks after giving birth, and the symptoms that are usually recognized are hallucinations, delusions, anger, hyperactivity, and rapid mood swings.[23] The primary characteristic of postpartum psychosis is the disturbance that includes the sudden emergence of one or more of the specified positive psychotic symptoms.[24] The episode typically begins with problems getting to sleep and feelings of restlessness or excessive irritability.[25]

Neonatal mental health by birth

Neonatal cognitive–emotional–behavior problems

According to a recent study, neonatal cognitive and emotional health were adversely affected by both parental depressive disorders and poverty. According to a recent review of studies that had been published in the previous years, mental distress and mental health conditions, such as depression and anxiety, have been shown to affect neonatal mental, emotional, and behavioral abilities in addition to having an impact on a child’s birth impacts and developmental milestones.[6] Neonatal mental and social well-being can be seriously impacted by neurodevelopmental, emotional, and behavioral disorders that limit the brain’s capacity to develop.[25] Autism spectrum disorders, difficulty with cognition or learning, and problems with neurodevelopment can all cause problems with neonatal development. Problems with cognition and learning, emotional or psychological disorders like autism, or issues with neurodevelopment may all be signs of neonatal development issues.[26]

Conclusion

Mothers’ mental health issues are a serious yet underappreciated public health problem that significantly increases maternal and newborn morbidity and death. Depression and anxiety disorders are the most common issues. One of the main reasons for pregnancy-related deaths is suicide. Poor mental health affects a mother’s ability to care for herself and her children, which may impair their survival, health, and growth. For instance, mother depression in the antenatal and postpartum stages is associated with worse growth and an increased risk of diarrhea in newborns, which may lower the likelihood of a child’s survival. Children’s growth and health are impacted by mothers’ poor mental health. To achieve the objectives of enhancing maternal health, it is essential to pay attention to mental health. Specific stress reduction interventions in high-stress or depressive pregnant women could potentially decrease neonatal development issues, though further research on both the underlying causes and suitable interventions is necessary.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.