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. 2025 Aug 10;47(1):e70037. doi: 10.1002/imhj.70037

Fetal programming of infant temperament: An examination of prenatal maternal stress during the COVID‐19 pandemic

Jessica Pearson 1,2,✉, Rosalie Caron 1, Magdalena A Zdebik 2,3, Claire Baudry 1,2, Gabrielle Fréchette‐Boilard 1,2
PMCID: PMC12715457  PMID: 40783842

Abstract

Pregnant women were exposed to multiple sources of stress during the COVID‐19 pandemic, raising concerns about the potential fetal programming effects of child development. A few studies show that prenatal maternal stress during the pandemic is associated with greater negative affectivity and more extraversion in infants. However, studies investigating this association are very few and need to be replicated. This study aims to prospectively investigate the association between prenatal maternal stress during the COVID‐19 pandemic and infant temperament, while assessing the relative contribution of postnatal maternal stress. A total of 269 low‐risk, French‐speaking women from the province of Quebec, Canada, completed questionnaires during pregnancy to report on their prenatal maternal stress (general and pandemic‐related). When their child was 6 months old, the mothers completed a second questionnaire to collect information on postnatal stress and infant temperament. The results show that prenatal maternal stress in the context of the pandemic significantly predicted infants’ negative affectivity and orienting/regulation factors, even after controlling for postnatal stress. The results support the fetal programming hypothesis, while highlighting the additional contribution of maternal stress during the child's first months of life.

Keywords: COVID‐19, fetal programming, prenatal maternal stress, temperament

1. INTRODUCTION

The 2019 coronavirus disease (COVID‐19) pandemic impacted the entire world, causing major individual and social upheaval. Many stressors, including massive job losses, strict public health measures of social distancing, mandatory lockdowns and curfews, changes in health and social services, and the closure of schools and daycare centers, affected the mental health of the general population (Bourmistrova et al., 2022). The lack of knowledge about the virus, including its mode of transmission and presumed health consequences, was a source of stress for many people, but certain populations were identified as being more at risk.

Key Findings

  • Mothers’ perceived impact of the pandemic on their pregnancy is the most salient index of prenatal maternal stress during the COVID‐19 pandemic.

  • Pandemic‐related prenatal maternal stress significantly predicted higher negative affectivity and lower regulation in 6‐month‐old infants.

  • Postnatal maternal stress uniquely and additionally contributed to variations in infant temperament.

Statement of Relevance

Several concerns have been raised regarding the mental health issues that children born during the COVID‐19 pandemic may experience. Since early temperament is a significant predictor of infant mental health, it is particularly important to examine it in the context of the pandemic. The identification of pandemic‐related maternal stress as being associated with infant temperament provides a more comprehensive understanding of the potential risk factors for infant mental health, and thus of preventive interventions to promote early childhood adjustment.

In this context, pregnant women were considered particularly vulnerable due to their increased risk of developing physical and mental health problems (Davis & Narayan, 2020; Gildner & Thayer, 2020). Pregnant women were also exposed to additional stressors related to their physical health and to changes in antenatal care. In terms of physical health, they were faced with the lack of a clear answer on the possibility of vertical transmission of the virus to the fetus (i.e., transmission of the virus from the mother to her unborn child; Trocado et al., 2022) and on the effectiveness and safety of the vaccine against COVID‐19 during pregnancy (Bianchi et al., 2022). Significant changes were made to antenatal care to slow the spread of the virus and protect expectant mothers, such as a reduced number of antenatal appointments and ultrasound scans (Jardine et al., 2021). Additionally, pregnant women commonly reported difficulties in accessing antenatal and birth preparation classes and restrictions on the presence of partners or support persons during appointments (Groulx et al., 2021; Joo & Liu, 2023; Khoury et al., 2021; Preis, Mahaffey, Heiselman, et al., 2020).

These changes in pregnancy and postpartum conditions not only pose health risks at various stages of pregnancy and childbirth, but also represent a significant source of stress specific to the pregnant population. While several studies documented an increase in depressive and anxiety symptoms in pregnant women in the context of the pandemic (Groulx et al., 2021; Shorey et al., 2021; Tomfohr‐Madsen et al., 2021), others investigated a more specific form of prenatal maternal stress early in the pandemic, namely pandemic‐related prenatal stress. Hospital policies and changes in pregnancy monitoring were associated with significant increases in certain pregnancy‐related fears. For example, almost half of expectant mothers reported worrying that something might go wrong with their baby (Khoury et al., 2021; Pope et al., 2022). A large proportion were also concerned that the father would not be able to attend the birth (Bérard et al., 2021; Khoury et al., 2021). Preis, Mahaffey, Heiselman, et al. (2020) found that in April and May 2020, about 30% of pregnant women reported high levels of stress related to childbirth preparation and the risk of infection. Other studies assessing pandemic‐related prenatal maternal stress also reported that up to 87% of pregnant women were concerned about their newborn becoming infected during or after delivery (Akgor et al., 2021; Bérard et al., 2021).

Our research team documented that later during the pandemic (i.e., in 2021, about a year after the pandemic began; Pearson et al., 2023), overall levels of prenatal stress were comparable to those found in the general population before the pandemic (Lemyre & Tessier, 1988, 2003) and mothers reported relatively low levels of stress related to the pandemic in general. However, the perceived impact of the pandemic on their pregnancy was significantly higher. Pregnant women may have perceived public health measures implemented in clinics and hospitals as having a significant negative impact on antenatal care, without this necessarily being reflected in their subjective assessment of more general stress. These findings highlight the importance of assessing prenatal maternal stress in a variety of ways to ensure a deeper understanding of experiences of pregnant women, with a particular focus on pandemic‐related prenatal maternal stress.

1.1. The fetal programming hypothesis

Since the onset of the pandemic, many researchers have raised concerns about the potential adverse effects of this stressful context for pregnant women and its consequences for their children (Abdoli et al., 2020; Ding et al., 2021; Nabi et al., 2020). These concerns are grounded in the fetal programming hypothesis, which suggests that certain prenatal factors can alter fetal and child development in the long term or even permanently (Barker, 1998; Davis & Narayan, 2020; Glover et al., 2010; Van den Bergh et al., 2020; Weinberg et al., 2008). In recent decades, significant attention has been given to prenatal maternal stress as a potential fetal programming factor. The field has embraced a broad definition of prenatal maternal stress, encompassing various dimensions of maternal mental health during pregnancy, such as depression, anxiety, perceived subjective stress, and exposure to stressful events like natural disasters (Davis & Narayan, 2020; Lafortune et al., 2021). Consequently, studies assessing prenatal maternal stress employ diverse measures, including pregnancy‐specific stress and anxiety, general subjective stress or distress, as well as symptoms of anxiety or depression (Nazzari et al., 2024).

Pre‐pandemic studies have linked prenatal maternal stress to multiple aspects of child development and adjustment. These include emotional and behavioral problems, such as difficulties with emotional regulation, anxiety, depression, and conduct disorders (Glover, 2014; Hentges et al, 2019; Korja et al., 2017; Madigan et al., 2018; O'Donnell et al., 2014). Additional associations were observed with dysregulation of cortisol secretion (Pearson et al., 2015), as well as sleep problems (O'Connor et al., 2007) and impaired cognitive performance (Glover, 2014; Tarabulsy et al., 2014). Furthermore, prenatal maternal stress was associated with variations in child temperament (Davis et al., 2007; Madigan et al., 2018; McMahon et al., 2013; Simcock et al., 2017).

1.2. Prenatal maternal stress and infant temperament

Rothbart and colleagues define temperament as individual differences in reactivity and self‐regulation that are primarily biologically based (Rothbart, 2007; Rothbart & Bates, 2006; Shiner et al., 2012). Reactivity refers to the child's response to changes in the environment and is represented in Rothbart's model by two factors: (1) negative affectivity describes the child's predisposition to experience negative emotions such as frustration, fear and sadness; and (2) surgency refers to the child's predisposition to experience intense positive emotions and activity level. Regulation refers to the attentional and inhibitory processes that enable children to modulate their reactivity. During infancy, it is represented by the “orienting/regulation” factor. Temperament has consistently been identified as a key predictor of school readiness (Gobeil‐Bourdeau et al., 2022) and academic achievement (Ato et al., 2020). It has also been associated with various aspects of social‐emotional development during childhood and adolescence (Blandon et al., 2010; Nielsen et al., 2019; Sanson et al., 2011), underscoring the importance of exploring factors associated with its variation in early childhood.

Several studies have shown an association between prenatal maternal stress and infant temperament, including increased irritability and excessive crying, fearful temperament, emotional reactivity, and poor social adjustment (Bergman et al., 2007; Davis et al., 2007, 2004; Laplante et al., 2016; Nolvi et al., 2016; van der Wal et al., 2007; Zhang et al., 2018). A systematic review by Rodríguez‐Soto et al. (2021) found that prenatal maternal stress linked to stressful life events is likely to affect child temperament, particularly negative affectivity. Among the studies included in their review, exposure to stressful events during pregnancy was associated with increased negative affectivity in children in 75% of cases, reduced effortful control in 50% of cases, and lower surgency in 38% of cases (Rodríguez‐Soto et al., 2021). These studies support that early‐life temperament can be influenced by a stressful intrauterine environment, emphasizing the importance to investigate these developmental characteristics in children born during the COVID‐19 pandemic.

1.2.1. COVID‐19 pandemic‐related stress and infant temperament

To date, few researchers have studied prenatal maternal stress in the context of the COVID‐19 pandemic and its effects on child development, including temperament. A recent review by Nazzari and colleagues (2024) identified nine studies examining the association between prenatal maternal stress at the onset of the pandemic (including psychological stress, pandemic‐specific stress, anxiety, and depression) and infant temperament. These studies show conflicting results. For example, López‐Morales et al. (2021) demonstrated an increase in anxiety in pregnant women during the initial months of the lockdown. In the same sample, prenatal anxiety experienced during the second and third trimesters was later associated with greater negative affectivity (crying, frustration, sadness) and increased surgency (intense positive emotions, higher levels of physical activity) in children at 6 months of age (López‐Morales et al., 2024). Similar results were reported by Buthmann and colleagues (2022), who showed that prenatal maternal stress specific to the pandemic assessed in April and May 2020 was associated with higher negative affectivity in children at 13 months of age. However, some studies (e.g., Sacchi et al., 2024; Wiley et al., 2023) report no association between prenatal pandemic‐related stress and early socio‐emotional development.

The postnatal programming hypothesis is also relevant, as brain plasticity extends beyond the prenatal period, and prenatal maternal stress is likely to promote postnatal plasticity (Grant et al., 2010; Hartman et al., 2023). It is plausible that mothers experiencing stress in the prenatal period will also experience stress in the postnatal period, suggesting that the postnatal environment may partly account for the observed variations in child temperament (Field, 2018; Duguay et al., 2022; Provenzi et al., 2023). Some studies conducted during the pandemic identified an indirect association between prenatal maternal stress experienced during the pandemic and infant socio‐emotional development, suggesting that this association may be mediated by maternal distress experienced in the postnatal period (Duguay et al., 2022; Mattera et al., 2024; Provenzi et al., 2023). Conversely, a recent study by Morris and Saxbe (2023) supports the fetal programming hypothesis. The researchers compared a cohort of pregnant women recruited before the pandemic to another cohort recruited after the pandemic began. They assessed participants' depressive symptoms and stress during pregnancy, and later asked the mothers to rate the temperament of their 3‐month‐old infants. The findings revealed that mothers reported higher levels of negative affectivity in children born during the pandemic compared to those born before, and that this increase was explained by heightened prenatal maternal distress during the pandemic. The authors noted that the association between prenatal maternal distress and child temperament was comparable in magnitude for both cohorts, suggesting that stress experienced in the context of the pandemic may have the same fetal programming effect as stress experienced before the pandemic. The increase in child difficulties would thus be due to heightened prenatal maternal distress, rather than a more pronounced or pandemic‐specific fetal programming effect. Additionally, the authors reported that maternal distress in the prenatal period, but not in the postnatal period, explained the differences in temperament between children born during and before the pandemic.

To date, the existing studies do not allow for clear conclusions to be drawn about the role of prenatal stress on child temperament in the context of the pandemic, especially later during the pandemic. The inconsistencies in the findings of current studies may be explained by variations in the measures of prenatal stress (Nazzari et al., 2024) or in the geographical regions where the studies were conducted (Putnam et al., 2024). The paucity of studies that assess maternal stress during the postnatal period may also contribute to the observed variability in findings. Further research is therefore necessary to clarify the association between prenatal maternal stress experienced in the context of the pandemic and infant temperament, while considering the potential role of postnatal maternal stress. The present study aims to examine the association between stress experienced by pregnant women in Quebec, Canada, in the context of the pandemic and infant temperament at 6 months of age, while assessing the relative contribution of postnatal maternal stress. Although we might expect a significant association between prenatal stress and infant temperament, the potential contribution of postnatal stress is less clear given the current literature.

2. METHODS

2.1. Participants and procedure

A total of 320 French‐speaking pregnant women from the province of Quebec, Canada, were recruited during pregnancy. Recruitment was conducted through social media (Facebook pages for pregnant women or prenatal resources) and through emails sent through daycare centers. The study's participants were required to complete an electronic consent form. Inclusion criteria were (1) to have completed at least 14 weeks of pregnancy; and (2) the absence of congenital or genetic abnormalities or diseases that could significantly affect the development of the unborn child. The research project was approved by the Human Research Ethics Committee of the University of Quebec at Trois‐Rivières (CER‐20‐271‐07.03).

Participant consent was obtained at the time of recruitment. Participants completed an initial online questionnaire during pregnancy (T1) between January 2021 and October 2021. This questionnaire measured sociodemographic variables and prenatal maternal stress. When their child was 6 months old, mothers completed a second online questionnaire (T2) to measure postnatal stress and infant temperament. The final sample consists of 269 participants who have completed both T1 and T2 measures, who live with their child, and whose child does not have a condition or illness affecting his or her development. Five participants were lost because their child had a medical or developmental condition, while the others simply did not complete the questionnaires at T2. No significant differences were identified between participants who did and did not complete T2 on various sociodemographic variables (e.g., maternal age, maternal highest level of education, and family income; all ps > .05).

2.2. Measures

2.2.1. Maternal stress

Consistent with the broad definition of prenatal maternal stress (Davis & Narayan, 2020; Lafortune et al., 2021) and with studies on prenatal stress during the COVID‐19 pandemic, we used multiple measures of prenatal maternal stress, including general subjective stress, objective exposure to stressful events, and pregnancy‐related stress.

General stress level was measured at T1 and T2 using the short version of the psychological stress measure (PSM) (Lemyre & Tessier, 1988, 2003). This nine‐item questionnaire assesses stress according to four components: affective (e.g., “I feel preoccupied, tormented or worried”), cognitive (e.g., “I feel confused: my thoughts are muddled; I lack concentration; I cannot focus”), behavioral (e.g., “I have difficulty controlling my reactions, emotions, moods, or gestures”), and physical (e.g. “I have physical aches and pains: sore back, headache, stiff neck, stomachache”). This measure has been employed in numerous studies of parental stress (e.g., Bernard et al., 2022; Tessier et al., 1992), exhibiting good content validity and test‐retest reliability over a 2‐week period (Lemyre & Tessier, 1988). The total score, calculated by summing all items, ranges from 9 to 72. A higher score indicates greater stress, and a score of over 41 indicates very high stress. The internal consistency of the total scale in this sample was α = .84.

The assessment of pandemic‐related stress was conducted through two distinct methods: (1) objective exposure to COVID‐19; and (2) participants' subjective experience of pandemic‐related stress. Regarding objective exposure to COVID‐19, participants were asked to indicate whether they had experienced the following events since the beginning of their pregnancy (T1) or since the birth of their child (T2): one or more periods of lockdown or preventive isolation, testing for COVID‐19, infection with COVID‐19, hospitalization due to COVID‐19, infection of an immediate family member (children, spouse, parents) with COVID‐19, hospitalization of an immediate family member due to COVID‐19, or death of an immediate family member due to COVID‐19.

The subjective experience of pandemic‐related stress was assessed with two questions at T1 and T2. At T1, participants were first asked to report their perception of the impact of the pandemic on their pregnancy by answering the following question: “Indicate the extent to which you perceive the COVID‐19 pandemic has an impact on your pregnancy, including medical follow‐ups, appointments (e.g., unaccompanied ultrasound), birth preparation, etc.”. At T2, participants were asked to report their perception of the impact of the pandemic on their lives since the birth of their child (“Indicate the extent to which you feel that the situation with the COVID‐19 pandemic has had an impact on your life since the birth of your child (including medical care, support received, visits from relatives, etc.).”). Participants were instructed to respond using a Likert scale ranging from 1 to 10, with 1 denoting a perception of no impact and 10 denoting a perception of a very significant impact. At both T1 and T2, participants were also asked to indicate their overall level of stress related to the COVID‐19 pandemic (“Overall, indicate how stressed you feel about the COVID‐19 pandemic”) on a five‐point Likert scale where 1 was feeling not stressed at all, and 5 was feeling extremely stressed. This method of assessing pandemic‐related prenatal stress has been employed in several studies (e.g., Jeličić et al., 2021; McKee et al., 2024; Provenzi et al., 2023; Sacchi et al., 2024).

2.2.2. Infant temperament

Infant temperament was measured when children were 6 months of age using the short version of the Infant Behavior Questionnaire (3–12 months), Revised (IBQ‐R; Gartstein & Rothbart, 2003; Putnam et al., 2013). The questionnaire comprises 91 items, which are rated on a seven‐point Likert scale ranging from “never” to “always”. The items can be grouped into 14 dimensions (approach, vocal reactivity, high intensity pleasure, smile and laughter, activity level, perceptual sensitivity, sadness, distress to limitations, fear, falling reactivity/rate of recovery from distress, low intensity pleasure, cuddliness, duration of orienting, soothability). These dimensions combine to form the three temperament factors of Rothbart's theoretical model: negative affectivity, surgency/extraversion, and orienting/regulation. Following guidelines for scoring the IBQ‐R, a mean score is calculated for each dimension and factor (Gartstein & Rothbart, 2003; Putnam et al., 2013), with higher scores representing higher levels of negative affectivity, surgency, and orienting/regulation. The short version of the IBQ‐R has demonstrated good psychometric properties, exhibiting good internal consistency across dimensions (α = .70 to .80; Putnam et al., 2013). Convergent validity was also demonstrated between the original and the short version of the questionnaire. The dimensions of the short version strongly correlated with the original version (α = .63 to .86; Putnam et al., 2013). Finally, an internal structure analysis was also conducted, and the factor loadings were satisfactory (“negative affectivity” factor r = .31 and .79, “surgency” factor r = .45 and .74, and “orienting/regulation” factor r = .43 and .70; Gartstein & Rothbart, 2003). In this sample, the internal consistency across dimensions ranged from α = .68 to 83.

2.3. Statistical analyses

Statistical analyses were conducted using SPSS 28 software. Descriptive statistics were calculated for the primary variables, as well as bivariate correlations. To examine the association between prenatal maternal stress and infant temperament, three hierarchical linear regressions were performed, one for each temperament dimension: negative affectivity, surgency, and orienting/regulation. In the first step, sociodemographic variables correlated with temperament were entered into the regression model. Variables assessing prenatal maternal stress (general stress and pandemic‐related stress) were introduced in a second step. Finally, in a third step, postnatal maternal stress variables (general stress and pandemic‐related stress) were entered. This methodological approach enables the examination of the predictive role of prenatal maternal stress with regard to temperament factors, beyond that explained by sociodemographic variables, and takes into account the relative contribution of postnatal maternal stress. For correlation and regression analyses, categorical variables were first tested using all categories. To check that results were robust, analyses were also conducted by collapsing categories with fewer than five participants (e.g., income less than $40,000). Results remained the same when categories were combined. Therefore, we present results using the full range of all categorical variables. 

3. RESULTS

3.1. Descriptive statistics

Table 1 presents descriptive statistics for sociodemographic variables, prenatal maternal stress, postnatal maternal stress, and child temperament. At T1, expectant mothers were on average 29.57 years old (SD = 3.66), had completed between 14 and 40.2 weeks of pregnancy (M = 24.13; SD = 7.45), and 43.7% were expecting their first child. The majority had a college degree (65.9%), were in a relationship with the child's father (96.7%), and identified as Caucasian (87%). The median annual family income was between $100,000 and $150,000 (Can$). The mean age of the infants at T2 was 6.16 months (SD = .61), with 43.3% of the infants being girls and 56.7% of the infants being boys.

TABLE 1.

Descriptive statistics for sociodemographic variables, prenatal and postnatal maternal stress and child temperament.

Mean (standard deviation) n (%)
Sociodemographic variables
Maternal age 29.57 (3.66)
Maternal highest level of education
 Primary school 1 (.4)
 Secondary school 5 (1.9)
 Professionnal training 19 (7.1)
 Technical qualification 66 (24.7)
 Undergraduate degree 117 (43.8)
 Master degree 50 (18.7)
 Doctorate 9 (3.4)
Family income
 Less than $20,000 1 (.4)
 Between $20,000 and $40,000 8 (3.1)
 Between $40 000 and $60,000 17 (6.5)
 Between $60,000 and $80,000 35 (13.4)
 Between $80,000 and $100,000 67 (25.6)
 Between $100,000 and $150,000 100 (38.2)
 More than $150,000$ 34 (13.0)
Marital status
 Single 5 (1.9)
 In a relationship with the child's father 260 (96.7)
 In a relationship with another spouse 2 (.8)
Ethnicity
 Caucasian 234 (87.0)
 African Canadian 3 (1.1)
 Hispanic 4 (1.5)
 Asiatic 3 (1.1)
 Aboriginal 1 (.4)
 Mix 6 (2.2)
 Others 2 (.7)
Parity (nulliparous) 117 (43.7)
Gestational weeks at T1 24.13 (7.45)
Child age at T2 (in months) 6.16 (.6)
Child sex
 Boy 152 (56.7)
 Girl 116 (43.3)
Prenatal maternal stress
Lockdown 93 (35.4)
Test for COVID‐19 79 (29.5)
Infection with COVID‐19 6 (2.2)
Hospitalization due to COVID‐19 1 (.4)
Infection of a family member with COVID‐19 20 (7.5)
Hospitalization of a family member due to COVID‐19 5 (1.9)
Death of a family member due to COVID‐19 0 (0)
Objective exposition to COVID‐19 (total score) .78 (.96)
Psychological stress measure (PSM) 31.06 (9.72)
Perceived impact of the pandemic on pregnancy 5.88 (2.30)
Overall stress related to the pandemic 1.41 (.84)
Postnatal maternal stress
Lockdown 100 (38.2)
Preventive isolation 94 (35.1)
Test for COVID‐19 170 (63.4)
Infection with COVID‐19 73 (28)
Hospitalization due to COVID‐19 0 (0)
Test for COVID‐19 (infant) 96 (35.8)
Infection with COVID‐19 (infant) 50 (19.9)
Hospitalization due to COVID‐19 (infant) 3 (1.1)
Infection of a family member with COVID‐19 104 (39)
Hospitalization of a family member due to COVID‐19 3 (1.1)
Death of a family member due to COVID‐19 2 (.7)
Objective exposition to COVID‐19 (total score) 2.59 (2.38)
Psychological stress measure (PSM) 34.71 (12.28)
Perceived impact of the pandemic since birth 5.35 (2.40)
Overall stress related to the pandemic 1.26 (.91)
Child temperament
Negative affectivity 3.01 (.81)
Surgency 4.64 (.70)
Orienting/Regulation 5.37 (.60)
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In relation to prenatal maternal stress, PSM scores ranged from 12 to 63, with 14.6% of mothers reporting a high level of stress. With respect to pandemic‐related stress, the mean total score of objective exposure to COVID‐19 was .78 (SD = .96), with scores ranging from 0 to 6. In terms of subjective assessment of pandemic‐specific stress, 44.2% of participants reported a moderate impact of the pandemic on their pregnancy (score between 5 and 7), while 27.7% reported a high impact (score of 8 or more). Concerning the overall stress experienced by mothers in relation to the pandemic, the majority of mothers reported being “not at all” (12.7%), “slightly” (43.3%) or “moderately” (35.8%) stressed, while 8.2% reported being “very” or “extremely” stressed.

In relation to postnatal maternal stress, PSM scores ranged from 11 to 72, with 29.1% of mothers reporting a high level of stress. Since the birth of their child, mothers were exposed to a mean of 2.59 (SD = 2.38) stressful events related to COVID‐19, with scores ranging from 0 to 8. In terms of subjective pandemic‐related stress, 38.7% of participants reported a moderate impact of the pandemic on their life since the birth of their child (score between 5 and 7), while 21.9% reported a high impact (score of 8 or more). Most participants reported being “not at all” (19.8%), “slightly” (44.8%) or “moderately” (25.7%) stressed by the pandemic, while 9.7% reported being “very” or “extremely” stressed.

The mean scores obtained for the three temperament factors were 4.64 (SD = .70) for negative affectivity, 3.01 (SD = .81) for surgency, and 5.37 (SD = .60) for orienting/regulation. Table 2 presents the correlations between sociodemographic variables, prenatal maternal stress, postnatal maternal stress, and infant temperament.

TABLE 2.

Correlations between sociodemographic variables, prenatal maternal stress, postnatal maternal stress and child temperament.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  1. Maternal age

 –

  1. Maternal education

 .26 ***

  1. Family income

 .34 *** .36 ***

  1. Siblings in family

 .31 *** .06 .16 *

  1. Child age

 .08 −.08 −.07 .05

  1. Child sex

 .05 .05 .004 −.01 −.004

  1. Prenatal PSM

 .02 −.02 −.01 .18 ** .06 −.13 *

  1. Prenatal objective exposition to COVID‐19

 .11 † −.04 .01 −.001 −.003 −.08 .07

  1. Perceived impact of the pandemic on pregnancy

 −.08 −.03 −.02 −.12 * −.03 −.07 .16 ** .15 *

  1. Prenatal overall stress related to the pandemic

 .06 .07 −.01 .04 .01 .01 .34 *** .07 .58 ***

  1. Postnatal PSM

 .12 † .06 .05 .18 ** .08 −.01 .50 *** .10 .21 ** .30 ***

  1. Postnatal objective exposition to COVID‐19

 −.04 −.11 † −.09 .19 ** .05 .01 .02 −.12 † −.06 −.06 .06

  1. Perceived impact of the pandemic (postnatal)

 .04 .10 † .04 .10 .04 −.01 .14 * .04 .39 *** .32 *** .26 *** .12 *

  1. Postnatal overall stress related to the pandemic

 .06 .12 * .05 .14 * .06 .06 .24 *** −.03 .32 *** .43 *** .34 *** .03 .56 ***

  1. Negative affectivity

 .03 .07 .06 −.03 −.03 −.06 .09 .06 .21 *** .11 † .18 ** .04 .18 ** .21 **

  1. Surgency

 −.09 −.08 −.17 ** −.18 ** .05 −.03 −.05 .10 .14 * .06 −.03 −.08 .12 † .02 .06

  1. Effortful control

 −.03 −.03 −.13 * .07 −.02 .02 −.11 † .02 −.15 * −.12 * −.18 ** −.01 −.02 −.09 −.39 *** .44 ***
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Abbreviations: PSM, psychological stress measure.

†

p < .10;

*

p < .05;

**

p < .01;

***

p < .001.

3.2. Main analyses

Table 3 presents the results of the three hierarchical regressions designed to examine the predictive role of prenatal maternal stress in the context of the pandemic for the three temperamental factors, taking into account postnatal stress. Given that family income and the presence of other children in the family were correlated with infant temperament, they were entered first, and prenatal and postnatal maternal stress variables were entered as predictors in the second and third steps, respectively.

TABLE 3.

Prediction of temperament factors from prenatal and postnatal maternal tress.

Negative affectivity Surgency Orienting/regulation
Step 1 Step 2 Step 3 Step 1 Step 2 Step 3 Step 1 Step 2 Step 3

(F = .68, df = 239)

β

(F = 2.23 * , df = 239)

β

(F = 2.67 ** , df = 239)

β

(F = 4.47 * , df = 239)

β

(F = 2.35 * , df = 239)

β

(F = 1.79 † , df = 239)

β

(F = 2.00, df = 239)

β

(F = 2.38 * , df = 239)

β

(F = 2.14 * , df = 239)

β

Control variables
Family income .07 .07 .07 −.12 † −.12 † −.13 * −.09 −.10 −.10
Siblings in family .02 .03 −.01 −.14 * −.13 † −.13 † −.07 −.07 −.08
Prenatal stress
PSM .06 −.03 −.04 −.04 −.06 .02
Objective exposure to COVID‐19 .03 .04 .11 † .10 .09 .10
Perceived impact of the pandemic on pregnancy .22 ** .19 * .05 .02 −.17 * −.20 *
Overall stress related to the pandemic −.04 −.10 .04 .03 −.001 −.01
Postnatal stress
PSM .15 * .02 −.15 *
Objective exposure to COVID‐19 .05 −.08 −.04
Perceived impact of the pandemic −.03 .14 .15 †
Overall stress related to the pandemic .18 * −.05 −.02
ΔR2 .01 .05 * .05 * .04 * .02 .01 .02 .04 * .03
 R2 .01 .05 .10 .04 .06 .07 .02 .06 .09
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Abbreviations: PSM, psychological stress measure.

†

p < .10;

*

p < .05;

**

p < .01.

For negative affectivity, the second step assessing the role of prenatal stress was significant, accounting for 5% of the total variance (F = 2.23, p < .05). Adding postnatal maternal stress variables significantly improved the model (ΔR 2 = .05, p < .05). The final model accounted for 10% of the variance (F = 2.67, p < .05), with the perceived impact of the pandemic on pregnancy, overall postnatal stress (PSM), and overall postnatal stress related to the pandemic significantly predicting higher negative affectivity in infants.

Regarding surgency, the second step assessing the role of prenatal maternal stress significantly predicted 4% of variance (F = 2.35, p < .05). Lower family income, primiparity, and a higher perceived impact of the pandemic on pregnancy tended to predict higher surgency in children. However, the final model including postnatal maternal stress variables was no longer significant (F = 1.79, p = .06). Only sociodemographic variables significantly predicted surgency, with lower income predicting higher surgency and primiparity showing a trend to predict higher levels of surgency.

For orienting/regulation, the second model examining the role of prenatal maternal stress was significant, accounting for 6% of the observed variance (F = 2.38, p < .05). The final model including postnatal maternal stress was also significant and accounted for 9% of the variance (F = 2.14, p < .05). In the final model, a higher perceived impact of the pandemic on pregnancy and a higher overall postnatal stress (PSM) predicted lower regulation in infants, while a higher perceived impact of the pandemic since the birth of the child tended to predict higher regulation skills in infants.

4. DISCUSSION

The primary objective of this study was to prospectively examine the association between prenatal maternal stress in the context of the COVID‐19 pandemic and infant temperament. The results indicated that prenatal maternal stress in the context of the pandemic predicted infant temperament, even after accounting for postnatal stress. The results therefore support the fetal programming hypothesis, while underscoring the additional contribution of maternal stress during the initial postnatal period.

Specifically, for two of the three temperament factors, negative affectivity and orienting/regulation, the perceived impact of the pandemic on pregnancy was significantly associated with temperament. Expectant mothers who perceived a higher impact of the pandemic on their pregnancy reported more negative reactivity in their child, and poorer child regulation at 6 months of age. Analyses show that the perceived impact of the pandemic on pregnancy was not associated with surgency, and that other prenatal stress variables did not predict temperament. These results are generally consistent with those of studies conducted during the pandemic (López‐Morales et al., 2024; Provenzi et al., 2023), except for the association between prenatal maternal stress and extraversion documented by some authors (López‐Morales et al., 2024). The results of the present study suggest that the temperament factors of negative affectivity and orienting/regulation may be more sensitive to the stress experienced by the mother during pregnancy.

The perceived impact of the pandemic on pregnancy appears to be a particularly important variable in understanding pregnant women's experiences of the pandemic and the subsequent development of their child. A significant proportion of the pregnant women in the sample reported that the pandemic had a considerable impact on their pregnancies, with 71.9% indicating a moderate to high impact. Our research team (Pearson et al., 2023) documented in the same sample that this was the measure on which participants reported the highest level of stress, compared with their subjective assessment of their general level of stress or their overall level of stress related to the pandemic. This measure captures the numerous adaptations that pregnant women had to make in relation to changes in antenatal care and delivery conditions in the context of the pandemic (Barbosa‐Leiker et al., 2021; Khoury et al., 2021). As indicated by other studies (Akgor et al., 2021; Bérard et al., 2021; Preis, Mahaffey, Lobel, 2020), pandemic‐related prenatal stress appears to be the most salient indicator of prenatal maternal stress in the context of the pandemic.

The results of the study also underscore the distinctive contribution of both prenatal and postnatal maternal stress. On the one hand, the support for the fetal programming hypothesis provided by these findings is consistent with the results of the study by Morris and Saxbe (2023), which showed that higher negative affectivity in children born during the pandemic was due to prenatal (but not postnatal) maternal distress. These findings are also consistent with pre‐pandemic studies on fetal programming of temperament (Davis et al., 2007; Madigan et al., 2018; McMahon et al., 2013; Rodríguez‐Soto et al., 2021). Intrauterine environmental conditions thus appear to influence temperamental manifestations during the first months of life.

On the other hand, the findings also provide evidence for the additional contribution of maternal stress experienced during the postnatal period with regard to negative affectivity and orienting/regulation factors. Higher general and overall pandemic‐related stress in the mother predicted greater negative reactivity in the child. Heightened postnatal general stress in the mother predicted poorer orienting/regulation skills, whereas higher perceived impact of the pandemic during the initial postnatal period tended to predict better orienting/regulation skills in the child. This finding is particularly noteworthy in light of the established link between prenatal perceived impact of the pandemic on pregnancy and subsequent poorer regulation in the child. One potential explanation for this phenomenon is that mothers who reported a significant impact of the pandemic on their lives may have allocated more time to their children, possibly due to periods of lockdown or preventive isolation. This hypothesis is further supported by the notion that regulatory skills are partly developed through interactions with parents (Bernier et al., 2010). Consequently, the shared moments between parents and their children may have been beneficial for the children.

As mothers adapted to their new reality with a newborn, the ongoing pandemic may have presented a particularly significant challenge. In fact, 29.1% of mothers reported high levels of general stress during the postpartum period, twice as much as reported by the same participants in the prenatal period. Having a newborn may be challenging enough in itself to partly explain the increase in maternal stress. However, the reduced support the mothers received from relatives or postpartum resources, in conjunction with concerns regarding their own and their child's health, may have been additional sources of stress during the first months with their child. The restriction of access to antenatal classes (Khoury et al., 2021), which are designed to prepare women for the arrival of their child, may have exacerbated these challenges. The findings also showed that this postnatal general stress is associated with more manifestations of negative affectivity and emotional regulation difficulties and underscore the importance of supporting mothers during this transition, particularly in an adverse context such as the pandemic.

Finally, it is important to acknowledge that all the prenatal and postnatal stress variables account for a modest proportion of the observed variations in infant temperament, ranging from 7% to 10%. Consequently, it is important to avoid an alarmist attitude regarding the possible consequences of the pandemic on children's development. It is therefore necessary to exercise caution when drawing conclusions about the impact of the pandemic on infant development, while also recognizing the potential stress experienced by expectant mothers during this period. It also appears that child temperament may be predominantly influenced by other factors, such as parenting behaviors, parental mental health, and child health, which warrant further investigation in future studies.

4.1. Limitations

A number of limitations of this study need to be considered. First, the sample is predominantly composed of families from advantaged socioeconomic backgrounds. Several studies have documented that being in a relationship (Moyer et al., 2020; Stepowicz et al., 2020) and having a higher level of education (Giesbrecht et al., 2022; Kahyaoglu Sut & Kucukkaya, 2021; Luo et al., 2022; Moyer et al., 2020) serve as protective factors against prenatal maternal stress in the context of the pandemic. Given the characteristics of the sample, it is possible that the stress experienced may not be representative of that experienced by other populations, and therefore the documented fetal programming effect may be of lesser magnitude in our study. Additionally, the sample is composed of a high proportion of Caucasian women. While this sample is representative of the population in Quebec, Canada (Institut de la statistique du Québec, 2024), it does not allow for the examination of variations in prenatal stress according to ethnic group and cultural values. Some studies have documented higher levels of prenatal stress in other populations of pregnant women during the pandemic (López‐Morales et al., 2024; Parra‐Saavedra et al., 2020; Perzow et al., 2021), suggesting that the programming effect may be generalizable to or even more pronounced in other populations.

Second, it should also be noted that pandemic‐related subjective stress was assessed using only two items at each time point. While numerous studies on prenatal stress conducted during the pandemic have used a similar approach (e.g., Jeličić et al., 2021; McKee et al., 2024; Provenzi et al., 2023; Sacchi et al., 2024), a more comprehensive assessment of pandemic‐related stress (e.g., Preis, Mahaffey & Lobel, 2020) may have yielded more nuanced results. Moreover, the data collection period was extensive, suggesting variations in virus spread and public health measures at the time of questionnaire completion by the mothers. Despite the evidence that a loosening of specific public health restrictions was not associated with variations in prenatal stress reported by pregnant women (Matvienko‐Sikar et al., 2021), it is plausible that expectant mothers' prenatal experiences varied according to the timing of their questionnaire completion. However, the significant results regarding child temperament suggest that the pandemic, in its totality and not solely in its initial stages, may have been a substantial challenge for pregnant women and mothers of newborn babies.

In addition, all measurements were completed by the mothers themselves. Although these measures may offer increased ecological validity, this methodological limit could potentially have amplified the documented associations. For instance, unmeasured maternal characteristics, such as stress or symptoms of postpartum depression, may have influenced the perception of infant negative affectivity and low regulatory abilities. However, the longitudinal design with prospective measures of prenatal stress is a notable strength of the study, thereby enhancing the validity of the results.

Finally, stress experienced by mothers in the postnatal period is associated with the quality of care provided to the child, which could in turn be associated with child temperament (Hentges et al., 2019). Consequently, it would be important to conduct future studies that include all of these variables. Despite these limitations, the present study contributes to the emerging scientific literature on the association between prenatal maternal stress in the context of the COVID‐19 pandemic and child development.

5. CONCLUSION

The primary objective of the present study was to prospectively examine the association between prenatal maternal stress in the context of the COVID‐19 pandemic and infant temperament. The results of the study indicated that prenatal maternal stress broadly predicted early child temperament. Furthermore, the stress experienced by mothers in the postnatal period was found to be associated with their child's temperament in early life. While further research is needed to elucidate the underlying mechanisms linking prenatal stress and child temperament, it is important to provide support to mothers during the perinatal period to promote an optimal developmental trajectory for children.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

ACKNOWLEDGMENTS

This research was funded by the Fonds de recherche du Québec—Society and culture and by the Social Sciences and Humanities Research Council.

Pearson, J. , Caron, R. , Zdebik, M. A. , Baudry, C. , & Fréchette‐Boilard, G. (2026). Fetal programming of infant temperament: An examination of prenatal maternal stress during the COVID‐19 pandemic. Infant Mental Health Journal, 47, e70037. 10.1002/imhj.70037

DATA AVAILABILITY STATEMENT

Data not available/the data that has been used is confidential. When agreeing to participate, participants were assured that raw data would remain confidential.

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