Table 1.

Summary of studies examining exposure to postnatal maternal anxiety symptoms and child outcomes

Study, location, and design	Measures	Participants	Primary results	Main limitations
Somatic outcomes
1. Carey (1963) Location not reported Cross-sectional	Anxiety—clinical interview Infant colic—paroxysms of irritability, fussing, or crying in a healthy, well-fed infant occurring for >3 h a day and ≥ 3 days in any 1 week in infants under 4 months old	Recruited from one physician’s private practice 103 mother–infant pairs	Maternal anxiety during the postnatal period was associated with infant colic (χ2=13.4, p<0.01)	Unmasked assessment Cross-sectional design leaves temporality questionable Not generalizable No control of depression Article lacks sufficient detail for thorough evaluation
2. Akman et al. (2006) Turkey Nested case-control	Anxiety—State Trait Anxiety Inventory (STAI) at 1 month postpartum Infant colic—periods of irritability, fussing, or crying for >3 h a day, ≥3 days a week for at least 1 week in infants up to 6 months of age	Women with uneventful pregnancies recruited from one university hospital Maternal age: cases = 31.1 years± 6.0a; controls=29.6 years ±4.8a 78 mother–infant dyads	Mothers of infants with colic had higher median trait anxiety score [42.0 (IQR=33.5–51.0) versus 36 (IQR=31.5–44.5); NS] Overall STAI median was higher in colic group [44.0 (IQR=41.5–51.0) versus 41 (IQR=33.0–49.5); NS]	Small sample size No control of depression Not generalizable Single time point anxiety assessment may not be generalizable to entire postpartum period
3. Coulthard and Harris (2003) United Kingdom Prospective cohort	Anxiety—STAI Food refusal—Child Feeding Assessment Form (developed for study) at 1, 5, and 11 months postnatal	Primiparous women Recruited from one hospital Uncomplicated, singleton pregnancies Mean maternal age=28, range 17–40 years 106 mother–infant dyads	Association between incidence of food refusal and state anxiety at 1, 5, or 11 months, NS Unresolved food refusal was associated with State anxiety at 1 month [F (1,59)=3.88, p<0.05] and 11 months [F (1,59)=8.04, p<0.005]	Small sample size
4. Ramchandani et al. (2006) United Kingdom Prospective cohort	Anxiety—Crown-Crisp Anxiety subscale Recurrent abdominal pain—Recurrent Abdominal Pain Assessment (developed for study) in children 6.5 years of age	Children born in Avon, England Singleton births Child survived first year of life Mean maternal age 28, range 14–46 years 8,272 mother–infant dyads	Maternal anxiety in the first year of life was associated with risk of recurrent abdominal pain (RAP) at 6.5 years (OR=1.53, p<0.001) Increasing levels of maternal anxiety were associated with an increasing trend for RAP risk (χ2=90.86, 3 df., p<0.001)	Single time point anxiety assessment may not be generalizable to entire postpartum period
Developmental outcomes
5. Slykerman et al. (2007) New Zealand Cross-sectional	Anxiety—Perceived Stress Scale (PSS) Developmental delay—Revised Denver Prescreening Developmental Questionnaire in babies 12 months of age	All full-term, small for gestational age infants Random sample of full-term, normal size infants Recruited in two New Zealand regions Excluded multiple births and congenital abnormalities interfering with growth 655 mother–infant dyads	Stress at 12-months and developmental delay in small for gestational age infants, NS Developmental delay in normal sized infants, NS	Cross-sectional design prevents temporal association Single time point anxiety assessment may not be generalizable to entire postpartum period
6. Galler et al. (2000) Barbados Prospective cohort	Anxiety—Zung Anxiety Scale (ZAS) Cognitive development—Griffiths Mental Development Scales administered to 3 month old infants	Every other healthy mother–infant dyad Recruited from only Barbados hospital Maternal age 25.3 ± 5.3 yearsa Parity 2.6 ± 1.6a 92 mother–infant dyads	Anxiety at 7 weeks was negatively associated with personal-social development at 3 months (r=−0.34, p<0.001); PMA at 7 weeks and motor and cognitive development at 6 months, NS	Single time point anxiety assessment may not be generalizable to entire postpartum period
7. Galler et al. (2004b) Barbados Prospective cohort	Anxiety—ZAS Performance on Common Entrance Exam—standardized national exam given to 11 year old children	Every other healthy mother–infant dyad Recruited from only Barbados hospital Maternal age 25.3±5.3 yearsa Parity 2.3±1.5a 169 mother-infant pairs	Maternal anxiety at 7 weeks was associated with overall exam score (r=−0.25, p<0.05), and English scores (r=−0.29, p<0.01) Math and essay scores, NS	Single time point anxiety assessment may not be generalizable to entire postpartum period
Psychological outcomes
8. Nicol-Harper et al. (2007) United Kingdom Cross-sectional	Anxiety—STAI Infant emotional tone—videotaped, coded interactions; examining maternal characteristics and infant emotional tone at 1 year postpartum	Mothers of infants aged 10–14 months Recruited through community advertisements Maternal age: high anxious 33.2± 4.78 yearsa; low anxious 33.62± 4.04 yearsa 32 high- and 32 low-anxiety mother–infant dyads	Infant emotional tone was not associated with trait anxiety at 1 year postpartum (Mann-Whitney =−1.13, p=0.36)	Small sample size Cross-sectional design prevents temporal association Single time point anxiety assessment may not be generalizable to entire postpartum period
9. O’Connor et al. (2002) United Kingdom Prospective cohort	Anxiety—Crown-Crisp Anxiety subscale Behavioral and emotional problems—Strengths and Difficulties Questionnaire evaluated children at 4 years of age	Children born in Avon, England Singleton births Full-term infants Child survived first year of life Mean maternal age 28, range 14–46 years 7,824 mother–infant pairs	8-weeks postnatal maternal anxiety was associated with emotional problems in boys (OR=1.49, p<0.05) and girls (OR=1.48, p<0.05) and conduct problems in girls (OR=1.45, p<0.05) at 4-years-old Inattention and hyperactivity, NS	Single time point anxiety assessment may not be generalizable to entire postpartum period
10. O’Connor et al. (2003) United Kingdom Prospective cohort	Anxiety—Crown-Crisp Anxiety subscale Behavioral and emotional problems—Strengths and Difficulties Questionnaire evaluated children at 6.5 years of age	Children born in Avon, England Singleton births Full-term infants Child survived first year of life Mean maternal age 28, range 14–46 years 6,493 mother–infant pairs	Maternal anxiety at 8 weeks postpartum was associated with an increase risk of emotional problems in boys (OR=1.6, p<0.05) and conduct problems in girls (OR=1.94, p<0.05) Inattention and hyperactivity, NS	Single time point anxiety assessment may not be generalizable to entire postpartum period
11. Barnett et al. (1991) Australia Prospective cohort	Anxiety—STAI Child psychopathology Child Behavior Checklist in 5-year-olds	Primiparous women recruited on the 3rd or 4th postpartum day Mean maternal age=34, range 24–49 years 100 mother–child pairs Mean parity=2.1, range 1–4	Parental ratings of children of high anxiety mothers were rated as less active (t=1.7, p< 0.05) and lower in social competence (t=1.74, p<0.05). Boys were also rated as more immature (t=1.76, p<0.05), more delinquent (t=1.89, p<0.05) and more schizoid (t=1.8, p<.05) Teacher reports on the CBCL were not associated with maternal anxiety	Small sample size Single time point anxiety assessment may not be generalizable to entire postpartum period
12. Coplan et al. (2005) Canada Cross-sectional	Anxiety—STAI Infant temperament—Infant Behavior Questionnaire at 3 months of age	Mothers between 26 and 38 weeks pregnant Community sample Maternal age 31.85±4.46 yearsa 46 mother–infant dyads	PMA at 3 months was associated with infant activity level (state anxiety r=0.49, p<0.01), distress to limitations (state anxiety r=0.31, p<0.05; trait anxiety r=0.42, p<0.01), and soothability (trait r=−0.31, p<0.05)	Small sample size Single time point anxiety assessment may not be generalizable to entire postpartum period Cross-sectional design prevents temporal association
13. Diener et al. (1995) United States Cross-sectional	Anxiety—STAI Infant temperament—Bates Infant Characteristics Questionnaire assessed at 3 months postpartum	Primiparous, married women Recruited from community sources through advertisements Full-term infants 70 mother–infant pairs	Maternal anxiety scores at 3 months were not associated with perceived infant temperament ratings at 3 months postpartum	Small sample size Cross-sectional design prevents temporal association Single time point anxiety assessment may not be generalizable to entire postpartum period
14. McMahon et al. (2001) Australia Cross-sectional	Anxiety—STAI Infant temperament—Short Temperament Scale for Infants administered to 4 months old infants	Primiparous women with infants<4 months Resident women: recruited from one residential care unit Community women: recruited from one obstetrical practice Residential group maternal age 31±4.2 yearsa Community group maternal age 32±2.3 yearsa 128 residential care mothers and 58 community mothers	Infant difficultness at 4 months associated with both trait and state anxiety [(residential group r=0.41, p<0.001; control group r=0.36, p<0.001) (residential group r=0.43, p<0.001; control group r=0.30, p<0.01); respectively]	Small sample of controls Cross-sectional design prevents temporal association Single time point anxiety assessment may not be generalizable to entire postpartum period
15. Davis et al. (2004) United States Prospective cohort	Anxiety—STAI Infant temperament—videotapes of infants coded using the Harvard Infant Behavioral Reactivity evaluated at 4 months of age	Women recruited from 1 university obstetric clinic Healthy, singleton pregnancies No diagnosed psychological disorder No alcohol or substance use during pregnancy 22 mother–infant pairs	Infant behavior at 4 months was not associated with 8-week postpartum anxiety	Small sample size
16. Galler et al. (2004a) Barbados Prospective cohort	Anxiety—ZAS Infant temperament—Casey Revised Infant Temperament Questionnaire at 6 months of age	Every other healthy mother–infant dyad Recruited from only hospital Maternal age 25.3±5.3 yearsa Parity 2.6±1.6a 106 mother–infant dyads	PMA at 7 weeks and infant temperament at 6 months, NS PMA at 6 months was correlated with adaptability (r=−0.25, p<0.01), infant mood (r=−0.17, p<0.05), and threshold subscales (r=0.2, p<0.05)	Single time point anxiety assessment may not be generalizable to entire postpartum period
17. Pesonen et al. (2005) Finland Cross-sectional	Anxiety—PSS Infant temperament—Infant Behavior Questionnaire tested at 6 months postpartum	Consecutive mothers recruited from one Helsinki hospital Healthy, singleton infants Maternal age 29.1±4.3 yearsa 319 mother–infant dyads	Postnatal perceived stress at 6 months was associated with distress to limitations (β=0.23, t=3.1, p<0.001), fear (β=0.15, t=1.9, p<0.001), negative reactivity (β=0.23, t=3.1, p<0.001) and smiling and laughter (β =−0.15, t=−1.9, p<0.01) Activity, positive reactivity, and overall reactivity, NS	Cross-sectional design leaves temporality questionable
18. Susman et al. (2001) United States Prospective cohort	Anxiety—STAI Child temperament—Children’s Behavior Questionnaire evaluated in 3-year-olds	Primiparous mothers recruited at ≤16 weeks gestation <20 years at expected delivery date Planned to keep baby English fluency Absence of severe mental or chronic illness in mothers 67 mother–infant dyads	Association with postpartum emotions and child temperament, NS	Sample size Sample size may not be generalizable

r correlation coefficient, F ANOVA statistic, IQR Inter-Quartile Range, NS not significant, PMA postnatal maternal anxiety

^aMean ± Standard deviation