Exposure to maternal childhood abuse and depression in utero: effects on neonatal behavioral regulation and the hypothalamic-pituitary-adrenal (HPA) axis

Carmine M Pariante, Susan Conroy, Enrica Fantini, Sarah Osborne, Susan Pawlby, Patricia Zunszain, King's College London, Institute of Psychiatry, London, UK. Presented at the 14th World WAIMH Congress, Edinburgh, June 2014.

Childhood abuse predicts maternal depression at vulnerable times such as the perinatal period. Furthermore maternal depression in pregnancy is associated with poor neonatal outcome. Here we examine the effect of a mother's own experience of childhood abuse and of a major depressive disorder in pregnancy on the neonate's regulatory behavior. Sixty-six women were assessed at 25-weeks' gestation for Major Depressive Disorder (MDD; SCID-I) and for childhood abuse (CA; CECA-Q: Bifulco, 2005). Fifty-five neonates (15 offspring of mothers with neither MDD nor CA; 10 of mothers with MDD only; 8 of mothers with CA only; 22 of mothers with MDD and CA) were assessed with the Neonatal Behavioral Assessment Scale (NBAS). Neonatal salivary cortisol was measured before and after the assessment. Results: Group differences were found in the NBAS scores (alertness: KW(3)=13.40, p=.004; irritability: K-W(3)=8.24, p=.04). Compared with offspring of CA only mothers, those with MDD only mothers were less alert (z=2.89; p<.05) and more irritable (z=2.22; p<.05); likewise, offspring of mothers with MDD and CA were less alert (z=3.47; p<.05) and more irritable (z=2.52; p<.05). No differences were found in the NBAS scores of offspring of mothers with neither MDD nor CA compared with the other groups. Difficulties in neonatal regulatory behavior were significantly correlated with increased cortisol levels following the NBAS (alertness: r=-.41, p=.002; irritability: r=.39, p=.005). Prenatal exposure to MDD with or without maternal CA is associated with dysregulated neonatal behavior and increased HPA axis activity following the stress of being handled. One explanation why offspring exposed to maternal CA only had high alert and low irritability scores may be their over-regulation and unresponsivity to stress.