Abstract
The pregnancy period represents a unique window of opportunity to identify risks to both the fetus and mother and to deter the intergenerational transmission of adversity and mental health problems. Although the maternal-fetal dyad is especially vulnerable to the effects of stress during pregnancy, less is known about how the dyad is also receptive to salutary, resilience-promoting influences. The present review adopts life span and intergenerational perspectives to review four key areas of research. The first part describes how pregnancy is a sensitive period for both the mother and fetus. In the second part, the focus is on antecedents of maternal prenatal risks pertaining to prenatal stress response systems and mental health. The third part then turns to elucidating how these alterations in prenatal stress physiology and mental health problems may affect infant and child outcomes. The fourth part underscores how pregnancy is also a time of heightened fetal receptivity to maternal and environmental signals, with profound implications for adaptation. This section also reviews empirical evidence of promotive and protective factors that buffer the mother and fetus from developmental and adaptational problems and covers a sample of rigorous evidence-based prenatal interventions that prevent maladaptation in the maternal-fetal dyad before babies are born. Finally, recommendations elaborate on how to further strengthen understanding of pregnancy as a period of multilevel risk and resilience, enhance comprehensive prenatal screening, and expand on prenatal interventions to promote maternal-fetal adaptation before birth.
Highlights
The prenatal period is a time of rapid development, when a multitude of psychological and physiological changes occur for both mother and fetus
The present review focuses on the intergenerational transmission of risk and resilience during the pregnancy period, with a focus on understanding (a) antecedents of maternal prenatal mental health problems and stress rooted in maternal lifetime adversity, and (b) consequences of maternal mental health problems and stress on offspring outcomes
Prenatal stress includes perceptions of stress as well as stress physiology, and mental health problems during pregnancy include depression, generalized anxiety and post-traumatic stress disorder (PTSD). We focus on these three mental health problems because of their common occurrence in pregnant women, the increasing body of research linking them to alterations in stress physiology during pregnancy, and the evidence that when these disorders occur during pregnancy, they are associated with fetal development
Summary
The pace of fetal development far exceeds development during any other period of the life span. Neurogenesis commences as early as 42 days after conception (Stiles & Jernigan, 2010) and by the end of the second trimester, 200 billion neurons have been produced (Bourgeois, 1997) Cells migrate to their final destination where they begin to arborize and form dendritic branches (Sidman & Rakic, 1973). The developing fetal brain is susceptible to harm from teratogenic factors such as toxins, infection, maternal stress including prenatal mental health problems, and other environmental exposures (Davis, Head, Buss, & Sandman 2017; Davis et al, 2019; Kim et al, 2017; Madigan et al, 2018). Understanding the influence of prenatal experiences, both adverse and salutary, on fetal brain development is critical because it allows us to investigate individual differences in infants’ emotional and cognitive development and their subsequent vulnerability and resilience to mental health problems
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