Child Cognitive Outcomes Research Articles

Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis.

Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. We identified 21 trials with 28 284 mother-child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13-1.71, ten trials, N = 4749 mother-child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02-0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.

Parental education, television exposure, and children's early cognitive, language and behavioral development

The association between television exposure and children's development is subject to controversial debates. Heavy television exposure may be detrimental to children by overstimulating their developing brains. It may also infringe on time that children would otherwise spend on more developmentally beneficial activities or parental interactions. In the present analysis, we use data from the 2004/5 birth cohort of the Growing Up in Scotland study to investigate relations between hours of weekly television measured around the ages of two to four and as average over this period with children's linguistic, cognitive, and behavioral outcomes around the age of five. Our analysis shows differences in the level and growth of television exposure by parental education. However, we did not find any substantive associations between television exposure and children's cognitive or language ability. We found small associations of television exposure with conduct problems and prosocial behavior, particularly for children of less-educated parents. Overall, the results suggest that the impact of television on children's development is less pronounced than often assumed.

Young lives and wealthy minds: The nexus between household consumption capacity and childhood cognitive ability

Childhood cognitive outcomes are an important indicator of future human capital potential and a predictor of economic development in low-and middle-income countries. Recent studies have examined the role household resources have to play in fostering human capital potential from an early age. This paper contributes to the literature by examining the relationship between household consumption capacity and cognitive ability for children in Ethiopia, Peru, and Vietnam using longitudinal data from the Young Lives study. A modest relationship between household consumption capacity and cognitive ability is established using hierarchical fixed effects models. This result is robust to alternative measures of cognitive ability and wealth. Further, the study considered non-linear specifications to determine whether the association between consumption capacity and cognitive ability diminishes at relatively higher wealth levels. Contrary to theoretical predictions, results from the model suggest that the relationship between consumption capacity and cognitive ability is predominantly linear.

Brain Tumors in NF1 Children: Influence on Neurocognitive and Behavioral Outcome

Neurofibromatosis type-1 (NF1) is a monogenic tumor-predisposition syndrome creating a wide variety of cognitive and behavioral abnormalities, such as decrease in cognitive functioning, deficits in visuospatial processing, attention, and social functioning. NF1 patients are at risk to develop neurofibromas and other tumors, such as optic pathway gliomas and other tumors of the central nervous system. Few studies have investigated the impact of an additional diagnosis of brain tumor on the cognitive outcome of children with NF1, showing unclear results and without controlling by the effect of surgery, radio- or chemotherapy. In the present mono-institutional study, we compared the behavioral and cognitive outcomes of 26 children with neurofibromatosis alone (NF1) with two age-matched groups of 26 children diagnosed with NF1 and untreated optic pathway glioma (NF1 + OPG) and 19 children with NF1 and untreated other central nervous system tumors (NF1 + CT). NF1 + CT and NF1 + OPG showed significantly impaired cognitive abilities compared to NF1 group, with weaknesses in visuo-spatial abilities, visual scanning and verbal working memory, while general verbal abilities are preserved. Moreover, NF1 + OPG patients present more frequent internalizing problems and increased oppositional-deviant behaviors. These results suggest that the co-diagnosis of a brain tumor in NF1 children may partially worsen the cognitive and emotional outcome.

Trajectory Analysis of Cognitive Outcomes in Children With Perinatal HIV.

Children with perinatal HIV (pHIV) may display distinct long-term cognitive phenotypes. We used group-based trajectory modeling to identify clusters of children with pHIV after similar developmental trajectories and predictors of belonging to select cognitive trajectory groups. Participants included children, 4-17 years of age, with pHIV in Thailand and Cambodia. Cognitive measures included translated versions of Intelligence Quotient tests, Color Trails Tests and Beery-Buktenica Developmental Test of Visual-Motor Integration conducted semiannually over 3-6 years. The best fit of trajectory groups was determined using maximum likelihood estimation. Multivariate logistic regression identified baseline factors associated with belonging to the lowest scoring trajectory group. Group-based trajectory analyses revealed a 3-cluster classification for each cognitive test, labeled as high, medium and low scoring groups. Most trajectory group scores remained stable across age. Verbal IQ declined in all 3 trajectory groups and the high scoring group for Children's Color Trails Test 1 and 2 showed an increase in scores across age. Children in the lowest scoring trajectory group were more likely to present at an older age and report lower household income. Group-based trajectory modeling succinctly classifies cohort heterogeneity in cognitive outcomes in pHIV. Most trajectories remained stable across age suggesting that cognitive potential is likely determined at an early age with the exception of a small subgroup of children who displayed developmental gains in select cognitive domains and may represent those with better cognitive reserve. Poverty and longer duration of untreated HIV may predispose children with pHIV to suboptimal cognitive development.

Maternal mindfulness training during pregnancy has positive effect on cognitive development of young children

There is evidence that maternal anxiety during pregnancy affects child outcomes. However, there is lack of studies that have evaluated the effects of maternal psychosocial factors during pregnancy on child cognitive outcomes. This study evaluates the effect of the maternal mindfulness training during pregnancy on cognitive development in 5 years old children. In the current study we included 26 women who participated in the maternal mindfulness training during pregnancy. The control group included 26 women who did not participate in this training during pregnancy. When the offspring of the target pregnancies were 5 years of age, their cognitive development was assessed by Lurias's child neuropsychological assessment battery that enables to assess five functional domains, including executive abilities, language, memory, sensorimotor and visuospatial abilities. One-way ANOVA was used to reveal group differences in performing subtests from five functional domains of Luria's battery. We have revealed the significant differences (p < .05) between groups in two functional domains. The children from the experimental group performed better on subtests from language and memory functional domains. These results suggest that maternal mindfulness training during pregnancy may have positive effect on cognitive development of young children, particularly on the development of language and memory abilities in preschool children.

Causal inference and ensemble learning as new important tools for investigations of health effects of chemical mixtures.

OPS 05: Statistical methods to analyze mixtures, Room 114, Floor 1, August 27, 2019, 1:30 PM - 3:00 PM Background: Studies in environmental epidemiology consider each chemical separately when assessing the adverse health effects of environmental exposures. This single pollutant approach suffers from several pitfalls including: 1) risk of false positives; 2) confounding from correlated exposures; and 3) lack of insights on the cumulative or synergistic effects of exposures. Proposed method: We propose a flexible method that leverages an ensemble learning technique – SuperLearner - that offers greater flexibility in approximating the data generating mechanism, to estimate a robust model for the outcome, in combination with the G-computation - a maximum likelihood based substitution estimator – to infer valid estimates of individual and joint effects of mixtures. We extend the method to reconstruct dose-response relationships with no assumptions on the functional form, and to detect potential interactive effects. We end by proposing to augment the method to doubly robust estimation. Simulation study and application: We ran multiple simulations based on real scenarios and compared the method with available approaches handling complex mixtures (e.g. elastic net, weighted quantile regressions, gradient boosting, random forests, and environmental wide association studies). We subsequently applied the method to investigate the potential effects of a mixture of pollutants on child cognitive outcomes in a Faroese cohort. Main results: The proposed method had the lowest false discovery rate in terms of main effects and interactive effects and was able to adapt to the true underlying structure of the data. In the application part, the method confirmed previously reported associations between mercury and lower cognitive function. Additionally, some perfluorinated compounds showed detrimental effects on cognitive function. Conclusions: By combining concepts from data sciences and causal inference, the proposed approach opens new perspectives for estimating causal effects of environmental chemicals in high-dimensional settings, and will allow to correctly address environmental health causal questions that have policy-relevant consequences.

Brain Magnetic Resonance Imaging Findings Associated With Cognitive Impairment in Children and Adolescents With Human Immunodeficiency Virus in Zambia

BackgroundCognitive impairment is common in children and adolescents with human immunodeficiency virus (HIV). Brain magnetic resonance imaging (MRI) is a potentially useful tool to investigate the pathophysiology of HIV-associated cognitive impairment and may serve as a biomarker in future clinical trials. There are few published data on brain imaging in children with HIV in sub-Saharan Africa. MethodsThirty-four perinatally infected subjects with HIV and age-matched HIV-exposed uninfected controls between the ages nine and 17 years were recruited from the Pediatric Center of Excellence in Lusaka, Zambia, as part of the HIV-associated Neurocognitive Disorders in Zambia study. Brain MRI sequences were acquired, and clinical and volumetric assessments were performed. Subjects underwent a comprehensive neuropsychologic battery, and cognitive impairment status was classified using a global deficit score approach. Regression models were used to evaluate relationships between MRI findings and cognitive function. ResultsWe identified cerebrovascular disease in seven of 34 subjects with HIV compared with zero of 17 controls (21% vs 0%, P = 0.04). We also identified decreased total brain volumes (1036 vs 1162 cm3, P = 0.03) and decreased cortical thickness in the right temporal lobes (3.12 vs 3.29 mm; P = 0.01) and right fusiform gyri (3.10 vs 3.25 mm; P = 0.02) of HIV-infected subjects with cognitive impairment. ConclusionsThese findings support the hypothesis that brain volumes may be useful biomarkers for cognitive outcomes in children with HIV. Further studies are necessary to investigate mechanisms of cerebrovascular disease and volume loss in children with HIV.

Cognitive and Academic Outcomes Following Childhood Cortical Stroke.

The majority of pediatric neuropsychological stroke research has focused on perinatal stroke outcomes given its relative frequency. Meanwhile, childhood-onset stroke is under-represented in the literature, resulting in limited knowledge about its neurocognitive sequelae. This retrospective study examined cognitive outcomes in children and youth (n = 27) with childhood arterial ischemic stroke (stroke occurring between 29 days and 18 years of life) isolated to the cortical region. Intellectual, academic, language, visual-perception, visual-motor integration, fine motor coordination, and executive function scores were examined relative to normative means. Results indicate that although these children are doing well in terms of general intellectual ability, they demonstrate lower scores on tasks of processing speed and fine motor coordination. Exploratory analysis also revealed that of the personal and neurologic factors examined, age at stroke was positively correlated with perceptual reasoning and fine motor control, age at assessment was negatively correlated with math calculation abilities, and maternal education was positively correlated with working memory and parent-reported behavioral regulation and impulse inhibition abilities. While neurologic variables were not predictive of cognitive neuropsychological outcomes, those with significant poorer performance had higher rates of medium/large, right-sided lesions with frontal lobe involvement. Our results highlight the overall resilience of the injured developing brain but also the vulnerability of specific cognitive skills within this unique population.

Prenatal and early postnatal phthalate exposure and child neurodevelopment at age of 7 years – Polish Mother and Child Cohort

Phthalates are among the most frequently investigated environmental chemicals influencing children's health and particularly their neuropsychological development. However, the reported effects of these compounds on child behavior, cognitive and psychomotor outcomes are not fully consistent. The aim of this study is to evaluate the associations between prenatal and early postnatal phthalate exposures and child neurodevelopment at age of 7 years. A total of 134 mother-child pairs from Polish Mother and Child Cohort (REPRO_PL) constitute the basis for current analysis. Eleven phthalate metabolites were measured in urine samples collected from mothers in the 3rd trimester of pregnancy and from children at the age of 2 years. Child neuropsychological development at early school age (7 years) was assessed by both the Strengths and Difficulties Questionnaire (SDQ) filled by mothers and the Polish adaptation of the Intelligence and Development Scales (IDS) performed by psychologists. Mono-ethyl phthalate (MEP) concentration during pregnancy was significantly associated with increased risk of peer relationship problems in SDQ (OR = 2.7, p = 0.03). The results of the IDS analyses focused on child's cognitive and psychomotor development are not fully conclusive. Negative associations were evident between some phthalates in early childhood period and fluid intelligence and cognition (MEP: β = −5.2; p = 0.006; β = −4.2; p = 0.006; mono-n-butyl phthalate (MnBP): β = −4.9; p = 0.03; β = −4.0; p = 0.03; respectively), while positive associations have been found in the prenatal period (mono-2-ethyl-5-oxo-hexyl phthalate (oxo-MEHP): β = 3.6; p = 0.03 for fluid intelligence; β = 2.9; p = 0.03 for cognition). Further studies are required in order to elucidate which are the most critical periods of phthalate exposure on children's neurodevelopmental outcomes.

Nutrition, Hygiene and Stimulation Education for Impoverished Mothers in Rural Uganda: Effect on Maternal Depression Symptoms and Their Associations to Child Development Outcomes.

Optimal nutrition improves child development, and impaired development is associated with maternal depression symptoms, in particular in low resource settings. In this follow-up of an open cluster-randomized education trial, we examined its effects among mothers in rural Uganda on their depression symptoms and the association of these symptoms to child development. The education comprised complementary feeding, stimulation, and hygiene. We assessed 77 intervention mothers and 78 controls using Beck Depression Inventory-II (BDI-II) and Center for Epidemiologic Studies Depression Scale (CES-D) scores. Child development was assessed with Bayley Scales of Infant and Toddler Development-III (BSID-III) composite scores for cognitive, language and motor development. Compared to controls, the intervention reduced depression symptoms’ scores with mean (95% CI) differences: −8.26 (−11.49 to −1.13, p = 0.0001) and −6.54; (−8.69 to −2.99, p = 0.004) for BDI II at 20–24 and 36 months, respectively. Similar results were obtained with CES-D. There was a negative association of BDI-II scores and BSID-III cognitive and language scores at 20–24 (p = 0.01 and 0.008, respectively) and 36 months (p = 0.017 and 0.001, respectively). CES-D associations with BSID-III cognitive and language scores showed similar trends. BSID-III motor scores were associated with depression scores at 36 months for both BDI-II and CES-D (p = 0.043 and 0.028, respectively). In conclusion, the group education was associated with reduced maternal depression scores. Moreover, the depression scores were inversely associated with child cognitive and language development outcomes.

Center-Based Care in Toddlerhood and Child Cognitive Outcomes in Chile: The Moderating Role of Family Socio-Economic Status

ABSTRACTThere is little evidence regarding the benefits of early center-based care attendance (before three years old) for child development and most studies have focused on developed countries. Addressing this gap, this study examines the relationship between center-based care attendance during toddler years and children’s cognitive outcomes. Research Findings: Data used for this study came from the first and second wave of the Longitudinal Survey of Early Childhood (ELPI, 2010 and 2012). The nationally representative sample was 1,544 children aged 12 to 24 months in 2010, who received full-time home care during this period. Propensity score matching (PSM) and difference-in-differences techniques were used in the study. Compared to those in full-time home care, children who attended center-based care from the age of 24 months had higher cognitive scores in the endline (they were measured at some point between 36 and 48 months old). Children in center-based care scored higher on cognitive skills compared to children who were in full-time home care, according to the Child Development and Cognitive Evaluation Test (Test de Aprendizaje y Desarrollo Infantil, TADI) and the Battelle test (d = .21 p < .01 and d = .22 p < .01, respectively). However, we observed that children in low-income households benefited less from early center-based care attendance. Practice or Policy: These findings suggest that Chilean national policies supporting increased center-based care coverage in early years are a step in the right direction, but more work focused on helping disadvantaged children is needed.

The association of maternal alcohol use and paraprofessional home visiting with children's health: A randomized controlled trial.

This study examines the effect of a home visiting intervention on maternal alcohol use, problematic drinking, and the association of home visiting and alcohol use on children's behavioral, cognitive, and health outcomes at 5 time points over 5 years. We analyzed 5,099 observations of 1,236 mothers and their children from pregnancy to 5 years postbirth, within a longitudinal cluster-randomized trial evaluating the effect of a home visiting intervention on mothers in Cape Town, South Africa. Paraprofessional home visitors coached mothers on coping with multiple risk factors, including a brief, 1-visit intervention on alcohol prevention in pregnancy. We assessed changes in maternal drinking over time in relation to the intervention, and then examined the impact of these drinking patterns on child outcomes over five years. Drinking increased over the 5 years postbirth, but it was significantly lower in the intervention condition. Compared with abstinence, mothers' problematic drinking was associated with decreased child weight (-0.21 z-units) at all assessments, increased child aggressive behavior (3 to 7 additional symptoms), and decreased child performance on an executive functioning measure (the silly sounds task; odds ratio = .34) at 3 and 5 years. The intervention's effect was associated with increased child aggression (0.25 to 0.75 of 1 additional symptom), but the intervention appeared to decrease the effect of problem drinking on children's aggressive acts and executive functioning. These findings support the need for sustained interventions to reduce alcohol use, especially for mothers who exhibit problematic drinking. Maternal drinking influences children's health and development over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parenting and Child Development: A Relational Health Perspective.

A child's development is embedded within a complex system of relationships. Among the many relationships that influence children's growth and development, perhaps the most influential is the one that exists between parent and child. Recognition of the critical importance of early parent-child relationship quality for children's socioemotional, cognitive, neurobiological, and health outcomes has contributed to a shift in efforts to identify relational determinants of child outcomes. Recent efforts to extend models of relational health to the field of child development highlight the role that parent, child, and contextual factors play in supporting the development and maintenance of healthy parent-child relationships. This review presents a parent-child relational health perspective on development, with an emphasis on socioemotional outcomes in early childhood, along with brief attention to obesity and eating behavior as a relationally informed health outcome. Also emphasized here is the parent-health care provider relationship as a context for supporting healthy outcomes within families as well as screening and intervention efforts to support optimal relational health within families, with the goal of improving mental and physical health within our communities.

Light drinking during pregnancy: Social advantages explain positive correlates with child and early adolescent adjustment

Maternal heavy alcohol use during pregnancy is harmful to offspring's health and adjustment. However, findings from studies on lower levels of prenatal drinking are mixed; a few even predict positive cognitive and psychosocial outcomes. Given that alcohol is a neurotoxin and teratogen, scholars question developmental benefits and point to residual confounding as a potential explanation, particularly as light drinkers are positively selected with respect to health and socioeconomic status. Using prospective, intergenerational data from the nationally-representative Millennium Cohort Study (MCS) in the United Kingdom, we studied associations between mother's drinking during pregnancy and children's cognitive and psychosocial outcomes at ages 3, 5, 7, 11, and 14 years (n = 10,454). We included early life confounders (e.g., maternal education, health, smoking) and mother's cognitive ability, and assessed robustness of relationships across outcomes and alternate drinking classifications. Results of a series of multivariable regression models found no association between light drinking and cognitive and psychosocial outcomes up to and including the age of 14, after controlling for key confounders. Light drinking during pregnancy was linked to higher socioeconomic advantages (e.g., mothers' higher education, professional/managerial occupation, home ownership, cognitive scores), which together accounted for positive associations between light drinking and children's outcomes. Mother's cognitive ability was an especially important confounder.

The impact of Chinese Hukou reforms on migrant students' cognitive and non-cognitive outcomes

The Chinese Hukou system, a major tool for social control employed by the government, has undergone various fundamental reforms and has received increasing attention in recent years. This study investigates the relationship between Hukou policy innovations and migrant children's cognitive and non-cognitive outcomes, which are vital to the lifetime development of individuals. On the basis of 2654 children holding non-local Hukou from the 2013–2014 wave of the China Education Panel Survey, the results show that migrant students who expect to have fair access to local senior high schools have significantly higher test scores and higher educational aspirations than their counterparts. The expectation of attending a local senior high school improves migrant students' relationship with teachers and the social acclimation with classmates. These findings carry policy implications for addressing migrant children's educational challenges and shed light on China's reform of its Hukou system to achieve social justice and equality.

Randomized Trial of a Computer-Assisted Intervention for Children With Autism in Schools

Computer-assisted interventions (CAIs) are popular for educating children with autism, but their effectiveness is not well established. This study evaluated the effectiveness of 1 CAI designed to improve children's language, cognitive, and academic skills, TeachTown: Basics, in a large urban school district. Teachers (n= 59) in autism support classrooms and their consented students in kindergarten through second grade (n= 154) were randomized to TeachTown: Basics or waitlist control. Child outcome was measured at baseline and after 1 academic year using the Bracken Basic Concepts Scale-Receptive and Expressive versions and the Differential Ability Scales, Second Edition (DAS-II). Random effects regression models that included clustering of time within students and students within classrooms were used to test whether the change over time in each outcome differed between groups. There were no statistically significant differences in outcomes for children who received TeachTown: Basics or treatment as usual. Increased time spent using TeachTown: Basics was associated with worse receptive language outcomes for children in the experimental group after 1 academic year. However, there was no association between minutes spent using TeachTown and changes in expressive language or DAS-II score. Despite growing enthusiasm for CAIs in autism treatment, the present findings indicate that CAI might not be effective at improving language and cognitive outcomes for children with autism spectrum disorder. The decision to implement CAIs in schools should be carefully balanced against the evidence for effectiveness of these programs. Schools might be better served by investing in treatment strategies with established evidence. RCT of TeachTown in Autism Support Classrooms: Innovation and Exnovation; https://clinicaltrials.gov/; NCT02695693.

Household income dynamics and investment in children: Evidence from India

ABSTRACTHousehold income shocks in developing countries are known to have an impact on the education investments for children. In this paper, we explore the effects of various income and expenditure shocks on educational investment and cognitive outcomes of children using three rounds of household-level panel data from Young Lives survey conducted in two southern states of India – Andhra Pradesh and Telangana. We find that idiosyncratic shocks like paternal health shocks and livestock loss translate into lower inputs of children’s education, which reduce their cognitive ability captured through vocabulary and mathematics tests.

Spanish Validation of the PICCOLO (Parenting Interactions With Children: Checklist of Observations Linked to Outcomes).

Background/Objective: The aim of this study was to explore the psychometric properties of the Spanish version of the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO; Roggman et al., 2013a). This observational measure is composed of 29 items that assess the quality of four domains of parenting interactions that promote child development: affection, responsiveness, encouragement, and teaching.Methods: The sample included 203 mother-child dyads who had been video-recorded playing together. Fifty-six percent of the children were male, and 44% were female, aged from 10 to 47 months. Video-recorded observations were rated using PICCOLO items.Results: Confirmatory factor analysis supported that the instrument has four first-order factors corresponding to the hypothesized domains of parenting behaviors, and a second-order factor corresponding to a general factor of positive parenting. Construct validation evidence was compiled by examining the relationship between PICCOLO scores and child age. As expected, teaching domain and total PICCOLO scores were positively correlated with child age. The Spanish PICCOLO also demonstrated good inter-rater reliability (ranging from 0.69 to 0.84) and internal consistency reliability (ranging from 0.59 to 0.88) for the four domain scores and the total parenting score. Concurrent criterion-related validity was examined via correlations between parenting scores and child cognitive, language and motor skills outcomes, measured using the Bayley Scales of Infant Development.Conclusion: The Spanish version of the PICCOLO meets the criteria for a reliable and valid observational measurement of parenting interactions with children. The psychometric properties of the instrument make it appropriate for general research purposes, but also for program evaluation of Early Intervention and other parenting-support interventions. This measure, focused on parent strengths, could be used to facilitate family-centered practices in early intervention and other programs that have parenting as an outcome.

Course of perinatal depressive symptoms among South African women: associations with child outcomes at 18 and 36\xa0months

PurposeLatent modelling was used to identify trajectories of depressive symptoms among low-income perinatal women in South Africa. Predictors of trajectories and the association of trajectories with child outcomes were assessed.MethodsThis is a secondary analysis of data collected among women living in Cape Town settlements (N = 446). Participants were eligible if pregnant and 18 years or older, and included in the analysis if allocated to the control arm (routine perinatal care). Participants were excluded in case of non-singleton birth and baby death. Follow-up assessments were at 2 weeks, 6-, 18-, and 36-month postpartum. Trajectories of depressive symptoms were based on the Edinburgh Postnatal Depression Scale scores until 18-month postpartum, using latent class growth analysis. Child physical, cognitive, socio-emotional, and behavioural outcomes were assessed at 18 and/or 36 months. Univariate and multivariate regressions were used to identify predictors of trajectories and differences in child outcomes.ResultsFour trajectories were identified: chronic low (71.1%), late postpartum (10.1%), early postpartum (14.4%), and chronic high (4.5%). Low social support, unwanted pregnancy, and risky drinking were associated with the chronic high trajectory; unemployment and HIV-positive status with the early postpartum trajectory; and intimate partner violence with the late postpartum trajectory. Weight-to-length and weight-for-age z-scores at 18 months, and weight-for-age z-scores, length-for-age z-scores, emotional symptom, and peer problem scores at 36 months differed across trajectories.ConclusionsSevere depressive symptoms in postpartum period have a lasting effect on child physical and socio-emotional outcomes. Multiple screening throughout pregnancy and 1-year postpartum is essential.