Preschoolers’ Executive Control and Diurnal Cortisol as Mediators of the Relations of Prenatal Stress to Child Adjustment

Thesis (Ph.D.)--University of Washington, 2016-08

Prenatal stress is thought to confer unique and enduring impairments in postnatal functioning in children (Van den Bergh, Mulder, Mennes, & Glover, 2005). Although prenatal stress is thought to have pervasive and lasting effects on children, few human studies have formally tested putative mechanisms or mediators conferring such effects. The existing literature on prenatal stress is clouded by interchanging definitions of prenatal stress between maternal psychological symptoms experienced in pregnancy and maternal stressful experiences during pregnancy. This study examined the effects of maternal prenatal depression and stressful events on children’s adjustment in 306 preschool-age children and their mothers assessed across 4 time points. Multiple assessment methods were implemented, including neuroendocrine indicators of HPA activity, neuropsychological assessment of executive control, as well as the utilization of maternal and teacher-report questionnaire data. Using longitudinal modeling and multi-method assessments, the current study explored the unique effects of prenatal and postnatal psychological symptoms and the prenatal and postnatal experience of stress on preschooler’s social competence and total problems. Putative mediators, including children’s diurnal cortisol and executive functioning, were tested as potentially conferring the effect of prenatal stress. Sex differences in these relations were examined. Prenatal and postnatal maternal mood and stressful experiences were not related to children’s diurnal cortisol (morning level or slope). There were trends of higher prenatal mood symptoms and prenatal stressful experiences predicting lower initial levels of preschooler’s executive control. There was a trend for higher prenatal alcohol exposure predicting greater growth in executive control. Postnatal maternal mood and prenatal and postnatal stressful experiences did not predict executive control. Higher postnatal mood symptoms predicted lower social competence and higher mother-report total problems. There was a trend for higher prenatal mood symptoms to predict lower mother-report social competence. Greater prenatal exposure to medications predicted higher mother-report total problems. Greater prenatal exposure to alcohol predicted higher teacher-report total problems. Greater postnatal stressful experiences predicted higher mother-report total problems and lower mother-report social competence. Higher initial levels of executive control predicted higher social competence and lower total problems per teacher report. Greater growth in executive control predicted higher social competence and lower total problems by teacher report. There was no support for mediated relations. There was no evidence of child sex differences in these relations or evidence of differences in pathways predicted by prenatal maternal mood symptoms versus prenatal stressful experiences. The sample and study design afford the unique opportunity to evaluate two forms of prenatal stress, prenatal mood symptoms and prenatal stressful experiences, in a longitudinal framework. Prenatal medication and alcohol exposure were related to behavioral outcomes in the preschool period. Postnatal mood and stressful experiences related to mother report of adjustment. Study findings highlight potential targets for intervention for mothers in pregnancy that may promote long-term regulation and adjustment in children.