Trajectories of Perinatal Maternal Mental Health and Associations with Child Health Outcomes at 3 years of Age in the ORIGINS Cohort

Background To mitigate the rising burden of poor mental health in children, a deeper understanding of risk and protective pathways across the life course is essential for developing effective public health interventions in early life. We aimed to identify trajectories of maternal psychological distress (depression, anxiety and stress) during pregnancy and postnatally and examine associations with child mental and behavioural health at age three. Methods This study reports on a longitudinal analysis using maternal self-report measures collected at multiple antenatal and postnatal time points. Data collected between 2017 and 2024 in the ORIGINS cohort were analysed. ORIGINS is a longitudinal cohort study, based in Western Australia, tracking 10,000 pregnant women, their partners, and babies from pregnancy through childhood. Mothers were included in the trajectory analysis if they had measures of psychological distress antenatally and for at least one of the postnatal timepoints. Their children were included if they had Conners Early Childhood data at three years of age. Maternal psychological distress was measured using scores from the depression, anxiety and stress scale (DASS-21) antenatally, and at 6,12 and 24 months postnatally. To identify longitudinal trajectories, we used latent class growth analysis which identifies groups of individuals who follow similar patterns over time. Child behavioural and mental health outcomes at three years of age were measured using the Conners instrument domains of anxiety, mood and affect, and emotional lability. Results 1381 mothers were included in this study with 1442 pregnancies. The average age was 32.8 years old, with the largest ethnic descent from Britain (38.8%); almost 40% were in the highest quintile for socioeconomic status. We identified four trajectories of maternal depression; three of anxiety; and four of stress. From the total pregnancies, 510 children exhibited significantly greater scores in the Conners domains if their mothers belonged to the highest trajectories compared to the lowest. Conclusions In this cohort study of pregnant women and children, these findings highlighted the importance of early risk identification for maternal psychological distress. This is relevant for public health initiatives and developing targeted mental health support from conception, for the benefit of both mother and child.