Prenatal maternal stress, child internalizing and externalizing symptoms, and the moderating role of parenting: findings from the Norwegian mother, father, and child cohort study

Abstract

Background: Few studies have examined how parenting influences the associations between prenatal maternal stress and children's mental health. The objectives of this study were to examine the sex-specific associations between prenatal maternal stress and child internalizing and externalizing symptoms, and to assess the moderating effects of parenting behaviors on these associations.

Methods: This study is based on 15 963 mother-child dyads from the Norwegian Mother, Father, and Child Cohort Study (MoBa). A broad measure of prenatal maternal stress was constructed using 41 self-reported items measured during pregnancy. Three parenting behaviors (positive parenting, inconsistent discipline, and positive involvement) were assessed by maternal report at child age 5 years. Child symptoms of internalizing and externalizing disorders (depression, anxiety, attention-deficit hyperactivity disorder, conduct disorder, and oppositional-defiant disorder) were assessed by maternal report at age 8. Analyses were conducted using structural equation modeling techniques.

Results: Prenatal maternal stress was associated with child internalizing and externalizing symptoms at age 8; associations with externalizing symptoms differed by sex. Associations between prenatal maternal stress and child depression, and conduct disorder and oppositional-defiant disorder in males, became stronger as levels of inconsistent discipline increased. Associations between prenatal maternal stress and symptoms of attention-deficit hyperactivity disorder in females were attenuated as levels of parental involvement increased.

Conclusions: This study confirms associations between prenatal maternal stress and children's mental health outcomes, and demonstrates that these associations may be modified by parenting behaviors. Parenting may represent an important intervention target for improving mental health outcomes in children exposed to prenatal stress.

Keywords: Externalizing; MoBa; fetal programing; internalizing; parenting; prenatal stress.

Figure 1.

Johnson-Neyman plots of significant interactions between prenatal maternal stress and parenting behaviours at age 5 on child internalizing and externalizing symptoms at age 8. A) Moderating role of inconsistent discipline on the association between prenatal maternal stress and symptoms of depression. B) Moderating role of inconsistent discipline on the association between prenatal maternal stress and symptoms of conduct disorder in males. C) Moderating role of inconsistent discipline on the association between prenatal maternal stress and symptoms of oppositional defiant disorder (ODD) in males. D) Moderating role of positive parental involvement on the association between prenatal maternal stress and symptoms of attention deficit hyperactivity disorder (ADHD) in females. Plot lines represent effect (solid line) and 95% confidence interval of effect (dashed lines).