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The relationship between maternal health and school readiness — June 2017

Question

What does the research say about the relationship between maternal health and the school readiness (and other later outcomes) of the child?

Response

Following an established REL West research protocol, we conducted a search for research reports as well as descriptive study articles on maternal health and school readiness, as well as other child outcomes. The sources included ERIC and other federally funded databases and organizations, research institutions, academic research databases, and general Internet search engines. (For details, please see the methods section at the end of this memo.)

We have not evaluated the quality of references and the resources provided in this response. We offer them only for your reference. Also, we searched for references through the most commonly used sources of research, but the list is not comprehensive and other relevant references and resources may exist.

Research References

Currie, J. (2005). Health disparities and gaps in school readiness. Future of Children, 15(1), 117–138. Retrieved from https://pdfs.semanticscholar.org/3e59/8b6ed526e179c999819df3fcc07ef95c5147.pdf

From the abstract: “The author documents pervasive racial disparities in the health of American children and analyzes how and how much those disparities contribute to racial gaps in school readiness. She explores a broad sample of health problems common to U.S. children, such as attention deficit hyperactivity disorder, asthma, and lead poisoning, as well as maternal health problems and health-related behaviors that affect children’s behavioral and cognitive readiness for school. If a health problem is to affect the readiness gap, it must affect many children, it must be linked to academic performance or behavior problems, and it must show a racial disparity either in its prevalence or in its effects. The author focuses not only on the black-white gap in health status but also on the poor-nonpoor gap because black children tend to be poorer than white children. The health condition Currie considers seriously impair cognitive skills and behavior in individual children. But most explain little of the overall racial gap in school readiness. Still, the cumulative effect of health differentials summed over all conditions is significant. Currie’s rough calculation is that racial differences in health condition and in maternal health and behaviors together may account for as much as a quarter of the racial gap in school readiness. Currie scrutinizes several policy steps to lessen racial and socio-economic disparities in children’s health and to begin to close the readiness gap. Increasing poor children’s eligibility for Medicaid and state child health insurance is unlikely to be effective because most poor children are already eligible for public insurance. The problem is that many are not enrolled. Even increasing enrollment may not work: socioeconomic disparities in health persist in Canada and the United Kingdom despite universal public health insurance. The author finds more promise in strengthening early childhood programs with a built-in health component, like Head Start; family-based services and home visiting programs; and WIC, the federal nutrition program for women, infants, and small children. In all three, trained staff can help parents get ongoing care for their children.”

der Waerden, J., Bernard, J. Y., Agostini, M., Saurel-Cubizolles, M., Peyre, H., Heude, B., & Melchior, M. (2017). Persistent maternal depressive symptoms trajectories influence children’s IQ: The EDEN mother-child cohort. Depression & Anxiety, 34(2), 105–117. Retrieved from https://jvdwaerden.files.wordpress.com/2015/10/slls2015_jw_wordpress.pdf

From the abstract: “This study assessed the association between timing and course of maternal depression from pregnancy onwards and cognitive development at ages 5 to 6. Potential interaction effects with child sex and family socioeconomic status were explored. Methods: One thousand thirty-nine mother-child pairs from the French EDEN mother-child birth cohort were followed from 24 to 28 weeks of pregnancy onwards. Based on Center for Epidemiological Studies Depression (CES-D) and Edinburgh Postnatal Depression Scale (EPDS) scores assessed at six timepoints, longitudinal maternal depressive symptom trajectories were calculated with a group-based semi-parametric method. Children’s cognitive function was assessed at ages 5 to 6 by trained interviewers with the Wechsler Preschool and Primary Scale of Intelligence Third Edition (WPPSI-III), resulting in three composite scores: Verbal IQ (VIQ), Performance IQ (PIQ), and Full-Scale IQ (FSIQ). Results: Five trajectories of maternal symptoms of depression could be distinguished: no symptoms, persistent intermediate-level depressive symptoms, persistent high depressive symptoms, high symptoms in pregnancy only, and high symptoms in the child’s preschool period only. Multiple linear regression analyses showed that, compared to children of mothers who were never depressed, children of mothers with persistent high levels of depressive symptoms had reduced VIQ, PIQ, and FSIQ scores. This association was moderated by the child’s sex, boys appearing especially vulnerable in case of persistent maternal depression. Conclusions: Chronicity of maternal depression predicts children’s cognitive development at school entry age, particularly in boys. As maternal mental health is an early modifiable influence on child development, addressing the treatment needs of depressed mothers may help reduce the associated burden on the next generation.”

REL West note: This is an international study. Considering its subject is relevant to the request, we included it here for your information.

Hardie, J. H., & Landale, N. S. (2013). Profiles of risk: Maternal health, socioeconomic status, and child health. Journal of Marriage & Family, 75(3), 651–666. Retrieved from https://paa2015.princeton.edu/papers/152745

From the abstract: “Child health is fundamental to well-being and achievement throughout the life course. Prior research has demonstrated strong associations between familial socioeconomic resources and children’s health outcomes, with especially poor health outcomes among disadvantaged youth who experience a concentration of risks, yet little is known about the influence of maternal health as a dimension of risk for children. This research used nationally representative U.S. data from the National Health Interview Surveys in 2007 and 2008 (N = 7,361) to evaluate the joint implications of maternal health and socioeconomic disadvantage for youth. Analyses revealed that maternal health problems were present in a substantial minority of families, clustered meaningfully with other risk factors, and had serious implications for children’s health. These findings support the development of health policies and interventions aimed at families.”

Huang, C., Costeines, J., Kaufman, J., & Ayala, C. (2014). Parenting stress, social support, and depression for ethnic minority adolescent mothers: Impact on child development. Journal of Child & Family Studies, 23(2), 255–262. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956110/

From the abstract: “Rates of teenage pregnancies are higher for African American and Latina adolescents compared to their White peers. African American and Latina adolescent mothers also experience more adversities than their White peers, such as higher rates of depression, school dropout, and economic disadvantage. Furthermore, children of adolescent mothers are at higher risk for adverse development. Parenting stress and social support can impact outcomes experienced by adolescent parents and their children. The present study examined the influence of adolescent mothers’ parenting stress and perceived social support on maternal depression at baseline (6 months after birth), and its impact on infant development 1 year later (18 months after birth). Participants were 180 adolescent mothers of African American or Latino/Hispanic descent. Results suggest that higher levels of parenting stress and less perceived social support were associated with higher levels of depression in the adolescent mothers at baseline. Higher levels of maternal depression were also associated with more developmental delays in infants 1 year post-baseline. Additionally, depression mediated the relationship between parenting stress and later child outcomes. These findings highlight the importance of examining parenting factors such as parenting stress, social support, and maternal depression in ethnic minority adolescent parents, and provide valuable information regarding unique risk and protective factors associated with positive maternal outcomes for ethnic minority adolescent parents and healthy development for their children.”

Isaacs, J. B. (2012). Starting school at a disadvantage: The school readiness of poor children. Washington, DC: Center on Children and Families, Brookings Institution. Retrieved from https://www.brookings.edu/wp-content/uploads/2016/06/0319_school_disadvantage_isaacs.pdf

From the abstract: “Poor children in the United States start school at a disadvantage in terms of their early skills, behaviors, and health. Fewer than half (48 percent) of poor children are ready for school at age five, compared to 75 percent of children from families with moderate and high income, a 27 percentage point gap. This paper examines the reasons why poor children are less ready for school and evaluates three interventions for improving their school readiness. Poverty is one of several risk factors facing poor children. Mothers living in poverty are often unmarried and poorly educated, they have higher rates of depression and poor health than more affluent mothers, and they demonstrate lower parenting skills in certain dimensions. In fact, the gap in school readiness shrinks from 27 percentage points to 7 percentage points after adjusting for demographic, health, and behavioral differences between poor and moderate- and higher-income families. Even so, poverty remains an important influence on school readiness, partly through its influence on many of the observed differences between poor and more affluent families. Higher levels of depression and a more punitive parenting style, for example, may result from economic stress and so models controlling for these factors may understate the full effects of poverty on school readiness. In addition to poverty, key influences on school readiness include preschool attendance, parenting behaviors, parents’ education, maternal depression, prenatal exposure to tobacco, and low birth weight. For example, the likelihood of being school ready is 9 percentage points higher for children attending preschool, controlling for other family characteristics, and is 10 percentage points lower for children whose mothers smoke during pregnancy and also 10 percentage points lower for children whose mothers score low in supportiveness during parent-child interactions. These findings suggest a diverse set of policy interventions that might improve children’s school readiness, ranging from smoking cessation programs for pregnant women to parenting programs, treatments for maternal depression, income support programs and expansion of preschool programs. Preschool programs offer the most promise for increasing children’s school readiness, according to a simple simulation that models the effects of three different interventions. Expanding preschool programs for four-year-olds has more direct effects on school readiness at age five than either smoking cessation programs during pregnancy or nurse home visiting programs to pregnant women and infants, the two other alternatives considered.”

Knopik, V. S. (2009). Maternal smoking during pregnancy and child outcomes: Real or spurious effect? Developmental Neuropsychology, 34(1), 1–36. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581055/

From the abstract: “Maternal smoking during pregnancy (MSDP) is a major public health concern with clearly established consequences to both mother and newborn (e.g., low birth weight, altered cardiorespiratory responses). MSDP has also been associated with higher rates of a variety of poor cognitive and behavioral outcomes in children, including attention deficit hyperactivity disorder (ADHD), conduct disorder, impaired learning and memory, and cognitive dysfunction. However, the evidence suggesting causal effects of MSDP for these outcomes is muddied in the existing literature due to the frequent inability to separate prenatal exposure effects from other confounding environmental and genetic factors. Carefully designed studies using genetically sensitive strategies can build on current evidence and begin to elucidate the likely complex factors contributing to associations between MSDP and child outcomes.”

Kroelinger, C. D. (2012). Collaboration at the federal, state, and local levels to build capacity in maternal and child health: The impact of the maternal and child health epidemiology program. Journal of Women’s Health, 21(5), 471–475. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465589/

From the abstract: “This article provides a description of the Maternal and Child Health Epidemiology Program housed in the Division of Reproductive Health at the Centers for Disease Control and Prevention. The article highlights programmatic efforts to build capacity and increase infrastructure within states, localities, and among tribes in the field of maternal and child health by leveraging partnerships with other federal, nonprofit, private, and academic agencies.”

Li, Q., Tsui, A., & Tsui, A. O. (2016). Maternal risk exposure and adult daughters’ health, schooling, and employment: A constructed cohort analysis of 50 developing countries. Demography, 53(3), 835–863. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934894/

From the abstract: “This study analyzes the relationships between maternal risk factors present at the time of daughters’ births—namely, young mother, high parity, and short preceding birth interval—and their subsequent adult developmental, reproductive, and socioeconomic outcomes. Pseudo-cohorts are constructed using female respondent data from 189 cross-sectional rounds of Demographic and Health Surveys conducted in 50 developing countries between 1986 and 2013. Generalized linear models are estimated to test the relationships and calculate cohort-level outcomes proportions with the systematic elimination of the three maternal risk factors. The simulation exercise for the full sample of 2,546 pseudo-cohorts shows that the combined elimination of risk exposures is associated with lower mean proportions of adult daughters experiencing child mortality, having a small infant at birth, and having a low body mass index. Among sub-Saharan African cohorts, the estimated changes are larger, particularly for years of schooling. The pseudo-cohort approach can enable longitudinal testing of life course hypotheses using large-scale, standardized, repeated cross-sectional data and with considerable resource efficiency.”

REL West note: This is an international study. Considering its subject is relevant to the request, we included it here for your information.

Logan, C., Moore, K., Manlove, J., Mincieli, L., & Cottingham, S. (2007). Conceptualizing a “strong start”: Antecedents of positive child outcomes at birth and into early childhood. Bethesda, MD: Child Trends. Retrieved from https://www.childtrends.org/wp-content/uploads/2013/04/Child_Trends-2007_02_12_RB_StrongStart.pdf

From the abstract: “This research brief presents the results of an extensive review of research studies to identify maternal and family antecedents (conditions and characteristics before and during pregnancy) of healthy infant and child outcomes. The researchers identified seven major categories of antecedents associated with a strong start in life: the mother’s health, health-related services, health-related behaviors, lack of material hardship, social support and marriage, attitudes, and social and demographic characteristics. More specifically, research indicates that these factors include having a mother in good mental and physical health, who utilizes health-related prenatal services, who avoids substance use during pregnancy and engages in healthy prenatal behavior, who has access to adequate financial resources, who is involved in healthy relationships and has access to strong social support systems, who has a positive attitude toward the pregnancy, who bore her first child as an adult, and who has more years of education. Available evidence does not allow us to determine whether some elements carry more weight than do others.”

Pearson, R. M., Bornstein, M. H., Cordero, M., Scerif, G., Mahedy, L., Evans, J., & Stein, A. (2016). Maternal perinatal mental health and offspring academic achievement at age 16: The mediating role of childhood executive function. Journal of Child Psychology and Psychiatry, 57(4), 491–501. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789117/

From the abstract: “Elucidating risk pathways for under-achieving at school can inform strategies to reduce the number of adolescents leaving school without passing grades in core subjects. Maternal depression can compromise the quality of parental care and is associated with multiple negative child outcomes. However, only a few small studies have investigated the association between perinatal maternal depression and poor academic achievement in adolescence. The pathways to explain the risks are also unclear. Method: Prospective observational data from 5,801 parents and adolescents taking part in a large UK population cohort (Avon-Longitudinal-Study-of-Parents-and-Children) were used to test associations between maternal and paternal depression and anxiety in the perinatal period, executive function (EF) at age 8, and academic achievement at the end of compulsory school at age 16. Results: Adolescents of postnatally depressed mothers were 1.5 times (1.19, 1.94, p = .001) as likely as adolescents of nondepressed mothers to fail to achieve a ‘pass’ grade in math; antenatal anxiety was also an independent predictor of poor math. Disruption in different components of EF explained small but significant proportions of these associations: attentional control explained 16% (4%, 27%, p < .001) of the association with postnatal depression, and working memory explained 17% (13%, 30%, p = .003) of the association with antenatal anxiety. A similar pattern was seen for language grades, but associations were confounded by maternal education. There was no evidence that paternal factors were independently associated with impaired child EF or adolescent exams. Conclusion: Maternal postnatal depression and antenatal anxiety are risk factors for adolescents underachieving in math. Preventing, identifying, and treating maternal mental health in the perinatal period could, therefore, potentially increase adolescents’ academic achievement. Different aspects of EF partially mediated these associations. Further work is needed, but if these pathways are causal, improving EF could reduce underachievement in math.”

REL West note: This is an international study. Considering its subject is relevant to the request, we included it here for your information.

Pickles, A., Sharp, H., Hellier, J., & Hill, J. (2017). Prenatal anxiety, maternal stroking in infancy, and symptoms of emotional and behavioral disorders at 3.5 years. European Child & Adolescent Psychiatry, 26(3), 325–334. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323471/

From the abstract: “Animal findings of long-term effects of maternal behaviors mediated via altered GR gene expression will, if translated into humans, have far reaching implications for our understanding of child and adolescent psychopathology. We have previously shown that mothers’ self-reported stroking of their infants modifies associations between prenatal depression and anxiety and child outcomes at 29 weeks and 2.5 years. Here, we examine whether the effect of early maternal stroking is evident at 3.5 years, and in a much larger sample than in previous publications. A general population sample of 1233 first-time mothers completed anxiety measures at 20 weeks gestation, 865 reported on infant stroking at 9 weeks, and 813 on child symptoms at 3.5 years. Maternal stroking moderated the association between pregnancy-specific anxiety and internalizing (p = 0.010) and externalizing (p = 0.004) scores, such that an effect of PSA to increase symptoms was markedly reduced for mothers who reported high levels of stroking. There was no effect of maternal stroking on general anxiety. The findings confirm the previously reported effect of maternal stroking, and in a much larger sample. They indicate that there are long-term effects of early maternal stroking, modifying associations between prenatal anxiety and child emotional and behavioral symptoms.”

REL West note: This is an international study. Considering its subject is relevant to the request, we included it here for your information.

Other Resources

Evans, J., Melotti, R., Heron, J., Ramchandani, P., Wiles, N., Murray, L., & Stein, A. (2012). The timing of maternal depressive symptoms and child cognitive development: A longitudinal study. Journal of Child Psychology & Psychiatry, 53(6), 632–640. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22211468

From the abstract: “Maternal depression is known to be associated with impairments in child cognitive development, although the effect of timing of exposure to maternal depression is unclear. Methods: Data collected for the Avon Longitudinal Study of Parents and Children, a longitudinal study beginning in pregnancy, included self-report measures of maternal depression the Edinburgh Postnatal Depression Scale, completed on 6 occasions up to 3 years of age, and IQ of the index child (WISC) measured at aged 8 years. We used these data to assign women to 8 groups according to whether depression occurred in the antenatal, postnatal, preschool period, any combination of these times, or not at all. We compared a model comprising all patterns of depression (saturated model) with models nested within this to test whether there is a relationship between depression and child cognitive development and, if so, whether there is a sensitive period. We then investigated the relationship with child IQ for each model, following adjustment for confounders. Results: Six thousand seven hundred and thirty-five of 13,615 children from singleton births (49.5%, of eligible core sample) attended a research clinic at 8 years and completed a WISC with a score ≥ 70. A total of 5,029 mothers of these children had completed mood assessments over the 3 time periods. In unadjusted analyses, all three sensitive period models were as good as the saturated model, as was an accumulation model. Of the sensitive period models, only that for antenatal exposure was a consistently better fit than the accumulation model. After multiple imputation for missing data, there was no effect of postnatal depression on child IQ, independent of depression at other times. There was an effect of antenatal depression which attenuated following adjustment. Conclusions: The postnatal period is not a sensitive one for the effect of maternal depression on child cognitive development.”

REL West note: This is an international study. Considering its subject is relevant to the request, we included it here for your information.

Hardie, J. H., & Turney, K. (2015). The intergenerational consequences of poor maternal health (Conference Paper). Washington, DC: American Sociological Association. Retrieved from http://paa2015.princeton.edu/uploads/152745

From the abstract: “Scholars have theorized interrelationships between family members’ health, health behaviors, and wellbeing (Christensen, 2004; Novilla et al., 2006). Yet little is known about the influence of poor maternal health as a dimension of risk for children. This research uses panel data from the Fragile Families and Child Wellbeing Study (N=3,337) to estimate the relationship between maternal health problems (fair or poor overall health and health limitations) and children’s externalizing and internalizing behavior problems. Preliminary findings reveal that maternal health problems have serious implications for children’s behavior problems net of other family factors. These findings support the development of health policies and interventions aimed at families.”

Jensen, S. G., Dumontheil, I., & Barker, E. D. (2014). Developmental inter-relations between early maternal depression, contextual risks, and interpersonal stress, and their effect on later child cognitive functioning. Depression & Anxiety, 31(7), 599–607. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24027237

From the abstract: “Maternal depression and contextual risks (e.g., poverty) are known to impact children’s cognitive and social functioning. However, few published studies have examined how stress in the social environment (i.e., interpersonal stress) might developmentally inter-relate with maternal depression and contextual risks to negatively affect a child in these domains. This was the purpose of the current study. Method: Mother-child pairs (n = 6979) from the Avon Longitudinal Study of Parents were the study participants. Mothers reported on depression, contextual risks, and interpersonal stress between pregnancy and 33 months child age. At age 8, the children underwent cognitive assessments and the mothers reported on the children’s social cognitive skills. Results: Maternal depression, contextual risks, and interpersonal stress showed strong continuity and developmental inter-relatedness. Maternal depression and contextual risks directly predicted a range of child outcomes, including executive functions and social cognitive skills. Interpersonal stress worked indirectly via maternal depression and contextual risks to negatively affect child outcomes. Conclusion: Maternal depression and contextual risks each increased interpersonal stress in the household, which, in turn, contributed to reduced child cognitive and social functioning.”

REL West note: This is an international study. Considering its subject is relevant to the request, we included it here for your information.

Lereya, S. T., & Wolke, D. (2013). Prenatal family adversity and maternal mental health and vulnerability to peer victimisation at school. Journal of Child Psychology & Psychiatry, 54(6), 644–652. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23121554

From the abstract: “Prenatal stress has been shown to predict persistent behavioural abnormalities in offspring. Unknown is whether prenatal stress makes children more vulnerable to peer victimisation. Methods: The current study is based on the Avon Longitudinal Study of Parents and Children, a prospective community-based study. Family adversity, maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period. Parenting, partner conflict and temperament were measured at preschool age. Peer victimisation was assessed using multiple informants (child, parent, teacher) at primary school age (between ages 7 and 10). Results: Prenatal severe family adversity and maternal mental health directly increased the risk of victimisation at school even when controlled for postnatal family adversity and maternal mental health, parenting, partner conflict and temperament. Effects were found to be independent of sources of information of peer victimisation. Partner conflict and maladaptive parenting also independently increased the risk of peer victimisation. Conclusions: Experiences in pregnancy may affect the developing foetus and increase vulnerability to be victimised by peers. Conflict between parents and their parenting further increase the risk of being victimised by peers at school.”

REL West note: This is an international study. Considering its subject is relevant to the request, we included it here for your information.

Method

Keywords and Search Strings

The following keywords and search strings were used to search the reference databases and other sources:

(“maternal health” OR “maternal depression” OR “healthy pregnancy”) AND (“child outcomes” OR “school readiness” OR “developmental outcomes” OR “academic achievement” OR “graduation rate” OR “school success”)

Databases and Resources

We searched ERIC for relevant resources. ERIC is a free online library of over 1.6 million citations of education research sponsored by the Institute of Education Sciences. Additionally, we searched Google Scholar and PsychInfo.

Reference Search and Selection Criteria

When we were searching and reviewing resources, we considered the following criteria:

  • Date of the Publication: References and resources published for the last 15 years, from 2001 to present, were included in the search and review.
  • Search Priorities of Reference Sources: Search priority is given to study reports, briefs, and other documents that are published and/or reviewed by IES and other federal or federally funded organizations and academic databases, including ERIC, EBSCO databases, JSTOR database, PsychInfo, PsychArticle, and Google Scholar.
  • Methodology: Following methodological priorities/considerations were given in the review and selection of the references: (a) study types – randomized controlled trials, quasi-experiments, surveys, descriptive data analyses, literature reviews, policy briefs, etc., generally in this order; (b) target population, samples (representativeness of the target population, sample size, volunteered or randomly selected, etc.), study duration, etc.; and (c) limitations, generalizability of the findings and conclusions, etc.

This memorandum is one in a series of quick-turnaround responses to specific questions posed by educational stakeholders in the West Region (Arizona, California, Nevada, Utah), which is served by the Regional Educational Laboratory West at WestEd. This memorandum was prepared by REL West under a contract with the U.S. Department of Education’s Institute of Education Sciences (IES), Contract ED-IES-17-C-00014524, administered by WestEd. Its content does not necessarily reflect the views or policies of IES or the U.S. Department of Education nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.