Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant mental development Kerry-Ann Grant a, ⁎, Catherine McMahon a , Nicole Reilly b , Marie-Paule Austin b,c a Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, N.S.W.2109,Australia b St John of God Perinatal and Women's Mental Health Unit, Burwood,N.S.W.2109,Australia c School of Psychiatry, University of New South Wales, Sydney, N.S.W.2052,Australia a b s t r a c t a r t i c l e i n f o Article history: Received 24 April 2010 Received in revised form 25 June 2010 Accepted 9 July 2010 Keywords: Pregnancy Anxiety Infant Mental development Motor development Background: Animal studies have shown that postnatal rearing style can modify the association between pr stress exposure and offspring neurodevelopmental outcomes. However,little is known about how parenting quality impacts the association between maternal prenatal anxiety and development in human infants. Aim: This prospective study examined the impact of maternal prenatal anxiety disorder and maternal careg sensitivity on cognitive and psychomotor development in healthy, full-term, 7-month-old infants. Measures: Women completed a clinical interview during the third trimester of pregnancy to assess anxiety symptoms meeting DSM-IV diagnostic criteria. At infant age 7 months, maternal sensitivity to infant distress non-distress were observed and coded during the still-face procedure. Maternal postnatal (concurrent) anxi and depression were also assessed at this time. Infant mental and psychomotor development was assessed at infant age 7 months using the Bayley Scales of Infant Development II. Results: Analyses were based on 77 mother–infant dyads. Maternal sensitivity to infant distress moderated association between maternal prenatal anxiety disorder and infant mental development, F (1, 77) = 5.70, p Whereas there was a significant positive association between sensitivity and mental development among in whose mothers were anxious during pregnancy, sensitivity had little impact on mental development among infants of control (non-anxious) women. Results were independent of prenatal depression and postnatal anx and depression. A caregiving moderation effect was not found for infant psychomotor development, p N .10 Conclusions: These findings are consistent with a cumulative risk model suggesting that maternal prenatal and quality of maternal care act in concert to shape infant outcomes. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Animal studies provide strong support for a causal link between maternal stress during pregnancy and suboptimal neurodevelop- mental outcomes in offspring. In non-human primate models, stress in early or mid-gestation is linked to impaired motor development, shorter attention span, and delayed cognitive development in offspring [1,2]. In rodents, various forms of gestational stress, including restraint and foot shock, can induce memory and learning deficits in offspring (for reviews, see Refs. [3,4]). Much less is known about the impact of maternal prenatal stress on neurodevelopmental outcomes in human infants. Retrospective studies suggest that major stressful events experienced during pregnancy (e.g., natural disasters) can have a negative impact on children's development. In one study, prenatal stress exposure during an ice-storm uniquely accounted for 11% and 12% of the variance in toddlers' mental and language abilities, respectively — as measured by the Bayley Scales of Infant Develop- ment[5]. These findings were independent of obstetric complications, gestational age at birth, birth weight,maternal postnatal depression and socio-economic status. Similar results were reported by Bergman and colleagues [6]. They found that retrospectively reported prenatal stressfullife events accounted for 17% of the variance in cognitive ability (as assessed by the Bayley Scales) in infants aged between 14 and 19 months. Studies like these have made an important contribu- tion to our understanding of outcomes associated with exposure to prenatal stress. However, they are typically based on extreme stressors and are subject to the limitations of retrospective reporting. A number of recent studies have reported prospective associations between maternal stress in pregnancy and neurodevelopmental outcomes in infants and young children. For example,Huizink, De Medina,Mulder, Visser and Buitelaar [7] examined maternal reports of pregnancy-specificanxiety and daily hassles in a sample of nulliparous women. High levels of pregnancy-specific anxiety at 27– Early Human Development 86 (2010) 551–556 ⁎ Corresponding author. Tel.: + 61 2 9850 6750; fax: +61 2 9850 8062. E-mail address: kerryann.grant@mq.edu.au (K.-A. Grant). 0378-3782/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.earlhumdev.2010.07.004 Contents lists available at ScienceDirect Early Human Development j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / e a r l h u m d ev