Sex differences in the relation between prenatal maternal emotional complaints and child outcome Anouk T.C.E. de Bruijn ⁎, Hedwig J.A. van Bakel, Anneloes L. van Baar Pediatric Psychology, Department of Developmental, Clinical and Cross-cultural Psychology, Tilburg University, The Netherlands abstract article info Article history: Received 25 August 2008 Received in revised form 11 December 2008 Accepted 16 December 2008 Available online xxxx Keywords: Prenatal Depression Anxiety Sex Outcome DOHaD Background: Sex differences are found in animal studies concerning the relationship between prenatal maternal stress and outcome of the offspring. Most human studies in this field have not addressed sex differences, although differences between boys and girls may elucidate the biochemical as well as psychological processes involved. Associations between prenatal maternal emotional complaints and behavioural problems of toddlers and preschoolers as assessed by both mothers and fathers are studied separately for boys and girls. Methods: Healthy Dutch Caucasian singleton, pregnant women (N = 444) answered questionnaires about anxiety and depression in every trimester of pregnancy. When their children (227 boys, 217 girls) were between 14 and 54 months old, both parents reported on their current feelings of depression and anxiety and on the behavioural problems of their children. Results: Prenatal maternal emotional complaints were found to be associated with child behavioural problems both in boys and in girls, but in different ways. Prenatal maternal emotional complaints during the first trimester were associated with total and internalizing behavioural problems for boys. Emotional complaints during the third trimester were associated with total, internalizing, as well as externalizing behavioural problems for girls. Conclusions: Differentiation according to sex and information on timing of emotional complaints during pregnancy is needed in studies concerning the relation between prenatal maternal emotional complaints and child outcome. © 2008 Elsevier Ltd. All rights reserved. 1. Introduction Children of women with complaints reflecting distress, anxiety or depression during pregnancy, show more difficulties in motor, cognitive, and especially socio-emotional development from infancy to adolescence [1,2]. Several mechanisms have been proposed to explain these relations. First, the function of the hypothalamic-pituitary-adrenal (HPA) system may have been affected by prenatal maternal distress [1]. In addition, genetic factors or sex hormones may also be important in the processes that affect the developing fetus as a result from maternal distress [3,4]. The Developmental Origins of Health and Disease (DOHaD) approach states that the fetus will adapt and develop by shaping and structuring the organs for optimal performance in the fetal environment and maternal distress may elicit such biological programming processes [5]. Animal studies have shown different effects of prenatal stress on postnatal outcomes for male and female offsprings. Several animal studies indicated an effect of prenatal stress on the hypothalamic- pituitary-adrenal (HPA) function, specifically for females and showed more prominent, mainly externalizing behaviour of the female offspring [6,7]. Only a few studies have addressed sex differences in humans. Van den Bergh et al. [8] reported that antenatal exposure to maternal anxiety at 12–22 weeks pregnancy was associated with a high and more flattened cortisol day-time profile in both sexes and, in female adolescents only, with depressive symptoms. Rodriguez and Bohlin [9] found a significant association between prenatal stress experienced around the 10th week of pregnancy and ADHD symptoms in boys only. Martin et al. [10] found a stronger correlation for 5-year-old boys between maternal distress during the first trimester of pregnancy and ratings of negative emotionality. O'Connor et al. [11] however, found that high levels of anxiety at 32 weeks gestation were associated significantly with hyperactivity and inattention in 4-year-old boys, and with behavioural and emotional problems in boys as well as girls. They also found that high levels of anxiety at 18 weeks gestation were associated with more behavioural and emotional problems in girls at 81 months [12]. Hence, the available results are inconsistent for the nature of sex differences, the timing of distress during pregnancy and the nature of the maternal complaints involved. In this study, the association between prenatal maternal depressive and anxious complaints during different trimesters in pregnancy and externalizing and internalizing behavioural problems of the children is studied separately for boys and girls at toddler or preschool age, with both mothers and fathers as informants. Early Human Development xxx (2009) xxx–xxx ⁎ Corresponding author. Tilburg University, Pediatric Psychology, Department of Developmental, Clinical and Cross-cultural Psychology, P.O. Box 90153, 5000 LE Tilburg, The Netherlands. Tel.: +3113 466 2493. E-mail address: T.C.E.deBruijn@uvt.nl (T.C.E. de Bruijn). EHD-03070; No of Pages 6 0378-3782/$ – see front matter © 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.earlhumdev.2008.12.009 Contents lists available at ScienceDirect Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev ARTICLE IN PRESS Please cite this article as: de Bruijn TCE, et al, Sex differences in the relation between prenatal maternal emotional complaints and child outcome, Early Hum Dev (2009), doi:10.1016/j.earlhumdev.2008.12.009