Maternal Mental Health: Impact on the Child
The mental health of the mother during pregnancy and the first year postpartum is critical to the development of the child across several domains: physical, cognitive, social, and emotional. In this fact sheet, we outline the impact of untreated maternal mental health conditions on the child as well as various interventions and resources to support the health and well-being of the mother-infant dyad.
FACT SHEET PDF
Maternal Mental Health: Impact on the Child
Key Facts: Maternal Mental Health (MMH)
1 in 5 Mothers are Impacted by Mental Health Conditions
Maternal mental health (MMH) conditions are the MOST COMMON complication of pregnancy and birth, affecting 800,000 families each year in the U.S. [1, 2]
Mental Health Conditions are a Leading Cause of Maternal Deaths
Mental health conditions are a LEADING CAUSE of maternal mortality, accounting for 22% of pregnancy-related deaths. [3]
Most Women are Untreated, Increasing Risk of Negative Impacts
75% of women impacted by MMH conditions REMAIN UNTREATED, increasing the risk of long-term negative impacts on mothers, babies, and families. [4]
$14 Billion: The Cost of Untreated Maternal Mental Health Conditions
The cost of not treating MMH conditions is $32,000 per mother-infant pair, or $14 BILLION each year in the U.S. [5]
There are a Range of Maternal Mental Health Conditions
MMH conditions can occur during pregnancy and up to one year following pregnancy. They include depression, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar illness, psychosis, and substance use disorders. [6]
High-Risk Groups
Specific groups have a higher risk for maternal mental health conditions as determined by race, ethnicity, family history of mental illness, pregnancy and birth experience, and other risk factors. Learn More
Key Facts: Impact of MMH Conditions on the Infant
The mental health of the mother during pregnancy and the first year postpartum is critical to the development of the child across several domains: physical, cognitive, social, and emotional. [7]
Untreated MMH conditions during pregnancy increase the risk of poor outcomes for the newborn, including both physically (e.g. low birth weight) and behaviorally (e.g. increased fussiness). [8]
Untreated MMH conditions postpartum can negatively impact breastfeeding, bonding and attachment, and parenting behaviors, all of which can contribute to adverse outcomes for the infant. [9, 10, 11]
Fortunately, MMH conditions are most often temporary and treatable, and the human brain can heal and adapt with the right support and resources.
Impact of Systemic Racism, Trauma, and Chronic Stress
The legacy of structural racism in the United States — including unequal treatment in systems like health care and education, challenges in accessing care, fewer education and economic opportunities, and lack of representation — has created conditions that disproportionately undermine the health and well-being of children and families of color. [12]
Chronic stress caused by coping with systemic racism and everyday discrimination can have harmful effects on the mental and physical health of both caregivers and children. [12]
Infant and early child mental health is directly impacted by non-medical factors, such as economic stability, education, neighborhood conditions, and access to health care. [13]
Many infants and children of color do not receive the same amount or types of early developmental protectors as their white counterparts. In addition, racial stress and trauma have lasting impacts and can directly alter the mental health outcomes of mothers and babies, specifically for Black and Indigenous women and their children. As a result, children of color are disproportionately impacted: [14]
Black babies are twice as likely to have two or more Adverse Childhood Experiences as white babies.
American Indian/Alaska Native infants/toddlers are almost four times more likely to be removed from their homes as their white counterparts.
Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur in childhood. Toxic stress from ACEs can change brain development and affect how the body responds to stress (Centers for Disease Control and Prevention).
Impact of Untreated MMH Conditions
Impact during Pregnancy
Women with untreated MMH conditions during pregnancy are more likely to: [15, 16]
Have poor prenatal care, including not attending medical appointments.
Use substances such as alcohol, tobacco, or drugs.
Experience physical, emotional, or sexual abuse.
These factors can increase the risk of poor birth outcomes, including:
Preterm birth, small for gestational size, low birth weight. [16, 17]
Stillbirth. [16]
Longer stay in the neonatal intensive care unit. [18]
Impact Postpartum
Women with untreated MMH conditions postpartum are more likely to:
Be less responsive to their baby’s cues. [19]
Have fewer positive interactions with their baby. [19]
Experience breastfeeding challenges. [19]
Question their competence as mothers. [19]
Experience more difficulties in relationships with their partners. [9]
Resume smoking (if they stopped during pregnancy). [9]
Impact on Breastfeeding
While breastfeeding is often thought to be protective against MMH conditions, having a negative or challenging breastfeeding experience can contribute to MMH conditions, and experiencing MMH conditions can negatively impact a woman’s breastfeeding experience.
Either can lead to: [9, 20, 22]
Shorter breastfeeding sessions.
Increased breastfeeding difficulties.
Stopping breastfeeding earlier than planned.
Lower satisfaction or reduced confidence in breastfeeding.
Impact on Parenting Behaviors
Parents who are depressed or anxious are more likely to: [20, 21]
Make additional trips to the emergency department or doctor’s office for their child.
Find it challenging to manage their child’s chronic health conditions.
Not adhere to guidance for safe infant sleep and car seat usage.
Not engage in positive play with their infants, such as smiling at, singing to, or reading to their babies.
Impact on Bonding and Attachment
A mother’s positive emotional relationship with her baby – known as “bonding” – starts during pregnancy and typically grows and intensifies after the baby is born. [23]
Attachment Theory posits that an infant needs to develop a deep and positive relationship with at least one caregiver, typically the mother, to develop healthy social and emotional functioning. [24]
Positive bonding and secure attachment create an environment where the infant knows that the caregiver will respond to his/her needs, allowing the infant to grow and develop from a secure and stable base. [25]
Interruptions in bonding and/or poor attachment can cause the child to feel insecure or anxious. In the infant, this can manifest as excessive crying, sleep difficulties, or increased clinginess, all of which signal a greater need for regulation and connection. [10]
Impact on Long-Term Health of the Child
Untreated MMH conditions can increase the risk of the following:
Impaired parent-child interactions. [26]
Behavioral, cognitive, and emotional delays in the child. [26]
Conduct problems in older children. [27, 28]
Adverse Childhood Experiences (ACEs) that can have a long-term negative impact on the health and well-being of the child. [29]
Increased negative discipline by the parent, such as yelling or spanking.
[9, 20, 26]
[30]
The “Still-Face Experiment” captures how infants rely on caregivers to co-regulate their emotional states, showing that even temporary disruptions can impact a child’s sense of safety and connection. [31]
Infant and Early Childhood Mental Health (IECMH) [32]
Untreated MMH conditions can negatively impact the health and wellbeing of the infant: women experiencing MMH conditions may have fewer positive interactions with their infant and may have difficulty attuning to their baby's needs, which can interrupt mother-baby attachment and contribute to longer-term developmental challenges for the child.
The field of Infant and Early Childhood Mental Health (IECMH) recognizes the importance of the parent-infant relationship and focuses on supporting the mental health of both parents and their infants to ensure that every child gets a strong start in life.
IECMH is also a term used to describe the full continuum of services and support (i.e., promotion, prevention, and treatment) necessary to promote healthy development, prevent mental health problems, and treat mental health disorders. IECMH develops in the context of attentive, highly-engaged, consistent, nurturing relationships.
A baby’s social-emotional health is the foundation of all development, including:
Physical health
Cognitive and social skills
Language acquisition
Long-term life outcomes
A baby’s social-emotional health is the foundation of all development, including:
Physical health
Cognitive and social skills
Language acquisition
Long-term life outcomes
“Some researchers have described exposure to untreated MMH conditions as ‘the first adverse childhood experience.’ It is important to note that this framing reflects the impact of unaddressed intergenerational trauma and structural stressors rather than a reflection of parental love or intention. In fact, many mothers experiencing MMH conditions are doing everything they can to care for their children while navigating systems that often failed them first.”
— Lee Johnson III, PhD
The Importance of IECMH [32]
In the first years of life, more than one million new neural connections are formed every second.
Babies’ earliest relationships and experiences shape the architecture of their developing brains.
Social and emotional health involves developing the capacities of trust, motivation, persistence, and curiosity.
IECMH is the developing capacity of the child from birth to age 5 to experience, express, and regulate emotions; form secure and nurturing relationships; and grow and learn – all within the context of family, community, and culture. [32]
How IECMH is Developed [32]
IECMH develops through responsive, consistent, and nurturing caregiving.
Interactions with caregivers have a significant impact on a baby’s mental health.
Positive experiences with caregivers in infancy and early childhood can promote strong IECMH, while negative experiences can have an adverse impact on brain development.
Since untreated mental illness may decrease the parents’ ability to interact with their infants positively, often the best way to support IECMH is to address the mental health needs of the parents and caregivers.
ZERO to THREE uses early childhood development research to create meaningful resources for families, professionals, and policymakers who shape the lives of young children.
Interventions and Resources
Interventions that focus on the mother-infant relationship and interactions may be required to address the potential effects of MMH conditions on the child. Fortunately, several interventions — including the examples below — are available to enhance the relationship between parents and infants, which can lead to improved health outcomes for the child.
Dyadic Therapy [33]
Dyadic therapy involves treating the parent and infant together, thereby addressing multiple interacting factors, all within the context of their cultural understanding.
These factors include:
the parent’s health and needs
the baby's health and needs
their relationship
their family system
Dyadic therapy helps parents meet their own psychological and practical needs, enabling them to be fully attuned to their child.
Infant Massage [34]
Infant massage has benefits for both the baby and the parent.
Infant massage is shown to reduce symptoms of maternal anxiety, depression and stress, while also improving maternal confidence, satisfaction, and attitude towards physical contact with the infant.
Studies show that mothers who learn massage often continue practicing it, which supports increased infant attachment security.
Peer Support [35]
Peer support groups are an integral part of recovery from MMH conditions. Support groups provide an opportunity for new mothers to feel connected and learn from one another, thereby decreasing isolation, shame, stigma, and loneliness.
In groups where mothers and babies participate together, women can learn about positive parenting interactions by observing how other mothers care for and interact with their infants.
Organizations Dedicated to Infant Health
Georgetown University Center for Children and Families is devoted to improving the health of America’s children and families, particularly those with low and moderate income.
National Association for the Education of Young Children promotes high-quality learning by connecting practice, policy, and research.
Brazelton Touchpoints Center provides resources and services for professionals who work in infant and early childhood healthcare and education.
Perigee Fund invests in infant mental health and provides a range of resources and issue briefs.
Fact Sheet: Components of Mental Health and Wellness for Pregnancy and Postpartum
There are 6 components of mental health and wellness that can help parents prepare for a positive pregnancy and postpartum experience. Learn more with our fact sheet on this topic.
Special Thanks to Our Funders and Editorial Team
A special thank you to the Irving Harris Foundation, who generously provided funding for this Fact Sheet. MMHLA also wishes to acknowledge and thank the following individuals who provided input and feedback for this Fact Sheet: Ruthie Arbit, LICSW, MA; Ashley Febvay, MA; Lee Johnson III, PhD; Lamia Soghier, MD, MEd, MBA; and Terri Wright, PhD.
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