Writer: Claire Brotea
Editor: Madeleine Hjelt
Artist: Ahmad Bilal
Stress and anxiety are increasingly universal features of modern life. In response, millions of dollars have been invested in funding charities, research initiatives, and treatments aimed at understanding and managing these conditions. Yet despite these efforts, anxiety remains a pervasive issue: one in five adults in the United States experience it. For many, especially younger individuals, identifying the root cause of their depression or anxiety can often feel elusive. Even with growing awareness and the resources available, we have a tendency to dismiss these feelings as ‘normal’. But the reality is far more serious. Inadequate mental health support has profound and far-reaching consequences. For instance, 1 in 20 women of childbearing age suffer from anxiety, and 25% of women in the ‘Western’ world report heightened levels of anxiety and stress. These statistics raise an important question — what is driving this widespread issue? Although anxiety isn’t solely rooted in genetics, there may be deeper explanations as to why this condition seems to plague every generation. Recent research has begun to explore one compelling possibility: maternal stress during pregnancy may play a role in programming long-term mental health outcomes for the next generation
Up to 15% of pregnant women suffer from depression. This is often due to hormonal mood fluctuations, physical discomfort, financial and familial problems, or anxiety about pregnancy complications. The range of triggers are numerous and complex, and so are the potential consequences for fetal development. The prenatal period is a crucial window for neurodevelopment, during which the foetus’ brain is highly sensitive to the mother’s environment The brain begins growing quite early in the third week of pregnancy, and grows extremely fast in the third trimester. Because of this vulnerability, scientists have proposed the fetal origins hypothesis – the idea that prenatal environmental exposures, such as the mental state of the mother, can alter the physiology of a fetus in utero and cause long-lasting effects.
Evidence supporting the foetal origins hypothesis is compelling. For instance, one study in particular shows that a deficiency in essential fatty acids in the mother’s diet during pregnancy can lead to a lower birth weight in the child, which is associated with a reduction of cognitive and motor function. A striking historical case comes from the Dutch Hunger Winter of 1944: children of pregnant mothers at this time had a two-fold increase of developing schizophrenia and other personality disorders. These examples highlight how physical environmental factors from mothers can affect their children for a lifetime. But what about more abstract factors, such as a mother’s mental health during pregnancy?
Cortisol, the body’s primary stress hormone, plays a large role in the body’s stress response. When a pregnant woman is experiencing stress, cortisol levels in her body rise, and excess cortisol have been shown to disrupt foetal brain development. This disruption can negatively impact the child’s immune response to diseases, increase the risk of high blood pressure and cardiovascular diseases, and increase the child’s sensitivity to stress. One study found that middle-aged adults who were exposed to maternal stress during fetal development had elevated pro-inflammatory markers – biological signs of poor stress regulation – and experienced higher rates of depression and psychosis throughout their life.
This is because anxiety in pregnant women affects the brain development of babies, as mentioned before. Neural connection formation can change, causing various neurodevelopmental disorders and poor social and emotional behaviours in children. Of course, the postnatal environment also affects the mental health of these children, regardless of whether the mother had experienced stress during pregnancy. However, case studies have shown that even if a child has been born into a safe environment where stressful environments are rare, if the mother experiences high levels of anxiety during pregnancy, that child is predisposed to stress hypersensitivity. As a result, this causes nervous system dysregulation as they grow up.
Resting-state functional magnetic resonance imaging (rs-fMRI) has become a powerful tool for identifying how fetal neurodevelopment is affected by maternal stress. rs-fMRI analyses developing neural circuits in fetuses at different stages of development, allowing insight into how neural connectivity changes with time. Using rs-fMRI, maternal distress was correlated with decreased hippocampal and cerebellar volumes, and an overall decreased newborn head circumference at birth. The same study also found reduced levels of brain metabolites like choline, of which is also diminished in adults who suffer from anxiety disorders. One important pathway through which maternal mood influences fetal development is the hypothalamic-pituitary adrenal (HPA) axis — the central regulatory system for physiological distress. When exposed to high levels of cortisol, the HPA axis can become dysregulated which increases the child’s risk of developing ADHD.
It is also interesting to consider how different sexes have different outcomes from their mother’s poor mental health during pregnancy. Research has continuously found that girls are born with a larger amygdala if their mother experienced severe anxiety during pregnancy. This enlargement has not been observed in boys. In affected girls, the larger amygdala shows weaker connectivity to other parts of the brain, thus increasing the risk of poor stress perception.
This isn’t about placing blame on our parents for our mental health struggles – it’s far from it. After all, we all know that how we manage stress plays a significant role in our well-being. Techniques like mindfulness, cognitive behavioural therapy, and insight-oriented therapy are proven to significantly reduce anxiety. Similarly, surrounding ourselves with supportive friends and family can lower cortisol levels and foster emotional resilience. For pregnant women, the stakes are even higher. The mental health of expectant mothers is not just a personal issue – it can have generational implications. Yet, discussing mental health during pregnancy remains a taboo, often dismissed with harmful stereotypes such as ‘it’s just hormones’. This attitude undermines the very real challenge pregnant women face and discourages them from seeking help. Routine mental health surveillance during pregnancy, and indeed for everyone across all stages of life in our communities, is essential. Through multiple groundbreaking discoveries it is clear that the mental state of a mother can affect her child’s development. We have the potential to break generational cycles of this by addressing and alleviating this mental stress. Supporting women today could mean healthy futures for their children and generations to come.
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