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Maternal psychological distress and fetal growth trajectories: The Generation R Study

Published online by Cambridge University Press:  06 August 2009

J. Henrichs
Institute of Psychology, Erasmus University Rotterdam, The Netherlands
J. J. Schenk
Institute of Psychology, Erasmus University Rotterdam, The Netherlands
S. J. Roza
Department of Child and Adolescent Psychiatry, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
M. P. van den Berg
Department of Child and Adolescent Psychiatry, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
H. G. Schmidt
Institute of Psychology, Erasmus University Rotterdam, The Netherlands
E. A. P. Steegers
Department of Obstetrics and Gynaecology, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
A. Hofman
Department of Epidemiology and Biostatistics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
V. W. V. Jaddoe
Department of Epidemiology and Biostatistics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands The Generation R Study Group, Erasmus MC University Medical Centre, Rotterdam, The Netherlands Department of Paediatrics, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
F. C. Verhulst
Department of Child and Adolescent Psychiatry, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
H. Tiemeier*
Department of Child and Adolescent Psychiatry, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
*Address for correspondence: H. Tiemeier, Ph.D., Department of Child and Adolescent Psychiatry, Erasmus MC – Sophia Children's Hospital, PO Box 2060, 3000 CBRotterdam, The Netherlands. (Email:



Previous research suggests, though not consistently, that maternal psychological distress during pregnancy leads to adverse birth outcomes. We investigated whether maternal psychological distress affects fetal growth during the period of mid-pregnancy until birth.


Pregnant women (n=6313) reported levels of psychological distress using the Brief Symptom Inventory (anxious and depressive symptoms) and the Family Assessment Device (family stress) at 20.6 weeks pregnancy and had fetal ultrasound measurements in mid- and late pregnancy. Estimated fetal weight was calculated using head circumference, abdominal circumference and femur length.


In mid-pregnancy, maternal distress was not linked to fetal size. In late pregnancy, however, anxious symptoms were related to fetal size after controlling for potential confounders. Anxious symptoms were also associated with a 37.73 g [95% confidence interval (CI) −69.22 to −6.25, p=0.019] lower birth weight. When we related maternal distress to fetal growth curves using multilevel models, more consistent results emerged. Maternal symptoms of anxiety or depression were associated with impaired fetal weight gain and impaired fetal head and abdominal growth. For example, depressive symptoms reduced fetal weight gain by 2.86 g (95% CI −4.48 to −1.23, p<0.001) per week.


The study suggests that, starting in mid-pregnancy, fetal growth can be affected by different aspects of maternal distress. In particular, children of prenatally anxious mothers seem to display impaired fetal growth patterns during pregnancy. Future work should address the biological mechanisms underlying the association of maternal distress with fetal development and focus on the effects of reducing psychological distress in pregnancy.

Original Articles
Copyright © Cambridge University Press 2009

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