Maternal Distress in the Perinatal Period and Child Outcomes

Professional Resource Guide

Introduction

Pregnancy and the early years of parenting can be stressful times for parents, and research has shown that in some cases, high levels of stress may lead to premature births; low-birthweight infants; infant mortality; and health, development, and learning challenges in infancy and early childhood. This professional resource guide directs readers to a selection of current, high-quality resources that describe some of the sources of stress that pregnant women and new mothers experience and the impact of maternal distress on the developing fetus and young child. The professional resource guide points to policies, programs, and practices that enhance a woman's ability to cope with stress, provide social and emotional support for pregnant women and new mothers, and build protective factors in new families. Health professionals, program administrators, policymakers, and researchers can use this professional resource guide to learn more about maternal distress and child outcomes, to integrate what they know into their work in new ways to improve care, for program development, and to locate training resources and information to answer specific questions. A separate brief lists resources for families. This professional resource guide has been developed by the MCH Digital Library at Georgetown University and will be updated periodically.

View Related MCH Digital Library Resources for guides about child maltreatment, depression during and after pregnancy, domestic violence, infant mortality, prematurity and preterm birth, and more.

Overview

See Positively Moms, a 3-year initiative by the William J. and Dorothy K. O'Neill Foundation to develop, deliver, and evaluate research-based interventions to reduce distress in pregnant women and mothers of young children.

See Egerter S, Braveman P, Barclay C. 2011. How Social Factors Shape Health: Stress and Health. Princeton, NJ: Robert Wood Johnson Foundation (RWJF). This issue brief describes the links between socioeconomic status, stress, and health. Stress during the prenatal period and in infancy are among the health outcomes addressed.

Also view Unraveling the Mystery of Black-White Differences in Infant Mortality (2008), which examines the cumulative stress of racism on pregnancy outcomes. This video clip is part of the documentary series Unnatural Causes: Is Inequality Making Us Sick?

Resources for Professionals

Websites

• Administration for Children and Families (ACF).
  
  Early Head Start University Partnership Grants: Buffering Children from Toxic Stress, 2011–2016. Grants to implement promising parenting interventions in Early Head Start that provide buffers against toxic stress for infants and young children. The grants were made to New York University, University of Colorado Denver, University of Delaware, University of Denver, University of Maryland School of Social Work, and Washington University. All the projects screen for parental stress.
  
  State Issues and Innovations in Creating Integrated Early Learning and Development Systems—A Follow-Up to Early Childhood 2010: Innovations for the Next Generation. (2011). [Report].
  
  Supporting Healthy Marriage Evaluation: Early Impacts on Low-Income Families. (2012). [Report].
  
  
• American Academy of Pediatrics (AAP).
  
  Bright Futures. Practice guides, PowerPoint presentations, handouts, implementation materials, and family resources for this national health-promotion and disease-prevention initiative that addresses children's health needs in the context of family and community. Promoting family support is a key theme. Materials include
  
  
  • Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed. (2007). See chapter 2, Promoting Family Support.
    
  Early Brain and Child Development (EBCD) Education and Training Modules. (2014). The five modules and accompanying guides cover early brain development, toxic stress, adverse childhood experiences, supporting parents and cultivating community relationships, and advocacy.
  
  Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health. (2011). [Policy statement].
  
  Lifelong Effects of Early Childhood Adversity and Toxic Stress. (2011). [Technical report].
  
  Pediatrician's Role in Child Maltreatment Prevention. (2010). [Clinical report].
  
  
• Brazelton Touchpoints Center®. Research-based tools for professionals that serve infants and young children in health, education, child care, and social services settings to help strengthen families and the systems of care that surround them to optimize children's development.
  
  
• Center for Research on Child Wellbeing: Fragile Families and Child Wellbeing Study. Research study on the capabilities and relationships of parents, particularly unwed parents, as well as the effects of parental resources and public policies on children's well-being. Findings based on data from the study are presented in a working papers series and set of research briefs, including
  
  Child Care Subsidies, Maternal Well-Being, and Child-Parent Interactions: Evidence from Three Nationally Representative Datasets. (2012). [Working paper].
  
  Father Involvement and Mothers' Parenting Stress: The Role of Relationship Status. (2012). [Working paper].
  
  Maternal Stress and Mothering Behaviors in Stable and Unstable Families, rev. ed. (2004). [Working paper].
  
  
• Center for the Study of Social Policy (CSSP). Resources for system reform, effective public policies, and community change aimed at improving the lives of the most vulnerable children and families. Initiatives and publications include
  
  Strengthening Families. Research-based approach to increase family strengths, enhance child development, and reduce child abuse and neglect by focusing on building five protective factors that also promote healthy outcomes: parental resilience, social connections, knowledge of parenting and child development, concrete support in times of need, and children's social and emotional competence. Helping parents cope with stress is a theme woven throughout the framework. Includes information about the national, state, and community partners that have implemented the framework; background research; and tools for assessment, implementation, communication, and evaluation.
  
  Allied for Better Outcomes: Child Welfare and Early Childhood. (2010). [Paper].
  
  Growing and Sustaining Parent Engagement: A Toolkit for Parents and Community Partners. (2010).
  
  
• Center on the Developing Child. Reports, working papers, research briefs, and multimedia tools that translate and communicate the science of early childhood and early brain development to help inform policies that promote successful learning, adaptive behavior, and sound physical and mental health for all young children. Initiatives include the National Scientific Council on the Developing Child (NSCDC), a multidisciplinary collaboration of leading scholars in neuroscience, early childhood development, pediatrics, and economics from universities across the United States and Canada, and the National Forum on Early Childhood Policy and Programs, which complements the council's work by explaining why public investments should be made in the early childhood years. Resources include
  
  Early Experiences Can Alter Gene Expression and Affect Long-Term Development. (2010). [Working paper].
  
  Foundations of Lifelong Health Are Built in Early Childhood. (2010). [Report].
  
  Also see journal article citations for the center's director, Jack P. Shonkoff, M.D.
  
  
• Centers for Disease Control and Prevention (CDC).
  
  Adverse Childhood Experiences (ACE). Study to assess associations between childhood maltreatment and later-life health and well-being. Includes major findings, questionnaires, data and statistics, and publications. Also see journal article citations for leading researcher, Robert F. Anda, M.D., M.S.
  
  Legacy for Children. Set of studies examining the potential for improving child developmental outcomes through parenting programs designed to promote self-efficacy and a sense of community.
  
  
• Child Trends. Research briefs, fact sheets, and other publications for health and social services professionals and policymakers on topics that include poverty, child welfare, early childhood development, family relationships, fatherhood, and parenting programs. Publications include
  
  Disadvantaged Families and Child Outcomes: The Importance of Emotional Support for Mothers. (2012). [Research brief].
  
  Family Strengths: Often Overlooked, But Real. (2002). [Research brief].
  
  Parental Relationship Quality and Child Outcomes Across Subgroups. (2011). [Research brief].
  
  
• CityMatCH. Tools and resources for implementing initiatives to mobilize urban communities to reduce infant mortality and pregnancy loss and reduce racial inequities in infant mortality in urban communities. Resources include
  
  Making a Paradigm Shift in Maternal and Child Health: A Report on the National MCH Life Course Meeting. (2009).
  
  Taking the First Steps: Experiences of Six Community/State Teams Addressing Racism's Impacts on Infant Mortality. (2011). [Report].
  
  Toward Women's Health: A Compendium of Promising Practices to Improve Urban Women's Health. (2005).
  
  
• National Center on Family Homelessness. Program information, reports, briefs, and video clips about the special needs of homeless families, strategies for preventing and ending family homelessness, and evidence-based services that are responsive, effective, cost-efficient, and culturally sensitive. Includes resources about the impact of traumatic stress on the brain and body. Publications include
  
  Developing a Trauma-Informed Approach to Serving Young Homeless Families. (2012). [Issue brief].
  
  Supporting Homeless Young Children and Their Parents. (2012). [Issue brief].
  
  
• National Healthy Mothers, Healthy Babies Coalition: Maternal and Child Health Webinar Series.
  
  Acute Stress Disorder, Posttraumatic Stress Disorder, and Postpartum Depression in Parents of NICU Babies. (2011). [Slides, Audio clip]. Topics include symptoms, different trajectories of recovery, and research on a potentially dangerous relationship between high levels of emotional distress in new parents and impaired infant development.
  
  Paying Attention to Maternal Mental Health—Before, During and After Pregnancy. (2012). [Slides, Audio clip]. Topics include minimizing the long-term effects of mental health problems, how a mother's emotional wellness can enhance her infant's first year of life, and helpful resources for both professionals and parents.
  
  
• Unnatural Causes: Is Inequality Making Us Sick? Discussion guides, video clips, action toolkit, resource database, and other materials to accompany a seven-part documentary series exploring racial and socioeconomic inequalities in health. Episode 2, "When the Bough Breaks" (2008), examines disparities in birth outcomes and the cumulative stress of racism on pregnancy outcomes. Additional resources include
  
  How Racism Impacts Pregnancy Outcomes. (2008). [Video clip]
  
  Unsolved Mystery of Racial Disparities in Birth Outcomes: Is Racism-Related Stress a Missing Part of the Puzzle? (2008). [Presentation].
  
  
• Zero to Three. A wealth of research-based resources for professionals, policymakers, and parents to promote the healthy development of infants and young children. Resources include training tools, parent handouts, charts, tip sheets, articles, and presentations. Topics address sources of stress and child outcomes, such as divorce, homelessness, military deployment, financial hardship, child maltreatment, and family violence. Recent publications and initiatives include
  
  Building Resilience: The Power to Cope with Adversity. (2010). [Professional tips].
  
  Military Family Projects. Training tools for professionals and materials for families about the needs of very young children whose families are experiencing complicated deployments, reunifications, injuries, or death.
  

Additional Electronic Resources

This section contains policy and research reports. For clinical literature, see the PubMed sample searches.

• Aber L, Chaudry A. 2010. Low-Income Children, Their Families and the Great Recession: What Next in Policy? Washington, DC: Urban Institute. [Report].
  
  
• Adler N, Stewart J with Cohen S, Cullen M, Roux AD, Dow W, Evans G, Kawachi I, Marmot M, Matthews K, McEwen B, Schwartz J, Seeman T, Williams D. 2007. Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the U.S. San Francisco, CA: The John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health. [Report].
  
  
• Aizer A, Stroud L, Buka S. 2012. Maternal Stress and Child Outcomes: Evidence from Siblings. Cambridge, MA: National Bureau of Economic Research (NBER). [Working paper].
  
  
• Behrman RE, Stith Butler A, eds. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: National Academies Press. [Report].
  
  
• Bell J, Rubin V. 2007. Why Place Matters: Building a Movement for Healthy Communities. Oakland, CA: PolicyLink. [Report].
  
  
• Chatterji P, Markowitz S, Brooks-Gunn J. 2011. Early Maternal Employment and Family Wellbeing. Cambridge, MA: National Bureau of Economic Research (NBER). [Working paper].
  
  
• Child and Adolescent Health Measurement Initiative (CAHMI). 2010. Children with Special Health Care Needs: A Profile of Key Issues in California. Palo Alto, CA: Lucile Packard Foundation for Children's Health. [Report]. View chapter 6, Impact on the Family: Time, Employment, Finances, and Physical and Mental Health.
  
  
• Commission on Paternal Involvement in Pregnancy Outcomes (CPIPO). 2010. Commission Outlook: Best and Promising Practices for Improving Research, Policy, and Practice on Paternal Involvement in Pregnancy Outcomes. Washington, DC: Joint Center for Political and Economic Studies Health Policy Institute. [Report].
  
  
• Currie J, Rossin-Slater M. 2012. Weathering the Storm: Hurricanes and Birth Outcomes. Cambridge, MA: National Bureau of Economic Research (NBER). [Working paper].
  
  
• Declercq ER, Sakala C, Corry MP, Applebaum S. 2008. New Mothers Speak Out: National Survey Results Highlight Women's Postpartum Experiences. New York, NY: Childbirth Connection. [Report, Press release, Fact sheet, and Survey materials].
  
  
• Haskins R, Barnett WS. 2010. Investing in Young Children: New Directions in Federal Preschool and Early Childhood Policy. New Brunswick, NJ; Washington, DC: National Institute for Early Education Research (NIEER); Center on Children and Families. [Report].
  
  
• Herbst CM, Tekin E. 2012. Child Care Subsidies, Maternal Well-Being, and Child-Parent Interactions: Evidence from Three Nationally Representative Datasets. Cambridge, MA: National Bureau of Economic Research (NBER). [Working paper].
  
  
• Isaacs JB. 2012. Starting School at a Disadvantage: The School Readiness of Poor Children. Washington, DC: Brookings Institution. [Paper].
  
  
• Jackson FM. 2007. Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality. Washington, DC: Joint Center for Political and Economic Studies Health Policy Institute. [Paper].
  
  
• Johns Hopkins University. 2011. Stress and the Brain: Implications for Health, Development and Learning. Baltimore, MD: Johns Hopkins University. [Presentations, Journal of Adolescent Health special issue].
  
  
• McFarlane E, Kahili A, Johnson JA. 2014. Bridging the Research to Practice Gap to Prevent Maternal Stress and Depression. Hawai‘i Journal of Medicine and Public Health. 73(6): 195-196.
  
  
• Miller SR. 2008. Secure Attachment. Chicago, IL: Ounce of Prevention Fund. [Research brief].
  
  
• National Academy of Sciences. 2012. Biological Embedding of Early Social Adversity: From Fruit Flies to Kindergartners—Sackler Colloquium. Proceedings of the National Academy of Sciences of the United States of America 109 (Supplement 2). 17143-17307.
  
  
• Office on Women's Health. 2009. Action Steps for Improving Women's Mental Health. Washington, DC: Department of Health and Human Services (HHS). [Report].
  
  
• Olson, S. 2012. From Neurons to Neighborhoods: An Update—Workshop Summary. Washington, DC: National Academies Press.
  
  
• Olson S, ed. 2011. Toward an Integrated Science of Research on Families: Workshop Report. Washington, DC: National Academies Press.
  
  
• Shonkoff J, Phillips D, eds. 2000. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, DC: National Academies Press. [Report]. Also view From Neurons to Neighborhoods: An Update—Workshop Summary. (2012).
  
  
• Urban Indian Health Institute, Seattle Indian Health Board. (2011). Looking to the Past to Improve the Future: Designing a Campaign to Address Infant Mortality Among American Indians and Alaska Natives. Seattle, WA: Urban Indian Health Institute. [Report].
  
  
• Wood RG, McConnell S, Moore Q, Clarkwest A, Hsueh J. 2010. Strengthening Unmarried Parents' Relationships: The Early Impacts of Building Strong Families. Princeton, NJ: Mathematica Policy Research. [Report].
  

Databases

See the following set of MCH Digital Library resource briefs to identify additional data and statistics, literature and research (including leading researchers), and programs about maternal distress in the perinatal period and child outcomes.

Data and Statistics

• See the MCH Digital Library resource brief, Maternal and Child Health Data and Statistics.
  

Literature and Research Databases

• Child Welfare Information Gateway Library. Online catalog of publications about child welfare, child abuse and neglect, foster care, and adoption. In the Subject field, type (stress, anxiety, distress) & (mother, maternal, parent, pregnancy, prenatal, perinatal). Leave the side button (AND, OR, AND NOT) set at AND, and leave the rest of the fields blank. Click on Search to get your results. Presented by: Administration for Children and Families (ACF).
  
  
• ClinicalTrials.gov. Information about clinical research studies for a wide range of diseases and conditions. Under Search for Studies, select Advanced Search. Under Search Terms, type (stress OR anxiety OR distress) AND (mother OR maternal OR parent OR pregnancy OR prenatal OR perinatal). Click on Search to get your results. Select Modify this Search to add search criteria to further limit results. Presented by: National Institutes of Health (NIH).
  
  
• Maternal and Child Health Research Program: Funded Projects Search. Information about research grants issued annually by the Maternal and Child Health Bureau (MCHB). Under Key Terms, select Stress. Under Age, select Maternal. Click on Submit to get your results.
  
  
• PubMed. Citations for biomedical articles from MEDLINE and life science journals. Citations may include links to full-text content from PubMed Central and publisher websites. Use the MeSH (Medical Subject Headings) database to identify terms. For articles in your search results that are particularly useful to you, be sure to click on the Related citations link to find more on the same topic. Presented by: National Library of Medicine (NLM).
  
  These sample automated searches present English-language clinical literature indexed in PubMed from the last ten years:
  
  A. Maternal distress and infant/child development
  
  B. Maternal distress and pregnancy outcome
  
  C. Maternal distress during pregnancy and delayed effects
  
  D. Evidence-based or evaluated programs and infant/child development
  
  These automated searches identify articles by leading researchers in the field. Please note: A few unrelated articles by authors with similar names may appear in the listings.
  
  Robert F. Anda, M.D., M.S.
  
  Larissa G. Duncan, Ph.D.
  
  Christine Dunkel Schetter, Ph.D.
  
  Marci Lobel, Ph.D.
  
  Catherine Monk, Ph.D.
  
  Jack P. Shonkoff, M.D.
  
  
• Other useful databases include PsychInfo (by the American Psychological Association) and Sociological Abstracts, which require subscriptions and which can often be accessed at institutions such as university and medical libraries.
  
  
• See the MCH Digital Library resource brief, Maternal and Child Health Literature and Research Databases.
  

Programs Databases

• Discretionary Grant Information System (DGIS). Information about discretionary grants issued annually by the Maternal and Child Health Bureau (MCHB). Click on Abstracts. Under Search Word or Phrase, type maternal stress and click on All the words. Click on Search to get your results. Conduct another search using the terms stress perinatal and click on All the words. There will be overlap in the search results.
  
  
• See the MCH Digital Library resource brief, Maternal and Child Health Programs Databases.
  

Interventions to Reduce or Manage Maternal Distress

• Center on the Social and Emotional Foundations of Early Learning (CSEFEL): Parent Training Modules. Modules for professionals working with parents to promote positive and effective parenting behaviors to address the social and emotional needs of young children. Each module features PowerPoint presentations, discussion guides, activity ideas, and role-play cards. Most materials are available in English and Spanish. Some modules feature video clips.
  
  
• Healthy Families America. Evidence-based home visiting program for families from pregnancy until their child turns 5 who are at risk for adverse childhood experiences, including child maltreatment. Includes guidelines on developing programs, a directory of state contacts, fact sheets on successful program elements, evaluation results, innovative strategies, and training information.
  
  
• Maternal and Child Health Bureau (MCHB). Initiatives on behalf of America's women, infants, children, adolescents, and their families, including Healthy Start, a program to reduce the rate of infant mortality and improve perinatal outcomes in high-risk populations, and early childhood programs, such as the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, a federal, state, and community collaboration to improve health and development outcomes for children who are at risk through evidence-based home-visiting programs. Also see the Maternal and Child Health Research Program and the Discretionary Grant Information System (DGIS).
  
  
• National Healthy Start Association (NHSA). Information about the federal Healthy Start program and its efforts to address infant mortality, infants with low birthweights, and racial disparities in perinatal outcomes. Includes a directory of Healthy Start projects nationwide, tools to raise awareness about infant mortality, and a newsletter and blog. Recent publications include
  
  Federal Healthy Start Initiative: A National Network for Effective Home Visitation and Family Support Services. (2010). [White paper].
  
  Social Emotional Development of Young Children: Resource Guide for Healthy Start Staff. Topics include brain development, social emotional development, the life course, and how Healthy Start staff can help parents promote their children's social and emotional development. The guide shows parents and children of varying racial and ethnic identities and is available in three versions with a different population on each cover (version 1, version 2, version 3).
  
  
• Nurse-Family Partnership (NFP). Nurse home visiting model program for first-time mothers with low incomes from pregnancy until their child turns 2. Nurses guide first-time mothers through the emotional, social, and physical challenges they face as they prepare for a healthy birth and teach parenting and life skills that foster positive growth for both mother and child. Includes program information for nurses, mothers, communities, and supporters; a map of agencies that have adopted the NFP model; public policy updates; and research results.
  
  
• Parents as Teachers (PAT). Parent-education and family-support program that serves families from pregnancy until their child enters kindergarten. The program is designed to enhance child development and school readiness. Program services include home visits; child health, hearing, vision, and developmental screenings; parent-group meetings; and a resource network that links families with needed community resources.
  
  
• Triple P (Positive Parenting Program). Evidence-based program for the prevention of social, emotional, and behavioral problems in childhood; the prevention of child maltreatment; and the strengthening of parenting and parental confidence. Includes professional-training information as well as self-help and parenting resources. The program materials have been translated into Spanish, Arabic, Mandarin, and Malay and are used by a diverse range of cultural groups in the United States and internationally. Materials are available for a fee.
  
  
• Bavolek SJ, Rogers MS. 2012. Nurturing Parenting Programs Are Building Protective Factors in Families. Park City, UT: Family Development Resources. [Report]. Also view Nurturing Parenting Programs: Comprehensive Review, Upd. ed. (2014).
  
  
• California Diabetes and Pregnancy Program (CDAPP) Sweet Success. (2010). Stress Reduction: Tip of the Month. Sacramento, CA: California Department of Public Health. This set of 16 tips is designed for health professionals working with women who are pregnant and have diabetes.
  
  
• Mayer R, Anastasi J, Clark EM. 2006. What to Expect and When to Seek Help: Bright Futures Developmental Tools for Families and Providers. Washington, DC: National Technical Assistance Center for Children's Mental Health, Georgetown University Center for Child and Human Development, with National Center for Education in Maternal and Child Health. [Available in English and Spanish].
  
  
• National Center for Complementary and Alternative Medicine (NCCAM). 2011. Stress and Relaxation Techniques. Bethesda, MD: National Center for Complementary and Alternative Medicine (NCCAM). [Clinical digest].
  
  
• Pew Center on the States. 2010. Case for Home Visiting: Strong Families Start with a Solid Foundation. Washington, DC: Pew Center on the States. [Issue brief].
  
  
• Qureshi MF. 2010. Catalog of Preconception Health Initiatives in Region V States. Chicago, IL: Health Resources and Services Administration Region V, Department of Health and Human Services. This compilation specifies which initiatives educate women about the impact of stress on maternal health, screen for stress, and offer interventions for stress reduction.
  
  
• Also see the Administration for Children and Families (ACF), American Academy of Pediatrics (AAP), Center for the Study of Social Policy (CSSP), Centers for Disease Control and Prevention (CDC), National Center on Family Homelessness, and Zero to Three.
  

Resources for Women and Their Families

• See the MCH Digital Library family resource brief Stress During and After Pregnancy.
  

Related MCH Digital Library Resources

• Child Maltreatment resource brief
• Community Services Locator: An Online Directory for Finding Community Services for Children and Families professional resource guide
• Depression During and After Pregnancy professional resource guide, family resource brief
• Home Visiting resource brief
• Infant Mortality and Pregnancy Loss professional resource guide, family resource brief
• Intimate Partner Violence professional resource guide, family resource brief
• Life Course and Social Determinants resource brief
• Medications resource brief
• Preconception and Pregnancy professional resource guide, family resource brief
• Prematurity and Preterm Birth resource brief
• Social and Emotional Development in Children and Adolescents professional resource guide, family resource brief, school resource brief
  

Maternal Distress in the Perinatal Period and Child Outcomes: Professional Resource Guide. (January 2013). (Updated: August 2014).

Authors: Susan Brune Lorenzo, M.L.S., MCH Digital Library; Olivia K. Pickett, M.A., M.L.S., MCH Digital Library.
Reviewers: Rebekah L. Dorman, Ph.D., Cuyahoga County Office of Early Childhood/Invest in Children; Leah S. Gary, M.S., The William J. and Dorothy K. O'Neill Foundation; Rochelle Mayer, Ed.D., National Center for Education in Maternal and Child Health; Molly O'Neill, The William J. and Dorothy K. O'Neill Foundation; Deborah F. Perry, Ph.D., Georgetown University Center for Child and Human Development (GUCCHD); Rebecca Stone, The William J. and Dorothy K. O'Neill Foundation; S. Darius Tandon, Ph.D., Johns Hopkins Bloomberg School of Public Health.
Editor: Ruth Barzel, M.A., MCH Digital Library.
Funded by: William J. and Dorothy K. O'Neill Foundation.