Associations Between Maternal Stressful Life Events and Perceived Distress during Pregnancy and Child Mental Health at Age 4

Kristen L. Rudd, Sylvia S. Cheng, Alana Cordeiro, Michael Coccia, Catherine J. Karr, Kaja Z. LeWinn, W. Alex Mason, Leonardo Trasande, Ruby H.N. Nguyen, Sheela Sathyanarayana, Shanna H. Swan, Emily S. Barrett, Nicole R. Bush

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Accumulating evidence suggests that maternal exposure to objectively stressful events and subjective distress during pregnancy may have intergenerational impacts on children’s mental health, yet evidence is limited. In a multisite longitudinal cohort (N = 454), we used multi-variable linear regression models to evaluate the predictive value of exposure to stressful events and perceived distress in pregnancy for children’s internalizing problems, externalizing problems, and adaptive skills at age 4. We also explored two- and three-way interactions between stressful events, distress, and child sex. Both objective and subjective maternal stress independently predicted children’s behavior, with more stressful events and higher distress predicting more internalizing and externalizing problems and worse adaptability; stress types did not significantly interact. There was some evidence that more stressful events predicted higher externalizing behaviors only for girls. Three-way interactions were not significant. The current findings highlight the importance of considering the type of stress measurement being used (e.g., counts of objective event exposure or subjective perceptions), suggest prenatal stress effects may be transdiagnostic, and meet calls for rigor and reproducibility by confirming these independent main effects in a relatively large group of families across multiple U.S. regions. Results point to adversity prevention having a two-generation impact and that pre- and postnatal family-focused intervention targets may help curb the rising rates of children’s mental health problems.

Original languageEnglish (US)
Pages (from-to)977-986
Number of pages10
JournalResearch on Child and Adolescent Psychopathology
Issue number8
StatePublished - Aug 2022

Bibliographical note

Funding Information:
The TIDES study was funded by the National Institute of Environmental Health Sciences (R01ES0125169-05) and the National Institutes of Health (NIH 1UG3OD023271-01, 4UH3OD023271-05; 4UH3OD023305-05). Dr Emily Barrett was also supported by the NIEHS Center for Environmental Exposure and Disease (P30 ES005022). Dr Nicole R. Bush is the Lisa and John Pritzker Distinguished Professor in Developmental and Behavioral Health and is supported by the Lisa Stone Pritzker Fund.

Publisher Copyright:
© 2022, The Author(s).


  • Adaptive skills
  • Externalizing
  • Internalizing
  • Perceived distress
  • Prenatal programming
  • Stressful life events


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