JAMA Netw Open. 2025 Oct 1;8(10):e2540907. doi: 10.1001/jamanetworkopen.2025.40907.
ABSTRACT
IMPORTANCE: Maternal psychological distress is a risk factor for neurodevelopmental delay in the offspring, but no previous studies have examined this while considering the bidirectional relationship between psychological distress and child development over time.
OBJECTIVE: To estimate the risk of neurodevelopmental delay in toddlers following maternal psychological distress during mid- to late pregnancy and at 1 year post partum.
DESIGN, SETTING, AND PARTICIPANTS: This birth cohort study, the Japan Environment and Children’s Study (JECS), is an ongoing nationwide longitudinal cohort. Recruitment was conducted through 15 regional centers across Japan from January 2011 to March 2014. Participants were 82 418 mother-child pairs enrolled in the JECS. Data were analyzed from July 2024 to July 2025.
EXPOSURES: Psychological distress, defined as a Kessler Psychological Distress Scale (K6) score of 5 or greater.
MAIN OUTCOMES AND MEASURES: Neurodevelopmental delay, defined as a score less than the cutoff in any of 5 developmental areas identified at any of 4 measurement times (ages 1.5, 2.0, 2.5, and 3.0 years), using the Ages and Stages Questionnaire, Third Edition. A marginal structural modeling approach was used.
RESULTS: Among 82 418 mother-child pairs, the mothers’ mean (SD) age was 31.1 (5.0) years, and 40 125 children (48.7%) were female. Compared with having no psychological distress at either time point, the adjusted odds ratio was higher when psychological distress was present at 1 year post partum only (aOR, 1.25; 95% CI, 1.18-1.33) than when it was present during mid- to late pregnancy only (aOR, 1.08; 95% CI, 1.03-1.13). The aOR for psychological distress at both time points was 1.38 (95% CI, 1.30-1.46). No salient multiplicative interaction between the 2 exposure periods was observed (aOR, 1.02; 95% CI, 0.93-1.11).
CONCLUSIONS AND RELEVANCE: In this cohort study of 82 418 mother-child pairs, maternal psychological distress at 1 year post partum had an estimated higher risk of neurodevelopmental delay in toddlers than psychological distress during pregnancy. These findings suggest the importance of maintaining maternal mental health from pregnancy through 1 year post partum.
PMID:41171271 | DOI:10.1001/jamanetworkopen.2025.40907
