Association between prenatal maternal anxiety and/or stress and offspring’s cognitive functioning: a systematic review and meta-analysis

The relationship between prenatal maternal stress and/or anxiety and children’s cognitive development is inconclusive. This systematic review and meta-analysis aims to examine the relationship between the different domains of stress, anxiety and children’s cognitive outcomes during the first 18 years of life. Five databases were searched for all observational studies investigating the association between symptoms of prenatal maternal anxiety and/or stress and children’s cognitive outcomes. Of 7,004 articles identified, 21 met the inclusion criteria and 11 provided usable data that were further analysed quantitatively. A weak negative association was found between prenatal stress and/or anxiety exposure and the offspring’s language development. Associations varied based on the type of prenatal psychological exposure (i.e., trait anxiety, state anxiety, perceived stress, stress response). Specifically, maternal prenatal exposure to stress but not anxiety was found to correlate with children’s general intellectual skills. Moreover, trait anxiety but not the combined exposure to trait and state anxiety was correlated with attention in the offspring. While exposure to stress and/or anxiety at any stage of pregnancy was found to be associated with adverse cognitive outcomes in the offspring, there was a trend that timing of exposure may be associated with distinct cognitive outcomes. Findings support the need for screening and interventions to prevent or minimise mental health problems in pregnant women in order to optimise child development. Findings also have implications for conceptualising prenatal stress and anxiety in future research, as well as investigating timing and cumulative effects of prenatal stress and/anxiety exposure.