Impact of maternal mental health on neurodevelopment in babies

The early years beginning from the womb is a critical period in brain development. Research evidence strongly indicates that the environment in the womb affects fetal brain development, and the quality of care a baby receives influences brain structural changes and neural connections. This has direct impact on growth, cognitive functioning and emotional regulation well into child- and adulthood.

Maternal stress levels have been identified as one key factor in the neurodevelopment of babies, which is of particular concern given the one-in-seven prevalence of anxiety amongst Singapore mothers. Stress affects the production of cortisol, a hormone that is responsible for the chain of reactions that drives up adrenaline levels to fight or flight responses when a person is under stress.

Heightened levels of cortisol in the mother can move across the placenta to influence fetal cortisol levels, which in turn affect the development of important brain regions – such as the amygdala which is the emotional seed of the human brain.


Prolonged maternal stress associated with structural changes in the baby’s brain

Research on Singapore babies have shown that, in the presence of prolonged maternal stress and depression or anxiety, there are structural changes in the amygdala and reduced neural connectivity in cortical regions, which are responsible for social decisioning, emotional regulation and the development of a strong sense of self.

As the brain is neuroplastic, during the early years of rapid brain development, neural networks which are not utilised are pruned (die off) whilst those that are repeatedly activated are enhanced. In this way, the daily experiences of a baby can lead to the development of the brain in a way that forms the foundations of their personality traits and who they will be as a person.


Mother-child bond vital for secure attachment and child development

Babies are social beings who require nurturing within a relationship with a caregiver who is attuned to their needs, in order to thrive. By default, the key caregiver is the mother who has incubated the baby in her womb for nine months; the baby has heard her heartbeat and her voice, knows her smell and is very much in sync with her. Demonstrating how closely connected babies are to their mothers, babies have primitive reflexes that enable them to crawl towards the mother’s breast when they are placed on her tummy skin-to-skin at delivery.

The early bond between mother and baby lays the foundation of a strong attachment, and the development of a sense of security and self-worth. When a strong maternal-child bond and secure attachment is absent, the quality of the mother-child relationship can be poor, particularly during the tumultuous teenage years. Without secure attachment, a teen may find it difficult to confide in their mother about their struggles; a mother’s efforts to discipline her teen may be perceived as harsh punishment instead of tough love.


First three years of life are foundational for self-regulation and resilience

The best time to begin establishing the mother-child bond is from birth to three months, although the first thousand days of life (up to three years) are also particularly crucial. The child is largely preverbal in these early years and the mother largely relates to her baby through nonverbal communication, which determines the quality of the bonding and the strength of attachment.

During this early period, the baby experiences the mother and themself as a single entity. As the mother is able to reciprocate with attuned and sensitive caregiving, a strong mother-child bond is established which enables the mother to nurture the continual growth and development of their baby as the little one develops body- and self-awareness.

This process continues throughout the child’s life, as they gradually gain independence of their bodily functions and learn to self-regulate. This is particularly important for the child to gain confidence as an individual.

Women may at times feel that they are not good mothers because they feel stressed out and frustrated with caring for their baby. It is reassuring to know that good mothering does not need to be perfect or unfailingly attuned – mothers just need to be good enough, and when there are failings, or lapses, the mother-child bond can be repaired and rebuilt. In fact, “too good” mothering – where the baby is never allowed to feel any distress – is actually a problem, because the child will grow up unable to tolerate and appropriately cope with distress.


Whole-of-society involvement required for maternal and child health

Encouraging mothers to talk to their babies daily, beginning from pregnancy, is a simple exercise that can help mothers to establish and build the mother-child bond over time. This can be particularly helpful for mothers who are struggling to accept their pregnancies.

Counselling can be helpful for mothers who require support with processing feelings of conflict, ambivalence or apprehension surrounding motherhood.

Support from the family, workplace and community is also crucial for the development of the mother-child bond. As mothers frequently bear the burden of childbearing and child rearing, the stresses they experience in a workplace that is not supportive, or a family that is dismissive of her needs will make a crucial difference to the mother’s physical, mental and emotional wellbeing and therefore the child’s development.

Given the life-course impact of maternal mental health, interventions beginning in the preconception period, public education and a whole-of-society involvement are crucial to adequately address the wellbeing of the mother as well as the impact on the child.


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Associate Professor Helen Chen, Head and Senior Consultant, Department of Psychological Medicine, KK Women’s and Children’s Hospital

Associate Professor Helen Chen established the Women’s Mental Wellness Service and is director of the Postnatal Depression Intervention Programme at KKH. Assoc Prof Chen champions the needs of mothers suffering from maternal mental illness, with particular focus on building expertise in perinatal infant mental health.

A member of the GUSTO study investigation team, Assoc Prof Chen has contributed to key papers that have provided robust evidence into the link between maternal mental health, and child health and development outcomes. She is actively involved in teaching undergraduates and postgraduates, and serves in various national committees and workgroups.