The association between prenatal exposure to adversity and internalizing and externalizing problems in adolescence. Insight from the generation XXI Cohort
Year: 2025
Type: dissertation
Study design: Observational Study
Abstract: BackgroundThe prenatal period (PNP) represents a sensitive window in human development during which maternal biological, psychosocial, and socioeconomic factors exert significant influence on the intrauterine environment, thereby shaping fetal growth and neurodevelopment.Prenatal exposure to adversity, including maternal mental health disorders (MHDs) and stressful life events (SLEs), has been consistently associated with negative developmental outcomes.Evidence suggests that such exposures may predispose offspring to internalizing and externalizing problems in adolescence, a developmental stage characterized by rapid physical, cognitive, emotional, and social transitions. ObjectivesThe aim of this study is to examine the association between exposure to SLEs and violence during pregnancy and the development of internalizing and externalizing problems as well as depressive symptoms during adolescence. MethodsThis study utilized a longitudinal design using data from Generation XXI, a Portuguese population-based birth cohort comprising 8,647 infants, with analyses restricted to 4,640 participants with data available at baseline and 13 years follow up.Maternal stressful life events (SLEs) and physical violence during pregnancy were assessed via structured selfreport questionnaires at baseline, while adolescent depressive symptoms, internalizing and externalizing problems were evaluated at age 13 using validated instruments (BDI-II and SDQ).Sociodemographic covariates, including maternal age, education, income, employment and marital status, were also collected.Logistic regression analyses were conducted to estimate associations between prenatal exposure to adversity and adolescent outcomes, adjusting for relevant confounders, with statistical significance set at p<0.05. ResultsA total of 30.4% of mothers reported one stressful life event (SLE) during pregnancy and 17.7% reported experiencing two or more while physical violence was experienced by 0.7%.SLE exposure was more frequent among younger, less educated, unemployed, single or divorced mothers, and lower household income.At 13 years of age, 11.7% of adolescents presented high internalizing problems, 11,2% high externalizing problems and 12.4% depressive symptoms, with boys exhibiting more externalizing problems and girls reporting more depressive symptoms.After adjustment for maternal sociodemographic characteristics, exposure to ≥2 SLEs during pregnancy was significantly associated with internalizing problems (OR=1.40,95% CI: 1.08-1.80)and externalizing problems (OR=1.34,95% CI: 1.03-1.74)and depressive symptoms (OR=1.39,95% CI: 1.10-1.76).No significant associations observed for physical violence during pregnancy. ConclusionsThe study shows that exposure to multiple SLEs during pregnancy is significantly associated with internalizing and externalizing during adolescence, independent of maternal sociodemographic factors.Physical violence during pregnancy, although more frequent among socioeconomically disadvantaged mothers, was not significantly related to adolescent outcomes.These findings highlight the enduring impact of cumulative prenatal stress on offspring mental health and underscore the importance of addressing maternal stress prior and during pregnancy.
Author: Nydia Yasmin Romão Salimo
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7115033309