Article Summary: Protective Factors for Child Development

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Protective factors for child development at age 2 in the presence of poor maternal mental health: Results from the All Our Babies (AOB) pregnancy cohort 

Authors: Sheila McDonald, Heather Kehler, and Suzanne Tough                                  Journal: BMJ Open

What is this study about? This study looked at what combination of factors were most protective of developmental delay at age two among children exposed to poor maternal health.

Who are the participants? The study team recruited a cohort of 3000 pregnant women. Two years later, 1596 mother-child dyads completed questionnaires. Of these 1596 pairs, 305 mothers (27%) were determined to be high risk for having poor mental health. The results we describe below are based on information from these 305 mother-child pairs from the Calgary area.

Why is this study important? The authors explain that maternal depression is a risk factor for child developmental delay. Developmental delays (failing to meet developmental milestones like walking and talking on time) are associated with negative future outcomes like lower school readiness and poor school performance. With as many as a quarter of women experiencing poor mental health between conception and one year postpartum, it is important to better understand the factors that promote resilience and healthy development in their children.

What information was collected? Mothers completed comprehensive questionnaires and provided medical record data covering their pregnancy, birth, early postpartum period, and their child’s first two years of life. Women were considered to have poor mental health risk if they experienced two or more of the following:

  • A history of any abuse, a history of any mental health disorder, depression or anxiety during pregnancy, depression or anxiety at 4 months postpartum, or depression or anxiety at 1 year postpartum.

The child’s development and behaviour was assessed in the following areas:

  • Communication, gross motor, fine motor, problem solving, and personal-social.
  • Behaviour problems: Aggression, defiance, overactivity, negative emotionality, anxiety, withdrawal.
  • Social-emotional competencies: empathy, prosocial behaviours, and compliance.

Protective factors that might promote resilience in child development among children with mothers who have poor mental health risk include:

  • Maternal sociodemographics, maternal social support, maternal optimism, maternal relationship happiness, maternal community resource use, birth outcomes, childcare arrangement, child sleep habits, child screen time, child physical activity level, child second language exposure, maternal working status, and parenting outcomes.

What did the study find among the 305 pairs with mothers with high maternal mental health risk?

  • 18% of children had developmental problems. Protective factors were having a mother with higher social support during pregnancy and more relationship happiness at 1 year postpartum. 
  • 16% of children had delayed social-emotional abilities. Protective factors were having a mother who reported more relationship happiness at 1 year postpartum, less difficulty balancing family, work and other responsibilities, and the child being exposed to less than 1 hour of screen time per day. 
  • 24% of children had behavioural problems. Protective factors were having a mother who reported higher optimism during pregnancy, less difficulty balancing family, work and other responsibilities, and the child being able to fall asleep in less than 30 minutes at night and sleeping through the night by age 2. 
  • Higher social support in pregnancy and relationship happiness seem to be especially important for families with poor maternal mental health in comparison to the families without mental health risk.

What do the findings mean for public health? The authors conclude that “there are modifiable factors that are protective against developmental delays at age 2 in the presence of maternal mental health.” These include:

  • Having a child who sleeps well is a protective factor for their development. Sleep education and equipping parents with sleep strategies may be a low-cost and effective strategy for supporting mothers’ mental wellness and promoting healthy child development.
  • During baby visits to the public health centre, mothers could be screened for relationship happiness in addition to mental health screening.
  • A social support network during pregnancy and continuing on throughout the postpartum period is important.
  • There is research linking optimism to coping abilities and positive parenting practices. Cultivating maternal optimism may be an option for early intervention within parenting programs.
  •  It is important to help mothers with mental health risks cope with the multiple roles and demands in their lives so that they can feel better equipped to balance family and work roles.
  • The authors’ findings back up the Canadian Pediatric Society’s recommendation for limiting screen time for young children.

You can find more information about the larger All Our Babies cohort here.

Thank you for sending this article for a summary on the blog and a big shout out to all the mentors, family members, friends, public health nurses, and other individuals who are working to support women and children lead happy and healthy lives! 



Hello! I’m Dr. Marnie Makela and I’m one of the voices behind the CanFASD blog. I’m also a researcher with CanFASD and a Registered Psychologist in Edmonton, AB. I received my PhD in School and Clinical Child Psychology from the University of Alberta.  I work with individuals with FASD and other complex disabilities, their families, and their service providers to complete assessments and develop effective intervention plans that will create meaningful and positive life experiences. 












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