Maternal prenatal anxiety trajectories and infant developmental outcomes in one-year-old offspring

A longitudinal study of a sample of women and their offspring from two urban areas (N = 233) was conducted to test whether maternal prenatal anxiety trajectories from early to late pregnancy are associated with 12-month infant developmental outcomes, independent of maternal postpartum anxiety symptoms, prenatal and postpartum depressive symptoms, parity, birth outcomes and maternal education. Three types of maternal anxiety trajectories over the course of pregnancy were identified and labeled increasing, decreasing, and stable-low. Only increasing maternal prenatal anxiety was associated with 12-month infant outcomes, specifically lower Bayley-III scores on receptive language and gross motor skills. Maternal anxiety measured at each individual timepoint in pregnancy was not associated with infant Bayley-III outcomes, highlighting the importance of examining trajectories of maternal affect.     

Early infant temperament shapes the nature of mother-infant bonding in the first postpartum year

ObjectiveThis study examined longitudinal relations between maternal bonding and infant temperament in the first nine months after birth.DesignOur sample consisted of 281 women, enrolled at five maternity hospitals, who completed questionnaires during the first week (T1), at six weeks (T2) and nine months postpartum (T3). Maternal bonding was assessed using the Mother-to-Infant Bonding Scale at T1 and T2 and the Postpartum Bonding Questionnaire at T3. Infant temperament was measured using the Infant Characteristics Questionnaire, completed by the mothers at T2 and T3.ResultsThe results of a path model showed a long-term effect flowing from the child to the mother, with infant temperament at T2 predicting maternal bonding at T3 over and above stability in bonding. At T3, bonding was linked more strongly to child temperament at T2 than to child temperament assessed concurrently at T3. Maternal bonding did predict infant temperament, but this was true only of bonding reported at T1 and infant temperament at T2, that is, not of bonding assessed at T2 and infant temperament at T3.ConclusionOur results indicate that maternal bonding in the first week postpartum may temporarily affect child temperament, but infant’s temperament several weeks after birth – rather than several months postpartum – plays a pervasive role in shaping the long-lasting nature of the mother-child relationship. Our findings thus seem to support the suggestion that the early postpartum weeks represent an important period in the development of maternal bonding.     

Maternal self-confidence during the first four months postpartum and its association with anxiety and early infant regulatory problems

Maternal self-confidence has become an essential concept in understanding early disturbances in the mother-child relationship. Recent research suggests that maternal self-confidence may be associated with maternal mental health and infant development. The current study investigated the dynamics of maternal self-confidence during the first four months postpartum and the predictive ability of maternal symptoms of depression, anxiety, and early regulatory problems in infants. Questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory), and early regulatory problems (Questionnaire for crying, sleeping and feeding) were completed in a sample of 130 women at three different time points (third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3). Maternal self-confidence increased significantly over time. High maternal trait anxiety and early infant regulatory problems negatively contributed to the prediction of maternal self-confidence, explaining 31.8% of the variance (R = .583, F_3,96 = 15.950, p < .001).Our results emphasize the transactional association between maternal self-confidence, regulatory problems in infants, and maternal mental distress. There is an urgent need for appropriate programs to reduce maternal anxiety and to promote maternal self-confidence in order to prevent early regulatory problems in infants.     

Effects of maternal postpartum depression in a well‐resourced sample: Early concurrent and long‐term effects on infant cognitive,language, and motor development

This study examined early and long‐term effects of maternal postpartum depression on cognitive, language, and motor development in infants of clinically depressed mothers. Participants were 83 mothers and their full‐term born children from the urban region of Copenhagen, Denmark. Of this group, 28 mothers were diagnosed with postnatal depression three to four months postpartum in a diagnostic interview. Cognitive, language, and motor development was assessed with the Bayley Scales of Infant and Toddler Development third edition, when the infants were 4 and 13 months of age. We found that maternal postpartum depression was associated with poorer cognitive development at infant age four months, the effect size being large (Cohen's d = 0.8) and with similar effects for boys and girls. At 13 months of age infants of clinical mothers did not differ from infants of non‐clinical mothers. At this time most (79%) of the clinical mothers were no longer, or not again, depressed. These results may indicate that maternal depression can have an acute, concurrent effect on infant cognitive development as early as at four months postpartum. At the same time, in the absence of other risk factors, this effect may not be enduring. The main weaknesses of the study include the relatively small sample size and that depression scores were only available for 35 of the non‐clinical mothers at 13 months.     

War trauma and infant motor,cognitive, and socioemotional development: Maternal mental health and dyadic interaction as explanatory processes

BackgroundTaking care of infants in conditions of war is highly demanding and a few studies reveal the negative impact of war trauma on maternal and infant well-being. Yet, little is known regarding the influence of trauma on infant development and the potential explanatory mechanisms. First, the present study examines how mothers’ prenatal exposure to traumatic war events is associated with infant cognitive, motor, and socioemotional development. Second, it analyses the mediating roles of maternal postpartum mental health problems, quality of dyadic mother-infant interaction, and earlier infant development (at six months) in the association between prenatal traumatic war events and infants’ developmental skills at 18 months.MethodThis prospective three-wave study involved 502 Palestinian pregnant females in their first trimester during the 2014 Gaza War and participated at delivery (T1) and when the child was six (T2;N = 392) and eighteen (T3; N = 386) months of age. Mothers reported their exposure to traumatic war events (human and material losses, horrors, and threat to life) at T1 and T2, and researchers photo-documented the extent of destruction at T1. Mothers reported infants’ language, fine- and gross-motor, and socioemotional skills at T2 and researchers tested infants’ motor, cognitive-language and socioemotional skills using the Bayley Scales of Infant development (BSID-II) at T3. Mothers reported their mental health problems (symptoms of post-traumatic stress disorder [PTSD], depression and somatization) at T2 and T3 as well as dyadic interaction quality (the emotional availability self-report, [EA-SR] brief) at T2.ResultsFirst, the structural equation model (SEM) on direct effects indicated, in contrast to our hypotheses, that maternal prenatal exposure to traumatic war events did not associate with infants’ developmental skills at T2 and predicted higher level of developmental skills at T3. Second, as hypothesized, we found two negative underlying mechanisms (paths) between high exposure and low levels of motor, cognitive-language, and socioemotional skills at T3: (1) through increased maternal mental health problems at T2, which then were associated with problems at T3, and (2) through increased maternal mental health problems at T2, which then were associated with a low quality of mother-infant-interaction and low level of infant developmental skills at T2.ConclusionImproving maternal mental health and encouraging close and positive dyadic interaction can be critical for infant sensorimotor, cognitive, and socioemotional development in war conditions.     

Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant responses to the still-face procedure

Animal studies have demonstrated the interactive effects of prenatal stress exposure and postnatal rearing style on offspring capacity to manage stress. However, little is known about how parenting quality impacts the association between maternal prenatal anxiety and stress reactivity in human infants. This prospective study examined the impact of prenatal anxiety disorder and maternal caregiving sensitivity on infants’ responses to a standardised interactive stressor (still-face procedure). Eighty-four women completed a clinical interview during pregnancy to assess anxiety symptoms meeting DSM-IV diagnostic criteria. At infant age 7 months, maternal sensitivity to infant distress and infant negative affect were observed and coded during the still-face procedure. Maternal postnatal (concurrent) anxiety and depression were also assessed at this time. Results indicated a negative association between maternal sensitivity to infant distress and infant negative affect responses to the still-face procedure. An unexpected finding was a positive association between parity and infant reactivity. The main effect for sensitivity was qualified by a significant interaction, p < .05, suggesting that the impact of sensitivity was particularly marked among infants of women who experienced an anxiety disorder during pregnancy. This finding is consistent with a cumulative risk model suggesting that maternal prenatal anxiety and quality of maternal care act in concert to shape infant outcomes.     

Parenting and mother-infant interactions in the context of maternal postpartum obsessive-compulsive disorder: Effects of obsessional symptoms and mood

BackgroundMaternal mental illness is associated with negative effects on the infant and child. Increased attention has been paid to the effects of specific perinatal disorders on parenting and interactions as an important mechanism of influence. OCD can be a debilitating disorder for the sufferer and those around them. Although OCD is a common perinatal illness, no previous studies have characterized parenting and mother infant interactions in detail for mothers with OCD.Methods37 mothers with postpartum OCD and a 6 month old infant were compared with 37 community control dyads on a variety of measures of psychological distress and parenting. Observed mother-infant interactions were assessed independently.ResultsObsessions and compulsions were reported in both groups, although they did not cause interference in the control group. Mothers with OCD were troubled by their symptoms for a mean of 9.6 hours/day. Mothers with OCD were less confident, reported more marital distress and less social support than healthy peers and were less likely to be breastfeeding. Infant temperament ratings did not differ. Mothers with OCD were rated as less sensitive in interactions than the comparison group, partly attributable to levels of concurrent depression.ConclusionsMaternal postpartum OCD is a disorder that can affect experiences of parenting and mother-infant interactions although this may not be driven by OCD symptoms. Longitudinal studies are required to assess the trajectory and impact of maternal difficulties as the infant develops.     

Maternal depression and expressive communication in one-year-old infants

To separate effects of maternal depression on infant cognitive versus language development, 1-year-olds were assessed using the revised Bayley Scales of Infant and Toddler Development (BSID-III). Percentile scores on the Bayley Expressive Communication (EC) subscale were significantly negatively correlated with maternal self-report scores on the Beck Depression Inventory (BDI-II). However, mothers’ BDI-II scores did not correlate with infant percentile scores on the general cognitive (COG) or receptive communication (RC) subscales. Boys had significantly lower percentile scores than girls on the RC and EC scales, but did not differ on the Cog scale. Gender and maternal depression did not significantly interact on any of the scales. These findings suggest problems with expressive communication precede, and may at least partially account for, apparent deficits in general cognitive development.     

Postnatal depression and infant cognitive and motor development in the second postnatal year: The impact of depression chronicity and infant gender

A large body of literature has investigated the effects of postnatal depression on infant development. However, the particular circumstances in which depression is associated with adverse effects remain unresolved. Factors, such as the nature of depression (e.g., duration and severity) and the context with respect to other risk and protective factors (e.g., socioeconomic status and child gender) have been suggested as moderators of the effects of postnatal depression on infant outcomes. This study examined the impact of brief and chronic depression in a non-poverty sample of 112 mothers and their infants. Infant language development was assessed at 12 months, and at 15 months the Bayley Scales of Infant Development-II were administered. Chronic maternal depression, lasting throughout the first 12 months postpartum and beyond, was associated with lower infant cognitive and psychomotor development, with the effects being similar for boys and girls, while brief depression did not significantly impact the infant performance. Language development and infant behavior during testing were equivalent across the groups. The relatively high rates of motor development delay associated with chronic maternal depression found in this study are discussed along with the methodological issues and models of cumulative risk.     

Predicting maternal reactivity/sensitivity: The role of infant emotionality,maternal depressiveness/anxiety,and social support

It was hypothesized that an accumulation of unfavorable conditions, i.e., high negative emotionality and low positive emotionality of the infant, maternal depression and anxiety, and lacking social and emotional support can attenuate mothers' reactivity/sensitivity. Maternal reactivity/sensitivity was observed during home visits and in the laboratory. Infant negative and positive emotionality was assessed by mother reports and behavioral observations. Maternal depressiveness/anxiety as well as social support were assessed via questionnaires. All mothers were primiparous and had healthy infants. Data collection was conducted at the infants' ages of four months (37 dyads) and eight months (33 dyads). The sample consisted of 19 male and 18 female infants (four‐months' measurement). Whereas the presence of a single risk factor was not related to maternal reactivity/sensitivity, the combination was. A decrease in maternal reactivity/sensitivity over the course of time was demonstrated for mothers who had to deal with high negative emotionality of the infant in combination with either high depressiveness/anxiety or low social support at the infants' age of four months. No significant main or interaction effects could be shown for infant positive emotionality. ©2004 Michigan Association for Infant Mental Health.     

Perinatal depression influences on infant negative affectivity: Timing,severity, and co-morbid anxiety

Accumulating evidence suggests that antenatal depression predicts infants’ negative affectivity, albeit with variable effect sizes. With a prospective longitudinal design, we sought to explain that variability by addressing questions about timing of the depression across pregnancy and the early postpartum, the role of high symptom levels relative to diagnosed depression, comorbidity with anxiety, and the potential mediating role of neuroendocrine functioning. Primiparous women (n = 77) with histories of depression prior to pregnancy were assessed for cortisol levels monthly beginning by mid-pregnancy. Depression symptom levels and diagnostic status were similarly assessed monthly in pregnancy and also until infants reached three months of age, when mothers completed the Infant Behavior Questionnaire-Revised to measure infant negative affectivity. Antenatal depression symptoms and infant negative affectivity were positively associated (r = .39). Controlling for depression symptom levels in other trimesters, only second trimester depression symptoms predicted higher infant negative affectivity (β = .44). With postpartum depression symptom levels in the model, only antenatal depression symptoms predicted infant negative affectivity (β = .45). In the context of depression, neither antenatal anxiety symptoms nor anxiety disorder diagnosis were associated with infant NA scores. The hypothesized role of elevated maternal cortisol as a mechanism for the association between antenatal depression and infant NA was not supported. Our findings contribute to efforts to more precisely identify infants of perinatally depressed mothers who are at greater risk for elevated negative affectivity, suggesting a window of vulnerability in mid pregnancy and the need for further study of potential mechanisms.     

The association between observed non-verbal maternal responses at 12 months and later infant development at 18 months and IQ at 4 years: a longitudinal study

Background

An infant's early environment has an important influence on their development. For example, the sensitivity and warmth of a mother's responses towards her infant is associated with the infant's later socio-emotional development. However, it is less clear whether maternal responses are associated with the infant's later cognitive development.

Method

We used data from a large UK cohort study to investigate the association between non-verbal maternal responses and later infant development and IQ. Maternal responses were rated at 12 months during an observed mother–infant interaction. Infant development was assessed using the Griffiths scales at 18 months and IQ at 4 years was assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Data on the infant's developmental level at 6 months (prior to the maternal response ratings) was also available. The complete case sample comprised 732 mother–infant pairs.

Results

There was evidence for an association between positive maternal responses and infant development at 18 months. After adjusting for infant developmental level at 6 months and other confounders, we found a difference of 0.25 standard deviations (coef 2.0, 95% CI (0.8–3.2), p = 0.002) on the Griffiths scales between infant's whose mothers showed positive compared to neutral non-verbal responses at 12 months. However, an association between positive maternal responses and IQ at 4 years diminished following adjustment for maternal educational attainment.

Conclusion

The results provide evidence that positive maternal responses are associated with improved development in infants at 18 months. However, the association between maternal response and IQ at 4 years may be explained by higher educational attainment in mothers who show positive responses. Future studies are needed to explore the influence of maternal responses on different aspects of infant development as well as the role of maternal factors such as education.     

Antenatal and postnatal depressive symptoms: Association with quality of mother–infant interaction

Antenatal and postnatal depression are independently associated with an increased risk of adverse infant development. A key linking mechanism is the quality of mother–infant interaction.ObjectivesThis study assesses the association between postnatal depressive symptoms (PDS) and their severity, with the quality of mother–infant interaction and compare the quality of mother–infant interaction and severity of the symptoms depending on the presence or absence of antenatal depressive symptoms (ADS).Methodsobservational study in 177 psychosocial risk mother–infant dyads from Chile (infant aged 2–12 months).ResultsMothers with PDS had lower maternal sensitivity and a more intrusive/controlling style than mothers without PDS, although the severity of the symptoms was not associated with lower maternal sensitivity. Maternal sensitivity did not differ in the postnatal depressed mothers depending on the presence of ADS, although the mothers differed in interaction style and the severity of symptoms. Mothers with ADS and PDS presented with a predominant intrusive/controlling interaction style and more severe depressive symptoms, whereas those with only PDS presented with a predominant nonresponsive/passive interaction style and reduced severity of symptoms.ConclusionsThe results corroborate the need to offer treatment and dyadic interventions to antenatal and postnatal depressive mothers and postulate that the presence of antenatal depressive symptoms may influence the subsequent mother–infant interaction style and greater severity of symptoms.     

Postpartum maternal mood,feeding practices,and infant temperament in Barbados

Maternal mood, infant feeding practices, and infant temperament, using the Carey-R scales, were assessed in 226 healthy, well-nourished Barbadian mothers and their infants during the first 6 months of life. Maternal moods were assessed by self-report using the Zung depression and anxiety scales and a morale scale. Even after correcting for background variables, maternal depression and anxiety ratings and reports of despair at 6 months postpartum were significantly associated with infant temperament ratings at 6 months, using the original Carey-R scales, with factors derived from principal components analysis of the Carey items, and with summary difficulty scores. Maternal depressive symptoms were associated with decreased infant adaptability, reduced approach, negative mood and an increased sensory threshold. Infants of depressed and anxious mothers were more resistant to change and preferred constancy. These significant relationships were linear across the range of maternal mood scores and were not limited to diagnosed cases of depression or anxiety. In contrast, feeding practices were not significantly correlated with infant temperament, although infant difficulty on the temperament scales was associated with an increase in difficult feeding behaviors and with fathers’ involvement in the feeding of their infants. We conclude that interventions focused on improving maternal mood in the postpartum period are likely to impact positively upon maternal perceptions of their infants, with implications for improving child behavioral development and health in this underserved population.     

Toxic Environment of war: Maternal prenatal heavy metal load predicts infant emotional development

BackgroundPeople in war zones are exposed to heavy metal contamination deriving from new-generation weapons, in addition to exposure to psychologically traumatizing war events. Pregnant women and their children-to-be are particularly vulnerable to both biological and psychological war effects.ObjectiveThe aim of the current study was to analyse the impact of maternal prenatal heavy metal contamination on infant emotional development and to examine the potential moderating role of maternal symptoms of post-traumatic stress disorder (PTSD) in the association between heavy metal load and infant emotional development.MethodsThe participants were 502 Palestinian mothers, pregnant in their first trimester during the 2014 War on Gaza. The mothers were recruited at their delivery (T1) and followed at the infants’ age of 6–7 months (T2; N = 392). The load of five weapon-related heavy metals (chromium, mercury, vanadium, strontium, and uranium) was analysed by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) from mothers’ hair samples at childbirth (T1). Assessment of maternal PTSD symptoms was based on the Harvard Trauma Questionnaire (HTQ) and infant emotional development on the Infant Behavior Questionnaire (IBQ), both reported by mothers (T2).ResultsTwo of the analysed metals, chromium and uranium, adversely predicted children’s early emotional development, indicated by decreased positive affectivity, increased negative emotionality, and problems in early orientation and regulation. Mother’s PTSD did not moderate the impact of heavy metal contamination on children’s emotional development.ConclusionsAdverse impact of war is not limited to those who experience it directly, but is passed on to future generations through multiple mechanisms. International organizations are obliged to protect parents and infants from the modern weaponry in wars.     

Maternal pre‐ and postnatal anxiety and infant temperament. The generation R study

The aim of this study was to investigate whether maternal anxiety that is temporary or chronic during the pre‐ and postnatal period predicts infant temperament. Mothers of 2997 infants in a population‐based birth cohort reported levels of pregnancy‐specific anxiety (Pregnancy Outcome Questionnaire) and general anxiety symptoms (Brief Symptom Inventory) prenatal and at 6 months postnatal. Temperament characteristics were assessed by maternal report using the Infant Behavior Questionnaire—Revised when the infants were 6 months of age. Maternal pregnancy‐specific and general anxiety during the pre‐ and postnatal period were all independently associated with perceived infant temperamental difficulties. Chronically high maternal anxiety predicted the highest perceived infant activity level and negative affectivity. These findings show that different forms of maternal anxiety during both the pre‐ and postnatal period are independently related to perceived temperamental problems in infancy. They also emphasize the significance of chronic maternal anxiety for infant mental health. Copyright © 2009 John Wiley & Sons, Ltd.     

Maternal psychological distress after preterm birth: Disruptive or adaptive?

BackgroundMaternal postpartum distress is often construed as a marker of vulnerability to poor parenting. Less is known, however, about the impact of postpartum distress on parenting an infant born prematurely. The present study investigated whether high distress levels, which are particularly prevalent in mothers of preterm born infants, necessarily affect a mother’s quality of parenting.MethodLatent Class Analysis was used to group mothers (N = 197) of term, moderately, and very preterm born infants, based on their levels of distress (depression, anxiety, and PTSD symptoms) at one month postpartum, and their quality of parenting at one and six months postpartum. Parenting quality was assessed on the basis of maternal interactive behaviors (sensitivity, intrusiveness, and withdrawal) using observations, and maternal attachment representations (balanced, disengaged, or distorted) using interviews.ResultsA 5-Class model yielded the best fit to the data. The first Class (47%) of mothers was characterized by low distress levels and high-quality parenting, the second Class (20%) by low distress levels and low-quality parenting, the third Class (22%) by high distress levels and medium-quality parenting, the fourth Class (9%) by high distress levels and high-quality parenting, and finally the fifth Class (2%) by extremely high levels of distress and low-quality parenting.ConclusionsWhile heightened distress levels seem inherent to preterm birth, there appears to be substantial heterogeneity in mothers’ emotional responsivity. This study indicates that relatively high levels of distress after preterm birth do not necessarily place these mothers at increased risk with regard to poor parenting. Conversely, low distress levels do not necessarily indicate good-quality parenting. The results of the present study prompt a reconsideration of the association between postpartum distress and parenting quality, and challenge the notion that high levels of maternal distress always result in low-quality parenting practices.     

An examination of the interactions between mothers and children with anxiety disorders

This study examined the association between parenting styles and mother and child anxiety. Maternal overinvolvement and negativity/criticism were evaluated during a speech preparation task (N = 135 dyads) and a Five Minute Speech Sample (FMSS) from mothers (N = 155). During the speech task interaction, mothers of anxious children (aged 4–16 years), regardless of their own anxiety, were observed to be more overinvolved than mothers of nonanxious children. Similarly, the FMSS showed that mothers of anxious children (aged 4–17 years) were more overprotective, self-sacrificing, or nonobjective than mothers of nonanxious children, irrespective of maternal anxiety status. No differences in maternal negativity were found on the speech task between any of the groups. However, the FMSS showed that mothers of anxious children were more critical than mothers of nonanxious children, regardless of maternal anxiety status. These results support the relationship between overinvolved, critical parenting and child anxiety, but suggest that maternal anxiety is not associated with increased overinvolvement or criticism. Theoretical implications are discussed.     

Severity of anxiety moderates the association between neural circuits and maternal behaviors in the postpartum period

Neuroimaging research has suggested that activity in the amygdala, center of the socioemotional network, and functional connectivity between the amygdala and cortical regions are associated with caregiving behaviors in postpartum mothers. Anxiety is common in the early postpartum period, with severity ranging from healthy maternal preoccupation to clinical disorder. However, little is known about the influence of anxiety on the neural correlates of early caregiving. We examined these relationships in a community cohort of 75 postpartum women (ages 18–22; predominantly low-SES, minority race) who listened to infant cry sounds while undergoing an fMRI assessment. Maternal self-reported symptoms of anxiety were mostly within the subclinical range. Positive and negative caregiving behaviors during filmed face-to-face mother–infant interactions were coded by independent observers. The results from whole-brain analyses showed that anxiety severity moderated the brain–maternal behavior relationships. Specifically, our results showed that the higher a mother’s anxiety, the stronger the association between positive caregiving (i.e., maternal warmth and involvement) and amygdala–right posterior superior temporal sulcus (amygdala–RpSTS) functional connectivity. These results remained significant when we controlled for symptoms of depression and contextual variables. These findings suggest that functional connectivity between the amygdala and a social perception region (RpSTS) plays a particularly important role for anxious mothers in facilitating their positive parenting. These findings extend our understanding of the specific neural circuits that support positive maternal caregiving in the context of maternal anxiety, and they may help inform the future design of personalized and effective interventions.     

Association between Hyperemesis Gravidarum in pregnancy on postnatal ability of infants to attend to a play task with their mother

Research indicates a higher prevalence of attention deficits in children exposed to HG in utero compared to controls with some claiming that the deficit is due to prenatal effects of malnutrition in HG mothers and others that it is due to maternal mental health after birth. The current study examines the effect of hyperemesis gravidarum (HG) diagnosis during pregnancy on infant attention controlling for maternal stress, depression anxiety and attachment. Thirty-eight infants mean age 4 months were videotaped with their mothers (19 mothers with a hyperemesis diagnosis and 19 controls) during play with a soft toy and looking at a picture book. Infant attention was operationalized as gaze direction towards the play activity, mother, and ‘distracted’ (indicated by looking away from play or mother). Mothers completed stress, depression, anxiety, and attachment questionnaires. HG exposed infants attended for significantly less time during play with a book or soft toy compared to controls. Maternal stress, depression, anxiety, and attachment did not differ in HG mothers and controls. Infant ability to attend to the toy, book, mother or being distracted did not relate to maternal postnatal attachment, or mental health. These results suggest that the prenatal environment, especially exposure to HG might be associated with reduced infant attention abilities independent of maternal postnatal health.