Maternal Anxiety and Child Development

Running Head: MATERNAL ANXIETY 1
The Relationship between Maternal Anxiety and Child Development
Megan Dean-Mahoney, Psych 333 (Section AS01)
Grant MacEwan University

EFFECTS OF MATERNAL ANXIETY ON CHILD DEVELOPMENT 2
Abstract
This paper explores published articles that look at the relationship between maternal
anxiety, and child development. The articles all surround this same topic, but vary in
research focus and research format. Maternal anxiety has been associated with the
“anxious-avoidant” child attachment. Mothers who experienced enhanced anxiety were
shown to have a great proportion of children with biological delays, poor temperament
behaviors, and the diagnosis of borderline personality disorder (BPD). In contrast,
mothers with a relaxed demeanor, and who had the ability to form a secure child
relationship, presented children with higher levels of biological and social development.
Together, these findings suggest that the infant-mother relationship plays a key role in
healthy child development. Keywords: maternal, anxiety, depression, development, child,
early experience, relationships.

Introduction
A biological mother is the very first social and physical interaction that an infant
has experience with. For nine months a child in the womb lives the reality that their
mother projects upon them. During this time a child is submerged within this reality both
physically, and psychologically. These experiences play a significant role in shaping who
that child will become. It is therefore a great importance for mothers to form a strong,
relaxed, and healthy bond with their child; while also being knowledgeable on the risks
associated with not doing so. Harry Stack Sullivan’s idea of an evil nipple suggests that
maternal anxiety leads to disagreeable tension, and ultimately infant avoidance (Taylor
and Francis Group, 1953). Recent studies have since demonstrated that maternal stress in
the first half of pregnancy is an important predictor of problematic infantile formation
(Huizink, 2000). This paper will further explore both pre and post birth maternal anxiety,
while comparing them to the physical and social elements of a child.
“Today we know that the normal growth and development of an unborn child can be
negatively influenced by a number of factors, including complications of pregnancy,
infections, and teratogens” (Mulder, et al., 2002). Many studies have already confirmed
that exposure to certain substances can lead to improper child development. Less research
has been done on improper child development, and its relationship to maternal stress.
Maternal stress is a more subjective influence on the fetus when compared to chemicals.
The concept of stress has many factors associated with it, and is often observed through
qualitative research. At the most basic level, stress is correlated with the presence of
multiple stress hormones.

Biological Factors
The belief that a mother's psychological status may affect her fetus has been a
common theory within many societies (Rondo, et al., 2003). It has not yet been
scientifically proven how signals of maternal stress are passed along to a child. Three
possible mechanisms have been considered that may operate simultaneously, or amplify
each other's effects (Mulder, et al., 2002). “These possible mechanisms involve: (a)
reduction in blood flow to the uterus and fetus at increased levels of maternal stress; (b)
transplacental transport of maternal hormones; (c) stress-induced release of placental
CRH to the intrauterine environment” (Mulder, et al., 2002). Biological consequences of
these mechanisms have been shown to lead to low birth weight, and a lower infant
neurological development score.
Hoffman and Hatch (1996), cover the last 10 years of research on stress, social support
and pregnancy outcome; they concluded that acute life stressors have direct effects on
low-weight birth outcome, whereas strong partner or family support is a promoter of
healthy fetal growth (Rondo, et al., 2003). Paarlberg et al (1995) present evidence of
higher amounts of muscular tone existing in stressing conditions, which can probably
potentiate early contractions, and produce preterm labor. (Rondo, et al., 2003). Low birth
weight is commonly associated with early-child delivery, and can further lead to
developmental delays and health complications.
Maternal stress can directly affect the brain formation in a developing fetus. Davis and
Sandman (2010) reported that an elevated level of pregnancy-specific anxiety was

independently associated with lower 12-month mental development scores on the child.
This data further confirms that maternal cortisol and pregnancy-specific anxiety have
programming influences on the developing fetus (Davis & Sandman, 2010). Low birth
weight, pre-mature delivery, and under developed neurologic functioning, are all results
of pre-birth maternal stress. Furthermore, a child can be physically impacted by stress;
before they are socialized by it.
Attachment Style
For a long time the nature-nurture debate has been a common ground for
disagreement within the academic community. For the purpose of this paper I would like
to accept that both theories can coexist. The biology of a child is the platform of who they
are, but after delivery the process of socialization continues to shape them as a human
being.
A child’s attachment security is a major paradigm that serves to explain socio-emotional
development (Goldner & Scharf, 2013). The attachment theory emphasizes that a healthy
mental state is closely correlated with relationships, and emotional support provided
attachment figures (Bowlby, 1969). In contrast, children who present an anxious-avoidant
attachment style are shown to not have developed a strong sense of trust within their
environment, or themselves (Goldner & Scharf, 2013). Many Psychologists confirm
attachment style as being developed during the early stages of life; Harry Sullivan
believed it stemmed from breast feeding specifically. Sullivan’s evil nipple concept
proposed a child who is exposed to maternal anxiety will not form a secure attachment,

and will instinctively avoid their mother entirely. The anxious avoidant attachment style
has also been closely correlated to Borderline Personality Disorder.
Borderline Personality Disorder (BPD)
“Borderline personality disorder (BPD) is a serious psychiatric disturbance that is
characterized by emotional liability, poor impulse control, and angry outbursts”
(Crawford, Cohen, & Chen, 2009). Empirical literature to date has explored the role of
attachment disturbance and emotion dysregulation separately as they relate to BPD (Kim,
Sharp, & Carbone, 2014). Study by Kim, Sharp, and Carbone (2014) described emotional
and interpersonal dysregulation as what should be understood to constitute the central
features of borderline personality disorder. This study further states attachment security
functions as a buffer against BPD by enhancing positive emotional regulation strategies.
Poor emotional regulation strategies served to dilute these protective effects; culminating
in clinically significant levels of borderline traits (Kim, Sharp, & Carbone, 2014).
Hostile-helplessness is another attachment characterization found in BPD patients,
because it presents contradictory and malevolent internal representations of caregivers
(Lyons-Ruth, Melnicka, Patrick, & Hobson, 2007). The hostile-helpless(HH) state of
mind is characterized by Frigerio et al (2013) as having unintegrated mental contents that
become evident through opposing and globalized evaluations of the caregiver and the
self, without any attempts to resolve such contradictions. They break their definition
down further into describing each subtype separately. The hostile subtype refers to
individuals who tend to be identified with a malevolent attachment figure, while the
helpless subtype refers to individuals who are fearful and who may be identified with an

overwhelmed or helpless caregiver (Frigerio, Costantino, Ceppi, & Barone, 2013). While
each subtype is defined with a distinct pattern, the mixed subtype is commonly observed
in people presenting characteristics of both. Furthermore hostile-helplessness is strongly
associated with a disorganized state of mind, which is another prominent characteristic in
people with BPD.
Actual (physical) mother-child separation and perceived (emotional) separation can
potentially produce the same effects. Separations can be difficult for young children to
understand and may harmfully impact the child’s mental representation of themselves
and others (Crawford, Cohen, & Chen, 2009). If children believe that their mother does
not want to be with them or care about their needs, these distorted representations of
themselves may include being unworthy of love or expect significant others to be
rejecting (Crawford, Cohen, & Chen, 2009). These representations were also shown to
undermine attachment security, and increase risk for adult psychopathology (Crawford,
Cohen, & Chen, 2009).
It should be noted that the association with attachment avoidance and BPD has been
variable, sometimes showing a strong correlation, and other times inverse associations
(Crawford, Cohen, & Chen, 2009). This variability may reflect differences in how people
defend against high attachment anxiety, some by distancing themselves from close
relationships (high avoidance), while others clinging closely to relationships (low
avoidance) (Crawford, Cohen, & Chen, 2009). BPD was also associated with frequent
crying, mood reactivity, and demands for attention. Furthermore maternal anxiety can be

a risk factor for the formation emotional dysregulation, which in its severe form is
diagnosed as BPD.
Temperament
From the psychobiological framework, temperament is characterized by constitutionally
based individual differences in self-regulation and emotional reactivity, which are
influenced across time by aspects of the environment, heredity, and maturation (Rothbart
& Derryberry, 1981). The nurturing and one-on-one attention of a caregiver is a
commonly used and often successful tactic in calming a child down and reducing difficult
temperament. A mother’s emotional state is a well-known environmental factor that
relates to the development of infant temperament. Mother’s who are characterized by
intense anxiety will likely not positively contribute to the relaxation of the child. The
anxiety of the mother can be easily transmitted to, and picked up by the child through
their daily interactions. When a child senses anxiety, temperament often increases.
Associations between childhood temperament and BPD are significant in themselves
because they extend well into adulthood and have not been examined previously in
developmental data (Crawford, Cohen, & Chen, 2009).
A study was done that specifically observed infant temperament characteristics and
measured temperament with negative affectivity (NA), positive emotionality (PE), and
effortful control (EC). After accounting for demographic variables, maternal internalizing
problems, and maternal temperament characteristics, infant NA was positively associated
with stress related to the mother–infant attachment relationship (Oddi, Murdock,
Vadnais, Bridgett, & Gartstein, 2013). EC presented itself to be negatively associated

with levels of maternal stress. Infant orientated/regulation (O/R) was also found to be
negatively associated with parenting stress related to the mother–infant attachment
relationship. O/R has been indicated by the ease with which an infant is soothed (i.e.,
soothability) and the extent of affectionate physical contact experienced between
caregivers and their infants (i.e., cuddliness), both which are important for the attachment
relationship (Oddi, Murdock, Vadnais, Bridgett, & Gartstein, 2013).
Temperament and personality traits are two terms that are often used interchangeably, but
scientific definitions distinguish each as a separate category. Temperament is considered
to develop rapidly in the first few years of life, while personality traits are conceptualized
as developing over a longer period (McCrae et al., 2000; Rothbart, 2011; Rothbart &
Ahadi, 1994). Personality is also thought to extend beyond temperament, and to include
patterns of behavior, skills, the content of one’s thoughts, values, and perception of the
self, others, and events (Oddi, Murdock, Vadnais, Bridgett, & Gartstein, 2013). Oddi et al
(2013) also suggests that temperament works as a precursor for future adult personality.
Research Limitations
Maternal anxiety has been shown to present a substantial risk for poor child development.
Beyond this conclusion, many limitations do continue to exist. For starters, the level of
anxiety that a mother must experience in order to affect a child has been left unclear.
Secondly, most of these studies looked at the relationship between a birth mother and her
infant, but the role of an adopted or surrogate mother has not yet been discovered. Third,
many children who were raised in high-stress environments have proven to become fully
functioning and developed members of society. Fourth, many infants who don’t form a

close relationship with their mother may find the same bond with a different attachment
figure. Lastly, many children brought up in loving, calm, and nurturing environments
have been born with temperament, attachment, and developmental issues. In addition, the
correlation between maternal anxiety and child temperament does not distinguish which
one causes the other. Perhaps child temperament leads to maternal anxiety, and not the
other way around. The relationship between maternal anxiety and child development has
a strong correlation, but it is not a direct causation.
Future Studies
Future studies should focus on the role of other infant relationships including paternal
roles, and utilize a more quantitative process of measuring stress in mothers. Post-partum
depression is another significant and common source of maternal anxiety; one that is
often over looked. Post-partum depression is also projected upon the infant, which is
likely correlated with the same effects of general maternal anxiety. This is an area that
could also be studied in more detail. Many methods also seek to reduce the effects of
stress upon the infant through educational seminars, support groups, and relaxation
techniques.
One study refers to an intervention-empowerment program as a successful tactic in
decreasing stress, improving parental satisfaction, and increasing parent-child
communication (Borimnejad, Mehrnoosh, Fatemi, & Haghani, 2013). Having mothers
experience satisfaction, and improve overall happiness can bring the mother-child bond
together and decrease overall anxiety. Other retroactive self-help strategies have been
produced to alleviate emotional distress through yoga, eating chocolate, listening to calm

music, and participating in meditation. This study by Elizabeth Marley (2011) found
psychological benefits through these relaxation activities by focusing the mind, achieving
a sense of calmness, having peace and quiet, having a peace of mind, experiencing
humor, and doing something productive.
A more proactive stress reducer can be found in a variety support groups. Often people
experiencing stress struggle to connect with people who aren’t in their situation. A
parenting support group may release stress along the way, eliciting healthy conversation,
and build connections with people of common experience. Anxiety could also be reduced
by proactively educated and preparing mothers on what to expect in motherhood.
Maternal anxiety is more commonly experienced in first-time mothers who don’t have
previous experience with young children. Educational seminars could reduce potential
stress by teaching new moms healthy mothering techniques, as well as solutions to
overcoming stressful child-related situations. Going forward, an improved means of
identifying which pregnant women are at risk for increased stress and mental health
problems must be developed; such as measuring stress hormones (La Marca-
Ghaemmaghami & Ehlert, 2015).
Conclusion
To conclude, maternal anxiety affects a child both pre-term and postpartum. Pre-term
stress can influence a child biologically; leading to low birth weight, and delayed
neurodevelopment. Postpartum, a secure attachment relationship between a child and
mother is crucial to enhance personality and behavioral development. The presence of
post-term maternal anxiety can lead to the formation of an anxious-avoidance attachment

type. When a child does not form a proper secure attachment, they are at a heightened
risk to develop emotional dysregulation (temperament issues), and in extreme situations,
borderline personality disorder (BPD). The process of motherhood and pregnancy-related
changes is challenging in itself. The presence of everyday life stressors, and stress during
pregnancy is generally unavoidable. The role of motherhood is additionally a huge
responsibility, and can cause additional sensitivity, and emotional reactivity. It is
essential to raise awareness, and to create strategies to counter stress overexposure to the
infant (La Marca-Ghaemmaghami & Ehlert, 2015). The existence of maternal stress is
once again unavoidable. Through proper management, mothers can regulate these
stresses in a healthier way, and decrease the risk imposed upon the child.

References
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