Association between maternal mental health, the COVID-19 pandemic, and children's developmental outcomes in Scotland

Background: The number of reported maternal mental health (MH) MH difficulties during the COVID-19 pandemic was higher compared with the pre-pandemic period. Findings on the link between the COVID-19 pandemic and children's developmental outcomes suggest lower scores on the Ages and Stages Questionnaire (ASQ-3) among children born during the COVID-19 pandemic compared to the pre-COVID-19 pandemic cohort. The present study explored the effects of maternal MH and being born during COVID-19 on children's developmental outcomes. Further, it examined the combined effect of maternal MH and birth during COVID-19 on children's developmental outcomes.

Study design
This study used a linked administrative dataset from Scotland. Children born between 1st March 2020 and 30th June 2021, inclusive (n=32,683), and a comparative historical cohort that included those born between 1st April 2017 and 31st October 2018 in Scotland (n=50,257) were included. Regression models were used to adjust for covariates, with outcomes such as ASQ-3 scores and developmental concerns and predictors such as maternal MH and birth during the COVID-19 pandemic.

Results
A history of MH hospital admission was associated with increased odds of developmental concerns (odds ratio (OR)= 1.038, 95% CI [1.012, 1.064], p=0.004**) and reduced ASQ scores SD; 0.13 (β =-0.130, 95% CI [-0.204, -0.056], p<0.001***). There were mixed findings on the association between being born during the COVID-19 pandemic (developmental concerns: OR= 1.024, 95% CI [1.019, 1.029], p<0.001***) and ASQ scores (β= 0.012, 95% CI [-0.002, 0.025], p=0.08) but no interaction between a history of MH hospital admission and birth during the COVID-19 pandemic. However, there was an interaction effect on mental health assessed by outpatient records association and birth during the COVID-19 pandemic on the ASQ scores SD; -0.07 (β =-0.066, 95% CI [-0.106, -0.027], p<0.001***).

Conclusions
Our findings suggest that although being born during the COVID-19 pandemic and MH influenced child development with relatively small effects, with mixed findings on their combined presence. Our study only examined developmental outcomes up to age 13 – 15 months. Future studies should explore the potential long-term effects of being born during the pandemic and MH.