# Maternal internalizing symptoms as a mechanism linking pre- and postnatal COVID-19 pandemic exposure with preschool-aged children’s neurodevelopment

## TL;DR

This study explores how maternal mental health during the pandemic may affect children's development, finding that prenatal stress could impact motor skills.

## Contribution

The study identifies maternal internalizing symptoms as a potential mechanism linking pandemic exposure to children's neurodevelopmental outcomes.

## Key findings

- Prenatal maternal internalizing symptoms were associated with lower child gross motor skills at 24 months.
- Higher maternal internalizing symptoms at 8 and 24 months were marginally linked to lower child personal-social and gross motor skills.
- Prenatal pandemic exposure's effect on child motor abilities was marginally mediated by maternal internalizing symptoms.

## Abstract

There is some evidence that children exposed to the COVID-19 pandemic experienced more neurodevelopmental difficulties than children before the pandemic, as well as evidence that women with young children experienced more mental health challenges during this period compared to pre-pandemic. However, it is unclear whether increased maternal mental health challenges acted as a mechanism linking pandemic exposure to children’s neurodevelopment difficulties.

As part of the Ontario Birth Study, women (N = 862) reported their internalizing (i.e., depression and anxiety) symptoms using the Patient Health Questionnaire-4 (PHQ-4) at three timepoints (prenatally and 8 and 24 months postnatally). Child neurodevelopment was assessed at 24 months using the Ages and Stages Questionnaire-3 (ASQ-3). Analyses included a combination of regression and path analyses with adjustment for covariates.

Women exposed to the pandemic prenatally and at 8 and 24 months postnatally reported more concurrent internalizing difficulties than those not exposed; however, women exposed both pre- and postnatally did not differ from those only exposed postnatally. Higher prenatal maternal internalizing symptoms were associated with lower child gross motor skills at 24 months. Higher maternal internalizing symptoms at 8 and 24 months were marginally (p < 0.1) associated with lower child personal-social and gross motor skills, respectively, at 24 months. The association between prenatal pandemic exposure and lower gross motor skills was marginally mediated by the presence of prenatal maternal internalizing symptoms.

Mothers and young children may have been particularly vulnerable to pandemic stress. Maternal internalizing symptoms, especially during pregnancy, may serve as a pathway linking pandemic exposure with child neurodevelopment and may represent a malleable target for intervention.

The online version contains supplementary material available at 10.1007/s00737-026-01686-2.

Women exposed to the pandemic both prenatally and postnatally had greater internalizing difficulties compared to non-exposed mothers.Higher maternal internalizing symptoms prenatally was associated with lower child gross motor skills at 24 months.Higher maternal internalizing symptoms at 8 and 24 months were marginally associated with lower child personal-social and gross motor skills, respectively, at 24 months.The presence of any maternal internalizing symptoms marginally mediated the association between prenatal pandemic exposure and children’s gross motor abilities.

Women exposed to the pandemic both prenatally and postnatally had greater internalizing difficulties compared to non-exposed mothers.

Higher maternal internalizing symptoms prenatally was associated with lower child gross motor skills at 24 months.

Higher maternal internalizing symptoms at 8 and 24 months were marginally associated with lower child personal-social and gross motor skills, respectively, at 24 months.

The presence of any maternal internalizing symptoms marginally mediated the association between prenatal pandemic exposure and children’s gross motor abilities.

The online version contains supplementary material available at 10.1007/s00737-026-01686-2.