Maternal Depressive Symptoms During and After Pregnancy and Psychiatric Problems in Children Marius Lahti, PhD, Katri Savolainen, MA, Soile Tuovinen,

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Maternal Depressive Symptoms During and After Pregnancy and Psychiatric Problems in Children Marius Lahti, PhD, Katri Savolainen, MA, Soile Tuovinen, PhD, Anu-Katriina Pesonen, PhD, Jari Lahti, PhD, Kati Heinonen, PhD, Esa Hämäläinen, PhD, Hannele Laivuori, PhD, Pia M. Villa, MD, Rebecca M. Reynolds, PhD, Eero Kajantie, PhD, Katri Räikkönen, PhD Journal of the American Academy of Child & Adolescent Psychiatry Volume 56, Issue 1, Pages 30-39.e7 (January 2017) DOI: 10.1016/j.jaac.2016.10.007 Copyright © 2016 American Academy of Child and Adolescent Psychiatry Terms and Conditions

Figure 1 Maternal depressive symptoms during pregnancy and psychiatric problems in children. Note: (Panel A) Crude unadjusted means and 95% CI (error bars) of maternal biweekly depressive symptoms during pregnancy according to child’s Internalizing, Externalizing, and Total Problems scores above (solid lines) and below (dashed lines) the borderline clinical cutoffs. (Panel B) Unstandardized regression coefficients (B) and 95% CI of linear regression analyses on the associations between trimester-weighted mean of maternal depressive symptoms during pregnancy and child internalizing, externalizing, and total problems in linear regression models 1 to 4. SD = standard deviation. Journal of the American Academy of Child & Adolescent Psychiatry 2017 56, 30-39.e7DOI: (10.1016/j.jaac.2016.10.007) Copyright © 2016 American Academy of Child and Adolescent Psychiatry Terms and Conditions

Figure 2 Additive effects of maternal trimester-specific depressive symptoms during pregnancy on child psychiatric problems. Note: (Panel A) Estimated marginal means and 95% CIs of child internalizing, externalizing, and total problems according to the number of pregnancy trimesters during which the mother had mean depressive symptoms above the clinical cutoff of ≥16 are shown. Estimated marginal means are adjusted for child’s age and sex; p values refer to linear trends in regression models 1 to 4. (Panel B) Estimated marginal means and 95% CI of child internalizing, externalizing, and total problems in three groups identified by latent profile analysis on maternal depressive symptoms across pregnancy. Estimated marginal means are adjusted for child’s age and sex; p values refer to linear trends in regression models 1 to 4. Journal of the American Academy of Child & Adolescent Psychiatry 2017 56, 30-39.e7DOI: (10.1016/j.jaac.2016.10.007) Copyright © 2016 American Academy of Child and Adolescent Psychiatry Terms and Conditions

Figure 3 Maternal depressive symptoms during pregnancy partially act via symptoms after pregnancy on child psychiatric problems. Note: Mediation analyses showing that maternal depressive symptoms during pregnancy act partially via maternal depressive symptoms after pregnancy to affect child internalizing (panel A), externalizing (panel B), and total (panel C) problems are shown. Numbers represent unstandardized regression coefficients (B), 95% CIs, and p values. The estimates are adjusted for child’s age and sex; p values refer to effects in regression models 1 to 3. Journal of the American Academy of Child & Adolescent Psychiatry 2017 56, 30-39.e7DOI: (10.1016/j.jaac.2016.10.007) Copyright © 2016 American Academy of Child and Adolescent Psychiatry Terms and Conditions

Figure 4 Additive effects of maternal depressive symptoms during and after pregnancy on child internalizing and total problems. Note: Estimated marginal means and 95% CIs of child internalizing (panel A) and total (panel B) problems according to mean maternal depressive symptoms during pregnancy above and below the clinical cutoff of ≥16 on the Center for Epidemiologic Studies Depression Scale (CES-D) and after pregnancy above and below the clinical cutoff of ≥14 on the Beck Depression Inventory−II (BDI-II) are shown. The estimated marginal means are adjusted for child’s age and sex: p values refer to linear trends in regression models 1 to 3. Journal of the American Academy of Child & Adolescent Psychiatry 2017 56, 30-39.e7DOI: (10.1016/j.jaac.2016.10.007) Copyright © 2016 American Academy of Child and Adolescent Psychiatry Terms and Conditions

Figure S1 Latent profile analysis on the course of maternal depressive symptoms during pregnancy. Note: The figure shows the mean levels of depressive symptoms at different gestational weeks in three latent profile analysis−derived groups of mothers who showed consistently low, moderate, and high levels of depressive symptoms throughout pregnancy. CES-D = Center for Epidemiologic Studies Depression Scale. Journal of the American Academy of Child & Adolescent Psychiatry 2017 56, 30-39.e7DOI: (10.1016/j.jaac.2016.10.007) Copyright © 2016 American Academy of Child and Adolescent Psychiatry Terms and Conditions

Figure S2 Maternal depressive symptoms during pregnancy and child psychiatric problems in groups with and without pregnancy disorders. Note: Maternal depressive symptoms during pregnancy and child psychiatric problems among those with maternal pregnancy disorders (pre-pregnancy obesity, gestational hypertensive disorders, and gestational diabetes) (panel A: n = 541) and among those without (panel B: n = 1,755) are shown. Unstandardized regression coefficients (B) and their 95% CIs of linear regression models adjusted for the covariates in models 1 to 3. The third models refer here to regression models adjusted further for maternal depressive symptoms at the time of rating the child’s problems. Journal of the American Academy of Child & Adolescent Psychiatry 2017 56, 30-39.e7DOI: (10.1016/j.jaac.2016.10.007) Copyright © 2016 American Academy of Child and Adolescent Psychiatry Terms and Conditions

Figure S3 Maternal depressive symptoms during pregnancy and child psychiatric problems in groups with and without maternal diagnosis of depression before pregnancy. Note: Maternal depressive symptoms during pregnancy and child psychiatric problems among those with maternal self-reported history of physician-diagnosed depression before pregnancy (panel A: n = 214) and among those without (panel B: n = 1,982) are shown. Unstandardized regression coefficients (B) and their 95% CIs of linear regression models adjusted for the covariates in models 1 to 4. Journal of the American Academy of Child & Adolescent Psychiatry 2017 56, 30-39.e7DOI: (10.1016/j.jaac.2016.10.007) Copyright © 2016 American Academy of Child and Adolescent Psychiatry Terms and Conditions