NIH Study Suggests Association Between Prenatal Depression and Greater Autism-related Traits in Children

Posted on August 1, 2023August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Children of mothers with prenatal depression had slightly more autism-related traits compared to those without that exposure, according to a study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

While this study didn’t explore why this association might exist, future research could investigate whether these findings reflect overlap in genetic risk for depression and autism-related traits or another mechanism.

Prior studies linked prenatal depression and depression history to autism spectrum disorder, but this study focused broadly on autism-related traits. By studying social communication and other autism-related traits, researchers can better understand how prenatal depression influences these traits, which may show up in children without an official diagnosis of autism spectrum disorder.

“Autism-related traits can significantly impact a child's physical, social, and psychological development, regardless of their clinical diagnosis. Screening and treating pregnant patients for depression and detecting autism-related traits in these children early on can lead to timely support of healthy development and outcomes for mothers and children,” said study author Lyndsay Avalos, PhD, MPH, of Kaiser Permanente Northern California Division of Research.

The analysis included 3,994 parent-child pairs with prenatal depression data and 1,730 pairs with depression severity data from 33 ECHO research sites across the United States. Autism-related traits were assessed using the Social Responsiveness Scale (SRS) for children up to 12 years of age.

Dr. Avalos and Lisa Croen, PhD, also of Kaiser Permanente Northern California Division of Research, led this collaborative research published in Autism Research.

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About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

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Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

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Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

New ECHO Research Suggests Link Between Prenatal Depression and Autism-related Traits

Posted on August 1, 2023November 22, 2023 by Jodi Snare

Collaborative ECHO research led by Lyndsay A. Avalos, PhD and Lisa A. Croen, PhD of Kaiser Permanente Northern California Division of Research investigates the potential link between prenatal depression or a history of depression prior to pregnancy and autism-related traits in children. This research, titled “Prenatal Depression and Risk of Child Autism-Related Traits Among Participants in the Environmental influences On Child Health Outcomes Program,” is published in Autism Research.

Previous research suggests an association between prenatal depression or a history of depression prior to pregnancy and autism spectrum disorder (ASD) in children, but most studies have focused on a formal ASD diagnosis, rather than autism-related traits.

This study examined parent-child pairs at 33 prenatal and pediatric research sites in the United States. The primary analysis included 3,994 parent-child pairs with prenatal depression diagnosis data; a secondary analysis included 1,730 parent-child pairs with depression severity data. Children of mothers with prenatal depression had slightly more autism-related traits compared to those without. The association was similar among boys and girls. Prenatal depression also increased the likelihood of moderate to severe autism-related traits, indicating a higher likelihood of ASD diagnosis.

“Autism-related traits can significantly impact a child’s physical, social, and psychological development, regardless of their clinical diagnosis. Screening and treating pregnant patients for depression and detecting autism-related traits in these children early on can lead to timely support of healthy development and outcomes for mothers and children,” said study author Dr. Avalos.

This study adds to the understanding of how prenatal depression may be associated with neurodevelopment in children, such as social communication and behavioral characteristics that may not reach a clinical threshold but can still impact a child’s social and behavioral functioning. These findings highlight the need for early ASD screening for children whose parents had prenatal depression to promote early intervention and support their healthy development. Mental health screening and prevention efforts for depression in pregnant individuals could also be beneficial.

Read the research summary.

Prenatal Depression May Be Linked to Autism-Related Traits in Children

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

Authors: Lyndsay A. Avalos, Lisa A. Croen, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

Why was this study needed?

Previous research suggests an association between prenatal depression or a history of depression prior to pregnancy and autism spectrum disorder (ASD) in children, but most studies have focused on a formal ASD diagnosis, rather than autism-related traits. Studying social communication and other autism-related traits can help researchers and clinicians understand how prenatal depression may be associated with these traits present in children at varying levels without a formal diagnosis. This is critical because autism‑related traits can impact children’s physical, social, and psychological development, regardless of whether they receive a clinical diagnosis.

What were the study results?

Children of mothers with prenatal depression had slightly more autism-related traits compared to those without. The association was similar among boys and girls. Prenatal depression also increased the likelihood of moderate to severe autism-related traits, indicating a higher likelihood of ASD diagnosis.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study adds to the understanding of how prenatal depression may be associated with neurodevelopment in children, such as social communication and behavioral characteristics that may not reach a clinical threshold but can still impact a child’s social and behavioral functioning. These findings highlight the need for early ASD screening for children whose parents had prenatal depression to promote early intervention and support their healthy development. Mental health screening and prevention efforts for depression in pregnant individuals could also be beneficial.

Who was involved?

The study involved 33 prenatal and pediatric research sites with information on depression in birth parents and autism-related traits in children. The primary analysis included 3,994 parent-child pairs with prenatal depression diagnosis data; a secondary analysis included 1,730 parent-child pairs with depression severity data.

What happened during the study?

Researchers measured the incidence and severity of prenatal depression and assessed autism-related traits using the Social Responsiveness Scale (SRS) for children up to 12 years of age.

What happens next?

While this study didn’t explore the reason for the association between autism-related traits in children and prenatal depression in mothers, future research may analyze parent and child genetic data to clarify whether certain genes increase the likelihood of depression and autism-related traits, or what other factors affect the findings.

Where can I learn more?

Access the full journal article, titled “Prenatal Depression and Risk of Child Autism-Related Traits Among Participants in the Environmental influences On Child Health Outcomes Program,” in Autism Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 1, 2023

Access the associated article.

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

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Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

Authors: Jean Frazier, Michael O’Shea, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Inflammation is a normal part of the body’s defense to injury or infection. The investigators in this study wanted to find out whether factors known to be linked with inflammation during pregnancy (such as socioeconomic conditions, environmental exposures, and maternal infections) might be associated with emotional, cognitive, and behavioral dysregulation in children after birth. “Dysregulation” in this context refers to children’s attention, anxiety and depression, and aggression being measurably different from what is typically expected for children of their age.

What were the study results?

In this study, several maternal risk factors correlated with inflammation (lower education attainment, pre-pregnancy obesity, prenatal infections, and prenatal tobacco use) were strongly associated with dysregulation in offspring.

Researchers used a tool called the Child Behavior Checklist (CBCL) to measure aggressive behavior, anxiety/depression, and attention problems in children. Approximately 13.4 % of children and adolescents in the study met the criteria for the CBCL Dysregulation Profile. More youth with dysregulation (35%) were born to mothers with prenatal infections compared with 28% of youth without dysregulation.

Some additional maternal factors, including being overweight before pregnancy, lower education attainment, and smoking during pregnancy, were associated with higher likelihoods of childhood dysregulation. Children and adolescents who had a parent or sibling with a mental health disorder were more likely to experience dysregulation. Having a mother with gestational diabetes had no significant association with child dysregulation.

What was the study's impact?

By providing information about how maternal inflammation and relevant risk factors may be associated with dysregulation in a mother’s offspring, this study can help inform interventions to improve child health outcomes.

Who was involved?

This study included 4,595 children and adolescents (ages 6-18 years) from 18 ECHO research sites across the United States.

What happened during the study?

This study assessed perinatal factors known to be related to maternal and neonatal inflammation.

ECHO researchers collected data on maternal factors before and during pregnancy, including information about infections during pregnancy. They used the CBCL to collect parent-reported information about each child’s behavior. CBCL assessments were collected between 2009 and August 31, 2021, and researchers used these assessments to determine whether a child met criteria for the CBCL Dysregulation Profile based on their scores for aggression, anxiety/depression, and attention.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future studies could focus on identifying the mechanisms that link maternal factors with childhood dysregulation. These studies could also look at whether certain interventions are able to reverse or partially reverse the mechanisms that contribute to the development of dysregulation.

Where can I learn more?

Access the full journal article, titled “Perinatal Factors and Emotional, Cognitive, and Behavioral Dysregulation in Childhood and Adolescence,” in the Journal of the American Academy of Child and Adolescent Psychiatry.

Published May 17, 2023

Access the associated article.

Download this summary

Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

NIH Study Finds Association Between Gestational Diabetes, Maternal Depression, and Early Childhood Behavior Problems

Posted on May 12, 2023August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Gestational diabetes, prenatal depression, and postpartum depression were each individually associated with higher levels of early childhood behavior problems such as attentional problems, anxiety, and depression in new research funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Previous research has linked gestational diabetes to prenatal and postpartum depression. Researchers wanted to determine how that combination of maternal symptoms affected early childhood behaviors.

“Our findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy could benefit from receiving additional monitoring for behavioral problems during early childhood,” said Lauren Shuffrey, PhD, an ECHO Program investigator at Columbia University.

The researchers also found that gestational diabetes was associated with autism-related behaviors only in children whose mothers reported higher levels of depressive symptoms during and immediately after pregnancy. Gestational diabetes was also associated with child behavioral problems only in male children.

This study included 2,379 children from ECHO research sites in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of participants were male, and 216 participants were born to mothers who were diagnosed with gestational diabetes.

During this study, ECHO researchers collected information from the participating mothers, including gestational diabetes diagnosis and self-reports of depression symptoms during and after pregnancy. To investigate the effect of these maternal conditions on child behavior, the researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5 years old.

Dr. Shuffrey led this collaborative research published in Child Development.

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

ECHO Researchers Investigate Associations Between Gestational Diabetes, Perinatal Maternal Depression, and Early Childhood Behavioral Problems

Posted on May 9, 2023December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Lauren C. Shuffrey, PhD of Columbia University investigates the effects of gestational diabetes, a type of diabetes that mothers develop during pregnancy, prenatal depression, and postpartum depression on early childhood behavior. This study found gestational diabetes, prenatal maternal depressive symptoms, and postnatal maternal depressive symptoms were each independently linked to higher levels of externalizing and internalizing behavior problems during early childhood. The study also found that gestational diabetes was only associated with autism-related behaviors when children were exposed to higher levels of perinatal maternal depressive symptoms. Finally, maternal gestational diabetes was only associated with child behavioral problems for male children.

This research, titled “Association of Gestational Diabetes Mellitus and Perinatal Maternal Depression with Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study” is published in Child Development.

Although previous research has shown associations between gestational diabetes and pre- and postnatal depression in mothers, prior studies have not determined if the combination of these conditions affect child behavioral outcomes.

This study included 2,379 children from ECHO cohorts located in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of child participants (52%) were male, and 216 participants were born to mothers with gestational diabetes during pregnancy.

More than half of maternal participants were from an underrepresented minority group with 32% self-identifying as Black, 23% as Hispanic, 15% as Mixed Race, and 4% as Asian.

In this study, ECHO researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5 years old. The researchers also collected information from the mothers, including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The study evaluated how gestational diabetes, prenatal depression, and postpartum depression affected children’s behavioral outcomes using the CBCL.

“Our findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy could benefit from receiving additional monitoring for behavioral problems during early childhood,” said Dr. Shuffrey. “Future research should investigate potential biological mechanisms underlying associations between gestational diabetes, maternal depression, and early childhood behavioral outcomes.”

Read the research summary.

Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

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Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

Authors: Lauren C. Shuffrey, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

Why was this study needed?

Previous research has linked gestational diabetes (a type of diabetes mothers develop during pregnancy) to prenatal and postpartum depression in mothers. However, studies have not examined how the combination of gestational diabetes, prenatal depression, and postpartum depression affect early childhood behavior.

What were the study results?

The study found that gestational diabetes, prenatal maternal depressive symptoms, and postnatal maternal depressive symptoms were each associated with increased child externalizing (e.g., acting out, aggression, hyperactivity) and internalizing (e.g., anxiety, depression) behavior problems. This study also found that gestational diabetes was associated with increased autism behaviors only among children exposed to above average perinatal maternal depressive symptoms. Finally, the researchers observed gestational diabetes was only associated with child behavioral problems for male children, and not for female children.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the impact?

These findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy should receive additional monitoring for behavioral problems during early childhood.

Who was involved?

This study included 2,379 children from ECHO cohorts located in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of participants were male, and 216 participants were born to mothers with gestational diabetes during pregnancy.

More than half of maternal participants were from an underrepresented minority group with 32% self-identifying as Black, 23% as Hispanic, 15% as mixed race, and 4% as Asian.

What happened during the study?

ECHO researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5. They also collected information from the mothers including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The study evaluated how gestational diabetes, prenatal depression, and postpartum depression affected children’s behavioral outcomes using the CBCL.

What happens next?

ECHO researchers are currently analyzing blood samples collected during pregnancy to investigate potential inflammatory mechanisms that may influence the associations between gestational diabetes, maternal depression, and early childhood behavior.

Where can I learn more?

Access the full journal article titled, “Gestational Diabetes Mellitus, Perinatal Maternal Depression, and Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study” in Child Development.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published May 2, 2023

Access the associated article.

Download this summary

Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

New ECHO Study Finds Prenatal Antidepressant Use Does Not Increase Risk for Child Autism-related Traits

Posted on November 28, 2022March 31, 2025 by Jodi Snare

Collaborative ECHO research led by Patricia Brennan, PhD of Emory University, investigates whether maternal prenatal antidepressant use affects a child’s risk for autism spectrum disorder (ASD) or autism-related traits. The study included over 3,000 mothers and their children and found no correlation between the use of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), during pregnancy and child autism-related traits. This research, titled “Prenatal Antidepressant Exposures and Autism Spectrum Disorder or Traits: A Retrospective, Multi-Cohort Study,” is published in Research on Child and Adolescent Psychopathology.

Previous research has not offered conclusive findings on the effect of prenatal antidepressants on child autism-related traits. It is important that pregnant women and the physicians that treat them have the data they need to make informed treatment decisions.

For this study, researchers looked at a large sample of mothers and their children from ECHO cohorts across the United States, collecting data on prenatal antidepressant use and autism-related traits when the children were between 1 and 12 years of age. About 5% of the mothers who participated took antidepressants during pregnancy, according to medical records and self-reported measures. Mothers also reported on whether their child received an ASD diagnosis and completed rating scales about their child’s behavior, including social, language, and other autism-related traits.

“Depression is common during pregnancy, and pregnant women and the physicians who treat them must weigh multiple risks when making treatment decisions,” said Dr. Brennan. “This study suggests that the use of antidepressants and SSRIs during pregnancy does not increase a child’s risk for autism-related outcomes.”

Future studies may consider evaluating if the dose or timing of antidepressant use during pregnancy modifies the effect on child health outcomes.

Read the Research Summary.

ECHO Researchers Examine Associations Between Gestational Diabetes, Prenatal Depression, and Postpartum Depression

Posted on October 10, 2022December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Lauren C. Shuffrey, PhD of Columbia University examines the effects of gestational diabetes, a type of diabetes that develops during pregnancy, and prenatal depression on a person’s risk for developing postpartum depression. The study found that people with gestational diabetes were more likely to be classified as having prenatal depression. Those with both gestational diabetes and prenatal depression were at an increased risk for postpartum depression. But gestational diabetes on its own, without prenatal depression, was not associated with increased risk for postpartum depression.

This research, titled “Gestational Diabetes Mellitus, Prenatal Maternal Depression, and Risk for Postpartum Depression: An Environmental Influences on Child Health Outcomes (ECHO) Study,” is published in BMC Pregnancy and Childbirth.

Previous research has yet to examine the association between the combination of gestational diabetes and prenatal maternal depression and postpartum depression. To address this question, the researchers looked at data from 5,822 participants in 16 ECHO cohorts across 13 U.S. states and Puerto Rico. A total of 4,606 participants had neither gestational diabetes nor prenatal maternal depression, 416 had gestational diabetes only, 689 had prenatal maternal depression only, and 111 had both gestational diabetes and prenatal maternal depression. Participants self-reported on their depression symptoms during and after pregnancy using the PROMIS-D (Patient-Reported Outcomes Measurement Information System) scale. The researchers used this data to evaluate the relationships between maternal depression symptoms and gestational diabetes.

“Our findings underscore the importance of universal depression screening during pregnancy and in the first postpartum year,” said Dr. Shuffrey. “Future studies should examine potential biological mechanisms underlying the relationship between gestational diabetes and maternal depression.”

The ECHO program is currently working towards analyzing blood samples collected during pregnancy to identify potential factors involved in the relationship between gestational diabetes, prenatal depression, and postpartum depression.

Read the research summary.

Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

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Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

Author(s): Lauren Shuffrey, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

The study found that participants with gestational diabetes were more likely to be classified as having prenatal depression compared to those without gestational diabetes. Participants with both gestational diabetes and prenatal depression had an increased risk of developing postpartum depression. But gestational diabetes on its own, without prenatal maternal depression, was not linked to an increased risk of postpartum depression.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

These findings underscore the importance of universal depression screenings during pregnancy and for at least a year following birth.

Why was this study needed?

There is a lack of research into how the combination of gestational diabetes (a type of diabetes that develops during pregnancy) and prenatal depression affects a person’s risk for postpartum depression.

Who was involved?

This study included 5,822 participants from 16 ECHO cohorts across 13 U.S. states and Puerto Rico. A total of 4,606 participants had neither gestational diabetes nor prenatal depression, 416 had gestational diabetes only, 689 had prenatal maternal depression only, and 111 had both gestational diabetes and prenatal maternal depression.

What happened during the study?

Researchers collected information from the participants including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The researchers then used that data to evaluate the relationship between gestational diabetes, prenatal depression, and postpartum depression.

What happens next?

Future studies should examine potential mechanisms underlying the relationship between gestational diabetes, prenatal depression, and postpartum depression. The ECHO Program is currently working towards analyzing blood samples collected during pregnancy to identify potential factors involved in this relationship.

Where can I learn more?

Access the full journal article, titled “Gestational Diabetes Mellitus, Prenatal Maternal Depression, and Risk for Postpartum Depression: An Environmental Influences on Child Health Outcomes (ECHO) Study” in BMC Pregnancy and Childbirth.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published October 8, 2022

Access the associated article.

Download this summary

Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

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Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

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Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

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Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

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