Association of depressive and/or pregnancy-related anxiety symptoms in pregnancy with maternal and neonatal biologic aging

Prenatal depression and anxiety affect nearly 20% of individuals, and emerging evidence links psychological distress to accelerated biological aging. However, the joint effects of depressive and anxiety symptoms on biological aging in mother-infant dyads are understudied. We investigated associations of prenatal maternal depressive and/or pregnancy-related anxiety symptoms with two markers of biological aging [leukocyte telomere length (LTL) and mitochondrial DNA copy number (mtDNAcn)], in maternal blood and neonatal cord blood. This was a secondary analysis of a prospective cohort of mother-infant dyads enrolled 1999–2002 during their first prenatal visit to a multispecialty practice in Massachusetts. Participants were eligible if they were carrying a singleton gestation, English-speaking, and under 22 weeks gestational age. The exposure was prenatal depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS] ≥ 13) and/or pregnancy-related anxiety (PrAS moderate-high), grouped into four mutually exclusive categories: 1) low anxiety and low depressive symptoms (referent); 2) high depressive symptoms alone; 3) moderate-high PrAS alone; 4) and both. The primary outcome was maternal and neonatal markers of biological aging and oxidative stress (LTL and mtDNAcn), measured from maternal (1st or 2nd trimester) and neonatal (cord) blood and calculated using quantitative PCR. Multivariable linear generalized estimating equation regression models were used to assess the relationship between prenatal mental health symptoms and maternal/neonatal biological aging/oxidative stress, adjusting for confounders. Among 751 pregnancies, 479 (64%) had low pregnancy-related anxiety and low depressive symptoms, 33 (4%) had high depressive symptoms alone, 209 (28%) had moderate-high PrAS alone, and 30 (4%) had both. High depressive symptoms alone and moderate-high PrAS were each associated with shorter maternal LTL [ß = -0.07, 95% Confidence Interval (CI) -0.13, -0.02 for depressive; ß = -0.04, 95% CI -0.08, -0.01 for PrAS]. Mothers with depressive symptoms alone also had higher neonatal cord blood mtDNAcn (ß = 0.11, 95% CI 0.01, 0.21). Prenatal symptoms of depression or pregnancy-related anxiety were independently associated with molecular signatures of accelerated biologic aging in mothers and their neonates. These findings underscore that perinatal mental health symptoms exert measurable biological effects that could influence long-term health trajectories, and reinforce the urgent need for comprehensive mental health care during pregnancy.