Parental subjective well-being from prenatal to postpartum years: Effects on birth outcomes, child development, and health

Parental psychological well-being has been found to influence child health and development. Several countries have implemented public health programs to enhance parents’ well-being. However, apart from assessing subjective well-being (SWB) as one construct and scant literature on its effects on child health outcomes, studies focus mostly on mothers. Additionally, the effect of coronavirus disease 2019 (COVID-19) on perinatal SBW has not been examined. This study aims to determine the effect of parental SWB from prenatal to postpartum years on child health outcomes (atopic dermatitis (AD), allergic rhinitis, digestive diseases, birthweight, gestational age, and developmental delay) and investigates the impact of COVID-19 on SWB and birth outcomes.
Methods
Data from the Longitudinal Examination Across Prenatal and Postpartum Health in Taiwan (LEAPP-HIT) were utilized to test the study hypotheses. LEAPP-HIT is an ongoing prospective longitudinal study that began in 2011 in Taipei and New Taipei City, Taiwan, with the goal of examining parental and child's health status and health behavior from early pregnancy to up to 6 years postpartum. During prenatal visits at five medical institutions and regional hospitals, pregnant women and their spouses were purposefully selected. Trained interviewers addressed the couples during their early-pregnancy prenatal visit, explaining the study purpose, obtaining informed consent, and handing out questionnaires to both parents to self-complete on-site (baseline evaluation). The participants were then followed up on for 3 years after childbirth through postal delivery of questionnaires and phone reminders to maximize the response rate. In study I, we applied generalized estimating equations among 567 couples to determine the association between parental SWB (i.e., life evaluation, eudaimonic well-being, positive affect and negative affect) and child atopic dermatitis up to 1 year, allergic rhinitis at 3 years and digestive diseases from 6 months to 3 years, using data collected between February 2012 and September 2022.The second study, used data collected from October 2016 to Avril 2021, a total of 1224 participants were analyzed through linear regression analyses and generalized estimating equations to explore the association between prenatal SWB (i.e., life evaluation, eudaimonic well-being, positive affect and negative affect) and birth outcomes (i.e., birthweight and gestational age) and child suspected developmental delay as well as the associated effect modifiers. In the third study, linear regression analysis and generalized estimating equations were carried out among 294 couples to assess the effects of COVID-19 pandemic on perinatal SWB and preterm birth and low birthweight as well as the associated effect modifiers. The data collect from January 2018-August 2022 was used for analysis.
Results
Study 1: The results demonstrated that, higher prenatal maternal eudaimonic well-being [adjusted odds ratio (AOR) = 0.34, with 95% confidence interval (CI)=0.15,0.81] and positive affect (AOR= 0.37, 95%C= 0.15, 0.88) trajectories were associated with lower risk of AD among children born in winter and spring. However, higher prenatal maternal depression (AOR=2.62, 95%CI= 1.24, 5.55), anxiety (AOR=2.31, 95%CI= 1.10, 4.88), as well as higher postpartum negative affect (AOR = 3.18, 96%CI= 1.37, 3.78) and anxiety (AOR = 2.78, 95%CI= 1.14, 6.77) were associated with higher risk of atopic dermatitis among children born in summer and autumn. Moreover, higher postpartum maternal life evaluation (AOR= 0.47 95%CI= 0.23, 0.94) and eudaimonic well-being (AOR= 0.52, 95%CI= 0.28, 0.94) were associated with child’s lower risks of digestive symptoms, whereas higher postpartum anxiety symptoms (AOR= 2.24, 95%CI= 1.25, 4.02) was associated with higher risk of digestive symptoms. Our results highlighted the protective role of maternal SWB on child’s AD at on year and digestive symptoms up to three years.

Study 2: Our research findings indicated that higher levels of prenatal eudaimonic well-being were linked to longer gestational duration (adjusted beta (aβ) = 0.36, 95% confidence interval (CI) = 0.03, 0.68) and increased birth weight (aβ= 124.71, 95% CI = 35.75, 213.66). Additionally, we observed that greater positive affect was connected to longer gestational length (aβ = 0.38, 95% CI = 0.06, 0.70). Conversely, higher levels of negative affect were associated with lower birth weight (aβ = −93.51, 95% CI = −178.35, −8.67). Furthermore, we found that higher trajectories of prenatal eudaimonic well-being were linked to reduced risks of suspected developmental delay among children of multiparous mothers (AOR = 0.18, 95% CI = 0.05, 0.70). On the other hand, higher depression (AOR= 1.72, 95% CI= 1.20, 2.48) and anxiety (AOR= 1.79, 95%CI= 1.24, 2.66) symptoms trajectories were associated with increased risks of suspected developmental delay for children of primiparous mothers.
Study 3: Our study revealed that, the pandemic was associated with a smaller gestational age among children o whose mother’s had a part-time job (aβ= -0.93, 95%CI = -174, -0.12), but not birthweight. The pandemic period also associated with poorer maternal positive affect (aβ = -0.67, 95%CI; -1.08, -0.25) particularly among primiparous mothers. However, we did not find any association for fathers. The sensitivity analysis also revealed that, the lockdown period was associated with better maternal (aβ = 1.57, 95% CI= 0.25, 2.89) and paternal (aβ = 1.16, 95% CI;0.19, 2.14) eudaimonic well-being, and better maternal positive affect (aβ = 0.73, 95% CI= 0.11, 1.35). Nevertheless, the pandemic (aβ =- 0.38, 95% CI= -0.74, -0.02) and lockdown (aβ = -1.11, 95% CI= -1.70, -0.52) periods were associated with smaller negative affect.
Conclusion
The research indicated that maternal prenatal eudaimonic well-being and positive affect were associated with children’s lower risks of AD, particularly those born in the winter and spring. Conversely, higher maternal depression and anxiety during pregnancy, along with increased negative emotions and anxiety in the postpartum period, were linked to a heightened risk of atopic dermatitis among children born in the summer and autumn. Moreover, prenatal maternal eudaimonic well-being was associated with a lower risk of suspected developmental delay for children of multiparous mothers. Additionally, higher postpartum maternal life evaluation and eudaimonic well-being were associated with a child’s lower risk of digestive symptoms. These findings enhance our understanding of the protective impact of parental SWB on child health. Consequently, it is essential to incorporate SWB indicators when designing perinatal mental health preventive strategies, particularly in identifying high-risk mothers.