JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY,

VOL. 23, NO. 1, FEBRUARY 2005, pp. 6375

Associations between child development and

womens attitudes to pregnancy and motherhood

T. DEAVE
Centre for Child & Adolescent Health, University of Bristol, UK

Abstract A womans psychological state during pregnancy has been shown in previous
research to be predictive of her adaptation to maternal functioning. Two hypotheses were
examined: (a) women who have a negative attitude to pregnancy and motherhood have
children who exhibit slower development at 2 years, compared with children of women who
have more positive attitudes; (b) women with poor psychological health antenatally have
children who exhibit slower development at 2 years, compared with children of women who
have good psychological health antenatally. Three aspects of child development were assessed:
cognitive, motor and behaviour, as measured using the Bayley Scales of Infant Development.
This prospective, longitudinal study recruited primiparous women in the last trimester of
pregnancy, registered at seven health centres in socially deprived areas of Bristol City
(N5436). Baseline data were collected antenatally, and postnatally at 6 weeks, 1 year and 2
years. Developmental assessments were administered at 1 and 2 years of age. Fifty-seven
percent of women had planned their pregnancy. Using the EPDS, 25% scored above the cut-off
(12/13) for risk of depression antenatally. Multivariable analyses found associations between
advanced cognitive development and children whose mothers had been aware of the changes
that motherhood might bring. Associations were also found between cognitive development and
pregnant women who scored below the cut-off for risk of depression (EPDS,13). The effect
sizes were small and could therefore be due to chance, but the associations were consistent.

Introduction
Pregnancy is generally a time when a woman experiences positive mental health.
However, it may bring with it anxiety which can be regarded as a sign of psychological
adaptation and a positive, experiential process (Grossman et al., 1980). Becoming a
mother is a major transition and requires physical, social and emotional adaptation
(Sethi, 1995). Some mothers enjoy the challenge of motherhood and child care, but
those with low self-esteem are more likely to encounter problems during pregnancy and
the postnatal period (Field et al., 1985; Fox & Gelfand, 1994).

Address for correspondence: Toity Deave, Research Fellow, Centre for Child & Adolescent Health, University of
Bristol, Hampton House, Cotham Hill, Bristol BS6 6JS, UK. Tel: +44 (0)117 331 0897; Fax: +44 (0)117 331 0891;
E-mail: toity.deave@uwe.ac.uk.
Received: 1 November 2002. Accepted: 10 May 2004

ISSN 0264-6838/print/ISSN 1469-672X/online/05/010063-13

# 2005 Society for Reproductive and Infant Psychology
DOI: 10.1080/02646830512331330938
64 T. DEAVE

Previous studies have shown clear associations between a womans antenatal

psychological state and her adaptation to maternal functioning (Coleman et al., 1999;
Green et al., 1990; McIntosh, 1993; OHara et al., 1990; Shereshefsky & Yarrow,
1973). Difficulty in adjusting to pregnancy and/or motherhood can also compromise
the quality of motherinfant relationships with resulting detrimental effects on infant
socio-emotional and cognitive development (Coleman et al., 1999; de Muylder et al.,
1992; Doty, 1967; Lederman, 1984; Miller et al., 1996). Research suggests that the
early weeks and months of life provide the foundation for the development and
acquisition of motor and cognitive skills (Cohn & Tronick, 1983; Field et al., 1985).
The literature pertaining to maternal expectations previously reviewed have been
conducted following childbirth (Campbell & Cohn, 1996; Field et al., 1985). Several
studies have suggested that prenatal knowledge and attitudes are associated with
various parental outcomes (Green, 1998; Sommer et al., 1993). However, the few
studies that have investigated the interrelationships between womens antenatal
attitudes and knowledge, and particular aspects of child development have used
retrospective rather than prospective data (Cogill et al., 1986; Murray & Cooper,
1997).
Cognitive, behavioural and emotional development is partly determined by the
developmental resources available to a child (Baydar, 1995; Blumberg, 1980). Baydar
found that these resources for skill development after 1 year of life were significantly
associated with the intention status of pregnancy. Three factors put children from
unplanned pregnancies at developmental risk: the mothers characteristics (for
example, educational achievements); experience of a less-favourable family environ-
ment; and the presence of relatively few developmental resources available to the
children (Baydar, 1995).
Studies of healthy motherinfant dyads have mainly focused on child development in
relation to maternal postnatal depression (Campbell & Cohn, 1996; Cogill et al., 1986;
Murray, 1992; Murray et al., 1996a,b; Sharp et al., 1995). The current paper
concentrates on the particular area of mothers attitude to pregnancy and motherhood
in the antenatal period, and child development at 2 years old.
Two hypotheses were tested in this study:
(a) Women who have a negative attitude to pregnancy and motherhood have children
who exhibit slower development at 2 years, compared with children of women who
have more positive attitudes.
(b) Women with poor psychological health antenatally have children who exhibit
slower development at 2 years, compared with children of women who have good
psychological health antenatally.

Methods
Study design
The study reported here was part of a longitudinal experimental project evaluating a
specific method of health visiting: the First Parent Health Visitor Scheme (Emond
et al., 2002). The project was supported by a grant from the NHS Executive (South &
West) Regional Research and Development Directorate. Ethical approval was obtained
from the Medical Ethics Committees of United Bristol Healthcare Trust, Southmead
and Frenchay Trusts.
 CHILD DEVELOPMENT AND WOMENS ATTITUDES 65

Study population
Recruitment and exclusion of participants. Over a period of 16 months in 1994/5, all first-
time mothers who had booked their pregnancy with the community midwifery service
in one of seven GP catchment areas in Bristol were contacted by letter, telephone and/
or home visit (N5761). These are predominantly areas of socio-economic deprivation.
A total of 475 (60% of those initially approached) women returned the consent form
indicating their agreement to take part in the study, of which 436 (100%) remained
after specified exclusions: subsequent refusals (n516), those unavailable for home visits
(n516), the second sibling in each set of twins (n53) and congenitally abnormal
children (n54). Non-participants included women who were eligible for the study but
who either returned the consent form with a refusal, who did not return the reply slip,
or who repeatedly could not be contacted either by telephone or through a pre-arranged
home visit, in the antenatal period. Baseline data available for these women were
examined to identify any systematic bias in the data set. The evidence suggests no
significant differences between the groups of women who refused and those women
who took part in the study, except that there were more women in the group that
refused to take part in the study who did not have a telephone in working order, who
smoked and who did not have a partner.
At 1 year, of those 436 cases who started the project, 406 (93%) remained in the
study and at 2 years 358 (82%) cases remained (Figure 1). The majority of those who
were not retained had moved out of the study area.

Figure 1. Recruitment and refusal rates for study.

66 T. DEAVE

Table 1. Demographic characteristics, well-being and attitudes to feeding data at recruitment (N5436).

Demographic data
White British women 84
Womens age: 21 years or under 23
Partners age: 21 years or under 11
Married 46
Without partner 11
Womens occupational class (I & II) 37
Womens occupational class (IV & V) 16
Women: no qualifications 6
Women: A levels 13
Overcrowding (.1 person/room) 19

Womens well-being
Women who scored above the EPDS cut-off (.12) antenatally 25
Life events.5 events 37
Planned pregnancy 57

Feeding
Intention to breast feed 80
Breast fed within the first year (n5406) 56

Study group
The womens average age was 26 years (1543 years), 48 (11%) did not have a partner,
366 (84%) women were White British, 131 (37%) were of occupational class I and II
and 70 (16%) of occupational class IV and V, 25 (6%) had not attained O levels or
equivalent, and 81 (19%) families were living in overcrowded conditions (Table 1).
Adopting the 12/13 cut-off for the EPDS (Cox et al., 1987), 79 (25%) women in the
antenatal period were regarded as possibly experiencing some degree of depression.

Participant attrition
A policy was followed that all families who moved out of the geographical area of Avon
would be lost to follow-up. Baseline data available for these families were examined to
identify any systematic bias in the data set (Richardson & McCluskey, 1983). The
groups were sufficiently similar to progress with the data collection. Only full data sets
were used in the analysis of the results reported here.

Data collection
Data were collected prospectively on first-time mothers and their first child using self-
completion and researcher-completed questionnaires, and child developmental
assessments administered by the research health visitor (RHV). The RHV visited the
woman at home in the antenatal period when baseline, epidemiological and
psychosocial data were collected. Further visits were undertaken postnatally at 6
weeks, at 1 year and at 2 years of age. On the latter two visits a developmental
assessment was undertaken using the Bayley Scales of Infant Development (Bayley,
1993). The BSID-II consists of three complementary scales: the Mental Scale (MDI),
 CHILD DEVELOPMENT AND WOMENS ATTITUDES 67

Motor Scale (PDI) and Behaviour Rating Scale (BRS). There is no overall index score.
The three scales are considered complementary and each makes a unique contribution
to the assessment of the child. The data collected at each contact are outlined in
Table 2.

Instruments
The measures described below were completed in the last trimester (3238 weeks
gestation) to provide an indication of the overall psychological well-being of the women
taking part in the study.
The Life Events Scale was administered at the antenatal stage to assess the number of
life events, and therefore the possible stresses, that the woman had experienced over the
course of her pregnancy that might have had an effect on her attitude to her pregnancy
and forthcoming motherhood. This inventory was adapted from three Life Events
Schedules previously used with obstetric groups (Barnett et al., 1983; Brown & Harris,
1978; Stanley, in Golding & ALSPAC Study Team, 1996, 1997). This inventory was
specifically devised for ALSPAC1 (Golding, 1990) and contains 37 items, which
include death; illness; disturbance in relationships with partner, family or friends; and
specific obstetric events.
The 12-item Self-Esteem Scale (SES) (Rosenberg, 1965) measures self-worth or self-
acceptance and is a scale that Bachman et al. (1978) used in a longitudinal study of young
American men, adapted from Rosenberg (1965) and Cobb (1976). It is one of the most
widely used measures of self-esteem and it has been used in the ALSPAC cohort
(Golding, 1990). Over the period of the child-rearing years it has been found to be
remarkably stable and is reported to have good re-test reliability, good content and good
construct reliability (Cowan et al., 1985; Leifer, 1980). It was chosen for use in this study
due to its suitability for a wide range of ages, and because it is brief and simple to complete.
The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-rating
depression scale (Cox et al., 1987) on which women rate their feelings over the
previous 7 days. Each question has four stem questions that are scored 03 (resulting
range 030). Validation studies propose that a score .12 indicates the possible
presence of depression (Cox & Holden, 1996). The EPDS has become the measure of
choice in many studies of depression in child-bearing women, most typically in the first
year postpartum. The use of it outside the first postpartum year was examined by
Thorpe (1993); this produced similar findings to that of a previous validity study
(Murray & Carothers, 1990).
The Social Support Network Scale was designed to measure womens perceived
availability of support for both general and specific situations (Dragonas, 1987).
Perceived social support was measured using nine four-category and one two-category
Likert-format items, that had been derived from an inventory used in a Western
Australian study of a social support intervention to prevent low birth-weight (Stanley,
in Golding & ALSPAC Study Team, 1996). This larger questionnaire was based in a
current review of literature for content validity, concurrent validity and discriminant
validity. The questions have been extensively piloted and have been found to have high
completion rates with little error (Golding, 1990).
Each woman was asked to identify the planning status of her pregnancy by asking the
question, Were you planning to get pregnant this time?. To measure the womans
feelings concerning her pregnancy, questions included: How would you describe your
reaction when you first found you were pregnant this time?; Are you aware of the
68 T. DEAVE

Table 2. Contents and measures used in the questionnaires.

Variable ANb PNc 1 year 2 year

Socio-demographic data
Education and occupation Educational qualifications of woman, *
partner and her parents; employment
details
Ethnicity Ethnic grouping of woman, partner and *
her parents
a a
Home environment Type of housing, tenure, overcrowding, *
amenities; length of time lived in Avon,
no. of times moved in last 5 years;
satisfaction with housing and area; access
to telephone and car
a a
Household Partners health; if cohabiting; marital *
status
Attitude to pregnancy data
Plans, expectations and reac- Were you planning to get pregnant this *
tions to pregnancy time?
How would you describe your reaction *
when you first found you were pregnant
this time?
Are you aware of the changes that *
motherhood might bring?
Does becoming a mother give you new *
opportunities and interests?
How do you feel about your pregnancy *
now?
How do you think your partner feels *
about your pregnancy?
How has your partner reacted to you since *
you became pregnant this time? when he
first knew? now?
Attitude to infant feeding Womans and partners attitude to infant *
feeding measure; anticipated method of
feeding; if woman was breastfed as baby
Maternal health data
Womans psychological Recent life events (Golding, 1990) * * *
health Self-esteem scale (Rosenberg, 1965) * * *
EPDS (Cox et al., 1987) * * * *
Social network Perceived social support network measure *
(Gjerdingen et al., 1991)
Miscellaneous
Babys details DOB, gestation, gender *
Method of feeding Initiation and duration of breast feeding * *
Developmental assessment Bayley Scales of Infant Development: * *
MDI, PDI, BRS (BSID-II: Bayley, 1993)
Motherinfant relationship Observation by RHV *
a
If family moved house; bantenatal questionnaire, completed between 32 and 38 weeks gestation; cpostnatal
questionnaire, completed at 6 weeks postnatally.
*indicates that these variables were measured in the questionnaires.
 CHILD DEVELOPMENT AND WOMENS ATTITUDES 69

changes that motherhood might bring?; Does becoming a mother give you new
opportunities and interests?; How do you feel about your pregnancy now?; How do
you think your partner feels about your pregnancy?; How has you partner reacted to
you since you became pregnant this time, (a) when he first knew?, (b) now?. These
questions were used by ALSPAC (Golding, 1990) and found to be suitable.
Outcome variables were the Bayley Scales of Infant Development (BSID-II) scores at 2
years, using the three elements that it consists of: mental (MDI), motor (PDI) and
behaviour (BRS) (Bayley, 1993). The BSID-II scores track over time, i.e. year one
outcomes predict year two outcomes. In this study the year one outcomes were considered
to be interim findings and therefore have not been reported. The predictor variables
include the womans socio-economic status, educational qualifications, life events,
womens mental health, and planning status of pregnancy. The womans present or last
occupation at the time of the first contact was recorded. The Registrar Generals
classification was applied and used to create the final occupational classification
(Employment Department Group, 1990; Government Statistical Service, 1995).

Data analysis
Analysis was conducted using the statistical software package Intercooled Stata, Version 7.0
(Stata Corp., 1997). Descriptive statistics (ranges, means, frequencies and standard
deviations) and chi-square tests provided details about the characteristics of the study
population and the distribution of data collected. Factor analysis was used to identify the
underlying dimensions of the concepts of independent variables that were inherently
difficult to measure. Multiple regression analyses were then undertaken to quantify the
individual relationships between the explanatory variables and the outcome variables
relating to child development (using the categorical BSID-II scoring method).

Results
Womens feelings concerning their pregnancy
The initial area of interest of this study had been to examine the association between a
planned pregnancy and child development. Some analyses were therefore undertaken
to investigate potential relationships between a planned pregnancy and womens
attitude to motherhood and their feelings about their pregnancy in the last trimester.
It is reasonable that a womans attitude to her pregnancy may be influenced by
whether the pregnancy was planned or not (planned pregnancy, not planned
pregnancy). Therefore, before looking at attitudes to pregnancy further, associations
between these two variables were explored by applying multivariable analyses. A
significant association was found between planning a pregnancy (n5248, 57%) and
being overjoyed with the pregnancy (x2516.16, p,0.0001). A significant association
was also found between planning a pregnancy and being less aware of the changes that
motherhood might bring (x257.09, p50.008). However, there was no association
between planned pregnancy and a woman feeling that motherhood opens up new
opportunities (x252.12, p50.15) (Table 3).
By the final home visit, when the children were 2 years old, 40 (13%) women scored
above 12 on the EPDS, of whom five had been high EPDS scorers at each time point.
Using multivariate analyses at aged 2, children of women scoring below the cut-off
for risk of depression antenatally had higher cognitive scores (2.4 points) than children
70 T. DEAVE

Table 3. Associations between a planned pregnancy and womens attitudes.

Planned N5248 Unplanned N5182

n (column %) n (column %)

(a) Feelings about pregnancya,b

Overjoyed 136 (55) 62 (34)
Pleased 79 (32) 81 (45)
Mixed feelings 32 (13) 38 (21)

(b) Awareness of the changes that motherhood might bringc

Yes, great deal 8 (3) 14 (8)
Yes, q. a lot 37 (15) 38 (21)
No, not really 154 (62) 102 (56)
Definitely not 49 (20) 28 (15)

(c) Motherhood opens up new opportunities and interestsd

Yes 47 (19) 46 (25)
Other 201 (81) 136 (75)
a 2
x 518.457, df52, p50.001; linear trend x2516.16, df51, p,0.0001; bmissing data, for two women did not
respond to this question; cx257.998, df53, p50.05; linear trend x257.09, df51, p50.008; dx252.12, df51,
p50.02.

of women who were high EPDS scorers. Children of women who had been aware of the
changes that might accompany motherhood also had higher cognitive scores (4.2
points) (Table 4). Each of these variables was also significantly associated with child
behaviour. Using the Behaviour Scale of the BSID-II, (BRS, BSID-II), the children of
low EPDS scorers were less attentive and engaged less well with the RHV (2.0 points)
and the children of women who had been aware of changes that might accompany
motherhood were similarly less attentive and engaged less well with the RHV (1.6
points) (Table 5). There was no association between motor development and either of
these two antenatal variables.

Discussion
The findings of this study are focused around three main aspects: the women who had
planned their pregnancies, childrens cognitive development (MDI), and childrens
behaviour (BRS).

Table 4. Associations between antenatal attitudes and EPDS with cognitive development (MDI, BSID-II).

Variable BSID-II pts SE 95% CI p value

Women who had been aware of the 4.2 1.2 1.96.5 ,0.001
changes that might accompany
motherhooda
EPDS,13a 2.4 1.2 0.14.7 0.03
a
Regression coefficient quoted is versus the baseline, i.e. women who were not aware of the changes that
might accompany motherhood, and those with an EPDS score of .12.
 CHILD DEVELOPMENT AND WOMENS ATTITUDES 71

Table 5. Associations between antenatal attitudes and EPDS with behaviour (BRS, BSID-II).

Factor/variable BSID-II pts SE 95% CI p value

Women who had been aware of 1.6 0.63 0.42.9 0.01

changes that might accompany
motherhooda
EPDS,13a 2.0 1.0 0.013.9 0.05
a
Regression coefficient quoted is versus the baseline, i.e. women who were not aware of the changes that
might accompany motherhood, and those with an EPDS score of .12.

Firstly, women who planned their pregnancy were more likely to report positive
feelings about their pregnancy and be more aware of changes that motherhood might
bring. Secondly, in relation to the MDI of the Bayley Scales of Infant Development
(Bayley, 1993), children of women who had been aware of changes that motherhood
might bring had higher cognitive scores at 2 years than children of women who had not
anticipated changes. In addition, children whose mothers had scored below the cut-off
for risk of depression on the EPDS (12/13 score) in the antenatal period had higher
cognitive development scores, on average, than children of women who were high
EPDS scorers.
Thirdly, there was an association between childrens behaviour at 2 years and their
mothers awareness during pregnancy of the changes that motherhood might bring
(BRS, Bayley, 1993). Similarly, childrens behaviour at 2 years was associated with
mothers having had EPDS scores lower than the cut-off during the antenatal period.
The children were likely to be less attentive and engage less well with the RHV for the
women who were more aware and had lower EPDS scores.
This study was observational and therefore it is important to consider alternative
explanations for the findings. The size of all the above findings are not particularly
significant (0.05.p.0.01) and may therefore be due to chance. However, by and large
the associations were consistent. Differences are unlikely to be due to information bias
since, when the developmental assessments were undertaken, the RHV did not know
either the womens score on the awareness variable or their EPDS scores. The effects
of recall bias were minimized in this study by asking the women for current
information. For measures of psychological health, they were not asked to recall further
back than 1 week, except in relation to whether their pregnancy was planned and their
initial feelings about their pregnancy.
The characteristics of the child and the mother may have influenced the RHVs
assessment of the child, for example, due to individual differences in temperament or
personality. Other factors, such as the childs fatigue or hunger, may also have
contributed. If, on average, a childs temperament is due to factors such as mothers
psychological well-being this would be interesting, and it would be appropriate that
these origins of the behaviour are/should be reflected in the behaviour scale. However,
if a childs behaviour is unrelated to such factors, any effect of a childs temperament
would only contribute noise and therefore tend to obscure the underlying association.
The fact that significant associations were observed implies that they are real.
The women who refused to take part in this study and who were lost to follow-up
were more likely to smoke and were less likely to have a partner or a working telephone
than those who remained in the study. Therefore, the sample available for analysis was
72 T. DEAVE

almost certainly less deprived than the reference population. It is credible that the
associations found by this study would have been strengthened, not weakened, if data
for these women had been available.

Negative attitude to pregnancy

A pregnant womans capacity to visualize herself as a mother is central to maternal
psychological preparation for parenting (Barnard & Martell, 1995). The womans
character and personality, her background, her socio-economic situation, her previous
health and well-being, and the support available to her are all dimensions that
contribute to a womans psychological well-being during pregnancy. They also play an
important role in her attitude towards, and her adjustment to pregnancy, as well as her
future parenting practices and her childs subsequent development (Brown & Harris,
1978; Doty, 1967; Murray, 1989; Phoenix et al., 1994). The most widely researched
aspect of well-being is a womans depression levels, and studies suggest that maternal
postnatal depression has a detrimental effect on child development (Cox & Holden,
1994; Green, 1998; Hay & Kumar, 1995; Murray, 1989, 1992; Murray & Cooper,
1997; Sharp et al., 1995; Stein et al., 1991). This study found that the only maternal
well-being instrument completed in the antenatal period that was significantly
associated with child development was the EPDS. An association between antenatal
EPDS scores and child development was found but, unlike previous studies, after
taking account of antenatal depression, no association was found between postnatal
depression scores and child development at 2 years. The reason for this discrepancy is
unclear, but it is clear there were substantive differences in the design used by other
studies. For example, postnatal depression tends to occur in women who have
antenatal depression; therefore, it might arise since earlier studies did not measure
antenatal depression.
Associations between childrens less attentive behaviour and children of women who
had EPDS scores lower than the cut-off is a counter-intuitive finding. One might
speculate, nevertheless, that this could be due to the children feeling more secure and
confident and therefore more exploratory.
This study used a prospective, longitudinal design to investigate the association
between womens antenatal attitude to pregnancy and motherhood, characterizing a
range of factors and child development up to 2 years of age. Other studies have looked
at maternal well-being in relation to motherinfant interaction, child development,
behaviour and/or health status (Caplan et al., 1989; Cogill et al., 1986; Field et al.,
1985, 1990; Hay & Kumar, 1995; Oakley et al., 1996; Sharp et al., 1995) but several
important differences in the design of this study make it distinct from others. Field et al.
looked at problems in pregnancy as well as depression (1985, 1990), and Oakley et al.
investigated the effect of social support (1996), but typically, most previous research
has not examined relationships between child development and a mothers experiences
and attitude towards motherhood and pregnancy in the antenatal period. The
concentration has been on maternal depression (in some cases as a proxy for well-
being), whereas in the present study an attempt was made to measure a broad spectrum
of first-time mothers expectations of motherhood and pregnancy and emotional well-
being in pregnancy in relation to child development. The sample size in this study is
large. However, the cohort was taken from a predominantly socially deprived
population. The study would need to be replicated with a wider population to test
the generalizability of the results.
 CHILD DEVELOPMENT AND WOMENS ATTITUDES 73

Even though this study found no link between women at risk of depression in the 2
years following childbirth and child development, it does form a link between two
relationships that previous studies have established: between antenatal expectations
and the risk of antenatal/postnatal depression, and between women at risk of depression
and cognitive development (Caplan et al., 1989; Kumar & Robson, 1984; McIntosh,
1993).
From a research perspective these findings highlight the need for further studies of
the effect of antenatal mothers attitude to pregnancy and motherhood on child
development. From a clinical perspective, these findings highlight the importance of
early identification of women who express ambiguity about their pregnancy or distinct
uncertainties about their capacity for motherhood. Studies of this kind uphold the
development of programmes to prepare and support women at risk in order to enhance
the motherinfant relationship and to counteract the adverse consequences on child
development. However, such programmes should be carefully evaluated.

Conclusion
The results from this study suggest that the development of children is influenced by
womens attitudes during the antenatal period towards parenthood and the forth-
coming child. More specifically, the results implicate a possible role for womens
awareness of changes that might accompany motherhood and womens depressed
outlook. In spite of small differences in the findings, womens positive attitude to
pregnancy and motherhood have been linked to higher cognitive development scores.
At 2 years, children whose mothers, during their pregnancy, were aware of changes that
motherhood might entail had higher cognitive scores, compared to children whose
mothers were less aware of the future changes. Further studies in the development,
together with careful evaluation of the preparation and support of women at risk, are
necessary.

Note
1. The Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) is an Avon-wide, total population
study. This is a prospective study of women, their partners and an index child which aims to examine the
multiple prenatal and postnatal influences on childrens health and development. All births in the former
area of Avon with an expected date of delivery between April 1991 and December 1992 were eligible
(Golding, 1990).

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