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The Pertinent Prenatal Period: A Secondary Analysis 
Examining the Relationship Between Prenatal Mater-
nal Anxiety and Child Language Development at 18 

Months

 Prenatal anxiety, an issue impacting pregnant 
persons with a prevalence ranging from 21% to 25% 
(Field, 2017), could potentially play an important role 
in shaping child language development. While few 
studies have examined the links between anxiety and 
language development, existing studies suggest that 
greater anxiety is associated with poorer development 
(Ibanez et al., 2015). In studies that have examined 
prenatal anxiety as an independent variable, maternal 
mental health tends to be discussed broadly without 
consideration for distinct aspects of prenatal mental 
health (e.g., anxiety versus depression; Rogers et al., 
2020). Moreover, there has been a focus on child cog-
nitive outcomes such as memory or learning rather 
than language development (Keim et al., 2011). 
 One prominent study exploring the association 
between prenatal mental health, as encompassed by 
depression and anxiety, and children’s cognitive out-
comes found that prenatal anxiety was significantly as-
sociated with lower scores on assessments of cognition 
(Ibanez et al., 
2015). In this study, the MacArthur Communicative 
Development Inventory (CDI) was used to assess lan-
guage as a cognitive domain, and it was observed that 
higher levels of prenatal anxiety were associated with 
lower CDI scores in children (Ibanez et al., 2015). 
However, this study did not disentangle the influence 
of anxiety from that of depression. Additionally, the 

CDI is based entirely on maternal reports, which may 
introduce outcomes such as social desirability bias or 
the inability to accurately attribute differences in re-
ported vocabulary skills to true differences in skill, in 
addition to the possibility that more anxious mothers 
may simply report differently than non-anxious moth-
ers. 
 Additionally, two studies investigated the trajecto-
ry of maternal prenatal anxiety throughout pregnan-
cy and developmental outcomes in 1-year-old infants 
(Irwin et al., 2020; Keim et al., 2011). These studies 
examined prenatal anxiety as an independent variable 
but did not control for varying mental health disor-
ders that are highly comorbid. Both studies found 
that higher prenatal anxiety was associated with lower 
scores on assessments of cognition. Specifically, Irwin 
et al. (2020) found that increasing maternal anxiety 
across pregnancy was associated with lower receptive 
language, also known as the “input” of language. 
 Next, a study conducted by Rogers et al. (2020) 
aimed to assess whether maternal prenatal depression 
and anxiety were adversely associated with varying de-
velopmental skills in children during the first 18 years 
of life. They found that prenatal anxiety was associat-
ed with poorer language abilities in early childhood, as 
measured through a composite, without controls for 
varying mental health disorders. 
  In a study that controlled for confounding mental 

Maternal mental health is thought to be an important factor that may shape child development as early as the pre-
natal period. Prenatal maternal mental health has been linked to both physiological and factors that are theorized to 
explain the links between mental health and child language development. Whereas some past research has examined 
the associations between prenatal mental health and child language development, most have examined broad mea-
sures that include both anxiety and depression. Given that there are distinct mechanisms by which these aspects of 
maternal mental health are hypothesized to impact development, this study aims to parse the association between 
anxiety and child language development specifically. This study utilized data from a longitudinal prospective study to 
examine the associations between prenatal anxiety and child language development at 18 months in 167 families. We 
conducted a series of three regression models beginning with a simple linear regression examining prenatal anxiety 
and language development, followed by two models, first adding demographic covariates, then including prenatal 
depression. We did not find associations between maternal anxiety and child language development; inadvertently 
raising the question of when and by which mechanisms maternal mental health may or may not impact aspects of 
child development, which are crucial answers to be discerned in order to determine the most effective way to support 
pregnant mothers and their children throughout the prenatal period.
 Keywords: prenatal anxiety, language development, maternal mental health, child outcomes

Melanie Lucia Esterine
Department of Counseling and Clinical Psychology, Teachers College at Columbia University, New York, NY USA

Graduate Student Journal of Psychology
Fall 2025 - Vol. 25

Copyright 2025 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University



21

ESTERINE

health comorbidities, Brouwers et al. (2001) showed 
that high prenatal anxiety during late pregnancy was 
uniquely associated with lower attention-related pro-
cess skills at three weeks, one year, and two years. This 
finding may lend insight to investigations of language 
acquisition, given that attention-related processes are 
thought to be related to language acquisition and 
processing abilities (de Diego-Balaguer et al., 2016; 
Kannass & Oakes, 2008). Finally, a pertinent study 
conducted by Clifford et al. (2022), which examined 
the association between postnatal maternal mental 
health and children’s expressive language (i.e., output 
of language) at approximately one and a half years of 
age (Mage = 17.03 months), found that postnatal ma-
ternal anxiety was negatively related to child language 
production scores, as reported by a parent. In this 
study, prenatal anxiety is not the independent variable; 
however, its relevance lies in the dependent variables 
falling within the domain of language. 
  Researchers have theorized that both physiolog-
ical and psychological processes could underlie the 
associations between prenatal anxiety and postnatal 
child development. Physiological issues have been pro-
posed as one mechanism by which prenatal anxiety 
could shape development. Notably, greater prenatal 
anxiety has been associated with poorer fetal devel-
opment, including reduced fetal head circumference 
(Lewis et al., 2015), with slower or decreased fetal head 
growth during gestation associated with language dif-
ficulties in children two years of age compared to their 
typically developed peers (Villar et al., 2021). Research 
has also found that extremely high levels of prenatal 
anxiety may restrict blood flow and oxygen to develop-
ing fetal organs (Hobel & Culhane, 2003). Restricted 
blood flow in particular can cause Maternal Vascular 
Malperfusion, a placental abnormality, which has been 
linked to poor language development (Straughen et 
al., 2017). These findings highlight physiological path-
ways through which prenatal anxiety may implicate a 
child’s language abilities. 
 It is also possible that prenatal anxiety forecasts 
or precedes less developmentally supportive parent-
ing behaviors. Research has demonstrated prenatal 
anxiety to be a distinct predictor of postnatal mood 
disturbance (Blackmore et al., 2016), which has the 
potential to negatively influence child development, 
including language development, through the possi-
ble presence of these less developmentally supportive 

parenting behaviors. The Family Stress Model, origi-
nally introduced by Conger et al. (1992), suggests that 
parental psychological distress, including anxiety, can 
lead to parenting practices that may negatively impact 
child development (Masarik & Conger, 2017). De-
velopmentally unsupportive parenting practices may 
include insensitivity (Newland et al., 2013); reduced 
time and quality of time spent with children (Iruka et 
al., 2012); and harsh, punitive, and over-controlling 
behaviors (Emmen et al., 2013) that increase the risk 
of child abuse or neglect (Warren & Font, 2015). Fur-
thermore, maladaptive maternal behaviors and affect, 
as encompassed by diminished mental well-being, 
yield a less stimulating environment for children as it 
relates to the home language environment (i.e., the lan-
guage that happens in the home, including the words 
that the child hears and reciprocal back-and-forth 
parent-child conversations; Clifford et al., 2021). Re-
search has suggested that the quality of a child’s early 
home language environment is a crucial predictor of 
their later linguistic skills and cognitive development 
(Dailey & Bergelson, 2022; Romeo et al., 2018). It is 
the exposure to more words and engagement that yield 
more successful linguistic developmental outcomes, 
such as the ability to learn vocabulary faster, exhibit 
increased processing speed, and produce overall stron-
ger language (Gilkerson & Richards, 2009; Hart et al., 
1997; Hurtado et al., 2014). Examining these kinds of 
developmental outcomes around 18 months of age is 
crucial, given the rapid growth in vocabulary skills that 
happens around this time (Kuhl, 2010). 
 Despite much theory suggesting various pathways 
through which prenatal anxiety could impact child 
language development, research on the associations 
between these constructs is limited. Child language de-
velopment is important to understand, given the cru-
cial insight it may provide into other aspects of child 
development, such as cognitive and social abilities 
(Anderson & Freebody, 1981; Gertner et al., 1994). 
Objectives and Rationale 
 The present research aims to examine the asso-
ciation between prenatal anxiety and child language 
development at 18 months of age. Relatively few pub-
lished studies have examined the association between 
prenatal maternal mental health and language devel-
opment, let alone the specific association between 
prenatal anxiety and language at 18 months. An im-
portant consideration for correlational research on 



22

THE PERTINENT PRENATAL PERIOD

memory, and cognition. This study was approved 
by the Teachers College Institutional Review Board 
(IRB), and all participants provided written informed 
consent after being briefed on the study’s purpose and 
procedures. They were also informed that they could 
refrain from specific measure collection or withdraw at 
any point. Participation was voluntary, though partic-
ipants were compensated with differing cash amounts 
based on the time point. Participants were recruited 
in New York City through social media, community 
events, and prenatal clinics. An intentionally racially 
and socioeconomically diverse sample was recruited 
for participation. Recruitment for this study occurred 
in two waves, with a pause due to the COVID-19 pan-
demic. Thus, 93 mothers were recruited in the first co-
hort (before the pandemic) and 116 were recruited in 
the second cohort (after the height of the pandemic). 
In this study, we used data from both cohorts. Before 
enrollment in the study, mothers were screened over 
the phone to ensure that they met inclusion require-
ments, including that they were 18 years or older, were 
at least 35 weeks along in their pregnancy, and had no 
knowledge of fetal neurological or developmental is-
sues. Upon successful enrollment in the study, all 209 
mothers completed the prenatal visit. After the child 
was born, further inclusion criteria were enforced for 
subsequent participation. These criteria included the 
child’s gestational age being greater than or equal to 37 
weeks with no known neurological or developmental 
issues at birth. 205 mother-child dyads met these cri-
teria. Participants were invited to participate in visits 
occurring from approximately every six months after 
birth through their child’s third birthday.
 In the current research project, we examined data 
from families who completed both the measure of 
prenatal anxiety and the measure of child language de-
velopment at 18 months. The total number of moth-
er-child dyads with complete data was 65 for cohort 
one and 104 for cohort two. Two mothers failed to 
complete demographic measures used as covariates in 
the analyses. Thus, my final analytic sample comprised 
167 participants. Table 1 presents descriptive statistics 
corresponding to demographics and covariate vari-
ables.   
Prenatal Anxiety 
 Prenatal anxiety was measured by the Beck Anx-
iety Inventory (BAI). The BAI is a 21-item question-
naire that helps in rating anxiety levels. It is a self-report 

this topic is the susceptibility to omitted variables bias 
(Duncan et al., 2004). Given this possibility, examin-
ing the links between prenatal maternal anxiety and 
child development with a full set of controls for poten-
tial confounders may yield a better sense of whether 
these associations reflect bias or a true association. It is 
important to understand that although various mental 
health disorders may be comorbid with one another, 
they present with different symptoms, require differ-
ent therapeutic interventions, and–in the case of par-
ent-child dyads–signify different implications for the 
child (Rogers et al., 2020). 
 Insofar as this correlational work could lay the 
foundation for testing whether interventions that 
target maternal mental health have positive effects 
on child language development, establishing wheth-
er these associations are robust is an important first 
step. By focusing specifically on prenatal anxiety, we 
can hone in on this construct as it relates to child lan-
guage development. Furthermore, by controlling for 
numerous potentially confounding variables, includ-
ing prenatal maternal depression, this research may 
strengthen the current research on this topic. Not 
only does the present research hope to lay the frame-
work for possible interventions for mothers struggling 
with mental health, anxiety in particular, but it also 
strives to do so for children who may be susceptible 
to some of the unintentional consequences prenatal 
anxiety may bring. By distinguishing the potential im-
plications of prenatal anxiety from those of prenatal 
depression and narrowing the scope, we enhance our 
understanding and ability to develop tailored interven-
tions aimed at the prevention of any adverse develop-
mental outcomes that may surface in the presence of 
prenatal maternal anxiety.
Hypothesis 
 The present research hypothesizes that higher 
levels of prenatal maternal anxiety are associated with 
lower levels of expressive and receptive language skills 
in children as measured at 18 months. 

Methods 
Participants 
 The mothers included in the current research were 
originally recruited for participation in a longitudinal 
study known as BUDDY, a study examining associa-
tions among various sociocultural factors, early expe-
riences, and child development, particularly language, 



23

ESTERINE

measures. These correlations attained a rounded value 
of 0.93 with significance (LENA Foundation, 2022). 
The LENA snapshot has proven to be efficacious as it 
relates to monitoring the progress of language devel-
opment as well as helping to identify the probability 
of language delay (LENA Foundation, 2022). Espe-
cially given the multilingual nature of the participants 
recruited for BUDDY, it is crucial to mention that the 
LENA snapshot has demonstrated limited validity in 
multilingual contexts.
Covariates 
Prenatal Depression 
 Prenatal depression was measured by the Patient 
Health Questionnaire Depression Scale (PHQ-8). The 
PHQ-8 is an 8-item scale used as a diagnostic and se-
verity measure for depression (Kroenke et al., 2009). It 
is a self-report questionnaire that implements a Likert 
scale with responses for items ranging from zero (“not 
at all”) to three (“nearly every day”). The question-
naire asks respondents to consider the presence of the 
items’ corresponding symptoms during the previous 
two weeks (Arias-de la Torre et al., 2023). The items 
correspond to symptoms outlined in the DSM-IV as 
diagnostic criteria for major depressive disorder. Sam-
ple items for this measure include “I am sad all the time 
and I can't snap out of it" and "I am so sad or unhappy 
that I can't stand it”. The PHQ-8 is scored by sum-
ming the respondents’ scores to each of the items, with 
total scores closer to zero representing lower levels of 
depression and total scores closer to 24 representing 
higher levels (Arias-de la Torre et al., 2023). The tool 
displays high internal consistency reliability (α = .82) 
and construct validity (Pressler et al., 2011). For the 
purposes of BUDDY, the PHQ-8 was administered as 
opposed to the PHQ-9, which includes a ninth ques-
tion on suicidal ideation, due to the study’s desire to 
focus on the core aspects of depression while avoid-
ing potential issues that may arise with Item Nine in 
non-clinical settings.  
Demographic Variables 
 Demographic variables included child sex, child 
age at LENA snapshot completion, mother’s race/
ethnicity (with White mothers as the reference group), 
years of formal education completed by the mother 
(i.e., maternal education), and family income. 
Data Analysis Plan 
 To examine the associations between maternal 
prenatal anxiety and child language development, we 

assessment developed in 1988 that asks about com-
mon anxiety symptoms and their impact over a week 
(Rung, 2024). The questionnaire assesses short-term 
symptoms, primarily those that are physical. Sample 
items include: “Numbness or tingling” and “Unable 
to relax”. For each question, there is a uniform set of 
four answer choices with scores ranging from zero to 
three. As a result, overall scores ranged from 0 to 63 
characterized by grouping as follows: 0 to 7 = minimal 
anxiety; 8 to 15 = mild anxiety; 16 to 25 = moderate 
anxiety; and 26 to 63 = severe anxiety (Rung, 2024). 
While the BAI is not a diagnostic tool, this score can 
help mental health professionals determine the severi-
ty of anxiety. The measure shows high discrimination 
(between anxious and non-anxious persons) in clini-
cal populations and high internal consistency (α = 
.93) and test-retest reliability as measured over a week 
(rICC = .84; Oh et al., 2018). However, it is important 
to note that the measure shows limited discriminant 
validity against depressive disorders (Oh et al., 2018).    
Language Development
 Child language development at 18 months was 
measured by the Language Environment Analysis 
(LENA) Snapshot. The LENA snapshot is a 52-ques-
tion, parent-completed questionnaire that measures a 
child’s expressive and receptive language skills (LENA 
Foundation, 2022). Sample items from the LENA 
snapshot include “Does your child spontaneously pro-
duce sentences that are 10 or more words in length?” 
and “Does your child understand concepts like ‘least’, 
‘most’, and ‘first’?” The questionnaire is norm-refer-
enced to a sample of typically developing children who 
participated in a natural language study by its creators 
(LENA Foundation, 2022). The LENA system uses 
an algorithm to automatically score responses and 
compares the score to the normative dataset of the 
language development of other monolingual, North 
American English-speaking children at that age. Fol-
lowing this, the system generates a standard score 
that estimates the child's developmental language age, 
placing them at below or above their true age (LENA 
Foundation, 2022). The assessment has strong test-re-
test reliability, acquiring a correlational value of ~.93 
over two years (LENA Foundation, 2022). This tool 
has also been correlated to various standardized lan-
guage and cognitive assessments, including the Cog-
nitive Adaptive Test and the Preschool Language 
Scale 4th Edition, both the expressive and receptive 



24

THE PERTINENT PRENATAL PERIOD

sults, a high positive correlation was observed between 
prenatal anxiety and depression, which likely impact-
ed the results attained by the third regression, which 
included all the covariates. 
Analyses 
 First, we ran a linear regression model to examine 
the relation between prenatal anxiety and language de-
velopment at 18 months without the inclusion of any 
covariates. The model results are presented in Table 
4, alongside all of the results produced by my analy-
ses. The model’s standard deviation indicated a small 
negative association (SD = -0.06), indicating that a one 
standard deviation increase in maternal anxiety was 
associated with a .06 reduction in language develop-
ment. In raw units, this corresponded to a reduction of 
-0.15 units on the measure of language development. 
However, importantly, this association was imprecise 
and not statistically significant (p = .43), indicating 
that the association is not statistically distinct from a 
correlation of zero. 
 To examine the extent to which this small associa-
tion was biased by child and family characteristics, we 
then ran a model that controlled for the following vari-
ables: child sex, child age at LENA snapshot, mother’s 
race and ethnicity, maternal education, and income. 
The association between anxiety and language de-
velopment became slightly larger but remained im-
precise and statistically non-significant. Despite this 
slight increase, the first and second regression analyses 
produced consistently small estimates that hovered 
around 0, suggesting a near zero effect. Although the 
association remained statistically non-significant, in-
terestingly, in this second regression analysis, the direc-
tion of the β value flipped from negative to positive (β 
= .03). On the other variables included in this regres-
sion model, notably, two attained statistically signifi-
cant coefficients, child sex (β = .20, p = .01) and moth-
er’s race when specified to be Black (β = -.20, p = .03). 
 The last regression model we ran included the pre-
viously mentioned covariates in addition to prenatal 
depression. The inclusion of depression in the model 
substantially changed the association between prena-
tal anxiety and children’s language development. In-
deed, the association increased from near zero in earlier 
models (β = .20) and became nearly statistically signifi-
cant by conventional standards (p = .06). This pattern 
of results looks a lot like what we might expect if sup-
pressor effects were at play, leading me to be suspicious 

ran a series of three regression models using SPSS v29 
(IBM Corp). First, we ran a simple linear regression 
model to test the relationship between prenatal anx-
iety and language development. Next, we conducted 
a multiple linear regression model to account for de-
mographic covariates: child sex, child age at LENA 
snapshot completion, mother’s race/ethnicity, mater-
nal educational attainment, and family income. Final-
ly, we ran a multiple linear regression model in which 
we included prenatal depression in addition to the 
demographic covariates introduced in model two. We 
tested this final model to probe the unique association 
between prenatal anxiety and child language develop-
ment while holding constant the influence of prenatal 
depression, given the robust high correlation between 
depression and anxiety. 

Results 
Descriptive Statistics 
 Beginning with some discussion on descriptive 
statistics of the sample, the sample for the present 
study was relatively diverse. 44% of mothers in the 
sample identified as White and 55% identified as non-
White, while 40% identified as Hispanic or Latino and 
59% as not. As for family income and maternal edu-
cation, the range for these variables was vast, though 
both distributions did skew towards the right (i.e., the 
higher end of the spectrum). On average, child age at 
LENA snapshot completion was 18 months, and the 
total score on the PHQ-8 had an average of five (M = 
5) with a left-leaning distribution (i.e., the lower end of 
the spectrum) representing lower levels of prenatal de-
pression for the mothers in the sample, on average. Re-
garding the BAI and prenatal anxiety, the average score 
was approximately nine (M = 9) with the data skewing 
left as well, representing lower levels of prenatal anxi-
ety for the mothers included in the present study. Last-
ly, the total LENA snapshot score (i.e., child language 
development) skewed right toward higher scores and 
greater language abilities with an average score of 104 
(M = 104). 
 Table 3 shows the correlations among variables 
included in my analyses. Of note, a low negative cor-
relation was observed between prenatal anxiety and 
language development, and a moderate negative cor-
relation was observed between prenatal depression and 
language. 
Interestingly, in the context of the effect it had on re-



25

ESTERINE

analyses in this study, yielded null results. In the con-
text of this particular study, one important consider-
ation is the small sample size. The small sample size of 
167 participants can pose a myriad of limitations for 
data analysis and interpretation. For starters, smaller 
sample sizes make it more difficult to ascertain the va-
lidity of a found effect, especially small effects. This is 
attributed to the lower statistical power often achieved 
by smaller sample sizes. Small sample sizes also yield 
unreliable results due to low generalizability, making 
it difficult to accurately attribute results to the broader 
population.
 In the second regression analysis, we similarly 
found a statistically nonsignificant association be-
tween prenatal anxiety and child language develop-
ment. However, as previously noted, a peculiar change 
occurred with the standardized coefficient value for 
this association from the first analysis to the second–
the direction of this value shifted from negative to 
positive. Though we should be careful not to heav-
ily interpret these coefficients, given that they were 
both very close to zero, this hypothetical interpreta-
tion opposes current literature in the field, highlight-
ing the need for continued research. On top of this, 
it raises the question of whether there could be cases 
in which the experience of anxiety confers advantag-
es to parent-child interactions that support child de-
velopment. However, again, ultimately the estimate 
from this model was quite small and suggestive of no 
association. Interestingly, in this second regression, we 
did observe two statistically significant associations. 
An association was found between child sex and lan-
guage development, a finding that aligns with a sub-
stantial amount of literature in the field, depicting 
significant gender differences in language acquisition 
spanning from early childhood through adolescence. 
Though empirical evidence is not robust and findings 
are mixed, numerous studies highlight a female advan-
tage in various aspects of language acquisition in early 
childhood (Clarke-Stewart, 1973; Heister, 1982). We 
also observed a negative association between maternal 
race when identified as Black and child language de-
velopment. This finding raises concern that warrants 
further examination, given its illustration of a vulner-
able population that may benefit from interventions 
geared towards the promotion of early childhood 
language development. This association has been ob-
served in other literature, such as Cho et al. (2007), 

about the estimate. Such effects will be discussed fur-
ther; however, they tend to occur with highly correlat-
ed variables when simultaneously input as predictors. 
Of note, there was an observed negative association 
between maternal depression and child language (β = 
-.25, p = .02) as well as an association between child sex 
and child language (β = .20, p = .007). And, as men-
tioned earlier, there was a strong positive correlation 
between prenatal anxiety and prenatal depression (r = 
.70). 

Discussion 
 Overall, this study found little evidence to suggest 
an association between prenatal anxiety and child lan-
guage development at 18 months of age. 
 In the first analysis, which most closely replicated 
existing literature due to its refrain from controlling 
for covariates, opposing results to current literature 
were observed. For example, Ibanez et al. (2015) ex-
plored the associations between prenatal depression 
and anxiety with children’s cognitive outcomes with-
out controlling for depression. In contrast to the 
current study, they found that prenatal anxiety was 
significantly associated with poorer cognitive develop-
ment, as characterized by language, at three years old 
(Ibanez et al., 2015). Results also conflict with those of 
Rogers et al. (2020), which aimed to assess the associa-
tion between prenatal depression and anxiety with var-
ious developmental skills, including language, during 
the first 18 years of life. Again, in this study, there was 
no control for the covariate prenatal depression, yet 
researchers found that prenatal anxiety was associat-
ed with diminished language abilities. This pattern is 
consistent with other prominent studies such as Irwin 
et al. (2020) and Clifford et al. (2022), which found 
higher prenatal anxiety to be associated with poorer re-
ceptive communication skills and postnatal maternal 
anxiety to be associated with child expressive language, 
respectively. 
 The antithetical nature of these results alone em-
phasizes the need to continue conducting research 
within this realm to better understand the implica-
tions of prenatal mental health on child language de-
velopment and other facets of child development at 
large in order to design and implement tailored inter-
ventions geared towards positive outcomes for moth-
ers and children as needed. One can hypothesize many 
reasons why this first analysis, and ultimately all of the 



26

THE PERTINENT PRENATAL PERIOD

to lead to difficulties in detecting small effects and un-
reliable results. It is also worth noting the two-cohort 
study design necessitated by the pandemic. As previ-
ously mentioned, participants were recruited at two 
different time points due to the pandemic, resulting in 
two cohorts. Recruitment for cohort one began before 
the pandemic and was interrupted once restrictions 
were imposed. Under “normal” circumstances where 
participants are recruited at different time points, a 
study faces the risk of the “cohort effect”, which is de-
scribed as the variation in characteristics of a group of 
people over time based on a shared experience (Caru-
ana et al., 2015). This effect is all the more applicable 
in this study where participants of cohort two were 
recruited after a shared experience as life-changing as 
the COVID-19 pandemic. The cohort effect implies 
that different experiences attributed to a given period 
can impact the perceptions and responses of a partic-
ipant in a research study (i.e., economic circumstanc-
es; Caruana et al., 2015). Meaning that participants 
of cohort two may showcase attitudes and behaviors 
that are highly attributed to their shared exposure to 
and experience with the pandemic. This phenomenon 
can ultimately introduce bias into the research because 
it signals a possible distortion of observed trends at-
tributed to differences in shared life experiences that 
may have independently implicated the results. 
 Additionally, the lack of consistency in the child’s 
age at which mothers completed the LENA snapshot 
serves as a limitation. Considering the correlation be-
tween prenatal anxiety and age at snapshot completion 
is low (r = .1), this limitation would be more pertinent 
if there were some sort of correspondence between 
prenatal anxiety and child age at snapshot completion, 
such that mothers with higher levels of prenatal anxiety 
were systematically completing the LENA snapshot at 
a different time than those with lower levels of prena-
tal anxiety. However, it remains an important factor to 
consider. The target age for the current study was 18 
months; however, mothers with children as young as 
16 months and as old as 21 months filled out the snap-
shot for the 18-month time point, contributing to the 
data the current study used. Though the mean age at 
snapshot completion was approximately 18 months 
(M = 17.98), the standard deviation was 0.895, sig-
naling that the data is rather spread out. This standard 
deviation–     though not exorbitantly high–is notable 
given that, as mentioned previously children’s vocabu-

which observed that at three years old, White children 
of White mothers had a lesser likelihood of presenting 
with language delays than non-White children and 
mothers (the majority of them Black). The consistent 
nature of this association highlights an exceedingly real 
equity issue that needs to be addressed to attain more 
positive outcomes for all children, regardless of their 
race or their mother’s race. 
 Lastly, in the third linear regression, though it 
yielded a statistically insignificant relationship be-
tween total prenatal anxiety and language develop-
ment, a notable change was observed in the estimate 
attained for the prenatal anxiety–child language devel-
opment relationship. The p-value for this relationship 
changed significantly from the second analysis (p = 
.72) to the third (p = .06). This change, although there 
is a lack of association, represents a marked increase in 
the predictive power of prenatal anxiety. This compel-
ling finding signifies what this research hypothesizes to 
be a suppressor effect induced by the control of pre-
natal depression. A suppressor effect in a regression 
occurs when controlling for a variable increases the 
predictive power of the model, as observed here. This 
represents the possibility of a rather complex relation-
ship between prenatal anxiety and child language de-
velopment that is somehow mediated by the presence 
of prenatal depression, should said relationship exist. 
Moreover, in this regression model, two statistically 
significant associations were observed: one between 
child sex and language development and another be-
tween prenatal depression and language development. 
The former of the two was also noted in the previous 
regression; however, the latter is specific to this re-
gression, given that prenatal maternal depression was 
introduced here. A negative association between pre-
natal depression and child language development at 
18 months was observed, representing a relationship 
characterized by a diminishing of language abilities 
in the presence of higher prenatal maternal depres-
sion. This coincides with existing literature which has 
found that at 12 months, children of mothers who 
were diagnosed with major depressive disorder while 
pregnant showcased lower language abilities compared 
to the control group (O’Leary et al., 2019). 
Limitations 
 Myriad factors limit the conclusions of the current 
study. As previously mentioned, the small sample size 
is a large limitation of the current study for its potential 



27

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studies may account for the inability to interpret cor-
relation as causation. 
 Lastly, the current study is limited in its failure 
to account for or consider pregnancy-specific anxiety 
(PSA). Though often conceptualized interchangeably 
with prenatal anxiety, PSA is a unique phenomenon 
(Langille et al., 2023). PSA is common, affecting 20-
40% of women during pregnancy (Araji et al., 2020). 
It differs from trait anxiety in that PSA is an affective 
state in which a pregnant person feels worry, fear, or 
nervousness surrounding matters related to their preg-
nancy such as their prenatal health, the baby’s health, 
labor and delivery, and parenting (Dunkel et al., 2022). 
It is important to consider these phenomena distinctly 
considering they have distinct clinical impacts (Lan-
gille et al., 2023). 
Conclusion 
 Despite the limitations mentioned above, the cur-
rent study serves as a significant step in understanding 
the role that maternal mental health may play in child 
development, especially as it pertains to prenatal men-
tal health and child language outcomes. Moreover, it 
contributes to the literature surrounding the impor-
tance of distinguishing between the ramifications of 
varying clinical disorders, which are crucial given their 
differences in treatment. Though the current study did 
not provide evidence that prenatal maternal anxiety 
influences child language development at 18 months, 
this null hypothesis suggests a need to achieve greater 
clarity into its true impact, given that these findings 
oppose current literature. The implications of im-
properly understanding the effects of prenatal anxiety, 
or maternal mental health, on child development are 
such that we remain incapable of providing adequate 
resources to children who may be at a disadvantage or 
to mothers who may be unaware of possible conse-
quences. It also provides thoughtful insight into other 
associations present within this realm such as maternal 
race and child gender’s seeming to influence child de-
velopment as well. By means of attempting to answer 
a question and shed light on prenatal mental health, 
the current study raises new questions regarding pat-
terns and relationships that may exist in the sphere of 
the mother-child matrix. It’s important to understand 
the implications that may arise for child development 
based on prenatal maternal mental health to know 
how to best support pregnant mothers and their chil-
dren not only during pregnancy but at other stages as 

lary is characterized by rapid growth at 18 months of 
age, with studies showcasing that infants may add up 
to 10-20 new words to their vocabularies daily (Fenson 
et al., 1993; Reznick & Goldfield, 1992). It is import-
ant to note that in the current study we controlled for 
child age, which addresses this concern. 
 The data was also limited by the measures used to 
capture the independent and dependent variables–the 
Beck Anxiety Scale and the LENA snapshot. Both 
measures relied on parent reporting, which introduces 
the potential for social desirability bias, where individ-
uals answer questions in a way that might make them 
seem more “acceptable” (Paulhus, 2017). One specific 
limitation of the LENA snapshot includes what may 
be perceived as a limited scope, given that the snapshot 
primarily focuses on expressive and receptive language, 
failing to capture other parts of language, such as met-
alinguistic awareness and higher-order language skills 
(LENA Foundation, 2022). Additionally, currently, 
there is limited validity for multilingualism with the 
snapshot questionnaire, given that responses are com-
pared to norms established by monolingual, North 
American English-speaking children. This fails to ac-
count for the nuances which multilingualism adds to 
language development and acquisition. A large por-
tion of the study’s participants, mothers and children 
alike, fall into this demographic, raising a concern re-
garding the accuracy of language abilities as captured 
by LENA snapshot scores. A specific limitation of 
the Beck Anxiety Inventory (BAI) is its low discrimi-
nant validity in distinguishing between symptoms of 
anxiety and depression (Muntingh et al., 2011). This 
raises a concern for the present study’s aim to isolate 
the effects of anxiety, as BAI scores may not accurately 
capture anxiety independent of depressive symptoms.
 The study’s correlational design also limits its im-
plications for drawing causal inferences. While we had 
causal theories about the links between maternal anx-
iety and child development, it’s impossible to discern 
whether a causal relationship exists due to the lack of 
experimental manipulation in correlational research. 
Indeed, a range of confounding variables–including 
those that we did and did not control for–could have 
biased any observed associations between the con-
structs in our study. Though no significant association 
was observed in the present study, this limitation im-
pacts all studies conducted without random assign-
ment. Thus, it is important to consider how future 



28

THE PERTINENT PRENATAL PERIOD

this nature, within the same vein as the aforemen-
tioned recommendation, would be to control for 
more covariates, such as prenatal stress. It is important 
to note that the study whose data the current study 
used also measured maternal stress at the prenatal time 
point. To advance the mission of dissecting varying 
facets of mental health (i.e., depression vs. anxiety vs. 
stress, etc.) in order to further understand their differ-
ences and implications, it is important to account for 
as many variables as possible, including prenatal stress. 
Future studies could assess the association between 
prenatal mental health and child outcomes by compre-
hensively accounting for different components of the 
former. To date, in the domain of child language devel-
opment, research has found that the level of prenatal 
stress can account for variance in 2-year-old toddlers’ 
productive and receptive language abilities (LaPlante 
et al., 2004), showcasing the ability of prenatal stress 
to dictate child language development in some capac-
ity. Differentiating aspects of maternal mental health 
and understanding their possible implications for not 
only children but also for mothers is incredibly perti-
nent. This is particularly evident given the intersection 
between research and understanding      as well as in-
tervention and policy. For the sake of best supporting 
these communities, it’s essential to appreciate the intri-
cacies of factors that may affect them. 
 Ultimately, the current study contributes to an 
under-researched area of child psychology and de-
velopment. Although the findings do not necessarily 
demonstrate a cause for concern, it is essential to con-
tinue researching in this domain to identify opportu-
nities for action. 

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Table 1 

Descriptives (Demographic Variables)

Note. N = 304

Note. This table shows descriptive statistics for the demographic variables. The total participant count 
for the current study is 167 children/families, as stated in the last row in the table. Maternal Age is 
reported in years. Family Income is reported in USD. Maternal Education is reported in years. Child 
age at LENA (Language Environment Analysis) snapshot completion is reported in months. Family 
income was log-transformed.



33

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Table 2

 Descriptives (IV & DV)      

Note. LENA is representative of Language Environment Analysis.



34

Table 3

Correlation Matrix 

Note. Bolded correlations indicate statistically significant correlations (p < .05). Construct names rather 
than measure names are used in the matrix.

THE PERTINENT PRENATAL PERIOD



35

Table 4

Correlation Matrix 

ESTERINE

Note. Bolded correlations are significant of highly correlated variables. Only correlations relevant to the 
current study and the overarching literature are included in the matrix. Construct names rather than 
measure names are used in the table.
* Covariate Included
– Covariate Not Included


