20 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 ESTERINE 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. References Anderson, R. C., & Freebody, P. (1981). Vocabulary knowledge. Comprehension and teaching: Re- search reviews, 77-117. Araji, S., Griffin, A., Dixon, L., Spencer, S. K., Peavie, C., & Wallace, K. (2020). An overview of maternal anxiety during pregnancy and the post-partum pe- riod. Mental Health Journal, 4(4), 47–56. https:// doi.org/10.29245/2578-2959/2020/4.1221 Arias-de la Torre, J., Vilagut, G., Ronaldson, A., Val- deras, J. M., Bakolis, I., Dregan, A., ... & Alonso, J. (2023). Reliability and cross-country equivalence of the 8-item version of the patient health ques- tionnaire (PHQ-8) for the assessment of depres- well—including pre-conception, the postnatal period, and various time points throughout the child’s lifes- pan. Future Recommendations The current paper posits a few recommendations for future research within the prenatal mental health- child development domain. As previously mentioned, a limitation of the current research is the small sample size. Thus, it is recommended that future studies repli- cate this research with larger sample sizes to be able to detect small effects and draw reliable conclusions from the observed results more confidently. This character- istic would also improve the representativeness of the dataset, allowing for the well-informed curation and tailoring of interventions. Another recommendation for studies examining the impacts of prenatal anxiety alone is to emphasize and find a way to distinguish prenatal anxiety from what is known as pregnancy-specific anxiety. The cur- rent study does not account for these types of mental health that are vastly different in factors such as lon- gitudinal course and prediction of postnatal mood disturbance (Blackmore et al., 2016). Most impor- tantly, these ideas are different in their foundations. Pregnancy-specific anxiety encompasses feelings of nervousness or worry regarding personal health and appearance while pregnant, the baby’s health, experi- ence with the birthing process, and the healthcare sys- tem, and so on (Chandra & Nanjundaswamy, 2020), whereas prenatal state anxiety represents more general feelings of anxiety that happen to occur during preg- nancy. Due to these differences, future research exam- ining anxiety during pregnancy should individualize these two forms and assess their implications for not only children but also the pregnant person separately. The discourse surrounding prenatal mental health is minimal, let alone that of pregnancy-specific anxiety. 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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