Prenatal maternal psychiatric disturbance and offspring neurodevelopmental disorders: a retrospective case–control study from Egypt

Background Maternal mental health during pregnancy is an under-recognized predictor of offspring neurodevelopment, particularly in low-resource settings with limited perinatal mental health screening. This study investigated the association of the presence and diagnostic subtype of neurodevelopmental disorders (NDDs) in offspring with maternal depression, anxiety, stress, physical or verbal abuse, and perceived social support during the last trimester of pregnancy in an Egyptian sample. Methods A retrospective case–control design compared 200 mothers of children diagnosed with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) or attention deficit disorder (ADD) (cases) with 300 mothers of typically developing children (controls) aged 3–17 years. Participants were recruited in Egypt through a university hospital, charitable medical convoys, a private child psychiatry clinic and the community, and controls were frequency-matched on child age, sex and maternal socioeconomic status (SES). Mothers retrospectively reported depression, anxiety and stress (Depression Anxiety Stress Scales-21), perceived social support (Multidimensional Scale of Perceived Social Support), and physical or verbal abuse and emotional distress during the last trimester; child behavior was described with the Strengths and Difficulties Questionnaire. Associations were estimated with logistic regression adjusted for child age, sex, maternal SES and maternal age, with covariates selected a priori . Because SES matching was not achieved and recruitment sources differed between groups, sensitivity analyses included restriction to the only site that recruited both cases and controls. Results Case mothers had significantly higher severity of depression, anxiety and stress, more physical or verbal abuse (45.2% vs. 13.7%) and lower perceived social support than control mothers (all p <.001). In models adjusted for child age, sex, maternal SES and maternal age, abuse (odds ratio [OR] = 4.09, 95% CI 2.52–6.64), depression (OR = 2.94, 95% CI 2.33–3.70 per severity category), anxiety (OR = 1.99, 95% CI 1.70–2.32) and stress (OR = 2.12, 95% CI 1.74–2.58) were associated with higher odds of case status, and perceived social support with lower odds (OR = 0.45, 95% CI 0.36–0.56 per scale point). Associations were similar at the single site that recruited both cases and controls. When all exposures were modelled together, depression (OR = 2.56), anxiety (OR = 1.37) and social support (OR = 0.45) remained associated with case status, whereas the abuse estimate was attenuated (OR = 1.84, 95% CI 0.96–3.54); because this mutually adjusted model conditions on potential mediators of abuse, its estimate should not be interpreted as either a total association or a direct effect. Among cases, maternal psychosocial factors only weakly distinguished autism from ADHD. Conclusion Prenatal psychosocial adversity and maternal psychological distress, particularly depression and anxiety, were strongly associated with offspring NDDs in this Egyptian sample, and depression and anxiety remained associated after mutual adjustment. Because exposures were recalled after the child’s diagnosis and cases and controls were recruited largely from different sources, these estimates may overstate the true associations. Because exposures were recalled retrospectively in a case–control design, these associations cannot be interpreted as causal, but they support the embedding of screening for maternal mental health and violence within routine antenatal care in similar under-resourced settings.