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Protective factors for child development at age 2 in the presence of poor maternal mental health: results from the All Our Babies (AOB) pregnancy cohort
  1. Sheila W McDonald1,
  2. Heather L Kehler1,
  3. Suzanne C Tough2
  1. 1Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  2. 2Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Sheila W McDonald; SheilaW.McDonald{at}


Objective To identify the combination of factors most protective of developmental delay at age 2 among children exposed to poor maternal mental health.

Design Observational cohort study.

Setting Pregnant women were recruited from primary healthcare offices, the public health laboratory service and community posters in Calgary, Alberta, Canada.

Participants 1596 mother–child dyads who participated in the All Our Babies study and who completed a follow-up questionnaire when their child was 2 years old. Among participants who completed the 2-year questionnaire and had complete mental health data (n=1146), 305 women (27%) were classified as high maternal mental health risk.

Primary measures Child development at age 2 was described and a resilience analysis was performed among a subgroup of families at maternal mental health risk. The primary outcome was child development problems. Protective factors were identified among families at risk, defined as maternal mental health risk, a composite measure created from participants’ responses to mental health life course questions and standardised mental health measures.

Results At age 2, 18% of children were classified as having development problems, 15% with behavioural problems and 13% with delayed social–emotional competencies. Among children living in a family with maternal mental health risk, protective factors against development problems included higher social support, higher optimism, more relationship happiness, less difficulty balancing work and family responsibilities, limiting the child's screen time to <1 hour per day and the child being able to fall asleep in <30 min and sleeping through the night by age 2.

Conclusions Among families where the mother has poor mental health, public health and early intervention strategies that support interpersonal relationships, social support, optimism, work–life balance, limiting children's screen time and establishing good sleep habits in the child's first 2 years show promise to positively influence early child development.

  • child development
  • resilience
  • protective factors
  • maternal mental health
  • cohort study

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  • Contributors SCT is responsible for the overall integrity, progress, questionnaire development and timely completion of the AOB study. SWM, HLK and SCT were involved in the conception and design of this study. SWM and HLK drafted the manuscript. HLK conducted the data analysis. All authors helped to conceptualise ideas, interpret findings, and review and revise drafts of the manuscript.

  • Funding This work was supported by Alberta Innovates Health Solutions through Interdisciplinary Team Grant #200700595 and by providing salary support for SCT. The Alberta Children's Hospital Foundation provided additional funding support for the AOB study for cohort maintenance and follow-up.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Conjoint Health Research Ethics Board at the University of Calgary (Ethics ID 20821 and 22821).

  • Data sharing statement Requests for data from the All Our Babies Study, and other studies, can be made to the Child Data Centre of Alberta, managed by the Alberta Centre for Child, Family and Community Research by emailing

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