Exposure to the in utero environment provides offspring risk or protection with respect to postpartum development and health across the lifespan. We used latent profile analysis (LPA), considering self-report and physiological indicators to assess the influence of maternal prenatal stress/distress on infant temperament. We predicted that participants who reported greater prenatal stress/distress would have infants with less optimal temperament characteristics (e.g., higher fearfulness, lower smiling/laughter). Women (N = 67) were recruited in the Southwest Washington and Eastern Washington/North Idaho areas. Participants responded to surveys during the third trimester and provided hair samples for cortisol analyses. Postpartum mothers reported on infant temperament. LPA resolved two statistically supported profiles, reflecting lower and higher maternal stress/distress during pregnancy, which we compared with respect to infant temperament (e.g., fearfulness, smiling/laughter). The greater stress/distress exposure group demonstrated higher cortisol concentrations, depression, general anxiety, and perceived stress. Mothers with greater prenatal stress/distress profiles reported their children exhibiting more challenging temperaments (e.g., higher negative emotionality). This pattern of results suggests that groups discernable in terms of prenatal stress/distress exposure also differ with respect to infant reactivity and regulation.

1 Introduction

1.1 Prenatal Stress Exposure and “Fetal Programming”

Developmental origins of health and disease (DOHaD) research has demonstrated that exposures to the in utero environment confer risk or protection for offspring with respect to postpartum development and health across the lifespan (e.g., Fukuoka 2015; Monk and Fernandez 2022). Founded in research addressing the impacts of maternal nutrition on offspring development (Barker 1995), the DOHaD conceptual model was more recently applied in the study of maternal stress and psychopathology/symptoms as predictors of postpartum outcomes (e.g., Wu et al. 2022). Prenatal stress may lead to intergenerational transmission of risk, affecting offspring development (e.g., Bowers and Yehuda 2016; Monk et al. 2012; Roubinov et al. 2021; Yao et al. 2014), with maternal physiological stress, operationalized in terms of cortisol levels/hypothalamic–pituitary–adrenal (HPA) axis activity, observed to confer vulnerability (Meaney et al. 2007; Sandman et al. 2012).

Offspring's exposure to excess maternal glucocorticoids in utero was shown to influence infant development in humans (Matthews and Phillips 2012; Sandman et al. 2012), and is evolutionarily conserved across species (sticklebacks [Giesing et al. 2011], rodents [Meaney et al. 2007; Golub et al. 2016], snowshoe hares [Sheriff et al. 2009]). Because elevated maternal cortisol during pregnancy has been reported to be related to increased infant cortisol concentrations (Davis et al. 2011; Gutteling et al. 2004; Gutteling et al. 2005; Tollenaar et al. 2011), prenatal stress was described as “programming” infants’ HPA axis development and stress response, with a spectrum of behavioral implications (Harris and Seckl 2011). Negative intergenerational impacts of maternal stress during pregnancy have been demonstrated throughout the lifespan, with associated physical and mental health difficulties (e.g., increased risk of schizophrenia and depression; higher rates of Type II diabetes) for the exposed offspring (Babenko et al. 2015; Roseboom et al. 2011). Overall, prenatal stress exposure, including physiological and perceived maternal stress, and related internalizing symptoms (e.g., depression), has been linked with HPA axis dysregulation and challenging temperament profiles (i.e., marked by reactivity/limited self-regulation) for offspring, with consistent effects across cultures (Roubinov et al. 2021).

1.2 Relationships With Socioemotional Development

Understanding precursors of greater emotional reactivity and poorer regulation, defined as components of temperament, is important because of links with increased behavioral problems/symptoms (Gartstein et al. 2012; Gartstein et al. 2016; Lengua 2006; Rothbart and Bates 2007; Thomas et al. 2017). Infant temperament is understood to develop as a function of a biological foundation and contextual influences (Rothbart and Derryberry 1981) and is considered a critical domain of social–emotional functioning and, a precursor to personality (Cloninger 1994; Diamond 1974; Rothbart and Ahadi 1994; Rothbart et al. 2000). In infancy, the most widely used operational definition of temperament includes a number of components related to approach/positive affect (e.g., activity level, smiling and laughter), negative emotionality/distress proneness (e.g., fear, frustration), and attention-based regulatory capacity (e.g., duration of orienting, soothability). These fine-grained temperament dimensions have been linked with unique outcomes, as well as biological pathways and developmental patterns. For example, infant fear was associated with limbic system activation (Kalin et al. 1998) and elevated cortisol (Pérez-Edgar et al. 2008), also predicting internalizing (e.g., anxiety, depression) symptoms, whereas distress to limitations/frustration posed a risk for externalizing (e.g., noncompliance, aggression) problems (Lengua 2006; Oldehinkel et al. 2004).

Maternal stress/distress during pregnancy has been associated with adverse infant temperament outcomes. Werner et al. (2013) reported that higher maternal cortisol concentrations during pregnancy were related to observed crying and increased motor behavior in response to novelty in infants. Effects of perceived maternal stress and depressive symptoms on infant cortisol reactivity were also reported, including atypical (Lawler et al. 2019) and dampened (Barclay et al. 2022) reactivity. Such altered functioning, in turn, was linked to heightened emotionality (Weinstock 1997) and behavioral dysregulation (Griffin et al. 2003). Infants born to mothers with mental health difficulties (e.g., depression, anxiety) related to stress tend to fall into the high emotional reactivity category more frequently (Spry et al. 2020). Maternal depression mediated the association between maternal childhood adversities, infant negative emotionality, and behavioral dysregulation (Bouvette-Turcot et al. 2020). Maternal prenatal anxiety was also shown to predict infant autonomic arousal (i.e., higher reactivity and lower recovery), related to later fearful temperament (de Vente et al. 2020). The most reliable prenatal effects have been observed with respect to facets of infant negative emotionality/distress proneness and regulatory capacity, warranting further study of potential “fetal programming” and specific emergent profiles related to adverse infant outcomes.

1.3 Latent Profile Analysis

Latent profile analysis (LPA) relies on maximum likelihood estimation to identify distinct groups or types (latent categories) using a set of continuous observed variables (Berlin et al. 2014). This procedure classifies individuals from a heterogenous population into smaller, more homogenous groups and has been utilized to study relationships between specific profiles and maternal and child outcomes. For instance, Walsh et al. (2019) captured three maternal prenatal stress latent profiles (or phenotypes): healthy group (HG), psychologically stressed group (PSYG), and physically stressed group (PHSG), which were differentially associated with infant neurodevelopmental outcomes (e.g., potential delays in central nervous system development for the PHSG vs. the HG leading to slower auditory-evoked responses among PHSG newborns). Luo et al. (2021) observed four maternal prenatal stress profiles. These profiles were associated with variations in levels of reported anxiety and resilience during the COVID-19 pandemic in Chinese pregnant mothers, suggesting that targeted interventions would be helpful for each of the different profiles (Luo et al. 2021). Research by Njoroge et al. (2023) further supports the usage of LPA in identifying profiles to describe mother and child outcomes. Specifically, researchers observed that having a higher maternal depression/anxiety profile at neonatal intensive care unit discharge was related to later increased maternal anxiety and stress as well as reports of greater symptoms of depression/anxiety for children (Njoroge et al. 2023).

LPA allows researchers to examine multiple indicators of stress and potential transmission pathways and represents a useful tool in identifying prenatal exposure phenotypes/groups (e.g., Walsh et al. 2019), as well as links with infant temperament outcomes. While the variable-centered approaches continue to be the norm in the literature, person-centered approaches, and LPA in particular, offer a number of advantages, providing a window into individual differences (Lanza and Cooper 2016). First, a person-centered approach defines meaningful profiles or types with which individuals are affiliated, revealing different patterns of prenatal stress exposure and effects on infant temperament that might not be apparent in variable-centered analyses. Leveraging LPA enables us to examine how certain types of stress exposure affect specific temperamental attributes. Second, prenatal stress effects on infant temperament can be expected to differ due to factors like genetics, maternal health, and environmental influence. A person-centered approach allows us to capture this heterogeneity, considering constellations of influences, rather than isolating each variable, elucidating how multiple stress factors work jointly to shape temperament. That is, using LPA, we can identify profiles that represent groups of individuals that share stress-related characteristics, as well as similarities with respect to their etiology, involving overlapping biological and contextual effects. LPA relies on covariation among traits to reveal emergent psychophysiological profiles, optimizing the use of rich multivariate data, as well as reducing the number of statistical tests, and was described as an ideal technique for research questions that address configurations of multiple variables (Spurk et al. 2020; Zyphur 2009).

1.4 Current Study

This study is aimed at improving our understanding of infant temperament outcomes related to “fetal programming” by examining different facets of negative reactivity and regulation based on documented links with critical long-term social–emotional/psychiatric outcomes, and associations with prenatal stress effects (e.g., Baibazarova et al. 2013). Specifically, we relied on a data-driven approach considering a variety of maternal prenatal stress/distress indicators, identifying meaningful subgroups via LPA, previously used in this context (e.g., Walsh et al. 2019). Resulting profiles/types were subsequently compared with respect to mother-reported temperament attributes (e.g., fearfulness, soothability). Based on observed relations between higher maternal stress and poorer outcomes in the literature (e.g., Njoroge et al. 2023), we expected that the probability of membership in the subgroup(s) reflecting greater maternal stress/distress would be associated with less optimal infant temperament outcomes. The literature has been most consistent in identifying negative emotionality and dysregulation effects (e.g., Bouvette-Turcot et al. 2020), which we anticipated at the factor and fine-grained levels (e.g., higher overall negative emotionality, distress to limitations/frustration with greater stress exposure). As LPA represents a data-driven approach, we did not formulate specific a priori hypotheses regarding prenatal stress profiles but did expect subgroup separation in terms of lower and greater stress exposure, with maternal self-perceptions and physiological stress contributing to this differentiation.

2 Method

2.1 Participants

Women (N = 67) were recruited during their third trimester of pregnancy from Southwestern Washington and Eastern Washington/Idaho. To meet eligibility criteria, the women needed to be 18 years or older, fluent in English, and could not be diagnosed with heart disease or taking cardiac medications. Participants were also excluded if their infant was diagnosed with a cardiac defect or a neurodevelopmental condition, with the latter exclusion as a function of temperament-related effects (Chen et al. 2011).

During pregnancy, the mean age of participants was 30 years (SD = 4.27). The sample was predominately White (82.8%) and in a romantic partnership (94.1%). Over half of the women were employed prior to giving birth (58.6%). The women completed the pregnancy survey at an average of 31 weeks gestation (SD = 2.99). The average gestational age at birth was 38.73 weeks (SD = 1.66), and 58.2% of infants were female. Average infant age was 9.34 weeks (SD = 5.63) at the 2-month postpartum evaluation and 27.95 weeks (SD = 3.78) at the 6-month postpartum assessment.

Prenatal survey data were not collected for four participants, and these women were therefore excluded from the current analyses, resulting in a final sample size of 63 women. Fourteen participants were lost to attrition between the prenatal and 2-month visit (22.22%). An additional seven women were lost to attrition between the 2- and 6-month visits (11.11%). However, seven women who did not complete the 2-month assessment participated at the 6-month timepoint. Women were lost to attrition due to factors such as difficulty with the time commitment required for participation and moving out of state. Across the variables included in the current analyses, missing data were assumed to be effectively missing completely at random using Little's MCAR test (χ²(655) = 407.55, p = 1.00). The Institutional Review Board approved each phase of the study, and informed consent was obtained.

2.2 Measures

2.2.1 Prenatal Internalizing Symptoms

During the third trimester of pregnancy, the women completed the Edinburgh Postnatal Depression Scale (EPDS; Cox et al. 1987), State-Trait Anxiety Inventory (STAI; Spielberger et al. 1970), Pregnancy Related Anxiety Questionnaire-Revised (PRAQ-R; Huizink et al. 2004), and Perceived Stress Scale (PSS, Cohen et al. 1983). The EPDS is a self-report measure of depressive symptoms. The STAI is comprised of self-report scales measuring state- and trait-anxiety. The PRAQ-R is a self-report measure of anxiety concerns specific to pregnancy and birth. The PSS is a self-report measure assessing the degree to which respondents view situations occurring over the past month as stressful. These measures demonstrate strong psychometric properties (Cohen et al. 1983; Cox et al. 1987; Huizink et al. 2004; Newham et al. 2012; Solivan et al. 2015; Spielberger et al. 1970). In the present study, the PRAQ-R (α = 0.79), EPDS (α = 0.83), STAI state subscale (α = 0.89), and STAI trait subscale (α = 0.93) demonstrated good to excellent internal consistency. However, internal consistency dipped into the questionable range for the PSS (α = 0.58).

2.2.2 Hair Cortisol Concentration Measurement

Hair samples were collected during the third trimester and the surveys were administeredat the same time. Following Wright et al. (2015), the most proximal three centimeters of hair was cut from the participants' posterior vertex and stored at room temperature in the dark until analysis. Based on an average hair growth rate of 1 cm/month (Wennig 2000), the hair cortisol concentration (HCC) ascertained that these samples (mean hair weight = 14.7 mg/sample) represented an aggregate measure of circulating cortisol concentrations over the previous 3 months (Wright et al. 2015). In our case, on average, this measure reflected the circulating cortisol concentrations from ∼20 to 32 weeks of gestation.

Following the protocol of Sauvé et al. (2007) lipophilic compounds were extracted from hair using methanol, and cortisol was quantified using an enzyme-linked immunosorbent assay (ELISA, Cayman Scientific, Ann Arbor, MI, USA). Hair samples were washed with isopropanol, dried under an air stream, minced, and then incubated for 18 h in methanol. Methanol was evaporated under a nitrogen stream in a 40°C water bath, and the sample was resuspended with between 200 and 400 µL of ELISA buffer (provided by the manufacturer). The intra-assay coefficient of variation (CV) was 7.1% (range: 0.46–23.1), and the inter-assay CVs of three standards run across plates were 4%, 11%, and 19% (Madigan et al. 2024).

2.2.3 Infant Temperament

At 2- and 6-months postpartum, mothers were administered the Infant Behavior Questionnaire-Revised (IBQ-R; Gartstein and Rothbart 2003), a fine-grained measure with established psychometric properties (Bosquet Enlow et al. 2016; Parade and Leerkes 2008). Three broad factors and component subscales: negative emotionality (distress to limitations, fear, sadness, and falling reactivity), positive affectivity (activity level, approach, smiling/laughter, vocal reactivity, perceptual sensitivity, and high-intensity pleasure), and regulatory capacity (duration of orienting, low-intensity pleasure, cuddliness, and soothability) were considered. In the current study, most IBQ-R scales demonstrated good to excellent internal consistency at 2 months (α = 0.76–0.98) and 6 months (α = 0.73–0.93). At 2 months, distress to limitations had marginally adequate internal consistency (α = 0.68), and perceptual sensitivity was found to have poor internal consistency (α = 0.53).1 At 6 months, regulatory capacity (α = 0.59) and duration of orienting (α = 0.52) had poor internal consistency.

2.3 Analyses

2.3.1 Latent Profile Analysis

LPA was performed to identify profiles of maternal stress during pregnancy using Mplus (Muthén and Muthén 2017), with full information maximum likelihood estimation employed to account for missing data (Enders 2013). The LPA included prenatal measures of depression, state anxiety, trait anxiety, pregnancy-specific anxiety, perceived stress, and HCC. Prior to running the LPA, HCC was log₁₀ transformed to help adjust for non-normality. All variables were also converted to z-scores to place them on the same scale (see Figure 1 for the distribution of z-scores across profiles). Several metrics were simultaneously considered to determine the optimal number of profiles (Lanza and Cooper 2016). The Lo–Mendell–Rubin Likelihood Ratio Test (Lo et al. 2001) was prioritized, determining whether adding a profile improved the overall fit of the model. We also attempted to minimize the Akaike information criteria (AIC) and sample-size adjusted Bayesian information criteria (BIC). Finally, the entropy index, which reflects the effectiveness of categorizations based on posterior probabilities, with values closer to 1 indicating greater precision, was considered. Multiple solutions (up to four profiles) were evaluated.

Details are in the caption following the image — **FIGURE 1**
Open in figure viewer PowerPoint

The distribution of z-scores for the two-profile solution. z-Scores with standard errors presented for low and high stress groups.

2.3.2 Prenatal Stress Profiles and Temperament

Robust regression models were computed using SPSS (IBM Corporation 2017). To determine whether profiles resulting from the LPA were associated with infant temperament, models for 2- and 6-month outcomes were examined separately. Predictors included (1) the logit of the class 1 probability, which is ln(p/1 − p) and (2) significant covariates (i.e., infant age in weeks and/or family income). Covariates were included when they accounted for significant amounts of variance in dependent variables. Models were examined separately for each of the temperament factors and fine-grained scales.

3 Results

3.1 Preliminary Analyses

Descriptive statistics were computed (Table 1) along with correlation coefficients (Tables S1–S3). Preliminary analyses were also conducted to determine relations between HCC and whether the hair was dyed, the washing regime, or the use of hair products. None were significant, so these variables were not included in subsequent analyses.

TABLE 1. Descriptive statistics for prenatal stress/distress and infant temperament.

Measure	Prenatal				2 Month				6 Month
	N	M	SD	Range	N	M	SD	Range	N	M	SD	Range
Maternal stress
Depression^a	58	6.60	4.16	0.00–17.00
State anxiety^b	59	36.83	9.41	14.00–63.00
Trait anxiety^c	59	36.46	10.59	13.00–61.00
Pregnancy-specific anxiety^d	58	16.05	4.79	10.00–29.00
Perceived stress^e	59	17.07	4.19	6.00–25.00
Hair cortisol	61	0.85	0.37	0.27–1.82
Infant negative emotionality					49	4.53	2.57	0.23–11.47	49	4.36	2.46	−0.31−10.39
Distress to limitations^f					49	3.91	0.77	2.33–5.62	49	3.69	0.91	1.69–5.88
Falling reactivity					49	4.83	0.97	2.55–6.25	49	5.14	0.82	3.15–6.64
Fear					49	2.13	0.86	1.18–4.67	49	2.43	0.89	1.35–4.64
Sadness					49	3.31	1.04	1.33–5.44	49	3.38	0.84	2.00–5.36
Infant Positive Affectivity					41	20.06	5.43	8.58–34.56	49	27.30	3.28	20.14–34.72
Activity					49	3.51	0.79	1.73–5.54	49	4.33	0.80	2.87–6.67
Approach					43	2.91	1.22	1.00–5.92	49	5.17	0.80	3.20–6.64
High-intensity pleasure					46	4.36	1.32	1.25–6.60	49	5.55	0.82	2.78–7.00
Perceptual sensitivity					48	2.74	1.10	1.00–5.17	49	3.51	1.00	1.33–5.25
Smiling/laughter					46	3.26	1.44	1.00–6.44	49	4.48	1.01	2.20–6.70
Vocal reactivity					45	3.27	1.24	1.00–5.57	49	4.28	0.96	2.18–6.08
Infant regulatory capacity					44	17.89	2.28	12.99–22.11	49	19.45	1.70	15.55–23.67
Cuddliness					49	5.99	0.56	4.38–6.85	49	5.82	0.55	4.38–6.69
Duration of orienting					45	2.88	1.35	1.00–6.78	49	3.86	0.85	1.80–6.20
Low-intensity pleasure					47	4.50	1.00	2.27–7.00	49	4.92	0.80	3.20–7.00
Soothability					49	4.58	0.75	3.00–6.59	49	4.84	0.74	3.39–6.39

^a Scores range from 0 to 30.
^b Scores range from 20 to 80.
^c Scores range from 20 to 80.
^d Scores range from 10 to 50.
^e Scores range from 0 to 40.
^f IBQ-R scale scores are on a 7-point Likert scale.

3.2 Latent Profile Analysis

According to the Lo–Mendel–Rubin Likelihood Ratio Testing, an additional profile improved the overall fit from a one-profile to a two-profile model but not from a two-profile to a three-profile solution or from a three-profile to a four-profile solution (Table 2). BIC and AIC were optimized in the four-profile model, along with entropy; however, this model resulted in classes with a sample size of less than 10, making it a less acceptable solution. It should also be noted that the three-profile solution resulted in somewhat lower AIC and BIC compared to the two-profile one; however, other indicators (i.e., entropy and the Lo–Mendel–Rubin Likelihood Ratio Testing) favored the two-group solution. Based on these metrics, the two-profile model was determined to be optimal and utilized in subsequent analyses. Thus, the overall pattern of results suggests that, while additional profiles may provide a slightly more favorable fit, the increased complexity did not make a meaningful difference. Thus we opted for a more parsimonious solution, which also enabled us to maximize statistical power in subsequent analyses.

TABLE 2. Latent profile analysis: Assessing model fit.

	1 Class	2 Classes	3 Classes	4 Classes
AIC	1014.04	898.93	894.83	873.43

Sample size adjusted BIC	1002.00	879.87	868.74	840.31

Entropy	na	0.86	0.81	0.87

Lo–Mendell–Rubin Test	na	2 vs 1	3 vs 2	4 vs 3
Significance	na	p = 0.02	p = 0.54	p = 0.40

N for each class^a	C1 = 63	C1 = 44	C1 = 18	C1 = 35
		C2 = 19	C2 = 33	C2 = 8
			C3 = 12	C3 = 12
				C4 = 8

Abbreviations: AIC, akaike information criteria; BIC, Bayesian information criteria.
^a C1–C4 values represent the sizes of classes/profiles.

Consistent with prior investigations (e.g., Beekman et al. 2015), interpretation of type was guided by physical inspection in combination with statistical tests. The resulting types were compared using t-tests. Profile 2 was significantly higher on prenatal depression (t(56) = −8.77, p < 0.001), state anxiety (t(56) = −8.34, p < 0.001), trait anxiety (t(56) = −8.65, p < 0.001), perceived stress (t(35) = −8.54, p < 0.001), and HCC (t(24) = −2.26, p = 0.02) relative to Profile 1. The two profiles did not significantly differ in pregnancy-specific anxiety. Profile 2 was labeled high prenatal stress, and Profile 1 was labeled low prenatal stress.

3.3 Prenatal Stress Profiles and Temperament

At 2 months, one significant finding emerged—a higher probability of having a mother in the lower prenatal stress subgroup was associated with greater falling reactivity (β = 0.06, p = 0.02; Table 3). Infants born to mothers with a greater likelihood of belonging to the lower stress profile during pregnancy had lower negative emotionality (β = −0.19, p = 0.03) at 6 months. At the fine-grained level, this effect was similarly present for distress to limitations (β = −0.06, p = 0.03). Prenatal stress/distress profile probability did not predict overall regulatory capacity. However, at the fine-grained level, there was a relation of prenatal stress profile assignment probability with infant soothability at 6 months. Infants born to mothers more likely to experience lower stress/distress exposure during pregnancy had higher soothability (β = 0.05, p = 0.02). Although a priori hypotheses regarding positive affectivity were not articulated, exploratory analyses were undertaken. There was no significant association of prenatal stress exposure for overall positive affectivity, however, greater probability of assignment to the lower prenatal stress profile was associated with higher vocal reactivity (β = 0.05, p = 0.008).

TABLE 3. Robust regression models examining prenatal stress profile probability as a predictor of infant temperament.

	β	Robust standard error	t	p	95% Confidence Interval
Falling reactivity at 2 months
Prenatal stress profile probability	0.06	0.03	2.34	0.02^*	[0.01, 0.11]

Negative emotionality at 6 months
Prenatal Stress Profile Probability	−0.19	0.09	−2.23	0.03^*	[−0.36, −0.02]

Distress to Limitations at 6 Months
Prenatal stress profile probability	−0.06	0.03	−2.19	0.03^*	[−0.12, −0.01]

Vocal reactivity at 6 months
Prenatal stress profile probability	0.05	0.02	2.40	0.02^*	[0.01, 0.09]
Infant age	0.10	0.04	2.82	0.008^**	[0.03, 0.17]

Soothability at 6 months
Prenatal stress profile probability	0.05	0.02	2.77	0.008^**	[0.01, 0.09]

Note: Only models with significant effects involving prenatal stress are presented.
** p < 0.01.
* p < 0.05.

4 Discussion

4.1 Profile Structure and Descriptives

Two stress/distress profiles (i.e., low and high levels of exposure) emerged using a data-driven approach to examine the relations between prenatal maternal stress/distress and infant temperament. The high-stress group demonstrated significantly higher prenatal depression, state anxiety, trait anxiety, perceived stress, and HCC when compared to the low-stress group (Figure 1), suggesting consistent elevations in prenatal mental health symptoms shaping the mothers’ experience and the infants’ prenatal environment. However, pregnancy-specific anxiety did not differ significantly across the two groups. It may be that pregnancy-specific anxiety represents a more normative experience, wherein most women may report some related symptoms (e.g., fear of giving birth), and these do not define high- versus low-risk groups in terms of prenatal stress/distress.

Overall, the person-centered approach enabled us to identify a constellation of variables most critical to capturing the experience of maternal prenatal stress, including physiological and perceived stress as well as internalizing symptoms, which are not readily discernable via variable-centered techniques. Relying on the most parsimonious solution, we identified two distinct groups of pregnant women experiencing high and low levels of stress and anxiety/depressive symptoms. It is notable that this distinction emerged even in the context of a community sample, not selected due to adversity or socioeconomic risk. Links between the probability of profile membership and infant temperament further support this differentiation and speak to the ubiquitous importance of maternal well-being during pregnancy.

4.2 Relations With Temperament

4.2.1 Age 2 Months

Infants born to mothers who were more likely to be assigned to the lower stress profile were rated higher on falling reactivity (i.e., ability to lower one's own distress). Research by Rigato et al. (2024) suggests that better infant regulation is related to the mother–infant dyad's ability to share and co-regulate their emotions. Our finding suggests that mothers reporting lower prenatal depression, state and trait anxiety, and perceived stress, also demonstrating lower chronic cortisol concentrations, may have more capacity to co-regulate with their infant, enabling their infant to manage their own distress more effectively. As no other significant prenatal stress profile membership effects were observed, falling reactivity stands out as a particularly important aspect of temperament in early infancy. This pattern of results is consistent with Erickson et al. (2020), wherein worry about the transition to parenthood was predictive of falling reactivity in particular, and this temperament trait was interpreted as more salient relative to others during this developmental period.

The lack of relations between stress profile probability and other temperament measures at 2 months also suggests that behavioral manifestations of temperament may only be emerging at this early age. In line with this, Huizink et al. (2002) found that effects of prenatal stress on infant temperament were stronger at 8 months compared to 3 months.

4.2.2 Age 6 Months

At 6 months of age, infants born to mothers more likely to belong to the lower prenatal stress group demonstrated lower negative emotionality and related distress to limitations, as well as higher soothability and vocal reactivity.

Our finding that lower child negative emotionality was predicted by the probability of being in the lower maternal stress profile aligns with prior reports regarding links between maternal stress during pregnancy and child distress proneness. For example, Davis et al. (2007) found that higher maternal cortisol at 30–32 weeks of gestation was related to higher infant negative reactivity. A recent review by Rodríguez-Soto et al. (2021) considering multiple types of prenatal maternal stress (e.g., stress due to disasters, intimate partner violence in pregnancy) also reported associations between reported stress exposure and increased offspring negative emotionality, lower effortful control, and lower positive affectivity in 67%–75% of studies. As negative emotionality has been related to key cognitive and behavioral outcomes (e.g., Lawson and Ruff 2004), our finding suggests that children more likely to experience higher stress/distress exposure in utero may benefit from targeted interventions.

Similarly, our finding that lower infant distress to limitations was predicted by an increased probability of the mother's membership in a lower stress profile aligns with previous literature linking maternal prenatal stress and child distress to limitations (e.g., at 3 months [Baibazarova et al. 2013], at 6 months [Henrichs et al. 2009]). Further, Räikkönen et al. (2011) observed that regardless of the temperament measure or its timing, associations between prenatal stress and distress to limitations persisted. Consistent relations between facets of negative emotionality and maternal stress during pregnancy (for review, see Van den Bergh et al. 2020) highlight the importance of exposure for this domain of temperament.

Greater infant soothability was predicted by a higher probability of maternal membership in the lower prenatal stress group, consistent with prior reports linking prenatal stress exposure and lower regulatory capacity (e.g., Buthmann et al. 2019; Korja et al. 2017). Similar results have been reported for racially/ethnically diverse low-income samples, wherein higher prenatal stress was related to lower regulatory capacity in 6-month-old infants (Bush et al. 2017). This relation has been observed across different measures of prenatal stress (i.e., cortisol and perceived stress), wherein different types of stress were related to a slower rate of behavioral recovery and a stronger cortisol response to heel stick blood draw 24 h after birth (Davis et al. 2011). Thus, maternal stress during infancy appears to be related to the infant's ability to either self-soothe or to use external support of regulation effectively. Younger infants primarily rely on caregivers for assistance in regulation (e.g., co-regulation in mother–child dyads; Verde-Cagiao et al. 2022), putting demands on their capacity and receptiveness to bids for co-regulation.

Exploratory analyses of positive affectivity dimensions indicated that infants of mothers who were more likely to belong to the lower stress profile demonstrated higher vocal reactivity. Nolvi et al. (2016) observed that mothers who experienced high prenatal stress reported higher vocal reactivity in their infants. However, this effect disappeared after controlling for covariates (Nolvi et al. 2016). Nomura et al. (2019) found no relation between reported child vocal reactivity and in utero exposure to stress. Thus, the literature has not been consistent, and additional research is needed to further interpret the results obtained in this study.

Lack of significant effect for other temperament facets at 6 months of age could be interpreted as an indication that these are not as impacted by in utero stress exposure. However, it may also be that effects for other temperament domains (e.g., fear) become more prominent with age as these develop. It is also possible that temperament-related effects were limited for our community sample and would be more pronounced in infants whose mothers face greater adversity (e.g., traumatic events).

4.3 Limitations and Future Directions

The study is not without its limitations, including those related to the current sample being of smaller size, predominately White, and in a romantic partnership. Thus, results of the study should be generalized with care and future research will need to include larger and more diverse samples to ensure statistical power sufficient to detect smaller effect sizes and support greater generalizability. Internal consistency of several indicators should be viewed as a limitation as well. Lower internal consistency of the PSS and several IBQ-R dimensions (distress to limitations, perceptual sensitivity at 2 months, regulatory capacity, and duration of orienting at 6 months) could have contributed to the lack of associated significant effects. Further, potential reporter bias could have contributed to the observed pattern of results as mothers provided perceptions of stress and internalizing symptoms, also reporting on the IBQ-R. Although this potential is somewhat mitigated by including an objective marker of physiological stress (i.e., HCCs), future studies should utilize objective measures of child temperament (e.g., behavioral observations) as well. Finally, clustering algorithms, like LPA, possess inherent limitations (e.g., failing to create truly homogenous groups; Harrell 2024); thus, replication of the present findings should be undertaken, ideally with a larger, more demographically diverse sample. Moreover, clustering analyses are inherently exploratory, and results of the present study should be interpreted as such. Future studies could utilize methods such as item response theory (IRT; An and Yung 2014) or structural equation modeling (SEM; Jöreskog 1993; Tarka 2018) to address this limitation as larger samples become available.

Despite limitations, differences observed between the two stress profiles suggest a wide-ranging influence of prenatal stress exposure on infant reactivity/regulation. The present findings provide further support for the existing literature (for review see Korja et al. 2017), demonstrating an increased risk for distress proneness/dysregulation in a high-stress/distress subgroup of our community sample. This increased vulnerability may exacerbate behavioral and physical health problems/symptoms (e.g., Babenko et al. 2015; Roseboom et al. 2011). For example, a longitudinal study demonstrated that higher negative emotionality predicted greater internalizing symptoms, alcohol use, and cortisol output during a stress task 15 years after the initial assessment, even after adjusting for initial childhood internalizing symptoms (Hagan et al. 2016). Greater endorsement of overall negative emotionality and its facets (i.e., distress to limitations, falling reactivity) in our high prenatal stress exposure group suggests that these infants may be particularly vulnerable to later symptoms/disorders.

Overall, this study sought to improve our understanding of infant temperament outcomes related to fetal “programming.” As hypothesized, distinctive profiles reflecting lower and higher prenatal stress exposure emerged. Effects observed for negative emotionality and its fine-grained dimensions are particularly important given subsequent connections to psychopathology and suggest a developmental pathway culminating in the latter. With increasing evidence regarding the impact of prenatal stress exposure on child development, it is important to develop interventions aimed at buffering against negative effects (Zhang et al. 2019). Evidence from the present study builds the foundation for subsequent efforts to support women whose infants are likely to exhibit more challenging attributes.

Author Contributions

The study was designed by Sara F. Waters, Maria A. Gartstein, and Erica J. Crespi. Data were collected and curated by Jennifer A. Mattera, SuYeon Lee, Jennifer Madigan, Sara F. Waters, Maria A. Gartstein, Erica J. Crespi, and Christie Pham. The data were analyzed by Jennifer A. Mattera. The manuscript was developed and revised by Christie Pham, Jennifer A. Mattera, Maria A. Gartstein, Sara F. Waters, Erica J. Crespi, SuYeon Lee, and Jennifer Madigan.

Acknowledgments

We greatly appreciate the internal award provided by Washington State University (Seed Grant) supporting this research, and especially the participation of pregnant women/mothers, without whom this work would not have been possible.

Conflicts of Interest

The authors declare no conflicts of interest.

Endnotes

1 The internal consistency of positive affectivity at two months could not be calculated due to an inadequate number of cases with complete data.

Open Research

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supporting Information

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Volume67, Issue2

March 2025

e70035

Filename	Description
dev70035-sup-0001-tableS1.docx16.4 KB	Supplemental Table 1: Correlations between Prenatal Stress Indicators
dev70035-sup-0002-tableS2.docx46.7 KB	Supplemental Table 2: Correlations between Temperament Indicators at 2 months
dev70035-sup-0003-tableS3.docx48.2 KB	Supplemental Table 3: Correlations between Temperament Indicators at 6 months

Advancing the Study of Maternal Prenatal Stress Phenotypes and Infant Temperament Outcomes

ABSTRACT

1 Introduction

1.1 Prenatal Stress Exposure and “Fetal Programming”

1.2 Relationships With Socioemotional Development

1.3 Latent Profile Analysis

1.4 Current Study

2 Method

2.1 Participants

2.2 Measures

2.2.1 Prenatal Internalizing Symptoms

2.2.2 Hair Cortisol Concentration Measurement

2.2.3 Infant Temperament

2.3 Analyses

2.3.1 Latent Profile Analysis

2.3.2 Prenatal Stress Profiles and Temperament

3 Results

3.1 Preliminary Analyses

3.2 Latent Profile Analysis

3.3 Prenatal Stress Profiles and Temperament

4 Discussion

4.1 Profile Structure and Descriptives

4.2 Relations With Temperament

4.2.1 Age 2 Months

4.2.2 Age 6 Months

4.3 Limitations and Future Directions

Author Contributions

Acknowledgments

Conflicts of Interest

Endnotes

Open Research

Data Availability Statement

Supporting Information

References

Figures

References

Related

Information