Tied to mommy*s womb?: the effects of prenatal maternal thyroid function and emotional complaints on infants*, toddlers* and preschoolers* self-regulation and socio-emotional adjustment; Part I

Maternal hypothyroxinemia (fT4 smaller or equal to the lowest tenth percentile
with normal TSH) during early gestation increases the risk of subsequent
developmental delay of infants at one and two years of age (Pop et al., 2003).
High maternal anxiety during pregnancy is also related to a delay in infant
development (Brouwers et al., 2002). More research regarding the consequences
of these factors, in relation to each other and controlling for other important
factors (confounders), is necessary, because of different theoretical
viewpoints and practical consequences.
One of the theoretical viewpoints concerns the possibility that the endocrine
regulation of the mother has a lasting influence on the development of the
fetus: *fetal programming* (Godfrey & Barker, 2001). Abnormalities in this
regulation disturb fetal development or the fetus adapts in a way that his own
regulation systems are not optimally attuned to further postnatal development
(Zoeller, 2003). In particular, the functioning of the child*s HPA axis is
possibly negatively influenced (O*Connor et al., 2002 and 2003). The endocrine
regulation of the mother can be mildly disturbed, for example when maternal
hypothyroxinemia occurs, and directly affecting fetal development. Also
indirect disturbance of maternal endocrine regulation systems can result of her
emotional complaints. Subsequently the own regulation systems of the fetus may
be affected with consequences for later development. Children of depressed and
anxious mothers appear to have several developmental problems that are possibly
influenced in this way (Elgar et al., 2004; Huizink et al., 2004). In all
studies concerning the development of children after perinatal risk factors,
not all children with the same degree of risk are found to display
developmental problems. Possibly there are factors that play a protective role.
As potential protective factors, the influence of the father and the
self-regulation capacities of the child need further research.

To gain insight in the relation between maternal thyroid function and maternal
emotional complaints during pregnancy and the development of the child in
relation to the self-regulation capacities of the child.

Parents who indicated they are willing to participate with future research will
receive several questionnaires at home. Current depressive symptoms and
complaints of anxiety of the parents will be measured with self-report
questionnaires: the Edinburgh Depression Scale (EDS; Pop et al., 1992) and the
anxiety subscale of the Symptom Checklist-90 of Derogatis (SCL-90; Arrindell &
Ettema, 2005). Personality of the parents will be measured with the Type D
questionnaire (Denollet et al., 1996); the parents also have to answer a
questionnaire that measures the degree they are inclined to answer in a
socially desirable way (Crowne & Marlowe, 1964).
The development of the child will be measured with a questionnaire answered by
the mother, the Dutch translation of the Ages and Stages Questionnaire (Bricker
& Squires, 1996; Van Baar, van Bakel, & Hunnius, 2006). Behavioral problems
will be measured with the Child Behavior Checklist (CBCL; Achenbach & Rescorla,
2001). The degree of behavioral problems reflects also problems with self
regulation.

The burden for the parents will be to answer questionnaires and experience a
possible confrontation with unpleasant characteristics of themselves or their
child. Because these characteristics will already be known to them, this is
seen as a limited burden. When parents have questions or would like to get
further advice they can contact the researchers or the independent general
practitioner.