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However, it is unclear whether increased maternal mental health challenges acted as a mechanism linking pandemic exposure to children\u2019s neurodevelopment difficulties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      As part of the Ontario Birth Study, women (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009862) reported their internalizing (i.e., depression and anxiety) symptoms using the Patient Health Questionnaire-4 (PHQ-4) at three timepoints (prenatally and 8 and 24\u00a0months postnatally). Child neurodevelopment was assessed at 24\u00a0months using the Ages and Stages Questionnaire-3 (ASQ-3). Analyses included a combination of regression and path analyses with adjustment for covariates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Women exposed to the pandemic prenatally and at 8 and 24\u00a0months postnatally reported more concurrent internalizing difficulties than those not exposed; however, women exposed both pre- and postnatally did not differ from those only exposed postnatally. Higher prenatal maternal internalizing symptoms were associated with lower child gross motor skills at 24\u00a0months. Higher maternal internalizing symptoms at 8 and 24\u00a0months were marginally (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.1) associated with lower child personal-social and gross motor skills, respectively, at 24\u00a0months. The association between prenatal pandemic exposure and lower gross motor skills was marginally mediated by the presence of prenatal maternal internalizing symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Mothers and young children may have been particularly vulnerable to pandemic stress. Maternal internalizing symptoms, especially during pregnancy, may serve as a pathway linking pandemic exposure with child neurodevelopment and may represent a malleable target for intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00737-026-01686-2","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T04:02:17Z","timestamp":1774497737000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal internalizing symptoms as a mechanism linking pre- and postnatal COVID-19 pandemic exposure with preschool-aged children\u2019s neurodevelopment"],"prefix":"10.1007","volume":"29","author":[{"given":"Katherine E.","family":"Finegold","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia A.","family":"Knight","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayjean J.","family":"Hung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy-Lee","family":"Dennis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakesh S.","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jody","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kashtin","family":"Bertoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D.","family":"Levitan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen G.","family":"Matthews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Wade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"issue":"4","key":"1686_CR1","doi-asserted-by":"publisher","first-page":"986","DOI":"10.3390\/psycholint6040062","volume":"6","author":"S Alcon","year":"2024","unstructured":"Alcon S, Shen S, Wong H-N, Rovnaghi CR, Truong L, Vedelli JKH, Anand KJS (2024) Effects of the COVID-19 pandemic on early childhood development and mental health: a systematic review and meta-analysis of comparative studies. 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