The prenatal foundations of the early caregiving environment: a longitudinal analysis of maternal psychosocial antecedents and depression trajectories

Early home environment quality is a critical determinant of children’s development, yet little is known about how maternal psychosocial conditions during pregnancy shape caregiving environments via maternal mental health. Using longitudinal data from a randomized controlled trial of a nurse-led home-visiting program in Korea, this study examined whether prenatal psychosocial risk and protective factors predicted the quality of the home environment at 24 months postpartum and whether maternal depressive symptoms mediate these associations. The analytic sample included 753 mothers followed from pregnancy through 24 months postpartum.

During pregnancy, mothers reported adverse childhood experiences (ACEs), intimate partner violence (IPV), stressful life events (SLEs), and social support. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) once during pregnancy and at three postpartum time points, and home environment quality was measured with the Infant-Toddler Home Observation for Measurement of the Environment (IT-HOME) at 24 months. Latent growth curve modeling indicated that prenatal social support predicted higher-quality home environments both directly and indirectly through reduced depressive symptoms at 6 months postpartum.

In contrast, ACEs, IPV, and SLEs were not directly associated with later home environment quality; rather, their associations appeared to operate indirectly through maternal depressive symptoms. Specifically, higher depressive symptoms at 6 months postpartum and slower decline in symptoms over time were each associated with poorer caregiving environments. These findings suggest that prenatal psychosocial conditions shape children’s early caregiving environments in part through their effects on maternal depressive symptoms, and that pregnancy represents a strategic window for intervening on these pathways.

Efforts to enhance maternal social connectedness and address interpersonal trauma and life stress during pregnancy may promote higher-quality child-rearing environments by reducing the downstream burden of postpartum depressive symptoms. Trail registration: This study is a secondary data analysis of a pre-registered clinical trial registered at ClinicalTrials.gov, NCT04749888, on February 11 2021. This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health and Welfare, Republic of Korea (grant number: RS-2025-02216373).

Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea The authors declare that there is no competing interests. This study was approved by the Institutional Review Board (IRB) at Seoul National University Hospital (IRB # E-2509-039-1674). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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