This study recruits women from early-mid pregnancy and later follows their children after birth, tracking both the mother and child until the child reaches at least 4 years of age. The study aims to examine the determinants of maternal mental health during pregnancy and how genetic factors could influence maternal mental health and child outcomes.

Prenatal maternal mental health has a significant long-lasting impact on both maternal functioning and child development. In Singapore and other developed nations, approximately 40% of pregnant women report symptoms of depression or anxiety at levels that predict poor maternal psychosocial functioning, as well as altered neurodevelopment and emotional-cognitive difficulties in their children. Despite the high prevalence and well-established consequences of prenatal mood disorders, the biological mechanisms underlying these conditions remain poorly understood. Prior research has implicated stress hormones, gonadal steroids, and genes, particularly within the serotonergic system, in contributing to perinatal depression and anxiety. However, candidate gene approaches have limitations. Mental health disorders arise from the combined effects of multiple genetic variants across distributed networks, rather than isolated loci. This understanding has led to the use of polygenic risk scores (PRS), which aggregate genetic variants associated with psychiatric conditions, to capture cumulative biological susceptibility. This MAMS study aims to build a predictive model for maternal antenatal i) anxiety, ii) depression, as well as iii) identify the genomic contribution to a composite score representing maternal mental health/well-being across a series of instruments. The research will also examine predictors of co-morbid conditions, notably depression and anxiety, where the effects on child developmental outcomes appear to be greater. Participants will be followed up from pregnancy through the child turning at least four years old. A subset of participants is enrolled in a sub-study Mapping Antenatal Maternal Stress - Child Outcomes (MAMS-CO).

Data will be collected through questionnaires done online, biological samples collection, and assessments done during lab-based visits.

• Questionnaires related to depression, anxiety, psychosocial risk factors such as life stressors, social and partner support, socioeconomic factors, medical history, behavior, cognition, lifestyle, health status, parental bonding, childhood adversity experienced, socio-emotional factors, executive function, family dynamics, sleep quality, personality traits
• Collection of samples such as blood, buccal swabs, and saliva
• Sleep actigraphy measures on pregnant mothers and infants
• Child developmental assessments

Inclusion Criteria:

1. Mothers aged 21 - 40 years
2. Below 24 weeks of pregnancy by ultrasonography
3. Proficient and able to respond to questionnaires in English
4. Intends for herself and her child to stay in Singapore for the next 5 years
5. Access to a smartphone or standard laptop/desktop
6. All participants whose data on pregnancy follow-up and delivery would be available from healthcare professionals
7. Willing to take part in this study and able to provide written consent

Exclusion Criteria:

1. Women with pre-existing or a history of psychotic depression, schizophrenia and bipolar disorders
2. Women currently on oral/IV steroids and/or thyroids medication
3. Women with a history of thyroid disease
4. Women who are pregnant via any assisted reproduction
5. Women carrying multiples
6. Women currently enrolled into any interventional randomized controlled trials

Singapore