Jodi Gilman, PhD, on cumulative prenatal adversity linked to adolescent mental health risk

Multiple prenatal adversities may cumulatively increase the risk of mental health problems during adolescence, according to findings discussed by Jodi Gilman, PhD, a neuroscientist and associate professor at Massachusetts General Hospital and Harvard Medical School. The research adds to existing evidence on individual prenatal exposures by demonstrating a dose-dependent relationship between layered prenatal risk factors and persistent psychopathology in youth.

“There’s a lot of research showing that individual prenatal exposures such as substance use during pregnancy, like cannabis, alcohol, or tobacco, or birth complications, or pregnancy complications increase risk for later psychopathology and adolescence,” Gilman said. “But this study’s strength lies in demonstrating that multiple prenatal adversities…cumulatively confer these dose-dependent risks in adolescence.”

The study examined the cumulative impact of prenatal adversities, including maternal substance use, pregnancy complications, and birth complications. Adolescents with greater exposure to these factors showed higher rates of mental health symptoms compared with those with fewer or no exposures.

Implications for early identification and clinical monitoring

The findings underscore the importance of prenatal care and longitudinal follow-up, particularly for children with known prenatal risk factors. Gilman emphasized that clinicians may be able to use prenatal history to guide earlier screening and intervention rather than waiting for a formal psychiatric diagnosis to emerge.

“So, I think for clinicians, this study underscores the importance of high-quality prenatal care as well as early identification and long-term monitoring of children with these known prenatal risk factors,” she said.

She also noted that prenatal history may not consistently be incorporated into routine mental health assessments. “I don’t know if this is routinely asked, but this study indicates that this could be an important part of understanding the full picture,” Gilman said.

Developmental symptom trajectories during adolescence

The study identified differing symptom trajectories over time, with attention-deficit/hyperactivity disorder (ADHD) symptoms declining and depressive symptoms increasing during adolescence. According to Gilman, these trends reflect normative developmental patterns rather than effects specific to prenatal adversity.

“That is a developmental phenomenon that has nothing to do with prenatal adversity,” she said. However, she emphasized that cumulative prenatal adversity remained associated with higher symptom levels across development. “Even though everybody’s going down for ADHD, the kids who had had multiple prenatal adverse exposures are still higher than the kids who had no prenatal exposures.”

Neuroimaging findings and biological context

Neuroimaging analyses revealed accelerated cortical thinning in adolescents who had higher exposure to prenatal adversity. Gilman explained that cortical thinning is a normal developmental process, but appeared to occur more rapidly in this group.

“What’s happening in these kids with prenatal exposures is it’s happening too quickly,” she said, adding that the findings suggest a biological association with psychiatric risk, though causality cannot be determined.

Opportunities for intervention across development

Gilman identified multiple opportunities for intervention, spanning pregnancy, early childhood, and adolescence. She emphasized that prenatal adversity does not deterministically lead to psychopathology and highlighted the role of resilience and postnatal environment.

“Not all children with early risk develop psychopathology,” she said. “This isn’t a one-to-one. This is a group effect.”

Future research, she noted, may help clarify how caregiving, social supports, and early interventions can buffer risk and inform targeted prevention strategies.

Disclosure

Gilman reports no relevant disclosures.

Reference

Zhi D, Perdomo SA, Arteaga LR, et al. Prenatal Adversities and Risk of Persistent Youth Psychopathology and Altered Cortical Thinning. JAMA Psychiatry. Published online January 7, 2026. doi:https://doi.org/10.1001/jamapsychiatry.2025.4080