Peer-reviewed article

Hypoxia-associated birth complications and offspring childhood internalizing, externalizing, and adolescent depression symptoms.

Nicole L Davies, Emma C Smith, Madeline R Pike, Ronan Cunningham, Barbara A Cohn et al. · 28 Sept 2026

Abstract

INTRODUCTION: Hypoxia-associated birth complications (termed fetal hypoxia, herein) have been linked with increased offspring schizophrenia, autism spectrum disorder, and attention-deficit/hyperactivity disorder, all comorbid with depression. The current study examined the contribution of fetal hypoxia exposure to adolescent depression symptoms through childhood internalizing and externalizing symptom pathways. METHODS: Included mother-offspring dyads (N = 1679) were drawn from a subset of the Child Health and Development Studies (CHDS). Participants were part of two follow-up studies during childhood (ages 9 to 11) and adolescence (ages 15 to 19). Fetal hypoxia exposure was assessed prospectively from pregnancy and birth medical visits. Childhood internalizing and externalizing symptoms were assessed through questionnaires completed by mothers, and adolescent depressive symptoms were assessed via offspring self-report. RESULTS: Exposure to fetal hypoxia significantly increased childhood internalizing symptoms, which were subsequently linked to heightened adolescent depression symptoms. Fetal hypoxia showed no significant direct association with adolescent depression and was not associated with childhood externalizing symptoms. CONCLUSION: Findings indicate that fetal hypoxia is linked to offspring childhood internalizing symptoms, which in turn, increased risk for adolescent depression symptoms. These findings add to preclinical and preliminary human evidence linking fetal hypoxia to offspring depression.