Blame, Motherhood, and Mental Health

When Mothers Are Blamed for Everything: Pregnancy, Postpartum, and the Weight of Responsibility

Pregnancy as a Life Transition

Pregnancy and the postpartum period are profound life transitions, marked by rapid biological, psychological, and social change. These phases shift not only a person’s body and routines, but also their identity, responsibilities, and sense of self. This post was partly inspired by recent news claiming a link between Tylenol (acetaminophen) use during pregnancy and autism. Headlines like these can generate fear and guilt among expectant parents, even when the science is complex and inconclusive.

Here, I explore how expectant and new mothers navigate the intersection of science, societal expectations, and mental health, while also considering paternal and multigenerational influences. Understanding these transitions through evidence-based knowledge can help reduce undue self-blame, support mental well-being, and highlight the complex, multilevel factors that shape both parent and child during these critical life stages.

A Personal Story: The Weight of Blame

I was diagnosed with asthma at just four months old. Growing up, it became a running joke in our family that my mother’s bath the night I was born somehow caused it. The teasing was meant in good fun, and my mom never said it bothered her. But as I got older, I realized that the humour didn’t erase the subtle weight of responsibility she may have carried. That tiny anecdote opened my eyes to a larger issue: the intense, often misplaced, expectations placed on mothers during pregnancy and postpartum.

The Burden of Blame

Mothers often absorb the brunt of responsibility for their child’s health. Advice and “rules” abound: what to eat, what to avoid, how to sleep, even how to think. The rise of social media and 24/7 news cycles only adds to the pressure. Pregnant and postpartum parents are constantly exposed to conflicting information, from diet fads to infection risks, and more recently, COVID-19 has added another layer of uncertainty. This environment can exacerbate anxiety, depression, and the sense of being solely accountable for outcomes that are often beyond anyone’s control.

A History of Blaming Mothers: The “Cold Mom” Theory

Blaming mothers for their children’s health outcomes has a long history. In the mid-20th century, autism was wrongly attributed to the so-called “refrigerator mother” theory, which suggested that emotionally distant, unloving mothers caused the condition. This idea was promoted by prominent voices such as Bruno Bettelheim, whose book The Empty Fortress (1967) became influential despite its lack of scientific foundation. For decades, mothers were made to feel personally responsible for their children’s autism, carrying an enormous burden of guilt and stigma.

Over time, rigorous research demonstrated that autism is a neurodevelopmental condition with strong genetic and biological underpinnings, NOT the result of parenting style (Herbert et al., 2002; Crowell et al., 2019). The “cold mom” theory has since been thoroughly discredited, but its legacy serves as a cautionary tale: when science is misinterpreted or prematurely communicated, the consequences can be deeply damaging for families. A more recent and still pervasive example is the false claim linking the MMR vaccine to autism, which despite being debunked by extensive research (Taylor et al., 2014; Hviid et al., 2019), continues to fuel vaccine hesitancy and cause harm worldwide.

What Science Actually Shows: Increased Risk, Not Certainty

Certain exposures during pregnancy are associated with an increased risk of specific health outcomes in offspring. RISK DOES NOT MEAN CERTAINTY - many children exposed to these factors do not develop autism or related conditions.

• Smoking increases the risk of low birth weight and preterm birth (Delcroix-Gomez, 2022; Delcroix et al., 2023). Low birth weight and preterm birth can lead to complications such as delayed growth, impaired lung development, and increased susceptibility to infections and chronic diseases later in life (Crump, 2020; Jańczewska et al., 2023; Gette et al., 2025).

  
  

• Alcohol consumption during pregnancy elevates the risk of fetal alcohol spectrum disorders (FASD) (American Academy of Pediatrics, 2000). FASD refers to a range of physical, cognitive, and behavioral impairments associated with prenatal alcohol exposure (Wozniak et al., 2019). This can include facial anomalies, growth deficits, learning difficulties, and challenges with attention, memory, and social skills.

  
  

• Certain medications, such as thalidomide, have historically been shown to cause severe birth defects, including limb malformations (phocomelia), facial anomalies, and ear defects (Vargesson, 2015; Fraga et al., 2016).

  
  

• Maternal infections and fever can increase the risk of congenital anomalies (heart, brain, eyes) (Botto et al., 2014; Mohan Dass et al., 2022) and neurodevelopmental disorders, including autism spectrum disorder (Cordeiro et al., 2015; Antoun et al., 2021).

  
  

• Severe malnutrition during pregnancy elevates the risk of impaired fetal growth and long-term metabolic disorders (Barker, 1998).

  
  

• Illicit drug use can increase the risk of neurodevelopmental and cognitive impairments in children (Etemadi-Aleagha and Akhgari, 2022; Chen et al., 2024).

  
  

It is critical to recognize that these exposures INCREASE THE LIKELIHOOD of certain outcomes but do NOT GUARANTEE THEM. Biology, genetics, environment, and social factors all intersect to influence whether an outcome occurs. Minor everyday behaviors, like taking a bath before giving birth, do NOT carry measurable risk. Scientific evidence points to specific, measurable exposures, not maternal perfection.

Beyond the Mother: Paternal and Multigenerational Influences

Paternal Contributions to Offspring Health

Fathers contribute more than just genetic material. Several mechanisms influence child development (de Kluiver et al., 2016):

1. Epigenetics: Environmental exposures, lifestyle, and age can alter chemical tags on sperm DNA, which can influence gene expression in the offspring (^aSoubry, 2018, ^bSoubry, 2018). Examples include smoking, stress, diet, and even exposure to toxicants (Day et al., 2016).

   
   

2. Age Effects: Advanced paternal age is associated with slightly increased risks for neurodevelopmental disorders, including autism and schizophrenia (Frans et al., 2015), likely through accumulated genetic mutations and epigenetic changes.

   
   

3. Lifestyle and Health: Obesity, poor diet, and chronic illness in fathers can affect sperm quality and potentially influence metabolic outcomes and cardiovascular risk in children (Eberle et al., 2020).

   
   

4. Transgenerational Effects: Emerging studies suggest that some paternal environmental exposures may influence not only children but potentially grandchildren, via epigenetic inheritance (Frans et al., 2011).

   
   

Including paternal influences helps challenge the narrative that mothers alone are responsible for offspring health and emphasizes that child development is shaped by both parents, their environments, and even previous generations.

Maternal Transgenerational Effects

Some effects extend across generations: exposures in grandparents, such as maternal grandmother smoking during pregnancy, have been linked to asthma risk in grandchildren (Soubry, 2018).

Child health outcomes are shaped by these multigenerational factors, not just maternal behavior (van den Berg et al., 2016). Yet mothers often remain the visible target of responsibility, while other contributors are largely invisible in public discussion.

A mother’s environmental exposures during pregnancy can influence not only her child but potentially her grandchildren. This happens because when a grandmother is pregnant, the female fetus she is carrying already has developed all the eggs she will ever have, these eggs could one day become her grandchildren. This means that environmental, nutritional, or chemical exposures during pregnancy could have effects that span multiple generations. This highlights the multigenerational nature of development and the importance of considering both maternal and paternal contributions.

A Note on Reading the Literature

Understanding scientific research is not always simple. Studies vary in quality, methods, sample size, and sometimes even conclusions. What seems like “evidence” may later be updated or refuted.

For example, my MSc student recently conducted a study examining whether maternal infection during pregnancy was associated with postpartum depression (Erak, 2025). We did not find a statistically significant relationship, but this does not mean that a connection does not exist. Conversely, if a relationship is found in a single study, it must also be interpreted cautiously, taking into account limitations such as sample size, survey methods, and timing of assessments. Importantly, a reported relationship or correlation does not imply causation, which is a fundamental principle of statistical analysis. Evidence must be interpreted in context, and no single study provides definitive answers.

So, What Should Parents Believe?

With so much information, oftentimes conflicting, expectant and new parents can feel unsure about what to trust. Peer-reviewed scientific evidence is generally more reliable than headlines or social media posts, but even studies can have limitations. The key is to look for patterns across multiple studies rather than relying on one single report. If a study identifies a potential risk, it doesn’t necessarily mean it will happen to every parent or child. Evidence should be used to inform choices and discussions with healthcare providers, not to assign blame or create unnecessary anxiety. Over time, staying informed, asking questions, and seeking guidance from trusted professionals can help parents navigate the flood of information in a balanced, grounded way.

In this blog, I’ve focused on peer-reviewed studies and systematic reviews to provide a reliable overview, but even these should be interpreted carefully. In a future post, I plan to explore how to weed through all the information, identify trustworthy sources, and navigate the flood of fast news and social media claims, especially important for expectant parents exposed to well-meaning advice, sensational headlines, and misinformation that can add unnecessary anxiety.

Supporting Maternal Mental Health

The combination of societal expectations, misinformation, and real biological influences can create a heavy mental load. Anxiety about “doing everything right” is common, and it’s compounded when parents are inundated with conflicting health guidance. Recognizing the broader picture, including paternal and multigenerational contributions, can alleviate some of that undue self-blame for mothers.

For mothers and families, access to compassionate guidance, evidence-based information, and mental health support is essential, not only to navigate the complex landscape of pregnancy and postpartum care, but also to counteract the unfair burden of blame society often places on mothers. Reflecting on my own story, I have come to appreciate the invisible weight that mothers carry and the importance of approaching these transitions with empathy, understanding, and support. By focusing on guidance rather than guilt, we can create a culture that empowers parents to make informed choices, protects mental health, and fosters healthier outcomes for both families and children.

Blame has never built healthy families… empathy and evidence do.

-- Anne TM Konkle, PhD

References

American Academy of Pediatrics. Committee on Substance Abuse and Committee on Children With Disabilities. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics. 2000 Aug;106(2 Pt 1):358-61.

Antoun S, Ellul P, Peyre H, Rosenzwajg M, Gressens P, Klatzmann D, Delorme R. Fever during pregnancy as a risk factor for neurodevelopmental disorders: results from a systematic review and meta-analysis. Molecular Autism. 2021 Sep 18;12(1):60. doi: 10.1186/s13229-021-00464-4.

Barker DJ. In utero programming of chronic disease. Clinical Science (Lond). 1998 Aug;95(2):115-28.

Bettelheim, B. (1967). The Empty Fortress: Infantile Autism and the Birth of the Self. Free Press.

Botto LD, Panichello JD, Browne ML, Krikov S, Feldkamp ML, Lammer E, Shaw GM; National Birth Defects Prevention Study. Congenital heart defects after maternal fever. American Journal of Obstetrics and Gynecology. 2014 Apr;210(4):359.e1-359.e11. doi: 10.1016/j.ajog.2013.10.880. Epub 2013 Nov 1.

Chen VC, Lee CT, Wu SI, Gossop M. Neurobehavioral disorders among children born to mothers exposed to illicit substances during pregnancy. BMC Medecine. 2024 Dec 18;22(1):581. doi: 10.1186/s12916-024-03762-9.

Cordeiro CN, Tsimis M, Burd I. Infections and Brain Development. Obstetrical and Gynecological Survey. 2015 Oct;70(10):644-55. doi: 10.1097/OGX.0000000000000236.

Crowell JA, Keluskar J, Gorecki A. Parenting behavior and the development of children with autism spectrum disorder. Comprehensive Psychiatry. 2019 Apr;90:21-29. doi: 10.1016/j.comppsych.2018.11.007. Epub 2018 Nov 20.

Crump C. An overview of adult health outcomes after preterm birth. Early Hum Development. 2020 Nov;150:105187. doi: 10.1016/j.earlhumdev.2020.105187. Epub 2020 Sep 9.

Day J, Savani S, Krempley BD, Nguyen M, Kitlinska JB. Influence of paternal preconception exposures on their offspring: through epigenetics to phenotype. American Journal of Stem Cells. 2016 May 15;5(1):11-8.

de Kluiver H, Buizer-Voskamp JE, Dolan CV, Boomsma DI. Paternal age and psychiatric disorders: A review. American Journal of Medical Genetics, Part B Neuropsychiatric Genetics. 2017 Apr;174(3):202-213. doi: 10.1002/ajmg.b.32508. Epub 2016 Oct 22.

Delcroix MH, Delcroix-Gomez C, Marquet P, Gauthier T, Thomas D, Aubard Y. Active or passive maternal smoking increases the risk of low birth weight or preterm delivery: Benefits of cessation and tobacco control policies. Tobacco Induced Diseases. 2023 May 29;21:72. doi: 10.18332/tid/156854.

Delcroix-Gomez C, Delcroix MH, Jamee A, Gauthier T, Marquet P, Aubard Y. Fetal growth restriction, low birth weight, and preterm birth: Effects of active or passive smoking evaluated by maternal expired CO at delivery, impacts of cessation at different trimesters. Tobacco Induced Diseases. 2022 Aug 26;20:70. doi: 10.18332/tid/152111.

Eberle C, Kirchner MF, Herden R, Stichling S. Paternal metabolic and cardiovascular programming of their offspring: A systematic scoping review. PLoS One. 2020 Dec 31;15(12):e0244826. doi: 10.1371/journal.pone.0244826.

Erak, A. (2025). Underexposed: Postpartum depression, infection, and the hidden gaps in perinatal mental health care in Canada [Master’s thesis, University of Ottawa].

Etemadi-Aleagha A, Akhgari M. Psychotropic drug abuse in pregnancy and its impact on child neurodevelopment: A review. World Journal of Clinical Pediatrics. 2022 Jan 9;11(1):1-13. doi: 10.5409/wjcp.v11.i1.1.

Fraga LR, Rafipay A, Vargesson N.  Thalidomide and Birth Defects.  In: eLS. John Wiley & Sons, Ltd: Chichester. DOI: 10.1002/9780470015902.a0026052.

Frans E, MacCabe JH, Reichenberg A. Advancing paternal age and psychiatric disorders. World Psychiatry. 2015 Feb;14(1):91-3. doi: 10.1002/wps.20190.

Frans EM, McGrath JJ, Sandin S, Lichtenstein P, Reichenberg A, Långström N, Hultman CM. Advanced paternal and grandpaternal age and schizophrenia: a three-generation perspective. Schizophrenia Research. 2011 Dec;133(1-3):120-4. doi: 10.1016/j.schres.2011.09.027. Epub 2011 Oct 14.

Gette F, Aziz Ali S, Ho MSP, Richter LL, Chan ES, Yang CL, Kieran E, Mammen C, Roberts A, Kang KT, Wong J, Rassekh SR, Castaldo M, Harris KC, Lee J, Lam CKL, Chan NH, Lisonkova S, Ting JY. Long-term health outcomes of preterm birth: a narrative review. Frontiers in Pediatrics. 2025 Apr 23;13:1565897. doi: 10.3389/fped.2025.1565897.

Herbert JD, Sharp JR, Gaudiano BA. Separating Fact from Fiction in the Etiology and Treatment of Autism: A Scientific Review of the Evidence. Scientific Review of Mental Health Practice. 2002; 1: 23-43.

Hviid A, Hansen JV, Frisch M, Melbye M. Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Annals of Internal Medecine. 2019 Apr 16;170(8):513-520. doi: 10.7326/M18-2101. Epub 2019 Mar 5.

Jańczewska I, Wierzba J, Jańczewska A, Szczurek-Gierczak M, Domżalska-Popadiuk I. Prematurity and Low Birth Weight and Their Impact on Childhood Growth Patterns and the Risk of Long-Term Cardiovascular Sequelae. Children (Basel). 2023 Sep 25;10(10):1599. doi: 10.3390/children10101599.

Mohan Dass NL, Botto LD, Tinker SC, Canfield MA, Finnell RH, Gallaway MS, Hashmi SS, Hoyt AT, Nembhard WN, Waller DK; National Birth Defects Prevention Study. Associations between maternal reports of periconceptional fever from miscellaneous causes and structural birth defects. Birth Defects Research. 2022 Sep 1;114(15):885-894. doi: 10.1002/bdr2.2068. Epub 2022 Aug 6.

^aSoubry A. Epigenetics as a Driver of Developmental Origins of Health and Disease: Did We Forget the Fathers? Bioessays. 2018 Jan;40(1). doi: 10.1002/bies.201700113. Epub 2017 Nov 23.

^bSoubry A. POHaD: why we should study future fathers. Environmental Epigenetics. 2018 Apr 26;4(2):dvy007. doi: 10.1093/eep/dvy007.

Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine. 2014 Jun 17;32(29):3623-9. doi: 10.1016/j.vaccine.2014.04.085. Epub 2014 May 9.

van den Berg GJ, Pinger PR. Transgenerational effects of childhood conditions on third generation health and education outcomes. Economics and Human Biology. 2016 Dec;23:103-120. doi: 10.1016/j.ehb.2016.07.001. Epub 2016 Jul 11.

Vargesson N. Thalidomide-induced teratogenesis: history and mechanisms. Birth Defects Research Part C: Embryo Today. 2015 Jun;105(2):140-56. doi: 10.1002/bdrc.21096. Epub 2015 Jun 4.

Wozniak JR, Riley EP, Charness ME. Clinical presentation, diagnosis, and management of fetal alcohol spectrum disorder. Lancet Neurology. 2019 Aug;18(8):760-770. doi: 10.1016/S1474-4422(19)30150-4. Epub 2019 May 31.