Key biopsychosocial lessons from a South African birth cohort: A review and reflection

Background: Birth cohorts provide evidence regarding factors promoting child neurodevelopment, including optimal maternal mental health and a secure early environment. Few birth cohorts exist in low- and middle-income countries (LMICs), and it is unclear how findings from high-income birth cohorts generalise elsewhere. Aim: This study aims to undertake a narrative review of psychosocial publications from the Drakenstein Child Health Study (DCHS) and to reflect on overarching themes. Setting: The DCHS is based in the Western Cape, South Africa. Methods: The DCHS is a birth cohort that has followed ~1000 mother–infant dyads since 2012, collecting maternal mental health and child neurodevelopment data, including brain imaging and genomics. This review (2013–2025) synthesises psychosocial publications and emerging themes within prior literature. Results: Seventy-five psychosocial articles were reviewed. Four themes emerged: (1) prenatal and postnatal maternal mental health risk factors are associated with negative infant birth and child neurodevelopment outcomes; (2) prenatal and postnatal maternal physical health risk factors are associated with negative infant birth and child neurodevelopment outcomes; (3) we are beginning to understand the neural circuitry, genomic alterations, immunological changes and other mechanisms that underlie impaired neurodevelopment; and (4) an integrative biopsychosocial perspective is needed to fully understand and promote optimal child neurodevelopment. Conclusion: Findings indicate that many high-income countries’ observations generalise to a peri-urban South African setting while also highlighting context-specific pathways and intervention targets. These themes inform research priorities, interventions and policies to optimise child neurodevelopment in LMICs. Contribution: This review highlights context-specific risk and resilience factors and emerging mechanistic pathways, underscoring the value of LMIC birth cohort research.