Summary: Stress, anxiety, and depression during pregnancy were associated with key features of impaired fetal brain development, resulting in decreased cognitive offspring in an 18-month-old child.
Source: National Children’s Hospital
The women’s high anxiety, depression, and stress during pregnancy impaired key features of the fetal brain, which subsequently diminished the cognitive development of their offspring at 18 months.
These changes also increased internalizing and dysregulating behaviors, according to a new study from Children’s National Hospital published in Open JAMA Network. The researchers followed a cohort of 97 pregnant women and their babies.
The results further suggest that persistent psychological distress after the baby is born may influence parent-child interaction and infant self-regulation.
This is the first study to shed light on an important link between impaired fetal brain development in utero and the long-term consequences on cognitive development of fetuses exposed to high levels of toxic stress during pregnancy.
In the womb, the researchers observed changes in the depth of the sulci and the volume of the left hippocampus, which could explain the neurodevelopmental problems observed after birth.
Once they become toddlers, these children may experience persistent social-emotional problems and have difficulty forming positive relationships with others, including their mother. To further confirm this, future studies with larger sample sizes that reflect more regions and populations are needed.
“By identifying pregnant women with high levels of psychological distress, clinicians could recognize babies who are at risk of later developing neurodevelopmental disorders and could benefit from early and targeted interventions,” said Catherine Limperopoulos, Ph.D. , head and director of the Children’s National Developing Brain Institute and lead author of the study.
Regardless of their socioeconomic status, about one in four pregnant women suffer from stress-related symptoms, the most common pregnancy complication. The relationship between impaired fetal brain development, prenatal maternal psychological distress, and long-term neurodevelopmental outcomes remains unknown.
Studying fetal brain development in utero poses challenges due to fetal and maternal movements, imaging technology, signal-to-noise ratio issues, and changes in brain growth.
All pregnant participants were in good health, most had some level of education and were employed. To quantify prenatal maternal stress, anxiety, and depression, the researchers used self-reported validated questionnaires.
Fetal brain volumes and cortical folding were measured from three-dimensional reconstructed images derived from MRI scans. Fetal brain creatine and choline were quantified using proton magnetic resonance spectroscopy. The neurological development of the 18-month-old child was measured using validated scales and assessments.
This study builds on previous work from the Developing Brain Institute led by Limperopoulos, which found that anxiety in pregnant women appears to affect the brain development of their babies. Her team also found that maternal mental health, even for women with high socioeconomic status, alters the structure and biochemistry of the developing fetal brain. A growing body of evidence points to the importance of mental health support for pregnant women.
“We envision changing the healthcare paradigm and embracing these changes more broadly to better support moms,” Limperopoulos said.
“What is clear is that early interventions could help mothers reduce their stress, which can have a positive impact on their symptoms and therefore on their baby long after birth.”
About this psychology and neurodevelopment research news
Original research: Free access.
“Association of High Maternal Psychological Distress, Fetal Brain Impairment, and Offspring Cognitive and Socio-Emotional Outcomes at 18 Monthsby Catherine Limperopoulos et al. Open JAMA Network
Association of High Maternal Psychological Distress, Fetal Brain Impairment, and Offspring Cognitive and Socio-Emotional Outcomes at 18 Months
Prenatal maternal psychological distress is associated with disturbances in fetal brain development. However, the association between impaired fetal brain development, prenatal maternal psychological distress, and long-term neurodevelopmental outcomes is unknown.
To determine the association of fetal brain development using three-dimensional magnetic resonance imaging (MRI) volumes, cortical folding, and metabolites in the setting of maternal psychological distress with 18-month-old infant neurodevelopment.
Design, framework and participants
Healthy mother-infant dyads were prospectively recruited in a longitudinal observational cohort study from January 2016 to October 2020 at Children’s National Hospital in Washington, DC. Data analysis was conducted from January 2016 to July 2021.
Prenatal maternal stress, anxiety and depression.
Main results and measures
Prenatal maternal stress, anxiety, and depression were measured using validated self-report questionnaires. Fetal brain volumes and cortical folding were measured from reconstructed three-dimensional T2-weighted MRIs. Fetal brain creatine and choline were quantified using proton magnetic resonance spectroscopy. Infant neurodevelopment at 18 months was measured using the Bayley Scales of Infant and Toddler Development III and Infant and Toddler Social and Emotional Assessment. Parenting stress in the parent-child dyad was measured using the Parenting Stress Index-Short Form at 18 months.
The cohort consisted of 97 mother-child dyads (mean [SD] maternal age, 34.79 [5.64] years) who underwent 184 fetal MRI visits (87 participants with 2 fetal studies each) with measures of maternal psychological distress between 24 and 40 weeks gestation and follow-up infant neurodevelopmental testing.
Prenatal maternal stress was negatively associated with infant cognitive performance (β = -0.51; 95% CI, -0.92 to -0.09; P= 0.01), and this association was mediated by the volume of the fetal left hippocampus. Additionally, prenatal maternal anxiety, stress, and depression were positively associated with all measures of parental stress when tested at 18 months.
Finally, the fetal cortical local gyrification index and furrow depth were negatively associated with infant socio-emotional performance (local gyrification index: β = -54.62; 95% CI, -85.05 to -24 .19; P<0.001; sulcal depth: β = −14.22; 95% CI, -23.59 to -4.85; P= 0.002) and skill scores (local gyrification index: β = -24.01; 95% CI, -40.34 to -7.69; P= 0.003; sulcal depth: β = −7.53; 95% CI, -11.73 to -3.32; P< .001).
Conclusions and relevance
In this cohort study of 97 mother-infant dyads, fetal cortical local gyrification index and furrow depth were associated with infant socio-emotional and skill outcomes at 18 months, and fetal left hippocampal volume mediated the association between prenatal maternal stress and infant cognitive outcome.
These results suggest that impaired prenatal brain development in the context of high maternal distress has adverse sociocognitive outcomes for the infant, and the identification of early biomarkers associated with long-term neurodevelopment may aid in early targeted interventions.