When pregnant moms are stressed out, babies' brains suffer
65% of moms of fetuses with heart conditions are stressed, but so are 27% of future moms with uncomplicated pregnancies
January 13, 2020
Science Daily/Children's National Hospital
Knowing that your unborn fetus has congenital heart disease causes such pronounced maternal stress, anxiety and depression that these women's fetuses end up with impaired development in key brain regions before they are born, according to research published online Jan. 13, 2020, in JAMA Pediatrics.
While additional research is needed, the Children's National Hospital study authors say their unprecedented findings underscore the need for universal screening for psychological distress as a routine part of prenatal care and taking other steps to support stressed-out pregnant women and safeguard their newborns' developing brains.
"We were alarmed by the high percentage of pregnant women with a diagnosis of a major fetal heart problem who tested positive for stress, anxiety and depression," says Catherine Limperopoulos, Ph.D., director of the Center for the Developing Brain at Children's National and the study's corresponding author. "Equally concerning is how prevalent psychological distress is among pregnant women generally. We report for the first time that this challenging prenatal environment impairs regions of the fetal brain that play a major role in learning, memory, coordination, and social and behavioral development, making it all the more important for us to identify these women early during pregnancy to intervene," Limperopoulos adds.
Congenital heart disease (CHD), structural problems with the heart, is the most common birth defect.
Still, it remains unclear how exposure to maternal stress impacts brain development in fetuses with CHD.
The multidisciplinary study team enrolled 48 women whose unborn fetuses had been diagnosed with CHD and 92 healthy women with uncomplicated pregnancies. Using validated screening tools, they found:
65% of pregnant women expecting a baby with CHD tested positive for stress
27% of women with uncomplicated pregnancies tested positive for stress
44% of pregnant women expecting a baby with CHD tested positive for anxiety
26% of women with uncomplicated pregnancies tested positive for anxiety
29% of pregnant women expecting a baby with CHD tested positive for depression and
9% women with uncomplicated pregnancies tested positive for depression
All told, they performed 223 fetal magnetic resonance imaging sessions for these 140 fetuses between 21 and 40 weeks of gestation. They measured brain volume in cubic centimeters for the total brain as well as volumetric measurements for key regions such as the cerebrum, cerebellum, brainstem, and left and right hippocampus.
Maternal stress and anxiety in the second trimester were associated with smaller left hippocampi and smaller cerebellums only in pregnancies affected by fetal CHD. What's more, specific regions -- the hippocampus head and body and the left cerebellar lobe -- were more susceptible to stunted growth. The hippocampus is key to memory and learning, while the cerebellum controls motor coordination and plays a role in social and behavioral development.
The hippocampus is a brain structure that is known to be very sensitive to stress. The timing of the CHD diagnosis may have occurred at a particularly vulnerable time for the developing fetal cerebellum, which grows faster than any other brain structure in the second half of gestation, particularly in the third trimester.
"None of these women had been screened for prenatal depression or anxiety. None of them were taking medications. And none of them had received mental health interventions. In the group of women contending with fetal CHD, 81% had attended college and 75% had professional educations, so this does not appear to be an issue of insufficient resources," Limperopoulos adds. "It's critical that we routinely to do these screenings and provide pregnant women with access to interventions to lower their stress levels. Working with our community partners, Children's National is doing just that to help reduce toxic prenatal stress for both the health of the mother and for the future newborns. We hope this becomes standard practice elsewhere."
Adds Yao Wu, Ph.D., a research associate working with Limperopoulos at Children's National and the study's lead author: "Our next goal is exploring effective prenatal cognitive behavioral interventions to reduce psychological distress felt by pregnant women and improve neurodevelopment in babies with CHD."
https://www.sciencedaily.com/releases/2020/01/200113111143.htm
Prenatal stress could affect baby's brain
October 8, 2019
Science Daily/King's College London
New research from King's College London has found that maternal stress before and during pregnancy could affect a baby's brain development.
In their study published in Biological Psychiatry, MRC Doctoral Researcher in Perinatal Imaging and Health, Alexandra Lautarescu and Head of Advanced Neuroimaging, Professor Serena Counsell, for the first time looked at the relationship between maternal stress and brain development in 251 premature babies.
They found evidence for impaired development of a white matter tract, the uncinate fasciculus, in babies whose mothers experienced more stress in the prenatal period.
The mothers completed a questionnaire which asked them about their experiences of stressful events, which ranged from everyday stress such as moving house or taking an exam to more severe stressors like experiencing bereavement, separation or divorce. A score of severity of stress was calculated based on how many stressors they experienced as well as how severe those stressors were. This is what was related to the baby's brain. The researchers used a medical imaging technique called diffusion tensor imaging that was specifically developed to look at the structure of the white matter. The white matter tract has previously been implicated in anxiety disorders -- adults that have an anxiety disorder may show changes in this tract.
"We found that in the mums that were more stressed during pregnancy and the period before birth, white matter was altered in the babies," said lead researcher Alexandra Lautarescu from King's College London.
Scientists say the study highlights the importance of providing support for expectant mothers, as previous studies have shown that interventions such as cognitive behavioural therapy can help mitigate adverse outcomes in the baby. Clinicians have an important role to play when speaking with expectant mothers. While questions are asked about depressive symptoms, few questions are asked about general stress and anxiety. Women who deal with stressful life events during pregnancy are not picked up by their GPs or by their health care providers very often.
"It is not diagnosed as often as it should be during pregnancy and we are trying to emphasise that maternal mental health during pregnancy can impact the baby's brain development which may impact on their outcomes later in life," Alexandra Lautarescu said. "No one is asking these women about stress and hence they don't receive any support.
"Antenatal services need to be aware that it is important to think about stress of the mums and we need to have some kind of support there for the mums who identify that they are stressed. If we try to help these women either during the pregnancy or in the early post-natal period with some sort of intervention this will not only help the mother, but may also prevent impaired brain development in the baby and improve their outcomes overall."
There is some evidence to suggest that if mothers experience poor mental health during pregnancy that leads to adverse outcomes in the baby -- obstetric outcomes, lower birth weight or premature birth. A mother's poor mental health may also lead to altered early behavior such as more frequent crying.
Further studies are needed to understand whether the observed changes in the brain development of these babies will lead to adverse outcomes later in life.
https://www.sciencedaily.com/releases/2019/10/191008094309.htm