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
Stress during pregnancy may affect baby's sex, risk of preterm birth
October 15, 2019
Science Daily/Columbia University Irving Medical Center
A new study has identified markers of maternal stress -- both physical and psychological -- that may influence a baby's sex and the likelihood of preterm birth.
It's becoming well established that maternal stress during pregnancy can affect fetal and child development as well as birth outcomes, and a new study from researchers at Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian now identifies the types of physical and psychological stress that may matter most.
The study was published online in the journal PNAS, the Proceedings of the National Academy of Sciences.
"The womb is an influential first home, as important as the one a child is raised in, if not more so," says study leader Catherine Monk, PhD, professor of medical psychology at Columbia University Vagelos College of Physicians and Surgeons and director of Women's Mental Health in the Department of Obstetrics & Gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center.
Because stress can manifest in a variety of ways, both as a subjective experience and in physical and lifestyle measurements, Monk and her colleagues examined 27 indicators of psychosocial, physical, and lifestyle stress collected from questionnaires, diaries, and daily physical assessments of 187 otherwise healthy pregnant women, ages 18 to 45.
About 17% (32) of the women were psychologically stressed, with clinically meaningful high levels of depression, anxiety, and perceived stress. Another 16% (30) were physically stressed, with relatively higher daily blood pressure and greater caloric intake compared with other healthy pregnant women. The majority (nearly 67%, or 125) were healthy.
Fewer Baby Boys with Mental Stress?
The study suggested that pregnant women experiencing physical and psychological stress are less likely to have a boy. On average, around 105 males are born for every 100 female births. But in this study, the sex ratio in the physically and psychologically stressed groups favored girls, with male-to-female ratios of 4:9 and 2:3, respectively.
"Other researchers have seen this pattern after social upheavals, such as the 9/11 terrorist attacks in New York City, after which the relative number of male births decreased," says Monk. "This stress in women is likely of long-standing nature; studies have shown that males are more vulnerable to adverse prenatal environments, suggesting that highly stressed women may be less likely to give birth to a male due to the loss of prior male pregnancies, often without even knowing they were pregnant."
Other Impacts of Stress
· Physically stressed mothers, with higher blood pressure and caloric intake, were more likely to give birth prematurely than unstressed mothers.
· Among physically stressed mothers, fetuses had reduced heart rate-movement coupling -- an indicator of slower central nervous system development -- compared with unstressed mothers.
· Psychologically stressed mothers had more birth complications than physically stressed mothers.
Social Support Matters
The researchers also found that what most differentiated the three groups was the amount of social support a mother received from friends and family. For example, the more social support a mother received, the greater the likelihood of her having a male baby.
When social support was statistically equalized across the groups, the stress effects on preterm birth disappeared. "Screening for depression and anxiety are gradually becoming a routine part of prenatal practice," says Monk. "But while our study was small, the results suggest enhancing social support is potentially an effective target for clinical intervention."
An estimated 30% of pregnant women report psychosocial stress from job strain or related to depression and anxiety, according to the researchers. Such stress has been associated with increased risk of premature birth, which is linked to higher rates of infant mortality and of physical and mental disorders, such as attention-deficit hyperactivity disorder and anxiety, among offspring.
How a mother's mental state might specifically affect a fetus was not examined in the study. "We know from animal studies that exposure to high levels of stress can raise levels of stress hormones like cortisol in the uterus, which in turn can affect the fetus," says Monk. "Stress can also affect the mother's immune system, leading to changes that affect neurological and behavioral development in the fetus. What's clear from our study is that maternal mental health matters, not only for the mother but also for her future child."
https://www.sciencedaily.com/releases/2019/10/191015171554.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
Stress during pregnancy affects the size of the baby
Growth outcome opposite due to adversity at the beginning and end of gestation period
November 28, 2017
Science Daily/University of New Mexico
Babies are physically affected by the stress level of their mother during pregnancy, new research indicates.
Researchers from The Universities of New Mexico and Göttingen, as well as the German Primate Center, have now proposed a hypothesis that largely predicts why there are highly variable patterns in the growth rates of disadvantaged offspring across 719 studies on 21 mammal species.
"The idea is that prenatal stress affects offspring in two different ways depending on the timing of the stressor during pregnancy -- yielding different outcomes before birth, after birth, and after weaning" says Andreas Berghänel, evolutionary anthropologist at The University of New Mexico and lead author of the study.
For example, prenatal maternal stress late in gestation causes mothers to invest less energy in their offspring, which leads to slower grow in the womb and during infancy. Once the baby has reached nutritional independence, however, they are no longer affected directly by their mother's provisioning, and consequently grow at the same rate as non-disadvantaged offspring. Thus, maternal stress late in gestation leads to slow growth during dependent phases, but doesn't affect growth later.
By contrast, prenatal maternal stress early in gestation additionally causes the fetus to be entirely reprogrammed to deal with a reduced life expectancy. To "make the best of a bad job," the early challenged offspring switches to an accelerated pace of life and grows and matures faster than unchallenged offspring to ensure that it reproduces before it dies. Once set on the fast track, the offspring under early prenatal maternal stress remain on this trajectory even after weaning and therefore overshoot the usual body size for age throughout development.
"These new results may bear some translational value for understanding why girls start their menstrual cycles earlier in poorer neighborhoods." In combination, an infant's acceleration of their developmental processes together with a deceleration due to reduced maternal investment could then cancel each other out during phases of intense maternal investment -- gestation and lactation. It is not until the infant is nutritionally independent that the programming effects become clear.
This new comparative study finds all of these predictions are supported in a large sample of studies that each measured the effects of prenatal stress on offspring size and growth compared to an unchallenged control group.
"We found that stress during late gestation reduces offspring growth during dependence, resulting in a reduced body size throughout development, whereas stress during early gestation results in largely unaffected growth rates during dependence but accelerated growth and increased size after weaning," says Berghänel.
All stressors seem to have the same effect, and the results are stable across a variety of experiments. Whether mothers were exposed directly to stressors via food restriction or other adversities or were experimentally manipulated to increase their "stress hormones" for example, cortisol, the patterns of offspring growth across developmental stage relative to the timing of the stressor remained the same.
Significance
These new results may bear some translational value for understanding why girls start their menstrual cycles earlier in poorer neighborhoods, why teenage pregnancies are more frequent in disadvantaged families, and why adverse conditions during early development, particularly in formula-fed children, often lead to obesity and other metabolic health problems later in life.
Maternal stress during gestation causes numerous effects on infant physiology that extend well into adulthood. Empirical tests of this hypothesis across mammals suggest that the timing of the stressor during gestation and a simultaneous consideration of maternal investment and adaptive growth plasticity effects are crucial for a full comprehension of prenatal stress effects on offspring growth. The results support an adaptive life history perspective on maternal effects that is relevant for evolutionary biology, medicine, and psychology.
https://www.sciencedaily.com/releases/2017/11/171128185924.htm