Summary: Elevated maternal stress, anxiety, and depression during pregnancy were linked to measurable changes in fetal brain structure and biochemistry and to lower cognitive performance and increased social-emotional difficulties in children at 18 months.
Source: Children’s National Hospital
Elevated anxiety, depression and stress in pregnant women were associated with alterations in key fetal brain features and with reduced cognitive scores in their children at 18 months.
A longitudinal study led by researchers at Children’s National Hospital and published in JAMA Network Open followed 97 pregnant women and their infants and found that higher prenatal psychological distress corresponded with changes in fetal brain anatomy and chemistry. Those prenatal alterations were associated with poorer infant cognitive outcomes and greater social-emotional and self-regulation difficulties at 18 months.
The research suggests that persistent maternal distress after birth may further affect parent–child interactions and a child’s ability to regulate emotions and behavior. This study is the first to link specific in utero fetal brain differences with later cognitive and social-emotional outcomes in infants exposed to elevated maternal psychological distress during pregnancy.
During fetal MRI assessments, the team observed differences in cortical folding measures such as sulcal depth and in the left hippocampal volume. These brain features are important for cognition, memory and social-emotional processing, and their alteration may help explain the neurodevelopmental challenges seen later in infancy.
Children exposed to higher maternal distress in utero were more likely, by 18 months, to show internalizing behaviors, difficulties with emotional regulation, and lower cognitive scores. The investigators emphasize the need for larger and more diverse studies to confirm and extend these findings across regions and populations.
“Identifying pregnant women experiencing elevated psychological distress could help clinicians recognize infants at higher risk for later neurodevelopmental problems and target early support and interventions,” said Catherine Limperopoulos, Ph.D., chief and director of the Developing Brain Institute at Children’s National, and the study’s senior author.
Psychological distress is a common pregnancy complication: roughly one in four pregnant women report stress-related symptoms regardless of socioeconomic status. Yet determining how prenatal maternal stress, anxiety and depression translate into long-term neurodevelopmental outcomes requires careful study of fetal brain development, which presents technical and practical challenges.
Fetal imaging is difficult because of fetal and maternal movement, limits of imaging technology, signal-to-noise constraints and rapid changes in brain growth. In this study, all participating pregnant women were healthy, the majority were educated and employed, and prenatal distress was measured using validated self-report questionnaires to quantify stress, anxiety and depression during pregnancy.
Fetal brain volumes and cortical folding measures were derived from three-dimensional reconstructions of T2-weighted MRI scans. Proton magnetic resonance spectroscopy quantified fetal brain metabolites including creatine and choline. Infant neurodevelopment at 18 months was assessed using established instruments, providing standardized measures of cognitive, social-emotional and adaptive functioning. Parenting stress in the parent–child dyad was also measured at the 18-month visit.
This study builds on prior work by the Developing Brain Institute showing that maternal mental health during pregnancy affects the developing brain even among women with higher socioeconomic status. Together, these findings highlight the potential benefit of screening for and treating maternal distress prenatally to support both maternal wellbeing and infant neurodevelopment.
“Shifting clinical practice to routinely identify and address maternal stress during pregnancy could improve outcomes for both mothers and their children,” said Limperopoulos. “Early interventions that reduce maternal distress have the potential to improve maternal symptoms and to support healthier developmental trajectories for infants.”
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Author: Press Office
Source: Children’s National Hospital
Contact: Press Office – Children’s National Hospital
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Original Research: Open access.
“Association of Elevated Maternal Psychological Distress, Altered Fetal Brain, and Offspring Cognitive and Social-Emotional Outcomes at 18 Months” by Catherine Limperopoulos et al. JAMA Network Open
Abstract
Association of Elevated Maternal Psychological Distress, Altered Fetal Brain, and Offspring Cognitive and Social-Emotional Outcomes at 18 Months
Importance
Prenatal maternal psychological distress has been linked to disturbances in fetal brain development. The relationship between these prenatal brain changes and long-term neurodevelopmental outcomes in children remains incompletely understood.
Objective
To evaluate associations between maternal psychological distress during pregnancy and fetal brain development—measured with three-dimensional MRI volumes, cortical folding metrics, and brain metabolites—and to relate those prenatal measures to infant neurodevelopment at 18 months.
Design, Setting, and Participants
A prospective longitudinal observational cohort study enrolled healthy mother–infant dyads from January 2016 to October 2020 at Children’s National Hospital in Washington, DC. Data analysis was performed from January 2016 to July 2021.
Exposures
Prenatal maternal stress, anxiety, and depression, assessed by validated self-report questionnaires.
Main Outcomes and Measures
Fetal brain volumes and cortical folding were obtained from reconstructed 3D T2-weighted MRI scans; fetal brain creatine and choline were measured with proton magnetic resonance spectroscopy. Infant neurodevelopment at 18 months was evaluated using the Bayley Scales of Infant and Toddler Development, Third Edition, and the Infant-Toddler Social and Emotional Assessment. Parenting stress was measured with the Parenting Stress Index–Short Form at the 18-month visit.
Results
The study followed 97 mother–infant dyads (mean maternal age 34.79 years) and included 184 fetal MRI visits. Prenatal maternal stress was negatively associated with infant cognitive performance at 18 months, and this relationship was mediated by smaller fetal left hippocampal volume. Prenatal anxiety, stress, and depression were also positively associated with higher parenting stress scores at 18 months. Measures of fetal cortical folding—the local gyrification index and sulcal depth—were negatively associated with infant social-emotional scores and competence.
Conclusions and Relevance
In this cohort, alterations in fetal cortical folding and hippocampal volume were linked to infant social-emotional and cognitive outcomes at 18 months. These findings indicate that elevated maternal psychological distress during pregnancy can have measurable effects on fetal brain development that relate to later sociocognitive outcomes. Early identification of at-risk pregnancies and biomarkers of altered fetal brain development may help guide targeted interventions to support maternal mental health and improve child developmental trajectories.