Knowing that your unborn baby has congenital heart disease causes stress, anxiety and maternal depression so pronounced that these women’s fetuses end up with impaired development in key regions of the brain before birth, according to research published online at JAMA Pediatrics.
While additional research is needed, the authors of the Children’s National Hospital study say their unprecedented findings underscore the need for universal screening for psychological distress as a routine part of prenatal care and taking other measures to support stressed pregnant women. and safeguard the developing brains of their newborns. .
“We were alarmed by the high percentage of pregnant women with a diagnosis of a major fetal heart problem that tested positive for stress, anxiety and depression,” says Catherine Limperopoulos, Ph.D., director of the Center for Brain Development at Children’s National and the corresponding author of the study. “Equally worrying is how frequent psychological distress is among pregnant women in general. We report for the first time that this challenging prenatal environment affects regions of the fetal brain that play an important role in learning, memory, coordination and social and behavioral development, which makes it even more important for us to identify these women intervene early in pregnancy, “adds Limperopoulos.
Congenital heart disease (CHD), structural problems with the heart, is the most common congenital defect.
Even so, it is unclear how exposure to maternal stress affects brain development in fetuses with CHD.
The multidisciplinary study team included 48 women whose unborn fetuses had been diagnosed with CHD and 92 healthy women with uncomplicated pregnancies. Using validated detection tools, they found:
- 65% of pregnant women who expect a baby with CHD tested positive for stress
- 27% of women with uncomplicated pregnancies tested positive for stress
- 44% of pregnant women waiting for a baby with CHD tested positive for anxiety
- 26% of women with uncomplicated pregnancies tested positive for anxiety.
- 29% of pregnant women who expect a baby with CHD tested positive for depression and
- 9% of women with uncomplicated pregnancies tested positive for depression
In total, they performed 223 fetal MRI sessions for these 140 fetuses between 21 and 40 weeks gestation. They measured the cerebral volume in cubic centimeters for the total brain, as well as volumetric measurements for key regions such as the brain, cerebellum, brainstem and left and right hippocampus.
Maternal stress and anxiety in the second trimester were associated with smaller left hippocampus and smaller cerebellums only in pregnancies affected by fetal CHD. In addition, specific regions (the head and body of the hippocampus and the left cerebellar lobe) were more susceptible to growth retardation. 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 time of diagnosis of CHD may have occurred at a particularly vulnerable time for the development of the 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 tested for depression or prenatal anxiety. None of them were taking medication. And none of them had received mental health interventions. In the group of women with fetal CHD, 81% had attended college and 75% had a professional education, so this does not seem to be a problem of insufficient resources, ”adds Limperopoulos. “It is essential that we conduct these exams routinely and provide pregnant women with access to interventions to reduce their stress levels. Working with our community partners, Children’s National is doing exactly that to help reduce toxic prenatal stress for both mother’s health as for future newborns. We hope this becomes a common practice in other places. “
Add Yao Wu, Ph.D., associate researcher working with Limperopoulos at Children’s National and lead author of the study: “Our next goal is to explore effective prenatal cognitive behavioral interventions to reduce the psychological distress that pregnant women feel and improve neurological development. in babies with CHD. “
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