Psychological Distress in Pregnancy Harms Brain Development in Fetuses With CHD

By Megan Brooks

January 16, 2020

NEW YORK (Reuters Health) - Psychological distress is common among pregnant women carrying fetuses with congenital heart disease (CHD) and is associated with impaired fetal brain development, new research indicates.

"The data underscore the importance of universal screening for maternal psychological distress, integrated prenatal mental health support, and targeted early cognitive-behavioral interventions given that stress is a potentially modifiable risk factor in this high-risk population, the study team writes in JAMA Pediatrics.

"We already know that mental health problems are the most common complications of pregnancy. Our study reports an alarmingly high prevalence of stress, anxiety and depressive symptoms in pregnant women carrying fetuses diagnosed with CHD," Dr. Catherine Limperopoulos, director of the Center for the Developing Brain at Children's National Hospital and the study's corresponding author, said in email to Reuters Health.

"We also show that prenatal maternal psychological distress among these women is associated with adverse fetal hippocampal and cerebellar development in the womb," she added.

The researchers studied 48 pregnant women carrying fetuses with CHD and 92 healthy volunteers with low-risk pregnancies from the Children's National Health System.

Maternal stress was assessed with the Perceived Stress Scale; anxiety with the Spielberger State-Trait Anxiety Inventory; and depression with the Edinburgh Postnatal Depression Scale.

Among the women carrying fetuses with CHD, 31 (65%) tested positive for stress, 21 (44%) for anxiety, and 14 (29%) for depression.

"Feelings of stress, anxiety and depression aren't limited to women who receive a fetal CHD diagnosis, however," Dr. Limperopoulos told Reuters Health. About one in four women with uncomplicated pregnancies in the study tested positive for stress and anxiety and 9% for depression, she noted.

The researchers also assessed 223 MRI scans obtained between 21 and 40 weeks' gestation from 140 fetuses (74 MRIs from 48 fetuses with CHD and 149 MRIs from 92 healthy fetuses). They found that maternal stress and anxiety were associated with decreased cerebellar and hippocampal volumes in fetuses with CHD during the second half of gestation.

It's important to note, the researchers say, that none of the women they studied had been formally screened for prenatal depression or anxiety, and none were taking medications nor were receiving any mental health intervention.

"Taken as a whole, these findings are important for clinicians because maternal stress is underappreciated clinically," Dr. Limperopoulos told Reuters Health. "Stress is a modifiable risk factor, and we have the ability to intervene through early diagnosis followed by targeted behavioral interventions to improve the behavioral well-being of pregnant women and the well-being of their fetuses. This is especially important for infants diagnosed with CHD, since they already are at heightened risk for neurodevelopmental disabilities."

"It's critical to overcome the lingering stigma that still accompanies mental health disorders in order to make these screenings a routine part of prenatal care. Only then can we realize the potential to act on this risk factor while these infants are still in the womb," she added.

The study had no commercial funding and the authors have declared no relevant conflicts of interest.

SOURCE: JAMA Pediatrics, online January 14, 2020.