January 17, 2020
2 min read

Maternal stress over CHD linked to impaired fetal brain development

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Catherine Limperopoulos, PhD
Catherine Limperopoulos

Psychological distress in women carrying fetuses with congenital heart disease, or CHD, is associated with impaired cerebellar and hippocampal development during the second half of gestation, according to results from a study published in JAMA Pediatrics.

“Prenatal signs or symptoms of stress or depression and anxiety are common when we're dealing with a high-risk pregnancy or a high-risk fetus, and it's very important [for pregnant women] to talk to their providers about the feelings that they may be experiencing,” Catherine Limperopoulos, PhD, director of the Center for the Developing Brain at Children’s National Hospital, told Healio. “The goal is to ensure that we can connect these women with mental health services so that we can better support their behavioral well-being and try to work through some of the stress and anxiety that they're experiencing in a more supportive way.”

Limperopoulos and colleagues examined 48 women whose unborn fetuses had CHD and 92 healthy women with uncomplicated pregnancies, using validated screening tools to test for stress, anxiety and depression among the mothers. Among the women with fetuses with CHD, 65% tested positive for stress, 44% tested positive for anxiety and 29% tested positive for depression. Among the women with uncomplicated pregnancies, 27% tested positive for stress, 26% tested positive for anxiety and 9% tested positive for depression.

Fetal MRI scans were performed between 21 and 40 weeks of fetal gestation. Maternal anxiety and stress were associated with smaller cerebellar (–0.06 cm3; 95% CI, –0.09 to –0.02 cm3) left hippocampal (–0.003 cm3; 95% CI, –0.005 to –0.001 cm3) and right hippocampal (–0.004; 95% CI, –0.007 to –0.002 cm3) volumes among the women with fetuses with CHD.

Previous research has shown that maternal depression can also affect children’s stress levels and immune systems. Limperopoulos noted that one of the study’s limitations was the lack of a method to determine the timing of the onset of stress-related symptoms.

“Our plan is to continue to follow these women and their offspring after they're born to ask the important question, ‘How and to what extent did the prenatal stress and anxiety that these women were experiencing during pregnancy have long-term effects on their children after birth?’" Limperopoulos said.

Even in the absence of depression symptoms, elevated levels of stress and anxiety in the women examined still showed significant effects on the fetal brain, according to Limperopoulos, which suggests screening for symptoms of stress and anxiety may be pertinent to safeguarding fetal brain development.

“Routine screening and surveillance of women who are reporting symptoms of elevated stress and anxiety is so critical,” Limperopoulos said. “We really need to overcome this stigma — the stigma that still exists around mental health disorders.” – by Eamon Dreisbach


Ulmer-Yaniv A, et al. Depress Anxiety. 2018;doi:10.1002/da.22818.

Wu Y, et al. JAMA Pediatr. 2019;doi: 10.1001/jamapediatrics.2019.5316.

Disclosures: The authors report no relevant financial disclosures.