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5.7.3: Prenatal Stress and the Developing Brain

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    Postnatal Environments Promoting Resilience

    Pregnancy is often viewed as a period of happiness and joy. Mothers are expected to be “glowing” and grateful for the opportunity to bring new life into the world. For a vast number of women, however, this is not the case. Stress-related symptoms are now recognized as the most common complication of pregnancy, affecting approximately one in every four women, even those with healthy pregnancies and high socioeconomic status (Wu et al., 2020). Meta-analyses showed that between 18.2% and 24.6% of women reported elevated anxiety symptoms during pregnancy, with higher symptom severity in the third trimester (Dennis et al., 2018). Moreover, about 14.4% of pregnant women in the United States reported the use of psychiatric medication during pregnancy (Huybrechts et al., 2013). Similar rates (15%) have been found in other countries, such as the Netherlands (Browne et al., 2020). [1] [2]

    The prevalence of postpartum depression (PPD) has been estimated to 30 and 50% for women with a history of depression or bipolar disorder, respectively, and to 8% in women without previous mental illness (Viguera et al., 2011). Figure \(\PageIndex{1}\) is a map of the global estimate of PPD–warmer colors note a higher prevalence. The global prevalence of PPD was found to be approximately 17.22% (Wang et al., 2021). According to the International Classification of Diseases (11th revision), diagnostic criteria for PPD are identical to depression outside the peripartum period but with an onset within six weeks of delivery (WHO, 2019). While some symptoms are identical to those for Major Depressive Disorder (MDD) outside the peripartum period, including depressed mood, loss of interest and motivation, feelings of guilt and worthlessness and suicidal thoughts, research indicates that anxiety may be more prevalent in PPD than MDD (Batt et al., 2020). Moreover, mothers are at increased depression risk for at least six months after delivery, and researchers and clinical practitioners consider depression within this period as PPD (Musters et al., 2008; Wisner et al., 2002). [3] [4]

    Definition: Postpartum depression (PPD)

    Postpartum depression is a serious mood disorder that may last for weeks or months at a time after having a baby

    Definition: Major depressive disorder (MDD)

    Also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities

    Unbalanced prevalence of postpartum depression was observed between different continents, countries and regions
    Figure \(\PageIndex{1}\): Map of the global prevalence of depression among postpartum women. Accessible table of information on figure [5]

     

    Besides impacting pregnant women, maternal stress during pregnancy can also affect the unborn child (Monk, Lugo-Candelas, & Trumpff, 2019; Van den Bergh et al., 2020). The rapidly developing fetal brain may be particularly sensitive to maternal stress during pregnancy (Andersen, 2003; Bock, Wainstock, Braun, & Segal, 2015; van den Bergh, Dahnke, & Mennes, 2018). [6]

    More than a decade of brain imaging research has shown that maternal psychological distress during pregnancy, including depression and anxiety, affects the developing fetal brain, with later life consequences for children’s cognition and mental health (Adamson, Letourneau, & Lebel, 2018; Dufford, Spann, & Scheinost, 2021; Pulli et al., 2019; Van den Bergh et al., 2018). Recent studies found evidence for changes in children’s structural gray matter (Acosta et al., 2019, 2020; Donnici et al., 2021; Moog et al., 2021) and white matter (Demers et al., 2021; Manning et al., 2022; Rifkin-Graboi et al., 2015) as well as functional brain changes (Humphreys, Camacho, Roth, & Estes, 2020; Rajasilta et al., 2023; Scheinost et al., 2020). Several pioneering studies have even started to show that the timing of these brain alterations begins prenatally, by studying the offspring in utero (De Asis-Cruz et al., 2020; Thomason, Hect, Waller, & Curtin, 2021; van den Heuvel et al., 2021; Wu et al., 2022). Such neural alterations potentially underlie the observed behavioral problems and mental health challenges of children exposed to maternal stress prenatally (Monk, Lugo-Candelas, & Trumpff, 2019; Van den Bergh et al., 2018). [7]

    Rather than examine specific brain structures, Turk et al., (2023) looked at the global brain function and network properties of adults who were prenatally exposed to maternal stress. Take a look at Figure \(\PageIndex{1}\) to see some of their results. The researchers sorted the participants into two groups, those who were exposed to a level of low-to-medium anxiety (LMA), located on the left side of the figure and those exposed to a level of high anxiety (HA), located on the right. To understand this figure, it is critical to first explain the term “connectome”. The brain contains vast numbers of interconnected neurons that constitute anatomical and functional networks that make up the “connectome” of the brain. The image in the figure titled “Average LMA Connectome” represents the average functional network connections of adults who were prenatally exposed to a low-to-moderate level of anxiety. The image in the figure titled “Average HA Connectome” represents the average functional network connections of adults who were prenatally exposed to a high level of anxiety. The acronyms note specific brain areas; so MPFC is an acronym for medial prefrontal cortex. The colorful lines at the center of each image in the figure represent the average functional connectivity across brain regions, the average connectome. [8]

    Definition: Connectome

    A comprehensive map of neural connections in the brain, and may be thought of as its "wiring diagram". A nervous system is made up of neurons which communicate through synapses. A connectome is constructed by tracing the neuron in a nervous system and mapping where neurons are connected through synapses

    Connectome rings from adults with low-to-medium (left) and high (right) prenatal anxiety exposure. Figure described in caption
    Figure \(\PageIndex{1}\): displays the functional group-based connectome rings of offspring of low-medium (left) and high (right) prenatal anxiety. Significant ROI-to-ROI connections (p < .05, FDR-corrected) of both groups are displayed in a color ranging from blue (negative) to red (positive) and represent the T-statistics (see color-bar below the connectome graphs for specific values). The arrow points to the MPFC ROI to indicate that this region (visually) shows most difference between groups, with less significant connections to other areas in the HA group as compared to the LMA group. ROI labels and descriptions for the abbreviations can be found in the supplemental materials [9]

    What do you notice when you compare the average connectomes of the two groups? The connectome of the LMA group appears to have more connections across brain regions than the HA group. Because the two groups are distinguished by the level of prenatal stress, this research shows that prenatal stress in general can impact brain development, but that higher levels may have an even greater negative impact. More specifically, adult functional brain connectivity is weaker in adults exposed prenatally to higher maternal anxiety. Additionally, because the brain data from this study was collected when the individuals were adults (twenty-eight years of age), this study also suggests that prenatal exposure to stress can have life-long effects on brain development. [10]

    Supportive environments during early postnatal life may promote brain development and reverse atypical developmental trajectories induced by prenatal stress and depression. Research highlights the first year of life as an extremely important time for promoting optimal developmental outcomes (Ainsworth, 1979). Caregiving that is warm, sensitive, and responsive to infant's signals (Ainsworth, Blehar, Waters, & Wall, 2015), may play a particularly important role in child neurodevelopment and long-term developmental outcomes (Malmberg et al., 2016; Spinrad & Stifter, 2002; Wang et al., 2019). [11] [12]

    figure caption describes image

    Figure \(\PageIndex{1}\):Image is divided into two main time periods, prenatal and postnatal, each with associated factors. On the left side, labeled "PRENATAL," lists factors that can affect brain development before birth:- Altered Gestational Biology, HPA-axis Regulation, Immune-Related Pathways, Low Birth Weight, Preterm Birth, Depression, Anxiety, Distress. In the center top "Infant Brain Development" signifying the result of both prenatal and postnatal influences. On the right side, labeled "POSTNATAL," list factors and their influence on child outcomes. At the top "Late Child Outcomes," indicating long-term impact of these factors. The central image shows a family with a father, mother, and grandmother around a baby, indicating the importance of family and social support. Listed postnatal factors include Linguistic Stimulation, Cognitive Stimulation, Social Support, Parental Caregiving Quality, Socioeconomic Status Arrows flow from the prenatal factors up towards the infant brain, and from the postnatal factors towards the child outcomes, illustrating the continuum of development from prenatal influences through postnatal care and environment to the eventual outcomes in the child. [13]

    For example, Grande et al., (2021) found that high-quality caregiving during the first postnatal year ameliorates the negative cognitive and emotional outcomes from exposure to prenatal distress. Their data suggests that high-quality caregiving can compensate for the impact of prenatal distress by altering developmental trajectories and improving child mental health. Indeed, children in their study that were exposed to prenatal stress showed reduced cognitive and emotional performance, but not if they received high-quality caregiving during infancy. In the study, high-quality caregiving was measured as the level of sensitive caregiving. As shown in Figure#, children exposed to elevated prenatal maternal distress and low sensitive caregiving exhibited the poorest cognitive performance, but children exposed to higher prenatal maternal distress who then received sensitive caregiving did not display deficits in cognitive function. This research is supported by a similar study that found prenatal stress predicted lower cognitive performance in children, but not if caregivers provided positive engagement, which the authors confirm align with the operationalization of sensitive caregiving (Schechter et al., 2017). [14]

    Impact of caregiver sensitivity levels on child cognition.
    Figure \(\PageIndex{1}\): Maternal sensitivity composite was analyzed as a continuous variable using regression, but for illustrative purposes are depicted here as low (1 SD below the mean), average (at the mean), and high (1 SD above the mean) levels of maternal sensitivity. Prenatal maternal distress (on the x-axis) is the standardized composite of anxiety, depressive symptoms, and perceived stress scores. Children exposed to elevated prenatal maternal distress did not exhibit impaired cognitive function at age 2 if they received higher quality maternal caregiving. [15]

    Another measure of high-quality caregiving is the level of secure attachment a child has with a caregiver. Attachment is an important topic for the discussion of the impact of prenatal stress/depression because ​​the rate of insecure attachment in infants with mothers who are depressed is approximately 20% higher than the rate for mothers who are not depressed (Barnes & Theule, 2019). Infants with a secure attachment relationship to their caregiver do not show behavioral problems following prenatal stress (Ali et al., 2020; Bergman, Sarkar, Glover, & O'Connor, 2008). Furthermore, infants prenatally exposed to stress were more likely to show lower cognitive performance as toddlers, but not if they had a secure attachment to their caregiver (Bergman et al., 2010).  [16]

    In addition to social and cognitive improvements, caregiving can positively impact brain development. High-quality caregiving is associated with enhanced child hippocampal volume growth; this growth trajectory is further associated with improved child emotion regulation (Luby et al., 2017) as well as with greater child gray matter volume at 8 years (Kok et al., 2015). This research is further corroborated by animal research, providing strong evidence that maternal care directly impacts neural circuits underlying cognitive and emotional vulnerabilities that are impacted by prenatal maternal distress (Gee, 2016; Granger et al., 2021; Liu et al., 2000; Rao et al., 2010). [17]

    Taken together, findings from this body of research suggest that altered brain development following exposure to prenatal adversity is less likely when children are provided with resilience-promoting early postnatal environments. High-quality caregiving that is sensitive and supports a secure attachment can reverse the effects of prenatal stress on brain structure and function in children. [18]

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    5.7.3: Prenatal Stress and the Developing Brain is shared under a not declared license and was authored, remixed, and/or curated by LibreTexts.

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