Maternal anxiety and depression during late pregnancy and newborn's brain white matter development

Authors: GRAHAM, RACHEL - University Arkansas For Medical Sciences (UAMS); JIANG, LI - Arkansas Children'S Hospital; MCCORKLE, GINGER - Arkansas Children'S Nutrition Research Center (ACNC); BELLANDO, BETTY JAYNE - University Arkansas For Medical Sciences (UAMS); SORENSEN, SETH - University Arkansas For Medical Sciences (UAMS); GLASIER, CHARLES - University Arkansas For Medical Sciences (UAMS); RAMAKRISHNAIAH, RAGHU - University Arkansas For Medical Sciences (UAMS); ROWELL, AMY - University Arkansas For Medical Sciences (UAMS); COKER, JESSICA - University Arkansas For Medical Sciences (UAMS); OU, XIAWEI - University Arkansas For Medical Sciences (UAMS)

Submitted to: American Journal of Neuroradiology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/6/2020
Publication Date: 10/6/2020
Citation: Graham, R., Jiang, L., Mccorkle, G., Bellando, B., Sorensen, S., Glasier, C., Ramakrishnaiah, R., Rowell, A., Coker, J., Ou, X. 2020. Maternal anxiety and depression during late pregnancy and newborn's brain white matter development. American Journal of Neuroradiology. 41(10):1908-1915. https://doi.org/10.3174/ajnr.A6759.
DOI: https://doi.org/10.3174/ajnr.A6759

Interpretive Summary: Recent studies have shown that anxiety and depression during pregnancy may be associated with unfavorable brain and neurodevelopmental outcomes in offspring. Little is known regarding why there would be a such link, and studies are needed to understand the exact regions of the brain that might be affected. We hypothesized that the in utero influence of anxiety and depression of the pregnant mother would lead to changes in fetal brain development that can be measured by brain imaging in babies. To test this, pregnant women were recruited at third trimester and evaluated their anxiety and depression symptoms using standard tests. When their babies were born, we performed magnetic resonance imaging of the newborn's brain. We found that the fractional anisotropy value, a marker of brain white matter development, was lower in many regions of the newborn brain for those born to mothers with higher anxiety and depression symptom scores during pregnancy. The results suggest that mental health during pregnancy is very important for the optimal development of the fetal brain and optimal neurodevelopmental outcomes of children. These findings raise the possibility that strategies known to help lower stress, improve mental health, and promote wellness during a mother's pregnancy (e.g., high quality diet and regular exercise) could have beneficial effects on the offspring's brain.

Technical Abstract: Anxiety and depression during pregnancy have been associated with an increased risk of adverse neurodevelopmental outcomes in offspring. We aimed to study the in utero effects of maternal anxiety and depression on early brain development. Pregnant women were recruited at ~36'weeks of gestation for this prospective study. They were assessed for anxiety symptoms by the State-Trait Anxiety Inventory and for depression symptoms by the Beck Depression Inventory, 2nd Edition. After delivery, infant underwent an MR imaging examination of the brain without sedation, including DTI, for evaluation of white matter (WM) development. Infant fractional anisotropy values, a putative marker of WM integrity, were correlated with the mothers' State-Trait Anxiety Inventory and Beck Depression Inventory scores by using both tract-based spatial statistics and ROI methods. Thirty-four infants were included in this study. Both maternal State-Anxiety and Trait-Anxiety scores negatively correlated (P'<'.05, corrected) with fractional anisotropy values in widespread brain WM regions; Beck Depression Inventory scores also negatively correlated (P'<'.05) with fractional anisotropy values in one cluster in the brain. Further ROI analyses confirmed significant negative correlations between average fractional anisotropy values in ROIs including left and right prefrontal WM, left and right middle frontal gyrus WM, and the fornix, and State-Anxiety (R values, –0.47 to –0.67; P values, .008 to <.001), Trait-Anxiety (R, –0.37 to –0.59; P, .04 to <.001), and Beck Depression Inventory (R values, –0.36 to –0.55; P, .05 to .002) scores. Higher maternal anxiety and depression symptom scores during late pregnancy were associated with lower estimated infant brain WM development, which indicated in utero influences of maternal mental health during pregnancy on the developing brain.