Developmental and Behavioral Pediatrics : Behavior Problems
Developmental and Behavioral Pediatrics 6
Yao Wu, PhD
Developing Brain Institute
Children's National Hospital
washington, District of Columbia, United States
Prenatal maternal stress has detrimental effects on pregnancy and is increasingly linked with altered fetal programming. Pregnant women with a fetal diagnosis of congenital heart disease (CHD) report an alarming high prevalence of mental distress. Our previous study suggests that elevated prenatal maternal mental distress is associated with impaired brain growth in in utero CHD fetuses, especially in the hippocampus and cerebellum. This may have consequences on long-term neurodevelopment in children with CHD.
To determine the association between prenatal maternal mental distress (i.e., stress, anxiety, and depression) and neurodevelopmental outcomes in 18-month toddlers with CHD.
We prospectively recruited women with pregnancies complicated by a fetal CHD diagnosis. Prenatal maternal anxiety, stress, and depression were measured using the Spielberger State-Trait Anxiety Inventory, Perceived Stress Scale, and Edinburgh Postnatal Depression Scale, respectively. Neurodevelopment at 18 months was measured using Bayley Scales of Infant and Toddler Development III and Infant-Toddler Social and Emotional Assessment. Generalized estimating equations were used to measure the association between prenatal maternal mental distress and 18-month neurodevelopmental outcomes, controlling for maternal education, sex, ventricle physiology (single ventricle vs two ventricles), perioperative events (i.e., cardiac arrest, respiratory arrest, seizures, stroke, sepsis, yes or no), and length of hospitalization. Characteristics of the study sample are shown in Table 1.
Results: We studied 91 pregnant women with distress measures between 21-40 gestational weeks, of which 41 completed distress measures twice. Twenty-four CHD subjects died (5 prenatally, 3 postnatally before neonatal cardiac surgery, 16 after neonatal cardiac surgery and before neurodevelopmental testing). Fifty-five toddlers completed neurodevelopmental testing. Prenatal maternal stress (β=-0.30, p=0.03) and depression (β=-0.55, p=0.01) were negatively associated with motor scores in CHD toddlers. Additionally, prenatal maternal trait anxiety was positively associated with toddler externalizing behavioral problems (β=0.21, p=0.03) and maternal depression was positively associated with toddler competence scores (β=0.38, p=0.02) (Table 2).
We report that elevated prenatal maternal mental distress is associated with impaired motor and social-emotional outcomes in CHD toddlers at 18 months. Identifying early modifiable biomarkers associated with long-term neurodevelopment may assist in early targeted interventions.