Maternal psychological distress during the COVID-19 pandemic and structural changes of the human fetal brain

Abstract

Background

Elevated maternal psychological distress during pregnancy is linked to adverse outcomes in offspring. The potential effects of intensified levels of maternal distress during the COVID-19 pandemic on the developing fetal brain are currently unknown.

Methods

We prospectively enrolled 202 pregnant women: 65 without known COVID-19 exposures during the pandemic who underwent 92 fetal MRI scans, and 137 pre-pandemic controls who had 182 MRI scans. Multi-plane, multi-phase single shot fast spin echo T2-weighted images were acquired on a GE 1.5 T MRI Scanner. Volumes of six brain tissue types were calculated. Cortical folding measures, including brain surface area, local gyrification index, and sulcal depth were determined. At each MRI scan, maternal distress was assessed using validated stress, anxiety, and depression scales. Generalized estimating equations were utilized to compare maternal distress measures, brain volume and cortical folding differences between pandemic and pre-pandemic cohorts.

Results

Stress and depression scores are significantly higher in the pandemic cohort, compared to the pre-pandemic cohort. Fetal white matter, hippocampal, and cerebellar volumes are decreased in the pandemic cohort. Cortical surface area and local gyrification index are also decreased in all four lobes, while sulcal depth is lower in the frontal, parietal, and occipital lobes in the pandemic cohort, indicating delayed brain gyrification.

Conclusions

We report impaired fetal brain growth and delayed cerebral cortical gyrification in COVID-19 pandemic era pregnancies, in the setting of heightened maternal psychological distress. The potential long-term neurodevelopmental consequences of altered fetal brain development in COVID-era pregnancies merit further study.

Plain language summary

We investigated whether the mental health of pregnant mothers influenced the brain development of their fetuses during the COVID-19 pandemic. We imaged the brains of fetuses before and during the COVID-19 pandemic and asked the mothers questions about any distress experienced during pregnancy. We found increased maternal stress and depression in women pregnant during the pandemic compared to those pregnant before the pandemic. The volume of some areas of the fetal brain decreased, and there was a delay in the development of the brain folds in the fetuses of the distressed mothers.

Abstract

Lu, Andescavage et al. scanned fetal brains by MRI and assessed maternal distress before and during the COVID-19 pandemic. Impaired fetal brain growth, delayed cerebral cortical gyrification and increased maternal distress was seen in COVID-19 pandemic era pregnancies.