Association of Maternal Psychological Distress With In Utero Brain Development in Fetuses With Congenital Heart Disease

Wu, Yao; Kapse, Kushal; Jacobs, Marni; Andescavage, Nickie; Donofrio, Mary T.; Krishnan, Anita; Vézina, Gilbert; Wessel, David; Plessis, Adré du; Limperopoulos, Catherine

doi:10.1001/jamapediatrics.2019.5316

Cited by 82 publications

(81 citation statements)

References 63 publications

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“…Pregnant mothers of fetuses with CHD have been found to experience high incidences of stress, depression, and anxiety. This psychological distress was associated with reduced cerebellar and hippocampal growth during the latter half of gestation when compared to healthy pregnancies (105).…”

Section: Maternal Stressmentioning

confidence: 94%

Fetal brain issues in congenital heart disease

et al. 2021

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Following the improvements in the clinical management of patients with congenital heart disease (CHD) and their increased survival, neurodevelopmental outcome has become an emerging priority in pediatric cardiology. Large-scale efforts have been made to protect the brain during the postnatal, surgical, and postoperative period; however, the presence of brain immaturity and injury at birth suggests in utero and peripartum disturbances. Over the past decade, there has been considerable interest and investigations on fetal brain growth in the setting of CHD. Advancements in fetal brain imaging have identified abnormal brain development in fetuses with CHD from the macrostructural (brain volumes and cortical folding) down to the microstructural (biochemistry and water diffusivity) scale, with more severe forms of CHD showing worse disturbances and brain abnormalities starting as early as the first trimester. Anomalies in common genetic developmental pathways and diminished cerebral substrate delivery secondary to altered cardiovascular physiology are the forefront hypotheses, but other factors such as impaired placental function and maternal psychological stress have surfaced as important contributors to fetal brain immaturity in CHD.The characterization and timing of fetal brain disturbances and their associated mechanisms are important steps for determining preventative prenatal interventions, which may provide a stronger foundation for the developing brain during childhood.

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Section: Maternal Stressmentioning

confidence: 94%

Fetal brain issues in congenital heart disease

et al. 2021

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“…Elevated maternal psychological distress has been reported for severe and complex anomalies such as various congenital heart diseases, but also for abnormalities that are less severe and can be treated, such as cleft lip/palate. For example, in a recent study of 48 mothers carrying a fetus with complex congenital heart disease, maternal psychological distress was evident for 65% of the mothers, in contrast to 25% of those carrying a healthy fetus (Wu et al, 2020). Similarly, Rey- Bellet and Hohlfeld (2004) interviewed 29 expectant parents and found that most reacted with severe psychological shock in response to cleft lip/palate detection, but awareness that the deformity could be treated has been reported as a great relief (Nusbaum et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Paternal Psychological Stress After Detection of Fetal Anomaly During Pregnancy. A Prospective Longitudinal Observational Study

et al. 2020

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Background and Aims: Knowledge of carrying a fetus with a prenatal diagnosed anomaly may cause acute psychological stress to the parents. Most studies focus on maternal stress, yet fathers are often present at the ultrasound examinations and birth, and therefore may be affected, similarly, to the expectant mother. However, to date no existing studies have examined how detection of a fetal anomaly emotionally affects the expectant fathers throughout the pregnancy. Our aim was to longitudinally examine general health perceptions, social dysfunction and psychological distress in a subgroup of men where fetal anomaly was detected during pregnancy. Methods and Results: This study is part of the SOFUS study, a prospective, longitudinal, observational study. Participants were recruited when referred for an ultrasound examination conducted by a specialist in fetal medicine at Oslo University Hospital on suspicion of fetal malformation (study group). We examined differences between the men in the study group (N = 32) and a comparison group (N = 83) on the General Health Questionnaire (GHQ), Impact of Event Scale (IES) and Edinburgh Postnatal Depression Scale (EDPS) across four time points in pregnancy. Results from repeated measured ANOVA suggests that depression decreased over time among men in both groups (η 2 = 0.15, p < 0.001). This effect was stronger in the study group, and differed from the comparison group (η 2 = 0.08, p < 0.001). There was also a main effect of time on IES scores, which decreased over time for both men in the study group and in the comparison group (η 2 = 0.32, p < 0.001). That is, men in the study group were higher on IES initially, but this effect decreased more in the study group than in the comparison group. Men in the study group and comparison group did not differ on perceived general health (GHQ: p = 0.864). Conclusion: Results suggests that detection of a fetal anomaly has implications for paternal mental health during pregnancy. Expectant fathers scored higher on EPDS and IES than the comparison group in the acute phase after detection of fetal anomaly, thus there is impetus to provide psychological support for fathers, as well as mothers, at this difficult time.

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“…The prevalence of prenatal diagnoses of CHD has led to a greater understanding of the vulnerability of this unique patient group, starting in utero. Elevated psychobiological markers of maternal stress during pregnancy, especially early in gestation, may correlate with altered placental function, delayed fetal maturation, and decreased cerebellar and hippocampal volumes in fetuses with CHD [ 26 ]. In addition, these markers may be associated with disrupted emotional regulation and impaired cognitive performance during infancy, and decreased brain volume in areas associated with learning and memory in 6- to 8-year-old children [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Redefining the Relationship: Palliative Care in Critical Perinatal and Neonatal Cardiac Patients

et al. 2021

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Patients with perinatal and neonatal congenital heart disease (CHD) represent a unique population with higher morbidity and mortality compared to other neonatal patient groups. Despite an overall improvement in long-term survival, they often require chronic care of complex medical illnesses after hospital discharge, placing a high burden of responsibility on their families. Emerging literature reflects high levels of depression and anxiety which plague parents, starting as early as the time of prenatal diagnosis. In the current era of the global COVID-19 pandemic, the additive nature of significant stressors for both medical providers and families can have catastrophic consequences on communication and coping. Due to the high prognostic uncertainty of CHD, data suggests that early pediatric palliative care (PC) consultation may improve shared decision-making, communication, and coping, while minimizing unnecessary medical interventions. However, barriers to pediatric PC persist largely due to the perception that PC consultation is indicative of “giving up.” This review serves to highlight the evolving landscape of perinatal and neonatal CHD and the need for earlier and longitudinal integration of pediatric PC in order to provide high-quality, interdisciplinary care to patients and families.

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Association of Maternal Psychological Distress With In Utero Brain Development in Fetuses With Congenital Heart Disease

Cited by 82 publications

References 63 publications

Fetal brain issues in congenital heart disease

Fetal brain issues in congenital heart disease

Paternal Psychological Stress After Detection of Fetal Anomaly During Pregnancy. A Prospective Longitudinal Observational Study

Redefining the Relationship: Palliative Care in Critical Perinatal and Neonatal Cardiac Patients

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