Division of Diagnostic Imaging and Radiology, Children's National, Washington DC.
Division of Neonatology, Children's National, Washington DC.
JAMA Netw Open. 2020 Dec 1;3(12):e2022349. doi: 10.1001/jamanetworkopen.2020.22349.
Maternal psychological distress during pregnancy is associated with adverse obstetric outcomes and neuropsychiatric deficits in children. Currently unavailable in vivo interrogation of fetal brain function could provide critical insights into the onset and timing of altered neurodevelopmental trajectories.
To investigate the association between prenatal maternal stress, anxiety, and depression and in vivo fetal brain resting state functional connectivity.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included pregnant women scanned between January 2016 and April 2019. A total of 50 pregnant women with healthy pregnancies were prospectively recruited from low-risk obstetric clinics in the Washington DC area and were scanned at Children's National in Washington DC.
Maternal stress, anxiety, and depression.
The association of prenatal maternal stress, anxiety, and depression with whole-brain connectivity was analyzed using multivariate distance matrix regression. Prenatal maternal stress, anxiety, and depression were assessed using the Perceived Stress Scale, Spielberger State Anxiety Inventory and Spielberger Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale, respectively. Whole-brain connectivity was measured from 100 functionally defined regions of interest.
This study analyzed 59 resting-state functional connectivity magnetic resonance image data sets from the fetuses (mean [SD] gestational age, 33.52 [4 weeks]) of 50 healthy pregnant women (mean [SD] age, 33.77 [5.51]). Mean (SD) scores for the questionnaires were as follows: Spielberger State Anxiety Inventory, 26.66 (6.72) (range, 20-48); Spielberger Trait Anxiety Inventory, 28.09 (6.62) (range, 20-50); Perceived Stress Scale, 9.27 (5.13) (range, 1-25); and Edinburgh Postnatal Depression Scale 3.24 (2.84) (range, 0-14). Prenatal maternal anxiety scores measured using the Spielberger Trait and State Anxiety Inventories were associated with differences in fetal connectivity (Spielberger State Anxiety Inventory: pseudo-R2 = 0.019, P = .04; Spielberger Trait Anxiety Inventory: pseudo-R2 = 0.021, P = .007). Interhemispheric connections, such as those involving the parietofrontal and occipital association cortices, were associated with reduced maternal prenatal anxiety, and those between the brainstem and sensorimotor areas were associated with higher anxiety scores.
In this cohort study, an association was found between prenatal maternal anxiety and disturbances in fetal brain functional connectivity, suggesting altered fetal programming. Early onset of functional deviations suggests the need for more widespread screening of pregnant women for symptoms of anxiety.
孕妇怀孕期间的心理困扰与不良产科结局和儿童神经精神缺陷有关。目前无法对胎儿大脑功能进行体内检测，这可能为改变神经发育轨迹的发生和时间提供重要的见解。
研究产前母婴压力、焦虑和抑郁与胎儿大脑静息状态功能连接之间的关系。
设计、地点和参与者：本队列研究纳入了 2016 年 1 月至 2019 年 4 月期间接受扫描的孕妇。总共从华盛顿特区地区的低风险产科诊所前瞻性招募了 50 名健康妊娠的孕妇，并在华盛顿特区的儿童国家进行了扫描。
母婴压力、焦虑和抑郁。
使用多元距离矩阵回归分析产前母婴压力、焦虑和抑郁与全脑连接的关系。分别使用感知压力量表、斯皮尔伯格状态焦虑量表和斯皮尔伯格特质焦虑量表以及爱丁堡产后抑郁量表评估产前母婴压力、焦虑和抑郁。从 100 个功能定义的感兴趣区测量全脑连接。
本研究分析了 50 名健康孕妇（平均[SD]年龄 33.77[5.51]岁）胎儿的 59 个静息状态功能连接磁共振成像数据集（平均[SD]妊娠年龄 33.52[4 周]）。问卷的平均（SD）评分如下：斯皮尔伯格状态焦虑量表 26.66（6.72）（范围 20-48）；斯皮尔伯格特质焦虑量表 28.09（6.62）（范围 20-50）；感知压力量表 9.27（5.13）（范围 1-25）；爱丁堡产后抑郁量表 3.24（2.84）（范围 0-14）。使用斯皮尔伯格特质和状态焦虑量表测量的产前母婴焦虑得分与胎儿连接的差异有关（斯皮尔伯格状态焦虑量表：伪 R2=0.019，P=0.04；斯皮尔伯格特质焦虑量表：伪 R2=0.021，P=0.007）。涉及顶额和枕叶联合皮质等脑半球间的连接与较低的产前母婴焦虑有关，而涉及脑干和感觉运动区域的连接则与较高的焦虑评分有关。
在这项队列研究中，发现产前母婴焦虑与胎儿大脑功能连接障碍之间存在关联，提示胎儿发育受到干扰。功能偏差的早期发生表明，需要更广泛地筛查孕妇的焦虑症状。
