Tag Archive for: maternal health

stressed pregnant mom

Pandemic stress reshapes the placentas of expectant moms

stressed pregnant mom

Elevated maternal stress during the COVID-19 pandemic changed the structure, texture and other qualities of the placenta in pregnant mothers.

Elevated maternal stress during the COVID-19 pandemic changed the structure, texture and other qualities of the placenta in pregnant mothers – a critical connection between mothers and their unborn babies – according to new research from the Developing Brain Institute at Children’s National Hospital.

Published in Scientific Reports, the findings spotlight the underappreciated link between the mental health of pregnant mothers and the health of the placenta – a critical organ that develops during pregnancy to nourish and protect babies. The long-term neurodevelopmental impact on their children is under investigation.

“During the pandemic, mothers were exposed to a litany of negative stressors including social distancing, fear of dying, financial insecurity and more,” said Catherine Limperopoulos, Ph.D., chief and director of the Developing Brain Institute, which led the research. “We now know that this vital organ was changed for many mothers, and it’s essential that we continue to investigate the impact this may have had on children who were born during this global public health crisis.”

The big picture

Dr. Limperopoulos’s team compared magnetic resonance imaging (MRI) of 165 women who were pregnant before March 2020 to 63 women who became pregnant during the pandemic. Those pregnant during the pandemic were not knowingly exposed to COVID-19, and they collectively scored significantly higher on questionnaires measuring stress and depression. They were recruited at Children’s National as part of a clinical trial aimed at reducing pregnant women’s elevated stress levels during the pandemic.

The placenta is a temporary organ that grows during pregnancy to provide oxygen, nutrients and immunological protection to babies, and its health is vital to the well-being of the developing fetus. The data showed key changes in how the placenta grew and developed among women pregnant during the pandemic, especially when compared to placental growth and development among women who were pregnant before the pandemic. Changes in placental development also were associated with the infant’s birth weight at delivery. Importantly, these changes seem to be connected to maternal stress and depression symptoms.

Taken as a whole, the findings suggest that the disturbances measured on placental development in the womb may influence the placenta’s ability to support fetal health and wellness. “We are continuing to follow up on these mother-baby dyads to determine the long-term functional significance of these placental changes in utero,” Dr. Limperopoulos said.

Studies have shown that the placenta adapts to negative changes in the maternal environment and mental health status, and disruptions in placental function impact infant brain development and children’s neurobehavior and temperament.

The patient benefit

Dr. Limperopoulos’s research studying childbirth amid the pandemic builds on her extensive work investigating the impact of maternal stress on unborn children, including its adverse effect on brain structure and biochemistry. She’s also working on treatments and interventions to better support new families. Her program, DC Mother-Baby Wellness, brings together community partners to provide wrap-around care to expectant and new moms with elevated scores for stress, anxiety and depression.

“When identified early, maternal stress is a modifiable risk factor that can be treated with psychotherapy, social support and other personalized, evidence-based interventions,” Dr. Limperopoulos said. “We look forward to continued research in this area to better understand the mechanisms behind these biological changes and the needs of mothers and children who are born during pandemics, natural disasters and other significantly stressful events.”

Hand holding newborn baby's hand

DC Mother Baby Wellness marks 1,000-referral milestone

Hand holding newborn baby's hand

Launched 18 months ago, the city-wide DC MBW program brings together prenatal care providers, pediatricians, community-based organizations and birthing hospitals to provide essential services to mothers and babies at high risk for adverse health outcomes.

Launched 18 months ago, the city-wide DC MBW program brings together prenatal care providers, pediatricians, community-based organizations and birthing hospitals to provide essential services to mothers and babies at high risk for adverse health outcomes. Using evidence-based screening and evaluation tools, the program provides timely and targeted resources – including mental health care for mothers, developmental screening and treatment for newborns and other support – to ensure that families with the most acute social and medical needs have access to culturally relevant resources.

“Healthy moms are the foundation of healthy families and communities,” says Catherine Limperopoulos, Ph.D., the program’s director and director of the Developing Brain Institute at Children’s National. “Perinatal mood and anxiety disorders are among the most common complications of pregnancy. By offering thoughtful, individualized mental health resources – in English and Spanish – we are improving outcomes for local families facing some of the most complex and challenging health needs.”

Dr. Limperopoulos has done extensive research on the profound, negative effects of expectant mothers’ stress on their unborn children. Using advanced fetal MRI technology, her published research continues to show that stress, anxiety or depression in pregnant mothers alters babies’ brain development. These mental health challenges are associated with poor obstetric outcomes and social, emotional and behavioral problems in children.

The DC MBW 1,000-referral milestone comes as Dr. Limperopoulos expands her research role at Children’s National with the creation of a new Center for Prenatal, Neonatal & Maternal Health Research that she will lead. Opened in April, the center will be a research hub for maternal health and prevalent pediatric disorders that may be present in the earliest stages of life.

At DC MBW, Dr. Limperopoulos and her team serve mostly women of color with complex social needs that drive their anxiety, stress, depression and other mental health concerns. More than a third of the mothers referred to the wellness program are experiencing housing insecurity at intake – a number that climbs to more than 75% during their pregnancy and first year postpartum. About 30% of referred women are experiencing food insecurity. One in four are experiencing intimate partner violence, and 10% report contemplating suicide.

Dr. Limperopoulos says the team’s data indicate expectant mothers’ symptoms of depression drop dramatically within as few as six weeks of engagement with the wellness program’s services. These mothers are supported during pregnancy and beyond, as they check in with their providers during primary care visits at various Children’s National locations, participate in interactive, evidence-based play to boost child development and attend prenatal group classes that start this spring.

“It is not an overstatement to say that this program has saved lives,” says Siobhan Burke, M.D., director of Obstetrics and Gynecology at Unity Health Care. “There are so many initiatives and programs that focus on screening for depression in pregnancy, but DC MBW is actually doing the work and getting patients the treatments that they want and need. The team has designed a program that focuses on removing barriers. Whether that’s things like transportation, insurance status or language barriers, they find a way to help.”

The Centers for Disease Control and Prevention reports that the U.S maternal death rate continues to climb locally and nationally. The rates for Black mothers are significantly higher than for white and Latina mothers, making early intervention and wrap-around healthcare services even more vital to reverse this sobering trend.

The DC MBW program was underwritten by a $36 million investment from the A. James & Alice B. Clark Foundation and has hired more than a dozen full-time experts who provide care coordination, psychotherapy and patient referrals to a range of community resources. Most often, patients are referred by providers at Unity Health Care, the George Washington University Hospital, MedStar Washington Hospital Center and other leading prenatal care practices in the city.

“I credit our team’s tireless efforts for achieving this milestone so quickly. I have witnessed firsthand the dedication, time and boundless energy that they have devoted to each and every one of these people, walking side by side with them on their journey toward wellness,” Dr. Limperopoulos says. “Our research clearly supports the need for the care and resources we provide through the DC Mother-Baby Wellness initiative. Through our existing referral collaborative, we look forward to welcoming even more patients to this city-wide network as we welcome their babies into the world.”

doctor examining pregnant woman

Low parental socioeconomic status alters brain development in unborn babies

doctor examining pregnant woman

A first-of-its-kind study with 144 pregnant women finds that socioeconomic status (SES) has an impact in the womb, altering several key regions in the developing fetal brain as well as cortical features.

Maternal socioeconomic status impacts babies even before birth, emphasizing the need for policy interventions to support the wellbeing of pregnant women, according to newly published research from Children’s National Hospital.

A first-of-its-kind study with 144 pregnant women finds that socioeconomic status (SES) has an impact in the womb, altering several key regions in the developing fetal brain as well as cortical features. Parental occupation and education levels encompassing populations with lower SES hinder early brain development, potentially affecting neural, social-emotional and cognitive function later in the infant’s life.

Having a clear understanding of early brain development can also help policymakers identify intervention approaches such as educational assistance and occupational training to support and optimize the well-being of people with low SES since they face multiple psychological and physical stressors that can influence childhood brain development, Lu et al. note in the study published in JAMA Network Open.

“While there has been extensive research about the interplay between socioeconomic status and brain development, until now little has been known about the exact time when brain development is altered in people at high-risk for poor developmental outcomes,” said Catherine Limperopoulos, Ph.D., director of the Developing Brain Institute and senior author. “There are many reasons why these children can be vulnerable, including high rates of maternal prenatal depression and anxiety. Later in life, these children may experience conduct disorders and impaired neurocognitive functions needed to acquire knowledge, which is the base to thrive in school, work or life.”

The findings suggest that fetuses carried by women with low socioeconomic backgrounds had decreased regional brain growth and accelerated brain gyrification and surface folding patterns on the brain. This observation in lower SES populations may in part be explained by elevated parental stress and may be associated with neuropsychiatric disorders and mental illness later in life.

In contrast, fetuses carried by women with higher education levels, occupation and SES scores showed an increased white matter, cerebellar and brainstem volume during the prenatal period, and lower gyrification index and sulcal depth in the parietal, temporal and occipital lobes of the brain. These critical prenatal brain growth and development processes lay the foundation for normal brain function, which ready the infant for life outside the womb, enabling them to attain key developmental milestones after birth, including walking, talking, learning and social skills.

There is also a knowledge gap in the association between socioeconomic status and fetal cortical folding — when the brain undergoes structural changes to create sulcal and gyral regions. The study’s findings of accelerated gyrification in low SES adds to the scientific record, helping inform future research, Limperopoulos added.

The Children’s National research team gathered data from 144 healthy women at 24 to 40 weeks gestation with uncomplicated pregnancies. To establish the parameters for socioeconomic status, which included occupation and education in lieu of family income, parents completed a questionnaire at the time of each brain magnetic resonance imaging (MRI) visit. The researchers used MRI to measure fetal brain volumes, including cortical gray matter, white matter, deep gray matter, cerebellum and brain stem. Out of the 144 participants, the scientists scanned 40 brain fetuses twice during the pregnancy, and the rest were scanned once. The 3-dimensional computational brain models among healthy fetuses helped determine fetal brain cortical folding.

Potential proximal risk factors like maternal distress were also measured in the study using a questionnaire accounting for 60% of the participants but, according to the limited data available, there was no significant association with low and high socioeconomic status nor brain volume and cortical features.

Authors in the study from Children’s National include: Yuan-Chiao Lu, Ph.D., Kushal Kapse, M.S., Nicole Andersen, B.A., Jessica Quistorff, M.P.H., Catherine Lopez, M.S., Andrea Fry, B.S., Jenhao Cheng, Ph.D., Nickie Andescavage, M.D., Yao Wu, Ph.D., Kristina Espinosa, Psy.D., Gilbert Vezina, M.D., Adre du Plessis, M.D., and Catherine Limperopoulos, Ph.D.