Effects of Maternal Psychological Stress During Pregnancy on Offspring Brain Development: Considering the Role of Inflammation and Potential for Preventive Intervention

Abstract

Heightened psychological stress during pregnancy has repeatedly been associated with increased risk for development of behavior problems and psychiatric disorders in offspring. This review covers a rapidly growing body of research with the potential to advance a mechanistic understanding of these associations grounded in knowledge about maternal-placental-fetal stress biology and fetal brain development. Specifically, we highlight research employing magnetic resonance imaging to examine the infant brain soon after birth in relation to maternal psychological stress during pregnancy. This approach increases capacity to identify specific alterations in brain structure and function and to differentiate between effects of pre- versus postnatal exposures. We then focus on the extensive preclinical literature and emerging research in humans that have found that heightened maternal inflammation during pregnancy as a mechanism through which maternal stress influences the developing fetal brain. We place these findings in the context of recent work identifying psychotherapeutic interventions that have been found to be effective for reducing psychological stress among pregnant individuals and that also show promise for reducing inflammation. We argue that a focus on inflammation, among other mechanistic pathways, may lead to a productive and necessary integration of research focused on the effects of maternal psychological stress on offspring brain development and on prevention and intervention studies aimed at reducing maternal psychological stress during pregnancy. In addition to increasing capacity for common measurements and understanding potential mechanisms of action relevant to maternal mental health and fetal neurodevelopment, this focus may inform and broaden thinking about prevention and intervention strategies.

Keywords: Inflammation; Intervention; Neurodevelopment; Pregnancy; Prenatal stress; Psychological distress.

Figure 1.

Psychological stress during pregnancy is hypothesized to be a common pathway through which life history, current events, environmental conditions, physical and mental health, and other factors influence stress-sensitive aspects of gestational biology, including immune functioning. Psychological stress during pregnancy has potential to both mediate and moderate these other influences on gestational biology (e.g. impacts of psychological stress on metabolism would lead to consideration of stress as a moderator of the effects of birth parent nutrition on gestational biology). Direct pathways also exist from these other factors to gestational biology, but we highlight the role of psychological stress here as a potentially modifiable factor. Evidence-based psychotherapeutic interventions are hypothesized to reduce inflammation via reduction in psychological stress during pregnancy.