Fetal Body Composition and Organ Volume Trajectories in Association With Maternal Perceived Stress or Depressive Symptoms in the Fetal 3D Study

Abstract

Objectives: Evaluate associations between maternal perceived stress and depressive symptoms, and fetal body composition and organ volumes.

Methods: In the NICHD Fetal 3D Study (2015-2019; n = 2457), stress and depressive symptoms were assessed at enrollment (10-13 weeks). High stress was defined as a Perceived Stress Scale (PSS) score ≥15 and high depressive symptoms, defined as an Edinburgh Postnatal Depression Scale (EPDS) score ≥10. Fetal body composition and organ volumes (cerebellar, lung, liver, and kidney) were measured up to five times between 15 and 40 weeks using three-dimensional (3D) ultrasound technology. Trajectories of body composition and organ volumes across pregnancy by high versus low PSS and EPDS were created using linear mixed models. Overall and weekly differences were compared after adjusting for covariates.

Results: Six hundred (24.4%) women scored ≥15 on the PSS, and 334 (13.6%) scored ≥10 on the EPDS. Fetuses whose mothers had PSS ≥15 had 0.4-0.9 cm³ smaller fractional fat arm volumes between 33 and 37 weeks, 0.2-0.5 cm³ larger fractional fat thigh volumes between 26 and 29 weeks, 4.0-8.0 cm³ larger average lung volumes between 33 and 37 weeks, and 1.0 cm³ smaller liver volumes between 19 and 21 weeks; and for EPDS ≥10, fetuses had 2.0-3.0 cm³ larger cerebellar volumes between 35 and 38 weeks. Findings were statistically significant (P < .05) and similarly robust in sensitivity analyses.

Conclusions: Greater maternal perceived stress and depressive symptoms early in pregnancy were associated with up to an 8.0 cm³ difference in fetal limb adiposity and organ volume growth. While health implications are unclear, our findings support current clinical practice guidelines for prenatal mental health screening.

Keywords: body composition; fetal development; fetal growth; maternal psychosocial distress; organ growth.