Mindfulness-based stress reduction intervention during pregnancy changes maternal brain

Abstract

Our aim is to evaluate the effect of a structured stress reduction intervention based on mindfulness during pregnancy on the maternal brain. We report a secondary analysis of IMPACT BCN, a randomized clinical trial including pregnant women randomly allocated to 8-week Mindfulness-Based Stress Reduction (n = 41) or usual care (without any intervention, n = 35). Maternal magnetic resonance (MR) was performed in the third trimester, cluster-wise analysis was used to assess cortical morphometric differences, and proton magnetic resonance spectroscopy (¹H-MRS) to evaluate the metabolic characteristics. Mindfulness status was evaluated using the Five Facet Mindfulness Questionnaire (FFMQ). Results showed that participants from Stress reduction group had significantly larger surface areas in the right superior frontal region as compared to the Usual care group (90%CI: 0.023-0.029, p = 0.03). The¹H-MRS revealed that Stress reduction group participants, had higher concentrations of myo-inositol (adjusted mean difference D 0.37 mol/L, 95%CI 0.05-0.69) as compared to Usual care. Participants who had high mindfulness on FFMQ facets of non-judgmental (D 358.5 mm², 95%CI 53.5-663.6) and non-reactivity (D 362.3 mm², 95%CI 18.8-705.7) had larger right superior frontal area. In conclusion, Mindfulness-Based Stress Reduction program during pregnancy has a significant effect on maternal brain structure and is associated with metabolite concentration changes.

Keywords: Brain; MRI; Mindfulness-based stress reduction; Pregnancy; Proton magnetic resonance spectroscopy; Small-for-gestational age.

Fig. 1

Flow chart of the study population.

Fig. 2

Map and table of cortical surface area differences between Stress reduction group and Usual care group mothers. CWP clusterwise p-value, CWPLow-High 90% confidence interval for CWP, MNI Tal (XYZ) is the Talairach (MNI305) coordinate of the maximum. (A) Left hemisphere. (B) Right hemisphere: right superior frontal area, p = 0.03. Maternal brain surface on lateral and medial views. Images generated from a general linear model with total intracranial volume, maternal age, magnetic resonance protocol, nulliparity, maternal thyroid disease and work class. The color bar indicates logarithmic scale of p values (-log10). Red to yellow color reflects the increased area surface in the Stress reduction group participants as compared to Usual care group participants. (C) Cortical surface area difference between Stress reduction group and Usual care group participants.

Fig. 3

Right superior frontal surface area differences between high mindfulness and low mindfulness. FFMQ five facet mindfulness questionnaire. Z scores higher than 0.4 was considered as High mindfulness group. High and Low mindfulness group sample sizes are: Observation: High n = 43, Low n = 23; Description: High n = 18, Low n = 48; Awareness: High = 18, Low n = 48; Non-judgmental: High n = 33, Low n = 33; Non-reactivity: High n = 23, Low n = 43.

Fig. 4

Sample of voxel location and the spectra in the anterior cingulate cortex. (a) Location of the voxel position in the anterior cingulate gyrus, (b)Spectra obtained from the MR scanner. Cr creatine, mI myo-inositol, Cho choline, NAA N-acetyl aspartate.