When deciding whether or not to make use of psychotropic medications while pregnant, we must consider the potential risks related to untreated psychiatric illness within the mother. Untreated psychiatric illness while pregnant can pose significant risks to each the mother and her unborn child. Previous studies have demonstrated a link between depression and/or anxiety within the mother and increased risk for preterm birth and low birth weight.

A recent study published in JAMA has used ultrasonography to observe fetal growth in the course of the critical rapid growth stage (CRGS). Between roughly 30 and 37 weeks of gestation, there’s a critical period of rapid fetal growth during which fetal weight and stores of adipose tissue increase essentially the most rapidly. Rapid growth during this stage contributes to newborns’ adaptation to the thermal and dietary stressors after birth and plays an important role in the event and maturation of white matter within the fetal brain. Disruptions in fetal growth during this sensitive time period may result in increased vulnerability to heart problems, obesity, and neuropsychiatric disorders. 

On this study, a complete of two,676 pregnant women were included, during which the mean (SD) age of moms was 28.0 (4.4) years. Nearly half (48.4%) of the offspring were female. Measures of biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC), and calculated estimates of fetal weight (EFW) were evaluated longitudinally, taking measurements at two time points: at 30 weeks of gestation (range, 28 to 32) and at 37 weeks of gestation (range, 35 to 39). Depressive symptoms within the mother were measured using the Edinburgh Postnatal Depression Scale (EPDS).

On this prospective cohort study, the researchers observed an association between maternal depressive symptoms while pregnant with slower rates of fetal growth (femur length, abdominal circumference, and estimated fetal weight) between 30 and 37 weeks of gestation. These associations continued to be significant after adjusting for maternal demographic characteristics, socioeconomic status, lifestyle aspects, and eating regimen. Interestingly, they observed more pronounced reductions in fetal growth rate in female fetuses and in those born to wealthier families.

Clinical Implications

The findings of the present study are consistent with earlier studies reporting associations between maternal depressive symptoms and increased risk of low birth weight and reductions in fetal head circumference. Given the importance of this developmental stage for subsequent cognitive function in childhood and cardiovascular health in later life, this study suggests a possible pathway by which maternal depressive symptoms can contribute to opposed health outcomes in children. 

Most significantly, this study provides additional evidence indicating that maternal depression while pregnant may negatively affect fetal development. What we don’t yet know is how treatment for depression may impact this trajectory. If we discover depression earlier in the middle of pregnancy, would appropriate treatment prevent these deficits in fetal growth? Further research will help to reply this query; nevertheless, there are a lot of studies indicating that treatment of depression while pregnant may improve outcomes. 

Ruta Nonacs, MD PhD

References
Zhang L, Li P, Ge Q, Sun Z, Cai J, Xiao C, Yu C, Nosarti C, Liao J, Liu Z. Maternal Prenatal Depressive Symptoms and Fetal Growth Throughout the Critical Rapid Growth Stage. JAMA Netw Open. 2023 Dec 1;6(12):e2346018.