Prenatal Maternal Depression and Anxiety Associated with Placental Structural and Functional Changes

• In Event: 2-123 - The Placenta and Child Development

Integrative Statement

Introduction: Developmental programming proposes that in utero exposures instigate an adaptive response in the fetus/child with long-term implications for health and development. Many studies suggest that maternal prenatal anxiety and depression may be one programming exposure, with long-term effects on neurodevelopmental deficits, behavioral and emotional difficulties, and metabolic and immune outcomes. The placenta, the intermediary between the maternal environment and the developing fetus, is unfortunately routinely overlooked in this research. The primary function of the placenta is to maintain homeostasis of the intrauterine environment via the transplacental barrier while providing the fetus with essential nutrients. This bi-directional communication is critical to a healthy pregnancy but may leave the fetal systems vulnerable to dysregulation of maternal biology. We examine the degree to which maternal prenatal anxiety and depression have reliable effects on placental structure and function, which could mediate the impact of these prenatal risks on child behavioral and health outcomes.
Methods: 290 women were recruited during their first trimester of pregnancy from outpatient obstetrics clinics in the community, oversampling for high psychosocial risk but medically normal-risk pregnancies. Women were assessed at each trimester and provided information on prenatal symptoms, socio-demographic risk, and health behaviors. Depression was measured using the Edinburgh Postnatal Depression Survey (EPDS); anxiety was measured using the Penn State Worry Questionnaire (PSWQ). The placentae were collected and processed according to an established protocol. To date, detailed analyses of placental structure and function have been completed on 85 placentae. Analyses involved 3-dimensional imaging, tissue sampling for inflammation, placental blood collection, and liquid nitrogen-frozen placental villous aliquots for genomic analyses and environmental exposures.
Results: Our success rate in collecting placenta data was ~95%. Bivariate correlations indicated that depression and anxiety (averaged over pregnancy) predicted lower birth weight (-.32* and -.27*, respectively) and, more notably and more novel, several placental characteristics. Specifically, maternal depression predicted total surface area (-.37**) and volume (-.34*); mean anxiety predicted total surface area (-.37*), total standard thickness (-.29*) and total volume (-.25+).
Conclusion:
This is the first study to demonstrate a reliable association between documented prenatal maternal psychological risks for poor child health outcomes and measures of placental function and structure. In general, the findings imply weaker vascularization of the placenta when mothers report higher levels of anxiety and depression during pregnancy. These results clarify and extend research on the developmental origins of health and disease (DOHaD) model, highlighting the long- lasting effects of prenatal exposures on children. These analyses will be extended at the meeting to include a larger sample of placenta and child neurobehavioral outcomes through 6 months of age.

Authors

• Ana Vallejo Sefair, University of Rochester Medical Center
  Presenting Author

• Richard Kermit Miller, University of Rochester School of Medicine and Dentistry
  Non-Presenting Author

• Allison Ciesla, University of Rochester
  Non-Presenting Author

• Emily Barrett, Rutgers School of Public Health
  Non-Presenting Author

• Carolyn Salafia, Placental Analytics
  Non-Presenting Author

• Ruchit Shah, Placental Analytics
  Non-Presenting Author

• Thomas O'Connor, University of Rochester
  Non-Presenting Author