Maternal distress during COVID-19 linked to reduced neonatal brain volumes


A recent study found that maternal psychological distress during the COVID-19 pandemic is associated with reduced white matter and other brain volumes in newborns, highlighting potential long-term impacts on child development.

Maternal distress during COVID-19 linked to reduced neonatal brain volumes | Image Credit: © sebra - © sebra -

Maternal distress during COVID-19 linked to reduced neonatal brain volumes | Image Credit: © sebra - © sebra -

There is a link between maternal psychological distress and regional neonatal brain volumes, according to a recent study published in JAMA Network Open.1


  1. Maternal psychological distress during pregnancy, especially during the COVID-19 pandemic, is linked to reduced white matter and other brain volumes in neonates.
  2. Newborns of mothers with high psychological distress exhibited significant reductions in white matter volume, with a notable difference of -0.41 cm³ compared to those born pre-pandemic.
  3. Increased maternal distress was inversely associated with neonatal white matter, right hippocampal, and left amygdalar volumes, indicating widespread effects on brain development.
  4. The COVID-19 pandemic significantly heightened maternal anxiety and stress, leading to higher rates of psychological distress among pregnant women compared to pre-pandemic levels.
  5. The study underscores the need for further investigation into the long-term developmental impacts of prenatal exposure to maternal psychological distress, particularly during global crises such as the COVID-19 pandemic.

Fetal brain development is impacted by intrauterine stressors, influencing the growth and development of a child. Data has indicated maternal psychological distress as a stressor of early brain development, potentially lowering cognitive scores and increasing negative temperament up to 2 years of age.

Maternal stress has also been linked to other negative birth outcomes.2 One study reported significantly increased composite stress, anxiety, and depression (SAD) scores among women with unpredicted birth complications. Women with these complications also had increased hair cortisol concentration, which is associated with SAD scores.

The prevalence of psychological distress significantly increased during the COVID-19 pandemic, with pregnant women also impacted.1 During this time, fetal brain development was linked to reduced cerebral white matter, hippocampal, and cerebellar volumes, but the enduring effects of these prenatal alterations are unclear.

Investigators conducted a study to evaluate the impact of prenatal maternal mental health with neonatal brain development during the COVID-19 pandemic. Participants included mother-infant dyads undergoing magnetic resonance imaging (MRI) studies.1

Women with multiple gestational pregnancy, documented chromosomal abnormalities, congenital infection, maternal contraindications to MRI, or documented COVID-19 infection were excluded from the analysis. Self-reported data obtained included race, ethnicity, maternal age, and education level.

Maternal distress measures such as the Spielberger State Anxiety Inventory (SSAI), Spielberger Trait Anxiety Inventory (STAI), and Perceived Stress Scale (PSS) were used to determine maternal distress. Psychological distress was determined by an SSAI score over 40, STAI score over 40, or PSS score over 15.

A 3T MR scanner (Discovery MR750; GE Healthcare) and 8-channel high-resolution brain array were used to conduct neonatal MRI studies. The DrawEM (Developing Brain Region Annotation With Expectation-Maximization) tool was used to process volumetric brain measurements.

There were 223 dyads enrolled, with 64 excluded from the final analysis. A median gestational age of 39.6 weeks and median maternal age of 34.5 years were reported.1

Of mothers, 27.7% were Hispanic, Asian, or multiracial, 17% were Black, and 55.3% were White. A college or graduate degree was reported in 81.8% and employment as business professionals in 70.4%.

Maternal age, employment education level, neonatal sex, head circumference, gestational age, and weight at birth did not differ between cohorts. However, the gestational age when receiving a postnatal MRI was higher in the pandemic cohort vs the prepandemic cohort, at 44.9 weeks vs 41.9 weeks, respectively.

The pandemic cohort presented with increased SSAI, STAI, and PSS scores vs the prepandemic cohort. Anxiety, stress, and pooled psychological distress rates were 21.1%, 24.7%, and 28.4%, respectively, in the prepandemic cohort vs 61.8%, 69.1%, and 72.7%, respectively, in the pandemic cohort.1

White matter volume was significantly reduced among neonates born during the pandemic period vs the prepandemic period, with a difference of -0.41 cm3. However, differences were not reported for amygdalar, hippocampal, and cerebellar volumes.

White matter was significantly reduced among infants of mothers with increased psychological distress in both cohorts, with a difference of -0.36 cm3. Additionally, right hippocampal and left amygdalar volumes were reduced by -0.35 cm3 and -0.49 cm3, respectively.

An inverse association was reported for cerebral white matter and left amygdalar volumes with increased maternal psychological distress when adjusting for pandemic effects, at -4.94 cm3 and -0.03 cm3, respectively.

These results indicated a link between maternal psychological distress during the COVID-19 pandemic and decreased volumetric brain growth in offspring. Investigators recommended further studies about the long-term impact on offspring development.1


  1. Weiner S, Wu Y, Kapse K, et al. Prenatal maternal psychological distress during the COVID-19 pandemic and newborn brain development. JAMA Netw Open. 2024;7(6):e2417924. doi:10.1001/jamanetworkopen.2024.17924
  2. Krewson C. Maternal cortisol linked to birth complications. Contemporary OB/GYN. February 8, 2024. Accessed June 20, 2024.
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