Abstract
Antenatal depression is associated with an increased risk of offspring neuro-developmental disorders, potentially as a consequence of an altered brain development in utero. We hypothesized that reducing maternal depression by Cognitive Behavioral Therapy (CBT) during pregnancy may ameliorate the offspring’s brain (micro)structural outcomes. 54 pregnant women with a diagnosed clinical depression were randomly allocated to CBT or Treatment as Usual (TAU), showing moderate to large depression symptom improvements after CBT. In 16 of their children (69% boys, N(TAU) = 8, N(CBT) = 8, mean age = 5.9 years, range = 3.9–7.1 years) brain Magnetic Resonance Imaging (MRI) scans were conducted. Children from the CBT group had a thicker right lateral occipital cortex (difference: 0.13 mm, 95% CI = 0.005–0.26) and lingual gyrus (difference: 0.18 mm, 95% CI = 0.01–0.34). In the CBT group, Voxel-Based Morphometry analysis identified one cluster showing increased gray matter concentration in the right medial temporal lobe at p < 0.05 uncorrected, and fixel-based analysis revealed reduced fiber-bundle cross-section in the Fornix, the Optical Tract, and the Stria Terminalis at p < 0.01 uncorrected. However, none of the results survived correction for multiple testing. Our explorative analyses provided some indication that antenatal CBT for depression may ameliorate offspring’s brain (micro)structural outcomes, but the sample size was extremely small, and our results should be cautiously interpreted. Larger studies are warranted to confirm our preliminary conclusions that CBT for antenatal depression affects brain development in children.
Highlights
There is considerable evidence that prenatal exposure to maternal depression is associated with less favorable child outcomes, with varying directions of effects depending on the timing of the exposure, as well as the outcome measured [1,2,3,4]
We aimed to address this gap in the literature, by conducting an explorative brain Magnetic Resonance Imaging (MRI) study, in children born to mothers who had participated in a pilot Randomized Controlled Trial (RCT) on the effectiveness of Cognitive Behavioral Therapy (CBT) for depression during their pregnancy [21]
We found no robust evidence for a treatment effect of CBT for antenatal depression onstructural brain characteristics in 6-year-old offspring
Summary
There is considerable evidence that prenatal exposure to maternal depression is associated with less favorable child outcomes, with varying directions of effects depending on the timing of the exposure, as well as the outcome measured [1,2,3,4]. Higher levels of depression and anxiety in pregnancy have been linked to more “difficult” temperament, and more emotional and behavioral problems in children, when postnatal confounding factors were taken into account [4,7,8,9,10]. Neonates prenatally exposed to maternal depression show altered functional connectivity, as well as lower fractional anisotropy and axonal diffusivity between the amygdala and the left temporal cortex and insula, the bilateral anterior cingulate, medial orbitofrontal and ventromedial prefrontal cortices [13,14]. Studies in children in early to late childhood report that prenatal exposure to maternal depression is associated with cortical thinning, primarily in the right superior, medial orbital, and frontal pole regions of the prefrontal cortex, as well as in temporal brain regions [15,16,17], and an increased volume of the amygdala [18]
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