Pregnancy Stress, Anxiety, and Depression Sequela on Neonatal Brain Development—Reply

In Reply We thank Abbasi and Puusepp-Benazzouz for raising an important question about our study that was published in JAMA Pediatrics, “Association of Maternal Psychological Distress With In Utero Brain Development in Fetuses With Congenital Heart Disease.”¹ In healthy fetuses, we reported that maternal trait anxiety was negatively associated with left and right hippocampal volumes. However, these associations were no longer significant after adjusting for multiple testing.¹ Following Abbasi and Puusepp-Benazzouz’s suggestion, we further investigated whether brain volumes were different in healthy fetuses with high (positive) maternal psychological distress vs low (negative) maternal psychological distress. We found that healthy fetuses of pregnant women with high trait anxiety had significantly smaller left (mean, 0.508 cm³ vs 0.540 cm³; P = .007) and right (mean, 0.539 cm³ vs 0.578 cm³; P = .01) hippocampal volumes compared with healthy fetuses of pregnant women with low trait anxiety. There were no differences in other brain regions (ie, total brain, cerebrum, cerebellum, and brainstem) between healthy fetuses in pregnancies with high vs low maternal psychological distress.