COVID-19 Pandemic–Related Prenatal Distress and Infant Functional Brain Development

Psychological distress (eg, anxiety and depression) during pregnancy can disrupt fetal brain development and negatively affect infant behavior. Prenatal distress rose substantially during the COVID-19 pandemic according to most, but not all, studies, raising concerns about its potential effects on brain connectivity and behavior in infants. We investigated 63 mother-infant pairs as part of the Pregnancy during the COVID-19 Pandemic study. Mothers reported depression and anxiety symptoms prospectively during pregnancy; these were combined into one measure of prenatal maternal distress. Infant brain resting state functional magnetic resonance imaging (rs-fMRI) scans were obtained at 3 months of age, and mothers assessed infant behavior at 6 and 12 months using the Infant Behavior Questionnaire-Revised (IBQ-R) and the Ages and Stages Questionnaire (ASQ-3), respectively. The rs-fMRI was processed to measure functional connectivity within auditory, left frontoparietal, and default mode networks, and connectivity was tested for relationships to prenatal maternal distress. Prenatal distress and brain connectivity were also tested for relationships with infant behavior. Higher prenatal maternal distress was related to stronger functional connectivity in the infant auditory network (T = 2.5, p = 0.01, q = 0.04, df = 59) and higher infant ASQ-3 personal-social scores (T = 2.9, p = 0.006, q = 0.03, df = 48). No significant associations were found between brain connectivity and infant behavior. The impact of exposure to maternal prenatal distress on infant brain networks may be more apparent in networks that develop early, such as the auditory network, compared to later-developing networks, the effects of which may emerge later in childhood. The link between prenatal maternal distress and higher infant behavior scores may suggest compensatory changes, although further study is needed to determine how behavior manifests in the longer term. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. We actively worked to promote sex and gender balance in our author group.