Perinatal Stressors and Consequences for Neonates with Critical Congenital Heart Disease
Christina Ronai1,2, Isabel Katlaps3, Amanda Kim3
1Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA.
Insights
Prenatal stress in pregnancies with congenital heart disease (CHD) is linked to increased need for corticosteroid treatment in newborns after surgery. Higher prenatal stress scores correlate with worse neonatal outcomes.
Area of Science:
- Perinatal Medicine
- Pediatric Cardiology
- Neonatal Surgery
Background:
- Prenatal diagnosis of congenital heart disease (CHD) causes significant parental stress.
- Maternal stress during pregnancy may negatively affect neonatal outcomes.
- Existing psychosocial stressors can exacerbate maternal stress.
Purpose of the Study:
- To investigate the relationship between prenatal stress and neonatal outcomes in pregnancies with prenatally diagnosed CHD.
- To explore the impact of maternal stress on neonates undergoing cardiac surgery.
Main Methods:
- Pilot retrospective cohort study (2019-2021) of pregnancies with critical CHD.
- Data collected on pregnancy, neonatal, and postoperative outcomes, including exogenous corticosteroid treatment (ECT).
- A composite prenatal stress score (PSS) was developed to quantify maternal stress.
Main Results:
- 41 maternal-fetal dyads were analyzed; 32% of neonates had single-ventricle anatomy.
- Higher prenatal stress scores (PSS) were associated with the need for ECT after CHD surgery (p=0.01).
- PSS did not correlate with birthweight, infection, or hypoglycemia.
Conclusions:
- Prenatal stress is multifactorial and linked to neonatal outcomes.
- Higher prenatal stress correlates with the need for post-bypass ECT.
- A stressful intrauterine environment may be associated with poorer neonatal postoperative outcomes in CHD cases.
Introduction:
The prenatal diagnosis of congenital heart disease (CHD) is a traumatic event that can cause expectant parents to experience anxiety, depression, and toxic stress. Prenatal exposure to stress may impact neonatal postoperative outcomes. In addition, expectant parents may have other psychosocial stressors that may compound maternal stress. We investigated the relationship between stress in pregnancies complicated by prenatally diagnosed CHD and their neonatal outcomes.
Methods:
A pilot retrospective cohort study of pregnancies with prenatally diagnosed critical CHD (2019-2021) was performed. The collected data included pregnancy characteristics and neonatal and postoperative outcomes (including the need for exogenous corticosteroid treatment (ECT)). In order to quantify prenatal stressors, a composite prenatal stress score (PSS) was established and utilized.
Results:
In total, 41 maternal-fetal dyads were evaluated. Thirteen (32%) neonates had single-ventricle anatomy. The need for ECT after CHD surgery was associated with higher pregnant patient PSS (p = 0.01). PSS did not correlate with birthweight, infection, or hypoglycemia in the neonatal period.
Conclusions:
Prenatal stress is multifactorial; higher PSS is correlates with post-bypass ECT, suggesting that a stressful intrauterine environment may be associated with worse neonatal postoperative outcomes.
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