“Does infection in pregnancy impact baby’s brain development?”

This is a topic that I’ve been asked to cover quite a few times lately. I’ll be honest. It’s a tough subject and one that I’ve been hesitant to discuss. Why? Because the data is limited, and I obviously do not want to cause unnecessary widespread panic. In short…We still need more research.

According to a December 2019 article published in AJOG, “the impact of infections and inflammation during pregnancy on the developing fetal brain remains incompletely defined, with important clinical and research gaps.”

“However, prenatal exposure to a wide variety of viral and bacterial infections—may subtly alter fetal brain development, leading to neuropsychiatric consequences for the child later in life” (Al-Haddad et al., 2019).

Ahhh so scary! I know. This is not meant to completely freak you out, but rather shed a little light on what the current data shows AND  hopefully you will find the key points below to be reassuring and helpful.

First, know that psychiatric disorders are extremely complex and likely multifactorial…and strong data looking at randomized controlled trials is unethical. Therefore, we’re left to analyze data that is from an observational type of framework. That being said, I’ve done quite a bit of research looking into what we do have available, which is in fact pretty substantial. Here’s a very high level summary of what I’ve found.

According to the expert summary, “Fetal Origins of Mental Illness”, published in the American Journal of Gynecology, “The link between influenza infections in pregnant women and an increased risk for development of schizophrenia in their children was first described more than 30 years ago. Since then, evidence suggests that a range of infections during pregnancy may also increase risk for autism spectrum disorder and depression in the child. Subsequent studies in animal models demonstrated that both pregnancy infections and inflammation can result in direct injury to neurons and neural progenitor cells or indirect injury through activation of microglia and astrocytes, which can trigger cytokine production and oxidative stress (Al-Haddad et al., 2019). Whew. That’s a mouthful.

Another recent study published in the American Journal of Psychiatry looked at data from over 15,000 pregnancies of women enrolled b/w 1959 and 1966 through the Collaborative Perinatal Project and concluded that systemic maternal bacterial infection during pregnancy is associated with an elevated risk of psychotic disorder in offspring and that the association varies by infection severity and offspring sex (Lee et al., 2020). Additional studies have linked maternal viral infection and challenges to the immune system to schizophrenia and related psychoses in offspring.

newborn

Ok. Don’t freak out. Here are a few take-home points that I want to make.

  1. This BY NO MEANS is saying that if you have experienced an infection in pregnancy that your child will experience a psychological disorder. That would be absurd based on how susceptible pregnant women are to infection.
  2. If you currently have a child with a psychological disorder, please know that this is NOT pointing directly to an infection you experienced as the culprit.
  3. For those trying to conceive OR currently pregnant, please see a Board Certified & Licensed Clinical Medical Provider (MD, DO, CNM, NP, or PA) before and during your pregnancy who can ensure that you remain healthy and are also immune to potential teratogenic and even injury causing infections such as Rubella and who can also evaluate and treat you appropriately if you are experiencing an infection.
  4. Let your provider know if you are experiencing any illness and do not delay treatment if they deem it necessary.
  5. Play your part in supporting your immune system. Eat well, exercise, get plenty of sleep, and strongly consider your provider’s recommendation for  immunization to specific teratogenic or injury causing illnesses. 
  6. Do not freak out. Severity* of SYSTEMIC  infection was a key player in these studies. Women who are pregnant already have a lowered immune system and certainly experience infections commonly (such as the common cold). This is expected. However, we want to prevent severe infection. Here’s where doing your part and also being under the care of a medical provider is key.

 

Ok folks. This was a very tough subject to cover. My hope is that this did not instill fear but rather equipped you with a little knowledge and insight into a few actions that you can take. Again, causes of psychological disorders in offspring are still being studied, extremely complex, and multifaceted.

 

Disclaimer: This article is not to be used as personal medical advice. It is solely intended for the purpose of education only.

 

Author: Brookes Vaughan – Board Certified WHNP and Founder and CEO of The Women’s Health Company. If you live in Georgia and would like to schedule a telemedicine appointment with Brookes, she would be honored to see you as a patient. Schedule Here

nursepractitioner

 

References:

Al-Haddad, B., Oler, E., Armistead, B., ElSayed, N., Wienberger, D., Kapur, R., … Waldorf, K. A. (2019). The Fetal Origins of Mental Illness. American Journal of Obstetrics and Gynecology , 221(6), 549–562. doi: 10.1007/0-387-32632-4_17

Buka SL, Tsuang MT, Torrey EF, Klebanoff MA, Bernstein D, Yolken RH. Maternal Infections and Subsequent Psychosis Among Offspring. Arch Gen Psychiatry. 2001;58(11):1032–1037. doi:10.1001/archpsyc.58.11.1032

Lee YH, Cherkerzian S, Seidman LJ, Papandonatos GD, Savitz DA, Tsuang MT, Goldstein JM, Buka SL. (2020). Maternal Bacterial Infection During Pregnancy and Offspring Risk of Psychotic Disorders: Variation by Severity of Infection and Offspring Sex. American Journal of  Psychiatry, 177 (1), doi: 10.1176/appi.ajp.2019.18101206. 

Lee YH, Papandonatos GD, Savitz DA, Heindel WC, Buka SL. (2020). Effects of prenatal bacterial infection on cognitive performance in early childhood. Paediatric Perinatal Epidemiology. doi: 10.1111/ppe.12603.

 

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