Prenatal maternal psychological distress is associated with neurodevelopmental outcomes in toddlers with congenital heart disease

BACKGROUND: Pregnant women carrying fetuses with congenital heart disease (CHD) report high psychological distress. This study examines associations between prenatal maternal distress and 18-month neurodevelopmental outcomes in toddlers with CHD. METHODS: We recruited women with pregnancies complicated by fetal CHD. Maternal anxiety, stress, and depression were measured using the Spielberger State-Trait Anxiety Inventory, Perceived Stress Scale, and Edinburgh Postnatal Depression Scale. Neurodevelopment at 18 months was assessed using Bayley Scales of Infant and Toddler Development III and Infant-Toddler Social and Emotional Assessment. Postnatal parenting stress was measured using Parenting Stress Index-Short Form. RESULTS: We studied 123 pregnant women (21-39 gestational weeks). Half screened positive for elevated anxiety, 60% for stress, and 34% for depression. Elevated prenatal maternal psychological distress was associated with lower motor scores and increased externalizing behaviors in CHD toddlers, with stronger associations in single-ventricle than two-ventricle CHD. Elevated prenatal maternal distress was associated with increased postnatal parenting stress at 18-month testing, including higher Total Stress, Parental Distress, and Difficult Child scores. Postnatal parenting stress mediated associations between prenatal psychological distress and toddler externalizing behaviors. CONCLUSION: Elevated prenatal maternal psychological distress is associated with impaired motor and social-emotional development in toddlers with CHD and persistent postnatal parenting stress. IMPACT: The impact of maternal psychological distress on the long-term neurodevelopmental outcomes of toddlers with congenital heart disease (CHD) is unknown. This study examines the association between prenatal maternal distress and 18-month neurodevelopmental outcomes in toddlers with CHD. Increased prenatal maternal psychological distress is associated with impaired motor and social-emotional development in toddlers with CHD, as well as persistently elevated parenting stress. Associations between elevated prenatal maternal psychological distress and adverse motor and externalizing outcomes were stronger in toddlers with single-ventricle versus two-ventricle CHD. Identifying early risk factors for neurodevelopmental impairment in CHD toddlers is critical for developing early interventions that reduce maternal distress and improve long-term outcomes.