Prenatal Maternal Depression and the Neural Development of Social Cognition

Depression during pregnancy is prevalent, under-diagnosed, and under-treated. Children of mothers with major depressive disorder (MDD) during pregnancy often exhibit cognitive, social, emotional, and behavioral dysfunction that persists into adolescence and adulthood. Knowledge of how prenatal depression affects children's brain development is necessary to inform practice guidelines for treating depression during pregnancy.;Twenty one mother-child dyads with longitudinally characterized prenatal and postnatal maternal MDD were studied. The children were behaviorally evaluated and scanned (3T fMRI) at 4-6 years of age. During scanning, they completed a social joint attention task that included affective, cognitive conflict, and attentional demands. Independent Component Analysis (ICA) of fMRI data was conducted to assess the impact of prenatal maternal depression (PMD) on both intrinsic and extrinsic connectivity of three select neural processing networks (the left occipital temporal, limbic, and fronto-cingulate networks).;PMD severity was associated with diminished intrinsic activity within the fronto-cingulate and limbic networks during social conflict trials and was not associated with changes intrinsic activity in the left occipital temporal network. Moreover, PMD was related to increased extrinsic connectivity of the left dorsal lateral prefrontal cortex into the limbic network, decreased extrinsic connectivity of the right inferior frontal gyrus into the limbic network, and decreased extrinsic connectivity of the right anterior cingulate into the fronto-cingulate network. PMD was not related to extrinsic connectivity for the left occipital temporal network.;The present study adds to the limited literature in this subject area by characterizing younger children at risk for mood disorders. Results indicate that exposure to PMD leads to disrupted neural development in the intrinsic and extrinsic functional organization of neural networks. The significance of this outcome is relevant to clinical decision-making related to the aggressive management of moderate to severe depression in pregnancy. This study highlights the neurodevelopmental cost to the offspring of unresolved maternal depression and suggests a re-evaluation of the clinical decision to avoid first-line treatment in pregnancy.