ISPP 2015

Career Opportunities in Pharmacy
Does a mother’s mental health affect her fetus? (Part 1) – interview with Catherine Monk | VIEWPOINT


Dr: Monk: I think the bottom line is that
we need to be paying attention to women’s emotional well-being during pregnancy as much
as we do to their physical well-being, and by doing so, we can help not only women but,
potentially, their future children. Katharine: So, Dr. Monk, I’m so happy to have
you here talking about your research in early development. Maybe you can start by saying a little bit
about what kind of work you do, what kinds of questions you’re trying to answer. Dr. Monk: Sure, sure, and thank you for having
me here. So, our work falls under the rubric of the
developmental origins of health and disease. And by development, we’re really starting
with the fetus. And our main question is understanding the
risk for what we call psychopathology. Another way to call that is really having
mental health problems. So, I know this is probably not how people
are used to thinking about it. But we are going all the way back to the fetal
period, so the developmental origins of the disease, of mental health disease, and finding
how some of the early factors influencing the risk for having poor mental health outcomes
may start in utero. And we actually think that a risk factor is
what’s called an exposure that happens to the fetus in utero, and that exposure is the
mother’s mental health problems. And so, really and crucially, what this suggests
is that there are three possible pathways by which mental illness may travel in families. So, we all think about genes of risk that
likely happen in families. Then, we are pretty used to thinking about
a child that grows up in a very, very dysfunctional home, say, with an alcoholic parent, an abusive
parent, a very, very depressed parent, has risk for mental health problems. It’s a hard way to grow up. Then, we’re pushing back the timeframe to
say there’s a third pathway. So, the mother’s mental health problems while
she’s pregnant can get transmitted to the fetus and put that child at risk for future
mental health problems. Katharine: So, you’re doing research on pregnant
women and the fetus in utero? Dr. Monk: Yes. Katharine: So, how do you do that kind of
research? Dr. Monk: Right. I always like to say, “How do you ask the
fetus questions?” And we are limited. It’s not as easy as you and I having a conversation,
obviously. But again, there is this developing brain
and there is some fetal behavior and we can probe that fetal behavior. So, some of the ways that the fetus gives
us an answer in his or her behavior is heart rate reactivity, so to stimuli, and also movement
reactivity to stimuli. So, we can see individual differences in how
fetuses respond to stimuli just the way we can see in, say, child temperament at three
or four years old. Some kids are less or more reactive, even
four months old. And now, we’re pushing the time back. So, in heart rate reactivity to stimuli or
movement reactivity, we can see differences in how fetuses are developing. Katharine: So, what are some of the factors
that you’re seeing impacting the reactivity, the behavior, really, of the fetus? Dr. Monk: Right. So, we’ve been focused on actually, you know,
this maternal experience of distress, specifically having significant depression or stress or
anxiety during your pregnancy, and that that actually seems to be associated with differences
on how the fetus is developing. So, let me take a few steps back and walk
you through this. So, some researchers going way back to 1967
did a very interesting study, again, asking the fetus questions and getting the answer
in fetal heart rate. And what they did, believe it or not, was
tell a pregnant woman towards the end of her pregnancy that she was in a room, it had just
about half the amount of oxygen needed for life, but that her baby would probably live. And you can imagine, this is a life-threatening
shock. Well, her heart rate went right up because
they were monitoring her. And at the same time, the fetus’ heart rate
went way up. So, that tells us, if the woman is having
an emotional experience, there was no change in the air in the room. Just the thought that “This may hurt my baby,”
she had a reaction and so did her fetus. So, we’ve learned from that paradigm and we
don’t give the women a stress that’s life-threatening. Thankfully, we’re not allowed to do things
like that anymore, but we do give pregnant women a stressor in our lab. It’s a cognitive challenge, and what we’ve
seen is that fetuses whose mothers have significant anxiety and stress in their lives, when their
mothers are doing this task and feeling nervous themselves, their heart rate goes up. Katharine: So, what is the task? Dr. Monk: Well, it’s called a Stroop color-word
matching test and it’s been around for almost 50 years in psychology. It’s really a task where you read words, color
words, but in a different color than the word itself. Katharine: Ah, okay. Dr. Monk: But because we all read so automatically
as adults, if you see the word blue in red ink, you punched down blue, but the right
answer is the color of the letters. And when we do the task, we have someone in
a white coat letting them know they’re not working fast enough. The computer tells them when they get it wrong. So, it’s a performance anxiety. And interestingly, the women, on average,
do show physiologic and psychological stress reactivity. But what’s really amazing is that fetuses
differentiate themselves. So, it’s only the fetuses of highly anxious
and stressed or depressed women that shows heart rate increase during that stressor in
the lab, and then their heart rate goes down when the women are in recovery. So, what we think is happening is, again,
like a temperament in a baby, these fetuses are more reactive to stimuli. It’s a little complicated here. But what the stimuli is is that, again, the
mother’s life is the fetus’ life, it’s the fetus’ experiences. When she has a reaction, she’s getting stressed,
her heart rate’s beating faster, that’s sound in vestibular stimuli for the fetus. So, some of these fetuses are reacting to
their world changing. And some of the other fetuses of the women
who don’t have distress in their lives, their fetuses, their heart rates don’t change. Katharine: So, you’re saying a really strong
correlation then between the kind of calmness of the fetus and the emotional condition that
the mother is in. So, when you say stress, anxiety, is it like
they have to commute a long way to work? What are the factors that you’ve identified
that are really having this kind of an impact? Dr. Monk: Right. That’s such an important question because
we all have stress in our lives. And, you know, I’m not the only one doing
research in this area. There are many different labs across the world
and none of us want to be giving pregnant women something else to worry about. And frankly, we all have a bit of a stress
in our lives and many people think fetuses need to feel a little stress because they
need to get inoculated. The world out there has ups and downs. So, we’re really talking about a serious depression. We’re really talking about feeling overwhelmed
by life that you can’t handle things or, you know, there are many people…anxiety disorders
are one of the most common mental health problems. And so just anticipatory something’s gonna
go wrong, I don’t…or rethinking over and over past things that didn’t go well. So, it’s really people who are quite…women,
I should say, who are quite troubled in their emotional well-being. But it is not a continuum and we don’t…there’s
not, you know, certain cut-point where we can say, “Yes, this woman is affecting the
fetus and this woman isn’t.” Fetuses differ in their sensitivity. We’re still learning a lot about this. I think the bottom line is that we need to
be paying attention to women’s emotional well-being during pregnancy as much as we do to their
physical well-being. And by doing so, we can help not only women,
but potentially, their future children. Katharine: So, that’s what I wanted to ask
you. So there’s a fetus. Some are more reactive in the womb, some are
less reactive. So, what? What are the…are you seeing differences
in babies and young children after they’ve been born based on what you’d observed in
their physical state in the womb? Dr. Monk: Yeah, another key question. So, first, I’ll site research from other labs
where they’ve followed children out. Vivette Glover is one of the primary
people. And one of the major findings is that…actually,
I’ll tell you two…is that children exposed in utero to either significant maternal anxiety
or depression. You know, anxiety is really associated with
risk in six and seven-year-old children showing emotional problems themselves particularly
ADHD. And then, when girls have been followed, anxiety
and depression in their mothers in pregnancy, when these girls go into the puberty period,
they’re much more at risk for depression. So, there are these long-term outcomes. In terms of what we’ve seen in my lab, because
I stop around age two with the kids and we don’t quite have our data yet for age two,
but we have done follow-up studies, the first is that we see these babies who are, as fetuses,
are more reactive. They actually do go on at four months old
to have a more reactive temperament. And that is to a novo [SP] mobile being put
in front of them. They cry and move more, and fuss more. And then, going back in time but looking at
the brain directly instead of behavior, we’ve seen that having greater fetal heart rate
reactivity, as I described, is associated with differences in what’s called functional
brain connectivity, and we get that by having a newborn resting, being asleep, and going
into our MRI scanner. And so, we can look at different areas of
the brain and how much they are communicating. And what we’ve seen in these newborns is that
a part of the brain that’s very associated with fear reactions and detecting stimuli
and trying to tell if it’s a…or at least having a reaction if it’s gonna be a bad or
good experience, called the amygdala, is more strongly connected to a part of the brain
called the prefrontal cortex. And that, actually, is more the part of the
brain that helps us decide if it’s something to be worried about or not. Now, obviously, as a newborn, we don’t…we
imagine not…there’s certainly not verbal thinking going on, but the brain is getting
connected, and we see that fetuses who have more reactive heart rate, as newborns, just
resting in the scanner. They have this part of the brain, the amygdala
of the prefrontal cortex, that is more intensely connected as if they’re already ready to be
aware of stimuli out in the world. Katharine: So, the amygdala is the part of
the brain deep inside that is thought to be associated with kind of emotional reactions,
fight or flight instincts. Is that correct? Dr. Monk: Absolutely. That’s right, part of the limbic system and
key to our having emotional experiences. Katharine: So, when you are explaining that
in these infants who had higher reactivity in the womb, that their amygdala is somehow
more active? Dr. Monk: It’s actually…that was the second
part of our finding which we didn’t go into is through some complex statistical analyses. And I should really cite my colleague on this,
Jonathan Posner and Jack Cook Shaw and his lab. They were actually able to see that it was
the amygdala, the activity of the amygdala, just as you’ve anticipated that was driving
this greater connectivity. So, that’s exactly right. Katharine: Hey, everyone. Thanks for watching Part 1 of our discussion
with Dr. Catherine Monk. If you enjoyed what you saw, remember to like
the video or leave us a comment. And if you wanna see more, please check out
Part 2.

10 thoughts on “Does a mother’s mental health affect her fetus? (Part 1) – interview with Catherine Monk | VIEWPOINT

  1. Does Monk have any suggestions for books on the subject? I started getting interested in neonatal environment after reading some of Sopalsky's work on glucocorticoids but would prefer something more specifically focused. I mean I'll check out the articles but I like to really dive in on these things.

  2. Of course. Moral of the story: Don't have sex with a bat shit crazy.

    Bat shit crazy parents have an even greater effect on the mental well being of the child after they are born also.

  3. So if a woman who is genetically disposed for depression, gets pregnant and gets depressed, has a baby ( that is probably also genetically disposed of depression) when that baby grows up and gets depressed it's mostly because of fetal development stressors? I need to see a little more causation and less correlation

  4. Fascinating conversation. I think a lot of people aren't going to like the realization that working pregnant women is probably a bad idea. And also single pregnant women is likely a bad idea since a provider male is not present. This is going to be a contentious area in our current hyper PC environment…

  5. To speak to some of the comments – The fetal origins of adult disease (FOAD) has been making tremendous discoveries and strides since WWII and includes a study of women exposed to the extreme stress of WWII during the Dutch Hunger winter. While initial studies focused on nutritional stress it's since been found that emotional stress has just as strong of an effect on babies and children. Prenatal stress can affect birth size and risk for chronic diseases such as heart disease, obesity, and diabetes in adults. And boys develop in the womb too – so it's not just a need to care for and support women but to care for famiiies and children. Studies by Antonio Madrid have shown that stress in this time frame is a risk factor for asthma and that helping mothers heal from difficult or traumatic events during this early time frame can often cure asthma in their kids. Thanks so much for this great interview!

    Veronique Mead, MD, MA

  6. My sister-in-law was very stressed out and anxious during her 1st pregnancy. Her 1st kid is a bit of an anxious child. My sister-in-law was much more calm and less worried during her 2nd pregnancy. Her 2nd child is much more self-assured. My sister-in-law was worried and stressed again during her 3rd pregnancy (though not as much as her 1st). Her 3rd kid is less emotionally balanced than the 2nd, but more-so than the 1st. Is all of this anecdotal? Yes. Is it correlative? Absolutely. Does it, nevertheless, suggest certain conclusions? Potentially. If the mother is experiencing more stress hormones than normal, it makes sense that the child within her would also experience those hormones. This doesn't have to be about "crazy" women, just about the daily stresses that all human beings experience. The take-away is this- if you are a pregnant woman, do your best to stay calm and emotionally stable, for the good of your pre-born infant. Remember, you're emoting for two! 😀

  7. Hello! Have you tested mothers who are drug users and pregnant? Then they give up their child for adoption? And their adoptive parents deal with behavioral issues

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