{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:44:19Z","timestamp":1760150659447,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T00:00:00Z","timestamp":1702598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>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\u20132021) 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\u2013fetal 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.<\/jats:p>","DOI":"10.3390\/jcdd10120497","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T08:12:57Z","timestamp":1702627977000},"page":"497","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Perinatal Stressors and Consequences for Neonates with Critical Congenital Heart Disease"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1503-7100","authenticated-orcid":false,"given":"Christina","family":"Ronai","sequence":"first","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, MA 02115, USA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel","family":"Katlaps","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy M.","family":"Valent","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR 97239, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kent L.","family":"Thornburg","sequence":"additional","affiliation":[{"name":"Center for Developmental Health, Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Madriago","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,15]]},"reference":[{"key":"ref_1","unstructured":"CDC (2022, January 03). Data and Statistics on Congenital Heart Defects, Available online: https:\/\/www.cdc.gov\/ncbddd\/heartdefects\/data.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1067\/mje.2002.116310","article-title":"Maternal psychological impact of fetal echocardiography","volume":"15","author":"Sklansky","year":"2002","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1017\/S1047951121004030","article-title":"\u201cThe Mental Health Piece is Huge\u201d: Perspectives on developing a prenatal maternal psychological intervention for congenital heart disease","volume":"32","author":"Espinosa","year":"2022","journal-title":"Cardiol. Young"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101142","DOI":"10.1016\/j.ppedcard.2019.101142","article-title":"Heart care before birth: A psychobiological perspective on fetal cardiac diagnosis","volume":"54","author":"Kasparian","year":"2019","journal-title":"Prog. Pediatr. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e195316","DOI":"10.1001\/jamapediatrics.2019.5316","article-title":"Association of Maternal Psychological Distress with In Utero Brain Development in Fetuses with Congenital Heart Disease","volume":"174","author":"Wu","year":"2020","journal-title":"JAMA Pediatr."},{"key":"ref_6","first-page":"30","article-title":"OC13.01: Psychological stress and maternal cortisol when carrying a fetus with congenital heart disease","volume":"52","author":"Rychik","year":"2018","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.jpeds.2012.07.023","article-title":"Maternal Psychological Stress after Prenatal Diagnosis of Congenital Heart Disease","volume":"162","author":"Rychik","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"8645","DOI":"10.1080\/14767058.2021.1992379","article-title":"Depression and socioeconomic stressors in expectant parents with fetal congenital anomalies","volume":"35","author":"Kim","year":"2021","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.1016\/j.placenta.2010.01.002","article-title":"Review: The placenta is a programming agent for cardiovascular disease","volume":"31","author":"Thornburg","year":"2010","journal-title":"Placenta"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"104579","DOI":"10.1016\/j.psyneuen.2019.104579","article-title":"Prenatal traumatic stress and offspring hair cortisol concentration: A nine year follow up to the Red River flood pregnancy study","volume":"113","author":"Strahm","year":"2020","journal-title":"Psychoneuroendocrinology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1093\/ije\/dys116","article-title":"The placental origins of sudden cardiac death","volume":"41","author":"Barker","year":"2012","journal-title":"Int. J. Epidemiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e020299","DOI":"10.1161\/JAHA.120.020299","article-title":"Impact of Maternal\u2013Fetal Environment on Mortality in Children With Single Ventricle Heart Disease","volume":"11","author":"Savla","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/S0140-6736(89)90710-1","article-title":"Weight in infancy and death from ischaemic heart disease","volume":"2","author":"Barker","year":"1989","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1097\/GRF.0b013e31829cb9ca","article-title":"The Obstetric Origins of Health for a Lifetime","volume":"56","author":"Barker","year":"2013","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1038\/s41372-018-0128-5","article-title":"Second trimester serum cortisol and preterm birth: An analysis by timing and subtype","volume":"38","author":"Bandoli","year":"2018","journal-title":"J. Perinatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/j.1552-6909.2009.01034.x","article-title":"Are Maternal Cortisol Levels Related to Preterm Birth?","volume":"38","author":"Giurgescu","year":"2009","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/AOG.0000000000001287","article-title":"Measures of Maternal Stress and Mood in Relation to Preterm Birth","volume":"127","author":"Hoffman","year":"2016","journal-title":"Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E103","DOI":"10.25011\/cim.v30i2.986","article-title":"The relationship between stress and hair cortisol in healthy pregnant women","volume":"30","author":"Kalra","year":"2007","journal-title":"Clin. Investig. Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Romero-Gonzalez, B., Caparros-Gonzalez, R.A., Gonzalez-Perez, R., Delgado-Puertas, P., and Peralta-Ramirez, M.I. (2018). Newborn infants\u2019 hair cortisol levels reflect chronic maternal stress during pregnancy. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0200279"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.1097\/ANC.0000000000000660","article-title":"Maternal and Neonatal Hair Cortisol Levels and Psychological Stress Are Associated with Onset of Secretory Activation of Human Milk Production","volume":"19","year":"2019","journal-title":"Adv. Neonatal Care"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Caparros-Gonzalez, R.A., Romero-Gonzalez, B., Strivens-Vilchez, H., Gonzalez-Perez, R., Martinez-Augustin, O., and Peralta-Ramirez, M.I. (2017). Hair cortisol levels, psychological stress and psychopathological symptoms as predictors of postpartum depression. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0182817"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1210\/en.2017-00896","article-title":"Prenatal Stress, Glucocorticoids, and Developmental Programming of the Stress Response","volume":"159","author":"McGowan","year":"2018","journal-title":"Endocrinology"},{"key":"ref_23","first-page":"299","article-title":"Maternal Stress during Pregnancy Is Associated with Decreased Cortisol and Cortisone Levels in Neonatal Hair","volume":"90","author":"Hollanders","year":"2019","journal-title":"Horm. Res. Paediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e1919940","DOI":"10.1001\/jamanetworkopen.2019.19940","article-title":"Association of Prenatal Maternal Psychological Distress with Fetal Brain Growth, Metabolism, and Cortical Maturation","volume":"3","author":"Wu","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.tins.2020.03.008","article-title":"Glucocorticoids as Mediators of Adverse Outcomes of Prenatal Stress","volume":"43","author":"Krontira","year":"2020","journal-title":"Trends Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1007\/s00246-023-03161-6","article-title":"Prenatal Congenital Heart Disease-It Takes a Multidisciplinary Village","volume":"44","author":"Ronai","year":"2023","journal-title":"Pediatr. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bratt, E.-L., J\u00e4rvholm, S., Ekman-Joelsson, B.-M., Mattson, L.-\u00c5., and Mellander, M. (2015). Parent\u2019s experiences of counselling and their need for support following a prenatal diagnosis of congenital heart disease\u2014A qualitative study in a Swedish context. BMC Pregnancy Childbirth, 15.","DOI":"10.1186\/s12884-015-0610-4"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2138","DOI":"10.1056\/NEJMoa2212667","article-title":"Methylprednisolone for Heart Surgery in Infants\u2014A Randomized, Controlled Trial","volume":"387","author":"Hill","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1046\/j.1365-2265.1997.1230939.x","article-title":"Placental 11 beta-hydroxysteroid dehydrogenase: A key regulator of fetal glucocorticoid exposure","volume":"46","author":"Benediktsson","year":"1997","journal-title":"Clin. Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1038\/s41366-018-0270-3","article-title":"Depressive symptoms, perceived stress, and metabolic health: The REGARDS study","volume":"43","author":"Gowey","year":"2019","journal-title":"Int. J. Obes."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/12\/497\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:39:15Z","timestamp":1760132355000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/12\/497"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,15]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["jcdd10120497"],"URL":"https:\/\/doi.org\/10.3390\/jcdd10120497","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2023,12,15]]}}}