Prenatal and Postnatal Maternal Depressive Symptoms Are Associated With White Matter Integrity in 5-Year-Olds in a Sex-Specific Manner

BACKGROUND

Prenatal and postnatal maternal psychological distress predicts various detrimental consequences on social, behavioral, and cognitive development of offspring, especially in girls. Maturation of white matter (WM) continues from prenatal development into adulthood and is thus susceptible to exposures both before and after birth.

METHODS

WM microstructural features of 130 children (mean age, 5.36 years; range, 5.04-5.79 years; 63 girls) and their association with maternal prenatal and postnatal depressive and anxiety symptoms were investigated with diffusion tensor imaging, tract-based spatial statistics, and regression analyses. Maternal questionnaires were collected during first, second, and third trimesters and at 3, 6, and 12 months postpartum with the Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms and Symptom Checklist-90 for general anxiety. Covariates included child's sex; child's age; maternal prepregnancy body mass index; maternal age; socioeconomic status; and exposures to smoking, selective serotonin reuptake inhibitors, and synthetic glucocorticoids during pregnancy.

RESULTS

Prenatal second-trimester EPDS scores were positively associated with fractional anisotropy in boys (p < .05, 5000 permutations) after controlling for EPDS scores 3 months postpartum. In contrast, postpartum EPDS scores at 3 months correlated negatively with fractional anisotropy (p < .01, 5000 permutations) in widespread areas only in girls after controlling for prenatal second-trimester EPDS scores. Perinatal anxiety was not associated with WM structure.

CONCLUSIONS

These results suggest that prenatal and postnatal maternal psychological distress is associated with brain WM tract developmental alterations in a sex- and timing-dependent manner. Future studies including behavioral data are required to consolidate associative outcomes for these alterations.

Role of Neonatal Behavioral Neurological Assessment combined with magnetic resonance diffusion tensor imaging in evaluating white matter development in preterm infants

OBJECTIVES

To study the correlation of fractional anisotropy (FA) on magnetic resonance diffusion tensor imaging with Neonatal Behavioral Neurological Assessment (NBNA) score in preterm infants, and to study the role of FA in evaluating white matter development from the perspective of imaging.

METHODS

A prospective study was performed for 98 preterm infants who were admitted to the Neonatal Intensive Care Unit of the Third Affiliated Hospital of Zhengzhou University within 24 hours after birth from October 2016 to January 2020. According to the results of NBNA, they were divided into an abnormal group with 51 infants (NBNA score <37) and a normal group with 47 infants (NBNA score ≥37). The FA values of 10 regions of interest were collected and compared between the two groups. The correlations of FA value and umbilical arterial blood gas pH value with the NBNA score were analyzed.

RESULTS

Compared with the normal group, the abnormal group had significantly lower FA value of the posterior limb of the internal capsule and umbilical arterial blood pH (P<0.05). The FA value of the posterior limb of the internal capsule and umbilical arterial blood pH were positively correlated with the NBNA score (r=0.584 and 0.604 respectively, P<0.001), and the FA value of the posterior limb of the internal capsule was positively correlated with umbilical arterial blood pH (r=0.426, P<0.05).

CONCLUSIONS

The FA value of the posterior limb of the internal capsule can quantitatively reflect white matter development in preterm infants and is correlated with the NBNA score. The combination of the two indices can help to evaluate white matter development in preterm infants more accurately and objectively. Citation.

White matter microstructure correlates of age, sex, handedness and motor ability in a population-based sample of 3031 school-age children

Understanding the development of white matter microstructure in the general population is an imperative precursor to identifying its involvement in psychopathology. Previous studies have reported changes in white matter microstructure associated with age and different developmental patterns between boys and girls. Handedness has also been related to white matter in adults. Motor performance, tightly dependent on overall neuronal myelination, has been related to the corpus callosum. However, the association between motor performance and global white matter microstructure has not been reported in the literature. In general, these age, sex, handedness, and motor performance associations have been observed using small and poorly representative samples. We examined the relationships between age, sex, handedness, and motor performance, measured with a finger tapping task, and white matter microstructure in the forceps major and minor and in 5 tracts bilaterally (cingulum, corticospinal, inferior and superior longitudinal fasciculi, and uncinate) in a population-based sample of 3031 children between 8 and 12 years of age. Diffusion tensor imaging (DTI) data were acquired using a single, study-dedicated 3 Tesla scanner. We extracted and quantified features of white matter microstructure for each tract. We computed global DTI metrics by combining scalar values across multiple tracts into single latent factors using a confirmatory factor analysis. The adjusted linear regression models indicated that age was associated with global fractional anisotropy (FA), global mean diffusivity (MD), and almost all the tracts. Further, girls showed lower global MD than boys, while FA values differed by tract, and no age-sex interactions were found. No differences were observed in white matter microstructure between right- and left-handed children. We observed that FA in forceps major was associated with right-hand finger tapping performance. White matter FA in association tracts was only related to motor function before multiple testing correction. Our findings do not provide evidence for a relationship between finger tapping task performance and global white matter microstructure.

Investigating the association between sleep quality and diffusion-derived structural integrity of white matter in early adolescence

INTRODUCTION

Poor sleep quality has been linked to reduced neural connectivity through decreased white matter (WM) structural integrity. WM tract development has been shown to continue throughout adolescence with studies reporting positive correlations between diffusion-derived estimates of structural integrity and reduced sleep quality in adult samples. Few studies have investigated this relationship exclusively within a sample of young adolescents.

METHODS

N = 51 participants aged 12 years (M = 151.5 months, SD = 4 months) completed a self-report questionnaire which included the Pittsburgh Sleep Quality Index (PSQI) and underwent Diffusion Tensor Imaging (DTI) as part of their baseline assessment in the Longitudinal Adolescent Brain Study (LABS) being undertaken in Queensland, Australia. Fractional anisotropy (FA) were extracted using Tract-Based Spatial Statistics (TBSS) to investigate associations between sleep quality and WM integrity across the brain.

RESULTS

Significant correlations were found between the posterior limb of the internal capsule and the PSQI total sleep quality and sleep latency scores. There was also a significant difference in sleep duration between male and female participants.

CONCLUSION

These findings provide an important insight of the impact that sleep may have on early adolescent WM development. Ongoing longitudinal assessment of sleep on WM development across adolescence is likely to provide further important information about how WM maturation relates to variations in sleep quality as circadian rhythm changes occur during middle and late adolescence.

Fingolimod protects against neonatal white matter damage and long-term cognitive deficits caused by hyperoxia

Cerebral white matter injury is a leading cause of adverse neurodevelopmental outcome in prematurely born infants involving cognitive deficits in later life. Despite increasing knowledge about the pathophysiology of perinatal brain injury, therapeutic options are limited. In the adult demyelinating disease multiple sclerosis the sphingosine-1-phosphate (S1P) receptor modulating substance fingolimod (FTY720) has beneficial effects. Herein, we evaluated the neuroprotective potential of FTY720 in a neonatal model of oxygen-toxicity, which is associated with hypomyelination and impaired neuro-cognitive outcome. A single dose of FTY720 (1mg/kg) at the onset of neonatal hyperoxia (24h 80% oxygen on postnatal day 6) resulted in improvement of neuro-cognitive development persisting into adulthood. This was associated with reduced microstructural white matter abnormalities 4 months after the insult. In search of the underlying mechanisms potential non-classical (i.e. lymphocyte-independent) pathways were analysed shortly after the insult, comprising modulation of oxidative stress and local inflammatory responses as well as myelination, oligodendrocyte degeneration and maturation. Treatment with FTY720 reduced hyperoxia-induced oxidative stress, microglia activation and associated pro-inflammatory cytokine expression. In vivo and in vitro analyses further revealed that oxygen-induced hypomyelination is restored to control levels, which was accompanied by reduced oligodendrocyte degeneration and enhanced maturation. Furthermore, hyperoxia-induced elevation of S1P receptor 1 (S1P1) protein expression on in vitro cultured oligodendrocyte precursor cells was reduced by activated FTY720 and protection from degeneration is abrogated after selective S1P1 blockade. Finally, FTY720s' classical mode of action (i.e. retention of immune cells within peripheral lymphoid organs) was analysed demonstrating that FTY720 diminished circulating lymphocyte counts independent from hyperoxia. Cerebral immune cell counts remained unchanged by hyperoxia and by FTY720 treatment. Taken together, these results suggest that beneficial effects of FTY720 in neonatal oxygen-induced brain injury may be rather attributed to its anti-oxidative and anti-inflammatory capacity acting in concert with a direct protection of developing oligodendrocytes than to a modulation of peripheral lymphocyte trafficking. Thus, FTY720 might be a potential new therapeutic option for the treatment of neonatal brain injury through reduction of white matter damage.

Nutritional influences on early white matter development: response to Anderson and Burggren

Does breastfeeding alter early brain development? In a recent retrospective study, our group examined the cross-sectional relationship between early infant feeding practice and white matter maturation and cognitive development. In groups matched for child and mother age, gestation duration, birth weight, gender distribution, and socio-economic status; we observed that children who were breastfed exclusively for at least 3 months showed, on average, increased white matter myelin development compared to children who either were exclusively formula-fed, or received a mixture of breast milk and formula. In secondary analysis on sub-sets of these children, again matched for important confounding variables, we found improved cognitive test scores of receptive language in the exclusively breast-fed children compared to formula or formula+breast-fed children; and that prolonged breastfeeding was associated with increased motor, language, and visual functioning in exclusively breast-fed children. In response to this work, Anderson and Burggren have questioned our methodology and, by association, our findings. Further, they use their critique as a platform for advancing an alternative interpretation of our findings: that observed results were not associated with prolonged breast-feeding, but rather delayed the introduction of cow's milk. In this response, we address and clarify some of the misconceptions presented by Anderson and Burggren.

Cognitive and neurodevelopmental benefits of extended formula-feeding in infants: re: Deoni et al. 2013

The recent Deoni et al. (2013) manuscript proposed that breastfeeding was associated with increased cognitive ability and white-matter in older children (over 26 months), using ms-DESPOT MRI imaging to indirectly measure white matter in children who were either breastfed, formula fed, or combined breast+formula fed. In this response, we identify limitations in drawing causal inference among white matter, cognitive ability, and breastfeeding. We propose that the observed cognitive and neurodevelopmental differences between breastfed and formula-fed infants might actually be caused by the premature introduction of cow's milk in the second year of life, among other contributing factors. The implication of a causal relationship between intelligence and white matter metrics, especially in a developmentally young population, is premature given the recency of this field. The original analyses did not control for important covariates; when comparing both white matter and test scores, mothers were not controlled for age and socio-economic status (SES) and their children were not controlled for gender. Raw test scores, instead of age-adjusted test scores, were used even though the children were of different ages. Mothers were not controlled for reason(s) not to breastfeed, even though many prenatal factors are known to predict this such as stress, parity, obesity, and smoking habits. The observed cognitive ability and white matter benefits identified primarily within the long-term breastfed children are at least partially attributable to other factors such as age, gender, and SES. We suggest methodological approaches to removing such ambiguity, and ways to dissociate cause from effect. The formula and breastfeeding groups didn't show differences until the "formula fed" children likely had been fed cow's milk for longer than they had been fed formula, at 2.2 years. The greatest cognitive differences however were observed within the high SES breastfed infants depending on breastfeeding duration; infants who were breastfed over 15 months showed increased cognitive ability compared to those breastfed less than months. This implicates the source of dairy during the second year of life, and not other SES factors or infant formula, as the most likely nutritional factor responsible for the observed differences within the breastfed children. Given the known nutritional deficiencies of cow's milk, these findings imply infants who received cow's milk during the second year of life were at a disadvantage compared to those who were breastfed, independent of whether they were fed formula or breast milk during the first year of life. This evidence suggests that infants should receive formula in lieu of cow's milk when breast milk is unavailable as a dairy source, until roughly 2 years of age.

Differential vulnerability of gray matter and white matter to intrauterine growth restriction in preterm infants at 12 months corrected age

Intrauterine growth restriction (IUGR) is associated with a high risk of abnormal neurodevelopment. Underlying neuroanatomical substrates are partially documented. We hypothesized that at 12 months preterm infants would evidence specific white-matter microstructure alterations and gray-matter differences induced by severe IUGR. Twenty preterm infants with IUGR (26-34 weeks of gestation) were compared with 20 term-born infants and 20 appropriate for gestational age preterm infants of similar gestational age. Preterm groups showed no evidence of brain abnormalities. At 12 months, infants were scanned sleeping naturally. Gray-matter volumes were studied with voxel-based morphometry. White-matter microstructure was examined using tract-based spatial statistics. The relationship between diffusivity indices in white matter, gray matter volumes, and perinatal data was also investigated. Gray-matter decrements attributable to IUGR comprised amygdala, basal ganglia, thalamus and insula bilaterally, left occipital and parietal lobes, and right perirolandic area. Gray-matter volumes positively correlated with birth weight exclusively. Preterm infants had reduced FA in the corpus callosum, and increased FA in the anterior corona radiata. Additionally, IUGR infants had increased FA in the forceps minor, internal and external capsules, uncinate and fronto-occipital white matter tracts. Increased axial diffusivity was observed in several white matter tracts. Fractional anisotropy positively correlated with birth weight and gestational age at birth. These data suggest that IUGR differentially affects gray and white matter development preferentially affecting gray matter. At 12 months IUGR is associated with a specific set of structural gray-matter decrements. White matter follows an unusual developmental pattern, and is apparently affected by IUGR and prematurity combined.

Breastfeeding and early white matter development: A cross-sectional study

Does breastfeeding alter early brain development? The prevailing consensus from large epidemiological studies posits that early exclusive breastfeeding is associated with improved measures of IQ and cognitive functioning in later childhood and adolescence. Prior morphometric brain imaging studies support these findings, revealing increased white matter and sub-cortical gray matter volume, and parietal lobe cortical thickness, associated with IQ, in adolescents who were breastfed as infants compared to those who were exclusively formula-fed. Yet it remains unknown when these structural differences first manifest and when developmental differences that predict later performance improvements can be detected. In this study, we used quiet magnetic resonance imaging (MRI) scans to compare measures of white matter microstructure (mcDESPOT measures of myelin water fraction) in 133 healthy children from 10 months through 4 years of age, who were either exclusively breastfed a minimum of 3 months; exclusively formula-fed; or received a mixture of breast milk and formula. We also examined the relationship between breastfeeding duration and white matter microstructure. Breastfed children exhibited increased white matter development in later maturing frontal and association brain regions. Positive relationships between white matter microstructure and breastfeeding duration are also exhibited in several brain regions, that are anatomically consistent with observed improvements in cognitive and behavioral performance measures. While the mechanisms underlying these structural differences remains unclear, our findings provide new insight into the earliest developmental advantages associated with breastfeeding, and support the hypothesis that breast milk constituents promote healthy neural growth and white matter development.

Modeling healthy male white matter and myelin development: 3 through 60months of age

An emerging hypothesis in developmental and behavioral disorders is that they arise from disorganized brain messaging or reduced connectivity. Given the importance of myelin to efficient brain communication, characterization of myelin development in infancy and childhood may provide salient information related to early connectivity deficits. In this work, we investigate regional and whole brain growth trajectories of the myelin water fraction, a quantitative magnetic resonance imaging measure sensitive and specific to myelin content, in data acquired from 122 healthy male children from 3 to 60 months of age. We examine common growth functions to find the most representative model of myelin maturation and subsequently use the best of these models to develop a continuous population-averaged, four-dimensional model of normative myelination. Through comparisons with an independent sample of 63 male children across the same age span, we show that the developed model is representative of this population. This work contributes to understanding the trajectory of myelination in healthy infants and toddlers, furthering our knowledge of early brain development, and provides a model that may be useful for identifying developmental abnormalities.

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Proposes various growth models for modeling MWF trajectories

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Demonstrates modeling of MWF trajectories of 122 male infants under 5 years

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Statistically compares tested models using Bayesian information criterion

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Generates first four-dimensional model of whole-brain myelination of early childhood

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Discusses the utility of developed model