Prenatal maternal stress and long-term neurodevelopmental outcomes: a narrative review
Dimitris Baroutis, Ioanna Myrto Sotiropoulou, Rafail Mantzioros, Marianna Theodora, George Daskalakis, Panagiotis Antsaklis
Abstract
INTRODUCTION: Maternal stress during pregnancy has been increasingly recognized as a significant factor influencing fetal development, with potential long-term effects on neurodevelopmental outcomes in offspring. Understanding the mechanisms and implications of prenatal stress exposure is crucial for informing preventative and interventional strategies in perinatal care. CONTENT: This narrative review synthesizes findings from epidemiological, neurobiological, and clinical research on the long-term consequences of prenatal maternal stress. It explores a broad spectrum of stressors - including psychological distress, depression, anxiety, and acute traumatic events such as natural disasters - and their associations with cognitive, behavioral, and emotional outcomes in offspring from infancy through adolescence. Key biological mechanisms are discussed, including alterations in the maternal-placental-fetal axis, HPA axis dysregulation, placental gene expression changes, epigenetic modifications, and neuroinflammatory responses. Neuroimaging and biomarker studies are highlighted to provide evidence for stress-related changes in brain structure and function. SUMMARY: Current literature supports a robust association between maternal stress during pregnancy and a heightened risk of neurodevelopmental challenges in children. These include deficits in executive function, increased anxiety and depressive symptoms, emotional dysregulation, and susceptibility to psychiatric disorders. The effects appear to be moderated by timing of exposure, genetic predispositions, and the postnatal environment. OUTLOOK: While the evidence base is growing, methodological limitations such as variability in stress assessment and inconsistent follow-up durations persist. Future research should emphasize longitudinal, biomarker-informed designs and evaluate interventions aimed at reducing prenatal stress. Integrating maternal mental health support into routine prenatal care may offer a promising pathway to improving both maternal and child outcomes.