Association Between Socioeconomic Status and In Utero Fetal Brain Development
Authors: Yuan-Chiao Lu, Kushal Kapse, Nicole Andersen, Jessica Quistorff, Catherine Lopez, Andrea Fry, Jenhao Cheng, Nickie Andescavage, Yao Wu, Kristina Espinosa, Gilbert Vezina, Adre du Plessis, Catherine Limperopoulos
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Children raised in settings with lower parental socioeconomic status are at increased risk for neuropsychological disorders. However, to date, the association between socioeconomic status and fetal brain development remains poorly understood. <h3>Objective</h3> To determine the association between parental socioeconomic status and in vivo fetal brain growth and cerebral cortical development using advanced, 3-dimensional fetal magnetic resonance imaging. <h3>Design, Setting, and Participants</h3> This cohort study of fetal brain development enrolled 144 healthy pregnant women from 2 low-risk community obstetrical hospitals from 2012 through 2019 in the District of Columbia. Included women had a prenatal history without complications that included recommended screening laboratory and ultrasound studies. Exclusion criteria were multiple gestation pregnancy, known or suspected congenital infection, dysmorphic features of the fetus, and documented chromosomal abnormalities. T2-weighted fetal brain magnetic resonance images were acquired. Each pregnant woman was scanned at up to 2 points in the fetal period. Data were analyzed from June through November 2020. <h3>Exposures</h3> Parental education level and occupation status were documented. <h3>Main Outcomes and Measures</h3> Regional fetal brain tissue volume (for cortical gray matter, white matter, cerebellum, deep gray matter, and brainstem) and cerebral cortical features (ie, lobe volume, local gyrification index, and sulcal depth) in the frontal, parietal, temporal, and occipital lobes were calculated. <h3>Results</h3> Fetal brain magnetic resonance imaging studies were performed among 144 pregnant women (median [interquartile range] age, 32.5 [27.0-36.1] years) with gestational age from 24.0 to 39.4 weeks; 75 fetuses (52.1%) were male, and 69 fetuses (47.9%) were female. Higher parental education level was associated with significantly increased volume in the fetal white matter (mothers: β, 2.86; 95% CI, 1.26 to 4.45;<i>P</i> = .001; fathers: β, 2.39; 95% CI, 0.97 to 3.81;<i>P</i> = .001), deep gray matter (mothers: β, 0.16; 95% CI, 0.002 to 0.32;<i>P</i> = .048; fathers: β, 0.16; 95% CI, 0.02 to 0.31;<i>P</i> = .02), and brainstem (mothers: β, 0.06; 95% CI, 0.02 to 0.10;<i>P</i> = .01; fathers: β, 0.04; 95% CI, 0.004 to 0.08;<i>P</i> = .03). Higher maternal occupation status was associated with significantly increased volume in the fetal white matter (β, 2.07; 95% CI, 0.88 to 3.26;<i>P</i> = .001), cerebellum (β, 0.17; 95% CI, 0.04 to 0.29;<i>P</i> = .01), and brainstem (β, 0.03; 95% CI, 0.001 to 0.07;<i>P</i> = .04), and higher paternal occupation status was associated with significantly increased white matter volume (β, 1.98; 95% CI, 0.71 to 3.25;<i>P</i> &lt; .01). However, higher socioeconomic status was associated with significantly decreased fetal cortical gray matter volume (mothers: β, −0.11; 95% CI, −0.18 to −0.03;<i>P</i> = .01; fathers: β, −0.10; 95% CI, −0.18 to −0.03;<i>P</i> = .01). Higher parental socioeconomic status was associated with increased volumes of 3 brain lobes of white matter: frontal lobe (mothers: β, 0.07; 95% CI, 0.02 to 0.13;<i>P</i> = .01; fathers: β, 0.06; 95% CI, 0.01 to 0.11;<i>P</i> = .03), parietal lobe (mothers: β, 0.07; 95% CI, 0.03 to 0.11;<i>P</i> &lt; .001; fathers: β, 0.06; 95% CI, 0.03 to 0.10;<i>P</i> = .001), and temporal lobe (mothers: β, 0.04; 95% CI, 0.02 to 0.07;<i>P</i> &lt; .001; fathers: β, 0.04; 95% CI, 0.02 to 0.07;<i>P</i> &lt; .001), and maternal SES score was associated with significantly decreased volume in the occipital lobe (β, 0.02; 95% CI, 0.002 to 0.04;<i>P</i> = .03). Higher parental socioeconomic status was associated with decreased cortical local gyrification index (for example, for the frontal lobe, mothers: β, −1.1; 95% CI, −1.9 to −0.3;<i>P</i> = .01; fathers: β, −0.8; 95% CI, −1.6 to −0.1;<i>P</i> = .03) and sulcal depth, except for the frontal lobe (for example, for the parietal lobe, mothers: β, −9.5; 95% CI, −13.8 to −5.3;<i>P</i> &lt; .001; fathers: β, −8.7; 95% CI, −13.0 to −4.4;<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> This cohort study found an association between parental socioeconomic status and altered in vivo fetal neurodevelopment. While being born and raised in a lower socioeconomic status setting is associated with poorer neuropsychological, educational, and socioeconomic outcomes in children, these findings suggest that altered prenatal programming may be associated with these outcomes and that future targeted prenatal interventions may be needed.