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.