Prenatal Maternal Mental Health and Neurodevelopment in Congenital Heart Disease (Neuro-Moms)

Prenatal Maternal Mental Health and Neurodevelopment in Children With an Antenatal Diagnosis of Congenital Heart Disease: The Neuro-Moms CHD Study

Congenital heart disease (CHD) is the leading cause of congenital malformations, representing 1% of live births. Progress in surgical care have led to the dramatic increase in the population of children and adults living with heart disease. As survival is no longer a concern, long-term outcomes have become the major public health issue. Prenatal diagnosis of CHD requiring open-heart surgery can be a traumatic event for expecting mothers and fathers. In the general population, maternal mental health distress is associated with fetal disturbances in the hypothalamic-adrenal-pituitary system axis, restricted intrauterine growth and adverse outcomes in the offspring. It is unknown whether prenatal maternal psychological distress have an impact on neurodevelopmental outcomes in CHD. Our national study seeks to (1) characterize the impact of prenatal maternal psychological distress on neurodevelopmental outcomes at age 1 for children with CHD who undergo neonatal open-heart surgery; (2) investigate the sociodemographic and medical determinants associated with prenatal maternal mental health of women carrying a foetus diagnosed with complex CHD; (3) explore the mediating role of prenatal risk factors (i.e., sociodemographic, medical and maternal coping mechanisms) in the association of prenatal maternal mental health (i.e., distress, anxiety and depression) and neurodevelopment in children with CHD; and (4) explore the impact of paternal or the co-parent's mental health impact on neurodevelopmental outcomes at age 1 in children with CHD. This study is a non-interventional, prospective, and longitudinal study of prenatal maternal mental health and subsequent child's neurodevelopmental and behavioural outcomes. It includes a follow-up period from the 3rd trimester of pregnancy until the child's first year of life. It will include children with a prenatally diagnosed heart defect requiring open-heart surgery within the first weeks of life. Understanding and preventing the neurodevelopmental sequelae of heart disease diagnosed in-utero is a public health priority.

Study Overview

• Status: Recruiting
• Conditions: Congenital Heart Disease; Hypoplastic Left Heart Syndrome; Cyanotic Congenital Heart Disease; d-Transposition of the Great Arteries

Detailed Description

This study is a non-interventional, prospective, and longitudinal study of prenatal maternal mental health and subsequent child's neurodevelopmental and behavioural outcomes in congenital heart disease. It includes a follow-up period from the 3rd trimester of pregnancy until the child's first year of life (between 12 and 18 months). It will include children with a prenatally diagnosed critical heart defect (i.e., cyanotic types of CHD with the potential to cause rapid hypoxemia after birth) requiring neonatal open-heart surgery (within the first weeks of life).

Expecting mothers who agree to participate will undergo comprehensive psychological evaluations conducted by a licensed mental health professional with defined expertise in perinatal mental health. Fathers or co-parent of the child with foetal CHD will also participate in self-reports during the prenatal period. A total of three time points of psychological assessment will be done: Time 1, during the prenatal period, after 28 weeks of gestation); Time 2, an interim self-report assessment using only questionnaires before post-surgery hospital discharge for the baby (after intensive care transfer to hospitalization); and Time 3, 1 year after the birth of their child. Maternal assessments will include standardized self-report measures of stress, anxiety, depression and other psychological symptoms as well as a clinical interview for Time 1 and 2. Co-parent assessment at Time 1 will include self-reports of overall mental health, anxiety and coping skills.

Infant neurodevelopmental and behavioural assessments will be conducted at year 1 (between 12-18 months for the child) during a joint visit of the dyad mother-child. All assessments will be standardized and have French norms and instructions for parents and the child. These assessments will evaluate areas such as cognition, emerging language, and motor skills (gross and fine motor abilities). Socio-behavioural outcomes will also be evaluated at this time. All infant developmental assessments will be administered by paediatric neuropsychologists.

• Study Type: Observational
• Enrollment (Estimated): 174

Contacts and Locations

• Study Contact: Name: Johanna Calderon, PhD; Phone Number: 330603830737; Email: johanna.calderon@inserm.fr

Study Locations

• France
  • Marseille, France
    • Recruiting
    • Hopital de Marseille la Timone
    • Contact: Beatrice DESNOUS
    • Principal Investigator: Beatrice DESNOUS
  • Montpellier, France
    • Recruiting
    • CHU de Montpellier
    • Contact: Marie VINCENTI
    • Principal Investigator: Marie VINCENTI
  • Palavas-les-Flots, France
    • Recruiting
    • Institut Saint Pierre
    • Contact: Sophie GUILLAUMONT
    • Principal Investigator: Sophie GUILLAUMONT
  • Paris, France
    • Recruiting
    • Hopital Necker Enfants Malades
    • Principal Investigator: Johanna CALDERON
    • Contact: Johanna CALDERON; Email: johanna.calderon@inserm.fr
  • Pessac, France
    • Recruiting
    • Hopital Haut Leveque
    • Contact: Julie CHABANEIX; Email: julie.chabaneix@chu-bordeaux.fr
    • Principal Investigator: Julie CHABANEIX

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Expecting women diagnosed with a foetal complex congenital heart disease. Fathers or co-parent of prenatally diagnosed children with CHD Children with complex congenital heart disease who require neonatal open-heart surgery.

Description

Inclusion Criteria for the mother of a child diagnosed with CHD:

1. Age at least 18 years old
2. Expecting women
3. Having received a diagnosis of foetal critical cyanotic CHD (i.e., CHD physiology that can compromise blood oxygenation after birth). This type of CHDs corresponds to the highest level of neurological risk as reported by the American Heart Association guidelines(1).
4. Pregnancy of at least 28 weeks of gestation (third trimester) and up to the 38 weeks of gestation at the time of enrolment and prenatal visit for the study.
5. Medical maternal and paediatric cardiology follow-up in one of the investigating hospitals (Montpellier, Necker Children's Hospital in Paris and Bordeaux).
6. A delay of a minimum of 4 weeks between the initial diagnosis of foetal congenital heart disease.
7. Social security affiliation in France.

Inclusion criteria for the father or co-parent:

1. Co-parent of an expecting woman participating in the study
2. Age at least 18 years old
3. Social security affiliation in France.

Inclusion criteria for the child diagnosed with congenital heart disease:

1. Child with a prenatal diagnosis of isolated complex congenital heart disease, born to a mother already participating in the study
2. Written consent from both parents
3. Social security affiliation in France.

Non-inclusion Criteria for mothers:

1. Patient refusal to participate
2. Participants (i.e., expecting women) who express a wish for medical termination of pregnancy
3. Diagnosis of a complex CHD associated with another foetal comorbidity with a clinically recognized impact on neurodevelopment (e.g., genetic syndromes such as trisomies, poly-malformation syndromes).
4. Participants who are not able to understand the instructions and/or complete the self-reports
5. Expecting women who currently have a major psychiatric condition (e.g., untreated major depression, severe anxiety disorders, psychotic disorders) with or without treatment, at the time of the cardiology consultation or at the time of the first psychological evaluation. Patients who will be excluded due to these conditions will be referred for perinatal psychiatric consultation.
6. Persons under legal or judicial guardianship.

Non-inclusion Criteria for fathers or co-parents:

1. Patient refusal to participate
2. Participants with a severe psychiatric disorder (severe depression, psychotic disorders) with or without treatment
3. Persons under legal or judicial guardianship.

Exclusion Criteria for the mother of a child diagnosed with CHD:

1. The child has not undergone surgery within 60 days of birth.

Exclusion Criteria for children with CHD:

1. Genetic anomalies, brain malformations that may render difficult the neurodevelopmental assessment.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Global Mental Health Self-questionnaire, The Symptom Checklist-90-Revised SCL-90 R (min score 20 - max score 80)	Mental Health Self-Report, Higher scores indicate worse outcomes	Time 1 Prenatal Visit and Time 3 1-year old Visit
Bayley Scales of Infant and Toddler Development (BAYLEY-4) (min score 50- max score 150)	Standardized Neurodevelopmental Assessment, Higher scores better outcome, Mean 100; SD 15	Time 3 1-year old Visit

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State-Trait Anxiety Inventory (STAI-Y) (min score 20 - max score 80)	Anxiety self-report, Higher scores worse outcomes	Time 1 Prenatal Visit, Time 2 immediately after the neonatal open-heart surgery during postoperative hospitalization, Postoperative Visit and Time 3 1-year old Visit
Coping Inventory for Stressful Situations (CISS), (min score 20 - max score 80)	Coping self-report, Higher scores better outcomes	Time 1 Prenatal Visit and Time 3 1-year old Visit
Post-partum depression Edinburgh Scale (EPDS) (min score 0 - max score 30)	Post-partum depression self-report, Higher scores worse outcomes	Time 2 immediately after the neonatal open-heart surgery during postoperative hospitalization, Postoperative Visit
Post-Traumatic Stress Scale (PCL-5), (min score 0 - max score 80)	Self-report scale on PTSD symptoms, Higher scores worse outcomes	Time 3 1-year old Visit
Ages and Stages Parent Report, 3rd Edition (min score 0 - max score 60)	Developmental questionnaire for parents, Higher scores worse outcomes	Time 3 1-year old Visit

Collaborators and Investigators

• Sponsor: Institut National de la Santé Et de la Recherche Médicale, France

Publications and helpful links

General Publications

• Deninotti J, Derridj N, Martins S, Laux D, Stos B, Levy M, Desnous B, Guillaumont S, Amedro P, Chabaneix J, Pfister M, Marguin G, Desmure G, Vincenti M, Bonnet D, Calderon J. Prenatal maternal mental health and neurodevelopment in congenital heart disease in France: the neuro-moms CHD multicentre prospective study protocol. BMJ Open. 2025 Dec 23;15(12):e104889. doi: 10.1136/bmjopen-2025-104889.

Helpful Links

• Video Neuro-Moms CHD

Study record dates

Study Major Dates

• Study Start (Actual): June 27, 2025
• Primary Completion (Estimated): October 1, 2027
• Study Completion (Estimated): January 1, 2028

Study Registration Dates

• First Submitted: November 20, 2024
• First Submitted That Met QC Criteria: November 28, 2024
• First Posted (Actual): December 2, 2024

Study Record Updates

• Last Update Posted (Actual): May 12, 2026
• Last Update Submitted That Met QC Criteria: May 11, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Neurodevelopment; psychological stress; Prenatal diagnosis; Cyanotic congenital heart disease; Maternal prenatal mental health
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases; Behavioral Symptoms; Congenital Abnormalities; Cardiovascular Abnormalities; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Behavior; Heart Defects, Congenital; Stress, Psychological; Hypoplastic Left Heart Syndrome
• Other Study ID Numbers: C23-22; 2024-A02138-39 (Registry Identifier: IDRCB)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No