Prenatal Social Determinants of Health: Narrative review of maternal environments and neonatal brain development

TL;DR

This narrative review summarizes evidence that prenatal social determinants of health—especially socioeconomic status, maternal stress, and neighborhood safety—are associated with neonatal brain structure, function, and connectivity. It also reviews secondary maternal factors such as sleep and psychopathology and calls for larger, longitudinal, and more mechanistic research.

Key findings

• In the eLABE sample of 280 term-born infants, prenatal social disadvantage was associated with smaller total gray, total subcortical gray, and total white matter volumes; mean gyrification index and bilateral amygdala/hippocampus volumes were also negatively associated, though amygdala and hippocampus effects were not significant after adjustment for total brain volume.
• Higher social risk was associated with lower fractional anisotropy in tracts including the frontolimbic uncinate fasciculus, posterior thalamic radiation, internal and external capsules, and corona radiata; prenatal social disadvantage was associated with lower mean diffusivity in the bilateral cingulum, bilateral uncinate, and right fornix.
• Maternal stress and psychopathology showed links to limbic connectivity: greater prenatal perceived stress was associated with smaller left hippocampus volume; prenatal depression was associated with increased amygdala functional connectivity with emotion regulation, sensory, and memory-related regions in one study (N=24 after motion exclusions); racial discrimination was associated with weaker amygdala–medial/anterior prefrontal cortex and stronger amygdala–fusiform connectivity.
• Neighborhood crime exposure was associated with widespread neonatal functional connectivity differences, including weaker thalamus–anterior default mode network, thalamus–anterior frontoparietal network, amygdala–hippocampus, and amygdala–anterior default mode network connectivity; violent and property crime were positively associated with externalizing symptoms at ages 1 and 2 years.

Methods

• Narrative review surveying literature linking prenatal SDoH to neonatal brain structure and function, including only studies with SDoH predictors before delivery and brain imaging completed within the first two months of life.
• Literature search used Google Scholar and PubMed between November 2023 and January 2024 without systematic search terms; example terms included “prenatal social determinants of health,” “structural MRI,” “functional MRI,” “functional connectivity,” “diffusion MRI,” “socioeconomic status,” “psychosocial stress,” “neighborhood safety,” and “maternal psychopathology.”
• Studies were grouped by prenatal exposure type and imaging modality; the review referenced SANRA and SWiM reporting standards.

Limitations

• The authors state this was not a systematic survey, so it is only a summary of included literature rather than an authoritative synthesis, and it may miss studies with null findings due to file-drawer effects or secondary MRI outcomes not identified in the search.
• The review states that the extant neonatal imaging literature has inconsistent image processing pipelines, small sample sizes, and a limited set of regions of interest examined.
• The text also makes evident heterogeneity and mixed results across studies, including inconsistent regional brain volume findings, differing directions of connectivity effects, and limited investigation of distal factors such as intimate partner violence, green space, local health systems, and societal attitudes toward prenatal care.