The Earliest Impressions: A Systematic Review of Early-Life Exposures on Brain Structure and Neurodevelopmental Outcomes

Prenatal and early postnatal life is a period of rapid brain growth, making the developing brain particularly susceptible to external influences. Adapting the biopsychosocial model of mental health and illness, this review provides a systematic overview of how biological, psychological, and social exposures from conception to age three critically converge to shape brain development and neurodevelopmental outcomes. Following a pre-registered protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, 55 studies were included, primarily published in the past 15 years. Earlier studies focused predominantly on biological exposures, while more recent work has increasingly examined psychological exposures and, more rarely, social exposures. While each exposure exhibited its own pattern of brain alterations and neurodevelopmental changes, an overarching pattern emerged across the different components of the biopsychosocial model. Adverse biological exposures were consistently associated with delayed brain maturation as reflected by brain imaging measures. Adverse psychosocial exposures showed a more complex pattern of associations with both delayed and accelerated brain maturation. Crucially, adverse exposures, whether associated with delayed or accelerated brain maturation, were consistently associated with poorer neurodevelopmental outcomes, underscoring the necessity of considering both brain and behavior when estimating the impact of early exposures. We conclude that research into early-life exposures on brain maturation and neurodevelopmental outcomes is on the rise, but there is a great need for further investigation, in particular of psychological and social exposures. The interactions between exposures, the brain, and outcomes are highly complex, requiring assessment of both brain development and behavior together, ideally in within-subject longitudinal designs in future studies.