PSYC 750 LIBERTY UNIVERSITY wk3 Research Proposal_2024.pdf

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

Impact of Mother’s Emotional and Mental Health on Neurological Development of the

Unborn Baby

Patricia Ann Carsten

School of Psychology, Liberty University

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

Exploring Impact of Mother’s Emotions on Developing Unborn Baby

Scientists have studied the impact of depression and other mental health struggles on the

emotional and developmental state of newborn babies and infants (Lazinski et al., 2008). Many

of the same stressors impacting the emotional health of the mother who just gave birth affect her

prior to delivery. It is known that drugs and alcohol can influence the psychological growth of

the fetus prior to birth (Goldstein et al., 2021). This gives reason for an investigation to be

performed to evaluate the chemical effects of emotional stages on the developing child within the

womb (Rice, et al., 2009).

The emotional state of the mother during pregnancy could impact the neurological

development of the infant within the womb later in life (Semeia et al.,2023, Rice, et al., 2009).

In addition, the developing child may sense rejection, which can manifest in an experiential and

behavioral way after birth (Kinsella & Monk, 2009). Studying children who were unwanted and

comparing to those who were wanted at the time of conception through the gestational cycle

could assist in development of a resiliency training to support the child in development of

healthy self-esteem despite external demonstrations of acceptance or rejection.

Variables

The independent variable for the proposed investigation is operationally defined using

surveys of mothers who admit struggling to feel maternal connection and affection for their

unborn child. The comparison group is participants who report feeling excited about and

connected to their unborn child.

The dependent variable to be measured in the research is the attachment style

demonstrated by the infants after birth to include secure, anxious, avoidant, and disorganized

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

which is believed to be influenced by the neurotransmitters in the brain that occur with various

emotional responses to external and internal stimuli (Kinsella & Monk, 2009).

Rationale

The emotional connection a mother has toward her unborn child can lead to various

negative attachment styles in the infant, which can be reaffirmed after birth by parenting styles

demonstrated by the mother (Ohara et al., 2017; Rohder et al., 2020). Many factors can influence

attachment styles, but influences from conception and during gestation can prove to be harder to

overcome because it is presented during th foundational growth period of the child (Schreffler et

al., 2021).

Hypothesis

It is predicted that unborn babies who are unwanted by the biological mother during

gestation are born with a heightened sensitivity to rejection and an awareness of emotional

dismissal from those around them that can last for decades than those who were wanted and

celebrated during gestation.

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

References

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pregnancy. Revista De Psiquiatria Clínica, 50(6), 254. https://doi.org/10.15761/0101-

60830000000737

Bianciardi, E., Ongaretto, F., De Stefano, A., Siracusano, A., & Niolu, C. (2023). The mother-

baby bond: Role of past and current relationships. Children (Basel), 10(3), 421.

https://doi.org/10.3390/children10030421

Goldstein, E., Nervik, K., Hagen, S., Hillard, F., Turnquist, A., Bakhiereva, L. N., McDonald, R.,

Ossorio, P. N., Lo, J., & Zgierska, A. E., (2021). A socioecological framework for

engaging substance-using pregnant persons in longitudinal research: Multi-stakeholder

perspectives. Neurotoxicology and Teratology, 87, 106997-106997.

https://doi.org/1016/j.ntt.2021.10699

Ierardi, E. , Bottini, M. , Facchinetti, M. & Crugnola, C. R.F(2022).FMaternal Anxiety,

Depression, Alexithymia, and Social Support.FInternational Journal of

Childbirth,(12((2),F67-75.Fdoi: 10.1891/IJC-2021-0047.

Jagtap, A., Jagtap, B., Jagtap, R., Lamture, Y., & Gomase, K., (2023). Effects of Prenatal Stress

on Behavior, Cognition, and Psychopathology: A Comprehensive Review. National

Libraryj of Medicine: National Center for Biotechnology Information. 15(10). doi:

10.7759/cureus.47044.

Kinsella, M. T., & Monk, C. (2009). Impact of stress, depression, and anxiety on fetal

neurobehavioral development Clinical obstetrics and gynecology. 52(3), 425-440. doi:

10.1097/GRF.0b013e3181b52df1.

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

Lriss

Lazinski, M. J., Shea, A. K., & Steiner, M. (2008). Effects of maternal prenatal stress on

offspring development: A commentary. Archives of Women’s Mental Health 11(5), 63-

375. doi:10.1007/s00373.008.0035.4

Lubetzky, O. (2020). The maternal-fetus relationship in the uterus: Essential for wellbeing

through life. Journal of Prenatal & Perinatal Psychology & Health, 34(6), 499-506.

Mcfarland, J., Salisbury, A. L., Battle, C. L., Hawes, K., Halloran, K., & Lester, B. M. (2011).

Major depressive disorder during pregnancy and emotional attachment to the fetus.

Archives of Women's Mental Health, 14(5), 425-34. https://doi.org/10.1007/s00737-011-

0237-z

Nordahl, D., Høifødt, R. S., Bohne, A., Landsem, I. P., Wang, C. E. A., & Thimm, J. C. (2019).

Early maladaptive schemas as predictors of maternal bonding to the unborn child. BMC

Psychology, 7(1), 23-23. https://doi.org/10.1186/s40359-019-0297-9

Ohara, M., Okada, T., Kubota, C., Nakamura, Y., Shiino, T., Aleksic, B., Morikawa, M.,

Yamauchi, A., Uno, Y., Murase, S., Goto, S., Kanai, A., Masuda, T., Ando, M., & Ozaki,

N. (2017). Relationship between maternal depression and bonding failure: A prospective

cohort study of pregnant women. Psychiatry and Clinical Neurosciences., 71(10), 733–

741. https://doi.org/10.1111/pcn.12541

Rice, F., Harold, G. T., Bovin, J. van den Bree, M, Hay, D. F., & Thapar, A. (2009). The links

between prenatal stress and offspring development and psychopathology: Disentangling

environmental and inherited influences. Psychological Medicine, 40(2), 335-345.

doi:10.1017/s0033291709005911

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

Riva Crugnola C., Ierardi E., & Canevini M. P. (2017). Reflective functioning, maternal

attachment, mind-mindedness, and emotional availability in adolescent and adult mothers

at infant 3 months. Attachment and Human Development, 20, 84-106.

https://doi.org/10.1080/14616734.2017

Riva Crugnola C., Ierardi E., Peruta V., Moioli M., & Albizzati A. (2019). Video-feedback

attachment based intervention aimed at adolescent and young mothers: effectiveness on

infant-mother interaction and maternal mind-mindedness. Early Child Development and

Care, 1-15,Fhttps://doi.org/10.1080/03004430.2019.1652172

Røhder, K., Vaever, M. S., Aarestrup, A. K., Jacobsen, R. K., Smith-Neilsen, J., & Schiotz.

(2020). Maternal-fetal bonding among pregnant women at psychosocial risk: The roles of

adult attachment style, prenatal parental reflective functioning, and depressive symptoms.

PloS One, 15,(9), pp. e0239208–e0239208,

https://www.researchgate.net/publication/344302316

Semeia, L., Bauer, I., Sippel, K., Hartkopf, J., Schaal, N. K., & Preissl, H. (2023). Impact of

maternal emotional state during pregnancy on fetal heartrate variability. Comprehensive

Psychoneuroeendoctinology, 14. https://doi.org/10.1016/j.cpnec.2023.100181

Shreffler, K. M., Spierling, T. N., Jespersen, J. E., & Tiemeyer, S. (2021). Pregnancy

intendedness, maternal–fetal bonding, and postnatal maternal–infant bonding. Infant

Mental Health Journal, 42(3), 362-373.

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Saul, H. (2013). Brain treats rejection like physical pain say scientists. Independent

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https://www.independent.co.uk/news/science/brain-treats-rejection-like-physical-pain-say-

scientists-8884507.html

Zhang, L., Wang, L., Yuan, Q., Huang, C., Cui, S., Zhang, K., & Zhou, X. (2021). The mediating

role of prenatal depression in adult attachment and maternal-fetal attachment in

primigravida in the third trimester. BMC Pregnan cy and Childbirth, 21(1), 307-307.

https://doi.org/10.1186/s12884-021-03779-5

brain scans can show the pain of rejection.For example, a study of

adolescent girls found that rejection showed up in brain scans to

varying degrees for each girl.Girls who tend toruminatehad the

highest activity in their brain scans.This suggests that girls who

ruminate are deeply internalizing thenegative feedbackinto

theirself-concept.

Brain imagingstudies also show that regions of the brain that

respond to physical pain overlap with those that react tosocial

rejection.The consensus is that a network of brain regions that

support the aversive quality of physical pain also underlie the

feeling of social rejection.These regions include the dorsalanterior

cingulate(dACC) andanterior insula(AI).

Research also shows that rejection can activate the same areas of

the brain as physical pain.For example, being asked to recall a

recent rejection has made people score significantly lower on

subsequentIQ tests.

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

Social rejection can cause a cascade of emotional and cognitive

consequences, including increased anger, anxiety, depression,

jealousy, and sadness.

Social rejection shares somatosensory representations ...

National Institutes of Health (NIH) (.gov)

https://www.ncbi.nlm.nih.gov› articles › PMC3076808

by E Kross·2011·Cited by 971—However, being rejected, however distressing, seems

different fromphysical pain; it does not result from the presence of a noxious bodily...

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https://my.clevelandclinic.org/health/diseases/24099-rejection-sensitive-dysphoria-rsd

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES
Rejection sensitive dysphoria (RSD) is when you experience severe emotional pain because of a 
failure or feeling rejected. This condition is linked to ADHD and experts suspect it happens due 
to differences in brain structure. Those differences mean your brain can’t regulate rejection-
related emotions and behaviors, making them much more intense.
ContentsOverview   Symptoms and Causes   Diagnosis and Tests   Management and    
Treatment   Prevention   Outlook / Prognosis   Living With   
Overview
What is rejection sensitive dysphoria (RSD)?
Rejection sensitive dysphoria (RSD) is when a person feels intense emotional pain 
related to rejection. The word “dysphoria” comes from an ancient Greek word that 
describes a strong — if not overwhelming — feeling of pain or discomfort. Though RSD 
isn’t an officially recognized symptom or diagnosis, it’s still a term that experts use in 
connection with recognized conditions.
While rejection is something people usually don’t like, the negative feelings that come 
with RSD are stronger and can be harder to manage or both. People with RSD are also 
more likely to interpret vague interactions as rejection and may find it difficult to control 
their reactions.
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services.5Policy
What’s the difference between rejection sensitivity and rejection 
sensitive dysphoria?
RSD and rejection sensitivity are closely linked, but there are subtle differences. To 
understand the differences, it helps to first know about an issue known as5emotional 
dysregulation.
What is emotional dysregulation?
The human brain has an elaborate network of connections between its different areas. 
Those areas have different jobs, with some areas managing memories, emotions, input 
from your senses, etc. As you get older, your brain learns to regulate those signals, 
keeping them at manageable levels. This is much like the volume control on a TV when 
it keeps the sound at levels you find comfortable.
Emotional dysregulation happens when your brain can’t properly regulate the signals 
related to your emotions. Without that ability to manage them, it’s as if the TV volume 
control is stuck at a disruptively or painfully high level. In effect, emotional dysregulation 

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

is when your emotions are too loud for you to manage, causing feelings of being

overwhelmed, uncomfortable or even in pain.

Emotional dysregulation can happen with many conditions, especially those affecting

your brain’s structure or how it processes information. It happens commonly

with5personality disorders,5mood disorders5and more.

Emotional dysregulation and rejection sensitivity

Emotional dysregulation happens with both rejection sensitivity and RSD. Dysphoria

doesn’t. People with rejection sensitivity can do one or more of the following:

Feel severe anxiety or other negative emotions before an anticipated rejection.

Have trouble seeing nonpositive interactions (such as neutral or vague reactions)

as anything but rejection and react accordingly.

Overreact to feelings of rejection, leading to behavior that reflects negative

emotions like anger, rage, extreme sadness, severe anxiety, etc.

While all of those are also possible with RSD, there’s one more component: People with

RSD describe feeling an intense — if not overwhelming — level of emotional pain.

Symptoms and Causes

What are the symptoms of rejection sensitive dysphoria?

As mentioned, the key symptom of RSD is intense emotional pain. That pain usually

has to be triggered by rejection or disapproval. However, people with RSD often have

difficulty describing what it feels like because it’s so intense and unlike most other forms

of pain (emotional or otherwise).

People with RSD often show the following traits and behaviors:

It’s very easy for them to feel embarrassed or self-conscious.

They show signs of low self-esteem and trouble believing in themselves.

They have trouble containing emotions when they feel rejected. This is often

noticeable in children and teenagers with this condition. Some may react with

sudden shows of anger or rage, while others may burst into tears.

Instead of losing control of their emotions outwardly, some people with RSD may

turn their feelings inward. This can look like a snap onset of severe depression,

and sometimes, it’s mistaken for sudden emotional shifts that can happen

with5bipolar disorder5or5borderline personality disorder.

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

They’re often “people pleasers” and become intensely focused on avoiding the

disapproval of others.

They may avoid starting projects, tasks or goals where there’s a chance of

failure.

They compensate for their fear of failure or rejection by going all-out or striving

for perfectionism. However, the downside of this is that they often experience

intense anxiety and may not easily make self-care or downtime a priority.

Who does rejection sensitive dysphoria affect, and how common is it?

There’s limited available research on exactly who experiences RSD and how common it

is. But the condition seems to happen most often in people with5ADHD. Experts have

also linked it to other personality and mood disorders, but more research is necessary

regarding who experiences this issue and how common it is.

What causes rejection sensitive dysphoria?

Experts aren’t sure exactly why RSD happens. But they suspect it involves issues with

the structure of your brain and that it happens for similar reasons as ADHD.

Researchers do know that social rejection — even when it’s vague or uncertain —

causes similar brain activity to pain. They also know that the brain of someone with

ADHD doesn’t regulate internal communication the same way as the brain of someone

without ADHD. The brain areas that filter and regulate signals aren’t as active. This

means there’s less of a filter on brain activity.

This difference in regulating internal communication is why people with ADHD

commonly have trouble processing information from their senses. It also makes them

prone to feeling overwhelmed by loud noises, bright lights or sudden changes in what’s

happening around them. The brain of someone with ADHD might not be able to regulate

pain-like activity, which would explain why rejection is so much more troubling and

painful to someone with RSD.

Genetic connections

ADHD is a condition that has a genetic component, which means it commonly runs in

families. Likewise, RSD — which has strong links to ADHD — is also more likely to

have a genetic link.

Is rejection sensitive dysphoria contagious?

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

RSD isn’t an infectious condition. You can’t catch it from or spread it to others.

Diagnosis and Tests

How is rejection sensitive dysphoria diagnosed?

RSD isn’t an officially recognized medical condition. It’s also a condition for which

there’s limited scientific research available. As a result, healthcare providers may not

know much about it or have a great deal of experience with it.

Instead, clinicians may suspect that you have it based on the symptoms you describe

and whether you have other conditions like ADHD. Unfortunately, providers may not

diagnose it because they aren’t familiar with RSD, or they mistake it for another

condition.

Management and Treatment

How is rejection sensitive dysphoria treated, and is there a cure?

While there’s much that experts don’t know about RSD, there are still ways that experts

can treat it. The treatment approaches can also take different forms, and it’s common to

use multiple treatment approaches at the same time.

Medications

Medications are the main way to treat RSD. The drugs in question typically treat ADHD

and related conditions. That’s because treating these conditions affects the same brain

areas responsible for RSD symptoms, so treating one condition affects both. Other

conditions have very similar effects on the same brain areas as RSD, and treatments for

those conditions can often help.

Because RSD isn’t an officially recognized medical condition, there aren’t any

medications specifically approved to treat it. Instead, healthcare providers use a

practice known as “off-label prescribing.”

Off-label prescribing means a healthcare provider prescribes a medication for conditions

other than the ones they’re specifically approved to treat. This kind of prescribing is

legal, medically acceptable and justified when evidence shows a medication has a low

risk of causing harmful side effects and is effective for off-label use.

The following medication types can treat RSD:

Alpha-2 receptor agonists . This type of medication activates a specific type of

chemical receptor found on neurons (brain cells) in specific brain areas.

Medications that activate those receptors, such as clonidine and guanfacine,

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

make those areas more active. Activating those brain areas makes it easier for

your brain to regulate internal communication, reducing the effect of RSD.

Stimulant medications . These medications increase the levels of

certain5neurotransmitters5in your brain. Neurotransmitters are chemical

messenger molecules that your brain uses to communicate and activate or

deactivate certain processes. Increasing certain types of neurotransmitters can

increase activity in specific brain areas. That’s how stimulant medications such

as amphetamine/dextroamphetamine (commonly known as Adderall®) and

methylphenidate (better known as Ritalin®) make brain areas that regulate

communication more active.

Monoamine oxidase inhibitor (MAOI) medications. This class of medications

treats depression, but experts also know medications such as tranylcypromine

can help with RSD. However, you can’t take these medications at the same time

as other common medications for ADHD. You also have to be careful with what

you eat because certain foods (such as aged or strong cheeses, aged meats,

etc.) can interact with MAOIs and cause a dangerous spike in blood pressure.

Psychotherapy

Psychotherapy5(also known as mental health therapy) can help people with RSD.

Therapy doesn’t stop RSD from happening or affect the symptoms. Instead, therapy can

help a person learn how to process and manage feelings so they’re less overwhelming.

That can help a person with RSD feel more in control of their emotions.

What are the possible side effects or complications of treatment?

The possible side effects and complications of the various treatments depend on

various factors, especially the treatments themselves. Because of that, your healthcare

provider is the best person to tell you what side effects or complications are possible or

likely, and what you can do to limit how they affect you.

How do I take care of myself or manage the symptoms on my own?

If you think you have RSD, it’s important to see a healthcare provider to get a diagnosis

of a related condition like ADHD and then to follow up with a mental health provider.

Some people can learn to manage RSD on their own, but it’s difficult to do so. That’s

because RSD happens based on how your brain functions.

People with RSD also commonly have other mental health conditions, including anxiety

and depression. In most cases, it takes a combination of medication and mental health

therapy to learn to live with this condition. Your provider can recommend treatment

options and guide you on what you can do to help yourself as you learn to manage

RSD.

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

How soon after treatment will I feel better?

The time it takes to notice a difference from treatment depends on the treatments you

receive. Medications can help with the symptoms, but mental health therapy offers the

best chance of learning to live with RSD.

Because no two people’s brains are alike, and conditions like ADHD and RSD affect

people differently, the time it takes to notice changes and improvements can also vary.

Your healthcare provider is the best person to tell you more about when you should

expect to notice changes and what else you can do to help yourself manage this

condition.

Prevention

How can I reduce my risk of developing rejection sensitive dysphoria or

prevent it entirely?

Unfortunately, RSD happens for unpredictable reasons that experts don’t yet

understand. Because of that, it’s impossible to prevent it or reduce your chances of

developing it.

Outlook / Prognosis

What can I expect if I have RSD?

People with RSD typically develop behaviors and mental health issues that stem from

their fear of rejection. Children with ADHD and RSD also face potential problems with

low self-esteem, fear of failure and severe5social anxiety. These issues can affect

performance in school, building social relationships and friendships, and more.

Researchers have also linked rejection sensitivity to a higher risk of having a personality

disorder.

Adults with RSD are more likely to experience anxiety, depression and loneliness.

People with RSD often avoid situations where the outcome or success is uncertain. This

can lead to avoiding job opportunities, forming friendships or romantic relationships, and

more.

How long does RSD last?

There’s limited available research to show how long RSD lasts. People may grow out of

ADHD as their brains develop, meaning that the condition eventually resolves on its

own. For people who don’t grow out of ADHD, a condition like RSD is most likely a

permanent, lifelong concern.

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

However, diagnosis and treatment — especially earlier in life — make it possible for

people to adapt and manage it. Eventually, people with RSD may overcome the effects

or at least learn how to limit its impacts on their lives.

What’s the outlook for this condition?

RSD on its own isn’t dangerous. But it does have connections to conditions that can be

dangerous. Among these are anxiety and depression, which may increase the risk of

self-harm or dying by suicide.

When to seek emergency care

You should get immediate help if you have thoughts about harming yourself, including

thoughts of5suicide, or about harming others. You should also seek immediate help if

you suspect someone you know is in imminent danger of harming themselves.

To get help in these situations, you can call any of the following:

National Suicide Prevention Lifeline (United States). This line can help people

who are struggling with suicidal thoughts or impulses. To call this line, dial 988.

Local crisis lines. Mental health organizations and centers in your area may

offer resources and help through crisis lines if you are struggling with thoughts of

suicide, self-harm or harming others.

911 (or your local emergency services number). You should call 911 (or the

local emergency services number) if you feel like you are (or someone you know

is) in5immediate5danger of self-harm or suicide. Operators and dispatchers for

911 lines can often help people in immediate danger because of a severe mental

crisis and send first responders to assist.

Living With

How do I take care of myself?

If you think you have RSD, it’s important to talk to a healthcare provider who specializes

or has experience with treating ADHD and its related conditions. A healthcare provider

is best prepared and qualified to diagnose RSD and guide you on possible treatments

and how to manage this condition.

You should also keep in mind the following:

Medications make a big difference. If medication is part of your treatment plan,

it’s important to build taking medication into your routine. These medications can

help make RSD and its effects easier for you to process and manage.

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

Find a therapist you click with and see them regularly. Learning to adapt

your thought processes and behaviors is crucial to managing RSD. Mental health

providers like therapists or counselors can help you develop new ways of

thinking and strategies that limit the impact of RSD on your life.

Make self-care a priority. Stress and anxiety can make RSD feel even worse.

Finding ways to limit your stress can help you adapt to RSD.

Be nicer to yourself. Failure and rejection are something that everyone

experiences at some point in life. Understanding and accepting that’s a part of

managing RSD. If you find yourself facing these feelings, finding healthy ways to

accept and process how you feel can help you avoid immediate reactions that

you might later wish you could take back.

How do I help my child if I think they have RSD?

Children who have ADHD have a much higher risk of also having RSD. If your child

shows symptoms of either, you can do the following to help them:

Talk to a healthcare provider. Early diagnosis and treatment can make an

enormous difference when it comes to the overall effect of RSD and its related

conditions.

Understand that RSD is real and how it works. Research shows that ADHD is

a condition that happens because of specific differences in an affected person’s

brain. Those same changes are likely what causes RSD to happen, too. That

means children with these conditions are often unable to manage their behavior

because of how their brains work, no matter how badly they want to or how hard

they try.

Be patient. Children with ADHD face challenges (see our article on what it

means to be5neurodivergent5to learn more), and frequent criticism can intensify

the effects of RSD and make it feel much worse.

Help your child learn resilience.5Failure and rejection happen to everyone.

Teaching children how to learn from failures and recover can help your child

cope with RSD and its effects.

A note from Cleveland Clinic

Rejection sensitive dysphoria (RSD) is a problem that interferes with your ability to

regulate your emotional responses to feelings of failure and rejection. While rejection is

almost always unpleasant, people with RSD experience overwhelming levels of

emotional pain. This can lead to long-term mental health issues, fear of failure and

behavior changes that negatively affect them throughout their lives.

EMOTIONS AND NEUROLOGICAL DEVELOPMENT OF FETUSES

While RSD isn’t an officially accepted medical condition, there’s growing evidence and

understanding of how this condition works. It’s also possible for healthcare providers to

treat it using treatments and approaches that help similar or related conditions. If you

suspect you have RSD, you should talk to a healthcare provider specializing in

conditions like ADHD. These professionals are best equipped to help you understand

and learn to manage this issue.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 08/30/2022.

Learn more about our5editorial process.

References

Care at Cleveland Clinic

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