Maternal early life stress is associated with pro-inflammatory processes during pregnancy

Investigating psychosocial factors and systemic inflammation using dried blood spots: a scoping review

PURPOSE

This scoping review has two primary aims: (1) to synthesize U.S.-based studies utilizing dried blood spot (DBS) sampling to examine associations between psychosocial factors and systemic inflammation, as measured by C-reactive protein (CRP), and (2) to evaluate the methodological utility of DBS for advancing inclusive, population-based biomarker research. We explore DBS adoption, variability in methods and findings, and how this approach can enhance understanding of health disparities driven by psychosocial stressors.

METHODS

A comprehensive search of databases including MEDLINE, Embase, Cochrane Library, CINAHL Plus, and PsycINFO was conducted. Inclusion criteria encompassed U.S.-based studies employing DBS sampling to quantify CRP in relation to psychosocial factors. Studies were categorized into four domains: socioeconomic and neighborhood contexts, adverse life events and trauma, social experiences and interpersonal dynamics, and mental health and emotional well-being. Data were extracted, synthesized, and narratively analyzed.

RESULTS

Thirty studies met inclusion criteria, with sample sizes ranging from 20 to 13,236. Key findings indicated strong associations between psychosocial stressors (e.g., discrimination, social isolation) and elevated CRP. Few studies conducted sex- or gender-based analyses. DBS was particularly effective for research in underrepresented populations, enabling cost-effective, minimally invasive sampling in diverse and resource-limited settings.

CONCLUSION

This review highlights DBS as an important tool for psychiatric biomarker research, offering scalability and inclusivity. Findings affirm the link between psychosocial factors and systemic inflammation, suggesting avenues for targeted interventions. Future research should explore additional biomarkers and psychosocial determinants with sex stratified analyses to better understand inflammation-related health disparities.

Role of early life adversities in inflammation-related neuropsychiatric comorbidity in obesity

A growing body of data highlights the key role of adiposity-related inflammation in the development of neuropsychiatric comorbidity in obesity. Nevertheless, despite similar levels of inflammation, only a subgroup of obese subjects is afflicted with neuropsychiatric symptoms, suggesting the contribution of additional vulnerability factors. In light of previous work suggesting the involvement of early life adversity (ELA), this study aims to determine whether ELA promotes the emergence of inflammation-related neuropsychiatric symptoms in a sample of obese subjects. Eighty-two adults afflicted with obesity (BMI > 30 kg/m2) and twenty-one lean individuals (BMI < 25 kg/m2) were recruited. Depressive symptoms, fatigue and neurobehavioral symptoms were assessed through semi-structured interviews and validated self-reports. ELA was measured using the Childhood Trauma Questionnaire (CTQ). Systemic inflammation was determined through serum concentrations of high-sensitivity C-reactive protein (hsCRP). In the whole population under study, hsCRP concentrations were significantly associated with neuropsychiatric symptoms, consistent with the increased prevalence of neuropsychiatric comorbidity in obese subjects. Significant associations were also found between ELA severity and neuropsychiatric symptoms. Although they did not influence hsCRP levels, ELA antecedents in obese subjects were associated with more marked mood, fatigue and cognitive symptoms. Among ELA, sexual abuse was the only significant predictor of the association between hsCRP levels and neuropsychiatric comorbidity in obesity. These findings support the hypothesis that ELA represents a potent vulnerability factor for the development of neuropsychiatric comorbidity in obese subjects with chronic inflammation.

Prenatal inflammation and trauma symptoms in Latina mothers: The role of discrimination and growing up in an ethnic minoritized context

Background

The race-based traumatic stress model proposes that discrimination elicits trauma-related symptoms. Cumulative discriminatory experiences and subsequent trauma symptoms may lead to prenatal inflammation, with far reaching consequences for the health of a mother and her child.

Methods

Latina mothers, primarily of Mexican and Central American heritage (n = 150), completed the Everyday Discrimination Scale and the Traumatic Avoidance subscale of the Inventory of Depression and Anxiety Symptoms-II during pregnancy (24-32 weeks). Plasma levels of cytokines were measured with multiplex assays, which were aggregated into a pro-inflammatory cytokine profile (IL-1β, TNF-α, IFN-γ, and IL-8) after a Confirmatory Factor Analysis supported this approach.

Results

Latina mothers who grew up in the US reported more discrimination, more traumatic avoidance symptoms, and had a more elevated cytokine profile than those who immigrated after childhood. Based on a two-mediator sequential model, discrimination and traumatic avoidance symptoms sequentially provided mechanistic support for the higher levels of cytokines observed in mothers who grew up in the US. Additionally, mothers who experienced trauma symptoms in response to discrimination had an elevated cytokine profile, whereas those who did not had a suppressed cytokine profile.

Conclusion

This is among the first studies to examine the association between trauma symptoms, discrimination, and inflammation during pregnancy. In so doing, it elucidates critical pathways by which discrimination may be differentially biologically embedded across immigrant generations. Emotional responses to and chronicity of discrimination may be critical factors for understanding how experiences of discrimination may influence the maternal inflammatory milieu.

Perinatal inflammation, fetal growth restriction, and long-term neurodevelopmental impairment in Bangladesh

BACKGROUND

There are limited data on the impact of perinatal inflammation on child neurodevelopment in low-middle income countries and among growth-restricted infants.

METHODS

Population-based, prospective birth cohort study of 288 infants from July 2016-March 2017 in Sylhet, Bangladesh. Umbilical cord blood was analyzed for interleukin(IL)-1α, IL-1β, IL-6, IL-8, and C-reactive protein(CRP). Child neurodevelopment was assessed at 24 months with Bayley-III Scales of Infant Development. We determined associations between cord blood inflammation and neurodevelopmental outcomes, controlling for potential confounders.

RESULTS

248/288 (86%) live born infants were followed until 24 months, among whom 8.9% were preterm and 45.0% small-for-gestational-age(SGA) at birth. Among all infants, elevated concentrations (>75%) of CRP and IL-6 at birth were associated with increased odds of fine motor delay at 24 months; elevated CRP was also associated with lower receptive communication z-scores. Among SGA infants, elevated IL-1α was associated with cognitive delay, IL-8 with language delay, CRP with lower receptive communication z-scores, and IL-1β with lower expressive communication and motor z-scores.

CONCLUSIONS

In rural Bangladesh, perinatal inflammation was associated with impaired neurodevelopment at 24 months. The associations were strongest among SGA infants and noted across several biomarkers and domains, supporting the neurobiological role of inflammation in adverse fetal development, particularly in the setting of fetal growth restriction.

IMPACT

Cord blood inflammation was associated with fine motor and language delays at 24 months of age in a community-based cohort in rural Bangladesh. 23.4 million infants are born small-for-gestational-age (SGA) globally each year. Among SGA infants, the associations between cord blood inflammation and adverse outcomes were strong and consistent across several biomarkers and neurodevelopmental domains (cognitive, motor, language), supporting the neurobiological impact of inflammation prominent in growth-restricted infants. Prenatal interventions to prevent intrauterine growth restriction are needed in low- and middle-income countries and may also result in long-term benefits on child development.

Adverse Childhood Experiences and Perinatal Mental Health: A Review of Progress and Future Directions

PURPOSE OF REVIEW

This review includes recent literature on adverse childhood experiences (ACEs) and perinatal mental health. We summarize key findings, including meta-analytic reviews and emerging data on broad risks for psychopathology, mechanistic pathways, protective factors, and ACEs screening within clinical care contexts.

RECENT FINDINGS

ACEs are associated with small to moderate risks for perinatal depression and anxiety. There is increasing evidence ACEs are also associated with other mental health concerns and transdiagnostic symptoms during pregnancy and postpartum. Possible mechanistic factors include a range of biological and psychosocial variables. Unique effects of benevolent childhood experiences (BCEs) on perinatal mental health are also notable. Continued emphasis on associations between ACEs and perinatal mental health concerns beyond depression and anxiety is needed. More empirical attention to mechanistic and protective factors, including benevolent childhood experiences, is also warranted. Although ACEs screening in clinical settings may be feasible and acceptable, implementation should occur within a healing centered engagement framework.

Maternal gut-microbiota impacts the influence of intrauterine environmental stressors on the modulation of human cognitive development and behavior

This review examines the longstanding debate of nature and intrauterine environmental challenges that shapes human development and behavior, with a special focus on the influence of maternal prenatal gut microbes. Recent research has revealed the critical role of the gut microbiome in human neurodevelopment, and evidence suggest that maternal microbiota can impact fetal gene and microenvironment composition, as well as immunophysiology and neurochemical responses. Furthermore, intrauterine neuroepigenetic regulation may be influenced by maternal microbiota, capable of having long-lasting effects on offspring behavior and cognition. By examining the complex relationship between maternal prenatal gut microbes and human development, this review highlights the importance of early-life environmental factors in shaping neurodevelopment and cognition.

A Brief Historic Review of Research on Early Life Stress and Inflammation across the Lifespan

BACKGROUND

Extensive evidence from animal and human studies indicates that exposure to stress during sensitive developmental periods significantly increases the risk for psychiatric and physical disorders, resulting in reduced longevity. Chronic immune activation has been suggested as one pathway through which early adverse experiences may become biologically embedded. This paper highlights selected key findings and questions that first emerged in the literature and founded the field and then examines how research methods and questions have evolved over time.

SUMMARY

During the past decades, evidence from preclinical, clinical, and epidemiological studies has accumulated suggesting consequences of early life stress (ELS) exposure for immune function, particularly increased chronic inflammation or inflammatory responses. Scientific approaches to study the effects of ELS on the immune system have changed since the first studies on this topic were published.

KEY MESSAGES

Across different study designs, species, and methods, a consistent association between childhood adversity and a pro-inflammatory phenotype has been reported. We critically discuss which topics warrant further consideration and how current findings could be used to develop targeted interventions to prevent or reverse the biological embedding of ELS and resultant disease manifestations.

C-reactive protein across pregnancy in individuals exposed to childhood maltreatment: The role of psychological and physical sequelae of maltreatment

BACKGROUND

Childhood maltreatment (CM) has long-term consequences for the regulation of stress biology which are particularly pronounced when mental and physical health sequelae have manifested. C-reactive protein (CRP) has been shown to be elevated in the non-pregnant state in association with CM as well as in the setting of CM-associated mental and physical health sequelae. In pregnancy, however, the association between CM and CRP is less clear. We sought to examine this association and consider the moderating role of four common health sequelae of CM (maternal depressive symptoms, overweight/obesity, smoking, and hypertensive disorders during pregnancy).

METHODS

A prospective, longitudinal study of 744 healthy pregnant participants was conducted, with analyses focusing on a sample of 643 participants. CM was assessed with the Childhood Trauma Questionnaire (CTQ) and categorized by whether no vs. one or more moderate to severe CM experiences were reported. Blood serum concentrations of CRP, maternal depression severity (continuous scores of the Center for Epidemiologic Studies Depression Scale, CES-D) and smoking during pregnancy were assessed in early (16.52 ± 2.50 weeks gestation) and late (33.65 ± 1.18 weeks gestation) pregnancy. Pre-pregnancy body mass index (BMI) was obtained at the first study visit and hypertensive disorders diagnosed during pregnancy were obtained from the medical record. Linear mixed effects models were employed to assess main effects of CM as well as interactive effects of CM and four common CM-associated sequelae as well as a sum score of these sequelae on repeatedly measured CRP concentration. In secondary analyses, we conducted latent class analyses to classify participants based on their specific experiences of childhood abuse and/or neglect and to assess the association of these CM subgroups with CM sequelae and CRP. All analyses were adjusted for potential confounders (maternal race and ethnicity and education/income).

RESULTS

CRP concentration decreased from early to late pregnancy (B = -0.06, SE = 0.01, p < 0.001). While there was no main effect of CM on CRP (p = 0.49), the interaction of CM and depressive symptoms was associated with CRP concentration (B = 0.08, SE = 0.04, p < 0.05), indicating higher CRP across pregnancy with increasing levels of depressive symptoms during pregnancy in participants with CM experience. This interaction was mainly driven by participants with co-occurring physical and emotional maltreatment. For none of the other CM-associated sequelae a statistically significant interaction with CM on CRP concentration was observed.

CONCLUSIONS

These results add to the growing empirical evidence suggesting higher inflammation during pregnancy in participants exposed to CM who experience depressive symptoms and highlight the detrimental effects of multiple co-occurring experiences of maltreatment. Given the negative consequences of chronic inflammatory state for the mother and the developing fetus, monitoring and treating psychiatric sequelae during pregnancy among participants exposed to CM is potentially an important opportunity to dampen long-term detrimental effects of CM, serving at least two generations.

Parental Preconception Posttraumatic Stress Symptoms and Maternal Prenatal Inflammation Prospectively Predict Shorter Telomere Length in Children

OBJECTIVE

Parental trauma exposure and trauma-related distress can increase the risk of adverse health outcomes in offspring, but the pathways implicated in intergenerational transmission are not fully explicated. Accelerated biological aging may be one mechanism underlying less favorable health in trauma-exposed individuals and their offspring. This study examines the associations of preconception maternal and paternal posttraumatic stress disorder (PTSD) symptoms with child telomere length, and maternal prenatal C-reactive protein (CRP) as a biological mechanism.

METHODS

Mothers ( n = 127) and a subset of the fathers ( n = 84) reported on PTSD symptoms before conception. Mothers provided blood spots in the second and third trimesters that were assayed for CRP. At age 4 years, children provided buccal cells for measurement of telomere length. Models adjusted for parental age, socioeconomic status, maternal prepregnancy body mass index, child biological sex, and child age.

RESULTS

Mothers' PTSD symptoms were significantly associated with shorter child telomere length ( β = -0.22, SE = 0.10, p = .023). Fathers' PTSD symptoms were also inversely associated with child telomere length ( β = -0.21, SE = 0.11), although nonsignificant ( p = .065). There was no significant indirect effect of mothers' PTSD symptoms on child telomere length through CRP in pregnancy, but higher second-trimester CRP was significantly associated with shorter child telomere length ( β = -0.35, SE = 0.18, p = .048).

CONCLUSIONS

Maternal symptoms of PTSD before conception and second-trimester inflammation were associated with shorter telomere length in offspring in early childhood, independent of covariates. Findings indicate that intergenerational transmission of parental trauma may occur in part through accelerated biological aging processes and provide further evidence that prenatal proinflammatory processes program child telomere length.Open Science Framework Preregistration:https://osf.io/7c2d5/?view_only=cd0fb81f48db4b8f9c59fc8bb7b0ef97 .

Early exposure to maternal stress and risk for atopic dermatitis in children: A systematic review and meta-analysis

BACKGROUND

The incidence of atopic dermatitis (AD) in children is increasing. Early exposure to stress factors may be associated with the AD development. This study aimed to summarize studies that reported an association between stress exposure and AD development in later life.

METHODS AND FINDINGS

A comprehensive literature search was performed using online databases (PubMed, EMBASE, PsycINFO, and Web of Science) for articles published up to May 1, 2023. Eligible studies were screened and selected based on the inclusion criteria. We incorporated cohort or case-control studies published in English which explored the relationship between stress experienced by parents or children and AD. The pooled odds ratio (OR) was calculated according to the type of stress using a random-effects model. Twenty-two studies were included. AD was related to maternal distress (OR 1.29, 95% Confidence Interval [CI]: 1.13-1.47), maternal anxiety (OR 1.31, 95% CI: 1.18-1.46), and negative life events (OR 2.00, 95% CI: 1.46-2.76). Maternal depression during pregnancy was associated with AD (OR 1.21, 95% CI: 1.09-1.33), whereas no significant association was found for postpartum depression. Research on stress experienced by paternal or children is scare.

CONCLUSIONS

Early maternal stress may potentially elevate the risk of AD in their offspring. Importantly, rigorously designed studies are required to corroborate the link between maternal stress and AD in children. These studies should aim to gather insights about the impact of stress during specific trimesters of pregnancy, postnatal stress, and paternal stress, and to identify potential prevention strategies.