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Nazzari S, Pili MP, Günay Y, Provenzi L. Pandemic babies: a systematic review of the association between maternal pandemic-related stress during pregnancy and infant development. Neurosci Biobehav Rev 2024:105723. [PMID: 38762129 DOI: 10.1016/j.neubiorev.2024.105723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
The COVID-19 pandemic, with its far-reaching influence on daily life, constituted a highly stressful experience for many people worldwide, jeopardizing individuals' mental health, particularly in vulnerable populations such as pregnant women. While a growing body of evidence links prenatal maternal stress to biological and developmental alterations in offspring, the specific impact of prenatal exposure to maternal pandemic-related stress (PRS) on infant development remains unclear. A comprehensive literature search was performed in October 2023 according to the PRISMA guidelines, which yielded a total of 28 records. The selected papers investigated a vast range of developmental and biological outcomes in the offspring with large methodological variations. Either direct associations between maternal PRS during pregnancy and infant temperament and socio-emotional development, or indirect links, mediated by maternal mental health, emerged in most reviewed studies. Furthermore, maternal PRS was associated with epigenetic and brain alterations in the offspring, although studies were limited in number. Collectively, the reviewed findings contribute to a deeper understanding of the role of early adverse exposures on infant development.
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Affiliation(s)
- Sarah Nazzari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Miriam Paola Pili
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Yaren Günay
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Livio Provenzi
- Developmental Psychobiology Lab, IRCCS Mondino Foundation, Pavia, Italy.
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Gennaro S, Melnyk BM, Szalacha LA, Gibeau AM, Hoying J, O'Connor CM, Cooper AR, Aviles MM. Effects of Two Group Prenatal Care Interventions on Mental Health: An RCT. Am J Prev Med 2024; 66:797-808. [PMID: 38323949 DOI: 10.1016/j.amepre.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Perinatal depression and anxiety cost the U.S. health system $102 million annually and result in adverse health outcomes. Research supports that cognitive behavioral therapy improves these conditions, but barriers to obtaining cognitive behavioral therapy have prevented its success in pregnant individuals. In this study, the impact of a cognitive behavioral therapy-based intervention on anxiety, depression, stress, healthy lifestyle beliefs, and behaviors in pregnant people was examined. STUDY DESIGN This study used a 2-arm RCT design, embedded in group prenatal care, with one arm receiving a cognitive behavioral therapy-based Creating Opportunities for Personal Empowerment program and the other receiving health promotion content. SETTING/PARTICIPANTS Black and Hispanic participants (n=299) receiving prenatal care from 2018 to 2022 in New York and Ohio who screened high on 1 of 3 mental health measures were eligible to participate. INTERVENTION Participants were randomized into the manualized Creating Opportunities for Personal Empowerment cognitive behavioral therapy-based program, with cognitive behavioral skill-building activities delivered by advanced practice nurses in the obstetrical setting. MAIN OUTCOME MEASURES Outcomes included anxiety, depression, and stress symptoms using valid and reliable tools (Generalized Anxiety Disorder scale, Edinburgh Postnatal Depression Scale, and Perceived Stress Scale). The Healthy Lifestyle Beliefs and Behaviors Scales examined beliefs about maintaining a healthy lifestyle and reported healthy behaviors. RESULTS There were no statistically significant differences between groups in anxiety, depression, stress, healthy beliefs, and behaviors. There were significant improvements in all measures over time. There were statistically significant decreases in anxiety, depression, and stress from baseline to intervention end, whereas healthy beliefs and behaviors significantly increased. CONCLUSIONS Both cognitive behavioral therapy and health promotion content embedded in group prenatal care with advanced practice nurse delivery improved mental health and healthy lifestyle beliefs and behaviors at a time when perinatal mood generally worsens. TRIAL REGISTRATION This study is registered with clinicaltrials.gov NCT03416010.
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Affiliation(s)
- Susan Gennaro
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | | | - Laura A Szalacha
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | | | - Caitlin M O'Connor
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts.
| | - Andrea R Cooper
- College of Nursing, The Ohio State University, Columbus, Ohio
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Lipner E, Mac Giollabhui N, Breen EC, Cohn BA, Krigbaum NY, Cirillo PM, Olino TM, Alloy LB, Ellman LM. Sex-Specific Pathways From Prenatal Maternal Inflammation to Adolescent Depressive Symptoms. JAMA Psychiatry 2024; 81:498-505. [PMID: 38324324 PMCID: PMC10851141 DOI: 10.1001/jamapsychiatry.2023.5458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/30/2023] [Indexed: 02/08/2024]
Abstract
Importance Prenatal maternal inflammation has been associated with major depressive disorder in offspring in adulthood as well as with internalizing and externalizing symptoms in childhood; however, the association between prenatal inflammation and offspring depression in adolescence has yet to be examined. Objective To determine whether maternal levels of inflammatory biomarkers during pregnancy are associated with depressive symptomatology in adolescent-aged offspring and to examine how gestational timing, offspring sex, and childhood psychiatric symptoms impact these associations. Design, Setting, and Participants This was an observational study of a population-based birth cohort from the Child Health and Development Studies (CHDS), which recruited almost all mothers receiving obstetric care from the Kaiser Foundation Health Plan (KFHP) in Alameda County, California, between June 1959 and September 1966. Pregnancy data and blood sera were collected from mothers, and offspring psychiatric symptom data were collected in childhood (ages 9-11 years) and adolescence (ages 15-17 years). Mother-offspring dyads with available maternal prenatal inflammatory biomarkers during first and/or second trimesters and offspring depressive symptom data at adolescent follow-up were included. Data analyses took place between March 2020 and June 2023. Exposures Levels of inflammatory biomarkers (interleukin 6 [IL-6], IL-8, IL-1 receptor antagonist [IL-1RA], and soluble tumor necrosis factor receptor-II) assayed from maternal sera in the first and second trimesters of pregnancy. Main Outcomes and Measures Self-reported depressive symptoms at adolescent follow-up. Results A total of 674 mothers (mean [SD] age, 28.1 [5.9] years) and their offspring (350 male and 325 female) were included in this study. Higher second trimester IL-6 was significantly associated with greater depressive symptoms in offspring during adolescence (b, 0.57; SE, 0.26); P = .03). Moderated mediation analyses showed that childhood externalizing symptoms significantly mediated the association between first trimester IL-6 and adolescent depressive symptoms in male offspring (b, 0.18; 95% CI, 0.02-0.47), while childhood internalizing symptoms mediated the association between second trimester IL-1RA and adolescent depressive symptoms in female offspring (b, 0.80; 95% CI, 0.19-1.75). Conclusions and Relevance In this study, prenatal maternal inflammation was associated with depressive symptoms in adolescent-aged offspring. The findings of the study suggest that pathways to adolescent depressive symptomatology from prenatal risk factors may differ based on both the timing of exposure to prenatal inflammation and offspring sex.
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Affiliation(s)
- Emily Lipner
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Naoise Mac Giollabhui
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Elizabeth C. Breen
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Barbara A. Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, California
| | - Nickilou Y. Krigbaum
- Child Health and Development Studies, Public Health Institute, Berkeley, California
| | - Piera M. Cirillo
- Child Health and Development Studies, Public Health Institute, Berkeley, California
| | - Thomas M. Olino
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Lauren B. Alloy
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Lauren M. Ellman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
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Tartour AI, Chivese T, Eltayeb S, Elamin FM, Fthenou E, Seed Ahmed M, Babu GR. Prenatal psychological distress and 11β-HSD2 gene expression in human placentas: Systematic review and meta-analysis. Psychoneuroendocrinology 2024; 166:107060. [PMID: 38677195 DOI: 10.1016/j.psyneuen.2024.107060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/10/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The placenta acts as a buffer to regulate the degree of fetal exposure to maternal cortisol through the 11-Beta Hydroxysteroid Dehydrogenase isoenzyme type 2 (11-β HSD2) enzyme. We conducted a systematic review and meta-analysis to assess the effect of prenatal psychological distress (PPD) on placental 11-β HSD2 gene expression and explore the related mechanistic pathways involved in fetal neurodevelopment. METHODS We searched PubMed, Embase, Scopus, APA PsycInfo®, and ProQuest Dissertations for observational studies assessing the association between PPD and 11-β HSD2 expression in human placentas. Adjusted regression coefficients (β) and corresponding 95% confidence intervals (CIs) were pooled based on three contextual PPD exposure groups: prenatal depression, anxiety symptoms, and perceived stress. RESULTS Of 3159 retrieved records, sixteen longitudinal studies involving 1869 participants across seven countries were included. Overall, exposure to PPD disorders showed weak negative associations with the placental 11-β HSD2 gene expression as follows: prenatal depression (β -0.01, 95% CI 0.05-0.02, I2=0%), anxiety symptoms (β -0.02, 95% CI 0.06-0.01, I2=0%), and perceived stress (β -0.01 95% CI 0.06-0.04, I2=62.8%). Third-trimester PPD exposure was more frequently associated with lower placental 11-β HSD2 levels. PPD and placental 11-β HSD2 were associated with changes in cortisol reactivity and the development of adverse health outcomes in mothers and children. Female-offspring were more vulnerable to PPD exposures. CONCLUSION The study presents evidence of a modest role of prenatal psychological distress in regulating placental 11-β HSD2 gene expression. Future prospective cohorts utilizing larger sample sizes or advanced statistical methods to enhance the detection of small effect sizes should be planned. Additionally, controlling for key predictors such as the mother's ethnicity, trimester of PPD exposure, mode of delivery, and infant sex is crucial for valid exploration of PPD effects on fetal programming.
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Affiliation(s)
- Angham Ibrahim Tartour
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar.
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Safa Eltayeb
- Qatar Biobank for Medical Research, Qatar Foundation, Doha, Qatar
| | - Fatima M Elamin
- Office of Research Ethics and Integrity, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Eleni Fthenou
- Qatar Biobank for Medical Research, Qatar Foundation, Doha, Qatar
| | - Mohammed Seed Ahmed
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Giridhara Rathnaiah Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
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Scarborough J, Iachizzi M, Schalbetter SM, Müller FS, Weber-Stadlbauer U, Richetto J. Prenatal and postnatal influences on behavioral development in a mouse model of preconceptional stress. Neurobiol Stress 2024; 29:100614. [PMID: 38357099 PMCID: PMC10865047 DOI: 10.1016/j.ynstr.2024.100614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
Depression during pregnancy is detrimental for the wellbeing of the expectant mother and can exert long-term consequences on the offspring's development and mental health. In this context, both the gestational environment and the postpartum milieu may be negatively affected by the depressive pathology. It is, however, challenging to assess whether the contributions of prenatal and postnatal depression exposure are distinct, interactive, or cumulative, as it is unclear whether antenatal effects are due to direct effects on fetal development or because antenatal symptoms continue postnatally. Preclinical models have sought to answer this question by implementing stressors that induce a depressive-like state in the dams during pregnancy and studying the effects on the offspring. The aim of our present study was to disentangle the contribution of direct stress in utero from possible changes in maternal behavior in a novel model of preconceptional stress based on social isolation rearing (SIR). Using a cross-fostering paradigm in this model, we show that while SIR leads to subtle changes in maternal behavior, the behavioral changes observed in the offspring are driven by a complex interaction between sex, and prenatal and postnatal maternal factors. Indeed, male offspring are more sensitive to the prenatal environment, as demonstrated by behavioral and transcriptional changes driven by their birth mother, while females are likely affected by more complex interactions between the pre and the postpartum milieu, as suggested by the important impact of their surrogate foster mother. Taken together, our findings suggest that male and female offspring have different time-windows and behavioral domains of susceptibility to maternal preconceptional stress, and thus underscore the importance of including both sexes when investigating the mechanisms that mediate the negative consequences of exposure to such stressor.
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Affiliation(s)
- Joseph Scarborough
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
| | - Monica Iachizzi
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
| | - Sina M. Schalbetter
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
| | - Flavia S. Müller
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
| | - Ulrike Weber-Stadlbauer
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Juliet Richetto
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
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Mancuso RA, Ross KM, Accortt E, Coussons-Read M, Okun ML, Irwin J, Carroll J, Hobel CJ, Schetter CD. Prenatal mood and anxiety disorders and associated cytokine changes. J Affect Disord 2024; 347:635-644. [PMID: 38070749 DOI: 10.1016/j.jad.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/11/2023] [Accepted: 12/02/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND We examined whether women with prenatal mood and anxiety disorders would exhibit differential pro- and anti-inflammatory marker trajectories during the prenatal and postpartum periods compared to women without these disorders. METHODS Approximately 179 pregnant women participated in a longitudinal study conducted in two urban areas. Blood samples for inflammatory markers were collected at six study visits. The Structured Clinical Interview for the DSM-IV (SCID) was administered to participants scoring above cutoffs on anxiety and depression. Pregnant women with SCID Axis I diagnoses of mood and/or anxiety disorders were compared to other participants on inflammatory markers. Multilevel modeling tested associations between SCID diagnoses and within-person interleukin (IL)6 and IL10 trajectories. RESULTS Prenatal SCID diagnoses were associated with linear, quadratic and cubic change in IL6 from prenatal to postpartum timepoints. Women with a prenatal SCID diagnosis had steeper decreases and increases in IL6 during prenatal and postpartum periods. SCID diagnoses were associated with lower IL10 in mid-pregnancy to postpartum (b = -0.078, SE = 0.019; p = .015). LIMITATIONS Future studies would benefit from a larger sample size and a larger number of participants with SCID diagnoses. Future research should also examine whether different prenatal Axis 1 diagnoses are associated with different patterns of immune response in pregnancy. CONCLUSIONS Pregnant women with prenatal mood and anxiety disorders had greater fluctuations in IL6 across prenatal and postpartum periods and lower IL10 through pregnancy and postpartum. They may have different proinflammatory states that remain after birth without a reciprocal anti-inflammatory response.
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Affiliation(s)
- Roberta A Mancuso
- Department of Psychology and Neuroscience, Regis University, Denver, CO, USA.
| | - Kharah M Ross
- Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada
| | - Eynav Accortt
- Reproductive Psychology Program, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mary Coussons-Read
- Department of Psychology, University of Colorado - Colorado Springs, Colorado Springs, CO, USA
| | - Michele L Okun
- Sleep and Biobehavioral Health Research Laboratory, University of Colorado - Colorado Springs, Colorado Springs, CO, USA
| | - Jessica Irwin
- Department of Psychology, University of La Verne, La Verne, CA, USA
| | - Judith Carroll
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Calvin J Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Kimmel MC, Verosky B, Chen HJ, Davis O, Gur TL. The Maternal Microbiome as a Map to Understanding the Impact of Prenatal Stress on Offspring Psychiatric Health. Biol Psychiatry 2024; 95:300-309. [PMID: 38042328 PMCID: PMC10884954 DOI: 10.1016/j.biopsych.2023.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023]
Abstract
Stress and psychiatric disorders have been independently associated with disruption of the maternal and offspring microbiome and with increased risk of the offspring developing psychiatric disorders, both in clinical studies and in preclinical studies. However, the role of the microbiome in mediating the effect of prenatal stress on offspring behavior is unclear. While preclinical studies have identified several key mechanisms, clinical studies focusing on mechanisms are limited. In this review, we discuss 3 specific mechanisms by which the microbiome could mediate the effects of prenatal stress: 1) altered production of short-chain fatty acids; 2) disruptions in TH17 (T helper 17) cell differentiation, leading to maternal and fetal immune activation; and 3) perturbation of intestinal and microbial tryptophan metabolism and serotonergic signaling. Finally, we review the existing clinical literature focusing on these mechanisms and highlight the need for additional mechanistic clinical research to better understand the role of the microbiome in the context of prenatal stress.
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Affiliation(s)
- Mary C Kimmel
- University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Branden Verosky
- Ohio State University College of Medicine, Ohio State University, Columbus, Ohio
| | - Helen J Chen
- Ohio State University College of Medicine, Ohio State University, Columbus, Ohio
| | - Olivia Davis
- University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tamar L Gur
- Ohio State University College of Medicine, Ohio State University, Columbus, Ohio
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Schwarze CE, von der Heiden S, Wallwiener S, Pauen S. The role of perinatal maternal symptoms of depression, anxiety and pregnancy-specific anxiety for infant's self-regulation: A prospective longitudinal study. J Affect Disord 2024; 346:144-153. [PMID: 37832733 DOI: 10.1016/j.jad.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/10/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Maternal symptoms of anxiety and depression are highly prevalent during pregnancy and postpartum and have the potential to impact fetal development and offspring behavior. However, research on the effects of fetal exposure to maternal subclinical affective symptoms on infant self-regulation is still lacking. Self-regulation provides a fundamental precondition for healthy development and overall life success whereas dysfunctional self-regulation can lead to behavioral problems, poor academic achievement, social rejection, and physical/mental disorders. During pregnancy and infancy, children largely depend upon their mothers in order to successfully regulate their internal states. Given the high prevalence of mothers suffering from anxiety and depressive symptoms during pregnancy and after childbirth, the aim of the present study is to explore how maternal affective symptoms change during the pre- and postnatal period, and how measures obtained in pregnancy and beyond impact self-regulation in infants, as indicated by crying-, sleeping-, and/or feeding problems. METHODS This prospective longitudinal study investigates the effects of maternal symptoms of depression, anxiety, and pregnancy-specific anxiety on infant's self-regulation in N = 225 mother-infant dyads. Maternal affective symptoms were examined at five prenatal and three postnatal time-points using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI) and the Pregnancy Related Anxiety Questionnaire Revised (PRAQ-R2). Infant's self-regulation was assessed twice - at the age of three and six months - using the Crying Feeding Sleeping Scale (SFS). RESULTS Maternal pregnancy-specific anxiety was the most significant predictor for infant self-regulatory problems. It predicted crying-, sleeping, and feeding problems and explained up to 18 % of the variance. Even when controlling for maternal postpartum affective symptoms, pregnancy-specific anxiety remained a significant predictor for infant self-regulation problems. LIMITATIONS Rather homogenous sample (high socioeconomic status). Data based on maternal reports of infant behavior. CONCLUSIONS Our results suggest that fetal exposure to maternal affective symptoms - specifically pregnancy-related anxiety - plays a substantial role in the development of infant self-regulation problems, potentially mediated by epigenetic modifications. Importantly, even though maternal symptoms of depression and anxiety only reached subclinical levels, they were predictive for infant crying-, sleeping-, and feeding problems. Our findings underline the importance of early prevention and clearly tailored interventions during pregnancy and postpartum to prevent adverse outcome for mother, child and family.
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Affiliation(s)
- Cornelia E Schwarze
- Heidelberg University, Department of Psychology, Developmental and Biological Psychology Unit, Heidelberg, Germany.
| | - Sina von der Heiden
- Heidelberg University, Department of Psychology, Developmental and Biological Psychology Unit, Heidelberg, Germany
| | - Stephanie Wallwiener
- University Hospital Heidelberg, Department of Gynecology and Obstetrics, Heidelberg, Germany; University of Halle-Wittenberg, Department of Obstetrics and Prenatal Medicine, Halle, Germany
| | - Sabina Pauen
- Heidelberg University, Department of Psychology, Developmental and Biological Psychology Unit, Heidelberg, Germany
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Li Y, Yao G, Wang R, Zhu J, Li H, Yang D, Ma S, Fu Y, Liu C, Guan S. Maternal immune activation mediated prenatal chronic stress induces Th17/Treg cell imbalance may relate to the PI3K/Akt/NF-κB signaling pathway in offspring rats. Int Immunopharmacol 2024; 126:111308. [PMID: 38061121 DOI: 10.1016/j.intimp.2023.111308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 12/28/2023]
Abstract
Maternal immune activation (MIA), defined as elevated levels of inflammatory markers beyond the normal range, can occur due to psychological stress, infection, and other disruptions during pregnancy. MIA affects the immune system development in offspring and increases the risk of immune-related disorders. Limited studies have investigated the effects of prenatal stress on offspring's immune system. In this study, pregnant rats were exposed to chronic unpredictable mild stress (CUMS) during pregnancy, involving seven different stressors. We examined the impact of prenatal stress stimuli on the offspring's immune system and observed activation of the PI3K/Akt/NF-κB signaling pathway, resulting in an imbalance of Th17/Treg cells in the offspring's spleen. Our findings revealed increased plasma levels of corticosterone, IL-1β, and IL-6 in female rats exposed to prenatal stress, as well as elevated serum levels of IL-6 and TNF-α in the offspring. Furthermore, we identified a correlation between cytokine levels in female rats and their offspring. Transcriptome sequencing and qPCR experiments indicated differentially expressed mRNAs in offspring exposed to prenatal stress, which may contribute to the imbalance of Th17/Treg cells through the activation of the Gng3-related PI3K/Akt/NF-κB pathway.
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Affiliation(s)
- Ye Li
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Guixiang Yao
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Rui Wang
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Jiashu Zhu
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Hongyu Li
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Deguang Yang
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Shuqin Ma
- General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Youjuan Fu
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Can Liu
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Suzhen Guan
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China.
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Modde Epstein C, Rice MJ, French JA, Kupzyk KA, Houfek JF. Social Support Buffers the Effects of Prenatal Depressed Mood: A Mixed-Methods Study. J Am Psychiatr Nurses Assoc 2024; 30:95-107. [PMID: 35081823 DOI: 10.1177/10783903211073793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Women use various coping strategies to deal with stress and depression. These strategies are shaped by social contexts over the life course and may attenuate and/or exacerbate the physiologic effects of depression. AIMS: The purpose of this study was to determine whether coping strategies (active, disengaged, or social support coping) moderate depression-related diurnal cortisol dysregulation and to explore how social context influences women's use of coping. METHODS: This was a mixed-methods study of pregnant women (N = 65) during mid-pregnancy. Cortisol was measured in saliva collected during the waking hours of the day. Participants completed the Edinburgh Depression Scale and the Brief COPE. A subset of the sample participated in semistructured qualitative interviews (n = 20). RESULTS: Social support coping, but not active or disengaged coping, moderated end-of-day cortisol levels. Among depressed women, higher use of social support was associated with lower and more dynamic (i.e., less flat) diurnal cortisol rhythms. The qualitative findings revealed how complex social dynamics related to financial insecurity, lack of mutuality, and social identity affected women's use of and access to social support. CONCLUSION: These findings support theories of the stress-buffering effects of social support. Future research is needed to examine how social determinants affect access to social support, and how early life social experiences condition women's adaptive formation of social support coping strategies over the life course. Clinically, these findings underscore the value of relationship-centered nursing care for depressed women.
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Affiliation(s)
- Crystal Modde Epstein
- Crystal Modde Epstein, PhD, RN, PMHNP-BC, University of Nebraska Medical Center, Omaha, NE, USA; University of North Carolina Greensboro, NC, USA
| | - Michael J Rice
- Michael J. Rice, PhD, APRN-NP, FAAN, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jeffrey A French
- Jeffrey A. French, PhD, University of Nebraska at Omaha, NE, USA
| | - Kevin A Kupzyk
- Kevin A. Kupzyk, PhD, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julia F Houfek
- Julia F. Houfek, PhD, APRN-CNS, University of Nebraska Medical Center, Omaha, NE, USA
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11
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Gomà M, Arias-Pujol E, Prims E, Ferrer J, Lara S, Glover V, Martinez M, Llairó A, Nanzer N. Internet-based interdisciplinary therapeutic group (Grupo Interdisciplinar Online, GIO) for perinatal anxiety and depression-a randomized pilot study during COVID-19. Arch Womens Ment Health 2023:10.1007/s00737-023-01412-2. [PMID: 38150150 DOI: 10.1007/s00737-023-01412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/09/2023] [Indexed: 12/28/2023]
Abstract
Early interventions may promote reductions in mothers' anxiety-depression (AD) symptoms and improvements in their offspring. This longitudinal randomized research was conducted to assess the effects of interdisciplinary online therapeutic groups (GIO) in at-risk mothers and babies during the COVID-19 pandemic in a disadvantaged neighborhood in Barcelona (Spain). A total of 135 babies were born from March 2020 to June 2021 in a primary healthcare center of Barcelona (Spain). Pregnant woman and new mothers were screened for AD symptomatology through EPDS and STAI questionnaires. Seventy-two of them met high-risk criteria for AD and were included in the study. They were randomly assigned into the two groups of the study: 40 participants were assigned to GIO, the therapeutic group (TG), while 32 of them were assigned to the control group (CG) and received treatment as usual. The course of the mothers' symptomatology was assessed, as well as the baby's development at 6 months old in a blind pediatric follow-up. No differences were found in AD between both groups before the intervention. However, we obtained a significant decrease in AD symptomatology (EPDS p < .001; STAI state p = .015 and STAI trait p < .001at 6 months of life) after the intervention in the TG compared to the CG. Pediatric follow-up at 6 months demonstrated significant differences between groups in babies' development assessment (manipulation p = .003; language p < .001; sociability p < .001). The GIO helped to ensure healthy development of the baby and reduction of the mothers' depressive-anxiety symptomatology.
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Affiliation(s)
- M Gomà
- Faculty of Psychology, Education and Sports Sciences Blanquerna, Ramon Llull University (URL), Barcelona, Spain.
- Department of Perinatal Care, Bruc Salut Clinical Psychology Center, Barcelona, Spain.
| | - E Arias-Pujol
- Faculty of Psychology, Education and Sports Sciences Blanquerna, Ramon Llull University (URL), Barcelona, Spain
| | - E Prims
- Roquetes-Canteres Primary Care Center, Catalan Public Health, Barcelona, Spain
| | - J Ferrer
- Roquetes-Canteres Primary Care Center, Catalan Public Health, Barcelona, Spain
| | - S Lara
- Roquetes-Canteres Primary Care Center, Catalan Public Health, Barcelona, Spain
| | - V Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - M Martinez
- Roquetes-Canteres Primary Care Center, Catalan Public Health, Barcelona, Spain
| | - A Llairó
- Faculty of Psychology, Education and Sports Sciences Blanquerna, Ramon Llull University (URL), Barcelona, Spain
- Department of Perinatal Care, Bruc Salut Clinical Psychology Center, Barcelona, Spain
| | - N Nanzer
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
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12
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Musillo C, Creutzberg KC, Collacchi B, Ajmone-Cat MA, De Simone R, Lepre M, Amrein I, Riva MA, Berry A, Cirulli F. Bdnf-Nrf-2 crosstalk and emotional behavior are disrupted in a sex-dependent fashion in adolescent mice exposed to maternal stress or maternal obesity. Transl Psychiatry 2023; 13:399. [PMID: 38105264 PMCID: PMC10725882 DOI: 10.1038/s41398-023-02701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
Maternal obesity has been recognized as a stressor affecting the developing fetal brain, leading to long-term negative outcomes comparable to those resulting from maternal psychological stress, although the mechanisms have not been completely elucidated. In this study, we tested the hypothesis that adverse prenatal conditions as diverse as maternal stress and maternal obesity might affect emotional regulation and stress response in the offspring through common pathways, with a main focus on oxidative stress and neuroplasticity. We contrasted and compared adolescent male and female offspring in two mouse models of maternal psychophysical stress (restraint during pregnancy - PNS) and maternal obesity (high-fat diet before and during gestation - mHFD) by combining behavioral assays, evaluation of the hypothalamic-pituitary-adrenal (HPA) axis reactivity, immunohistochemistry and gene expression analysis of selected markers of neuronal function and neuroinflammation in the hippocampus, a key region involved in stress appraisal. Prenatal administration of the antioxidant N-acetyl-cysteine (NAC) was used as a strategy to protect fetal neurodevelopment from the negative effects of PNS and mHFD. Our findings show that these two stressors produce overlapping effects, reducing brain anti-oxidant defenses (Nrf-2) and leading to sex-dependent impairments of hippocampal Bdnf expression and alterations of the emotional behavior and HPA axis functionality. Prenatal NAC administration, by restoring the redox balance, was able to exert long-term protective effects on brain development, suggesting that the modulation of redox pathways might be an effective strategy to target common shared mechanisms between different adverse prenatal conditions.
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Affiliation(s)
- Chiara Musillo
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
- Ph.D. Program in Behavioral Neuroscience, Department of Psychology, Sapienza University of Rome, 00185, Rome, Italy
| | - Kerstin C Creutzberg
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Barbara Collacchi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Maria Antonietta Ajmone-Cat
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Roberta De Simone
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Marcello Lepre
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Irmgard Amrein
- Functional Neuroanatomy, Institute of Anatomy, University of Zürich, Zurich, Switzerland
| | - Marco A Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alessandra Berry
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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13
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Volqvartz T, Andersen HHB, Pedersen LH, Larsen A. Obesity in pregnancy-Long-term effects on offspring hypothalamic-pituitary-adrenal axis and associations with placental cortisol metabolism: A systematic review. Eur J Neurosci 2023; 58:4393-4422. [PMID: 37974556 DOI: 10.1111/ejn.16184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
Obesity, affecting one in three pregnant women worldwide, is not only a major obstetric risk factor. The resulting low-grade inflammation may have a long-term impact on the offspring's HPA axis through dysregulation of maternal, placental and fetal corticosteroid metabolism, and children born of obese mothers have increased risk of diabetes and cardiovascular disease. The long-term effects of maternal obesity on offspring neurodevelopment are, however, undetermined and could depend on the specific effects on placental and fetal cortisol metabolism. This systematic review evaluates how maternal obesity affects placental cortisol metabolism and the offspring's HPA axis. Pubmed, Embase and Scopus were searched for original studies on maternal BMI, obesity, and cortisol metabolism and transfer. Fifteen studies were included after the screening of 4556 identified records. Studies were small with heterogeneous exposures and outcomes. Two studies found that maternal obesity reduced placental HSD11β2 activity. In one study, umbilical cord blood cortisol levels were affected by maternal BMI. In three studies, an altered cortisol response was consistently seen among offspring in childhood (n = 2) or adulthood (n = 1). Maternal BMI was not associated with placental HSD11β1 or HSD11β2 mRNA expression, or placental HSD11β2 methylation. In conclusion, high maternal BMI is associated with reduced placental HSD11β2 activity and a dampened cortisol level among offspring, but the data is sparse. Further investigations are needed to clarify whether the HPA axis is affected by prenatal factors including maternal obesity and investigate if adverse effects can be ameliorated by optimising the intrauterine environment.
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Affiliation(s)
- Tabia Volqvartz
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Lars Henning Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Agnete Larsen
- Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark
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Rebecchini L, Bind RH, Allegri B, Zamparelli A, Biaggi A, Hazelgrove K, Osborne S, Conroy S, Pawlby S, Sethna V, Pariante CM. Women with depression in pregnancy or a history of depression have decreased quality of mentalization in the speech to their infants. Acta Psychiatr Scand 2023. [PMID: 37931907 DOI: 10.1111/acps.13624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/20/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Our study aims to understand whether depression, either in pregnancy or lifetime, affects cognitive biases (comprising the attentional focus and affective state) and mentalizing features (ability to understand children's internal mental states, thereby detecting and comprehending their behavior and intention), in maternal speech during mother-infant interaction in the first postnatal year. METHODS We recruited 115 pregnant women (44 healthy, 46 with major depressive disorder [MDD] in pregnancy, and 25 with a history of MDD but healthy pregnancy) at 25 weeks' gestation. Three-minute videos were recorded at 8 weeks and 12 months postnatally for each dyad. Maternal speech was transcribed verbatim and coded for cognitive biases and mentalizing comments using the Parental Cognitive Attributions and Mentalization Scale (PCAMs). RESULTS Women suffering from antenatal depression showed a decreased proportion of mentalizing comments compared with healthy women, at both 8 weeks (0.03 ± 0.01 vs. 0.07 ± 0.01, P = 0.002) and 12 months (0.02 ± 0.01 vs. 0.04 ± 0.01, P = 0.043). Moreover, compared with healthy women, both those with antenatal depression and those with a history of depression showed decreased positive affection in speech (0.13 ± 0.01 vs. 0.07 ± 0.01 and 0.08 ± 0.02, respectively P = 0.003 and P = 0.043), and made significantly fewer comments focused on their infants' experience at 8 weeks (0.67 ± 0.03 vs. 0.53 ± 0.04 and 0.49 ± 0.05, respectively P = 0.015 and P = 0.005). In linear regression models women's socioeconomic difficulties and anxiety in pregnancy contribute to these associations, while postnatal depression did not. CONCLUSIONS Both antenatal depression and a lifetime history of depression are associated with a decreased quality of women's speech to their infants, as shown by less focus on their infant's experience, decreased positive affection, and less able to mentalize. Examining maternal speech to their infants in the early postnatal months may be particularly relevant to identify women who could benefit from strategies addressing these aspects of the interactive behavior and thus improve infant outcome in the context of depression.
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Affiliation(s)
- Lavinia Rebecchini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Rebecca H Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Beatrice Allegri
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Arianna Zamparelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Sarah Osborne
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Vaheshta Sethna
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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15
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Anns F, Waldie KE, Peterson ER, Walker C, Morton SMB, D'Souza S. Behavioural outcomes of children exposed to antidepressants and unmedicated depression during pregnancy. J Affect Disord 2023; 338:144-154. [PMID: 37295656 DOI: 10.1016/j.jad.2023.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Antenatal exposure to both antidepressants and maternal depression has been associated with child behavioural difficulties. However, previous research has not adequately distinguished between the effects of the antidepressants and the underlying maternal depression. METHODS Child behavioural difficulties were assessed using the Strengths and Difficulties Questionnaire at 2-, 4.5-, and 8-years of age by mothers in the Growing Up in New Zealand study (N = 6233 at 2-years; N = 6066 at 4.5-years; N = 4632 at 8-years). Mothers were classified as either on antidepressants, unmedicated depression, or neither based on self-reported antidepressant intake during pregnancy and the Edinburgh Postnatal Depression Scale. Hierarchical multiple logistic regressions were used to examine whether antenatal exposure to antidepressants and unmedicated depression had a differential association with child behavioural outcomes relative to no exposure. RESULTS When later life depression in the mother and a range of birth and sociodemographic variables were accounted for, neither antenatal exposure to unmedicated depression or antidepressants remained associated with an increased risk of behavioural difficulties at the ages investigated. However, maternal later life depression was associated with behavioural difficulties in the fully adjusted analyses at all three ages investigated. LIMITATIONS The current study relied on mother-report of child behaviour which may be susceptible to bias due to maternal mental health problems. CONCLUSIONS Adjusted results did not show an adverse association between antenatal antidepressant exposure or unmedicated depression in relation to child behaviour. Findings also suggest that efforts to improve child behaviour need to include more family-based approaches that support maternal wellbeing.
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Affiliation(s)
- Francesca Anns
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Elizabeth R Peterson
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Caroline Walker
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand; INSIGHT, University of Technology Sydney, Sydney, Australia
| | - Stephanie D'Souza
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand; School of Social Sciences, The University of Auckland, Auckland, New Zealand.
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16
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Rinne GR, Somers JA, Ramos IF, Ross KM, Coussons-Read M, Schetter CD. Increases in maternal depressive symptoms during pregnancy and infant cortisol reactivity: Mediation by placental corticotropin-releasing hormone. Dev Psychopathol 2023; 35:1997-2010. [PMID: 35983792 PMCID: PMC9938842 DOI: 10.1017/s0954579422000621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Maternal depressive symptoms in pregnancy may affect offspring health through prenatal programming of the hypothalamic-pituitary-adrenal (HPA) axis. The biological mechanisms that explain the associations between maternal prenatal depressive symptoms and offspring HPA axis regulation are not yet clear. This pre-registered investigation examines whether patterns of maternal depressive symptoms in pregnancy are associated with infant cortisol reactivity and whether this association is mediated by changes in placental corticotropin-releasing hormone (pCRH). METHOD A sample of 174 pregnant women completed assessments in early, mid, and late pregnancy that included standardized measures of depressive symptoms and blood samples for pCRH. Infant cortisol reactivity was assessed at 1 and 6 months of age. RESULTS Greater increases in maternal depressive symptoms in pregnancy were associated with higher cortisol infant cortisol reactivity at 1 and 6 months. Greater increases in maternal depressive symptoms in pregnancy were associated with greater increases in pCRH from early to late pregnancy which in turn were associated with higher infant cortisol reactivity. CONCLUSIONS Increases in maternal depressive symptoms and pCRH over pregnancy may contribute to higher infant cortisol reactivity. These findings help to elucidate the prenatal biopsychosocial processes contributing to offspring HPA axis regulation early in development.
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Affiliation(s)
| | | | - Isabel F. Ramos
- Department of Chicano/Latino Studies. University of California, Irvine
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17
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Paulzen M, Schoretsanitis G. [Psychopharmacotherapy during pregnancy and breastfeeding-Part I: focus on pregnancy : Support options by using therapeutic drug monitoring]. Nervenarzt 2023; 94:786-798. [PMID: 37460797 DOI: 10.1007/s00115-023-01528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 09/14/2023]
Abstract
The medicinal treatment of mental disorders during pregnancy and lactation requires special knowledge about possible effects of the psychopharmacotherapy on the intrauterine exposure of the embryo/fetus. Therefore, the first part of this 2‑part article focuses on the use of psychotropic drugs during pregnancy. In the second part, the use of psychotropic drugs during breastfeeding is addressed. Possible substance-specific risks as a consequence of the administration have to be assessed compared to the natural risk of pregnancy complications, birth complications and neonatal complications associated with the appropriate (untreated) mental disease. Pharmacokinetic changes during pregnancy require a special focus on the safety of drug treatment and treatment efficacy. Currently, neither the European Medicines Agency (EMA) nor the U. S. Food and Drug Administration (FDA) has approved any psychotropic drug for use during pregnancy or breastfeeding. A more detailed consideration of the risk profiles of all psychotropic drugs, prescribed off-label during this time, is important. Antidepressants, antipsychotics, and mood stabilizers are the main drugs used, despite their lack of approval. This first part of our 2‑part article provides an overview of the most frequently used substance groups during pregnancy and their special characteristics. Therapeutic drug monitoring (TDM) is presented as a clinical tool that can provide a supportive contribution to treatment safety and effectiveness during pregnancy and later also during breastfeeding, not only because of the changing pharmacokinetics. In this context, the measurement of concentrations of the active substance allows a better quantification of the intrauterine and postpartum exposure risk. Despite all clinical support possibilities, each therapeutic decision for the administration of a psychotropic drug remains an individual case decision. For those involved in the treatment, this means a careful balancing of the possible consequences of non-treatment and the possible sequelae of the use of psychopharmacotherapy.
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Affiliation(s)
- Michael Paulzen
- Alexianer Krankenhaus Aachen, Alexianer Aachen GmbH, Aachen, Deutschland, Alexianergraben 33, 52062.
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland.
| | - Georgios Schoretsanitis
- Psychiatrische Universitätsklinik Zürich (PUK), Zürich, Schweiz
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
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Abstract
Perinatal depression is a common psychiatric condition that has negative effects on pregnancy and infant outcomes. Screening for the condition is relatively easy and should be done routinely in all medical care of the pregnant and postpartum woman and her infant. The risk-benefit analysis favors the use of antidepressant medications during pregnancy and lactation compared with the risk of untreated maternal depression. Other, nonpharmacological treatments will be discussed as well as new treatments, including a new class of medications that act on the inhibitory GABAergic neurotransmitter system.
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Affiliation(s)
- Anne Louise Stewart
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 800548, Charlottesville, VA 22908, USA
| | - Jennifer L Payne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 800548, Charlottesville, VA 22908, USA.
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Crovetto F, Nakaki A, Arranz A, Borras R, Vellvé K, Paules C, Boutet ML, Castro-Barquero S, Freitas T, Casas R, Martín-Asuero A, Oller Guzmán T, Morilla I, Martínez-Àran A, Camacho A, Pasqual M, Izquierdo Renau M, Pozo ÓJ, Gomez-Gomez A, Estruch R, Vieta E, Crispi F, Gratacós E. Effect of a Mediterranean Diet or Mindfulness-Based Stress Reduction During Pregnancy on Child Neurodevelopment: A Prespecified Analysis of the IMPACT BCN Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2330255. [PMID: 37606923 PMCID: PMC10445211 DOI: 10.1001/jamanetworkopen.2023.30255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/16/2023] [Indexed: 08/23/2023] Open
Abstract
Importance Maternal suboptimal nutrition and high stress levels are associated with adverse fetal and childhood neurodevelopment. Objective To test the hypothesis that structured interventions based on a Mediterranean diet or mindfulness-based stress reduction (MBSR) during pregnancy improve child neurodevelopment at age 2 years. Design, Setting, and Participants This was a prespecified analysis of the parallel-group Improving Mothers for a Better Prenatal Care Trial Barcelona (IMPACT BCN) randomized clinical trial, which was conducted at a university hospital in Barcelona, Spain, from February 2017 to March 2020. A total of 1221 singleton pregnancies (19 to 23 weeks' gestation) with high risk of delivering newborns who were small for gestational age were randomly allocated into 3 groups: a Mediterranean diet intervention, an MBSR program, or usual care. A postnatal evaluation with the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III), was performed. Data were analyzed from July to November 2022. Interventions Participants in the Mediterranean diet group received monthly individual and group educational sessions and free provision of extra virgin olive oil and walnuts. Those in the stress reduction group underwent an 8-week MBSR program adapted for pregnancy. Individuals in the usual care group received pregnancy care per institutional protocols. Main Outcomes and Measures Neurodevelopment in children was assessed by Bayley-III at 24 months of corrected postnatal age. Results A total of 626 children (293 [46.8%] female and 333 [53.2%] male) participated at a mean (SD) age of 24.8 (2.9) months. No differences were observed in the baseline characteristics between intervention groups. Compared with children from the usual care group, children in the Mediterranean diet group had higher scores in the cognitive domain (β, 5.02; 95% CI, 1.52-8.53; P = .005) and social-emotional domain (β, 5.15; 95% CI, 1.18-9.12; P = .01), whereas children from the stress reduction group had higher scores in the social-emotional domain (β, 4.75; 95% CI, 0.54-8.85; P = .02). Conclusions and Relevance In this prespecified analysis of a randomized clinical trial, maternal structured lifestyle interventions during pregnancy based on a Mediterranean diet or MBSR significantly improved child neurodevelopmental outcomes at age 2 years. Trial Registration ClinicalTrials.gov Identifier: NCT03166332.
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Affiliation(s)
- Francesca Crovetto
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Ayako Nakaki
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Angela Arranz
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Roger Borras
- Cardiovascular Institute, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Kilian Vellvé
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Cristina Paules
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Maria Laura Boutet
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Sara Castro-Barquero
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Department of Internal Medicine Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
| | - Tania Freitas
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Department of Internal Medicine Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
| | - Rosa Casas
- Department of Internal Medicine Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
| | | | | | - Ivette Morilla
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Anabel Martínez-Àran
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Alba Camacho
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Mireia Pasqual
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Montserrat Izquierdo Renau
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Neonatology Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Óscar J. Pozo
- Applied Metabolomics Research Group, Institut Hospital del Mar d′Investigacions Mèdiques, Barcelona, Spain
| | - Alex Gomez-Gomez
- Applied Metabolomics Research Group, Institut Hospital del Mar d′Investigacions Mèdiques, Barcelona, Spain
| | - Ramon Estruch
- Department of Internal Medicine Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Fàtima Crispi
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases, Madrid, Spain
| | - Eduard Gratacós
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Centre for Biomedical Research on Rare Diseases, Madrid, Spain
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20
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Bind RH, Sawyer K, Hazelgrove K, Rebecchini L, Miller C, Ahmed S, Dazzan P, Sevdalis N, Bakolis I, Davis R, Lopez MB, Woods A, Crane N, Manoharan M, Burton A, Dye H, Osborn T, Greenwood L, Perkins R, Fancourt D, Pariante CM, Estevao C. Feasibility, clinical efficacy, and well-being outcomes of an online singing intervention for postnatal depression in the UK: SHAPER-PNDO, a single-arm clinical trial. Pilot Feasibility Stud 2023; 9:131. [PMID: 37501172 PMCID: PMC10373337 DOI: 10.1186/s40814-023-01360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) affects over 12% of mothers, with numbers rising during COVID-19. Singing groups can support mothers with PND; however, online delivery has never been evaluated. SHAPER-PNDO, a single-arm clinical trial, evaluated the feasibility, clinical efficacy, and well-being outcomes of a 6-week online version of Breathe Melodies for Mums (M4M) singing intervention developed for mothers with PND during COVID-19 lockdowns. METHODS The primary objective of this study was to assess the feasibility of a group online singing intervention for new mothers with postnatal depression. This was ascertained through recruitment rates, study retention rates, attendance rates to the singing sessions, and study completion rates. The secondary objective of the study was to assess the clinical efficacy and well-being outcomes of the singing intervention. Specifically, we measured change in Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Office for National Statistics Wellbeing Scale (ONS) scores from baseline to end-of-intervention (week 6); follow-up assessments were completed at weeks 3, 16, and 32. Mothers were eligible if they scored ≥10 on the baseline EPDS. RESULTS Eighty-seven percent of the 37 recruited mothers completed the study, attending, on average, 5 of the 6 group singing sessions. With regard to secondary outcomes, at end-of-treatment, mothers experienced significant reductions in depression (EPDS, 16.6 ± 3.7 to 11.2 ± 5.3, 95% CI [0.79,1.65]), anxiety (STAI-S, 48.4 ± 27.1 to 41.7 ± 26.8, 95% CI [4.96, 17.65]) and stress (PSS, 29.0 ± 5.7 to 19.7 ± 5.3, 95% CI [1.33, 7.07]); and, furthermore, significant improvements in life satisfaction (ONS, 50.5 ± 23.0 to 72.8 ± 11.7, 95% CI [- 39.86, - 4.64]) and feelings of worthwhileness (ONS, 51.7 ± 30.4 to 78.6 ± 15.1, 95% CI [- 52.79, - 0.85]). Reduction on the EPDS correlated with a reduction on the BDI and the STAI-S and maternal childhood maltreatment was predictive of a smaller treatment response. CONCLUSIONS M4M online was feasible to mothers who partook in the programme. Furthermore, M4M online supports the mental health and well-being of new mothers experiencing PND, especially when barriers to in-person treatment are present. TRIAL REGISTRATION ClinicalTrials.gov NCT04857593 . Registered 22 April 2021, retrospectively registered.
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Affiliation(s)
- Rebecca H Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK.
| | - Kristi Sawyer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Lavinia Rebecchini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Celeste Miller
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Subeyda Ahmed
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Rachel Davis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Maria Baldellou Lopez
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Anthony Woods
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Nikki Crane
- Culture Team, King's College London, Somerset House East Wing, London, WC2R 2LS, Strand, UK
| | - Manonmani Manoharan
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Hannah Dye
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Tim Osborn
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Lorna Greenwood
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Rosie Perkins
- Centre for Performance Science, Royal College of Music, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Carolina Estevao
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
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21
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Donnici C, Long X, Reynolds J, Giesbrecht GF, Dewey D, Letourneau N, Huo Y, Landman B, Lebel C. Prenatal depressive symptoms and childhood development of brain limbic and default mode network structure. Hum Brain Mapp 2023; 44:2380-2394. [PMID: 36691973 PMCID: PMC10028635 DOI: 10.1002/hbm.26216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023] Open
Abstract
Prenatal depressive symptoms are linked to negative child behavioral and cognitive outcomes and predict later psychopathology in adolescent children. Prior work links prenatal depressive symptoms to child brain structure in regions like the amygdala; however, the relationship between symptoms and the development of brain structure over time remains unclear. We measured maternal depressive symptoms during pregnancy and acquired longitudinal T1-weighted and diffusion imaging data in children (n = 111; 60 females) between 2.6 and 8 years of age. Controlling for postnatal symptoms, we used linear mixed effects models to test relationships between prenatal depressive symptoms and age-related changes in (i) amygdala and hippocampal volume and (ii) structural properties of the limbic and default-mode networks using graph theory. Higher prenatal depressive symptoms in the second trimester were associated with more curvilinear trajectories of left amygdala volume changes. Higher prenatal depressive symptoms in the third trimester were associated with slower age-related changes in limbic global efficiency and average node degree across childhood. Our work provides evidence that moderate symptoms of prenatal depression in a low sociodemographic risk sample are associated with structural brain development in regions and networks implicated in emotion processing.
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Affiliation(s)
- Claire Donnici
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Xiangyu Long
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Jess Reynolds
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gerald F Giesbrecht
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Dewey
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Nicole Letourneau
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Yuankai Huo
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Bennett Landman
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Catherine Lebel
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
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22
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Mancini VO, Brook J, Hernandez C, Strickland D, Christophersen CT, D'Vaz N, Silva D, Prescott S, Callaghan B, Downs J, Finlay-Jones A. Associations between the human immune system and gut microbiome with neurodevelopment in the first 5 years of life: A systematic scoping review. Dev Psychobiol 2023; 65:e22360. [PMID: 36811373 PMCID: PMC10107682 DOI: 10.1002/dev.22360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 01/13/2023]
Abstract
The aim of this review was to map the literature assessing associations between maternal or infant immune or gut microbiome biomarkers and child neurodevelopmental outcomes within the first 5 years of life. We conducted a PRISMA-ScR compliant review of peer-reviewed, English-language journal articles. Studies reporting gut microbiome or immune system biomarkers and child neurodevelopmental outcomes prior to 5 years were eligible. Sixty-nine of 23,495 retrieved studies were included. Of these, 18 reported on the maternal immune system, 40 on the infant immune system, and 13 on the infant gut microbiome. No studies examined the maternal microbiome, and only one study examined biomarkers from both the immune system and the gut microbiome. Additionally, only one study included both maternal and infant biomarkers. Neurodevelopmental outcomes were assessed from 6 days to 5 years. Associations between biomarkers and neurodevelopmental outcomes were largely nonsignificant and small in effect size. While the immune system and gut microbiome are thought to have interactive impacts on the developing brain, there remains a paucity of published studies that report biomarkers from both systems and associations with child development outcomes. Heterogeneity of research designs and methodologies may also contribute to inconsistent findings. Future studies should integrate data across biological systems to generate novel insights into the biological underpinnings of early development.
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Affiliation(s)
- Vincent O Mancini
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Juliet Brook
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Christian Hernandez
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
| | - Deborah Strickland
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Claus T Christophersen
- WA Human Microbiome Collaboration Centre, School of Molecular and Life Sciences, Curtin University, Bentley, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nina D'Vaz
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Desiree Silva
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Susan Prescott
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Bridget Callaghan
- Brain and Body Lab, University of California, Los Angeles, Los Angeles, California, USA
| | - Jenny Downs
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Amy Finlay-Jones
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
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23
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Putnick DL, Bell EM, Ghassabian A, Mendola P, Sundaram R, Yeung EH. Maternal antenatal depression's effects on child developmental delays: Gestational age, postnatal depressive symptoms, and breastfeeding as mediators. J Affect Disord 2023; 324:424-432. [PMID: 36565964 PMCID: PMC9885303 DOI: 10.1016/j.jad.2022.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal antenatal depression experienced around conception or during pregnancy may adversely affect child development. This study explores three potential mechanisms of the effects of antenatal depression on children's developmental delays at 2-3 years: gestational age of the child, continued depressive symptoms postnatally, and interrupted breastfeeding practices. METHODS Mothers (N = 2888) of 3450 children, including 2303 singletons and 1147 multiples from the Upstate KIDS cohort provided data. Linked hospital discharge data was combined with mothers' reports to identify women with moderate to severe antenatal depression. Gestational age was extracted from birth certificates. Mothers completed a depression screener at 4 months postpartum, reported about their breastfeeding practices from 4 to 12 months postpartum, and completed a developmental delay screener when children were 24, 30, and 36 months. RESULTS In unadjusted path analysis models, mothers with antenatal depression had more postnatal depressive symptoms and breastfed fewer months, which translated into children being more likely to have developmental delays. Gestational age was not a mediator. Effects were similar across girls and boys and singletons and twins, and largely held when adjusting for covariates. LIMITATIONS Main limitations were the relatively advantaged sample and reliance on maternal report. CONCLUSIONS Maternal antenatal depression may impact child development through continued depressive symptoms in the postpartum period and through reduced breastfeeding duration suggesting additional targets for intervention.
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Affiliation(s)
- Diane L Putnick
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA.
| | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany School of Public Health, USA
| | - Akhgar Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University Grossman School of Medicine, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA
| | - Edwina H Yeung
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA
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24
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Liu W, Wu X, Gao Y, Xiao C, Xiao J, Fang F, Chen Y. A longitudinal study of perinatal depression and the risk role of cognitive fusion and perceived stress on postpartum depression. J Clin Nurs 2023; 32:799-811. [PMID: 35501970 DOI: 10.1111/jocn.16338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/17/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore fluctuations in perinatal depression based on physiological, psychological and interpersonal dimensions to analyse risk factors across three time points: in the third trimester and at weeks 1 and 6 postpartum. BACKGROUND Pregnant women experience depression at multiple time points and require screening. Studies have shown protective and negative factors related to postpartum depression. Cognitive fusion refers to an individual's emotions and behaviours that are regulated and influenced by that individual's own cognitive overregulation, especially when facing stress. This is an important psychological factor related to depression, but little is known about it in pregnant women. DESIGN A longitudinal study was conducted from June 2019-July 2020, and the findings are reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. METHODS Pregnant women (n = 207) were recruited, and a questionnaire survey was performed at 32-34 weeks of pregnancy and at weeks 1 and 6 postpartum. Repeated-measures analysis of variance was performed to analyse the changes in depression over time. Regression analysis and linear mixed modelling were used to identify risk factors. Pearson's correlation analysis was performed to analyse the relationships between variables. RESULTS Of the pregnant women, 36.70% experienced antenatal depression and prolonged depression with the onset of postpartum depression (12.21%). Some depressive moods disappeared spontaneously after delivery (47.37%). Perceived stress was the highest risk predictor of postpartum depression (β = 0.332), followed by cognitive fusion (β = 0.178), which remained stable over time and might have been positively related to having a vulnerable personality (0.2 < r < 0.4). Social support plays a positive role in lowering postpartum depression (β = -0.027). CONCLUSIONS Changes in depression were influenced by multiple factors with stability and predictability across time. Psychological dimensions, such as perceived stress and cognitive fusion, are risk factors for developing postpartum depression and antenatal depression. RELEVANCE TO CLINICAL PRACTICE Pregnant women can be divided into depressive cohorts according to screening at different time points to provide targeted interventions.
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Affiliation(s)
- Wenting Liu
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaxin Wu
- School of Nursing, Peking University, Beijing, China
| | - Yuanmin Gao
- Nursing Department, Xiangya Third Hospital of Central South University, Changsha, China
| | - Chaoqun Xiao
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Julan Xiao
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Fan Fang
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yu Chen
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
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25
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Galanis P, Vraka I, Katsiroumpa A, Siskou O, Konstantakopoulou O, Zogaki E, Kaitelidou D. Psychosocial Predictors of COVID-19 Vaccine Uptake among Pregnant Women: A Cross-Sectional Study in Greece. Vaccines (Basel) 2023; 11:269. [PMID: 36851147 PMCID: PMC9967309 DOI: 10.3390/vaccines11020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
An understanding of the factors associated with the COVID-19 vaccine uptake in pregnant women is paramount to persuade women to get vaccinated against COVID-19. We estimated the vaccination rate of pregnant women against COVID-19 and evaluated psychosocial factors associated with vaccine uptake among them. We conducted a cross-sectional study with a convenience sample. In particular, we investigated socio-demographic data of pregnant women (e.g., age, marital status, and educational level), COVID-19 related variables (e.g., previous COVID-19 diagnosis and worry about the side effects of COVID-19 vaccines), and stress due to COVID-19 (e.g., danger and contamination fears, fears about economic consequences, xenophobia, compulsive checking and reassurance seeking, and traumatic stress symptoms about COVID-19) as possible predictors of COVID-19 vaccine uptake. Among pregnant women, 58.6% had received a COVID-19 vaccine. The most important reasons that pregnant women were not vaccinated were doubts about the safety and effectiveness of the COVID-19 vaccines (31.4%), fear that COVID-19 vaccines could be harmful to the fetus (29.4%), and fear of adverse side effects of COVID-19 vaccines (29.4%). Increased danger and contamination fears, increased fears about economic consequences, and higher levels of trust in COVID-19 vaccines were related with vaccine uptake. On the other hand, increased compulsive checking and reassurance seeking and increased worry about the adverse side effects of COVID-19 vaccines reduced the likelihood of pregnant women being vaccinated. An understanding of the psychosocial factors associated with increased COVID-19 vaccine uptake in pregnant women could be helpful for policy makers and healthcare professionals in their efforts to persuade women to get vaccinated against COVID-19. There is a need for targeted educational campaigns to increase knowledge about COVID-19 vaccines and reduce vaccine hesitancy in pregnancy.
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Affiliation(s)
- Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Irene Vraka
- Department of Radiology, P. & A. Kyriakou Children’s Hospital, 11527 Athens, Greece
| | - Aglaia Katsiroumpa
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Olga Siskou
- Department of Tourism Studies, University of Piraeus, 18534 Piraeus, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleftheria Zogaki
- Faculty of Midwifery, University of West Attica, West Attica, 12243 Aigaleo, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
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26
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King LS, Feddoes DE, Kirshenbaum JS, Humphreys KL, Gotlib IH. Pregnancy during the pandemic: the impact of COVID-19-related stress on risk for prenatal depression. Psychol Med 2023; 53:170-180. [PMID: 33781354 PMCID: PMC8047399 DOI: 10.1017/s003329172100132x] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/12/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pregnant women may be especially susceptible to negative events (i.e. adversity) related to the coronavirus disease 2019 (COVID-19) pandemic and negative affective responses to these events (i.e. stress). We examined the latent structure of stress and adversity related to the COVID-19 pandemic among pregnant women, potential antecedents of COVID-19-related stress and adversity in this population, and associations with prenatal depressive symptoms. METHOD We surveyed 725 pregnant women residing in the San Francisco Bay Area in March-May 2020, 343 of whom provided addresses that were geocoded and matched by census tract to measures of community-level risk. We compared their self-reported depressive symptoms to women matched on demographic factors and history of mental health difficulties who were pregnant prior to the pandemic. RESULTS Women who were pregnant during the pandemic were nearly twice as likely to have possible depression than were matched women who were pregnant prior to the pandemic. Individual- and community-level factors tied to socioeconomic inequality were associated with latent factors of COVID-19-related stress and adversity. Beyond objective adversity, subjective stress responses were strongly associated with depressive symptoms during the pandemic. CONCLUSIONS Highlighting the role of subjective responses in vulnerability to prenatal depression and factors that influence susceptibility to COVID-19-related stress, these findings inform the allocation of resources to support recovery from this pandemic and future disease outbreaks. In addition to policies that mitigate disruptions to the environment due to the pandemic, treatments that focus on cognitions about the self and the environment may help to alleviate depressive symptoms in pregnant women.
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Affiliation(s)
- Lucy S. King
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Daisy E. Feddoes
- Department of Psychology, Stanford University, Stanford, CA, USA
| | | | - Kathryn L. Humphreys
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Ian H. Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
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27
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Nazzari S, Grumi S, Biasucci G, Decembrino L, Fazzi E, Giacchero R, Magnani ML, Nacinovich R, Scelsa B, Spinillo A, Capelli E, Roberti E, Provenzi L. Maternal pandemic-related stress during pregnancy associates with infants' socio-cognitive development at 12 months: A longitudinal multi-centric study. PLoS One 2023; 18:e0284578. [PMID: 37068062 PMCID: PMC10109481 DOI: 10.1371/journal.pone.0284578] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Prenatal maternal stress is a key risk factor for infants' development. Previous research has highlighted consequences for infants' socio-emotional and cognitive outcomes, but less is known for what regards socio-cognitive development. In this study, we report on the effects of maternal prenatal stress related to the COVID-19 pandemic on 12-month-old infants' behavioral markers of socio-cognitive development. METHODS Ninety infants and their mothers provided complete longitudinal data from birth to 12 months. At birth, mothers reported on pandemic-related stress during pregnancy. At infants' 12-month-age, a remote mother-infant interaction was videotaped: after an initial 2-min face-to-face episode, the experimenter remotely played a series of four auditory stimuli (2 human and 2 non-human sounds). The auditory stimuli sequence was counterbalanced among participants and each sound was repeated three times every 10 seconds (Exposure, 30 seconds) while mothers were instructed not to interact with their infants and to display a neutral still-face expression. Infants' orienting, communication, and pointing toward the auditory source was coded micro-analytically and a socio-cognitive score (SCS) was obtained by means of a principal component analysis. RESULTS Infants equally oriented to human and non-human auditory stimuli. All infants oriented toward the sound during the Exposure episode, 80% exhibited any communication directed to the auditory source, and 48% showed at least one pointing toward the sound. Mothers who reported greater prenatal pandemic-related stress had infants with higher probability of showing no communication, t = 2.14 (p = .035), or pointing, t = 1.93 (p = .057). A significant and negative linear association was found between maternal prenatal pandemic-related stress and infants' SCS at 12 months, R2 = .07 (p = .010), while adjusting for potential confounders. CONCLUSIONS This study suggests that prenatal maternal stress during the COVID-19 pandemic might have increased the risk of an altered socio-cognitive development in infants as assessed through an observational paradigm at 12 months. Special preventive attention should be devoted to infants born during the pandemic.
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Affiliation(s)
- Sarah Nazzari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Serena Grumi
- Developmental Psychobiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Giacomo Biasucci
- Pediatrics & Neonatology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | | | - Elisa Fazzi
- Department of Clinical And Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child and Adolescence Neuropsychiatry, Azienda Ospedaliera Spedali Civili of Brescia, Brescia, Italy
| | | | | | - Renata Nacinovich
- Child and Adolescent Neuropsychiatry, Fondazione IRCCS San Gerardo dei Tintori Monza, Monza, Italy
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), Università Bicocca, Milan, Italy
| | - Barbara Scelsa
- Unit of Pediatric Neurology, Buzzi Children's Hospital, Milan, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Capelli
- Developmental Psychobiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Roberti
- Developmental Psychobiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Livio Provenzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Developmental Psychobiology, IRCCS Mondino Foundation, Pavia, Italy
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Adesanya AM, Barrett S, Moffat M, Aquino MRJ, Nicholson W, Turner G, Cook E, Tyndall S, Rankin J. Impact of the COVID-19 pandemic on expectant and new parents' experience of pregnancy, childbirth, breast feeding, parental responsiveness and sensitivity, and bonding and attunement in high-income countries: a systematic review of the evidence. BMJ Open 2022; 12:e066963. [PMID: 36523240 PMCID: PMC9748518 DOI: 10.1136/bmjopen-2022-066963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To review the evidence on how pregnancy, birth experience, breast feeding, parental responsiveness and sensitivity, and bonding and attunement were impacted by COVID-19. METHODS We searched eight literature databases and websites of relevant UK-based organisations. The review focused on evidence during pregnancy and the early years (0-5 years). Studies of any study design published in English from 1 March 2020 to 15 March 2021 and conducted in high-income countries were included. Screening and data extraction were undertaken in duplicate. Evidence was synthesised using a narrative approach. Study quality of included studies was assessed using the Mixed Methods Appraisal Tool. RESULTS The search yielded 9776 publications, of which 26 met our inclusion criteria. Significant knowledge gaps on how COVID-19 affected pregnancy and breast feeding limited healthcare providers' ability to provide consistent evidence-based information and care at the start of the pandemic. There was an enduring sense of loss about loved ones being restricted from taking part in key moments. Parents were concerned about the limitations of virtual healthcare provision. Some parents reported more opportunities for responsive breast feeding and improved parent-infant bonding due to reduced social and work pressures. Women from minoritised ethnic groups were less likely to continue breast feeding and attributed this to a lack of face-to-face support. CONCLUSIONS The evidence suggests that new and expectant families have been both negatively and positively impacted by the COVID-19 pandemic and the resulting restrictions. The impacts on parents' opportunities to bond with their young children and to be attuned to their needs were felt unequally. It is important that emergency response policies consider the mother and the partner as a family unit when making changes to the delivery of maternal and child health and care services, so as to mitigate the impact on the family and existing health inequalities. PROSPERO REGISTRATION NUMBER CRD42021236769.
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Affiliation(s)
- Adenike Motunrayo Adesanya
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Barrett
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration North East and North Cumbria, Newcastle upon Tyne, UK
| | - Wendy Nicholson
- Office of Health Improvement and Disparities, UK Department of Health and Social Care, London, UK
| | - Gillian Turner
- Office of Health Improvement and Disparities, UK Department of Health and Social Care, London, UK
| | - Emma Cook
- Office of Health Improvement and Disparities, UK Department of Health and Social Care, London, UK
| | - Sarah Tyndall
- Office of Health Improvement and Disparities, UK Department of Health and Social Care, London, UK
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration North East and North Cumbria, Newcastle upon Tyne, UK
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Wang S, Ding C, Dou C, Zhu Z, Zhang D, Yi Q, Wu H, Xie L, Zhu Z, Song D, Li H. Associations between maternal prenatal depression and neonatal behavior and brain function - Evidence from the functional near-infrared spectroscopy. Psychoneuroendocrinology 2022; 146:105896. [PMID: 36037574 DOI: 10.1016/j.psyneuen.2022.105896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Maternal prenatal depression is a significant public health issue associated with mental disorders of offspring. This study aimed to determine if maternal prenatal depressive symptoms are associated with changes in neonatal behaviors and brain function at the resting state. METHODS A total of 204 pregnant women were recruited during the third trimester and were evaluated by Edinburgh Postpartum Depression Scale (EPDS). The mother-infant pairs were divided into the depressed group (n = 75) and control group (n = 129) based on the EPDS, using a cut-off value of 10. Cortisol levels in the cord blood and maternal blood collected on admission for delivery were measured. On day three of life, all study newborns were evaluated by the Neonatal Behavior Assessment Scale (NBAS) and 165 infants were evaluated by resting-state functional near-infrared spectroscopy (rs-fNIRS). To minimize the influences of potential bias on the rs-fNIRS results, we used a binary logistic regression model to carry out propensity score matching between the depressed group and the control group. Rs-fNIRS data from 21 pairs of propensity score-matched newborns were used for analysis. The associations between maternal EPDS scores, neonatal NBAS scores, and cortisol levels were analyzed using linear regressions and the mediation analysis models. RESULTS Compared to the control group, the newborns in the depressed group had lower scores in the social-interaction and autonomic system dimensions of NBAS (P < 0.01). Maternal and umbilical cord plasma cortisol levels in the depressed group were higher (P < 0.01) than in the control group. However, only umbilical cord plasma cortisol played a negative mediating role in the relationship between maternal EPDS and NBAS in the social-interaction and autonomic system (β med = -0.054 [-0.115,-0.018] and -0.052 [-0.105,-0.019]. Proportional mediation was 13.57 % and 12.33 for social-interaction and autonomic systems, respectively. The newborns in the depressed group showed decreases in the strength of rs-fNIRS functional connections, primarily the connectivity of the left frontal-parietal and temporal-parietal regions. However, infants in the depressed and control groups showed no differences in topological characteristics of the brain network, including standardized clustering coefficient, characteristic path length, small-world property, global efficiency, and local efficiency (P > 0.05). The social-interaction Z-scores had positive correlations with functional connectivity strength of left prefrontal cortex-left parietal lobe (r = 0.57, p < 0.01),prefrontal cortex-left parietal lobe - left temporal lobe (r = 0.593, p < 0.01) and left parietal lobe - left temporal lobe (r = 0.498, p < 0.01). Autonomic system Z-scores were also significantly positive correlation with prefrontal cortex-left parietal lobe (r = 0.509, p < 0.01),prefrontal cortex-left parietal lobe - left temporal lobe (r = 0.464, p < 0.01), left parietal lobe - left temporal lobe (r = 0.381, p < 0.05), and right temporal lobe and left temporal lobe (r = 0.310, p < 0.05). CONCLUSION This study shows that maternal prenatal depression may affect the development of neonatal social-interaction and autonomic system and the strength of neonatal brain functional connectivity. The fetal cortisol may play a role in behavioral development in infants exposed to maternal prenatal depression. Our findings highlight the importance of prenatal screening for maternal depression and early postnatal behavioral evaluation that provide the opportunity for early diagnosis and intervention to improve neurodevelopmental outcomes.
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Affiliation(s)
- Shan Wang
- Department of Neonatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Neonatology, the Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chenxi Ding
- Department of Neonatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chengyin Dou
- Department of Neonatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zeen Zhu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dan Zhang
- Department of Neonatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiqi Yi
- Department of Neonatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haoyue Wu
- Department of Neonatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Longshan Xie
- Department of Functional Neuroscience, The First People's Hospital of Foshan (The Affiliated Foshan Hospital of Sun Yat -sen University), Guangdong, China
| | - Zhongliang Zhu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Maternal and Infant Health Research Institute and Medical College, Northwestern University, Xi'an, China
| | - Dongli Song
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA.
| | - Hui Li
- Department of Neonatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Neonatology, the Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, China.
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Naudé PJW, Pariante C, Hoffman N, Koopowitz SM, Donald KA, Zar HJ, Stein DJ. Antenatal maternal depression, early life inflammation and neurodevelopment in a South African birth cohort. Brain Behav Immun 2022; 105:160-168. [PMID: 35803482 DOI: 10.1016/j.bbi.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/07/2022] [Accepted: 07/03/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Antenatal exposure to maternal psychological adversity, including depression, increases the risk of impaired neurodevelopment in children. The underlying biological mechanisms remain unclear, especially in early life during critical windows of development and maturation. This study investigated the association of antenatal maternal depression, maternal and early life inflammatory markers and neurodevelopmental outcomes in children at 2 years of age. METHODS A subgroup of mothers and their children (n = 255) that were enrolled in a South African birth cohort study, the Drakenstein Child Health Study, were followed from the antenatal period through to 2 years of child age. Maternal depressive symptoms were measured by the Beck Depression Inventory (BDI-II) at 26 weeks gestation. Serum inflammatory markers [granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ (IFN-γ), interleukin IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, tumour necrosis factor-α (TNF-α), neutrophil gelatinase-associated lipocalin (NGAL) and metalloproteinase-9 (MMP-9)] were measured in mothers at enrolment and in their children at 6-10 weeks and at 2 years. Neurodevelopment was assessed at 2 years using the Bayley Scales of Infant and Toddler Development III. RESULTS Antenatal depressive symptoms (present in 25% of the mothers) were significantly associated with higher levels of IL-7 (p = 0.008), IL-8 (p = 0.019) and TNF-α (p = 0.031) in the mothers after correcting for sociodemographic and lifestyle factors. Serum IL-1β and NGAL levels were significantly elevated over time in children born to mothers with depressive symptoms compared to those without depression, after controlling for maternal and child health and sociodemographic factors. Elevated infant IL-1β at 6-10 weeks of age partially mediated the association of maternal depressive symptoms with poorer language scores at 2 years. CONCLUSION Alterations in early life immunity, as reflected by elevated IL-1β, is a potential pathway through which antenatal maternal depressive symptoms may impact language development in young children.
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Affiliation(s)
- Petrus J W Naudé
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Neuroscience Institute, University of Cape Town, South Africa.
| | - Carmine Pariante
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Nadia Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | | | - Kirsten A Donald
- Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa; SA-MRC Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Neuroscience Institute, University of Cape Town, South Africa; SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, South Africa
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Xia H, Zhu X, Zhu C. Associations between pro-inflammatory cytokines and fatigue in pregnant women. PeerJ 2022; 10:e13965. [PMID: 36193420 PMCID: PMC9526404 DOI: 10.7717/peerj.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023] Open
Abstract
Background Fatigue is one of the most prevalent symptoms among pregnant women. In patients with various diseases, pro-inflammatory cytokines are associated with fatigue; however, such associations are unknown in pregnant women. Objectives The objective of this study was to examine the associations between pro-inflammatory cytokines and prenatal fatigue. Methods A cross-sectional study was conducted on 271 pregnant Chinese women in their third trimester of pregnancy. Patient-reported Outcome Measurement Information System (PROMIS) was used to evaluate women's prenatal fatigue. Using enzyme-linked immunosorbent assay (ELISA), the serum concentrations of four pro-inflammatory cytokines, including tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), interleukin 6 (IL-6) and interleukin 8 (IL-8), were measured. The data was analyzed by correlation analysis and general linear regression analysis. Results In this sample, the mean (standard deviation) of fatigue scores was 51.94 (10.79). TNF-α (r = 0.21, p < 0.001), IL-6 (r = 0.134, p = 0.027) and IL-8 (r = 0.209, p = 0.001) were positively correlated to prenatal fatigue, although IL-1β was not. TNF-α (β = 0.263, p < 0.001), along with sleep quality (β = 0.27, p < 0.001) and depression (β = 0.376, p < 0.001) independently predicted prenatal fatigue. Conclusions TNF-α was identified as an independent biomarker for prenatal fatigue in our study. Reducing pro-inflammatory cytokines may be a unique method for lowering prenatal fatigue and, consequently, enhancing mother and child health.
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Affiliation(s)
- Haiou Xia
- School of Nursing, Fudan University, Shanghai, China
| | - Xiaoxiao Zhu
- School of Nursing, Fudan University, Shanghai, China
| | - Chunxiang Zhu
- Obstetrical Ward, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
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Hoirisch-Clapauch S. The Fibrinolytic System in Peripartum Depression. Semin Thromb Hemost 2022; 49:382-390. [PMID: 36113504 DOI: 10.1055/s-0042-1756194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractThe relationship between depression and reduced fibrinolytic activity reflects the role of tissue plasminogen activator and plasmin in brain remodeling underlying resilience, depression remission, and reward processing, rather than the dissolution of fibrin clots. Individuals who experience depression demonstrate hippocampal and prefrontal cortex atrophy, as well as impaired neuronal connectivity. Brain-derived neurotrophic factor (BDNF), synthesized as a precursor that is activated through cleavage by tissue plasminogen activator and plasmin, influences adult neurogenesis and neuronal plasticity in the hippocampus and prefrontal cortex. Depression is associated with decreased brain levels of BDNF, due to reduced activity of tissue plasminogen activator and plasmin. Tissue plasminogen activator and plasmin also mediate the release of dopamine, a neurotransmitter implicated in motivation and reward. Peripartum depression defines a depressive episode that occurs during pregnancy or in the first month after delivery, reinforcing the concept that postpartum depression may be a continuum of antenatal depression. This article describes the fibrinolytic status in the healthy brain, in stress and depression, emphasizing the links between biological markers of depression and defective fibrinolysis. It also discusses the association between hypofibrinolysis and risk factors for perinatal depression, including polycystic ovary syndrome, early miscarriage, preeclampsia, stressful life events, sedentariness, eating habits, gestational and type 2 diabetes, and antithyroid peroxidase antibodies. In addition, it reviews the evidence that antidepressant medications and interventions as diverse as placebo, psychotherapy, massage, video game playing, regular exercise, dietary modifications, omega 3 fatty acid supplementation, neurohormones, and cigarette smoking may reduce depression by restoring the fibrinolytic activity. Last, it suggests new directions for research.
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Murphy HR, Gu Y, Wu Q, Brunner J, Panisch LS, Best M, Arnold MS, Duberstein ZT, Putzig J, Carnahan J, Groth SW, Barrett ES, Qiu X, O'Connor TG. Prenatal diurnal cortisol: Normative patterns and associations with affective symptoms and stress. Psychoneuroendocrinology 2022; 143:105856. [PMID: 35797838 DOI: 10.1016/j.psyneuen.2022.105856] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis in pregnancy has attracted considerable research attention, in part, because it may be a mechanism by which diverse prenatal exposures alter perinatal and child health outcomes. Symptoms of affective disturbance and stress are among the most-studied prenatal factors associated with HPA axis alterations, but there remains uncertainty about the nature of the association because of the limitations to, and variability in, data collection and analytic approaches. The current study capitalized on a prospective, longitudinal pregnancy cohort that examined salivary diurnal cortisol, collected at 5 time points across the day, at each trimester in a diverse sample of women. Detailed data on affective symptoms and major life events were collected at each trimester, as were data on health behaviors, medication, and socio-demographics. Results indicated modest stability of individual differences in diurnal cortisol across pregnancy, which was evident for diurnal slope (ICC = .20) and measures of total output (area under the curve, ICC = .25); substantial gestation-related increases in total cortisol output across pregnancy was also observed (p < .001). Adjusting for health behaviors, medication, and socio-demographic covariates, elevated levels of depressive symptoms and major life events were significantly (p < .05) associated with a higher morning awakening value and flatter diurnal slope, which was evident across all trimesters. In addition to the normative gestation-related changes in cortisol production, our results demonstrate selective but robust associations between psychological symptoms, stressors, and the HPA axis across gestation, and suggest both methodological and mechanistic strategies for future study.
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Affiliation(s)
- Hannah R Murphy
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Yu Gu
- Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Blvd., Box 630, Rochester, NY 14642, USA
| | - Qiuyi Wu
- Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Blvd., Box 630, Rochester, NY 14642, USA
| | - Jessica Brunner
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Lisa S Panisch
- Wayne State University School of Social Work, 5447 Woodward Ave., Detroit, MI 48202, USA
| | - Meghan Best
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Molly S Arnold
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY 14627, USA
| | - Zoe T Duberstein
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY 14627, USA
| | - Jenelle Putzig
- Pediatrics Infectious Diseases, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Jennifer Carnahan
- Pediatrics Infectious Diseases, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, 255 Crittenden Blvd., Rochester, NY, USA
| | - Emily S Barrett
- Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, 170 Frelinghuysen Rd., Piscataway, NJ 08854, USA
| | - Xing Qiu
- Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Blvd., Box 630, Rochester, NY 14642, USA
| | - Thomas G O'Connor
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY 14627, USA; Neuroscience, University of Rochester, 601 Elmwood Avenue, Box 603, KMRB G.9602, Rochester, NY 14642, USA; Psychiatry, University of Rochester, 300 Crittenden Blvd., Rochester, NY 14642, USA.
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Ramsteijn AS, Verkaik-Schakel RN, Houwing DJ, Plösch T, Olivier JDA. Perinatal exposure to fluoxetine and maternal adversity affect myelin-related gene expression and epigenetic regulation in the corticolimbic circuit of juvenile rats. Neuropsychopharmacology 2022; 47:1620-1632. [PMID: 35102259 PMCID: PMC9283398 DOI: 10.1038/s41386-022-01270-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/11/2021] [Accepted: 01/04/2022] [Indexed: 12/30/2022]
Abstract
Many pregnant women experience symptoms of depression, and are often treated with selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine. In utero exposure to SSRIs and maternal depressive symptoms is associated with sex-specific effects on the brain and behavior. However, knowledge about the neurobiological mechanisms underlying these sex differences is limited. In addition, most animal research into developmental SSRI exposure neglects the influence of maternal adversity. Therefore, we used a rat model relevant to depression to investigate the molecular effects of perinatal fluoxetine exposure in male and female juvenile offspring. We performed RNA sequencing and targeted DNA methylation analyses on the prefrontal cortex and basolateral amygdala; key regions of the corticolimbic circuit. Perinatal fluoxetine enhanced myelin-related gene expression in the prefrontal cortex, while inhibiting it in the basolateral amygdala. SSRI exposure and maternal adversity interacted to affect expression of genes such as myelin-associated glycoprotein (Mag) and myelin basic protein (Mbp). We speculate that altered myelination reflects altered brain maturation. In addition, these effects are stronger in males than in females, resembling known behavioral outcomes. Finally, Mag and Mbp expression correlated with DNA methylation, highlighting epigenetic regulation as a potential mechanism for developmental fluoxetine-induced changes in myelination.
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Affiliation(s)
- Anouschka S. Ramsteijn
- grid.4830.f0000 0004 0407 1981Department of Neurobiology, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands ,grid.7107.10000 0004 1936 7291Present Address: Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, UK
| | - Rikst Nynke Verkaik-Schakel
- grid.4830.f0000 0004 0407 1981Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Danielle J. Houwing
- grid.4830.f0000 0004 0407 1981Department of Neurobiology, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands ,grid.10417.330000 0004 0444 9382Present Address: Department of Cognitive Neuroscience, Center for Medical Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Torsten Plösch
- grid.4830.f0000 0004 0407 1981Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jocelien D. A. Olivier
- grid.4830.f0000 0004 0407 1981Department of Neurobiology, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
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Sigurdardottir JN, White S, Flynn A, Singh C, Briley A, Rutherford M, Poston L. Longitudinal phenotyping of maternal antenatal depression in obese pregnant women supports multiple-hit hypothesis for fetal brain development, a secondary analysis of the UPBEAT study. EClinicalMedicine 2022; 50:101512. [PMID: 35784438 PMCID: PMC9241104 DOI: 10.1016/j.eclinm.2022.101512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Maternal antenatal depression is associated with offspring psychological disorders, but obesity is also widely implicated in maternal depression and neurodevelopment. In pregnant women with obesity we explored interrelationships between antenatal depressive symptom trajectories and multiple exposures implicated in fetal neurodevelopment which could explain these associations, as a prelude to exploring associations with infant mental health. METHODS The UK Pregnancies Better Eating and Activity Trial (UPBEAT) recruited multi-ethnic pregnant women with obesity (BMI >= 30kg/m2) between March 2009 and June 2014 from 8 UK sites and 1369 were included to model longitudinal antenatal depressive symptoms from Edinburgh Postnatal Depression Scale (EPDS) scores using Latent Class Growth Analysis. Classes were compared on maternal baseline demography, biomarkers of metabolism, inflammation and placental function, infection, diet and by pregnancy and birth outcomes. Odds ratios, mean differences and 95% Confidence Intervals were calculated using robust auxiliary modelling techniques. FINDINGS The chosen model produced four classes: "Not Depressed" (n=575 [42%], "reference"), "Mild" (n=523 [37·5%]), "Moderate" (n=219 [16%]) and "Severe" (n=62 [4·5%]) symptom trajectories. Socio-economic deprivation and ethnic diversity were greater in Severe and Moderate classes. Dietary glycaemic load and saturated fat intake were higher in Severe and Moderate classes (at 17 and 27 weeks). Higher Interleukin-6, glycoprotein acetyls (17 weeks), glucose (34 weeks) and lower placental growth factor (PlGF, 17 and 27 weeks) was found in the Severe class. PlGF was lower in the Moderate class (27 weeks). Infection was least likely in the Not Depressed class across gestation. Risks of preterm birth were associated with Severe depressive symptoms (aOR 3·05[1·11 to 8·36]). INTERPRETATION Comprehensive phenotyping exposes important fetal exposures implicated in adverse neurodevelopment, differing by depression class. This study expands substantially on causal models of suboptimal fetal neurodevelopment and offers potential new targets for intervention in obese pregnant women. FUNDING JNS was funded by a PhD studentship from the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. UPBEAT was supported by the European Union's 7th Framework Programme (FP7/2007-2013), project EarlyNutrition; grant agreement no. 289346 and the National Institute for Health Research (NIHR) (UK) Programme Grants for Applied Research Programme (RP-0407-10452), Medical Research Council UK Project Grant (MR/L002477/1). Support was also provided by the Chief Scientist Office Scotland, Guy's and St Thomas' Charity and Tommy's Charity (Registered charity no. 1060508). LP and SLW are funded by Tommy's Charity.
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Affiliation(s)
- Julie Nihouarn Sigurdardottir
- Department of Perinatal Imaging and Health, School of Biomedical Engineering & Imaging Sciences, King's College London, 1st Floor South Wing, St Thomas’ Hospital, London, SE1 7EH, United Kingdom
- Corresponding author.
| | - Sara White
- Department of Women and Children's Health, School of Life Course and Population Health Sciences, King's College London, 10th Floor, North Wing, St Thomas's, London, SE1 7EH, United Kingdom
| | - Angela Flynn
- Department of Women and Children's Health, School of Life Course and Population Health Sciences, King's College London, 10th Floor, North Wing, St Thomas's, London, SE1 7EH, United Kingdom
| | - Claire Singh
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, 57 Waterloo Road, London SE1 8WA, United Kingdom
| | - Annette Briley
- Department of Women and Children's Health, School of Life Course and Population Health Sciences, King's College London, 10th Floor, North Wing, St Thomas's, London, SE1 7EH, United Kingdom
- Caring Futures Institute, Flinders University, Sturt Rd, Bedford Park 5042, South Australia, Australia
| | - Mary Rutherford
- Department of Perinatal Imaging and Health, School of Biomedical Engineering & Imaging Sciences, King's College London, 1st Floor South Wing, St Thomas’ Hospital, London, SE1 7EH, United Kingdom
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course and Population Health Sciences, King's College London, 10th Floor, North Wing, St Thomas's, London, SE1 7EH, United Kingdom
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Craig MC, Sethna V, Gudbrandsen M, Pariante CM, Seneviratne T, Stoencheva V, Sethi A, Catani M, Brammer M, Murphy DGM, Daly E. Birth of the blues: emotional sound processing in infants exposed to prenatal maternal depression. Psychol Med 2022; 52:2017-2023. [PMID: 35786785 PMCID: PMC9386434 DOI: 10.1017/s0033291720002688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 03/16/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Offspring exposed to prenatal maternal depression (PMD) are vulnerable to depression across their lifespan. The underlying cause(s) for this elevated intergenerational risk is most likely complex. However, depression is underpinned by a dysfunctional frontal-limbic network, associated with core information processing biases (e.g. attending more to sad stimuli). Aberrations in this network might mediate transmission of this vulnerability in infants exposed to PMD. In this study, we aimed to explore the association between foetal exposure to PMD and frontal-limbic network function in infancy, hypothesising that, in response to emotional sounds, infants exposed to PMD would exhibit atypical activity in these regions, relative to those not exposed to PMD. METHOD We employed a novel functional magnetic resonance imaging sequence to compare brain function, whilst listening to emotional sounds, in 78 full-term infants (3-6 months of age) born to mothers with and without a diagnosis of PMD. RESULTS After exclusion of 19 datasets due to infants waking up, or moving excessively, we report between-group brain activity differences, between 29 infants exposed to PMD and 29 infants not exposed to PMD, occurring in temporal, striatal, amygdala/parahippocampal and frontal regions (p < 0.005). The offspring exposed to PMD exhibited a relative increase in activation to sad sounds and reduced (or unchanged) activation to happy sounds in frontal-limbic clusters. CONCLUSIONS Findings of a differential response to positive and negative valanced sounds by 3-6 months of age may have significant implications for our understanding of neural mechanisms that underpin the increased risk for later-life depression in this population.
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Affiliation(s)
- Michael C. Craig
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Natbrainlab, Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Female Hormone Clinic, Maudsley Hospital, SLAM NHS Foundation Trust, London, UK
| | - Vaheshta Sethna
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Gudbrandsen
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Carmine M. Pariante
- Stress, Psychiatry and Immunology & Perinatal Psychiatry Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Trudi Seneviratne
- Perinatal Services, Maudsley Hospital, SLAM NHS Foundation Trust, London, UK
| | - Vladimira Stoencheva
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Arjun Sethi
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Natbrainlab, Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marco Catani
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Natbrainlab, Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mick Brammer
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Declan G. M. Murphy
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eileen Daly
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Nazzari S, Fearon P, Rice F, Molteni M, Frigerio A. Maternal caregiving moderates the impact of antenatal maternal cortisol on infant stress regulation. J Child Psychol Psychiatry 2022; 63:871-880. [PMID: 34787327 DOI: 10.1111/jcpp.13532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emerging evidence suggests that antenatal exposure to maternal stress signals affects the development of the infant stress response systems. Animal studies indicate that maternal sensitive caregiving can reverse some of these effects. However, the generalizability of these findings to humans is unknown. This study investigated the role of maternal caregiving in the association between multiple markers of maternal antenatal stress and infant stress regulation. METHODS The sample consisted of 94 mother-infant (N = 47 males, mean postnatal weeks = 12; SD = 1.84) dyads. Maternal levels of Interleukin-6, C-Reactive Protein (CRP), diurnal cortisol and alpha amylase, depressive and anxiety symptoms were assessed in late pregnancy (mean gestational age = 34.76; SD = 1.12), whereas postnatal symptomatology, caregiving, and infant cortisol response to the inoculation were evaluated at 3 months. RESULTS Hierarchical linear models (HLMs) showed a significant interaction between maternal antenatal cortisol, caregiving, and time on infant cortisol reactivity, while controlling for gender, maternal age, and postnatal depression. Specifically, higher levels of maternal antenatal cortisol were associated with greater cortisol response only among infants of less emotionally available mothers. All other markers of antenatal stress were not significantly associated with infant cortisol reactivity either independently or in interaction with maternal caregiving. CONCLUSIONS Albeit preliminary, results provide the first evidence in humans that maternal sensitive caregiving may eliminate the association between antenatal maternal cortisol and infant cortisol regulation.
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Affiliation(s)
- Sarah Nazzari
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Frances Rice
- Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Section of Child and Adolescent Psychiatry, Cardiff University, Cardiff, UK
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Alessandra Frigerio
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
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Bind RH, Estevao C, Fancourt D, Hazelgrove K, Sawyer K, Rebecchini L, Miller C, Dazzan P, Sevdalis N, Woods A, Crane N, Manoharan M, Burton A, Dye H, Osborn T, Greenwood L, Bakolis I, Lopez MB, Davis R, Perkins R, Pariante CM. Online singing interventions for postnatal depression in times of social isolation: a feasibility study protocol for the SHAPER-PNDO single-arm trial. Pilot Feasibility Stud 2022; 8:148. [PMID: 35851430 PMCID: PMC9289358 DOI: 10.1186/s40814-022-01112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 07/07/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Postnatal depression (PND) affects 13% of new mothers, with numbers rising during the COVID-19 pandemic. Despite this prevalence, many women have difficulty with or hesitancy towards accessing pharmacological and/or psychological interventions. Group-based mother-baby activities, however, have a good uptake, with singing improving maternal mental health and the mother-infant relationship. The recent lockdowns highlight the importance of adapting activities to an online platform that is wide-reaching and accessible. AIMS The SHAPER-PNDO study will primarily analyse the feasibility of a 6-week online singing intervention, Melodies for Mums (M4M), for mothers with PND who are experiencing barriers to treatment. The secondary aim of the SHAPER-PNDO study will be to analyse the clinical efficacy of the 6-week M4M intervention for symptoms of postnatal depression. METHODS A total of 120 mothers and their babies will be recruited for this single-arm study. All dyads will attend 6 weekly online singing sessions, facilitated by Breathe Arts Health Research. Assessments will be conducted on Zoom at baseline and week 6, with follow-ups at weeks 16 and 32, and will contain interviews for demographics, mental health, and social circumstances, and biological samples will be taken for stress markers. Qualitative interviews will be undertaken to understand the experiences of women attending the sessions and the facilitators delivering them. Finally, data will be collected on recruitment, study uptake and attendance of the programme, participant retention, and acceptability of the intervention. DISCUSSION The SHAPER-PNDO study will focus on the feasibility, alongside the clinical efficacy, of an online delivery of M4M, available to all mothers with PND. We hope to provide a more accessible, effective treatment option for mothers with PND that can be available both during and outside of the pandemic for mothers who would otherwise struggle to attend in-person sessions, as well as to prepare for a subsequent hybrid RCT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04857593 . Registered retrospectively on 22 April 2021. The first participants were recruited on 27 January 2021, and the trial is ongoing.
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Affiliation(s)
- Rebecca H Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK.
| | - Carolina Estevao
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Kristi Sawyer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Lavinia Rebecchini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Celeste Miller
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Anthony Woods
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Nikki Crane
- Culture Team, King's College London, Somerset House East Wing, Strand, WC2R 2LS, UK
| | - Manonmani Manoharan
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Hannah Dye
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Tim Osborn
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Lorna Greenwood
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Maria Baldellou Lopez
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Rachel Davis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Rosie Perkins
- Centre for Performance Science, Royal College of Music, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
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Parikh AN, Triplett RL, Wu TJ, Arora J, Lukas K, Smyser TA, Miller JP, Luby JL, Rogers CE, Barch DM, Warner BB, Smyser CD. Neonatal Intensive Care Unit Network Neurobehavioral Scale Profiles in Full-Term Infants: Associations with Maternal Adversity, Medical Risk, and Neonatal Outcomes. J Pediatr 2022; 246:71-79.e3. [PMID: 35430247 PMCID: PMC10030163 DOI: 10.1016/j.jpeds.2022.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To examine healthy, full-term neonatal behavior using the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) in relation to measures of maternal adversity, maternal medical risk, and infant brain volumes. STUDY DESIGN This was a prospective, longitudinal, observational cohort study of pregnant mothers followed from the first trimester and their healthy, full-term infants. Infants underwent an NNNS assessment and high-quality magnetic resonance imaging 2-5 weeks after birth. A latent profile analysis of NNNS scores categorized infants into neurobehavioral profiles. Univariate and multivariate analyses compared differences in maternal factors (social advantage, psychosocial stress, and medical risk) and neonatal characteristics between profiles. RESULTS The latent profile analysis of NNNS summary scales of 296 infants generated 3 profiles: regulated (46.6%), hypotonic (16.6%), and fussy (36.8%). Infants with a hypotonic profile were more likely to be male (χ2 = 8.601; P = .014). Fussy infants had smaller head circumferences (F = 3.871; P = .022) and smaller total brain (F = 3.522; P = .031) and cerebral white matter (F = 3.986; P = .020) volumes compared with infants with a hypotonic profile. There were no differences between profiles in prenatal maternal health, social advantage, or psychosocial stress. CONCLUSIONS Three distinct neurobehavioral profiles were identified in healthy, full-term infants with hypotonic and fussy neurobehavioral features related to neonatal brain volumes and head circumference, but not prenatal exposure to socioeconomic or psychosocial adversity. Follow-up beyond the neonatal period will determine if identified profiles at birth are associated with subsequent clinical or developmental outcomes.
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Affiliation(s)
- Amisha N Parikh
- School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Regina L Triplett
- Department of Neurology, Washington University in St. Louis, St. Louis, MO.
| | - Tiffany J Wu
- School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Jyoti Arora
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Karen Lukas
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Tara A Smyser
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - J Philip Miller
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Joan L Luby
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO; Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO; Department of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Barbara B Warner
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Christopher D Smyser
- Department of Neurology, Washington University in St. Louis, St. Louis, MO; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO; Department of Radiology, Washington University in St. Louis, St. Louis, MO
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Laugesen K, Sørensen HT, Jørgensen JOL, Petersen I. In utero exposure to glucocorticoids and risk of anxiety and depression in childhood or adolescence. Psychoneuroendocrinology 2022; 141:105766. [PMID: 35447494 DOI: 10.1016/j.psyneuen.2022.105766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/04/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
Glucocorticoid use is prevalent in pregnant women, but whether in utero exposure impacts mental health in the offspring has not been fully explored. The aim of this study was to investigate if in utero exposure to synthetic glucocorticoids increases the risk of anxiety and depression in childhood or adolescence. The study was conducted as a nationwide cohort study, including negative control exposure analyses and a sibling design to optimize control of confounding. The study population comprised 1,275,909 children born in 1996-2015 in Denmark (median follow-up of 13 years). Exposure was divided into systemic and local glucocorticoid exposure, levels of cumulative dose, generic type and according to trimester of exposure. The comparison cohort was children without exposure born to maternal never-users. Negative control exposures included children without glucocorticoid exposure born to: maternal users of non-steroidal anti-inflammatory drugs or immunotherapy during pregnancy, maternal former users of systemic glucocorticoids, maternal users of systemic glucocorticoids in the postnatal period, and fathers who were prescribed glucocorticoids. The sibling design compared siblings with and without exposure. 9307 (0.7%) children were exposed to systemic glucocorticoids and 116,389 (9.1%) children were exposed to local glucocorticoids. High-dose systemic glucocorticoids (≥500 mg prednisolone equivalents) increased the risk of anxiety compared to the comparison cohort [aIRR 1.79 (95% CI: 1.36-2.37), cumulative risk 16% vs. 7.8% by age 20]. A similar result was found for depression [aIRR 1.45 (95% CI: 0.80-2.63), cumulative risk 3.6% vs. 2.6% by age 20]. The association with anxiety was consistent in the sibling design [aIRR 1.83 (95% CI: 1.03-3.66), exposed siblings (≥ 500 mg) vs. unexposed]. Sex did not modify the associations. Negative control exposure analyses indicated robustness towards confounding from genetics and family environment. No association was found with low doses of systemic exposure or local use. In conclusion, potential adverse mental health effects of in utero exposure to high-dose glucocorticoids merit clinical attention.
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Affiliation(s)
- Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43-45, 8200 Aarhus, Denmark.
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43-45, 8200 Aarhus, Denmark.
| | - Jens Otto Lunde Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus, Denmark.
| | - Irene Petersen
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43-45, 8200 Aarhus, Denmark; Department of Primary Care and Population Health, University College London, Rowland Hill Street, London NW3 2PF, UK.
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Jarbou NS, Newell KA. Exercise and yoga during pregnancy and their impact on depression: a systematic literature review. Arch Womens Ment Health 2022; 25:539-559. [PMID: 35286442 DOI: 10.1007/s00737-021-01189-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022]
Abstract
It is well established that exercise can improve depressive symptoms in the general population; however, it is not clear if these benefits are also seen in pregnancy. This review aimed to synthesize the evidence that examines whether exercise during pregnancy impacts depressive and associated symptoms (e.g. anxiety) during the perinatal period. The review was conducted in accordance with PRISMA guidelines and reporting criteria; literature was searched using PubMed, Scopus and Web of Science database engines. Clinical trials published in English evaluating the effects of a defined exercise protocol during pregnancy on depressive and/or anxiety symptoms during the perinatal period were included. Studies without a control group were excluded. Risk of bias was conducted by Cochrane assessment to appraise the quality of the included studies. Twenty-seven articles, between 1994 and 2019, were included. Of these, only 5 specifically recruited women with depression (n = 334), which all assessed a yoga-based intervention; 4 of these studies showed a statistically significant improvement in depressive and/or anxiety symptoms in the intervention group compared to baseline; however, 2 of these studies also showed an improvement in the control group. The remaining 22 studies used various exercise interventions in pregnant women (n = 4808) with 20 studies reporting that exercise during pregnancy has the ability to improve depressive and/or anxiety measures in the perinatal period compared to either baseline or control. The evidence suggests that exercise of various types in pregnancy can reduce depressive and/or anxiety symptoms in the perinatal period in otherwise healthy women. Specifically in women with antenatal depression, the incorporation of yoga in pregnancy can improve depressive/anxiety symptoms in the perinatal period; however, this is based on a small number of studies, and it is not clear whether this is superior to non-exercise controls. Further studies are needed to determine the potential therapeutic effects of exercise of various types during pregnancy on symptoms of antenatal depression.
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Affiliation(s)
- Noor S Jarbou
- Molecular Horizons and School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
| | - Kelly A Newell
- Molecular Horizons and School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.
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Voegtline KM, Dhaurali S, Wainger J, Lauzon S. Ontogeny of the Dyad: the Relationship Between Maternal and Offspring Neuroendocrine Function. Curr Psychiatry Rep 2022; 24:297-306. [PMID: 35451797 PMCID: PMC9648681 DOI: 10.1007/s11920-022-01337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW We review ontogeny of the maternal-offspring neuroendocrine relationship in human pregnancy. We present bidirectional genetic, physiological, and behavioral influences that enhance or disrupt HPA activity and its end product cortisol at the individual level and within the dyad. RECENT FINDINGS Consistent evidence supports that maternal mood and caregiving behavior are associated with maternal and offspring cortisol levels. Select studies support the buffering effects of antidepressant use and maternal positive affect on offspring cortisol. Growing research highlights evocative effects of fetal neuroendocrine activity, antenatal gene transfer, and infant behavioral distress and risk characteristics on maternal cortisol levels and dyadic attunement. There is potential to advance our understanding of the mother-offspring neuroendocrine relationship by consideration of other neuroactive steroids in addition to cortisol, and to consider developmental timing and measurement source in study design. Future study should emphasize in what context or for whom neuroendocrine attunement is adaptive versus maladaptive for mother and child.
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Affiliation(s)
- Kristin M. Voegtline
- Johns Hopkins School of Medicine, Department of Pediatrics,Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health
| | | | - Julia Wainger
- Johns Hopkins School of Medicine, Department of Gynecology and Obstetrics
| | - Sylvie Lauzon
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health
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Musillo C, Berry A, Cirulli F. Prenatal psychological or metabolic stress increases the risk for psychiatric disorders: the "funnel effect" model. Neurosci Biobehav Rev 2022; 136:104624. [PMID: 35304226 DOI: 10.1016/j.neubiorev.2022.104624] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022]
Abstract
Adverse stressful experiences in utero can redirect fetal brain development, ultimately leading to increased risk for psychiatric disorders. Obesity during pregnancy can have similar effects as maternal stress, affecting mental health in the offspring. In order to explain how similar outcomes may originate from different prenatal conditions, we propose a "funnel effect" model whereby maternal psychological or metabolic stress triggers the same evolutionarily conserved response pathways, increasing vulnerability for psychopathology. In this context, the placenta, which is the main mother-fetus interface, appears to facilitate such convergence, re-directing "stress" signals to the fetus. Characterizing converging pathways activated by different adverse environmental conditions is fundamental to assess the emergence of risk signatures of major psychiatric disorders, which might enable preventive measures in risk populations, and open up new diagnostics, and potentially therapeutic approaches for disease prevention and health promotion already during pregnancy.
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Affiliation(s)
- Chiara Musillo
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; PhD Program in Behavioral Neuroscience, Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Alessandra Berry
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
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Ahmad SI, Shih EW, LeWinn KZ, Rivera L, Graff JC, Mason WA, Karr CJ, Sathyanarayana S, Tylavsky FA, Bush NR. Intergenerational Transmission of Effects of Women's Stressors During Pregnancy: Child Psychopathology and the Protective Role of Parenting. Front Psychiatry 2022; 13:838535. [PMID: 35546925 PMCID: PMC9085155 DOI: 10.3389/fpsyt.2022.838535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 12/22/2022] Open
Abstract
Objective Experiences of stress and adversity, such as intimate partner violence, confer risk for psychiatric problems across the life span. The effects of these risks are disproportionately borne by women and their offspring-particularly those from communities of color. The prenatal period is an especially vulnerable period of fetal development, during which time women's experiences of stress can have long-lasting implications for offspring mental health. Importantly, there is a lack of focus on women's capacity for resilience and potential postnatal protective factors that might mitigate these intergenerational risks and inform intervention efforts. The present study examined intergenerational associations between women's prenatal stressors and child executive functioning and externalizing problems, testing maternal parenting quality and child sex as moderators, using a large, prospective, sociodemographically diverse cohort. Methods We used data from 1,034 mother-child dyads (64% Black, 30% White) from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) pregnancy cohort within the ECHO PATHWAYS consortium. Women's prenatal stressors included stressful life events (pSLE) and intimate partner violence (pIPV). Measures of child psychopathology at age 4-6 included executive functioning and externalizing problems. Parenting behaviors were assessed by trained observers, averaged across two sessions of mother-child interactions. Linear regression models were used to estimate associations between women's prenatal stressors and child psychopathology, adjusting for confounders and assessing moderation effects by maternal parenting quality and child sex. Results Women's exposures to pSLE and pIPV were independently associated with child executive functioning problems and externalizing problems in fully-adjusted models. Maternal parenting quality moderated associations between pSLE and both outcomes, such that higher parenting quality was protective for the associations between women's pSLE and child executive functioning and externalizing problems. No moderation by child sex was found. Discussion Findings from this large, sociodemographically diverse cohort suggest women's exposures to interpersonal violence and major stressful events-common for women during pregnancy-may prenatally program her child's executive functioning and externalizing problems. Women's capacity to provide high quality parenting can buffer this intergenerational risk. Implications for universal and targeted prevention and early intervention efforts to support women's and children's wellbeing are discussed.
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Affiliation(s)
- Shaikh I. Ahmad
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Emily W. Shih
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Luisa Rivera
- Department of Anthropology, Emory University, Atlanta, GA, United States
| | - J. Carolyn Graff
- College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, United States
- Center on Developmental Disabilities, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - W. Alex Mason
- Department of Preventative Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Catherine J. Karr
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Frances A. Tylavsky
- Department of Preventative Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
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45
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Rosa MJ, Tamayo-Ortiz M, Mercado Garcia A, Rivera Rivera NY, Bush D, Lee AG, Solano-González M, Amarasiriwardena C, Téllez-Rojo MM, Wright RO, Wright RJ. Prenatal lead exposure and childhood lung function: Influence of maternal cortisol and child sex. Environ Res 2022; 205:112447. [PMID: 34875261 PMCID: PMC8760170 DOI: 10.1016/j.envres.2021.112447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Maternal hypothalamic-pituitary-adrenal (HPA) axis disruption in pregnancy may contribute to the programming of childhood respiratory disease and may modify the effect of chemical toxins, like lead (Pb), on lung development. Child sex may further modify these effects. We sought to prospectively examine associations between maternal HPA axis disruption, prenatal Pb and childhood lung function and explore potential effect modification by maternal cortisol and child sex on the association between prenatal Pb and lung function outcomes. MATERIALS AND METHODS Analyses included 222 mothers and children enrolled in a longitudinal birth cohort study in Mexico City. Maternal diurnal salivary cortisol was assessed in pregnancy; cortisol awakening response (CAR) and diurnal slope were calculated. Blood Pb was measured during the second trimester of pregnancy. Post-bronchodilator lung function was tested at ages 8-11 years. Associations were modeled using generalized linear models with interaction terms, adjusting for covariates. RESULTS A higher (flatter) diurnal slope was associated with lower FEV1/FVC ratio (β: 0.433, 95%CI [-0.766, -0.101]). We did not find any main effect associations between prenatal Pb and lung function outcomes. We report an interaction between Pb and cortisol in relation to FEV1/FVC and FEF25-75% (pinteraction<0.05 for all). Higher prenatal Pb was associated with reduced FEV1/FVC only in children whose mothers had a high CAR. Higher prenatal Pb was also associated with reduced FEV1/FVC and FEF25-75% in mothers with a flatter diurnal slope. A 3-way interaction between prenatal Pb, CAR and sex on FEV1/FVC, indicated that boys born to women with high CAR and higher prenatal Pb levels had lower FEV1/FVC ratios (pinteraction = 0.067). CONCLUSIONS Associations between prenatal Pb and childhood lung function were modified by disrupted maternal cortisol in pregnancy and child sex. These findings underscore the need to consider complex interactions to fully elucidate effects of prenatal Pb exposure on childhood lung function.
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Affiliation(s)
- Maria José Rosa
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, 10029, New York, NY, USA.
| | - Marcela Tamayo-Ortiz
- Occupational Health Research Unit, Mexican Institute of Social Security (IMSS), Av. Cuahtemoc 330, Col. Doctores, 06720, Mexico City, Mexico.
| | - Adriana Mercado Garcia
- Center for Nutrition and Health Research, National Institute of Public Health, Av. Universidad #655 Col, Santa Maria Ahuacatitlan C.P, 62100, Cuernavaca, Morelos, Mexico.
| | - Nadya Y Rivera Rivera
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, 10029, New York, NY, USA.
| | - Douglas Bush
- Kravis Children's Hospital, Department of Pediatrics, Division of Pediatric Pulmonology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, 10029, New York, NY, USA.
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, 10029, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA.
| | - Maritsa Solano-González
- Center for Nutrition and Health Research, National Institute of Public Health, Av. Universidad #655 Col, Santa Maria Ahuacatitlan C.P, 62100, Cuernavaca, Morelos, Mexico.
| | - Chitra Amarasiriwardena
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, 10029, New York, NY, USA.
| | - Martha Maria Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Av. Universidad #655 Col, Santa Maria Ahuacatitlan C.P, 62100, Cuernavaca, Morelos, Mexico.
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, 10029, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA.
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, 10029, New York, NY, USA; Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, 10029, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA.
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Folger AT, Nidey N, Ding L, Ji H, Yolton K, Ammerman RT, Bowers KA. Association Between Maternal Adverse Childhood Experiences and Neonatal SCG5 DNA Methylation-Effect Modification by Prenatal Home Visiting. Am J Epidemiol 2022; 191:636-645. [PMID: 34791022 DOI: 10.1093/aje/kwab270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 09/21/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022] Open
Abstract
Maternal childhood adversity and trauma may elicit biological changes that impact the next generation through epigenetic responses measured in DNA methylation (DNAm). These epigenetic associations could be modified by the early postnatal environment through protective factors, such as early childhood home visiting (HV) programs that aim to mitigate deleterious intergenerational effects of adversity. In a cohort of 53 mother-child pairs recruited in 2015-2016 for the Pregnancy and Infant Development Study (Cincinnati, Ohio), we examined the association between maternal adverse childhood experiences (ACEs) and neonatal DNAm in the secretogranin V gene (SCG5), which is important in neuroendocrine function. We examined prenatal HV as an effect modifier. Mothers completed a questionnaire on ACEs during pregnancy, and infant buccal samples were collected 1 month postpartum. Multivariable linear regression was used to examine the association between maternal ACEs and neonatal DNAm expressed as M-values averaged across 4 cytosine-phosphate-guanine dinucleotide sites. A higher number of maternal ACEs (>3) was associated with a 5.79-percentage-point lower offspring DNAm (95% confidence interval: -10.44, -1.14), and the association was modified by the number of home visits received during pregnancy. In a population of at-risk mother-child dyads, preliminary evidence suggests that maternal ACEs have a relationship with offspring SCG5 DNAm that differs by the amount of prenatal HV.
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Costa TJ, De Oliveira JC, Giachini FR, Lima VV, Tostes RC, Bomfim GF. Programming of Vascular Dysfunction by Maternal Stress: Immune System Implications. Front Physiol 2022; 13:787617. [PMID: 35360231 PMCID: PMC8961444 DOI: 10.3389/fphys.2022.787617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
A growing body of evidence highlights that several insults during pregnancy impact the vascular function and immune response of the male and female offspring. Overactivation of the immune system negatively influences cardiovascular function and contributes to cardiovascular disease. In this review, we propose that modulation of the immune system is a potential link between prenatal stress and offspring vascular dysfunction. Glucocorticoids are key mediators of stress and modulate the inflammatory response. The potential mechanisms whereby prenatal stress negatively impacts vascular function in the offspring, including poor hypothalamic–pituitary–adrenal axis regulation of inflammatory response, activation of Th17 cells, renin–angiotensin–aldosterone system hyperactivation, reactive oxygen species imbalance, generation of neoantigens and TLR4 activation, are discussed. Alterations in the immune system by maternal stress during pregnancy have broad relevance for vascular dysfunction and immune-mediated diseases, such as cardiovascular disease.
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Affiliation(s)
- Tiago J. Costa
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Júlio Cezar De Oliveira
- Health Education Research Center (NUPADS), Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
| | - Fernanda Regina Giachini
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
| | - Victor Vitorino Lima
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
| | - Rita C. Tostes
- Health Education Research Center (NUPADS), Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
| | - Gisele Facholi Bomfim
- Health Education Research Center (NUPADS), Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
- *Correspondence: Gisele Facholi Bomfim,
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Czarzasta K, Bogacki-Rychlik W, Segiet-Swiecicka A, Kruszewska J, Malik J, Skital V, Kasarello K, Wrzesien R, Bialy M, Sajdel-Sulkowska EM. Gender differences in short- vs. long-term impact of maternal depression following pre-gestational chronic mild stress. Exp Neurol 2022; 353:114059. [DOI: 10.1016/j.expneurol.2022.114059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 11/04/2022]
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Bind RH. Immunological and other biological correlates of the impact of antenatal depression on the mother-infant relationship. Brain Behav Immun Health 2022; 20:100413. [PMID: 35112090 PMCID: PMC8790630 DOI: 10.1016/j.bbih.2022.100413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 01/07/2023] Open
Abstract
Antenatal depression affects up to 20% of pregnancies, yet research has historically focused on postnatal depression and its effects on mothers and their offspring. Studies are now emerging highlighting the impact that depression in pregnancy can also carry on both members of the dyad, including difficulties with psychological, physical, and social functioning. More specifically, researchers have begun to examine whether antenatal depression may lead to difficulties in the developing mother-infant relationship and subsequent infant attachment. While much of the research on this has explored psychosocial mechanisms behind the pathway from antenatal depression to a disrupted relationship in the postpartum, few studies have looked at biological underpinnings of this process. Of the literature that exists, it has been found that mothers with depression in pregnancy have lower levels of oxytocin and increased levels of inflammatory markers, plausibly creating difficulties in the mother-infant bonding process, leading to impaired mother-infant interactions and non-secure infant attachment. Furthermore, infants with non-secure attachments are at risk of entering a proinflammatory state due to a dysregulated stress response system. Overall, the literature on the neurobiology of mother-infant interactions and infant attachment in the context of antenatal depression is sparse, thus warranting future research.
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Affiliation(s)
- Rebecca H. Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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50
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Liu Y, Heron J, Hickman M, Zammit S, Wolke D. Prenatal stress and offspring depression in adulthood: The mediating role of childhood trauma. J Affect Disord 2022; 297:45-52. [PMID: 34670130 PMCID: PMC8641663 DOI: 10.1016/j.jad.2021.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is repeated evidence for a prenatal programming effect for the development of offspring depression. However, examination of environmental influences along this pathway is sparse. This study aimed to investigate the direct and indirect effects of pre- and postnatal stress on offspring depression in adulthood, via increased exposure to childhood trauma. METHODS A large longitudinal population-based cohort (N = 3506) was followed up from birth and assessed at 24 years. Diagnosis of depression was derived using the International Classification of Diseases-10th revision (ICD-10). Two separate sources of pre- and postnatal stress were examined - maternal depression and family adversity, and childhood trauma was assessed prospectively across childhood until 17 years. RESULTS Both pre- and postnatal maternal depression and family adversity were associated with offspring depression at 24 years in simple logistic regression models. When all pathways were modelled simultaneously, only childhood trauma was directly associated with offspring depression, and mediated all pathways from both sources of pre- and postnatal stress to offspring depression (7-16% of the total effect mediated). Sensitivity analysis on specific trauma found stronger evidence for a mediated pathway via physical, emotional abuse and peer bullying, compared to emotional neglect, sexual abuse and domestic violence. CONCLUSIONS These findings indicate that reducing childhood trauma could be a target to decrease depression in the general population, and the focus should also be on families at high risk of experiencing pre- or postnatal stress, to provide them with better support.
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Affiliation(s)
- Yiwen Liu
- Department of Psychology, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Stanley Zammit
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, United Kingdom
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry CV4 7AL, United Kingdom; Division of Health Sciences, Warwick Medical School, University of Warwick, United Kingdom.
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