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Ether ST, Afrin S, Habib NN, Akter F, Chowdhury AT, Sayeed A, Raza S, Ahmed A, Saif-Ur-Rahman KM. Managing pre and postpartum mental health issues of refugee women from fragile and conflict-affected countries: A systematic review. PUBLIC HEALTH IN PRACTICE 2025; 9:100573. [PMID: 39835221 PMCID: PMC11743345 DOI: 10.1016/j.puhip.2024.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 11/10/2024] [Accepted: 11/14/2024] [Indexed: 01/22/2025] Open
Abstract
Objective Refugee or immigrant women residing in conflict prone countries portray elevated mental health related vulnerabilities during their peripartum periods and require effective interventions for improved maternal and child well-being. The objective of this systematic review is to generate evidence on effective interventions for managing peripartum mental health issues among refugee women from conflicted settings. Study design Systematic review. Method Three databases MEDLINE/PubMed, Scopus, and Web of Science (core collection) were searched and Rayyan was used to perform screening. RoBANS tool was used to assess the risk of bias and narrative synthesis was conducted to narrate the result. Result 5425 potential articles were identified and seven studies were included for data extraction after a rigorous screening process. Four (n = 4), out of seven studies discussed improved Edinburgh Postnatal Depression Scale (EPDS) scores, reduced perinatal distress and depression, increased self-esteem, and knowledge about pregnancy and child development, etc. due to home visits during the antepartum and postpartum period. Two studies asserted the importance of group sessions and social support and found social support was negatively correlated with postpartum depression (r = -0.49, p < 0.0001). Formal/informal, public, private, or volunteered supports were explored to be important for increasing knowledge about maternal well-being, stress management, and childcare processes for refugee women. Conclusion The absence of limited experimental studies opens the opportunity for conducting further research on this topic. Besides, development partners can focus on this review to prioritise the intervention components during designing programmes on this related issue.
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Affiliation(s)
| | - Sadia Afrin
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Fahmida Akter
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Abu Sayeed
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Sahar Raza
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - KM Saif-Ur-Rahman
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
- College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
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Koutra K, Mouatsou C, Margetaki K, Roumeliotaki T, Mavroeides G, Psoma S, Kampouri M, Karachaliou M, Kogevinas M, Chatzi L. Perinatal maternal mental health and offspring internalizing and externalizing difficulties from early childhood through adolescence: Rhea mother-child cohort in Crete, Greece. Eur Child Adolesc Psychiatry 2025:10.1007/s00787-025-02746-1. [PMID: 40394216 DOI: 10.1007/s00787-025-02746-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 05/08/2025] [Indexed: 05/22/2025]
Abstract
Longitudinal research assessing childhood mental health is limited, particularly in terms of tracking how early-life factors influence the development of emotional and behavioral disorders over time. The present study aimed to examine the influence of both antenatal and postnatal maternal mental health on children's emotional and behavioral development, with a focus on the trajectory of internalizing, externalizing and attention deficit hyperactivity disorder (ADHD) symptoms from early childhood through adolescence. The present study included 434 mother-child pairs of the Rhea mother-child cohort in Crete, Greece. Maternal depressive symptoms (EPDS), trait anxiety (STAI-Trait), and personality traits (EPQ-R) were assessed during the third trimester of pregnancy, while postnatal depressive symptoms (EPDS) were evaluated 8-10 weeks after childbirth. Children's internalizing, externalizing and ADHD-related symptoms were assessed at ages 4 (using the SDQ and ADHDT, respectively), and at ages 6, 11, and 15 (using the CBCL and CPRS-R:S, respectively). Multivariate mixed regression models, incorporating a random intercept for each child and a random slope for age at follow-up, were used to analyze the trajectories of symptoms from ages 4 to 15. Significant long-term associations were found between maternal mental health and child outcomes between the ages of 4 and 15. Specifically, higher levels of maternal trait anxiety and neuroticism were associated with an increase in children's internalizing, externalizing, and ADHD symptoms. Both antenatal and postnatal maternal depressive symptoms were linked to a greater likelihood of internalizing and externalizing symptoms over time, but only postnatal depression was related to a rise in ADHD symptoms. The findings emphasize the importance of perinatal maternal mental health in children's emotional and behavioral development and suggest the need for prevention and early intervention programs to support the mental health of both mothers and children.
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Affiliation(s)
- Katerina Koutra
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus, 74100, Rethymno, Crete, Greece.
| | - Chrysi Mouatsou
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus, 74100, Rethymno, Crete, Greece
| | - Katerina Margetaki
- Clinic of Ρreventive and Social Medicine, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Theano Roumeliotaki
- Clinic of Ρreventive and Social Medicine, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Georgios Mavroeides
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus, 74100, Rethymno, Crete, Greece
| | - Sofia Psoma
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus, 74100, Rethymno, Crete, Greece
| | - Mariza Kampouri
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marianna Karachaliou
- Clinic of Ρreventive and Social Medicine, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Manolis Kogevinas
- Barcelona Institute for Global Health, Barcelona, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Lida Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Kahn LG, Hipwell AE, Charifson M, Ling R, Cajachagua-Torres KN, Ghassabian A. Maternal polycystic ovarian syndrome and offspring psychopathology and neurodevelopment. Hum Reprod 2025:deaf079. [PMID: 40380372 DOI: 10.1093/humrep/deaf079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 03/26/2025] [Indexed: 05/19/2025] Open
Abstract
Polycystic ovarian syndrome (PCOS) is a common female endocrinologic condition that affects both the metabolic and reproductive systems and is the most frequent cause of anovulatory infertility. It is also associated with a range of psychiatric outcomes in individuals, including bulimia nervosa, schizophrenia, bipolar disorder, depression, anxiety, and personality disorders. At the same time, evidence suggests that hyperandrogenism, the characteristic trait of PCOS, may impair fetal neurodevelopment. Epidemiological studies have linked maternal PCOS with a variety of behavioral and psychiatric conditions in offspring including autism spectrum disorder and attention deficit hyperactivity disorder. In this review, we explore evidence for potential underlying biological mechanisms that might explain these observed associations, discuss the complex interplay between genetics and various environmental factors across generations, and highlight avenues for future research.
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Affiliation(s)
- Linda G Kahn
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mia Charifson
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rui Ling
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kim N Cajachagua-Torres
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Jimenez-Barragan M, Del Pino Gutierrez A, Sauch Valmaña G, Monistrol O, Monge Marcet C, Pallarols Badia M, Garrido I, Carmona Ruiz A, Porta Roda O, Esquinas C, Falguera Puig G. Immersive Virtual Reality eHealth Intervention to Reduce Anxiety and Depression in Pregnant Women: Randomized Controlled Trial. JMIR Hum Factors 2025; 12:e71708. [PMID: 40306641 PMCID: PMC12079065 DOI: 10.2196/71708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 03/20/2025] [Accepted: 04/04/2025] [Indexed: 05/02/2025] Open
Abstract
BACKGROUND Mental health during pregnancy is a critical factor influencing maternal and fetal outcomes. Anxiety and depression affect up to 30% of pregnant women, with significant consequences for maternal well-being and child development. Despite this, interventions during pregnancy remain limited, creating a need for innovative, accessible solutions. OBJECTIVE This study aimed to evaluate the effectiveness of an immersive virtual reality (IVR) eHealth intervention in reducing anxiety and depression symptoms in women during pregnancy. METHODS A 2-arm, randomized controlled trial was conducted across 5 primary care centers in Catalonia, Spain, between October 2021 and May 2024. The study included pregnant women (N=70) aged ≥18 years with moderate anxiety and depression symptoms (Edinburgh Postnatal Depression Scale [EPDS] scores: 9-12) at 12 to 14 weeks of gestation. They were randomly assigned (1:1) to an IVR intervention or standard care group. The intervention group engaged in daily 14-minute IVR mindfulness and relaxation sessions for 6 weeks. Mental health outcomes were assessed using the EPDS and State-Trait Anxiety Inventory. RESULTS The intervention group demonstrated significant reductions in EPDS scores, with a mean decrease from 11.32 (SD 0.96) to 7.25 (SD 1.32; P<.001), compared to an increase in the control group from 11.32 (SD 0.94) to 16.23 (SD 1.25; P<.001). Similarly, State-Trait Anxiety Inventory scores improved markedly in the intervention group (mean decrease from 57.94, SD 5.23 to 35.03, SD 6.12; coefficient -30.47, 95% CI -45.23 to -15.72; P<.001), while the control group experienced a nonsignificant increase (from 66.10, SD 5.89 to 72.91, SD 6.34; P=.68). High adherence rates were observed, with 79% (26/33) of participants completing ≥30 sessions. Participant satisfaction was high, with 87% (29/33) reporting being "very satisfied" with the intervention. CONCLUSIONS The IVR eHealth intervention significantly reduced symptoms of anxiety and depression, demonstrating its potential as an accessible and effective tool for mental health support during pregnancy. High adherence and satisfaction levels underscore its feasibility and acceptability. Future research should explore the long-term effects and scalability of IVR interventions in diverse settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05756205; https://clinicaltrials.gov/study/NCT05756205. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12912-023-01440-4.
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Affiliation(s)
- Marta Jimenez-Barragan
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Amparo Del Pino Gutierrez
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Gloria Sauch Valmaña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Institut Universitari per la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Institut Català de la Salut, Barcelona, Spain
| | - Olga Monistrol
- Departament of Nursing and Physiotherapy, Campus Igualada, Universitat de Lleida, Lleida, Spain
| | - Carme Monge Marcet
- Department of Gynecology and Obstetrics, Assistential Foundation Mútua Terrassa, Mútua Terrassa, Terrassa, Spain
| | - Mar Pallarols Badia
- Department of Gynecology and Obstetrics, Assistential Foundation Mútua Terrassa, Mútua Terrassa, Terrassa, Spain
| | - Ignasi Garrido
- Psychiatry and Mental Health Service. Eating Disorder Unit, Mútua Terrassa, Terrassa, Spain
| | - Anna Carmona Ruiz
- Department of Obstetrics and Gynaecology, Fundacio Assitencial Mollet, Mollet, Spain
| | - Oriol Porta Roda
- Department of Gynecology and Obstetrics, Mútua Terrassa, Terrassa, Spain
| | - Cristina Esquinas
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Falguera Puig
- Primary Care Group, Germans Trias i Pujol Research Institute (IGTP), Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut, Barcelona, Spain
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5
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Zampieri G, Ionescu CA. The impact of inadequate prenatal care on maternal anemia and pregnancy outcomes in Romania. J Med Life 2025; 18:306-314. [PMID: 40405925 PMCID: PMC12094301 DOI: 10.25122/jml-2025-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2025] [Accepted: 05/02/2025] [Indexed: 05/26/2025] Open
Abstract
Prenatal care aims to ensure the well-being of both mother and baby by closely watching for potential problems and addressing them promptly. A lack of such care often stems from a combination of issues, including financial hardship, limited education, challenges in accessing healthcare, inadequate medical services, and insufficient social support. The study aimed to assess how iron supplements given during prenatal care affect the prevalence of anemia and whether lack of prenatal care leads to increased maternal and fetal morbidity. This analysis is based on the retrospective evaluation of medical data from 125 patients admitted to the Obstetrics and Gynecology Department of Sf. Pantelimon Hospital in Bucharest, Romania, from August 2024 to February 2025. The parameters considered in this study include prenatal care access, mode of delivery, antepartum anemia and its severity, iron supplementation, postpartum anemia and the necessity of blood transfusions, and length of hospitalization. The link between prenatal care and reduced antepartum anemia underscores the importance of monitoring during pregnancy to mitigate risks. Postpartum hemoglobin levels were significantly higher in patients who received prenatal care, leading to a decrease in severe and moderate anemia cases. Additionally, prenatal care was associated with shorter hospital stays for newborns. Comprehensive prenatal care demonstrably enhanced both maternal and neonatal prognoses across the continuum of pregnancy and the puerperium, thereby contributing to a significant reduction in rates of maternal and fetal morbidity and mortality.
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Affiliation(s)
- Giorgia Zampieri
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Obstetrics and Gynecology, Sf. Pantelimon Emergency Clinical Hospital, Bucharest, Romania
| | - Cringu Antoniu Ionescu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Obstetrics and Gynecology, Sf. Pantelimon Emergency Clinical Hospital, Bucharest, Romania
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6
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Zhou J, Zhu Z, Li R, Guo X, Li D. Comparative efficacy of non-pharmacological interventions on fear of childbirth for pregnant women: a systematic review and network meta-analysis. Front Psychol 2025; 16:1530311. [PMID: 40144029 PMCID: PMC11938124 DOI: 10.3389/fpsyg.2025.1530311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 02/19/2025] [Indexed: 03/28/2025] Open
Abstract
Objective To explore effectiveness of non-pharmacological interventions in fear of childbirth. Methods All published literature were searched from three databases (Pubmed, Cochrane CENTRAL, and Web of Science) as of April 2024. The risk of bias of the included studies was assessed using the Cochrane Systematic Review Manual 2.0 bias risk assessment tool. The primary outcome was FOC, the secondary outcomes were depression, anxiety, stress, childbirth self-efficacy, and mode of delivery. Results This study included 32 randomized controlled trials, involving 17 interventions and 3,187 pregnant women. Compared with usual care, cognitive-behavioral therapy (SMD = -1.62, 95%CI -2.47 to -0.66), haptonomy (SMD = -1.43, 95%CI -2.63 to -0.24), motivational interview (SMD = -1.35, 95%CI -2.35 to -0.35), counseling therapy (SMD = -1.08, 95%CI -1.91 to -0.25) statistically and significantly improved fear of childbirth in gestational period. Emotional freedom technique (SMD = -3.13, 95%CI -5.00 to -1.26), counseling therapy (SMD = -1.81, 95%CI -2.97 to -0.80), haptonomy (SMD = -1.78, 95%CI -2.89 to -0.66), cognitive-behavioral therapy (SMD = -1.42, 95%CI -2.53 to -0.32), motivational interview (SMD = -1.28, 95%CI -2.37 to -0.19) statistically and significantly improved fear of childbirth in postnatal period. The cluster analysis showed that emotional freedom technique, haptonomy, motivational interview, cognitive-behavioral therapy, counseling therapy were considered to be more effective non-pharmacological interventions. Conclusion Several non-pharmacological interventions are promising in the daily care of pregnant women with fear of childbirth. Healthcare professionals should be encouraged to apply these non-pharmacological interventions for informal caregivers of pregnant women with fear of childbirth. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, CRD42024536944.
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Affiliation(s)
- Juan Zhou
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Zhengting Zhu
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Ruoyu Li
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiujing Guo
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Dehua Li
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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7
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Nyman-Mallis T, Heffer RW, Brooker RJ. Maternal Social Phobia, but not Generalized Anxiety, Symptoms Interact with Early Childhood Error-Related Negativity to Prospectively Predict Child Anxiety Symptoms. Res Child Adolesc Psychopathol 2025; 53:417-428. [PMID: 39760790 PMCID: PMC11913571 DOI: 10.1007/s10802-024-01284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2024] [Indexed: 01/07/2025]
Abstract
The error-related negativity (ERN) has been called a putative neural marker of anxiety risk in children, with smaller ERN amplitudes denoting greater risk in early childhood. Children of anxious mothers are at elevated risk for anxiety problems compared to children of non-anxious mothers. Still unknown is whether discrete maternal symptoms interact with child ERN to predict different forms of child anxiety risk, knowledge of which could increase our understanding of the specificity of known conditions and pathways for transgenerational effects. Targeting two of the most prevalent forms of anxiety problems across children and adults, we tested whether maternal generalized anxiety disorder (GAD) and social phobia (SP) symptoms when children were 3 years old interacted with child ERN at age 4 years to predict child symptoms of overanxiousness and separation anxiety at age 5 years. We found that greater maternal SP, but not GAD, symptoms along with smaller (i.e., less negative) child ERN predicted more separation anxiety and overanxious symptoms in children, suggesting some specificity in prediction but less specificity in outcomes regarding the transmission of anxiety risk from mothers to offspring.
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Affiliation(s)
- Tristin Nyman-Mallis
- Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX, 77843, USA
| | - Robert W Heffer
- Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX, 77843, USA
| | - Rebecca J Brooker
- Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX, 77843, USA.
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Mulligan CJ, Quinn EB, Hamadmad D, Dutton CL, Nevell L, Binder AM, Panter-Brick C, Dajani R. Epigenetic signatures of intergenerational exposure to violence in three generations of Syrian refugees. Sci Rep 2025; 15:5945. [PMID: 40016245 PMCID: PMC11868390 DOI: 10.1038/s41598-025-89818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 02/07/2025] [Indexed: 03/01/2025] Open
Abstract
Maternal trauma influences infant and adult health outcomes and may impact future generations through epigenetic modifications such as DNA methylation (DNAm). Research in humans on the intergenerational epigenetic transmission of trauma effects is limited. In this study, we assessed DNAm signatures of war-related violence by comparing germline, prenatal, and direct exposures to violence across three generations of Syrian refugees. We compared families in which a pregnant grandmother versus a pregnant mother was exposed to violence and included a control group with no exposure to war. We collected buccal swab samples and survey data from mothers and 1-2 children in each of 48 families (n = 131 participants). Based on an epigenome-wide association study (EWAS), we identified differentially methylated regions (DMPs): 14 were associated with germline and 21 with direct exposure to violence. Most DMPs showed the same directionality in DNAm change across germline, prenatal, and direct exposures, suggesting a common epigenetic response to violence. Additionally, we identified epigenetic age acceleration in association with prenatal exposure to violence in children, highlighting the critical period of in utero development. This is the first report of an intergenerational epigenetic signature of violence, which has important implications for understanding the inheritance of trauma.
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Affiliation(s)
- Connie J Mulligan
- Department of Anthropology, University of Florida, Gainesville, FL, USA.
- Genetics Institute, University of Florida, Gainesville, FL, USA.
| | - Edward B Quinn
- Department of Anthropology, University of Florida, Gainesville, FL, USA
- Genetics Institute, University of Florida, Gainesville, FL, USA
- Baltimore City Department of Social Services, Baltimore, MD, USA
| | | | - Christopher L Dutton
- Department of Anthropology, University of Florida, Gainesville, FL, USA
- Genetics Institute, University of Florida, Gainesville, FL, USA
- Department of Biology, University of Florida, Gainesville, FL, USA
| | - Lisa Nevell
- Department of Anthropology, University of Florida, Gainesville, FL, USA
- Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Alexandra M Binder
- Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, USA
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - Catherine Panter-Brick
- Department of Anthropology, Yale University, New Haven, CT, USA
- Jackson School of Global Affairs, Yale University, New Haven, CT, USA
| | - Rana Dajani
- Department of Biology and Biotechnology, The Hashemite University, Zarqa, Jordan
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9
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Mazza M, Lisci FM, Marzo EM, De Masi V, Abate F, Marano G. Why Do They Do It? The Psychology Behind Antisocial Behavior in Children and Adolescents. Pediatr Rep 2025; 17:26. [PMID: 40126225 PMCID: PMC11932266 DOI: 10.3390/pediatric17020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2025] [Revised: 02/19/2025] [Accepted: 02/20/2025] [Indexed: 03/25/2025] Open
Abstract
Antisocial Personality Disorder (ASPD) is a complex and often debilitating condition that can emerge from early behavioral disturbances in childhood and adolescence. This narrative review provides a comprehensive overview of the current understanding of ASPD in pediatric and adolescent populations, examining key diagnostic challenges, developmental trajectories, and emerging treatment approaches. Recent research underscores the critical role of the early identification of conduct disorder (CD) and oppositional defiant disorder (ODD) as precursors to ASPD. Specific attention is given to biological, environmental, and psychosocial risk factors, including genetic predispositions, family dynamics, and socio-economic adversity. Additionally, neuro-psychological research highlights deficits in executive function, emotion regulation, and social cognition, which may underline the persistent antisocial patterns. Neuroimaging studies suggest atypical neural activity in regions associated with empathy, reward processing, and impulse control. Effective intervention remains a challenge, as treatment options are limited and often complicated by co-occurring conditions, such as attention deficit hyperactivity disorder (ADHD) and mood disorders. Promising evidence supports the efficacy of integrative, multimodal approaches combining behavioral therapy, family interventions, and pharmacotherapy to reduce symptom severity and improve long-term outcomes. The review concludes by advocating for a public health approach that emphasizes prevention and early intervention, aiming to mitigate the progression to full ASPD in adulthood.
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Affiliation(s)
- Marianna Mazza
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.M.L.); (E.M.M.); (V.D.M.); (F.A.); (G.M.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Maria Lisci
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.M.L.); (E.M.M.); (V.D.M.); (F.A.); (G.M.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ester Maria Marzo
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.M.L.); (E.M.M.); (V.D.M.); (F.A.); (G.M.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Valeria De Masi
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.M.L.); (E.M.M.); (V.D.M.); (F.A.); (G.M.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesca Abate
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.M.L.); (E.M.M.); (V.D.M.); (F.A.); (G.M.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Marano
- Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.M.L.); (E.M.M.); (V.D.M.); (F.A.); (G.M.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Geiger SD, Chandran A, Churchill ML, Mansolf M, Zhang C, Musaad S, Blackwell CK, Eick SM, Goin DE, Korrick S, Alshawabkeh A, Brennan PA, Breton CV, Cordero JF, Deoni S, D'Sa V, Dunlop AL, Elliott AJ, Ferrara A, Keddie A, LeBourgeois M, LeWinn KZ, Koinis-Mitchell D, Lucchini M, Nozadi SS, O'Connor T, Zhu Y, Zimmerman E, Schantz SL. Association between maternal stress and child sleep quality: a nationwide ECHO prospective cohort study. Pediatr Res 2025; 97:980-988. [PMID: 39394425 DOI: 10.1038/s41390-024-03542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 10/13/2024]
Abstract
BACKGROUND Childhood sleep quality is associated with physical, cognitive, and behavioral health and predicts later sleep quality; it has many determinants, including developmental exposures. OBJECTIVES To examine associations between maternal stress during pregnancy and childhood sleep quality and determine whether postnatal stress mediates the association. METHOD Data from the Environmental Influences on Child Health Outcomes cohort were used. Perceived Stress Scale (PSS) T-scores were the exposure measure. Outcome measures were preschool Child Behavior Checklist (CBCL) sleep syndrome scale and Patient-Reported Outcomes Measurement Information System Sleep Disturbance Parent Proxy short form 4a (PSD4a) T-scores at ages 4-8 years. Linear mixed-effects regression modeling was performed for each sleep outcome, adjusting for maternal age at delivery and education and child sex, gestational age at birth, and age at outcome ascertainment, with random intercepts for cohorts. RESULTS Prenatal PSS score was associated with both CBCL (B = 0.09, 95% confidence interval [CI]: 0.06, 0.11; p < 0.01) and PSD4a (B = 0.07, 95% CI: 0.03, 0.12; p < 0.01) scores. Postnatal perceived stress mediated a proportion of the total effect of prenatal stress in both CBCL (66.3%) and PSD4a (95.9%) samples. CONCLUSIONS Both pre- and postnatal maternal perceived stress appear to influence sleep quality during early life. IMPACT Prenatal stress significantly associates with child sleep problems and disturbances at ages 4-8 years; postnatal maternal stress is a significant mediator of these associations. Research suggests a range of prenatal affective/distress exposures associated with child sleep problems, but the conclusions remain in doubt due to the mixture of exposures and outcomes employed. Ours is the first US-based effort to explore associations between perceived maternal stress during pregnancy and child sleep problems and disturbance in early and middle childhood. Even a small effect of a prevalent issue like psychosocial stress may have important public health implications at the population level.
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Affiliation(s)
- Sarah Dee Geiger
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marie L Churchill
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maxwell Mansolf
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cai Zhang
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Salma Musaad
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Courtney K Blackwell
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stephanie M Eick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dana E Goin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Program on Reproductive Health and the Environment, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Susan Korrick
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA
| | | | - Carrie V Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jose F Cordero
- Department of Epidemiology, University of Georgia College of Public Health, Athens, Georgia
| | - Sean Deoni
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Viren D'Sa
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Anne L Dunlop
- Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Assiamira Ferrara
- Division of Research, Kaiser Permanente North California, Oakland, CA, USA
| | - Arlene Keddie
- School of Health Studies, Northern Illinois University, DeKalb, IL, USA
| | - Monique LeBourgeois
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Daphne Koinis-Mitchell
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Sara S Nozadi
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Thomas O'Connor
- Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Yeyi Zhu
- Kaiser Permanente North California Division of Research, Oakland, CA, USA
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA
| | - Susan L Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Wiley KS, Gouveia G, Camilo C, Euclydes V, Panter-Brick C, Matijasevich A, Ferraro AA, Fracolli LA, Chiesa AM, Miguel EC, Polanczyk GV, Brentani H. A Preliminary Investigation of Associations Between Traumatic Events Experienced During Pregnancy and Salivary Diurnal Cortisol Levels of Brazilian Adolescent Mothers and Infants. Am J Hum Biol 2025; 37:e70004. [PMID: 39905640 DOI: 10.1002/ajhb.70004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 12/28/2024] [Accepted: 01/19/2025] [Indexed: 02/06/2025] Open
Abstract
INTRODUCTION Interpersonal violence against women is a major global health problem that may have intergenerational effects. This study investigated associations between maternal experiences of interpersonal violence and other traumatic events and maternal and infant salivary diurnal cortisol in a cohort of adolescent mothers in São Paulo, Brazil. METHOD Adolescent mothers (14-19 years) participating in a home-visiting intervention were interviewed retrospectively about lifetime and pregnancy violence and trauma exposure. Mothers collected saliva at waking and before bedtime from themselves (n = 23) and their infants (n = 32) at 12 months postpartum. Multivariable regression models were used to examine associations between trauma history variables and salivary diurnal cortisol. RESULTS Adjusting for the intervention group, infant sex, maternal age, non-supplement medication use, and sample collection time, we found that higher-than-average lifetime trauma exposure was associated with maternal evening cortisol (b = 0.472, p-value = 0.028). Lifetime assaultive violence exposure was also associated with maternal evening cortisol (b = 0.196, p-value = 0.02). Maternal exposure to traumatic events in pregnancy was positively associated with bedtime cortisol levels of infants (b = 0.21, p = 0.01). Trauma variables were not associated with maternal or infant morning cortisol levels. CONCLUSION Results suggest that maternal trauma history influences both maternal and infant postnatal cortisol regulation as indexed by evening cortisol levels. These results are consistent with models of fetal programming; however, future studies should investigate potential postnatal psychobiological pathways. Lifetime trauma exposure may also become embedded in the maternal hypothalamic-adrenal-pituitary axis regulation. Future studies are needed to consider other biological pathways in the intergenerational transmission of trauma.
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Affiliation(s)
- Kyle S Wiley
- Department of Sociology & Anthropology, University of Texas at El Paso, El Paso, Texas, USA
| | - Gisele Gouveia
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Caroline Camilo
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Verônica Euclydes
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Catherine Panter-Brick
- Department of Anthropology, Yale University, New Haven, Connecticut, USA
- Jackson School of Global Affairs, Yale University, New Haven, Connecticut, USA
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Lislaine Aparecida Fracolli
- Departamento de Enfermagem Em Saúde Coletiva da Escola de Enfermagem, Universidade de São Paulo, São Paulo, Brazil
| | - Anna Maria Chiesa
- Departamento de Enfermagem Em Saúde Coletiva da Escola de Enfermagem, Universidade de São Paulo, São Paulo, Brazil
| | | | - Guilherme V Polanczyk
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Helena Brentani
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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12
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Maylott SE, Reese SE, Zhou AM, Kaliush PR, Terrell S, Saenz C, Brown L, Crowell SE, Lester B, Smid MC, Shakib JH, Garland EL, Conradt E. Maternal psychophysiology profiles: associations with prenatal opioid use, maternal emotion dysregulation, and newborn neurobehavior. Pediatr Res 2025; 97:1155-1165. [PMID: 39097654 DOI: 10.1038/s41390-024-03399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/05/2024] [Accepted: 07/01/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Opioid use among pregnant women has more than quadrupled over the past 20 years; however, comorbid risk factors such as emotion dysregulation confound the developmental consequences of prenatal opioid use. Maternal respiratory sinus arrhythmia (RSA) may help to disentangle the comorbid risk factors of prenatal emotion dysregulation and substance use and isolate their consequences on newborn neurobehavior. METHODS We examined maternal RSA in response to a mild, infant-related stress task in pregnant people (N = 192; 30 on medications for opioid use disorder) recruited from hospitals and a specialty prenatal clinic for substance use disorder. RESULTS Three latent profiles emerged based on maternal RSA reactivity. Mothers with RSA increasing (Profile 3; more nervous system dysregulation) had higher levels of emotion dysregulation than mothers with RSA decreasing (Profile 1; well-regulated nervous system responses) but were not more likely to use opioids. Additionally, RSA profiles were associated with newborn neurobehavior, including attention, regulation, handling, and arousal. CONCLUSIONS Given the variability in opioid use across RSA profiles and profile associations with newborn neurodevelopment, future studies should examine protective factors in pregnant individuals using opioids who show more flexible RSA responses. IMPACT Our study examined maternal psychophysiology and newborn outcomes in a unique population with high levels of emotion dysregulation and opioid use. Three profiles of maternal respiratory sinus arrythmia (RSA) reactivity were identified during pregnancy: decreasing, blunted, and increasing. The RSA increasing and blunted profiles were associated with higher emotion dysregulation than the decreasing profile. Most pregnant people on medications for opioid use disorder (65%) were grouped into the blunted profile, suggesting they might be more at risk for dysregulated RSA reactivity. Differences in RSA profiles were associated with newborn outcomes, with increasing and blunted RSA predicting more newborn neurobehavioral dysregulation.
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Affiliation(s)
- Sarah E Maylott
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
| | - Sarah E Reese
- University of Montana, School of Social Work, Missoula, MT, USA
| | - Anna M Zhou
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Parisa R Kaliush
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Sarah Terrell
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Celine Saenz
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Lydia Brown
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | - Barry Lester
- Departments of Psychiatry and Pediatrics, Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI, USA
| | - Marcela C Smid
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Julie H Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Eric L Garland
- University of Utah, College of Social Work, Salt Lake City, UT, USA
| | - Elisabeth Conradt
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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13
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Christoforou A, Duman EA, Caparros-Gonzalez RA. Editorial: Intergenerational impacts of perinatal mental health. Front Psychiatry 2025; 16:1542112. [PMID: 39925877 PMCID: PMC11802562 DOI: 10.3389/fpsyt.2025.1542112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 01/10/2025] [Indexed: 02/11/2025] Open
Affiliation(s)
- Andri Christoforou
- Department of Social and Behavioral Sciences, European University Cyprus, Engomi, Cyprus
| | - Elif Aysimi Duman
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Acıbadem University, Istanbul, Türkiye
- Institute of Natural and Applied Sciences, Acıbadem University, Istanbul, Türkiye
| | - Rafael A. Caparros-Gonzalez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigacion Biosanitaria ibs., University of Granada, Granada, Spain
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14
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Davis JA, Ohan JL, Bear N, Gibson L, Silva D, Prescott S, Finlay-Jones A. "Stop, pause and take a break": a mixed methods study of the longer-term outcomes of digital emotional wellbeing training for perinatal women. BMC Pregnancy Childbirth 2024; 24:811. [PMID: 39639213 PMCID: PMC11619203 DOI: 10.1186/s12884-024-07002-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/21/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Maternal psychological distress is related to poorer physical and mental health as well as child developmental problems. Interventions that optimise maternal mental health and wellbeing during the "first 1,000 days" of life should have wide-reaching benefits for the mother and her child. Digital mental health interventions (DMHIs) during this critical period have the potential to equip women with enhanced coping strategies that can be applied and maintained in daily life. This study aimed to understand uptake of DMHIs in pregnancy, and the extent participants apply intervention strategies 10-12 months post-participation in a pilot randomised controlled trial (RCT) comparing different digital programs. METHODS A mixed methods triangulation approach was undertaken. We explored demographic data and psychological distress measures in the intervention groups and a comparison group that were offered the intervention but did not participate or did not meet the inclusion criteria based on gestational age (n = 525). Intervention participants (n = 54) were invited to undertake an interview up to 12 months post-intervention to understand ongoing skills application. Fifteen interviews were undertaken using a phenomenological approach to analyse the data. RESULTS Baseline psychological distress results showed a significant difference between those who enrolled in the intervention, compared to those who did not, with higher psychological distress (combined), and stress and depression (sub-scale) scores for the intervention groups. Qualitative content analysis identified four main themes relating to long-term engagement: (1) Motivations to use skills; (2) Taking time for oneself; (3) Emotional support; and (4) Improving wellbeing (such as aids sleep and emotional impacts). Within each theme there were several sub-themes, including enablers or barriers to engagement. CONCLUSIONS This study indicated that women who chose to enrol in DMHIs in pregnancy have greater psychological distress than those who chose not to participate. Many participants in this study continued to apply learnt skills in everyday life, such as breathing exercises. This implies that digital strategies may be effective and applicable longer-term to enable women to apply positive coping skills during critical child developmental periods. Ultimately, this will contribute to designing apps that sustain wellbeing and could be protective in preventing postnatal psychological distress. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Number ( ACTRN12620000672954p ); (12/06/2020).
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Affiliation(s)
- Jacqueline A Davis
- The Kids Research Institute Australia (Formerly Telethon Kids Institute), Perth, Australia.
- The University of Western Australia, Perth, Australia.
- Edith Cowan University, Perth, Australia.
- Curtin University, Perth, Australia.
| | - Jeneva L Ohan
- The Kids Research Institute Australia (Formerly Telethon Kids Institute), Perth, Australia
- The University of Western Australia, Perth, Australia
| | - Natasha Bear
- The Kids Research Institute Australia (Formerly Telethon Kids Institute), Perth, Australia
- Notre Dame University, Perth, Australia
| | - Lisa Gibson
- The Kids Research Institute Australia (Formerly Telethon Kids Institute), Perth, Australia
- The University of Western Australia, Perth, Australia
- Edith Cowan University, Perth, Australia
| | - Desiree Silva
- The Kids Research Institute Australia (Formerly Telethon Kids Institute), Perth, Australia
- The University of Western Australia, Perth, Australia
- Joondalup Health Campus, Perth, Australia
- Edith Cowan University, Perth, Australia
| | - Susan Prescott
- The University of Western Australia, Perth, Australia
- Edith Cowan University, Perth, Australia
- Nova Institute for Health, Baltimore, MD, USA
- Family and Community Medicine, University of Maryland, Baltimore, MD, USA
| | - Amy Finlay-Jones
- The Kids Research Institute Australia (Formerly Telethon Kids Institute), Perth, Australia
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Matyas M, Apanasewicz A, Krzystek-Korpacka M, Jamrozik N, Cierniak A, Babiszewska-Aksamit M, Ziomkiewicz A. The association between maternal stress and human milk concentrations of cortisol and prolactin. Sci Rep 2024; 14:28115. [PMID: 39548101 PMCID: PMC11568148 DOI: 10.1038/s41598-024-75307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 10/03/2024] [Indexed: 11/17/2024] Open
Abstract
Psychosocial stress affects the relationship between prolactin (PRL) and cortisol (CORT). The dynamics of PRL and CORT changes under stress in human milk (HM) are largely unknown. We investigated how maternal stress related to recent life changes affects milk CORT and PRL concentrations. The study involved 116 mothers exclusively breastfeeding 5-month-old infants. Maternal psychological stress was evaluated using the Recent Life Changes Questionnaire (RLCQ). Stress response was determined by administering the cold pressor test and measuring CORT in saliva taken during and in milk collected after the test. Hormones concentrations were assayed using the ELISA method. The hierarchical regression models were run to test the association between maternal RLCQ, salivary CORT, and PRL, and CORT in milk. Maternal RLCQ correlated positively with the CORT in saliva, however, no direct association was found between RLCQ and PRL. After controlling for covariates, a positive association was found between salivary and milk CORT. A negative relationship was observed between salivary CORT and milk PRL. The results of the present study indicate that maternal psychological stress may affect the relationship between CORT and PRL in HM. In response to psychological stress, both hormones transported via milk can program infant development in the early postnatal period.
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Affiliation(s)
- Maja Matyas
- Laboratory of Anthropology, Institute of Zoology and Biomedical Research, Jagiellonian University, Gronostajowa Street 9, Krakow, 30-387, Poland.
| | - Anna Apanasewicz
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Weigla Street, Wroclaw, 53-114, Poland.
| | - Małgorzata Krzystek-Korpacka
- Department of Medical Biochemistry, Wroclaw Medical University, 10 Chalubinskiego Street, Wroclaw, 50-368, Poland
| | - Natalia Jamrozik
- Department of Medical Biochemistry, Wroclaw Medical University, 10 Chalubinskiego Street, Wroclaw, 50-368, Poland
| | - Agnieszka Cierniak
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga‑Grudzinskiego 1, Krakow, 30‑705, Poland
| | - Magdalena Babiszewska-Aksamit
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Weigla Street, Wroclaw, 53-114, Poland
- Department of Medical Biology, Medical University of Warsaw, Litewska Street 14/16, Warsaw, 00-575, Poland
| | - Anna Ziomkiewicz
- Laboratory of Anthropology, Institute of Zoology and Biomedical Research, Jagiellonian University, Gronostajowa Street 9, Krakow, 30-387, Poland
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16
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Reimer CJ, Willis MD, Wesselink AK, Hystad P, Campbell EJ, Hatch EE, Kirwa K, Gradus JL, Vinceti M, Wise LA, Jimenez MP. Exposure to residential greenness, perceived stress, and depressive symptoms in a North American preconception cohort. ENVIRONMENTAL RESEARCH 2024; 260:119438. [PMID: 38901815 DOI: 10.1016/j.envres.2024.119438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/10/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Studies suggest that greater exposure to natural vegetation (i.e., greenness) is associated with better mental health. However, there is limited research on greenness and mental health in the preconception period, a critical window of exposure in the life course. We investigated the associations of residential greenness with perceived stress and depressive symptoms using cross-sectional data from a cohort of pregnancy planners. METHODS From 2013 to 2019, we enrolled female-identified participants aged 21-45 years who were trying to conceive without the use of fertility treatment into a North American preconception cohort study (Pregnancy Study Online [PRESTO]). On the baseline questionnaire, participants completed the 10-item Perceived Stress Scale (PSS) and the Major Depression Inventory (MDI). Using geocoded addresses, we estimated residential greenness exposure via satellite imagery (Normalized Difference Vegetation Index [NDVI]) in a 100m buffer. We estimated mean differences and 95% confidence intervals for the association of greenness with perceived stress and depression scores using linear regression models, adjusting for individual and neighborhood sociodemographic characteristics. We also evaluated the extent to which associations were modified by urbanicity and neighborhood socioeconomic status (SES). RESULTS Among 9718 participants, mean age was 29.9 years, 81.5% identified as non-Hispanic White, 25% had household incomes <$50,000, and mean neighborhood income was $61,932. In adjusted models, higher greenness was associated with lower stress and depression scores (mean difference per interquartile range in greenness: -0.20, 95% CI: -0.39, -0.01; and -0.19, 95% CI: -0.48, 0.10, respectively). The association was stronger among residents of lower SES neighborhoods in urban areas (PSS: -0.57, 95% CI: -1.00, -0.15; MDI: -0.72, 95% CI: -1.40, -0.04). CONCLUSIONS Higher greenness exposure was associated with lower stress and depressive symptoms among pregnancy planners, particularly in lower-SES neighborhoods.
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Affiliation(s)
- Cameron J Reimer
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Mary D Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Perry Hystad
- School of Nutrition and Public Health, College of Health, Oregon State University, Corvallis, OR, USA
| | - Erin J Campbell
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Kipruto Kirwa
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Marco Vinceti
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Biomedical, Metabolic and Neural Sciences, Medical School, University of Modena and Reggio Emilia, Modena, Italy
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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17
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Abrishamcar S, Zhuang BC, Thomas M, Gladish N, MacIsaac JL, Jones MJ, Simons E, Moraes TJ, Mandhane PJ, Brook JR, Subbarao P, Turvey SE, Chen E, Miller GE, Kobor MS, Hüls A. Association between maternal perinatal stress and depression and infant DNA methylation in the first year of life. Transl Psychiatry 2024; 14:445. [PMID: 39438450 PMCID: PMC11496819 DOI: 10.1038/s41398-024-03148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 09/24/2024] [Accepted: 10/02/2024] [Indexed: 10/25/2024] Open
Abstract
Maternal stress and depression during pregnancy and the first year of the infant's life affect a large percentage of mothers. Maternal stress and depression have been associated with adverse fetal and childhood outcomes as well as differential child DNA methylation (DNAm). However, the biological mechanisms connecting maternal stress and depression to poor health outcomes in children are still largely unknown. Here we aim to determine whether prenatal stress and depression are associated with differences in cord blood mononuclear cell DNAm (CBMC-DNAm) in newborns (n = 119) and whether postnatal stress and depression are associated with differences in peripheral blood mononuclear cell DNAm (PBMC-DNAm) in children of 12 months of age (n = 113) from the Canadian Healthy Infant Longitudinal Development (CHILD) cohort. Stress was measured using the 10-item Perceived Stress Scale (PSS) and depression was measured using the 20-item Center for Epidemiologic Studies Depression Questionnaire (CESD). Both stress and depression were measured longitudinally at 18 weeks and 36 weeks of pregnancy and six months and 12 months postpartum. We conducted epigenome-wide association studies (EWAS) using robust linear regression followed by a sensitivity analysis in which we bias-adjusted for inflation and unmeasured confounding using the bacon and cate methods. To quantify the cumulative effect of maternal stress and depression, we created composite prenatal and postnatal adversity scores. We identified a significant association between prenatal stress and differential CBMC-DNAm at 8 CpG sites and between prenatal depression and differential CBMC-DNAm at 2 CpG sites. Additionally, we identified a significant association between postnatal stress and differential PBMC-DNAm at 8 CpG sites and between postnatal depression and differential PBMC-DNAm at 11 CpG sites. Using our composite scores, we further identified 2 CpG sites significantly associated with prenatal adversity and 7 CpG sites significantly associated with postnatal adversity. Several of the associated genes, including PLAGL1, HYMAI, BRD2, and ERC2 have been implicated in adverse fetal outcomes and neuropsychiatric disorders. These data further support the finding that differential DNAm may play a role in the relationship between maternal mental health and child health.
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Affiliation(s)
- Sarina Abrishamcar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Beryl C Zhuang
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Edwin S.H. Leong Centre for Healthy Aging, Vancouver, BC, Canada
| | - Mara Thomas
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Nicole Gladish
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Edwin S.H. Leong Centre for Healthy Aging, Vancouver, BC, Canada
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Julia L MacIsaac
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Edwin S.H. Leong Centre for Healthy Aging, Vancouver, BC, Canada
| | - Meaghan J Jones
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, ON, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Edith Chen
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Gregory E Miller
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Michael S Kobor
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.
- Edwin S.H. Leong Centre for Healthy Aging, Vancouver, BC, Canada.
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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18
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Al Eid F, Albanna A, Joseph J, Talo S, Jeyaseelan L, Sultan MA. Exploring the impact of stimulant medications on weight in children with attention deficit hyperactivity disorder in Dubai, United Arab Emirates. Front Psychiatry 2024; 15:1392846. [PMID: 39479597 PMCID: PMC11521801 DOI: 10.3389/fpsyt.2024.1392846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 09/25/2024] [Indexed: 11/02/2024] Open
Abstract
Objective Attention deficit hyperactivity disorder (ADHD), prevalent in 5% of children worldwide, impacts academic performance and often coexists with psychiatric disorders. Psychostimulant medications are primary treatments for ADHD, enhancing dopamine to reduce symptoms. However, dopamine increase may cause appetite loss. This pioneering study in the United Arab Emirates (UAE) explores psychostimulant effects on weight in children diagnosed with ADHD, aiming to uncover unique regional characteristics and contributing factors to weight changes. Methods This retrospective cohort study assessed data from electronic medical records from 2017 to 2022, aiming to assess the impact of psychostimulants on weight in children aged 6-18 years. Inclusion criteria covered psychostimulant-treated and untreated patients with ADHD. Statistical analysis, involving longitudinal data methods aimed to demonstrate significant weight differences. Results Data from 107 pediatric patients diagnosed with ADHD were analyzed, with 86 meeting inclusion criteria. Most patients were male (80.2%). ADHD presentations varied, and methylphenidate immediate release was the most prescribed stimulant medication. Patients experienced initial weight loss followed by overall gain over 12 months. Coexisting conditions, maternal factors, family history, and correlations with autism spectrum disorder were explored. Conclusion This study provides valuable insights into the effects of psychostimulant medications on the weight of children and adolescents diagnosed with ADHD in the UAE. It suggests avenues for future research, emphasizing extended follow-ups to understand long-term psychostimulant effects, nuanced examinations of age and gender, and exploring interactions with comorbidities. Despite limitations, the research provides insights into ADHD medication effects, guiding personalized treatment approaches for pediatric populations.
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Affiliation(s)
- Faten Al Eid
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- Mental Health Centre of Excellence, Al Jalila Children’s Specialty Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Ammar Albanna
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, United Arab Emirates
| | - Jessie Joseph
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Sami Talo
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Lakshmanan Jeyaseelan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Meshal A. Sultan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
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Sebők-Welker T, Posta E, Ágrez K, Rádosi A, Zubovics EA, Réthelyi MJ, Ulbert I, Pászthy B, Bunford N. The Association Between Prenatal Maternal Stress and Adolescent Affective Outcomes is Mediated by Childhood Maltreatment and Adolescent Behavioral Inhibition System Sensitivity. Child Psychiatry Hum Dev 2024; 55:1-21. [PMID: 36738426 PMCID: PMC11362206 DOI: 10.1007/s10578-023-01499-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Prenatal maternal stress is linked to offspring outcomes; however, there is little research on adolescents, behavioral, transdiagnostic outcomes, or the mechanisms through which relations operate. We examined, in N = 268 adolescents (Mage = 15.31 years; SD = 1.063; 57.8% boys) whether prenatal maternal stress is associated with adolescent affective outcomes; whether this association is mediated, serially, by childhood home atmosphere and adolescent behavioral inhibition system (BIS) sensitivity; and whether mediational effects are moderated by adolescent attention-deficit/hyperactivity disorder or maternal internalizing symptomology. Prenatal maternal daily stress and major life events were associated with adolescent outcomes through childhood negative atmosphere/neglect and BIS sensitivity, with no evidence of moderation. Results have implications regarding the effect of prenatal maternal stress on offspring outcomes and regarding corresponding sensitive periods.
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Affiliation(s)
- T Sebők-Welker
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Doctoral School of Mental Health Sciences, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - E Posta
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - K Ágrez
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - A Rádosi
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Doctoral School of Mental Health Sciences, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - E A Zubovics
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - M J Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - I Ulbert
- Integrative Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Práter Utca 50/A, Budapest, 1083, Hungary
| | - B Pászthy
- 1st Department of Paediatrics, Semmelweis University, Bókay János U. 53-54, Budapest, 1083, Hungary
| | - N Bunford
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary.
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Du S, Shang G, Tian X, Liu Z, Yang Y, Niu H, Bian J, Wu Y, Ma J. Effects of DNA Methylation of HPA-Axis Genes of F1 Juvenile Induced by Maternal Density Stress on Behavior and Immune Traits in Root Voles ( Microtus oeconomus)-A Field Experiment. Animals (Basel) 2024; 14:2467. [PMID: 39272253 PMCID: PMC11393846 DOI: 10.3390/ani14172467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 09/15/2024] Open
Abstract
The literature shows that maternal stress can influence behavior and immune function in F1. Yet, most studies on these are from the laboratory, and replicated studies on the mechanisms by which maternal stress drives individual characteristics are still not fully understood in wild animals. We manipulated high- and low-density parental population density using large-scale field enclosures and examined behavior and immune traits. Within the field enclosures, we assessed anti-keyhole limpet hemocyanin immunoglobulin G (anti-KLH IgG) level, phytohemagglutinin (PHA) responses, hematology, cytokines, the depressive and anxiety-like behaviors and prevalence and intensity of coccidial infection. We then collected brain tissue from juvenile voles born at high or low density, quantified mRNA and protein expression of corticotropin-releasing hormone (CRH) and glucocorticoid receptor gene (NR3C1) and measured DNA methylation at CpG sites in a region that was highly conserved with the prairie vole CRH and NR3C1 promoter. At high density, we found that the F1 had a lower DNA methylation level of CRH and a higher DNA methylation level of NR3C1, which resulted in an increase in the expression levels of the CRH mRNA and protein expression and further reduced the expression levels of the NR3C1 mRNA and protein expression, and ultimately led to have delayed responses to acute immobilization stress. Juvenile voles born at high density also reduced anti-KLH IgG levels and PHA responses, increased cytokines, and depressive and anxiety-like behaviors, and the effects further led to higher coccidial infection. From the perspective of population density inducing the changes in behavior and immunity at the brain level, our results showed a physiological epigenetic mechanism for population self-regulation in voles. Our results indicate that altering the prenatal intrinsic stress environment can fundamentally impact behavior and immunity by DNA methylation of HPA-axis genes and can further drive population fluctuations in wild animals.
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Affiliation(s)
- Shouyang Du
- Postdoctoral Research Base, Henan Institute of Science and Technology, Xinxiang 453003, China
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang 453003, China
| | - Guozhen Shang
- Key Laboratory of Adaptation and Evolution of Plateau Biota, Northwest Institute of Plateau Biology, Chinese Academy of Sciences, Xining 810001, China
- Qinghai Key Laboratory of Animal Ecological Genomics, Xining 810001, China
| | - Xin Tian
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang 453003, China
| | - Zihan Liu
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang 453003, China
| | - Yanbin Yang
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450007, China
| | - Hongxing Niu
- College of Life Science, Henan Normal University, Xinxiang 453007, China
| | - Jianghui Bian
- Key Laboratory of Adaptation and Evolution of Plateau Biota, Northwest Institute of Plateau Biology, Chinese Academy of Sciences, Xining 810001, China
- Qinghai Key Laboratory of Animal Ecological Genomics, Xining 810001, China
| | - Yan Wu
- School of Life and Environment Sciences, Hangzhou Normal University, Hangzhou 310012, China
| | - Jinyou Ma
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang 453003, China
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Kurbatfinski S, Woo J, Ntanda H, Giesbrecht G, Letourneau N. Perinatal Predictors and Mediators of Attachment Patterns in Preschool Children: Exploration of Children's Contributions in Interactions with Mothers. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1022. [PMID: 39201958 PMCID: PMC11352242 DOI: 10.3390/children11081022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/11/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024]
Abstract
Insecure and disorganized attachment patterns in children are linked to poor health outcomes over the lifespan. Attachment patterns may be predicted by variables that influence the quality of children's interactions with their primary caregivers/parents (usually mothers) such as prenatal and postnatal exposures and the children's own behaviours in interactions. The purposes of this exploratory study were to examine: (1) prenatal predictors of children's attachment patterns, and (2) postnatal mediators and moderators of associations between prenatal predictors and children's attachment patterns, with adjustment for relevant covariates. Mother-child dyads (n = 214) from the longitudinal Alberta Pregnancy Outcomes and Nutrition (APrON) cohort were studied using valid and reliable measures. Hayes' mediation analysis was employed to determine direct and indirect effects. Mothers' prenatal cortisol levels directly predicted disorganized (versus organized) child attachment in unadjusted models. Children's passivity (in adjusted models) and compulsivity (in unadjusted and adjusted models) in parent-child interactions mediated the pathway between mothers' prenatal cortisol levels and children's disorganized attachment patterns. Serial mediation analyses revealed that mothers' cortisol levels predicted their children's cortisol levels, which predicted children's compulsivity, and, ultimately, disorganized attachment in both unadjusted and adjusted models. No predictors were correlated with children's insecure (versus secure) attachment. This exploratory research suggests that prenatal exposure to mothers' cortisol levels and children's behavioural contributions to parent-child interaction quality should be considered in the genesis of children's attachment patterns, especially disorganization. Interventions focused on parent-child interactions could also focus on addressing children's behavioral contributions.
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Affiliation(s)
- Stefan Kurbatfinski
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.K.); (G.G.)
- Owerko Centre, Alberta Children’s Hospital Research Institute, Calgary, AB T2N 1N4, Canada;
| | - Jennifer Woo
- Department of Psychiatry, University of Saskatchewan, Regina, SK S7N 0W8, Canada;
| | - Henry Ntanda
- Owerko Centre, Alberta Children’s Hospital Research Institute, Calgary, AB T2N 1N4, Canada;
| | - Gerald Giesbrecht
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.K.); (G.G.)
- Owerko Centre, Alberta Children’s Hospital Research Institute, Calgary, AB T2N 1N4, Canada;
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Nicole Letourneau
- Owerko Centre, Alberta Children’s Hospital Research Institute, Calgary, AB T2N 1N4, Canada;
- Owerko Centre, Faculty of Nursing and Cumming School of Medicine, Departments of Pediatrics, Psychiatry, and Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada
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22
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Neumann D, Peterson ER, Underwood L, Morton SMB, Waldie KE. The Association Between Persistence and Change in Behavioral Difficulties During Early to Middle Childhood and Cognitive Abilities at Age 8. Child Psychiatry Hum Dev 2024; 55:1031-1043. [PMID: 36372805 PMCID: PMC11245443 DOI: 10.1007/s10578-022-01453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 07/25/2022] [Accepted: 09/26/2022] [Indexed: 11/15/2022]
Abstract
We investigated the association between persistence and change in behavioral difficulties during early to middle childhood and several cognitive outcomes. We observed 3904 8-year-olds enrolled in the longitudinal study Growing Up in New Zealand (50% male/female; 23% Māori, 9% Pacific Peoples, 13% Asian, 2% Middle Eastern/Latin American/African, 9% Other, 43% European). The NIH Toolbox Cognition Battery was used to assess cognitive functioning at 8 years and the Strengths and Difficulties Questionnaire for behavioral difficulties at 4.5 and 8 years. Multivariate logistic regression analyses were conducted, controlling for well-known sociodemographic confounders. Children with persistent or later onset of behavioral difficulties were at higher risk for poorer vocabulary, reading, inhibitory control/attention, episodic memory, working memory and processing speed at age 8 compared to children with no or improved difficulties. Our study supports the importance of addressing both cognitive and behavioral aspects when planning educational programmes and interventions in early and middle childhood.
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Affiliation(s)
- Denise Neumann
- School of Psychology, Faculty of Science, University of Auckland, Private Bag 92019, 1142, Auckland, New Zealand.
- 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.
| | - Elizabeth R Peterson
- School of Psychology, Faculty of Science, University of Auckland, Private Bag 92019, 1142, Auckland, New Zealand
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, 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
| | - Karen E Waldie
- School of Psychology, Faculty of Science, University of Auckland, Private Bag 92019, 1142, Auckland, New Zealand
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
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Nakaki A, Gomez Y, Darecka K, Borras R, Vellvé K, Paules C, Boutet ML, Basso A, Casu G, Traversi P, Youssef L, Casas I, Genero M, Benitez L, Larroya M, Casas R, Miranda J, Castro-Barquero S, Rodríguez-Sureda V, Arranz A, Pozo ÓJ, Gomez-Gomez A, Vieta E, Estruch R, Izquierdo Renau M, Eixarch E, Crispi F, Crovetto F, Gratacós E. Effects of Mediterranean Diet or Mindfulness-Based Stress Reduction during Pregnancy on Fetal Brain Development Detected by Neurosonography: A Secondary Analysis of a Randomized Clinical Trial (IMPACT BCN). Fetal Diagn Ther 2024; 52:46-58. [PMID: 39079502 DOI: 10.1159/000540580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/23/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION We investigated whether structured maternal lifestyle interventions based on Mediterranean diet or stress reduction influence fetal-infant neurodevelopment detected by detailed fetal neurosonography and Ages and Stages Questionnaires 3rd edition (ASQ) at 12 months old. METHODS This was a secondary analysis of a randomized clinical trial (2017-2020), including 1,221 singleton pregnancies at high risk for small-for-gestational age. Participants were randomized into three groups at 19-23 weeks' gestation: Mediterranean diet intervention, stress reduction program, or usual care. A detailed neurosonography was performed on 881 participants at mean (SD) 33.4 (1.1) weeks' gestation. Neurosonographic measurements were done offline. ASQ was performed on 276 infants at 1 year of corrected age. RESULTS Biparietal diameter was similar among study groups. Mediterranean diet group fetuses had deeper insula (26.80 [1.68] versus 26.63 [1.75], mm, p = 0.02) and longer corpus callosum (42.98 [2.44] versus 42.62 [2.27], mm, p = 0.04), with a lower rate of suboptimal score infants in ASQ problem-solving domain (6.2 vs. 16.3%, p = 0.03). Stress reduction group fetuses had deeper insula (26.90 [1.75] versus 26.63 [1.75], mm, p = 0.04) and lower rates of suboptimal score infants in ASQ fine motor domain (4.3 vs. 12.8%, p = 0.04), compared to usual care group fetuses. CONCLUSION Maternal structured intervention during pregnancy of the trial has the potential to modify offspring's neurodevelopment.
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Affiliation(s)
- Ayako Nakaki
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain,
- Fundació de Recerca Clínic Barcelona - IDIBAPS, Barcelona, Spain,
| | - Yvan Gomez
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
| | - Katarzyna Darecka
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
| | - Roger Borras
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Kilian Vellvé
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
| | - Cristina Paules
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Instituto de Investigación Sanitaria Aragón (IISAragon), Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de la Investigación y Fondo Europeo de Desarrollo Regional (FEDER), Zaragoza, Spain
| | - Maria Laura Boutet
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
| | - Annachiara Basso
- Department of Obstetrics and Pediatrics ASST Lecco, A. Manzoni Hospital, Lecco, Italy
| | - Giulia Casu
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
| | - Paola Traversi
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
| | - Lina Youssef
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - IDIBAPS, Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Hospital Clinic/Universitat de Barcelona (UB) Campus, Barcelona, Spain
| | - Irene Casas
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - IDIBAPS, Barcelona, Spain
| | - Mariona Genero
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Leticia Benitez
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - IDIBAPS, Barcelona, Spain
| | - Marta Larroya
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - IDIBAPS, Barcelona, Spain
| | - Rosa Casas
- Department of Internal Medicine Hospital Clinic, IDIBAPS, Universitat de Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Comunidad de Madrid, Madrid, Spain
- Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), Universitat de Barcelona (UB), Barcelona, Spain
| | - Jezid Miranda
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Cartagena, Cartagena de Indias, Colombia
| | - Sara Castro-Barquero
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Comunidad de Madrid, Madrid, Spain
- Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), Universitat de Barcelona (UB), Barcelona, Spain
| | - Víctor Rodríguez-Sureda
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - IDIBAPS, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Angela Arranz
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
| | - Óscar J Pozo
- Applied Metabolomics Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Alex Gomez-Gomez
- Applied Metabolomics Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Eduard Vieta
- Hospital Clinic, Department of Psychiatry and Psychology, Neuroscience Institute, IDIBAPS, Universitat de Barcelona (UB), CIBERSAM, Barcelona, Spain
| | - Ramon Estruch
- Department of Internal Medicine Hospital Clinic, IDIBAPS, Universitat de Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Comunidad de Madrid, Madrid, Spain
- Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), Universitat de Barcelona (UB), Barcelona, Spain
| | - Montserrat Izquierdo Renau
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Neonatology Department, Hospital Sant Joan de Déu, Universitat de Barcelona (UB), Barcelona, Spain
| | - Elisenda Eixarch
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Fàtima Crispi
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - IDIBAPS, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Francesca Crovetto
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin RD21/0012/0003, Instituto de Salud Carlos III, Madrid, Spain
| | - Eduard Gratacós
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona (UB), Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - IDIBAPS, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
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Jimènez-Barragan M, Falguera-Puig G, Curto-Garcia JJ, Monistrol O, Coll-Navarro E, Tarragó-Grima M, Ezquerro-Rodriguez O, Ruiz AC, Codina-Capella L, Urquizu X, Pino Gutierrez AD. Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study. BMC Pregnancy Childbirth 2024; 24:500. [PMID: 39054429 PMCID: PMC11270936 DOI: 10.1186/s12884-024-06695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE To assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems. DESIGN A prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks' gestation and followed at three different time points: at 12-14 weeks of pregnancy, at 29-30 weeks of pregnancy, and 4-6 weeks postpartum. All women completed a mental screening at week 12-14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS). SETTING Seven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain. PARTICIPANTS Pregnant women (N = 335, age 18-45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020. FINDINGS The most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12-14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner's income. In weeks 29-30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4-6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems. CONCLUSIONS Early screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.
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Affiliation(s)
- Marta Jimènez-Barragan
- Universitat de Barcelona, Fundació Assistencial Mútua Terrassa, (Terrassa), Research Group on Sexual and Reproductive Healthcare (GRASSIR), (2021-sgr-01489), Barcelona, 08221, Spain.
- ASSIR Fundació Assistencial Mútua Terrassa, Universitat de Barcelona, Plaça Dr. Robert 5, Barcelona, 08221, Spain.
| | - Gemma Falguera-Puig
- Atenció a la Salut Sexual i Reproductiva Metropolitana Nord, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- Research Group on Sexual and Reproductive Healthcare (GRASSIR), (2021-sgr-01489), Barcelona, 08007, Spain
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | | | - Olga Monistrol
- Faculty of Nursing and Physiotherapy, University of Lleida, Iguada, Spain
| | | | - Mercè Tarragó-Grima
- Midwife, Sexual and Reproductive Health Clinic (ASSIR) CAP Rambla Terrassa, Mollet, Spain
| | | | - Anna Carmona Ruiz
- Department of Obstetrics and Gynaecology, Fundació Sanitària Mollet, Mollet, Spain
| | - Laura Codina-Capella
- Department of Obstetrics and Gynaecology, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
| | - Xavier Urquizu
- Department of Obstetrics and Gynaecology, Fundació Sanitària Mollet, Mollet, Spain
| | - Amparo Del Pino Gutierrez
- Departament de Salut Pública, Facultat de Medicina i Ciències de la Salut, Salut Mental i Materno-infantil, Universitat de Barcelona, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Wu Y, De Asis-Cruz J, Limperopoulos C. Brain structural and functional outcomes in the offspring of women experiencing psychological distress during pregnancy. Mol Psychiatry 2024; 29:2223-2240. [PMID: 38418579 PMCID: PMC11408260 DOI: 10.1038/s41380-024-02449-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 03/01/2024]
Abstract
In-utero exposure to maternal psychological distress is increasingly linked with disrupted fetal and neonatal brain development and long-term neurobehavioral dysfunction in children and adults. Elevated maternal psychological distress is associated with changes in fetal brain structure and function, including reduced hippocampal and cerebellar volumes, increased cerebral cortical gyrification and sulcal depth, decreased brain metabolites (e.g., choline and creatine levels), and disrupted functional connectivity. After birth, reduced cerebral and cerebellar gray matter volumes, increased cerebral cortical gyrification, altered amygdala and hippocampal volumes, and disturbed brain microstructure and functional connectivity have been reported in the offspring months or even years after exposure to maternal distress during pregnancy. Additionally, adverse child neurodevelopment outcomes such as cognitive, language, learning, memory, social-emotional problems, and neuropsychiatric dysfunction are being increasingly reported after prenatal exposure to maternal distress. The mechanisms by which prenatal maternal psychological distress influences early brain development include but are not limited to impaired placental function, disrupted fetal epigenetic regulation, altered microbiome and inflammation, dysregulated hypothalamic pituitary adrenal axis, altered distribution of the fetal cardiac output to the brain, and disrupted maternal sleep and appetite. This review will appraise the available literature on the brain structural and functional outcomes and neurodevelopmental outcomes in the offspring of pregnant women experiencing elevated psychological distress. In addition, it will also provide an overview of the mechanistic underpinnings of brain development changes in stress response and discuss current treatments for elevated maternal psychological distress, including pharmacotherapy (e.g., selective serotonin reuptake inhibitors) and non-pharmacotherapy (e.g., cognitive-behavior therapy). Finally, it will end with a consideration of future directions in the field.
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Affiliation(s)
- Yao Wu
- Developing Brain Institute, Children's National Hospital, Washington, DC, 20010, USA
| | | | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, Washington, DC, 20010, USA.
- Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, DC, 20010, USA.
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Ryan N, Leahy-Warren P, Mulcahy H, O’Mahony S, Philpott L. The impact of perinatal maternal stress on the maternal and infant gut and human milk microbiomes: A scoping review protocol. PLoS One 2024; 19:e0304787. [PMID: 38837966 PMCID: PMC11152305 DOI: 10.1371/journal.pone.0304787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE The objective of this scoping review is to review the research evidence regarding the impact of perinatal maternal stress on the maternal and infant gut and human milk microbiomes. INTRODUCTION Perinatal stress which refers to psychological stress experienced by individuals during pregnancy and the postpartum period is emerging as a public health concern. Early exposure of infants to perinatal maternal stress can potentially lead to metabolic, immune, and neurobehavioral disorders that extend into adulthood. The role of the gut and human milk microbiome in the microbiome-gut-brain axis as a mechanism of stress transfer has been previously reported. A transfer of colonised aberrant microbiota from mother to infant is proposed to predispose the infant to a pro- inflammatory microbiome with dysregulated metabolic process thereby initiating early risk of chronic diseases. The interplay of perinatal maternal stress and its relationship to the maternal and infant gut and human milk microbiome requires further systematic examination in the literature. INCLUSION CRITERIA This scoping review is an exploratory mapping review which will focus on the population of mothers and infants with the exploration of the key concepts of maternal stress and its impact on the maternal and infant gut and human milk microbiome in the context of the perinatal period. It will focus on the pregnancy and the post-natal period up to 6 months with infants who are exclusively breastfed. METHODS This study will be guided by the Joanna Briggs Institute's (JBI) methodology for scoping reviews along with use of the Prisma Scr reporting guideline. A comprehensive search will be conducted using the following databases, CINAHL Complete; MEDLINE; PsycINFO, Web of Science and Scopus. A search strategy with pre-defined inclusion and exclusion criteria will be used to retrieve peer reviewed data published in English from 2014 to present. Screening will involve a three-step process with screening tool checklists. Results will be presented in tabular and narrative summaries, covering thematic concepts and their relationships. This protocol is registered with Open Science Framework DOI 10.17605/OSF.IO/5SRMV.
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Affiliation(s)
- Niamh Ryan
- School of Nursing and Midwifery, University College Cork, Wilton, Cork, Ireland
| | | | - Helen Mulcahy
- School of Nursing and Midwifery, University College Cork, Wilton, Cork, Ireland
| | - Siobhain O’Mahony
- Department of Anatomy and Neuroscience, APC Microbiome Ireland, University College Cork, Ireland
| | - Lloyd Philpott
- School of Nursing and Midwifery, University College Cork, Wilton, Cork, Ireland
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Bua A, Moirano G, Pizzi C, Rusconi F, Migliore E, Richiardi L, Popovic M. Maternal antenatal mental health and its associations with perinatal outcomes and the use of healthcare services in children from the NINFEA birth cohort study. Eur J Pediatr 2024; 183:2769-2781. [PMID: 38564067 DOI: 10.1007/s00431-024-05525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
To investigate the associations between maternal mental health disorders before and during pregnancy and perinatal outcomes and child healthcare utilization between 6 and 18 months of age. Among the 6814 mother-child pairs from the Italian Internet-based NINFEA birth cohort, maternal depression, anxiety, and sleep disorders diagnosed by a physician before and during pregnancy were assessed through self-reported questionnaires completed during pregnancy and 6 months after delivery. Perinatal outcomes (preterm birth, birth weight, small for gestational age, congenital anomalies, and neonatal intensive care unit (NICU)) and children's healthcare utilization (emergency department (ED) visits, hospitalizations, and outpatient visits) were reported by mothers at 6 and 18 months postpartum. We used regression models adjusted for maternal age, education, parity, country of birth, region of delivery, and household income. Maternal mental health disorders were not associated with perinatal outcomes, except for depression, which increased the risk of offspring admission to NICU, and anxiety disorders during pregnancy, which were associated with preterm birth and lower birth weight. Children born to mothers with depression/anxiety disorders before pregnancy, compared to children of mothers without these disorders, had an increased odds of a visit to ED for any reason (odds ratio (ORadj) = 1.26, 95% confidence interval (CI): 1.02-1.54), of an ED visit resulting in hospitalization (ORadj = 1.75, 95%CI: 1.27-2.42), and of planned hospital admissions (ORadj = 1.55, 95%CI: 1.01-2.40). These associations with healthcare utilization were similar for mental disorders also during pregnancy. The association pattern of maternal sleep disorders with perinatal outcomes and child healthcare utilization resembled that of maternal depression and/or anxiety disorders with these outcomes. Conclusion: Antenatal maternal mental health is a potential risk factor for child-health outcomes and healthcare use. Early maternal mental health interventions may help to promote child health and reduce healthcare costs. What is Known: • Poor maternal mental health affects pregnancy outcomes and child health, and children of mothers with mental health conditions tend to have increased healtcare utilization. • Parents with poor mental health often face challenges in caring for their children and have less parenting self-efficacy, which could potentially lead to frequent medical consultations for minor health issues. What is New: • Maternal pre-pregnancy mental disorders were not associated with preterm birth, low birth weight, SGA, and congenital anomalies, except for depression, which increased the risk of offspring admission to NICU. Anxiety disorders during pregnancy were associated with lower birth weight and an increased odds of preterm birth. • Maternal depression and/or anxiety and sleep disorders, both before and during pregnancy, were associated with an increase in children's healthcare utilization between 6 and 18 months of life.
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Affiliation(s)
- Adriana Bua
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Costanza Pizzi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Franca Rusconi
- Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Enrica Migliore
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
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Nordin-Remberger C, Wells MB, Woodford J, Lindelöf KS, Johansson M. Preferences of support and barriers and facilitators to help-seeking in pregnant women with severe fear of childbirth in Sweden: a mixed-method study. BMC Pregnancy Childbirth 2024; 24:388. [PMID: 38796427 PMCID: PMC11127315 DOI: 10.1186/s12884-024-06580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 05/13/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND There are few support interventions for women with fear of childbirth tailored towards type of fears and parity. To inform the future development of an acceptable and relevant intervention for women with severe fear of childbirth, primary objectives were to examine: (1) pregnant women's experiences of and preferences for support and (2) barriers and facilitators to help-seeking. Secondary objectives were to examine if there are any differences based on pregnant women's parity. METHODS Pregnant women with a severe fear of childbirth in Sweden completed an online cross-sectional survey between February and September 2022. Severe fear of childbirth was measured using the fear of childbirth scale. Quantitative data were analysed using descriptive and inferential statistics and free answers were analysed using manifest content analysis. A contiguous approach to integration was adopted with qualitative and quantitative findings reported separately. RESULTS In total, 609 participants, 364 nulliparous and 245 parous women, had severe fear of childbirth. The main category "A twisting road to walk towards receiving support for fear of childbirth" was explored and described by the generic categories: Longing for support, Struggling to ask for support, and Facilitating aspects of seeking support. Over half (63.5%), of pregnant women without planned or ongoing treatment, wanted support for fear of childbirth. Most (60.2%) pregnant women with ongoing or completed fear of childbirth treatment regarded the treatment as less helpful or not at all helpful. If fear of childbirth treatment was not planned, 35.8% of women would have liked to have received treatment. Barriers to help seeking included stigma surrounding fear of childbirth, previous negative experiences with healthcare contacts, fear of not being believed, fear of not being listened to, and discomfort of having to face their fears. Facilitators to help seeking included receiving respectful professional support that was easily available, flexible, and close to home. CONCLUSIONS Most pregnant women with severe fear of childbirth felt unsupported during pregnancy. Findings emphasise the need to develop individual and easily accessible psychological support for women with severe fear of childbirth, delivered by trained professionals with an empathetic and respectful attitude.
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Affiliation(s)
- Carita Nordin-Remberger
- Obstetric and Reproductive Health Research, Department of Women´s and Children´s Health, Uppsala University, Uppsala, 752 37, Sweden.
- Women's Mental Health during the Reproductive Lifespan - WOMHER, Uppsala University, Uppsala, Sweden.
| | - Michael B Wells
- Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | | | - Margareta Johansson
- Obstetric and Reproductive Health Research, Department of Women´s and Children´s Health, Uppsala University, Uppsala, 752 37, Sweden
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29
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Van den Bergh BRH, Antonelli MC, Stein DJ. Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation. Curr Opin Psychiatry 2024; 37:237-250. [PMID: 38415742 DOI: 10.1097/yco.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW Perinatal mental health research provides an important perspective on neurobehavioral development. Here, we aim to review the association of maternal perinatal health with offspring neurodevelopment, providing an update on (self-)regulation problems, hypothesized mechanistic pathways, progress and challenges, and implications for mental health. RECENT FINDINGS (1) Meta-analyses confirm that maternal perinatal mental distress is associated with (self-)regulation problems which constitute cognitive, behavioral, and affective social-emotional problems, while exposure to positive parental mental health has a positive impact. However, effect sizes are small. (2) Hypothesized mechanistic pathways underlying this association are complex. Interactive and compensatory mechanisms across developmental time are neglected topics. (3) Progress has been made in multiexposure studies. However, challenges remain and these are shared by clinical, translational and public health sciences. (4) From a mental healthcare perspective, a multidisciplinary and system level approach employing developmentally-sensitive measures and timely treatment of (self-)regulation and coregulation problems in a dyadic caregiver-child and family level approach seems needed. The existing evidence-base is sparse. SUMMARY During the perinatal period, addressing vulnerable contexts and building resilient systems may promote neurobehavioral development. A pluralistic approach to research, taking a multidisciplinary approach to theoretical models and empirical investigation needs to be fostered.
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Affiliation(s)
| | - Marta C Antonelli
- Laboratorio de Programación Perinatal del Neurodesarrollo, Instituto de Biología Celular y Neurociencias "Prof.E. De Robertis", Facultad de Medicina. Universidad de Buenos Aires, Buenos Aires, Argentina
- Frauenklinik und Poliklinik, Klinikum rechts der Isar, Munich, Germany
| | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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Mandl S, Alexopoulos J, Doering S, Wildner B, Seidl R, Bartha-Doering L. The effect of prenatal maternal distress on offspring brain development: A systematic review. Early Hum Dev 2024; 192:106009. [PMID: 38642513 DOI: 10.1016/j.earlhumdev.2024.106009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Prenatal maternal distress can negatively affect pregnancy outcomes, yet its impact on the offspring's brain structure and function remains unclear. This systematic review summarizes the available literature on the relationship between prenatal maternal distress and brain development in fetuses and infants up to 12 months of age. METHODS We searched Central, Embase, MEDLINE, PsycINFO, and PSYNDEXplus for studies published between database inception and December 2023. Studies were included if prenatal maternal anxiety, stress, and/or depression was assessed, neuroimaging was used to examine the offspring, and the offspring's brain was imaged within the first year of life. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-II. RESULTS Out of the 1516 studies retrieved, 71 met our inclusion criteria. Although the studies varied greatly in their methodology, the results generally pointed to structural and functional aberrations in the limbic system, prefrontal cortex, and insula in fetuses and infants prenatally exposed to maternal distress. CONCLUSIONS The hippocampus, amygdala, and prefrontal cortex have a high density of glucocorticoid receptors, which play a key role in adapting to stressors and maintaining stress-related homeostasis. We thus conclude that in utero exposure to maternal distress prompts these brain regions to adapt by undergoing structural and functional changes, with the consequence that these alterations increase the risk for developing a neuropsychiatric illness later on. Future research should investigate the effect of providing psychological support for pregnant women on the offspring's early brain development.
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Affiliation(s)
- Sophie Mandl
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - Johanna Alexopoulos
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria; Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Brigitte Wildner
- University Library, Medical University of Vienna, Vienna, Austria
| | - Rainer Seidl
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lisa Bartha-Doering
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Lipschutz R, Kulesz PA, Elgbeili G, Biekman B, Laplante DP, Olson DM, King S, Bick J. Maternal mental health mediates the effect of prenatal stress on infant temperament: The Harvey Mom Study. Dev Psychopathol 2024; 36:893-907. [PMID: 37078447 DOI: 10.1017/s0954579423000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Prenatal maternal stress and mental health problems are known to increase risk for developmental psychopathology in offspring, yet pathways leading to risk or resiliency are poorly understood. In a quasi-experimental design, we prospectively examined associations between disaster-related prenatal stress, maternal mental health symptoms, and infant temperament outcomes. Mothers who were pregnant during Hurricane Harvey (N = 527) reported on objective hardships (e.g., loss of belongings or income, evacuation, home flooding) related to the storm and subsequent mental health symptoms (anxiety/depression, posttraumatic stress) across time. At a postpartum assessment, mothers reported on their infant's temperament (negative affect, positive affect, orienting/regulatory capacity). Greater objective hardship indirectly predicted higher levels of infant orienting/regulatory capacity through its association with increased maternal posttraumatic stress symptoms. Greater objective hardship also indirectly predicted higher levels of infant negative affect through its association with increased maternal anxiety/depression symptoms across time. Our findings suggest a psychological mechanism linking prenatal stress with specific temperamental characteristics via maternal mental health symptoms. Findings point to the importance of high-quality assessment and mental health services for vulnerable women and young children.
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Affiliation(s)
| | - Paulina A Kulesz
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Brian Biekman
- Department of Psychology, University of Houston, Houston, TX, USA
| | - David P Laplante
- Lady Davis Institute - Jewish General Hospital, Montreal, Canada
| | | | - Suzanne King
- Psychosocial Research Unit, Douglas Research Centre, Verdun, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Johanna Bick
- Department of Psychology, University of Houston, Houston, TX, USA
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Campbell SA, Dys SP, Henderson JMT, Bradley HA, Rucklidge JJ. Exploring the impact of antenatal micronutrients used as a treatment for maternal depression on infant temperament in the first year of life. Front Nutr 2024; 11:1307701. [PMID: 38711532 PMCID: PMC11073451 DOI: 10.3389/fnut.2024.1307701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
Antenatal depression and maternal nutrition can influence infant temperament. Although broad-spectrum-micronutrients (BSM: vitamins and minerals) given above Recommended Dietary Allowances during pregnancy can mitigate symptoms of antenatal depression, their associated effects on infant temperament are unknown. One hundred and fourteen New Zealand mother-infant dyads (45 infants exposed to BSM during pregnancy (range of exposure during pregnancy: 12-182 days) to treat antenatal depressive symptoms (measured by Edinburgh Postnatal Depression Scale) and 69 non-exposed infants) were followed antenatally and for 12 months postpartum to determine the influence of in utero BSM exposure on infant temperament. The Infant Behavior Questionnaire-Revised: Very Short-Form assessed temperament at 4 (T1), 6 (T2) and 12 (T3) months postpartum via online questionnaire. Latent growth curve modeling showed BSM exposure, antenatal depression and infant sex did not statistically significantly predict initial levels or longitudinal changes in orienting/regulatory capacity (ORC), positive affectivity/surgency (PAS) or negative affectivity (NEG). Higher gestational age was positively associated with initial PAS, and smaller increases between T1 and T3. Breastfeeding occurrence was positively associated with initial NEG. Although not significant, BSM exposure exerted small, positive effects on initial NEG (β = -0.116) and longitudinal changes in ORC (β = 0.266) and NEG (β = -0.235). While BSM exposure did not significantly predict infant temperament, it may mitigate risks associated with antenatal depression. BSM-exposed infants displayed temperamental characteristics on par with typical pregnancies, supporting the safety of BSM treatment for antenatal depression.
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Affiliation(s)
- S. A. Campbell
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - S. P. Dys
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - J. M. T. Henderson
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - H. A. Bradley
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - J. J. Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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Dol J, Campbell-Yeo M, Leahy-Warren P, Hambly LaPointe C, Dennis CL. Bibliometric analysis of published articles on perinatal anxiety from 1920 to 2020. J Affect Disord 2024; 351:314-322. [PMID: 38290588 DOI: 10.1016/j.jad.2024.01.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Trends and gaps in perinatal anxiety research remain unknown. The objective of this bibliometric review was to analyze the characteristics and trends in published research on perinatal anxiety to inform future research. METHODS All published literature in Web of Science on perinatal anxiety from January 1, 1920 to December 31, 2020 were screened by two reviewers. VOSViewer was utilized to visualize linkages between publications. Bibliometric data were extracted from abstracts. RESULTS The search strategy identified 4561 publications. After screening, 2203 publications related to perinatal anxiety were used for the visualization analysis. For the bibliometric data, 1534 publications had perinatal anxiety as a primary focus. There were 7910 different authors, over half named only once (55.5 %), from 63 countries. 495 journals were identified, with over half (56.0 %) publishing only one article. Most articles were published between 2011 and 2020 (75.9 %). In terms of perinatal timing, over half (54.2 %) published on antenatal anxiety. Only 6.0 % of studies reported on perinatal anxiety in fathers and 56.5 % also reported on perinatal depression. LIMITATIONS Web of Science was solely used, and manual screening of each publication was required. CONCLUSION This bibliometric analysis found: (1) perinatal anxiety is a growing field of research, with publications increasing over time; (2) there is variation in authors and journals; (3) over half of the publications focus on antenatal anxiety; (4) paternal anxiety is understudied; and (5) only 6 % of publications came from low and lower-middle income countries. Gaps related to maternal postnatal anxiety and paternal perinatal anxiety exist.
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Affiliation(s)
- Justine Dol
- IWK Health, Halifax, Nova Scotia, Canada; Dalhousie University, Nova Scotia, Canada.
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Nova Scotia, Canada
| | | | | | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada; Lunenfeld-Tannenbaum Research Institute, Sinai Health, Ontario, Canada
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Milner JS, Crouch JL, Ammar J, Jensen AP, Travis WJ, Wagner MF. Concerns, Worries, and Fears During Pregnancy in Active-Duty United States Air Force Families. J Perinat Educ 2024; 33:52-64. [PMID: 39399784 PMCID: PMC11467706 DOI: 10.1891/jpe-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024] Open
Abstract
There are no published studies on pregnancy-related concerns, worries, and fears (CWFs) in primiparous and multiparous women and men in U.S. Air Force (USAF) families. Reflecting a biopsychosocial model of behavioral health, women's and men's pregnancy-related CWF Questionnaires were developed. Usable data were obtained from 260 women and 243 men in USAF families. Similarities and differences in pregnancy-related CWFs were found when USAF and general population data were compared. The present findings can inform not only the general provision of pregnancy health-related services but also USAF secondary prevention pregnancy-related programs (e.g., USAF nurse home visiting programs for first-time parents). If CWF Questionnaires are individually administered, the information can be used to tailor services to individual client needs.
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Affiliation(s)
- Joel S. Milner
- Correspondence regarding this article should be directed to Joel S. Milner, PhD. E-mail:
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Alnasheet AM, Abdulaal NA, Kamal N. The Prevalence and Risk Factors of Pregnancy-Related Anxiety in Bahrain. Cureus 2024; 16:e57404. [PMID: 38694669 PMCID: PMC11062578 DOI: 10.7759/cureus.57404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 05/04/2024] Open
Abstract
Objectives We aim to estimate the prevalence of anxiety among pregnant women, explore the possible risk factors, and compare the presence of anxiety in each gestational trimester in all pregnant women attending the antenatal care clinics at a tertiary care hospital in Manama, Bahrain. Methods This study followed a cross-sectional research design at the antenatal clinics of Salmaniya Medical Complex in Manama, Bahrain. Direct interviews with 513 participants were conducted using the Pregnancy Anxiety Questionnaire-Revised-2 (PRAQ-R2). Results Most participants (63%) were 25-35 years old. The majority (85.6%) were Bahraini nationals, and 52.2% were university-educated. Almost two-thirds were unemployed, 28.1% had associated chronic comorbidities, 3.1% had associated psychiatric disorders, 15% had a high level of anxiety, and 38% had a moderate level of anxiety. Employed participants had a significantly higher level of anxiety (p=0.022) than housewives/unemployed participants. Participants' levels of anxiety differed significantly according to their gestational age (p=0.043), with the highest anxiety among those in their third trimester (15.7%). Participants' anxiety levels were significantly higher among those with previously complicated pregnancies (p=0.002). Moreover, those with unplanned current pregnancy had significantly higher anxiety levels (p=0.019). Conclusions This study showed that anxiety seems to be a common disorder among pregnant women in Bahrain. It was more prevalent during the third trimester, and its occurrence was associated with the pregnant woman's employment, the occurrence of previously complicated pregnancies, and unplanned current pregnancies.
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Affiliation(s)
| | - Nada A Abdulaal
- Obstetrics and Gynecology, Al Kharj Military Industries Corporation Hospital (AKMICH), Riyadh, SAU
| | - Nahid Kamal
- Obstetrics and Gynecology, Salmaniya Medical Complex, Manama, BHR
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Bete T, Ali T, Misgana T, Negash A, Abraham T, Teshome D, Sirtsu A, Nigussie K, Amano A. Suicidal ideation and associated factors among pregnant women attending antenatal care at public hospitals of Harari regional state, eastern Ethiopia: A cross-sectional study. PLoS One 2024; 19:e0300417. [PMID: 38547179 PMCID: PMC10977762 DOI: 10.1371/journal.pone.0300417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Suicide is a global issue. It is the third responsible for death among the reproductive age group. Pregnancy is a complicated event and crucial in the life of a woman with considerable physiological, hormonal changes, social, and mental changes. However, third-world countries like Ethiopia have not been investigated well. Therefore, the study planned to assess the magnitude and factors associated with suicidal ideation. Furthermore, it will identify the role of hyperemesis gravidarum on suicidal ideation. METHOD A Cross-sectional study was employed for 543 pregnant participants attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal General Hospital, Harari regional state, eastern Ethiopia from June 1 to August 1, 2022. The recruited participants were selected by systematic random sampling method. Suicide was assessed using Composite International Diagnostic by interview methods data collection. Epi data and STATA version 14.1 were used for data entry and analysis respectively. Candidate variables were entered into a multivariate logistic regression then those variables that have p-value < 0.05 were considered as significantly associated. RESULTS The magnitude of suicidal ideation in this study was found to be 11.15% at (95% CI: 8.75-14.11). Regarding the associated factor, unwanted pregnancy (AOR = 3.39: at 95% CI = 1.58-7.27), Hyperemesis gravidarum (AOR = 3.65: at 95% CI = 1.81-7.34), having depressive symptoms (AOR = 2.79: at 95% CI = 1.49-5.23), having anxiety symptoms (AOR = 3.37; at 95% CI = 1.69-6.68), experiencing intimate partner violence (AOR = 2.88: at 95% CI = 1.11-7.46), and having stress (AOR = 3.46; at 95% CI = 1.75-6.86) were significantly associated variable with suicidal ideation among pregnant women. CONCLUSION AND RECOMMENDATION This study revealed that suicidal ideation is common among pregnant women. Regarding the associated factors unwanted pregnancy, hyperemesis gravidarum, having depressive and anxiety symptoms, experiencing intimate partner violence, and stress were significantly associated with suicidal ideation. Thus, giving awareness and early screening and interferences for antenatal suicide should be warranted.
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Affiliation(s)
- Tilahun Bete
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Ali
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Misgana
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Negash
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teklu Abraham
- Department of Psychiatry, School Medicine, College of Health and Medical Sciences, Arsi University, Assella, Ethiopia
| | - Dekeba Teshome
- Department of Psychiatry, School Medicine, College of Health and Medical Sciences, Arsi University, Assella, Ethiopia
| | - Addisu Sirtsu
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdulkerim Amano
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Tyson HR, Harrison DJ, Higgs MJ, Isles AR, John RM. Deficiency of the paternally-expressed imprinted Peg3 gene in mice has sexually dimorphic consequences for offspring communication and social behaviour. Front Neurosci 2024; 18:1374781. [PMID: 38595977 PMCID: PMC11002209 DOI: 10.3389/fnins.2024.1374781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Imprinted genes are expressed from one parental allele as a consequence of epigenetic processes initiated in the germline. Consequently, their ability to influence phenotype depends on their parent-of-origin. Recent research suggests that the sex of the individual expressing the imprinted gene is also important. We have previously reported that genetically wildtype (WT) dams carrying and caring for pups mutant for PEG3 exhibit anxiety-like behaviours and their mutant pups show a reduction in ultrasonic vocalisation when separated from their mothers. Sex-specificity was not examined. Methods WT female mice were mated with WT, heterozygous Peg3-/+ or homozygous Peg3-/- studs to generate all WT (control), 50:50 mixed or 100% mutant litters, respectively, followed by behavioural assessment of both dams and their pups. Results We reproduced our original finding that WT dams carrying and caring for 100% mutant litters exhibit postpartum anxiety-like symptoms and delayed pup retrieval. Additionally, these WT dams were found to allocate less time to pup-directed care behaviours relative to controls. Male Peg3-deficient pups demonstrated significantly reduced vocalisation with a more subtle communication deficit in females. Postweaning, male mutants exhibited deficits across a number of key social behaviours as did WT males sharing their environment with mutants. Only modest variations in social behaviour were detected in experimental females. Discussion We have experimentally demonstrated that Peg3 deficiency confined to the offspring causes anxiety in mouse mothers and atypical behaviour including deficits in communication in their male offspring. A male-specific reduction in expression PEG3 in the fetally-derived placenta has previously been associated with maternal depression in human pregnancy. Maternal mood disorders such as depression and anxiety are associated with delays in language development and neuroatypical behaviour more common in sons. Peg3 deficiency could drive the association of maternal and offspring behavioural disorders reported in humans.
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Affiliation(s)
- Hannah R. Tyson
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - David J. Harrison
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Mathew J. Higgs
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Anthony R. Isles
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Rosalind M. John
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, United Kingdom
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Kim J, Hurh K, Kim H, Park EC, Ha MJ. Effect of the peripartum depressive symptoms on the Internet use disorder of their offspring in late childhood: retrospective longitudinal study. Sci Rep 2024; 14:417. [PMID: 38172226 PMCID: PMC10764353 DOI: 10.1038/s41598-023-50603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
Internet use disorder (IUD) is an emerging social and mental health concern. This study aimed to analyze the relative risk of IUD in late childhood among children whose mothers experienced peripartum depressive symptoms. This study included 762 participants (397 boys and 365 girls) and was conducted in 2017 (aged 9) and 2019 (aged 11). We analyzed the adjusted relative risk of being at high risk for IUD based on whether the mother experienced depressive symptoms during pregnancy or one month after delivery. We also considered the persistence of depressed mood for 4 months after delivery and the severity of peripartum depressive symptoms. From 2017, 20.7% of boys and 14.0% of girls were at high risk of developing IUD. Compared to the non-peripartum depressive group, girls whose mothers experienced peripartum depressive symptoms and those that persisted for 4 months were 1.084 and 1.124 times more likely to be at high risk of IUD (95% confidence interval = 1.005-1.170 and 1.013-1.248), respectively. There were no statistically significant differences among boys. Peripartum depressed mood could be one of risk factors of IUD. IUD needs to be monitored in children whose mothers experienced peripartum depressive symptoms.
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Affiliation(s)
- Jinhyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyungduk Hurh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyunkyu Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Min Jin Ha
- Department of Health Informatics and Biostatistics, Graduate School of Public Health, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Morrison CA, Corbeil T, Kluisza L, Poku O, Liotta L, Attoh Okine ND, Dolezal C, Wiznia A, Abrams EJ, Robbins RN, Mellins CA. Identifying the Mental Health Effects of Cumulative Traumatic Exposure in HIV-Affected Youth: A Longitudinal Assessment. J Acquir Immune Defic Syndr 2024; 95:18-25. [PMID: 37820277 PMCID: PMC10841068 DOI: 10.1097/qai.0000000000003313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/17/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Traumatic events (TEs) in early life can precede adult psychopathology. Limited research exists on this relationship in young adults with perinatally acquired HIV-infection (PHIV) or perinatal HIV-exposure without infection (PHEU), who often experience social and health disparities. This study examined TEs experienced in childhood/adolescence and their association with psychiatric and substance use disorders in young adults with PHIV and PHEU. METHODS Participants in a New York City-based longitudinal cohort study were assessed for TE exposure at enrollment (mean age = 12 years) and the first 2 follow-up interviews. Past-year psychiatric and substance use disorders were evaluated via psychiatric interview (DISC-IV) at the fifth follow-up interview (mean age = 22 years). Unadjusted and adjusted logistic regression models assessed associations between cumulative childhood/adolescence TEs and young adult psychiatric and substance use outcomes. Group differences were tested for PHIV and PHEU subgroups. RESULTS Among 236 participants (60% Black, 51% Latinx), mean cumulative traumatic event count was 3.09 (SD = 1.77); 26% had a past-year psychiatric diagnosis, and 28% had a past-year substance use diagnosis. Increased TEs were associated with past-year psychiatric diagnoses in young adulthood [average marginal effects (AME) 4.21, 95% confidence interval (CI): 0.83 to 7.58]; for PHEU participants, increased TEs were associated with a past-year substance use disorder (AME 15.67, 95% CI: 8.08 to 23.25). CONCLUSIONS High levels of TEs in childhood/adolescence may contribute to psychiatric and substance use disorders in young adults with PHIV or PHEU. Research exploring relationships between TE exposure and later psychiatric problems is needed to inform interventions for HIV-affected youth.
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Affiliation(s)
- Corey A Morrison
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Thomas Corbeil
- Mental Health Data Science, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Luke Kluisza
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Ohemaa Poku
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Lucy Liotta
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Naa-Djama Attoh Okine
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, The Bronx, NY; and
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
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Saeed H, Wu J, Tesfaye M, Grantz KL, Tekola-Ayele F. Placental accelerated aging in antenatal depression. Am J Obstet Gynecol MFM 2024; 6:101237. [PMID: 38012987 PMCID: PMC10843762 DOI: 10.1016/j.ajogmf.2023.101237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Antenatal maternal depression is associated with poor pregnancy outcomes and long-term effects on the offspring. Previous studies have identified links between antenatal depression and placental DNA methylation and between placental epigenetic aging and poor pregnancy outcomes, such as preterm labor and preeclampsia. The relationship between antenatal depression and poor pregnancy outcomes may be partly mediated via placental aging. OBJECTIVE This study aimed to investigate whether antenatal depressive symptoms are associated with placental epigenetic age acceleration, an epigenetic aging clock measure derived from the difference between methylation age and gestational age at delivery. STUDY DESIGN The study included 301 women who provided placenta samples at delivery as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies - Singletons that recruited participants from diverse race and ethnic groups at 12 US clinical sites (2009-2013). Women underwent depression screening using the Edinburgh Postnatal Depression Scale up to 6 times across the 3 trimesters of pregnancy. Depressive symptoms status was determined for each pregnancy trimester using an Edinburgh Postnatal Depression Scale score, in which a score of ≥10 was defined as having depressive symptoms and a score of <10 was defined as not having depressive symptoms. Placental DNA methylation was profiled from placenta samples. Placental epigenetic age was estimated using a methylation-based age estimator (placental "epigenetic clock") that has previously been found to have high placental gestational age prediction accuracy for uncomplicated term pregnancies. Placental age acceleration was defined to be the residual upon regressing the estimated epigenetic age on gestational age at delivery. Associations between an Edinburgh Postnatal Depression Scale score of ≥10 and an Edinburgh Postnatal Depression Scale score of <10 in the first, second, and third trimesters of pregnancy (ie, depressive symptoms vs none in each trimester) and placental age acceleration were tested using multivariable linear regression adjusting for maternal age, parity, race and ethnicity, and employment. RESULTS There were 31 (10.3%), 48 (16%), and 49 (16.4%) women with depressive symptoms (ie, Edinburgh Postnatal Depression Scale score of ≥10) in the first, second, and third trimesters of pregnancy, respectively. Of these women, 21 (7.2%) had sustained first- and second-trimester depressive symptoms, 19 (7%) had sustained second- and third-trimester depressive symptoms, and 12 (4.8%) had sustained depressive symptoms throughout pregnancy. Women with depressive symptoms in the second trimester of pregnancy had 0.41 weeks higher placental age acceleration than women without depressive symptoms during the second trimester of pregnancy (β=0.21 weeks [95% confidence interval, -0.17 to 0.58; P=.28] during the first trimester of pregnancy; β=0.41 weeks [95% confidence interval, 0.10-0.71; P=.009] during the second trimester of pregnancy; β=0.17 weeks [95% confidence interval, -0.14 to 0.47; P=.29] during the third trimester of pregnancy). Sustained first- and second-trimester depressive symptoms were associated with 0.72 weeks higher placental age acceleration (95% confidence interval, 0.29-1.15; P=.001) than no depressive symptom in the 2 trimesters. The association between second-trimester depressive symptoms and higher placental epigenetic age acceleration strengthened in the analysis of pregnancies with male fetuses (β=0.53 weeks; 95% confidence interval, 0.06-1.08; P=.03) but was not significant in pregnancies with female fetuses. CONCLUSION Antenatal depressive symptoms during the second trimester of pregnancy were associated with an average of 0.41 weeks of increased placental age acceleration. Accelerated placental aging may play an important role in the underlying mechanism linking antenatal depression to pregnancy complications related to placental dysfunction.
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Affiliation(s)
- Haleema Saeed
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (Dr Saeed); Department of Maternal-Fetal Medicine, Medstar Washington Hospital Center, Washington, DC (Drs Saeed)
| | - Jing Wu
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (Drs Wu, Grantz, and Tekola-Ayele)
| | - Markos Tesfaye
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, University of Oslo, Oslo, Norway (Dr Tesfaye); Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Dr Tesfaye)
| | - Katherine L Grantz
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (Drs Wu, Grantz, and Tekola-Ayele)
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (Drs Wu, Grantz, and Tekola-Ayele).
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Gateau K, Schlueter L, Pierce LJ, Thompson B, Gharib A, Durazo-Arvizu RA, Nelson CA, Levitt P. Exploratory study evaluating the relationships between perinatal adversity, oxidative stress, and infant neurodevelopment across the first year of life. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001984. [PMID: 38153909 PMCID: PMC10754429 DOI: 10.1371/journal.pgph.0001984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/13/2023] [Indexed: 12/30/2023]
Abstract
Early childhood adversity increases risk for negative lifelong impacts on health and wellbeing. Identifying the risk factors and the associated biological adaptations early in life is critical to develop scalable early screening tools and interventions. Currently, there are limited, reliable early childhood adversity measures that can be deployed prospectively, at scale, to assess risk in pediatric settings. The goal of this two-site longitudinal study was to determine if the gold standard measure of oxidative stress, F2-Isoprostanes, is potentially a reliable measure of a physiological response to adversity of the infant and mother. The study evaluated the independent relationships between F2-Isoprostanes, perinatal adversity and infant neurocognitive development. The study included mother-infant dyads born >36 weeks' gestation. Maternal demographic information and mental health assessments were utilized to generate a perinatal cumulative risk score. Infants' development was assessed at 6 and 12 months and both mothers and infants were assayed for F2-isoprostane levels in blood and urine, respectively. Statistical analysis revealed that cumulative risk scores correlated with higher maternal (p = 0.01) and infant (p = 0.05) F2-isoprostane levels at 6 months. Infant F2-isoprostane measures at 2 months were negatively associated with Mullen Scales of Early Learning Composite scores at 12 months (p = 0.04). Lastly, higher cumulative risk scores predicted higher average maternal F2-isoprostane levels across the 1-year study time period (p = 0.04). The relationship between perinatal cumulative risk scores and higher maternal and infant F2-isoprostanes at 6 months may reflect an oxidative stress status that informs a sensitive period in which a biomarker can be utilized prospectively to reveal the physiological impact of early adversity.
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Affiliation(s)
- Kameelah Gateau
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, United States of America
- Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Lisa Schlueter
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Los Angeles, California, United States of America
| | - Lara J. Pierce
- York University, Department of Psychology, Toronto, ON, Canada
| | - Barbara Thompson
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, Michigan, United States of America
| | - Alma Gharib
- Children’s Hospital Los Angeles, Los Angeles, California, United States of America
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Los Angeles, California, United States of America
| | - Ramon A. Durazo-Arvizu
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, United States of America
- Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Charles A. Nelson
- Department of Pediatrics, Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Harvard Graduate School of Education, Boston, Massachusetts, United States of America
| | - Pat Levitt
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, United States of America
- Children’s Hospital Los Angeles, Los Angeles, California, United States of America
- York University, Department of Psychology, Toronto, ON, Canada
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Drzymalla E, Crider KS, Wang A, Marta G, Khoury MJ, Rasooly D. Epigenome-wide association studies of prenatal maternal mental health and infant epigenetic profiles: a systematic review. Transl Psychiatry 2023; 13:377. [PMID: 38062042 PMCID: PMC10703876 DOI: 10.1038/s41398-023-02620-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 12/18/2023] Open
Abstract
Prenatal stress and poor maternal mental health are associated with adverse offspring outcomes; however, the biological mechanisms are unknown. Epigenetic modification has linked maternal health with offspring development. Epigenome-wide association studies (EWAS) have examined offspring DNA methylation profiles for association with prenatal maternal mental health to elucidate mechanisms of these complex relationships. The objective of this study is to provide a comprehensive, systematic review of EWASs of infant epigenetic profiles and prenatal maternal anxiety, depression, or depression treatment. We conducted a systematic literature search following PRISMA guidelines for EWAS studies between prenatal maternal mental health and infant epigenetics through May 22, 2023. Of 645 identified articles, 20 fulfilled inclusion criteria. We assessed replication of CpG sites among studies, conducted gene enrichment analysis, and evaluated the articles for quality and risk of bias. We found one repeated CpG site among the maternal depression studies; however, nine pairs of overlapping differentially methylatd regions were reported in at least two maternal depression studies. Gene enrichment analysis found significant pathways for maternal depression but not for any other maternal mental health category. We found evidence that these EWAS present a medium to high risk of bias. Exposure to prenatal maternal depression and anxiety or treatment for such was not consistently associated with epigenetic changes in infants in this systematic review and meta-analysis. Small sample size, potential bias due to exposure misclassification and statistical challenges are critical to address in future efforts to explore epigenetic modification as a potential mechanism by which prenatal exposure to maternal mental health disorders leads to adverse infant outcomes.
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Affiliation(s)
- Emily Drzymalla
- Division of Blood Disorders and Public Health Genomics, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Krista S Crider
- Infant Outcomes Research and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Arick Wang
- Infant Outcomes Research and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Muin J Khoury
- Division of Blood Disorders and Public Health Genomics, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Danielle Rasooly
- Division of Blood Disorders and Public Health Genomics, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Nakaki A, Crovetto F, Urru A, Piella G, Borras R, Comte V, Vellvé K, Paules C, Segalés L, Dacal M, Gomez Y, Youssef L, Casas R, Castro-Barquero S, Martín-Asuero A, Oller Guzmán T, Morilla I, Martínez-Àran A, Camacho A, Pascual Tutusaus M, Arranz A, Rebollo-Polo M, Gomez-Chiari M, Bargallo N, Pozo ÓJ, Gomez-Gomez A, Izquierdo Renau M, Eixarch E, Vieta E, Estruch R, Crispi F, Gonzalez-Ballester MA, Gratacós E. Effects of Mediterranean diet or mindfulness-based stress reduction on fetal and neonatal brain development: a secondary analysis of a randomized clinical trial. Am J Obstet Gynecol MFM 2023; 5:101188. [PMID: 37839546 DOI: 10.1016/j.ajogmf.2023.101188] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Maternal suboptimal nutrition and high stress levels are associated with adverse fetal and infant neurodevelopment. OBJECTIVE This study aimed to investigate if structured lifestyle interventions involving a Mediterranean diet or mindfulness-based stress reduction during pregnancy are associated with differences in fetal and neonatal brain development. STUDY DESIGN This was a secondary analysis of the randomized clinical trial Improving Mothers for a Better Prenatal Care Trial Barcelona that was conducted in Barcelona, Spain, from 2017 to 2020. Participants with singleton pregnancies were randomly allocated into 3 groups, namely Mediterranean diet intervention, stress reduction program, or usual care. Participants in the Mediterranean diet group received monthly individual sessions and free provision of extra-virgin olive oil and walnuts. Pregnant women in the stress reduction group underwent an 8-week mindfulness-based stress reduction program adapted for pregnancy. Magnetic resonance imaging of 90 fetal brains was performed at 36 to 39 weeks of gestation and the Neonatal Neurobehavioral Assessment Scale was completed for 692 newborns at 1 to 3 months. Fetal outcomes were the total brain volume and lobular or regional volumes obtained from a 3-dimensional reconstruction and semiautomatic segmentation of magnetic resonance images. Neonatal outcomes were the 6 clusters scores of the Neonatal Neurobehavioral Assessment Scale. Multiple regression analyses were conducted to assess the association between the interventions and the fetal and neonatal outcomes. RESULTS When compared with the usual care group, the offspring exposed to a maternal Mediterranean diet had a larger total fetal brain volume (mean, 284.11 cm3; standard deviation, 23.92 cm3 vs 294.01 cm3; standard deviation, 26.29 cm3; P=.04), corpus callosum (mean, 1.16 cm3; standard deviation, 0.19 cm3 vs 1.26 cm3; standard deviation, 0.22 cm3; P=.03), and right frontal lobe (44.20; standard deviation, 4.09 cm3 vs 46.60; standard deviation, 4.69 cm3; P=.02) volumes based on magnetic resonance imaging measures and higher scores in the Neonatal Neurobehavioral Assessment Scale clusters of autonomic stability (mean, 7.4; standard deviation, 0.9 vs 7.6; standard deviation, 0.7; P=.04), social interaction (mean, 7.5; standard deviation, 1.5 vs 7.8; standard deviation, 1.3; P=.03), and range of state (mean, 4.3; standard deviation, 1.3 vs 4.5; standard deviation, 1.0; P=.04). When compared with the usual care group, offspring from the stress reduction group had larger fetal left anterior cingulate gyri volume (1.63; standard deviation, 0.32 m3 vs 1.79; standard deviation, 0.30 cm3; P=.03) based on magnetic resonance imaging and higher scores in the Neonatal Neurobehavioral Assessment Scale for regulation of state (mean, 6.0; standard deviation, 1.8 vs 6.5; standard deviation, 1.5; P<.01). CONCLUSION Maternal structured lifestyle interventions involving the promotion of a Mediterranean diet or stress reduction during pregnancy were associated with changes in fetal and neonatal brain development.
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Affiliation(s)
- Ayako Nakaki
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Department of Surgery and Surgical specializations, Faculty of Medicine and Helath Sciences, University of Barcelona, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Castro-Barquero, Arranz, Eixarch, Crispi and Gratacos)
| | - Francesca Crovetto
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain (Drs Crovetto, Izquierdo Renau, and Gratacos)
| | - Andrea Urru
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester)
| | - Gemma Piella
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester)
| | - Roger Borras
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, Universitat Autònoma de Barcelona, Barcelona, Spain (Mr Borras); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain (Mr Borras and Dr Bargallo)
| | - Valentin Comte
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester)
| | - Kilian Vellvé
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Cristina Paules
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Laura Segalés
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Marta Dacal
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Yvan Gomez
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Lina Youssef
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Josep Carreras Leukaemia Research Institute, Hospital Clinic, University of Barcelona Campus, Barcelona, Spain (Dr Youssef)
| | - Rosa Casas
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain (Drs Casas, Castro-Barquero, and Estruch); Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Madrid, Spain (Drs Casas, Castro-Barquero, and Estruch)
| | - Sara Castro-Barquero
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain (Drs Casas, Castro-Barquero, and Estruch); Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Madrid, Spain (Drs Casas, Castro-Barquero, and Estruch)
| | - Andrés Martín-Asuero
- Instituto esMindfulness, Barcelona, Spain (Dr Martín-Asuero and Ms Oller Guzmán)
| | - Teresa Oller Guzmán
- Instituto esMindfulness, Barcelona, Spain (Dr Martín-Asuero and Ms Oller Guzmán)
| | - Ivette Morilla
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain (Drs Morilla, Martínez-Àran, and Vieta)
| | - Anabel Martínez-Àran
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain (Drs Morilla, Martínez-Àran, and Vieta)
| | - Alba Camacho
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Mireia Pascual Tutusaus
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Angela Arranz
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Monica Rebollo-Polo
- Diagnostic Imaging and Image Guided Therapy, Institut de Recerca Sant Joan de Dèu, Esplugues de Llobregat, Spain (Drs Rebollo-Polo and Gomez-Chiari); Radiology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland (Dr Rebollo-Polo)
| | - Marta Gomez-Chiari
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Diagnostic Imaging and Image Guided Therapy, Institut de Recerca Sant Joan de Dèu, Esplugues de Llobregat, Spain (Drs Rebollo-Polo and Gomez-Chiari); Diagnostic Imaging Department, Hospital Sant Joan de Dèu, Esplugues de Llobregat, Spain (Dr Gomez-Chiari)
| | - Nuria Bargallo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain (Mr Borras and Dr Bargallo); Radiology Department, Center of Image Diagnostic, Hospital Clínic. Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain (Dr Bargallo)
| | - Óscar J Pozo
- Applied Metabolomics Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (Drs Pozo and Gomez-Gomez)
| | - Alex Gomez-Gomez
- Applied Metabolomics Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (Drs Pozo and Gomez-Gomez)
| | - Montserrat Izquierdo Renau
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain (Drs Crovetto, Izquierdo Renau, and Gratacos); Neonatology Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain (Dr Izquierdo Renau)
| | - Elisenda Eixarch
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain (Drs Eixarch, Crispi, and Gratacos)
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain (Drs Morilla, Martínez-Àran, and Vieta)
| | - Ramon Estruch
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain (Drs Casas, Castro-Barquero, and Estruch); Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Madrid, Spain (Drs Casas, Castro-Barquero, and Estruch)
| | - Fàtima Crispi
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain (Drs Eixarch, Crispi, and Gratacos).
| | - Miguel Angel Gonzalez-Ballester
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester); ICREA, Barcelona, Spain (Dr Gonzalez-Ballester)
| | - Eduard Gratacós
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain (Drs Crovetto, Izquierdo Renau, and Gratacos); Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain (Drs Eixarch, Crispi, and Gratacos)
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Ibiwoye OH, Thomson G. COVID-19 pandemic and perinatal mental health: A commentary on the impact, risk factors, and protective factors. Birth 2023; 50:651-656. [PMID: 37455498 DOI: 10.1111/birt.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/31/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
In summary, birthing women are at risk of poor mental health particularly in a pandemic. Identified protective factors such as social support, good sleep, exercise, and access to prenatal care, among others are pertinent to reducing negative effects on perinatal mental health should future crises occur.
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Affiliation(s)
- Oluwaseun Helen Ibiwoye
- University of Central Lancashire, Preston, UK
- NIHR Applied Research Collaboration - Northwest Coast (ARC-NWC), Manchester, UK
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit, School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
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Mariño-Narvaez C, Puertas-Gonzalez JA, Romero-Gonzalez B, Gonzalez-Perez R, Peralta-Ramírez MI. How prenatal cortisol levels may differentially affect the neurodevelopment of boys and girls. Early Hum Dev 2023; 187:105874. [PMID: 37866289 DOI: 10.1016/j.earlhumdev.2023.105874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Prenatal stress could have serious consequences on maternal and fetal health. In this sense, some studies have stated that maternal HCC during pregnancy could contribute to sex-specific effects on infant neurodevelopment, following the Developmental Origins of Health and Disease Hypothesis. AIM This study aimed to determine whether maternal hair cortisol concentration (HCC) during each trimester of pregnancy and postpartum could predict the neurodevelopmental outcomes of their 12-month-old offspring, with sex-specific differences considered. STUDY DESIGN longitudinal. SUBJECTS The study involved 93 pregnant women and their babies. OUTCOME MEASURE Hair samples collected during each trimester and postpartum and The Bayley Scales for Infant Development III was used to assess the infants' abilities. RESULTS The results showed that maternal HCC during the first and second trimesters could predict language and motor abilities. However, when discriminated by sex, only females' cognitive, expressive language, and fine and gross motor skills were predicted by cortisol, not males. CONCLUSIONS These findings support the idea that non-toxic levels of cortisol can positively influence infants' neurodevelopment.
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Affiliation(s)
| | | | - Borja Romero-Gonzalez
- Department of Psychology, Faculty of Education, Campus Duques de Soria, University of Valladolid, Soria, Spain.
| | - Raquel Gonzalez-Perez
- Pharmacology Departament, CIBERehd, Faculty of Pharmacy, University de Granada, Spain
| | - Maria Isabel Peralta-Ramírez
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain; Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Granada, Spain
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Muñoz-Vela FJ, Fernández-Carrasco FJ, Gómez-Salgado J, Allande-Cussó R, Marques Monteiro Dias Mendes IM, Martins Teixeira-da-Costa EI, Vázquez-Lara JM, Fagundo-Rivera J, Rodríguez-Díaz L. Assessment of Levels of Anxiety and Fear of Covid-19 in a Population of Pregnant Women in Spain. Psychol Res Behav Manag 2023; 16:4665-4676. [PMID: 38024653 PMCID: PMC10660725 DOI: 10.2147/prbm.s432792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The aim of the study was to assess the levels of fear and anxiety in the particularly vulnerable population group of women during pregnancy. Methods Cross-sectional study between March 2022 and July 2022 involving 978 pregnant women aged 16 to 50 years. It was carried out based on the scale for the assessment of fear and anxiety in pregnant women (AMICO_Pregnant) and the collection of sociodemographic data. Normality analysis was performed prior to univariate and bivariate statistical analysis. Results The sample was composed of a total of 978 pregnant women. The mean of the AMICO_Pregnant scale was intermediate (5.04 points; SD=2.36). The bivariate analysis showed a statistically significant relationship between the AMICO_Pregnant scale and the following variables: vaccination schedule status, contact with the disease, weeks of gestation, altered delivery or birth plan. Conclusion Women with pregnancies closer to term, with no contact with the disease, without a complete vaccination schedule, or who had undergone changes in their delivery or birth plans, showed higher levels of fear and anxiety.
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Affiliation(s)
- Francisco Javier Muñoz-Vela
- Department of Nursing, Faculty of Health Sciences, University of Málaga, Málaga, Spain
- Obstetrics and Gynecology Area, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | | | | | - Emilia Isabel Martins Teixeira-da-Costa
- Department of Nursing, Health School, University of Algarve, Faro, Portugal
- Health Sciences Research Unit: Nursing, Escola Superior de Enfermagem de Coimbra, Coimbra, Portugal
| | - Juana María Vázquez-Lara
- Department of Gynaecology and Obstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
| | | | - Luciano Rodríguez-Díaz
- Department of Gynaecology and Obstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
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Muñoz-Vela FJ, Rodríguez-Díaz L, Fernández-Carrasco FJ, Allande-Cussó R, Vázquez-Lara JM, Fagundo-Rivera J, Gómez-Salgado J. Adaptation and psychometric study of the scale for the measurement of fear and anxiety of COVID-19 disease in pregnant women (AMICO_Pregnant). Front Public Health 2023; 11:1225822. [PMID: 37809001 PMCID: PMC10552539 DOI: 10.3389/fpubh.2023.1225822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
Objective The aim of this research was to adapt and explore the psychometric properties of a specific scale to assess the levels of fear and anxiety of COVID-19 disease in pregnant women. Methods An adaptation phase, by a panel of experts, and a psychometric descriptive cross-sectional study were carried out on the final version of the 16-item, self-administered AMICO_Pregnant scale. Univariate and bivariate analyses were carried out, followed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The consistency of the scale was assessed using the Omega coefficient and Cronbach's Alpha. Results With a sample of 1,013 pregnant women living in Spain and over 18 years of age, the mean age was 33 years. The scale showed a bifactor structure (anxiety and fear) that was confirmed with good fit parameters. Reliability was assessed in terms of internal consistency by calculating Cronbach's Alpha coefficient (0.95) and McDonald's Omega coefficient (0.94) as indicators of robustness of the scale's reliability. Conclusion The AMICO_Pregnant scale of 16 items with scores ranging from 1 to 10 is a valid and reliable tool to assess levels of anxiety and fear of COVID_19 in Spanish pregnant women. Pregnant women have shown moderate levels of anxiety and fear regarding the COVID_19 disease in the final phase of the pandemic.
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Affiliation(s)
- Francisco Javier Muñoz-Vela
- Department of Nursing, Faculty of Health Sciences, University of Malaga, Málaga, Spain
- Regional University Hospital of Malaga, Málaga, Spain
| | - Luciano Rodríguez-Díaz
- Department of Nursing, Faculty of Health Sciences of Ceuta, University of Granada, Ceuta, Spain
| | | | | | | | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Escuela de Posgrado, Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
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Jimenez-Barragan M, del Pino Gutierrez A, Garcia JC, Monistrol-Ruano O, Coll-Navarro E, Porta-Roda O, Falguera-Puig G. Study protocol for improving mental health during pregnancy: a randomized controlled low-intensity m-health intervention by midwives at primary care centers. BMC Nurs 2023; 22:309. [PMID: 37674184 PMCID: PMC10483870 DOI: 10.1186/s12912-023-01440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Pregnancy-related anxiety and depression has received considerable attention worldwide. Mental health problems in pregnant women already since early weeks of gestation may have important consequences to the fetus. The necessity for more effective health care pathways, including some early interventions that reduce the overall burden of the childbearing situation appears a key factor for a successful birth and care of the baby. The few studies focalized in interventions, are focused on delivery and postpartum, without taking into account the whole maternity process. Current literature recommends the use of interventions based on new technologies for the treatment of mood disorders, already during the prenatal period. There have been scarce well-designed intervention studies that test technological low-intensity interventions by midwives to address pregnant women's mental health, diminishing anxiety and depression during pregnancy. METHODS/DESIGN Adult pregnant women (weeks 12-14 of gestation) will be recruited and screened from different primary care centers in Catalonia, Spain. Women who pass the initial mental screening will be randomly allocated to the relaxation virtual reality intervention or control group. The intervention aims to improve mental state of pregnant women during pregnancy, work through breathing, mindfulness and muscle relaxation techniques. Women in the control group will receive standard care offered by the public funded maternity services in Catalonia. The primary outcome measures will include the Edinburg Postnatal Depression (EPDS), State Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), and the Cambridge Worry Scale (CWS) instruments. Secondary outcome measures will include the Temperament and Character Inventory-Revised (TCI-R) and the Whooley and Generalized Anxiety Disorder-2 (GAD-2) questions. Routinary pregnancy monitoring measures will be also evaluated. DISCUSSION This study aims to test the efficacy of a low-intensity, midwife-led e-health intervention based on new technologies to work on women's anxiety and depression during pregnancy. We hypothesize that low-intensity mental health intervention during pregnancy, using an e-health (virtual reality) as a support tool, will be effective in reducing of anxiety, depressive symptoms, and improving satisfaction with pregnancy follow-up. TRIAL REGISTRATION Clinical Trials ID NCT05756205.
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Affiliation(s)
- Marta Jimenez-Barragan
- Fundació Assistencial Mútua Terrassa, (Terrassa), Universitat de Barcelona, Barcelona, Spain
- Research Group Atenció a La Salut Sexual I Reproductiva (GRASSIR), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Amparo del Pino Gutierrez
- Departament de Salut Pública, Salut Mental I Materno-Infantil, Facultat de Medicina I Ciències de La SalutUniversitat de Barcelona, Barcelona, Spain
- Ciber Fisiopatología Obesidad Y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Jorge Curto Garcia
- Departament de Salut Pública, Salut Mental I Materno-Infantil, Facultat de Medicina I Ciències de La SalutUniversitat de Barcelona, Barcelona, Spain
| | - Olga Monistrol-Ruano
- Patient Safety and Research Nurse, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
| | | | - Oriol Porta-Roda
- Obstetrics and Gynecology Department, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Falguera-Puig
- Research Group Atenció a La Salut Sexual I Reproductiva (GRASSIR), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Direcció d’Atenció Primària Metropolitana Nord, Atenció a La Salut Sexual I Reproductiva Metropolitana Nord, Institut Català de La Salut, Barcelona, Spain
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Zhang T, Liu M, Min F, Wei W, Liu Y, Tong J, Meng Q, Sun L, Chen X. Fear of childbirth and its determinants in pregnant women in the third trimester: a cross-sectional study. BMC Psychiatry 2023; 23:574. [PMID: 37553654 PMCID: PMC10408108 DOI: 10.1186/s12888-023-05070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Fear of childbirth (FOC) is a prevalent issue among pregnant women and significantly relates to adverse outcomes for the mother and child. However, it is not clear the prevalence and risk factors of FOC among pregnant women in a region with a moderate level of economic development in China. The aim of this study was to investigate the prevalence and risk factors of FOC among pregnant women in the third trimester of pregnancy in Lianyungang city, Eastern China. METHODS A cross-sectional survey was conducted from December 2022 to February 2023 among pregnant women in the third trimester who met the inclusion criteria and visited Lianyungang Maternal and Child Health Hospital in Jiangsu Province, Eastern China. A structured questionnaire including sociodemographic characteristics, clinical characteristics, FOC, family function, doctor-patient communication, social support, general self-efficacy, anxiety, depression, insomnia symptoms, and quality of life was used to collect data. A multiple linear regression model was used to identify predictors of FOC. RESULTS This study included 535 pregnant women in the third trimester. The mean score of FOC was 30.67 ± 10.18, and the median score was 29.00. The prevalence of FOC was 56.64%. Multiple linear regression analysis revealed that pregnant women with electronic screen exposure time more than 5 h per day (β = 2.02, 95%CI: 0.50-3.53, P < 0.05), no history of cesarean section (β = 2.66, 95%CI: 0.61-4.71, P < 0.05), likes sour food or hates greasy food (β = 1.75, 95%CI: 0.00-3.50, P < 0.05), anxiety (β = 0.50, 95%CI: 0.21-0.80, P < 0.05) and depression (β = 0.30, 95%CI: 0.04-0.57, P < 0.05) were more likely to have a greater level of FOC than their counterparts. However, a significantly lower level of FOC was observed in pregnant women who were multipara (β=-1.64, 95%CI: -3.27-0.01, P < 0.05), not worrying about delivery without family members (β=-3.75, 95%CI: -5.26-2.25, P < 0.001), had good family function (β=-0.32, 95%CI: -0.64-0.00, P < 0.05) and doctor-patient communication (β=-0.33, 95%CI: -0.64-0.02, P < 0.05). CONCLUSIONS The prevalence of FOC was high in Lianyungang city, Eastern China. FOC is influenced by multiple factors. There is an urgent need to develop interventions to reduce the prevalence of FOC in the third trimester of pregnancy, and to pay attention to pregnant women with risk factors for FOC.
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Affiliation(s)
- Teng Zhang
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Meilin Liu
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Fanli Min
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Wei Wei
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Yuan Liu
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Jiao Tong
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Qian Meng
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Lizhou Sun
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xu Chen
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China.
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Kaliush PR, Kerig PK, Raby KL, Maylott SE, Neff D, Speck B, Molina NC, Pappal AE, Parameswaran UD, Conradt E, Crowell SE. Examining implications of the developmental timing of maternal trauma for prenatal and newborn outcomes. Infant Behav Dev 2023; 72:101861. [PMID: 37399664 PMCID: PMC10528968 DOI: 10.1016/j.infbeh.2023.101861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/25/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Abstract
Separate literatures have demonstrated that mothers' experiences with trauma during childhood or pregnancy are associated with maternal prenatal health risks, adverse childbirth outcomes, and offspring internalizing and externalizing disorders. These literatures largely align with the intergenerational transmission or fetal programming frameworks, respectively. However, few studies have tested the effects of maternal childhood and prenatal trauma simultaneously on mothers' and infants' health outcomes, and no studies have examined these effects on newborn neurobehavioral outcomes. Thus, in the present study, we examined how the developmental timing of pregnant women's traumatic life experiences associated with their physical health and psychopathology (Aim 1) as well as their newborns' birth and neurodevelopmental outcomes (Aim 2; for pre-registered aims and hypotheses, see https://osf.io/ygnre/?view_only=cbe17d0ac7f24af5a4d3e37e24eebead). One hundred and fifty-two 3rd trimester pregnant women (Mage = 29 years; 17.1% Hispanic/Latina) completed measures of trauma history and psychopathology. Then, 24-48 h after birth, trained clinicians conducted newborn neurobehavioral exams (n = 118 newborns; 52.6% female). Results indicated that lifetime traumatic experiences associated with multiple prenatal maternal health outcomes, including depression, anxiety, emotion dysregulation, and pregnancy complications. Pregnant women's experiences with childhood trauma, but not adulthood or prenatal trauma, predicted higher neurobehavioral attention scores among female newborns. Our discussion highlights the importance of considering the developmental timing of maternal trauma on perinatal outcomes and contextualizes our findings within the intergenerational transmission and fetal programming literatures. DATA AVAILABILITY: Data pertaining to R01MH119070 (MPIs Crowell & Conradt) and that support these findings are uploaded to the NIMH repository.
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Affiliation(s)
| | | | - K Lee Raby
- Department of Psychology, University of Utah, USA
| | | | - Dylan Neff
- Department of Psychology, University of Utah, USA
| | - Bailey Speck
- Department of Psychology, University of Utah, USA
| | | | | | | | - Elisabeth Conradt
- Department of Psychiatry and Behavioral Sciences, Duke University, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, USA; Department of Obstetrics and Gynecology, University of Utah, USA; Department of Psychiatry, University of Utah, USA
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