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Duffy KA, Sammel MD, Johnson RL, Morrison KE, Bale TL, Epperson CN. Sex Differences in Stress-Induced Cortisol Response Among Infants of Mothers Exposed to Childhood Adversity. Biol Psychiatry 2024:S0006-3223(24)01350-7. [PMID: 38821195 DOI: 10.1016/j.biopsych.2024.05.015] [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: 12/08/2023] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) increase risk for mental illness in women and their children, and dysregulation of the hypothalamic-pituitary-adrenal axis may play a role. The impact of ACEs on the hypothalamic-pituitary-adrenal axis may be strongest when ACEs occur prepubertally and in people who are exposed to abuse ACEs. METHODS To test this, we measured salivary cortisol in 96 mother-infant dyads while mothers were separated from their infants, who were experiencing a laboratory stressor. Mothers completed the Adverse Childhood Experiences Questionnaire; ACEs that occurred prepubertally (pACEs) were measured, and mother-infant dyads were grouped based on maternal pACE history as follows: no pACEs, ≥1 pACEs with abuse, or ≥1 pACEs but no abuse. RESULTS Mothers with ≥1 pACEs exhibited decreases in cortisol (relative to preinfant stressor), which differed significantly from the cortisol increase experienced by mothers with no pACEs, regardless of abuse presence (p = .001) or absence (p = .002). These pACE groups did not differ from one another (p = .929). Significant sex differences in infant cortisol were observed in infants of mothers with ≥1 pACEs (regardless of abuse) but not in infants of mothers with no pACEs. When mothers had experienced ≥1 pACEs, males showed decreases in cortisol in response to a stressor whereas females demonstrated increases, and males and females differed significantly when their mothers had ≥1 pACEs with (p = .025) and without (p = .032) abuse. CONCLUSIONS Regardless of maternal exposure to childhood abuse, in response to a stressor, pACEs were associated with lower cortisol response in mothers and sex differences in 6-month-old infants, with males showing a lower cortisol response than females.
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Affiliation(s)
- Korrina A Duffy
- Department of Psychiatry, University of Colorado School of Medicine Anschutz, Medical Campus, Aurora, Colorado
| | - Mary D Sammel
- Department of Psychiatry, University of Colorado School of Medicine Anschutz, Medical Campus, Aurora, Colorado; Department of Biostatistics and Informatics, University of Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado
| | - Kathleen E Morrison
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Tracy L Bale
- Department of Psychiatry, University of Colorado School of Medicine Anschutz, Medical Campus, Aurora, Colorado
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine Anschutz, Medical Campus, Aurora, Colorado; Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.
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2
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Staal L, Plösch T, Kunovac Kallak T, Sundström Poromaa I, Wertheim B, Olivier JDA. Sex-Specific Transcriptomic Changes in the Villous Tissue of Placentas of Pregnant Women Using a Selective Serotonin Reuptake Inhibitor. ACS Chem Neurosci 2024; 15:1074-1083. [PMID: 38421943 PMCID: PMC10958514 DOI: 10.1021/acschemneuro.3c00621] [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: 09/26/2023] [Revised: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
About 5% of pregnant women are treated with selective serotonin reuptake inhibitor (SSRI) antidepressants to treat their depression. SSRIs influence serotonin levels, a key factor in neural embryonic development, and their use during pregnancy has been associated with adverse effects on the developing embryo. However, the role of the placenta in transmitting these negative effects is not well understood. In this study, we aim to elucidate how disturbances in the maternal serotonergic system affect the villous tissue of the placenta by assessing whole transcriptomes in the placentas of women with healthy pregnancies and women with depression and treated with the SSRI fluoxetine during pregnancy. Twelve placentas of the Biology, Affect, Stress, Imaging and Cognition in Pregnancy and the Puerperium (BASIC) project were selected for RNA sequencing to examine differentially expressed genes: six male infants and six female infants, equally distributed over women treated with SSRI and without SSRI treatment. Our results show that more genes in the placenta of male infants show changed expression associated with fluoxetine treatment than in placentas of female infants, stressing the importance of sex-specific analyses. In addition, we identified genes related to extracellular matrix organization to be significantly enriched in placentas of male infants born to women treated with fluoxetine. It remains to be established whether the differentially expressed genes that we found to be associated with SSRI treatment are the result of the SSRI treatment itself, the underlying depression, or a combination of the two.
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Affiliation(s)
- Laura Staal
- Neurobiology,
Groningen Institute for Evolutionary Life Sciences, University of Groningen, 9700 CC Groningen, The Netherlands
- Department
of Cardiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Torsten Plösch
- Departments
of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Perinatal
Neurobiology, Department of Human Medicine, School of Medicine and
Health Sciences, Carl von Ossietzky University
Oldenburg, 26129 Oldenburg, Germany
| | | | | | - Bregje Wertheim
- Evolutionary
Genetics, Development & Behaviour, Groningen Institute for Evolutionary
Life Sciences, University of Groningen, 9700 CC Groningen, The Netherlands
| | - Jocelien D. A. Olivier
- Neurobiology,
Groningen Institute for Evolutionary Life Sciences, University of Groningen, 9700 CC Groningen, The Netherlands
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3
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Abstract
Perinatal depression is a common psychiatric condition that has negative effects on pregnancy and infant outcomes. Screening for the condition is relatively easy and should be done routinely in all medical care of the pregnant and postpartum woman and her infant. The risk-benefit analysis favors the use of antidepressant medications during pregnancy and lactation compared with the risk of untreated maternal depression. Other, nonpharmacological treatments will be discussed as well as new treatments, including a new class of medications that act on the inhibitory GABAergic neurotransmitter system.
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Affiliation(s)
- Anne Louise Stewart
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 800548, Charlottesville, VA 22908, USA
| | - Jennifer L Payne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 800548, Charlottesville, VA 22908, USA.
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4
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Frommelt T, Bäumler L, Rohleder N, Schulte-Körne G, Platt B. Study protocol for a randomized controlled trial investigating the effect of online interpretation bias intervention on stress reactivity in the children of parents with depression: the CoCo study. BMC Psychiatry 2023; 23:378. [PMID: 37254177 DOI: 10.1186/s12888-023-04803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Current preventive interventions for the children of parents with depression demonstrate modest effects on depression incidence. This may be because existing interventions tend to comprise general psychotherapeutic tools, rather than targeting the specific mechanisms underlying familial transmission. Improved theoretical models of familial transmission could enhance the development of targeted interventions. Although existing models assume that cognitive and biological vulnerability factors influence one another, the precise mechanisms are unknown. This project is the first to experimentally test whether negative interpretation bias has an impact on cortisol response in children of parents with depression. This study protocol reports a randomised controlled trial of an interpretation bias intervention which aims to shift participants' interpretation bias in a more positive direction and thereby alter their stress response. METHODS Children aged 10-14 years who have i) one parent with a current or previous depression diagnosis, with at least one episode occurring during the child's lifetime and ii) do not have a current or previous psychiatric diagnosis themselves, will be assigned to one of two conditions: an interpretation bias intervention (n = 50) or a structurally similar placebo intervention (n = 50). The interpretation bias intervention consists of a short lab-based cognitive reappraisal of interpretations training, a four-week app-based Cognitive Bias Modification of Interpretations intervention and interpretation bias specific if-then plans. Interpretation bias will be assessed before and after the intervention using the Scrambled Sentences Task. The effect of the intervention on participants' stress response will be assessed by salivary cortisol collected at five different time points: from immediately before until 45 min after administering the Trier Social Stressor Test for Children. Stress reactivity will be measured via baseline to peak cortisol and stress recovery will be measured via the 45 min cortisol marker. We hypothesise that children who participate in the interpretation bias intervention will display a positive shift in interpretation bias and this, in turn, will alter their stress response. Children who receive the placebo intervention are expected to show a smaller positive shift in interpretation bias and stress reactivity. DISCUSSION The findings of the present study will contribute to models of familial depression transmission as well as informing preventive interventions. If training a more positive interpretation bias subsequently alters participants' stress response, then incorporating such tools may increase the efficacy of existing preventive interventions. TRIAL REGISTRATION Deutsches Register Klinischer Studien DRKS00028842. Registered August 19, 2022.
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Affiliation(s)
- Tonya Frommelt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany.
| | - Leonie Bäumler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Nicolas Rohleder
- Department of Psychology, Chair of Health Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nägelsbachstr. 49a, 91052, Erlangen, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany
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5
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Lengua LJ, Thompson SF, Calhoun R, Long RB, Price C, Kantrowitz-Gordon I, Shimomaeda L, Nurius PS, Katz LF, Sommerville J, Booth-LaForce C, Treadway A, Metje A, Whiley DJ, Moini N. Preliminary Evaluation of the Effectiveness of Perinatal Mindfulness-Based Well-Being and Parenting Programs for Low-Income New Mothers. Mindfulness (N Y) 2023; 14:933-952. [PMID: 37090851 PMCID: PMC9990962 DOI: 10.1007/s12671-023-02096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
Objectives This study examined specificity in the effects of three perinatal mindfulness-based prevention programs that differed in their timing (prenatal, postpartum) and target (maternal well-being, parenting). Effects on maternal mental health (depression, anxiety, resilience), mindfulness, and observed parenting, as well as observed, physiological, and mother-report indicators of infant self-regulation, were examined. Methods The programs were evaluated in a racially and ethnically diverse sample of first-time mothers (n = 188) living in low-income contexts using intention-to-treat analysis. Mothers were assigned to a prenatal well-being, postpartum well-being, parenting, or book control group. Multi-method assessments that included questionnaire, observational, and physiological measures were conducted at four time points: during pregnancy (T1) and when infants were 2–4 months (T2), 4–6 months (T3), and 10–12 months. Results Compared to the postpartum intervention and control groups, the 6-week prenatal well-being intervention was related to decreases in depressive symptoms during pregnancy but not postpartum, higher maternal baseline respiratory sinus arrhythmia (RSA), fewer intrusive control behaviors, and lower infant cortisol levels in the early postpartum period. Compared to all other groups, the postpartum parenting intervention was related to decreases in maternal anxiety and increases in responsive parenting. Some differential effects across programs might be due to differences in attendance rates in the prenatal (62%) vs. postpartum (35%) groups. Conclusions The findings suggest that brief mindfulness-based well-being and parenting preventive interventions can promote maternal and infant mental health in families living in low-income, high-stress settings, particularly if accessibility can be enhanced. Preregistration This study is not preregistered.
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Affiliation(s)
- Liliana J. Lengua
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | | | - Rebecca Calhoun
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | - Robyn B. Long
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | - Cynthia Price
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | | | - Lisa Shimomaeda
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | - Paula S. Nurius
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | | | | | | | - Anna Treadway
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | - Alina Metje
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | | | - Natasha Moini
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
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6
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Zhang X, Lin P, Sun J, Sun Y, Shao D, Cao D, Cao F. Prenatal stress self-help mindfulness intervention via social media: a randomized controlled trial. J Ment Health 2023; 32:206-215. [PMID: 34264775 DOI: 10.1080/09638237.2021.1952947] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prenatal stress is a pressing issue. However, there is a lack of robust evidence for psychosocial interventions to manage this problem. AIMS This study aimed to examine the effectiveness of a mindfulness-based intervention on reducing prenatal stress compared to participation in health education groups. METHODS A randomized controlled trial was conducted in a prenatal clinic of comprehensive tertiary care from April to October 2017. A total of 108 pregnant women were randomly assigned to an intervention or a control group. Participants completed self-report measures of depression, anxiety, perceived stress, fatigue, positive and negative affect, and mindfulness before, immediately after, and 15 weeks after the 4-week intervention period. Generalized estimating equations were used to analyze the intervention outcomes. RESULTS The results supported greater improvement in terms of perceived stress (Wald χ2=26.94, p<0.001), fatigue (Wald χ2=17.61, p<0.001), positive affect (Wald χ2=9.03, p = 0.011), negative affect (Wald χ2=11.37, p = 0.003), and mindfulness (Wald χ2=24.97, p<0.001) in the intervention group than in the control group. CONCLUSIONS The self-help mindfulness intervention decreased prenatal stress and negative affect and improved positive affect and mindfulness.
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Affiliation(s)
- Xuan Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Pingzhen Lin
- The First Hospital of Quanzhou, Quanzhou, Fujian Province, China
| | - Jiwei Sun
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Yaoyao Sun
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Di Shao
- School of Health Care Management of Shandong University, Jinan, Shandong Province, China
| | - Danfeng Cao
- Shandong Province Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Fenglin Cao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
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7
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Broeks CW, Molenaar N, Brouwer M, van den Akker EL, van Rossum EF, Van R, van den Berg SA, Hillegers M, Hoogendijk WJ, Burger H, Bockting C, Kamperman AM, Lambregtse-Van den Berg MP. Intergenerational impact of childhood trauma on hair cortisol concentrations in mothers and their young infants. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 14:100167. [PMID: 36819463 PMCID: PMC9930158 DOI: 10.1016/j.cpnec.2023.100167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/22/2023] Open
Abstract
Background Alterations in stress regulation and function of the hypothalamic-pituitary-adrenal (HPA) axis during infancy may be a risk factor for the development of psychopathology later in life. Maternal childhood trauma, depression, anxiety and stressful life events are individually associated with HPA axis dysregulation. Less is known about their interdependent influence on maternal and infant stress regulation in at risk populations. In a sample of mothers with a history of depressive-, and/or anxiety disorders and their infants we explored if a history of maternal childhood trauma, current depressive and anxiety symptomatology, and recent life events were associated with maternal and infant long-term cortisol levels three months postpartum. Methods Data were available of 89 mothers and 49 infants. All mothers fulfilled criteria for a lifetime depressive or anxiety disorder. Diagnosis was established with a diagnostic interview. Current depressive symptomatology was assessed with the Edinburgh Postnatal Depression Scale (EPDS), current anxiety with the State-Trait Anxiety Inventory (STAI), maternal childhood trauma with the Childhood Trauma Questionnaire (CTQ) and recent life events with the Everyday Problem Checklist (EPC). Maternal and infant hair cortisol concentrations (HCC) were quantified with liquid chromatography with tandem mass spectrometry (LC-MS/MS) three months after birth. Total scores of the CTQ and subscales, EPDS, STAI, and EPC were regressed on maternal and infant HCC using regression analyses. Differences in HCC regarding trauma history were tested with t-tests. Potential confounders were identified and adjusted for. Results In regression analyses, a positive curvilinear relationship was found between CTQ total score and maternal HCC (n = 83, B = 0.076, SE 0.033, p = .021), but not for current depression (n = 88, B = -0.001, SE 0.011, p = .931), current anxiety (n = 88, B = 0.002, SE 0.004, p = .650) or recent life events (n = 89, B = 0.018, SE 0.032, p = .568). Analyses were adjusted for confounders. A negative linear relationship was found between maternal CTQ score and infant HCC (n = 49, β = -0.264, B = -0.006, SE 0.003, p = .052), but not for current maternal depression (n = 45, β = -0.182, B = -0.011, SE 0.008, p = .164), current maternal anxiety (n = 45, β = -0.209, B = -0.005, SE 0.003, p = .113) or recent life events (n = 46, β = -0.128, B = -0.022, SE 0.023, p = .325). Analyses were adjusted for relevant infant hair characteristics. Specifically, maternal emotional and physical neglect were related to HCC in both mothers and infants. Conclusions Results suggest that maternal childhood trauma is more prominent in altering maternal and infant long-term cortisol levels than perinatal depressive and anxiety symptomatology or recent life stressors in mothers with a history of depressive and/or anxiety disorders, and their infants. As infants of mothers with psychopathology are at increased risk for later psychiatric disease, future studies should investigate the interplay of possible risk factors for transgenerational transmission, intra-uterine programming of the HPA axis, including (epi-)genetic phenomena, of the HPA axis, and the influence of parenting impairment.
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Affiliation(s)
- Carlinde W. Broeks
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | - Nina Molenaar
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Marlies Brouwer
- University Medical Centre Groningen, University of Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands,University of Amsterdam, Centre for Urban Mental Health, Amsterdam, the Netherlands
| | - Erica L.T. van den Akker
- Department of Pediatrics, Division of Pediatric Endocrinology, Sophia Children's Hospital and Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Elisabeth F.C. van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rien Van
- Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | - Sjoerd A.A. van den Berg
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Witte J.G. Hoogendijk
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Huibert Burger
- University Medical Centre Groningen, University of Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - Claudi Bockting
- University Medical Centre Groningen, University of Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands,University of Amsterdam, Centre for Urban Mental Health, Amsterdam, the Netherlands
| | - Astrid M. Kamperman
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Epidemiological and Social Psychiatric Research Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mijke P. Lambregtse-Van den Berg
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Corresponding author. P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.
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Brooker RJ, Mistry-Patel S, Kiel EJ, Liu S, Van Lieshout RJ, Schmidt LA, John-Henderson N. Infant Negativity Moderates Trajectories of Maternal Emotion Across Pregnancy and the Peripartum Period. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 11:100481. [PMID: 36700059 PMCID: PMC9873204 DOI: 10.1016/j.jadr.2023.100481] [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: 01/11/2023] Open
Abstract
Background Although the effects of maternal behavior on the development of child emotion characteristics is relatively well-established, effects of infant characteristics on maternal emotion development is less well known. This gap in knowledge persists despite repeated calls for including child-to-mother effects in studies of emotion. We tested the theory-based postulate that infant temperamental negativity moderates longitudinal trajectories of mothers' perinatal symptoms of anxiety and depression. Method Participants were 92 pregnant community women who enrolled in a longitudinal study of maternal mental health; symptoms of anxiety and depression were assessed during the second and third trimesters of pregnancy and again at infant age 4 months. A multimethod assessment of infants' temperament-based negative reactivity was conducted at infant age 4 months. Results Maternal symptoms of anxiety showed smaller postnatal declines when levels of infant negativity were high. Negative reactivity, assessed via maternal report of infant behavior, was related to smaller postnatal declines in maternal anxiety, while infant negative reactivity, at the level of neuroendocrine function, was largely unrelated to longitudinal changes in maternal anxiety symptoms. Infant negativity was related to early levels, but largely unrelated to trajectories of maternal symptoms of depression. Limitations Limitations of this work include a relatively small and low-risk sample size, the inability to isolate environmental effects, and a nonexperimental design that precludes causal inference. Conclusions Findings suggest that levels of infant negativity are associated with differences in the degree of change in maternal anxiety symptoms across the perinatal period.
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9
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Karl M, Huth V, Schälicke S, Müller-Stark C, Weise V, Mack JT, Kirschbaum C, Weidner K, Garthus-Niegel S, Steudte-Schmiedgen S. The association between maternal symptoms of depression and hair glucocorticoids in infants across the perinatal period. Psychoneuroendocrinology 2023; 147:105952. [PMID: 36370678 DOI: 10.1016/j.psyneuen.2022.105952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Maternal symptoms of depression constitute an early adversity for infants that is considered to exert its effects via the maternal-placental-fetal neuroendocrine axis. Previous research implicates associations between maternal prenatal symptoms of depression and infants' glucocorticoid (GC) levels shortly after birth. To date, associations have not been investigated in the early postnatal period. The current study aimed to investigate the influence of maternal perinatal symptoms of depression on infants' neonatal and postnatal hair GCs providing a retrospective reflection of integrated cortisol secretion in the intrauterine and early postnatal period, respectively. METHODS As part of a prospective cohort study, hair samples of infants were taken up to two weeks after delivery (N = 152) and again eight weeks after delivery (N = 165). Liquid chromatography-tandem mass spectrometry was used to determine hair cortisol and cortisone in scalp-near 2-cm hair segments. Maternal symptoms of depression were assessed during pregnancy and eight weeks postnatally based on the Edinburgh Postnatal Depression Scale. RESULTS Higher maternal prenatal symptoms of depression showed a significant association with higher infants' neonatal hair cortisol, when controlling for confounding variables (i.e., gestational age, mode of delivery, parity, storage time, pregnancy complications). A non-significant trend for this effect was found for the hair cortisol-to-cortisone ratio while no effect occurred for hair cortisone. No association of maternal postnatal symptoms of depression with infants' postnatal hair GCs was observed. Further exploratory analyses revealed no relationship between a change of maternal prenatal to postnatal symptoms of depression with the change from infants' neonatal to postnatal hair GC levels or postnatal hair GCs. CONCLUSION Our results suggest that maternal prenatal symptoms of depression are associated with dysregulated infants' hair cortisol levels mainly incorporated in the intrauterine period which, in turn, might contribute to increased susceptibility for later diseases. However, no relationship was observed in infants' hair samples additionally reflecting hair GCs of the early postnatal period. Future studies should consider research on associations between maternal symptoms of depression and infants' hair GCs also later in life and take into account additional risk factors with potential impacts on GC secretion during early infancy.
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Affiliation(s)
- Marlene Karl
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Vanessa Huth
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sarah Schälicke
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Corinna Müller-Stark
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Victoria Weise
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Judith T Mack
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Institute for Systems Medicine (ISM), Faculty of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
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10
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Alcala CS, Orozco Scott P, Tamayo‐Ortiz M, Hernández Chávez MDC, Schnaas L, Carroll KN, Niedzwiecki MM, Wright RO, Téllez‐Rojo MM, Wright RJ, Hsu HL, Rosa MJ. Longitudinal assessment of maternal depression and early childhood asthma and wheeze: Effect modification by child sex. Pediatr Pulmonol 2023; 58:98-106. [PMID: 36128727 PMCID: PMC9771993 DOI: 10.1002/ppul.26164] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Studies report associations between maternal mental health and adverse respiratory outcomes in children; however, the impact of timing and duration of maternal distress remains understudied. We sought to longitudinally examine associations between maternal depression and childhood asthma and wheeze, and explore sex differences. METHODS Maternal depression (n = 601) was assessed using the Edinburgh Depression Scale questionnaire, dichotomized at a clinically relevant cutoff (>12) (a) during pregnancy, (b) postpartum, and (c) postpartum and subsequent time points postnatally (recurrent depression). Report of wheeze in the past 12 months (current wheeze) and asthma were obtained using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire at 48 and 72 months. Associations were analyzed using a modified Poisson regression adjusted for covariates, and in interaction models. RESULTS Both postpartum and recurrent depression were associated with higher risk of current wheeze (relative risk [RR]: 1.87, 95% confidence interval [CI]: 1.21, 2.90; RR: 2.41, 95% CI: 1.53, 3.79) and asthma at 48 months (RR: 2.42, 95% CI: 1.01, 5.84; RR: 2.45, 95% CI: 1.02, 5.84). In interaction analyses, associations were stronger in females. Recurrent depression was associated with a higher risk of current wheeze at 48 months in females (RR: 4.34, 95% CI: 2.02, 9.32) when compared to males (RR: 1.89, 95% CI: 1.05, 3.39). CONCLUSIONS Postpartum and recurrent depression were associated with a higher risk of wheeze and asthma in children. Understanding the temporal- and sex-specific effects of maternal depression may better inform prevention strategies.
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Affiliation(s)
- Cecilia S. Alcala
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Paloma Orozco Scott
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Marcela Tamayo‐Ortiz
- Occupational Health Research UnitMexican Social Security InstituteMexico CityMexico
| | | | - Lourdes Schnaas
- Department of Developmental NeurobiologyNational Institute of PerinatologyMexico CityMexico
| | - Kecia N. Carroll
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Pediatrics, Icahn School of Medicine at Mount SinaiKravis Children's HospitalNew YorkNew YorkUSA
| | - Megan M. Niedzwiecki
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Robert O. Wright
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Institute for Exposomic ResearchIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Martha Maria Téllez‐Rojo
- Center for Nutrition and Health ResearchNational Institute of Public HealthCuernavaca, MorelosMexico
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Pediatrics, Icahn School of Medicine at Mount SinaiKravis Children's HospitalNew YorkNew YorkUSA
- Institute for Exposomic ResearchIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Hsiao‐Hsien Leon Hsu
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Maria José Rosa
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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11
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Zheng L, Yang H, Dallmann A. Antidepressants and Antipsychotics in Human Pregnancy: Transfer Across the Placenta and Opportunities for Modeling Studies. J Clin Pharmacol 2022; 62 Suppl 1:S115-S128. [PMID: 36106784 DOI: 10.1002/jcph.2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022]
Abstract
There is limited information about the transfer of antidepressants and antipsychotics across the human placenta. The objective of the current review was to systematically screen the scientific literature using relevant keywords to collect quantitative data on placental transfer of these drugs in humans and to give an overview of current modeling approaches used in this context. The collected data encompassed clinically measured fetal:maternal (F:M) concentration ratios (ie, the ratio between drug concentrations measured in the umbilical cord and drug concentrations measured in the mother) and transfer data obtained from ex vivo cotyledon perfusion experiments. These data were found for 18 antidepressants and some of their pharmacologically active metabolites, and for 10 antipsychotics and the metabolites thereof. Based on the collected data, similar maternal and fetal exposure could be observed for only a few compounds (eg, norfluoxetine and desvenlafaxine), whereas for most drugs (eg, paroxetine, sertraline, and quetiapine), fetal exposure appeared to be on average lower than maternal exposure. Venlafaxine appeared to be an exception in that the data indicated equivalent or higher concentrations in the umbilical cord than in the mother. Physiologically based pharmacokinetic (PBPK) models were sporadically used to investigate maternal pharmacokinetics of antidepressants or antipsychotics (eg, for sertraline, aripiprazole, and olanzapine), although without explicitly addressing fetal drug exposure. It is recommended that PBPK modeling is applied more frequently to these drugs. Although no substitute for clinical studies, these tools can help to better understand pregnancy-induced pharmacokinetic changes and ultimately contribute to a more evidence-based pharmacotherapy of depression and psychosis in pregnant subjects.
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Affiliation(s)
- Liang Zheng
- Department of Clinical Pharmacology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Hongyi Yang
- Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu, China.,Chengdu Gencore Pharmaceutical Technology Co., Ltd, Chengdu, China
| | - André Dallmann
- Pharmacometrics/Modeling and Simulation, Research and Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
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12
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Newton LE, Hageman C, Zhou C, Roberts H, Cusick RA, Needelman H. The Relationship Between Neonatal Surgery, Postpartum Depression, and Infant Clinical Course. Matern Child Health J 2022; 26:1087-1094. [PMID: 35064427 DOI: 10.1007/s10995-021-03353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Postpartum depression (PPD) affects 10-15% of mothers in the general population, and studies show increased incidence for mothers of infants with serious health conditions. This study investigates incidence of PPD in mothers of surgical patients in the neonatal intensive care unit (NICU) and characterizes these patients' clinical and neurodevelopmental outcomes. METHODS This retrospective cohort study analyzed Nebraska's Tracking Infant Progress Statewide (TIPS) database and referring hospital medical records from February 2013 to June 2018. Upon NICU discharge, children were referred to the TIPS program, with scheduled follow-up appointments at approximately 6 months corrected age. All patients seen in NICU follow-up clinic with recorded scores for maternal Edinburgh postnatal depression screen (EPDS) were eligible except infants with congenital heart disease as this cohort was previously studied. Patients were stratified into groups based on presence or absence of a general surgical procedure within the first 6 months of life and positive (≥ 10) or negative (< 10) EPDS score. Statistical analyses assessed for significant differences between groups regarding gestational age, birth weight, maternal age, length of NICU stay (LOS), number of days on a ventilator, payment method, ethnicity, developmental testing, and rate of referral for early intervention services. RESULTS Of 436 patients, 83 were surgical patients (16 with positive EPDS; 19.3% incidence), and 353 were non-surgical patients (44 with positive EPDS; 12.5% incidence). Statistical analysis showed no significant relationship between neonatal surgery and positive EPDS (χ2 = 2.6, p = 0.1). While the surgical cohort had longer LOS and days on ventilator, maternal EPDS did not predict these factors. In the surgical cohort, mothers of children not independent on oral feeding at discharge were more likely to screen positive for depression (7/14, 50% vs. 7/61, 11%; p < 0.05). CONCLUSION Mothers of surgical patients are not significantly more likely to screen positive for post-partum depression compared to other NICU mothers. This underscores the importance of routine screening for PPD in mothers of both surgical and non-surgical NICU patients in order to identify parents and children at risk.
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Affiliation(s)
- Laura E Newton
- College of Medicine, University of Nebraska Medical Center, S 42nd and Emile St., Omaha, NE, 68198, USA.,Department of General Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH, 03756, USA
| | - Clara Hageman
- College of Medicine, University of Nebraska Medical Center, S 42nd and Emile St., Omaha, NE, 68198, USA.,Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, 64108, USA
| | - Christina Zhou
- College of Medicine, University of Nebraska Medical Center, S 42nd and Emile St., Omaha, NE, 68198, USA
| | - Holly Roberts
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH, 03756, USA
| | - Robert A Cusick
- Division of Pediatric Surgery, Department of Surgery, University of Nebraska Medical Center, S 42nd and Emile St., Omaha, NE, 68198, USA.,Children's Hospital and Medical Center, 8200 Dodge St., Omaha, NE, 68114, USA
| | - Howard Needelman
- Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, 444 S 44th St., A8 412 South Saddle Creek, Omaha, NE, 68198-5380, USA. .,Children's Hospital and Medical Center, 8200 Dodge St., Omaha, NE, 68114, USA.
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13
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Scheiber FA, Ryckman MK, Demir-Lira E. Maternal depressive symptoms and maternal child-directed speech: A systematic review. J Affect Disord 2022; 297:194-207. [PMID: 34656673 PMCID: PMC8827171 DOI: 10.1016/j.jad.2021.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 09/09/2021] [Accepted: 10/12/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Up to 1 in 5 children are exposed to maternal depressive symptoms. Children exposed to maternal depressive symptoms have poorer language skills than children not exposed to maternal depressive symptoms. Due to the crucial role of children's language skills in school readiness and academic achievement, it is imperative to understand the factors that underlie the relation between maternal depressive symptoms and children's language skills. Previous reviews have examined the mechanistic role of social-pragmatic features of mother-child interactions. However, the literature on the relation between maternal depressive symptoms and data-providing aspects of mother-child interactions, including child-directed speech, has yet to be consolidated. In this systematic review, we present maternal child-directed speech as a potential pathway through which maternal depressive symptoms influence children's language skills. METHODS Following PRISMA guidelines, three database searches produced 546 articles related to maternal depressive symptoms, child-directed speech, and children's language skills, ten of which examined the relation between maternal depressive symptoms and child-directed speech. RESULTS Findings revealed that increases in maternal depressive symptoms may be associated with decreases in amount of child-directed speech but not necessarily with decreases in the complexity of child-directed speech. LIMITATIONS The studies in this review varied in sample size, the inclusion of important sociodemographic factors, and the operationalization of depression and child-directed speech, thereby limiting conclusions, especially about whether maternal depressive symptoms are associated with the complexity of child-directed speech. CONCLUSIONS This review has implications for prevention and intervention efforts aimed at optimizing children's language skills; child-directed speech is modifiable, and mothers experiencing depressive symptoms may benefit from resources encouraging rich child-directed speech.
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Affiliation(s)
| | - M.A., Kelli Ryckman
- University of Iowa,,Department of Epidemiology,,Iowa Perinatal Health Research Collaborative
| | - Ece Demir-Lira
- University of Iowa,,Department of Psychological and Brain Sciences,,DeLTA Center,,Iowa Neuroscience Institute
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14
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Klimes-Dougan B, Papke V, Carosella KA, Wiglesworth A, Mirza SA, Espensen-Sturges TD, Meester C. Basal and reactive cortisol: A systematic literature review of offspring of parents with depressive and bipolar disorders. Neurosci Biobehav Rev 2022; 135:104528. [PMID: 35031342 DOI: 10.1016/j.neubiorev.2022.104528] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/19/2022]
Abstract
One of the most consistent biological findings in the study of affective disorders is that those with depression commonly show abnormal cortisol response, which suggests dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Children of parents with mood disorders offer the opportunity to explore the biological pathways that may confer risk for psychopathology. This review explores basal and reactive cortisol in the offspring of parents who are currently depressed or have had a history of a depressive or bipolar disorder. Using PRISMA guidelines, search terms yielded 2002 manuscripts. After screening, 87 of these manuscripts were included. Results from the literature suggest that while the degree and direction of dysregulation varies, offspring of a parent with depression tend to show elevations in both basal (particularly morning and evening) and reactive (tentatively for social stressors) cortisol levels. There were few studies focused on offspring of parents with bipolar disorder. This review also discusses implications and recommendations for future research regarding the HPA axis in the intergenerational transmission of depressive disorders.
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Affiliation(s)
- Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA.
| | - Victoria Papke
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
| | - Katherine A Carosella
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
| | - Andrea Wiglesworth
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
| | - Salahudeen A Mirza
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
| | - Tori D Espensen-Sturges
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
| | - Christina Meester
- Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN 55455, USA
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15
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Burenkova OV, Podturkin AA, Naumova OY, Hein S, Li N, Cicchetti D, Luthar SS, Grigorenko EL. Neuroendocrine and autonomic stress systems activity in young adults raised by mothers with mental health and substance abuse problems: A prospective cohort study. Dev Psychobiol 2021; 63:e22213. [PMID: 34813100 DOI: 10.1002/dev.22213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/27/2021] [Accepted: 10/26/2021] [Indexed: 11/07/2022]
Abstract
Among the well-known physiological consequences of early adverse environments is dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. A number of studies demonstrate that negative parenting and living with parents with a history of substance abuse and mental health problems may be associated with HPA axis dysregulation in children. In contrast, studies of more delayed effects in adult offspring, especially prospective, are still scarce. This study was a prospective longitudinal investigation of the association between maternal mental illnesses/substance abuse and maternal negative parenting/parental stress on one side and, on the other side, adult offspring outcomes 10 years later-specifically, we studied the activity of offspring's neuroendocrine (cortisol) and autonomic (heart rate) systems when exposed to a mild psychological stressor. Children of mothers with mental illnesses and/or substance abuse were exposed to more disadvantaged conditions (higher negative parenting and community violence). Despite this, maternal risk groups (having a mother with mental illnesses and/or substance abuse) were not associated with any of the indicators of stress systems activity. Regardless of the risk group, participants with dysregulated HPA axis activity experienced a higher level of negative parenting. Altogether, our study provides evidence that negative parenting may have long-lasting effects on stress-sensitive physiological mechanisms.
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Affiliation(s)
- Olga V Burenkova
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Psychology, Saint-Petersburg State University, Saint Petersburg, Russian Federation
| | | | - Oksana Yu Naumova
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Psychology, Saint-Petersburg State University, Saint Petersburg, Russian Federation.,Human Genetics Laboratory, Vavilov Institute of General Genetics RAS, Moscow, Russian Federation
| | - Sascha Hein
- Department of Education and Psychology, Free University of Berlin, Berlin, Germany
| | - Nan Li
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Dante Cicchetti
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Suniya S Luthar
- Authentic Connections, Tempe, Arizona, USA.,Teachers College, Columbia University, New York City, New York, USA
| | - Elena L Grigorenko
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Psychology, Saint-Petersburg State University, Saint Petersburg, Russian Federation.,Baylor College of Medicine, Houston, Texas, USA
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16
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Braithwaite EC, Sharp H, Pickles A, Hill J, Wright N. Breast may not always be best: moderation of effects of postnatal depression by breastfeeding and infant sex. Biol Sex Differ 2021; 12:59. [PMID: 34743731 PMCID: PMC8573903 DOI: 10.1186/s13293-021-00403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background There is good evidence that female infants are particularly vulnerable to poor emotional outcomes following in utero glucocorticoid exposure. It is currently unclear whether such effects might persist into the postnatal period for breastfed infants, as maternal cortisol is expressed in breastmilk and is influenced by maternal psychological distress. We pre-registered hypotheses that maternal postnatal depression would be associated with infant negative emotionality, and that this effect would be moderated by breastfeeding status and infant sex. Methods We analysed data from the Wirral Child Health and Development Study (WCHADS), a prospective epidemiological study starting in pregnancy. Nine weeks after birth mothers self-reported depressive symptoms and breastfeeding status, and reported infant negative emotionality using the distress to limits subscale of the infant behaviour questionnaire (IBQ-R) when their infant was aged 9 weeks and 14 months. Maximum likelihood estimations made use of data from 857 mother-infant pairs. Results At 9 weeks of age, maternal postnatal depressive symptoms were positively associated with infant distress to limits; however, this effect was not moderated by infant sex or breastfeeding. At age 14 months, the association between postnatal depression symptoms and distress to limits was greatest in the breastfed females, whereas the association was smaller, but still significant, in the non-breastfed females. For males, the association was non-significant in both the breastfed and non-breastfed groups. A test of sex difference between breastfed males and females was significant. Conclusions We provide evidence that effects of maternal postnatal depression on child emotional outcomes are moderated by breastfeeding status and differ by infant sex. Female vulnerability to elevated maternal breastmilk glucocorticoids may, at least in part, explain these effects. Female infants breastfed by mothers with high depressive symptoms showed the highest levels of negative emotionality at age 14 months. Conversely, female infants breastfed by mothers with very low depressive symptoms showed the lowest negative emotionality. Negative emotionality of males was unrelated to maternal postnatal depression and breastfeeding at 14 months of age. We provide novel evidence that effects of maternal postnatal depression on infant emotional outcomes is moderated by breastfeeding status and differs by infant sex.
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Affiliation(s)
- Elizabeth C Braithwaite
- Department of Psychology, Faculty of Health and Education, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK.
| | - Helen Sharp
- Department of Primary Care and Mental Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Jonathan Hill
- School for Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Nicola Wright
- Department of Psychology, Faculty of Health and Education, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
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17
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Abstract
Active peripartum psychiatric illness is associated with adverse outcomes for exposed pregnancies/children. Likely due to high rates of obesity, pregnant women with psychiatric illness also have higher rates of preeclampsia, cesarean section, and gestational diabetes. Postpartum depression is associated with lower IQ, slower language development, and behavioral problems in exposed children. Discontinuing psychiatric medications for pregnancy increases risk for relapse significantly, and the postpartum time period is high risk for developing psychiatric illness. Obstetricians-gynecologists are front-line providers for psychiatric care of women during peripartum. This article provides a framework and knowledge base for management of psychiatric illness during peripartum.
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Affiliation(s)
- Jennifer L Payne
- Johns Hopkins Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 North Broadway, Suite 305, Baltimore, MD 21025, USA.
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18
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Milligan Armstrong A, Porter T, Quek H, White A, Haynes J, Jackaman C, Villemagne V, Munyard K, Laws SM, Verdile G, Groth D. Chronic stress and Alzheimer's disease: the interplay between the hypothalamic-pituitary-adrenal axis, genetics and microglia. Biol Rev Camb Philos Soc 2021; 96:2209-2228. [PMID: 34159699 DOI: 10.1111/brv.12750] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/21/2022]
Abstract
Chronic psychosocial stress is increasingly being recognised as a risk factor for sporadic Alzheimer's disease (AD). The hypothalamic-pituitary-adrenal axis (HPA axis) is the major stress response pathway in the body and tightly regulates the production of cortisol, a glucocorticoid hormone. Dysregulation of the HPA axis and increased levels of cortisol are commonly found in AD patients and make a major contribution to the disease process. The underlying mechanisms remain poorly understood. In addition, within the general population there are interindividual differences in sensitivities to glucocorticoid and stress responses, which are thought to be due to a combination of genetic and environmental factors. These differences could ultimately impact an individuals' risk of AD. The purpose of this review is first to summarise the literature describing environmental and genetic factors that can impact an individual's HPA axis reactivity and function and ultimately AD risk. Secondly, we propose a mechanism by which genetic factors that influence HPA axis reactivity may also impact inflammation, a key driver of neurodegeneration. We hypothesize that these factors can mediate glucocorticoid priming of the immune cells of the brain, microglia, to become pro-inflammatory and promote a neurotoxic environment resulting in neurodegeneration. Understanding the underlying molecular mechanisms and identifying these genetic factors has implications for evaluating stress-related risk/progression to neurodegeneration, informing the success of interventions based on stress management and potential risks associated with the common use of glucocorticoids.
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Affiliation(s)
- Ayeisha Milligan Armstrong
- Curtin Health Innovation Research Institute, Curtin University, Kent St, Bentley, WA, 6102, Australia.,Curtin Medical School, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Tenielle Porter
- Curtin Medical School, Curtin University, Kent St, Bentley, WA, 6102, Australia.,Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Hazel Quek
- QIMR Berghofer Medical Institute, 300 Herston Rd, Herston, QLD, Australia
| | - Anthony White
- QIMR Berghofer Medical Institute, 300 Herston Rd, Herston, QLD, Australia
| | - John Haynes
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia
| | - Connie Jackaman
- Curtin Health Innovation Research Institute, Curtin University, Kent St, Bentley, WA, 6102, Australia.,Curtin Medical School, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Victor Villemagne
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, 30 Royal Parade, Parkville, VIC, 3052, Australia
| | - Kylie Munyard
- Curtin Health Innovation Research Institute, Curtin University, Kent St, Bentley, WA, 6102, Australia.,Curtin Medical School, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Simon M Laws
- Curtin Medical School, Curtin University, Kent St, Bentley, WA, 6102, Australia.,Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Giuseppe Verdile
- Curtin Health Innovation Research Institute, Curtin University, Kent St, Bentley, WA, 6102, Australia.,Curtin Medical School, Curtin University, Kent St, Bentley, WA, 6102, Australia.,School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - David Groth
- Curtin Health Innovation Research Institute, Curtin University, Kent St, Bentley, WA, 6102, Australia.,Curtin Medical School, Curtin University, Kent St, Bentley, WA, 6102, Australia
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19
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Galbally M, Watson SJ, Lappas M, de Kloet ER, van Rossum E, Wyrwoll C, Mark P, Lewis AJ. Fetal programming pathway from maternal mental health to infant cortisol functioning: The role of placental 11β-HSD2 mRNA expression. Psychoneuroendocrinology 2021; 127:105197. [PMID: 33743501 DOI: 10.1016/j.psyneuen.2021.105197] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023]
Abstract
Placental 11β-HSD2 has been a focus of research for understanding potential fetal programming associated with maternal emotional disorders. This study examined the pathway from antenatal mental health via placental 11β-HSD2 mRNA to cortisol regulation in the infant offspring. This study reports on data obtained from 236 participants in the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). At term, placental tissue was collected within 30 min of birth from 52 participants meeting current criteria for a depressive disorder, and 184 control participants. Depressive disorders were diagnosed using the SCID-IV. In addition, antidepressant use, depressive and anxiety symptoms were measured in early and late pregnancy. Placental 11β-HSD2 mRNA expression was measured using qRT-PCR. Infant salivary cortisol samples were taken at 12 months of age. Women on antidepressant medication and with higher trait anxiety had higher placental 11β-HSD2 expression compared to women not taking medication. Furthermore, the offspring of women taking an antidepressant and who also had a current depressive disorder and high trait anxiety had high cortisol reactivity at 12 months of age and this was mediated through 11β-HSD2 mRNA expression. In contrast, offspring of women not taking antidepressant medication with depressive disorder and high anxiety there was low cortisol reactivity observed. Our findings suggest that the relationship between maternal antenatal depression and anxiety and infant cortisol reactivity is mediated through placental 11β-HSD2 mRNA expression. Furthermore, the direction differed for women taking antidepressants, where infant cortisol reactivity was high whereas when compared to those with unmedicated depression and anxiety, where infant cortisol reactivity was low.
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Affiliation(s)
- Megan Galbally
- Psychology, Murdoch University, Australia; School of Medicine, University of Notre Dame, Australia; King Edward Memorial Hospital, Subiaco, Australia.
| | - Stuart J Watson
- Psychology, Murdoch University, Australia; School of Medicine, University of Notre Dame, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - E Ron de Kloet
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Caitlin Wyrwoll
- School of Human Sciences, The University of Western Australia, Australia
| | - Peter Mark
- School of Human Sciences, The University of Western Australia, Australia
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20
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Irwin JL, Meyering AL, Peterson G, Glynn LM, Sandman CA, Hicks LM, Davis EP. Maternal prenatal cortisol programs the infant hypothalamic-pituitary-adrenal axis. Psychoneuroendocrinology 2021; 125:105106. [PMID: 33340919 PMCID: PMC9743740 DOI: 10.1016/j.psyneuen.2020.105106] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
One of the key proposed agents of fetal programming is exposure to maternal glucocorticoids. Experimental animal studies provide evidence that prenatal exposure to elevated maternal glucocorticoids has consequences for hypothalamic-pituitary-adrenal (HPA) axis functioning in the offspring. There are very few direct tests of maternal glucocorticoids, such as cortisol, during human pregnancy and associations with infant cortisol reactivity. The current study examined the link between maternal prenatal cortisol trajectories and infant cortisol reactivity to the pain of inoculation in a sample of 152 mother-infant (47.4% girls) pairs. The results from the current study provide insight into fetal programming of the infant HPA axis, demonstrating that elevated prenatal maternal cortisol is associated with a larger infant cortisol response to challenge at both 6 and 12 months of age.
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Affiliation(s)
- Jessica L Irwin
- Department of Psychology, University of La Verne, La Verne, CA 91750, United States; Department of Psychology, Chapman University, Orange, CA 92866, United States.
| | - Amy L Meyering
- Department of Psychology, University of Denver, Denver, CO 80208, United States
| | - Gage Peterson
- Department of Psychology, Chapman University, Orange, CA 92866, United States
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA 92866, United States; Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697, United States
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697, United States
| | - Laurel M Hicks
- Renée Crown Wellness Institute, University of Colorado, Boulder, CO 80302, United States
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO 80208, United States; Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697, United States
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21
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Bais B, Hoogendijk WJG, Lambregtse-van den Berg MP. Light therapy for mood disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:49-61. [PMID: 34266611 DOI: 10.1016/b978-0-12-819973-2.00004-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this chapter, light therapy for mood disorders is discussed, including mood disorders during and after pregnancy. In the introduction, we discuss the symptomatology, etiology, and treatment of a specific type of mood disorder, seasonal affective disorder, since it kick-started the first clinical trials with light therapy. Second, we elaborate on the pathophysiology of mood disorders, in particular in the peripartum period. Next, we present an overview of the proposed working mechanisms of light therapy, followed by a discussion of the clinical trials that have followed after the initial research in seasonal affective disorder. Finally, we also focus on the limitations of these trials, such as considerable heterogeneity among studies and many methodological shortcomings. This is complemented by a number of suggestions for future research. Further studies are needed, which stems from the fact that the results have not always been consistent. Despite this, light therapy may be a promising treatment option for various types of mood disorders, since it shows a significant reduction in symptoms in many patients with few adverse effects.
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Affiliation(s)
- Babette Bais
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mijke P Lambregtse-van den Berg
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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22
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Hanswijk SI, Spoelder M, Shan L, Verheij MMM, Muilwijk OG, Li W, Liu C, Kolk SM, Homberg JR. Gestational Factors throughout Fetal Neurodevelopment: The Serotonin Link. Int J Mol Sci 2020; 21:E5850. [PMID: 32824000 PMCID: PMC7461571 DOI: 10.3390/ijms21165850] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/24/2020] [Accepted: 08/11/2020] [Indexed: 12/21/2022] Open
Abstract
Serotonin (5-HT) is a critical player in brain development and neuropsychiatric disorders. Fetal 5-HT levels can be influenced by several gestational factors, such as maternal genotype, diet, stress, medication, and immune activation. In this review, addressing both human and animal studies, we discuss how these gestational factors affect placental and fetal brain 5-HT levels, leading to changes in brain structure and function and behavior. We conclude that gestational factors are able to interact and thereby amplify or counteract each other's impact on the fetal 5-HT-ergic system. We, therefore, argue that beyond the understanding of how single gestational factors affect 5-HT-ergic brain development and behavior in offspring, it is critical to elucidate the consequences of interacting factors. Moreover, we describe how each gestational factor is able to alter the 5-HT-ergic influence on the thalamocortical- and prefrontal-limbic circuitry and the hypothalamo-pituitary-adrenocortical-axis. These alterations have been associated with risks to develop attention deficit hyperactivity disorder, autism spectrum disorders, depression, and/or anxiety. Consequently, the manipulation of gestational factors may be used to combat pregnancy-related risks for neuropsychiatric disorders.
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Affiliation(s)
- Sabrina I. Hanswijk
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, 6525 EN Nijmegen, The Netherlands; (S.I.H.); (M.S.); (M.M.M.V.); (O.G.M.)
| | - Marcia Spoelder
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, 6525 EN Nijmegen, The Netherlands; (S.I.H.); (M.S.); (M.M.M.V.); (O.G.M.)
| | - Ling Shan
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, 1105 BA Amsterdam, The Netherlands;
| | - Michel M. M. Verheij
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, 6525 EN Nijmegen, The Netherlands; (S.I.H.); (M.S.); (M.M.M.V.); (O.G.M.)
| | - Otto G. Muilwijk
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, 6525 EN Nijmegen, The Netherlands; (S.I.H.); (M.S.); (M.M.M.V.); (O.G.M.)
| | - Weizhuo Li
- College of Medical Laboratory, Dalian Medical University, Dalian 116044, China; (W.L.); (C.L.)
| | - Chunqing Liu
- College of Medical Laboratory, Dalian Medical University, Dalian 116044, China; (W.L.); (C.L.)
| | - Sharon M. Kolk
- Department of Molecular Neurobiology, Donders Institute for Brain, Cognition and Behavior, Radboud University, 6525 AJ Nijmegen, The Netherlands;
| | - Judith R. Homberg
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, 6525 EN Nijmegen, The Netherlands; (S.I.H.); (M.S.); (M.M.M.V.); (O.G.M.)
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23
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Fields A, Harmon C, Lee Z, Louie JY, Tottenham N. Parent's anxiety links household stress and young children's behavioral dysregulation. Dev Psychobiol 2020; 63:16-30. [PMID: 32671835 DOI: 10.1002/dev.22013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 01/27/2023]
Abstract
Young children rely heavily on their caregivers to gain information about the environment, especially during times of duress. Therefore, considering parental assessments of behavior in the context of stressful environments may better facilitate our understanding of the longstanding association between early environmental stressors and changes in child behavior and physiology. Confirming many previous reports, a higher degree of household stress exposure was associated with elevated mental health symptoms in 2- to 6-year-old children (N = 115; anxiety and externalizing behaviors), which were verified in a subset of children with laboratory-based behaviors (N = 46). However, these associations were mediated by parental anxiety symptoms, which were also associated with increased cortisol levels in children. A closer look at the stressors indicated that it was the adult-targeted, and not the child-targeted, stressors that correlated most with children's behavior problems. These results highlight the importance of considering the mediating effect of parents, when examining associations between household stress and young children's behavioral development.
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Affiliation(s)
| | | | - Zoe Lee
- Columbia University, New York, NY, USA
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24
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Yong Ping E, Laplante DP, Elgbeili G, Jones SL, Brunet A, King S. Disaster-related prenatal maternal stress predicts HPA reactivity and psychopathology in adolescent offspring: Project Ice Storm. Psychoneuroendocrinology 2020; 117:104697. [PMID: 32442863 DOI: 10.1016/j.psyneuen.2020.104697] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 12/10/2019] [Accepted: 04/11/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prenatal stress has been associated with adverse outcomes in offspring, including elevated risk of psychopathology. Fetal programming of the hypothalamic-pituitary-adrenal (HPA) axis has been posited as a biological mechanism underlying such consequences. The present study aimed to examine whether dysregulation of the offspring HPA axis mediates the relationship between prenatal stress exposure and adolescent psychopathology. METHODS Five months after the Quebec ice storm of 1998, women who had been pregnant at the time of the storm completed questionnaires about their objective hardship and subjective distress from the disaster. A total of 45 of their children, exposed to the ice storm in utero, participated at 13 years of age. Adolescents completed the Trier Social Stress Test while providing salivary samples to measure circulating cortisol levels. Maternal report of adolescent behaviors was assessed with the Child Behavior Checklist. RESULTS Results from the study found that greater objective hardship was associated with elevated offspring cortisol reactivity at 13 years of age. Furthermore, greater subjective distress was associated with greater externalizing behaviors. While lower cortisol reactivity predicted greater externalizing behaviors, it did not mediate the association between maternal objective hardship or subjective distress and offspring externalizing or internalizing behaviors. CONCLUSIONS Findings suggest that objective hardship in pregnancy has long-term implications for offspring HPA axis functioning, which is also associated with externalizing behaviors. While dysregulation of the offspring HPA axis did not mediate the association between prenatal stress and offspring psychopathological symptoms, further research is warranted to investigate programming of alternative biological systems.
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Affiliation(s)
- Erin Yong Ping
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | | | | | - Sherri Lee Jones
- Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Alain Brunet
- Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Suzanne King
- Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada.
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25
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Hennelly SE, Perman-Howe P, Foxcroft DR, Smith LA. The feasibility of 'Mind the Bump': A mindfulness based maternal behaviour change intervention. Complement Ther Clin Pract 2020; 40:101178. [PMID: 32891269 DOI: 10.1016/j.ctcp.2020.101178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND and purpose: Women's health behaviours during pregnancy can affect their children's lifetime outcomes. Inactivity, poor diet, alcohol, and smoking during pregnancy are linked to maternal stress and distress. Mindfulness-based interventions can improve health behaviours and mental health. The purpose of the study was to develop and evaluate the feasibility of a mindfulness-based maternal behaviour change intervention. MATERIALS AND METHODS The eight-week 'Mind the Bump' intervention integrated mindfulness training with behaviour change techniques. It aimed to improve mindfulness, mental health, and adherence to UK maternal health behaviour guidance. Acceptability, practicability, effectiveness/cost-effectiveness, affordability, safety/side-effects, and equity were evaluated from baseline to post-course and follow-up. RESULTS Mindfulness, positive affect, and wellbeing improved. Stress, negative affect, depression, anxiety, and adherence to guidance did not improve. The intervention was practicable and safe, but the other implementability criteria were not satisfied. CONCLUSION The intervention was not fully feasible; recommendations to address its limitations are discussed.
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Affiliation(s)
- Sarah E Hennelly
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, OX3 0BP, United Kingdom.
| | - Parvati Perman-Howe
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, OX3 0BP, United Kingdom
| | - David R Foxcroft
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, OX3 0BP, United Kingdom
| | - Lesley A Smith
- Institute of Clinical and Applied Health Research, University of Hull, HU6 7RX, United Kingdom
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26
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Khalil D, Giurgescu C, Misra DP, Templin T, Javanbakht A. Recruiting Immigrant and Refugee Arab American Mother-Father-Infant Triads Resettling in the United States: A Feasibility Study. Can J Nurs Res 2020; 52:139-148. [PMID: 32192379 DOI: 10.1177/0844562120910856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Recent Iraqi and Syrian immigrant families are exposed to stress, anxiety, and depressive symptoms due to civil war. Recruitment challenges specific to conducting research within this population include the lack of knowledge about research, stigma of mental illness, and mistrust. PURPOSES Among immigrant Iraqi and Syrian families: (1) evaluate the approach to recruitment and retention; and (2) evaluate the acceptability of the study procedures. METHODS This feasibility study was conducted based on the work of Orsmond and Cohn. It is focused on the evaluation of recruitment capability and resulting sample characteristics and evaluation of acceptability and suitability of the study procedures. Mother-father-infant triads were recruited from a community center. Parents completed questionnaires about stress and depressive symptoms. Buccal swab samples were obtained from the triads to measure telomere length, and infant hair samples were obtained to measure cortisol level. Telomere length and hair cortisol were utilized as measures of chronic stress. RESULTS Ten mother-father-infant triads were enrolled out of 11 approached. Challenges faced this study included inability to reach families by telephone and the effect of cultural norms where the husband's permission was needed before proceeding, resulting in a slow pace of recruitment. The study strategy and procedures appeared to be feasible as all of the families who participated completed all study protocols. CONCLUSION This study provides feasibility data to inform the launching of a larger study to examine the associations of family stress with infant stress and development. These findings from Iraqi and Syrian families may be generalizable to studies seeking to recruit these and other immigrant and refugee population families.
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Affiliation(s)
- Dalia Khalil
- College of Nursing, Wayne State University, Detroit, MI, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Dawn P Misra
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Thomas Templin
- College of Nursing, Wayne State University, Detroit, MI, USA
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27
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The interaction between estradiol change and the serotonin transporter gene (5-HTTLPR) polymorphism is associated with postpartum depressive symptoms. Psychiatr Genet 2020; 29:97-102. [PMID: 31246736 DOI: 10.1097/ypg.0000000000000222] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although estrogenic fluctuation is considered a major risk factor for postpartum depression (PPD), the effects of the interactions between the genetic background and estradiol (E2) change on PPD are not well understood. Here, a cohort study with 437 postpartum women was carried out to evaluate the role of a serotonin transporter gene polymorphism (5-HTTLPR) and E2 change on the risk of PPD symptoms. The participants were assessed using the Edinburgh Postnatal Depression Scale and the Self-Rating Depression Scale at 1 and 6 weeks after delivery. The PCR-based restriction fragment length polymorphism method was utilized to examine the genotype distribution of the 5-HTTLPR polymorphism, and the serum levels of E2 were determined in individuals in the third trimester of pregnancy and at 1 week postpartum. A significant association was observed between E2 change and PPD susceptibility in the late postpartum period (6 weeks) [P = 0.002, odds ratio (OR) = 2.341, 95% confidence interval (CI) = 1.361-4.027], but it was not observed in the early postpartum period (1 week). There was no significant association between the 5-HTTLPR genotype and PPD risk at both the early and late postpartum periods (P > 0.05). However, the interaction between E2 change and the 5-HTTLPR polymorphism could reasonably influence PPD risk. The women who carried the SS genotype with large decreases in E2 showed a significantly higher risk for PPD at both the early (P = 0.002, OR = 2.525, 95% CI = 1.384-4.059) and late postpartum periods (P < 0.001, OR = 3.108, 95% CI = 1.562-4.436) compared with those who carried the SL/LL genotype. This study suggests that there is an association between E2 change in the perinatal period with the 5-HTTLPR genotype and the occurrence of PPD.
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28
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Zietlow AL, Nonnenmacher N, Reck C, Ditzen B, Müller M. Emotional Stress During Pregnancy - Associations With Maternal Anxiety Disorders, Infant Cortisol Reactivity, and Mother-Child Interaction at Pre-school Age. Front Psychol 2019; 10:2179. [PMID: 31607996 PMCID: PMC6773887 DOI: 10.3389/fpsyg.2019.02179] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 09/10/2019] [Indexed: 12/15/2022] Open
Abstract
There is growing evidence that even milder forms of maternal stress or anxiety during pregnancy affect the fetus causing possible long-term consequences for infant and child development. The mechanisms through which prenatal maternal stress may affect the unborn are not yet entirely clarified. Due to limited self-regulatory skills after birth, infants depend on sensitive behavior of their parents to regulate affective states and physiological arousal. Dyadic affect regulation has been linked to various developmental patterns up to adolescence and thereby represents a key element of early social relationships. Aim of the study was to evaluate possible long-term consequences of emotional stress during pregnancy and postpartum anxiety disorders, as well as infant postpartum cortisol reactivity on mother–child-interaction at pre-school age. The sample comprised of N = 63 mother–infant dyads at study entry, n = 28 diagnosed with postpartum anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), n = 35 were healthy controls. Mothers were interviewed with the Structured Clinical Interview for DSM-IV Disorders at an average infant age of M = 4.1 months and filled out a questionnaire regarding emotional stress during pregnancy. Further, they were videotaped during the Face-to-Face-Still-Face paradigm (FFSF), a widely used mild socio-emotional stressor for infants. To determine infant stress-reactivity, infant salivary cortisol was collected before, immediately after and 20 min after the FFSF. Missing values were estimated by multiple imputations. At the age of M = 5.3 years, mother-child-interaction was re-assessed in a follow-up sample of n = 30 dyads via a free-play situation. Moreover, dimensional measures for anxiety were assessed. Mothers in the clinical group reported significantly higher stress scores than the control group. Infant stress reactivity in the early postpartum period and maternal anxiety symptoms at the 5-year follow-up assessment were significantly associated with dyadic interaction quality at pre-school age. Even though maternal stress during pregnancy did not directly predict mother–child interaction quality at pre-school age, it was significantly correlated with infant cortisol reactivity during postpartum period. Nevertheless, caution should be taken when interpreting the results considering the small sample size.
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Affiliation(s)
- Anna-Lena Zietlow
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Nora Nonnenmacher
- General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Corinna Reck
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
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29
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Hernández‐Martínez C, Voltas Moreso N, Arija Val V, Jardí Piñana C, Bedmar Carretero C, Canals J. The role of maternal emotional states during pregnancy and early infancy on infant cortisol levels: A prospective study. INFANT AND CHILD DEVELOPMENT 2019. [DOI: 10.1002/icd.2149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Carmen Hernández‐Martínez
- Departament de Psicologia, Centre de Recerca en Avaluació i Mesura de la ConductaUniversitat Rovira i Virli Tarragona Spain
| | - Nuria Voltas Moreso
- Departament de Psicologia, Centre de Recerca en Avaluació i Mesura de la ConductaUniversitat Rovira i Virli Tarragona Spain
| | - Victoria Arija Val
- Departament de Ciències Mèdiques Bàsiques, Institut d'Investigació Sanitària Pere VirgiliUniversitat Rovira i Virgili Tarragona Spain
| | - Cristina Jardí Piñana
- Departament de Ciències Mèdiques Bàsiques, Institut d'Investigació Sanitària Pere VirgiliUniversitat Rovira i Virgili Tarragona Spain
| | - Cristina Bedmar Carretero
- Departament de Ciències Mèdiques Bàsiques, Institut d'Investigació Sanitària Pere VirgiliUniversitat Rovira i Virgili Tarragona Spain
| | - Josefa Canals
- Departament de Psicologia, Centre de Recerca en Avaluació i Mesura de la ConductaUniversitat Rovira i Virli Tarragona Spain
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30
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Perinatal exposure to venlafaxine leads to lower anxiety and depression-like behavior in the adult rat offspring. Behav Pharmacol 2019; 29:445-452. [PMID: 29561291 DOI: 10.1097/fbp.0000000000000393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Depression during pregnancy and in the post-partum period is a growing health issue. Venlafaxine, a representative of serotonin and noradrenaline reuptake inhibitors, is used to treat a wide spectrum of mood disorders. However, the limited number of prenatal and perinatal studies raises the question about the long-term consequences of venlafaxine therapy. The aim of this study was to investigate the effect of venlafaxine exposure during pregnancy and lactation on anxiety-like and depression-like behaviors, as well as adrenocortical hormone concentrations in the adult rat offspring. For this purpose, rat dams were treated orally with venlafaxine from day 15 of gestation to postnatal day 20 at doses of 7.5, 37.5, and 75 mg/kg. Administration of venlafaxine during gestation and lactation affected anxiety-like and depression-like behaviors in adult rat offspring of both sexes. The animals exposed through their mothers to venlafaxine, particularly at the lowest and middle doses, were less anxious and less depressive in several relevant behavioral tests, which can be considered a deviation from the normal state. At clinically relevant doses, venlafaxine did not alter circulating level of corticosterone and aldosterone in the adult offspring. In general, the consequences of venlafaxine were dose dependent and more apparent in females. Together, these results suggest that prenatal and early postnatal exposure to venlafaxine may interfere with functional development of the brain, though not necessarily in a negative way.
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Eckstein M, Zietlow AL, Gerchen MF, Schmitgen MM, Ashcroft-Jones S, Kirsch P, Ditzen B. The NeMo real-time fMRI neurofeedback study: protocol of a randomised controlled clinical intervention trial in the neural foundations of mother-infant bonding. BMJ Open 2019; 9:e027747. [PMID: 31315861 PMCID: PMC6661567 DOI: 10.1136/bmjopen-2018-027747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/22/2019] [Accepted: 05/22/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Most mothers feel an immediate, strong emotional bond with their newborn. On a neurobiological level, this is accompanied with the activation of the brain reward systems, including the striatum. However, approximately 10% of all mothers report difficulties to bond emotionally with their infant and display impaired reward responses to the interaction with their infant which might have long-term negative effects for the child's development. As previous studies suggest that activation of the striatal reward system can be regulated through functional MRI (fMRI)-based neurofeedback (NFB), we have designed and investigate fMRI-NFB training to treat maternal bonding difficulties. METHODS AND ANALYSIS In the planned trial, mothers will be presented pictures of their infant and real-time fMRI (rtfMRI), peripheral measures, neural, endocrine, psychophysiological and behavioural measures will be assessed. Mothers with bonding difficulties (n=68) will be randomised to one of two double-blind intervention groups at 4-6 months postpartum. They will participate in three repeated NFB training sessions with rtfMRI-NFB training to increase activation of (a) the ventral striatum or (b) the anterior cingulate. Interview data and real-time mother-infant interaction behaviour pre-intervention, post-intervention and at follow-up will serve as clinical outcome measures. ETHICS AND DISSEMINATION Study procedures are in line with the recommendations of the World Medical Association (revised Declaration of Helsinki) and were approved by the Ethics Committee of the Medical Faculty, s-450/2017, Heidelberg University. All participants will provide written informed consent after receiving a detailed oral and written explanation of all procedures and can withdraw their consent at any time without negative consequence. Results will be internationally published and disseminated, to further the discussion on non-pharmacological treatment options in complex mental disorders. TRIAL REGISTRATION NUMBER DRKS00014570; Pre-results.
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Affiliation(s)
- Monika Eckstein
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Anna-Lena Zietlow
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute for Mental Health, Mannheim, Germany
- Bernstein Center for Computational Neuroscience, Mannheim, Germany
| | | | - Sarah Ashcroft-Jones
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute for Mental Health, Mannheim, Germany
- Bernstein Center for Computational Neuroscience, Mannheim, Germany
| | - Beate Ditzen
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
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Abstract
The use of psychotropic drugs during pregnancy and breastfeeding remains a controversial topic. There are several reasons for the controversy, ranging from the misperception that pregnancy is protective against mental illness, to the notion that women should be "pure" during pregnancy and avoid all extraneous substance use, and finally, to the stigma and misunderstanding of psychiatric illness and underestimation of how serious it can be. Fortunately, the currently available data are reassuring for most psychiatric medications-properly controlled studies indicate little to no risk for most (but not all) psychiatric medications.
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Affiliation(s)
- Jennifer L Payne
- Johns Hopkins School of Medicine, 550 North Broadway, Suite 305, Baltimore, MD 21205, USA.
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Aktar E, Qu J, Lawrence PJ, Tollenaar MS, Elzinga BM, Bögels SM. Fetal and Infant Outcomes in the Offspring of Parents With Perinatal Mental Disorders: Earliest Influences. Front Psychiatry 2019; 10:391. [PMID: 31316398 PMCID: PMC6610252 DOI: 10.3389/fpsyt.2019.00391] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/17/2019] [Indexed: 12/16/2022] Open
Abstract
Mental illness is highly prevalent and runs in families. Mental disorders are considered to enhance the risk for the development of psychopathology in the offspring. This heightened risk is related to the separate and joint effects of inherited genetic vulnerabilities for psychopathology and environmental influences. The early years of life are suggested to be a key developmental phase in the intergenerational psychopathology transmission. Available evidence supports the idea that early exposure to parental psychopathology, during the pregnancy and first postpartum year, may be related to child psychological functioning beyond the postpartum period, up to adulthood years. This not only highlights the importance of intervening early to break the chain of intergenerational transmission of psychopathology but also raises the question of whether early interventions targeting parental mental disorders in this period may alleviate these prolonged adverse effects in the infant offspring. The current article focuses on the specific risk of psychopathology conveyed from mentally ill parents to the offspring during the pregnancy and first postpartum year. We first present a summary of the available evidence on the associations of parental perinatal mental illness with infant psychological outcomes at the behavioral, biological, and neurophysiological levels. Next, we address the effects of early interventions and discuss whether these may mitigate the early intergenerational transmission of risk for psychopathology. The summarized evidence supports the idea that psychopathology-related changes in parents' behavior and physiology in the perinatal period are related to behavioral, biological, and neurophysiological correlates of infant psychological functioning in this period. These alterations may constitute risk for later development of child and/or adult forms of psychopathology and thus for intergenerational transmission. Targeting psychopathology or mother-infant interactions in isolation in the postnatal period may not be sufficient to improve outcomes, whereas interventions targeting both maternal psychopathology and mother-infant interactions seem promising in alleviating the risk of early transmission.
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Affiliation(s)
- Evin Aktar
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Jin Qu
- Department of Psychology, Clarion University of Pennsylvania, Clarion, PA, United States
| | - Peter J Lawrence
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Marieke S Tollenaar
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Bernet M Elzinga
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
- Developmental Psychology, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
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Kress V, Steudte-Schmiedgen S, Kopp M, Förster A, Altus C, Schier C, Wimberger P, Kirschbaum C, von Soest T, Weidner K, Junge-Hoffmeister J, Garthus-Niegel S. The Impact of Parental Role Distributions, Work Participation, and Stress Factors on Family Health-Related Outcomes: Study Protocol of the Prospective Multi-Method Cohort "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Front Psychol 2019; 10:1273. [PMID: 31263435 PMCID: PMC6584823 DOI: 10.3389/fpsyg.2019.01273] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/14/2019] [Indexed: 12/12/2022] Open
Abstract
The Dresden Study on Parenting, Work, and Mental Health (“DResdner Studie zu Elternschaft, Arbeit, und Mentaler Gesundheit”, DREAM) aims to prospectively investigate the relationship between parental work participation, role distribution, stress factors, and their effects on perinatal outcomes and long-term family mental and somatic health in a community sample targeting N = 4,000 individuals, i.e., 2,000 couples, expecting a child and residing in Dresden, Germany (interim sample of N = 1,410 participants, recruitment ongoing). Various questionnaires are completed at four measurement points from pregnancy to 2 years postpartum (prolongation into middle childhood planned). Applying a multi-method approach, long-term endocrinological data (analyses of hair cortisol concentrations and other endogenous hormones, “DREAMHAIR”) and qualitative interview data (regarding gender role attitudes and distribution of domestic work, child care, and paid employment; “DREAMTALK”) are obtained. In this study protocol, the theoretical background, methods, and preliminary results considering sociodemographic characteristics during pregnancy and birth-related factors at 8 weeks postpartum are presented. Additionally, there is a focus on our endocrinological sub-study DREAMHAIR. In this sub-study currently comprising N = 152 participants, i.e., 88 families (recruitment ongoing), we want to gain knowledge on the transgenerational processes of stress regulation and psychopathology in the whole family by analyzing hair cortisol concentrations in both parents and children during the course from pregnancy (or after birth regarding children) to at least 2 years postpartum. By comparing data of the community sample to a clinical sample of mothers with postpartum mental disorders, their children, and their partners during the period between admission and discharge from a mother-baby unit and post-treatment (“DREAMMBU”), the course of mothers' psychopathology, parent-infant interaction, and infant regulation disorders with special regard to long-term endocrine correlates will be examined. With previous studies neglecting the fathers or partners involved, a major advantage of DREAM is the use of a multi-method and multi-level approach by examining the whole family in a longitudinal design. Therefore, the DREAM study will contribute to a better understanding of the role of social, work, and stress factors for mental and somatic health and its long-term endocrine correlates in the natural course of becoming a family.
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Affiliation(s)
- Victoria Kress
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany.,Institute of Biological Psychology, Faculty of Psychology of the Technische Universität Dresden, Dresden, Germany
| | - Marie Kopp
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Anke Förster
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Caroline Altus
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Caroline Schier
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Clemens Kirschbaum
- Institute of Biological Psychology, Faculty of Psychology of the Technische Universität Dresden, Dresden, Germany
| | - Tilmann von Soest
- Department of Psychology, PROMENTA Research Center, University of Oslo, Oslo, Norway
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Juliane Junge-Hoffmeister
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany.,Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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Lawler JM, Bocknek EL, McGinnis EW, Martinez-Torteya C, Rosenblum KL, Muzik M. Maternal Postpartum Depression Increases Vulnerability for Toddler Behavior Problems through Infant Cortisol Reactivity. INFANCY 2019; 24:249-274. [PMID: 32677203 DOI: 10.1111/infa.12271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 09/10/2018] [Accepted: 09/15/2018] [Indexed: 01/01/2023]
Abstract
The current study examined the role of hypothalamic-pituitary-adrenal reactivity (a physiological indicator of stress) in early infancy as a mediator of the relationship between maternal postpartum depression and toddler behavior problems. Participants were 137 at-risk mothers and their children participating in a longitudinal study of intergenerational transmission of risk. Mothers' depression was measured five times during the infants' first 18 months. Infant cortisol was collected during a social stressor (the still-face paradigm) when infants were 6 months old, and mothers reported on toddlers' internalizing and externalizing symptoms at 18 months. Among this sample of high-risk mother-infant dyads, early postpartum depression predicted atypical infant cortisol reactivity at 6 months, which mediated the effect of maternal depression on increased toddler behavior problems. Clinical implications are discussed.
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Affiliation(s)
| | | | | | | | | | - Maria Muzik
- Department of Psychiatry, University of Michigan
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Ince-Askan H, van den Akker ELT, de Rijke YB, van Rossum EFC, Hazes JMW, Dolhain RJEM. Associations between antenatal prednisone exposure and long-term cortisol and cortisone concentrations in children born to women with rheumatoid arthritis: results from a nationwide prospective cohort study. RMD Open 2019; 5:e000852. [PMID: 30815278 PMCID: PMC6361363 DOI: 10.1136/rmdopen-2018-000852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives To identify whether children with antenatal prednisone exposure have chronically elevated cortisol and cortisone concentrations, an altered body composition or higher blood pressure. In addition, to identify whether maternal rheumatoid arthritis disease (RA) activity is associated with these alterations. Methods In this prospective study, 56 children (mean age=10.0 years) with and 61 children (mean age=9.6 years) without antenatal prednisone exposure, born to women with RA, were included. Hair cortisol and cortisone were analysed using liquid chromatography-tandem mass spectrometry. Linear regression models were built to analyse differences between the two groups, corrected for relevant covariates. Hair cortisol concentrations were also compared between the study population and an age-matched healthy reference group(n=150 children, mean age=9.8 years). Results Hair cortisol and cortisone concentrations were similar in children with and without antenatal prednisone exposure (median cortisol 1.14 pg/mg (IQR 0.67-1.75) and 1.15 pg/mg (IQR 0.65-2.21) and median cortisone 6.76 pg/mg (IQR 5.42-8.86) and 7.40 pg/mg (IQR 5.39-10.73), respectively). Antenatal prednisone exposure and maternal RA disease activity were also not associated with body composition or blood pressure. Hair cortisol concentrations were not different in children born to mothers with RA compared with children from the reference group. Conclusion This, in its kind, large and unique long-term prospective study demonstrates that low-dose antenatal prednisone exposure and maternal RA disease activity are not associated with negative consequences in prepubertal childhood. The findings of this study are reassuring and support the assumption that low-dose maternal prednisone use during pregnancy is safe for the offspring, at least until the age of approximately 10 years.
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Affiliation(s)
- Hilal Ince-Askan
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Erica L T van den Akker
- Department of Pediatric Endocrinology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Abstract
Stress is an adaptive response to environment aversive stimuli and a common life experience of one's daily life. Chronic or excessive stress especially that happened in early life is found to be deleterious to individual's physical and mental health, which is highly related to depressive disorders onset. Stressful life events are consistently considered to be the high-risk factors of environment for predisposing depressive disorders. In linking stressful life events with depressive disorder onset, dysregulated HPA axis activity is supposed to play an important role in mediating aversive impacts of life stress on brain structure and function. Increasing evidence have indicated the strong association of stress, especially the chronic stress and early life stress, with depressive disorders development, while the association of stress with depression is moderated by genetic risk factors, including polymorphism of SERT, BDNF, GR, FKBP5, MR, and CRHR1. Meanwhile, stressful life experience particularly early life stress will exert epigenetic modification in these risk genes via DNA methylation and miRNA regulation to generate long-lasting effects on these genes expression, which in turn cause brain structural and functional alteration, and finally increase the vulnerability to depressive disorders. Therefore, the interaction of environment with gene, in which stressful life exposure interplay with genetic risk factors and epigenetic modification, is essential in predicting depressive disorders development. As the mediator of environmental risk factors, stress will function together with genetic and epigenetic mechanism to influence brain structure and function, physiology and psychology, and finally the vulnerability to depressive disorders.
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38
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Joinson C, Grzeda MT, von Gontard A, Heron J. A prospective cohort study of biopsychosocial factors associated with childhood urinary incontinence. Eur Child Adolesc Psychiatry 2019; 28:123-130. [PMID: 29980842 PMCID: PMC6349792 DOI: 10.1007/s00787-018-1193-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
The objective of the study was to examine the association between biopsychosocial factors and developmental trajectories of childhood urinary incontinence (UI). We used developmental trajectories (latent classes) of childhood UI from 4-9 years including bedwetting alone, daytime wetting alone, delayed (daytime and nighttime) bladder control, and persistent (day and night) wetting (n = 8751, 4507 boys, 4244 girls). We examined whether biopsychosocial factors (developmental level, gestational age, birth weight, parental UI, temperament, behaviour/emotional problems, stressful events, maternal depression, age at initiation of toilet training, constipation) are associated with the trajectories using multinomial logistic regression (reference category = normative development of bladder control). Maternal history of bedwetting was associated with almost a fourfold increase in odds of persistent wetting [odds ratio and 95% confidence interval: 3.60 (1.75-7.40)]. In general, difficult temperament and behaviour/emotional problems were most strongly associated with combined (day and night) wetting, e.g. children with behavioural difficulties had increased odds of delayed (daytime and nighttime) bladder control [1.80 (1.59-2.03)]. Maternal postnatal depression was associated with persistent (day and night) wetting [2.09 (1.48-2.95)] and daytime wetting alone [2.38 (1.46-3.88)]. Developmental delay, stressful events, and later initiation of toilet training were not associated with bedwetting alone, but were associated with the other UI trajectories. Constipation was only associated with delayed bladder control. We find evidence that different trajectories of childhood UI are differentially associated with biopsychosocial factors. Increased understanding of factors associated with different trajectories of childhood UI could help clinicians to identify children at risk of persistent incontinence.
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Affiliation(s)
- Carol Joinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK.
| | - Mariusz T. Grzeda
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN UK
| | - Alexander von Gontard
- grid.411937.9Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Jon Heron
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN UK
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Osborne S, Biaggi A, Chua TE, Du Preez A, Hazelgrove K, Nikkheslat N, Previti G, Zunszain PA, Conroy S, Pariante CM. Antenatal depression programs cortisol stress reactivity in offspring through increased maternal inflammation and cortisol in pregnancy: The Psychiatry Research and Motherhood - Depression (PRAM-D) Study. Psychoneuroendocrinology 2018; 98:211-221. [PMID: 30033161 PMCID: PMC6215770 DOI: 10.1016/j.psyneuen.2018.06.017] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Antenatal depression is associated with a broad range of suboptimal outcomes in offspring, although the underlying mechanisms are not yet understood. Animal studies propose inflammation and glucocorticoids as mediators of the developmental programming effect of prenatal stress on offspring stress responses, but studies in humans are not yet at this stage. Indeed, to date no single study has examined the effects of a rigorously defined, clinically significant Major Depressive Disorder (MDD) in pregnancy on maternal antenatal inflammatory biomarkers and hypothalamic-pituitary (HPA) axis, as well as on offspring HPA axis, behavior and developmental outcomes in the first postnatal year. METHODS A prospective longitudinal design was used in 106 women (49 cases vs. 57 healthy controls) to study the effect of MDD in pregnancy and associated antenatal biology (inflammatory and cortisol biomarkers), on offspring stress response (cortisol response to immunization, at 8 weeks and 12 months), early neurobehavior (Neonatal Behavioral Assessment Scale, NBAS, at day 6), and cognitive, language and motor development (Bayley Scales of Infant and Toddler Development at 12 months). RESULTS Compared with healthy controls, women with MDD in pregnancy had raised interleukin (IL) IL-6 (effect size (δ) = 0.53, p = 0.031), IL-10 (δ = 0.53, p = 0.043), tumor necrosis factor alpha (δ = 0.90, p = 0.003) and vascular endothelial growth factor (δ = 0.56, p = 0.008), together with raised diurnal cortisol secretion (δ = 0.89, p = 0.006), raised evening cortisol (δ = 0.64, p = 0.004), and blunted cortisol awakening response (δ = 0.70, p = 0.020), and an 8-day shorter length of gestation (δ = 0.70, p = 0.005). Furthermore, they had neonates with suboptimal neurobehavioral function in four out of five NBAS clusters measured (range of δ = 0.45-1.22 and p = 0.049-<0.001) and increased cortisol response to stress at one year of age (δ = 0.87, p < 0.001). Lastly, maternal inflammatory biomarkers and cortisol levels were correlated with infant stress response, suggesting a mechanistic link. CONCLUSION This study confirms and extends the notion that depression in pregnancy is associated with altered offspring behavior and biological stress response, and demonstrates that changes in maternal antenatal stress-related biology are associated with these infant outcomes.
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Affiliation(s)
- S Osborne
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK.
| | - A Biaggi
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Psychosis Studies, London, SE5 9AF, UK
| | - T E Chua
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; Department of Psychological Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - A Du Preez
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - K Hazelgrove
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Psychosis Studies, London, SE5 9AF, UK
| | - N Nikkheslat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - G Previti
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; Department of Mental Health and Addiction, Via Risorgimento 57 42123, Reggio Emilia, Italy
| | - P A Zunszain
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - S Conroy
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - C M Pariante
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
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Slopen N, Roberts AL, LeWinn KZ, Bush NR, Rovnaghi CR, Tylavsky F, Anand KJS. Maternal experiences of trauma and hair cortisol in early childhood in a prospective cohort. Psychoneuroendocrinology 2018; 98:168-176. [PMID: 30170311 DOI: 10.1016/j.psyneuen.2018.08.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Maternal trauma can have intergenerational consequences but little is known about whether maternal traumas affect key biological domains associated with mental health in their offspring. The objective of this study was to examine maternal lifetime history of traumatic events through mid-gestation in relation to offspring cortisol production in early childhood. METHODS The sample was comprised of 660 children (49.9% Black, 44.4% White) from a longitudinal study of mother-offspring dyads in Shelby County, Tennessee, followed from mid-gestation to child age 4 years (enrolled 2006-2011). Maternal lifetime history of traumatic life events were assessed mid-gestation using the Traumatic Life Events Questionnaire. Total cortisol output among offspring was measured using hair cortisol concentrations at ages 1 to 4 years. RESULTS Associations of maternal trauma history with child hair cortisol varied by child's age. No association was observed at age 1 or 2. In adjusted regression models, at ages 3 and 4, offspring of mothers in the third (β = 0.99, P < .01), fourth (β=0.72, P < .05), and fifth (β=0.83, P < .01) quintiles of trauma exposure history had elevated (natural log) hair cortisol concentrations, relative to mothers in the lowest quintile (P-trend = 0.003). The associations were not attenuated after adjustment for theorized pathways, including premature birth, maternal postpartum depression, and maternal parenting stress. CONCLUSIONS Maternal lifetime trauma exposures are associated with offspring hair cortisol concentrations. Future research is needed to determine intermediary mechanisms and functional significance of elevated hair cortisol concentration in young children.
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Affiliation(s)
- Natalie Slopen
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MA, United States.
| | - Andrea L Roberts
- Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Kaja Z LeWinn
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Nicole R Bush
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States; Department of Pediatrics, University of California, San Francisco, CA, United States
| | - Cynthia R Rovnaghi
- Pain/Stress Neurobiology Lab, Child Health Research Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Frances Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Nashville, TN, United States
| | - Kanwaljeet J S Anand
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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Zhao X, Liu Q, Cao S, Pang J, Zhang H, Feng T, Deng Y, Yao J, Li H. A meta-analysis of selective serotonin reuptake inhibitors (SSRIs) use during prenatal depression and risk of low birth weight and small for gestational age. J Affect Disord 2018; 241:563-570. [PMID: 30153640 DOI: 10.1016/j.jad.2018.08.061] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 06/10/2018] [Accepted: 08/12/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Selective Serotonin Reuptake Inhibitors (SSRIs) act as the first-line antidepressants prescribed for the treatment of prenatal depression. Evidence from previous studies has suggested that the use of SSRIs treatment for prenatal depression has adversely affected fetal growth. However, these results are inconsistent and inconclusive. METHODS In this study, we examined whether SSRIs use during pregnancy was related to low birth weight (LBW) and small for gestational age (SGA) using a meta-analysis approach. Relevant studies were retrieved by database searching and selected according to established inclusion criteria. RESULTS Fifteen articles involved 1,977,446 subjects were identified that tested the relationship between the SSRIs use, LBW and SGA outcomes. Statistical analyses revealed a significant association between SSRIs use and suboptimal fetal growth (RR = 1.45, 95% CI = 1.18 - 1.76, Z = 3.62, p = 0.00 for SGA; RR = 1.38, 95% CI = 1.13 - 1.69, Z = 3.14, p = 0.00 for LBW). LIMITATIONS These results must be treated with caution as we did not take the confounding factors into account (e.g., trimester SSRIs taken, specific SSRIs prescribed and maternal lifestyle during pregnancy) to elucidate their specific roles in the relationship between SSRIs use during pregnancy and fetal growth. CONCLUSION Our findings suggested that SSRIs use for prenatal depression is associated with suboptimal fetal growth.
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Affiliation(s)
- Xiaofeng Zhao
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, PR China
| | - Qian Liu
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, PR China
| | - Suxia Cao
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, PR China
| | - Jianyue Pang
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, PR China
| | - Huijie Zhang
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, PR China
| | - Tingting Feng
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, PR China
| | - Yajie Deng
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, PR China
| | - Jing Yao
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, PR China
| | - Hengfen Li
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, PR China.
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Ulmer-Yaniv A, Djalovski A, Priel A, Zagoory-Sharon O, Feldman R. Maternal depression alters stress and immune biomarkers in mother and child. Depress Anxiety 2018; 35:1145-1157. [PMID: 30133052 DOI: 10.1002/da.22818] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 06/08/2018] [Accepted: 07/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Exposure to maternal depression bears long-term negative consequences for children's well-being. Yet, no study has tested the joint contribution of maternal and child's hypothalamic pituitary axis and immune systems in mediating the effects of maternal depression on child psychopathology. METHODS We followed a birth cohort over-represented for maternal depression from birth to 10 years (N = 125). At 10 years, mother and child's cortisol (CT) and secretory immunoglobulin A (s-IgA), biomarkers of the stress and immune systems, were assayed, mother-child interaction observed, mothers and children underwent psychiatric diagnosis, and children's externalizing and internalizing symptoms reported. RESULTS Depressed mothers had higher CT and s-IgA levels and displayed more negative parenting, characterized by negative affect, intrusion, and criticism. Children of depressed mothers exhibited more Axis-I disorders, higher s-IgA levels, and greater social withdrawal. Structural equation modeling charted four paths by which maternal depression impacted child externalizing and internalizing symptoms: (a) increasing maternal CT, which linked with higher child CT and behavior problems; (b) augmenting maternal and child's immune response, which were associated with child symptoms; (c) enhancing negative parenting that predicted child social withdrawal and symptoms; and (d), via a combined endocrine-immune pathway suppressing symptom formation. CONCLUSIONS Our findings, the first to test stress and immune biomarkers in depressed mothers and their children in relation to social behavior, describe mechanisms of endocrine synchrony in shaping children's stress response and immunity, advocate the need to follow the long-term effects of maternal depression on children's health throughout life, and highlight maternal depression as an important public health concern.
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Affiliation(s)
- Adi Ulmer-Yaniv
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel.,The Gonda Multidisciplinary Center, Bar-Ilan University, Ramat Gan, Israel
| | - Amir Djalovski
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel.,Department of Psychology, Bar-Ilan University, Israel
| | - Avital Priel
- Department of Psychology, Bar-Ilan University, Israel
| | - Orna Zagoory-Sharon
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel
| | - Ruth Feldman
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel.,Yale Child Study Center, Yale University, New Haven, Connecticut
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43
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Testosterone-cortisol dissociation in children exposed to prenatal maternal stress, and relationship with aggression: Project Ice Storm. Dev Psychopathol 2018; 30:981-994. [PMID: 30068431 DOI: 10.1017/s0954579418000652] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Prenatal maternal stress (PNMS) has been associated with postnatal behavioral alterations that may be partly explained by interactions between the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-gonadal (HPG) axes. Yet it remains unclear whether PNMS leads to enduring HPA-HPG alterations in the offspring, and whether HPA-HPG interactions can impact behavior during development, in particular levels of aggression in childhood. Here we investigated the relationship between a marker for HPG axis function (baseline testosterone) and a marker for HPA axis response (cortisol area under the curve) in 11½-year-olds whose mothers were exposed to the 1998 Quebec ice storm during pregnancy (n = 59 children; 31 boys, 28 girls). We examined (a) whether the degree of objective or subjective PNMS regulates the testosterone-cortisol relationship at age 11½, and (b) whether this testosterone-cortisol relationship is associated with differences in aggressive behavior. We found that, at lower levels of subjective PNMS, baseline testosterone and cortisol reactivity were positively correlated; in contrast, there was no relationship between these hormones at higher levels of subjective PNMS. Cortisol response moderated the relationship between testosterone and aggression. These results support the notion PNMS may explain variance in fetal HPA-HPG interactions, and that these interactions may be associated with aggressive behavior in late childhood.
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44
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Children's stress regulation mediates the association between prenatal maternal mood and child executive functions for boys, but not girls. Dev Psychopathol 2018; 30:953-969. [PMID: 30068413 DOI: 10.1017/s095457941800041x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prenatal exposure to maternal mood disturbances shapes children's cognitive development reflected in the critical construct of executive functions (EFs). Little is known, however, about underlying mechanisms. By examining cortisol responses in both everyday and lab challenge settings, we tested whether the child/offspring hypothalamic-pituitary-adrenal axis mediates effects of prenatal maternal mood on child EFs at age 6. In 107 Canadian children born to women with a wide range of anxious and depressive symptoms during pregnancy, we found that in boys but not girls, depressed and/or anxious prenatal maternal mood is associated with heightened diurnal cortisol levels in everyday settings, as well as heightened cortisol reactivity to a lab challenge and that this heightened reactivity was associated with poorer EFs. Among boys we also observed that cortisol reactivity but not diurnal cortisol mediated the association between depressed and/or anxious prenatal maternal mood and EFs. Depressed and/or anxious prenatal maternal mood was related to child EFs for both girls and boys. To our knowledge, this is the first study to demonstrate a mediating role for child stress regulation in the association between prenatal maternal stress-related mood disturbances and child EFs, providing evidence of a mechanism contributing to fetal programming of cognition.
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45
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Prenatal depression, fetal neurobehavior, and infant temperament: Novel insights on early neurodevelopment from a socioeconomically disadvantaged Indian cohort. Dev Psychopathol 2018; 30:725-742. [PMID: 30068420 DOI: 10.1017/s0954579418000615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article extends the research focusing on the early origins of psychopathology into the prenatal period, by exploring the association between maternal prenatal depression and offspring (fetal and infant) neurobehavior. The sample is recruited from a rural population in South India where women in the third trimester of pregnancy were assessed for depression and the heart rate responses of their fetuses to extrinsically applied vibroacoustic stimuli were studied. At 2 months postbirth, infant temperament and cortisol responsivity to immunization were assessed. The association between maternal prenatal depression and fetal responsivity to vibroacoustic stimulation, and infant responsivity to immunization, was U shaped with higher levels of responsivity noted in the offspring of mothers with very high and very low depression scores, and lower levels noted in the offspring of mothers with moderate depression scores. Maternal prenatal depression was not associated with infant temperament. The findings highlight the importance of environmental influences in the developmental origins of neurobehavior, suggesting that such differences, not evident at baseline, may emerge upon exposure to stressors. The study also emphasizes the need for further investigation in low- and middle-income contexts by providing preliminary evidence of the differing patterns of association observed between high- and low-income populations.
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46
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Bleker LS, van Dammen L, Leeflang MMG, Limpens J, Roseboom TJ, de Rooij SR. Hypothalamic-pituitary-adrenal axis and autonomic nervous system reactivity in children prenatally exposed to maternal depression: A systematic review of prospective studies. Neurosci Biobehav Rev 2018; 117:243-252. [PMID: 30366609 DOI: 10.1016/j.neubiorev.2018.05.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/25/2022]
Abstract
Depression is a common condition affecting up to 20% of all pregnant women, and is associated with subsequent developmental and behavioral problems in children, such as conduct disorder and ADHD. One proposed mechanism underlying these associations is modification of the fetal hypothalamic pituitary adrenal (HPA)-axis and the autonomic nervous system (ANS), resulting in altered responses to stress. This review examined the evidence regarding altered HPA-axis and ANS reactivity in children prenatally exposed to high maternal depressive symptoms. A systematic search was conducted in the electronic databases MEDLINE, EMBASE and PsycINFO, for studies published till 25 July 2017. A total of 13 studies comprising 2271 mother-infant dyads were included. None of the studies were suitable for meta-analysis. Risk of bias assessment showed low risk for four studies. Only three studies described an independent association between exposure to high maternal prenatal depressive symptoms and altered stress reactivity in children. There is limited evidence of an independent association between prenatal exposure to maternal depression and altered HPA or ANS reactivity in children.
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Affiliation(s)
- Laura S Bleker
- Academic Medical Centre, Departments of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Lotte van Dammen
- University of Groningen - University Medical Centre Groningen, Department of Obstetrics and Gynaecology, 9713 GZ, Groningen, The Netherlands; University of Groningen - University Medical Centre Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Mariska M G Leeflang
- Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Academic Medical Centre, Department of Research Support - Medical Library, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Academic Medical Centre, Departments of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Susanne R de Rooij
- Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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47
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Davis EP, Hankin BL, Swales DA, Hoffman MC. An experimental test of the fetal programming hypothesis: Can we reduce child ontogenetic vulnerability to psychopathology by decreasing maternal depression? Dev Psychopathol 2018; 30:787-806. [PMID: 30068416 PMCID: PMC7040571 DOI: 10.1017/s0954579418000470] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Maternal depression is one of the most common prenatal complications, and prenatal maternal depression predicts many child psychopathologies. Here, we apply the fetal programming hypothesis as an organizational framework to address the possibility that fetal exposure to maternal depressive symptoms during pregnancy affects fetal development of vulnerabilities and risk mechanisms, which enhance risk for subsequent psychopathology. We consider four candidate pathways through which maternal prenatal depression may affect the propensity of offspring to develop later psychopathology across the life span: brain development, physiological stress regulation (hypothalamic-pituitary-adrenocortical axis), negative emotionality, and cognitive (effortful) control. The majority of past research has been correlational, so potential causal conclusions have been limited. We describe an ongoing experimental test of the fetal programming influence of prenatal maternal depressive symptoms using a randomized controlled trial design. In this randomized controlled trial, interpersonal psychotherapy is compared to enhanced usual care among distressed pregnant women to evaluate whether reducing prenatal maternal depressive symptoms has a salutary impact on child ontogenetic vulnerabilities and thereby reduces offspring's risk for emergence of later psychopathology.
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Affiliation(s)
- Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, Colorado
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine California
| | - Benjamin L. Hankin
- Department of Psychology, University of Illinois, Urbana Champaign, Illinois
| | | | - M. Camille Hoffman
- University of Colorado School of Medicine, Departments of Obstetrics and Gynecology and Psychiatry, Aurora, CO
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48
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Gemmel M, Bögi E, Ragan C, Hazlett M, Dubovicky M, van den Hove DL, Oberlander TF, Charlier TD, Pawluski JL. Perinatal selective serotonin reuptake inhibitor medication (SSRI) effects on social behaviors, neurodevelopment and the epigenome. Neurosci Biobehav Rev 2018; 85:102-116. [DOI: 10.1016/j.neubiorev.2017.04.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/10/2017] [Accepted: 04/21/2017] [Indexed: 12/15/2022]
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49
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Infant HPA axis as a potential mechanism linking maternal mental health and infant telomere length. Psychoneuroendocrinology 2018; 88:38-46. [PMID: 29161636 DOI: 10.1016/j.psyneuen.2017.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/13/2017] [Accepted: 11/15/2017] [Indexed: 01/01/2023]
Abstract
Maternal depression has been suggested to be an independent risk factor for both dysregulated hypothalamic-pituitary-adrenal axis (HPA) functioning and shorter telomere length in offspring. In contrast, research suggests that individual differences in mindfulness may act as a protective factor against one's own telomere degradation. Currently, research has yet to investigate the association between longitudinal changes in maternal mental health (depressive symptoms and mindfulness) and salivary infant telomere length, and whether such changes might be mediated by alterations in infant cortisol response. In 48 mother-infant dyads, we investigated whether the changes in maternal mental health, when infants were 6-12 months of age, predicted change in infant cortisol reactivity and recovery over this period. We also investigated whether these changes in infant HPA functioning predicted subsequent infant salivary telomere length at 18 months of age. Furthermore, we investigated whether change in infant HPA functioning provided a potential pathway between changes in maternal mental health factors and infant salivary telomere length. Analyses revealed that increases in maternal depressive symptoms over that six-month period indirectly related to subsequent shorter infant telomere length through increased infant cortisol reactivity. Implications for the ways in which maternal mental health can impact offspring stress mechanisms related to aging and disease trajectories are discussed.
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50
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Bernard K, Nissim G, Vaccaro S, Harris JL, Lindhiem O. Association between maternal depression and maternal sensitivity from birth to 12 months: a meta-analysis. Attach Hum Dev 2018; 20:578-599. [PMID: 29374991 DOI: 10.1080/14616734.2018.1430839] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Maternal sensitivity plays a central role in shaping children's development across a number of domains, and may be disrupted by depression. The current meta-analysis quantified the magnitude of the association between depression and maternal sensitivity, defined broadly as timely, contingent, and appropriate responding to infants' cues, from birth to 12 months. Across k = 48 studies and n = 4,934 mother-infant dyads, the aggregate effect size between depression and maternal sensitivity was r = -.16, p < .0001, indicating that mothers with higher depression levels were less sensitive than mothers with lower depression levels. Studies that compared a depressed group with a nondepressed/control group had larger effect sizes (r = -.35, p < .0001) than studies that examined depression within a single sample of either unselected cases or clinical-only cases (r = -.11, p < .001), suggesting that clinical levels of depression may pose a particular threat to sensitive parenting. Clinical implications (e.g. screening, prevention) are discussed.
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Affiliation(s)
- Kristin Bernard
- a Department of Psychology , Stony Brook University , Stony Brook , NY, USA
| | - Galia Nissim
- a Department of Psychology , Stony Brook University , Stony Brook , NY, USA
| | - Suzanne Vaccaro
- a Department of Psychology , Stony Brook University , Stony Brook , NY, USA
| | - Jordan L Harris
- b Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center, PA, USA
| | - Oliver Lindhiem
- c Department of Psychiatry , University of Pittsburgh School of Medicine , PA , USA
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