151
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Bayrampour H, McDonald S, Tough S. Risk factors of transient and persistent anxiety during pregnancy. Midwifery 2015; 31:582-9. [PMID: 25823754 DOI: 10.1016/j.midw.2015.02.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 12/05/2014] [Accepted: 02/20/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE chronic poor mental health over the course of pregnancy contributes to greater adverse maternal and child outcomes. Identifying women with chronic depressive or anxiety symptoms can provide opportunities to reduce distress and improve pregnancy outcomes. The objective of this study was to determine risk factors of chronic antenatal depressive and anxiety symptoms using a longitudinal pregnancy cohort in Alberta, Canada. METHODS women with singleton pregnancies were included (N=3021). Anxiety and depressive symptoms were measured in the second and third trimesters using the Spielberger State-Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale, respectively. On the basis of the timing and persistence of symptoms, the following three mutually exclusive subgroups for each anxiety and depressive symptoms were created: never symptomatic, symptomatic only in the second trimester, and symptomatic at both time points. Separate logistic regression models were used to derive risk factors for each subgroup. FINDINGS women with chronic anxiety or depressive symptoms were distinguished from those with transient symptoms or no symptoms by their optimism scores, in which less optimistic pregnant women had a four-fold increased risk for developing chronic depressive or anxiety symptoms compared with more optimistic women (AOR varied from 4.30 to 4.93). Additionally, high perceived stress, low social support, history of mental health issues were common predictors of chronic anxiety and depressive symptoms in pregnancy. Partner tension was the exclusive predictor of anxiety symptoms (AOR varied from 1.94 to 2.31) and poor physical health (AOR 2.54; 95% CI 1.32-4.89), unplanned pregnancy (AOR 3.05; 95% CI 1.61-5.79), and infertility treatments (AOR 4.98; 95% CI 1.85-13.39) were unique predictors of chronic depressive symptoms. CONCLUSIONS knowledge of the risk factors of chronic poor mental health during pregnancy might inform the development of effective strategies within the limited resources of health-care systems to target populations with greater needs for interventions.
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Affiliation(s)
- Hamideh Bayrampour
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Alberta Centre for Child, Family & Community Research - Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8.
| | - Sheila McDonald
- Maternal-Child Health, Research and Innovation, Population, Public, and Aboriginal Health, Alberta Health Services, Southport Atrium, ♯ 2240, 10101 Southport Rd. SW, Calgary, AB, Canada T2W 3N2.
| | - Suzanne Tough
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Alberta Centre for Child, Family & Community Research - Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8; Alberta Innovates Health Solutions, Canada.
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152
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Cognitive neuroscience, developmental psychology, and education: Interdisciplinary development of an intervention for low socioeconomic status kindergarten children. Trends Neurosci Educ 2015. [DOI: 10.1016/j.tine.2015.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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153
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Babb JA, Deligiannidis KM, Murgatroyd CA, Nephew BC. Peripartum depression and anxiety as an integrative cross domain target for psychiatric preventative measures. Behav Brain Res 2015; 276:32-44. [PMID: 24709228 PMCID: PMC4185260 DOI: 10.1016/j.bbr.2014.03.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/21/2014] [Accepted: 03/24/2014] [Indexed: 11/20/2022]
Abstract
Exposure to high levels of early life stress has been identified as a potent risk factor for neurodevelopmental delays in infants, behavioral problems and autism in children, but also for several psychiatric illnesses in adulthood, such as depression, anxiety, autism, and posttraumatic stress disorder. Despite having robust adverse effects on both mother and infant, the pathophysiology of peripartum depression and anxiety are poorly understood. The objective of this review is to highlight the advantages of using an integrated approach addressing several behavioral domains in both animal and clinical studies of peripartum depression and anxiety. It is postulated that a greater focus on integrated cross domain studies will lead to advances in treatments and preventative measures for several disorders associated with peripartum depression and anxiety.
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Affiliation(s)
- Jessica A Babb
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA.
| | - Kristina M Deligiannidis
- Departments of Psychiatry and Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, MA 01605, USA.
| | | | - Benjamin C Nephew
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA.
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154
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Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard LM, Pariante CM. Effects of perinatal mental disorders on the fetus and child. Lancet 2014; 384:1800-19. [PMID: 25455250 DOI: 10.1016/s0140-6736(14)61277-0] [Citation(s) in RCA: 1282] [Impact Index Per Article: 128.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Perinatal mental disorders are associated with increased risk of psychological and developmental disturbances in children. However, these disturbances are not inevitable. In this Series paper, we summarise evidence for associations between parental disorders and offspring outcomes from fetal development to adolescence in high-income, middle-income, and low-income countries. We assess evidence for mechanisms underlying transmission of disturbance, the role of mediating variables (underlying links between parent psychopathology and offspring outcomes) and possible moderators (which change the strength of any association), and focus on factors that are potentially modifiable, including parenting quality, social (including partner) and material support, and duration of the parental disorder. We review research of interventions, which are mostly about maternal depression, and emphasise the need to both treat the parent's disorder and help with associated caregiving difficulties. We conclude with policy implications and underline the need for early identification of those parents at high risk and for more early interventions and prevention research, especially in socioeconomically disadvantaged populations and low-income countries.
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Affiliation(s)
- Alan Stein
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Rebecca M Pearson
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; Elizabeth Blackwell Institute for Health Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Elizabeth Rapa
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Louise M Howard
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
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155
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Davis EP, Pfaff D. Sexually dimorphic responses to early adversity: implications for affective problems and autism spectrum disorder. Psychoneuroendocrinology 2014; 49:11-25. [PMID: 25038479 PMCID: PMC4165713 DOI: 10.1016/j.psyneuen.2014.06.014] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/28/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
During gestation, development proceeds at a pace that is unmatched by any other stage of the life cycle. For these reasons the human fetus is particularly susceptible not only to organizing influences, but also to pathogenic disorganizing influences. Growing evidence suggests that exposure to prenatal adversity leads to neurological changes that underlie lifetime risks for mental illness. Beginning early in gestation, males and females show differential developmental trajectories and responses to stress. It is likely that sex-dependent organization of neural circuits during the fetal period influences differential vulnerability to mental health problems. We consider in this review evidence that sexually dimorphic responses to early life stress are linked to two developmental disorders: affective problems (greater female prevalence) and autism spectrum disorder (greater male prevalence). Recent prospective studies illustrating the neurodevelopmental consequences of fetal exposure to stress and stress hormones for males and females are considered here. Plausible biological mechanisms including the role of the sexually differentiated placenta are discussed.
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Affiliation(s)
- Elysia Poggi Davis
- Neurodevelopmental Research Program, Department of Psychology, University of Denver, Denver, CO, USA; Department of Psychiatry and Human Behavior, University of California Irvine, Orange, CA 92868, USA.
| | - Donald Pfaff
- Laboratory of Neurobiology and Behavior, The Rockefeller University, New York, NY 10021, USA
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156
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Bayrampour H, McDonald S, Fung T, Tough S. Reliability and validity of three shortened versions of the State Anxiety Inventory scale during the perinatal period. J Psychosom Obstet Gynaecol 2014; 35:101-7. [PMID: 25123986 DOI: 10.3109/0167482x.2014.950218] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The screening for anxiety in obstetric settings has been challenging due to time and knowledge constraints. Brief, valid, and reliable instruments can provide health care professionals with a quick and easy method to assess anxiety. Three six-item forms of the State Anxiety Inventory scale have been constructed. The purpose of this study was to evaluate and compare the psychometric properties of these short versions in the perinatal period. Data were drawn from a longitudinal pregnancy cohort in Alberta, Canada. Internal consistency of the shortened versions was assessed. Confirmatory factor analysis was conducted to estimate and compare indicators of fit during pregnancy and at 4 and 12 months postpartum. All shortened scales demonstrated high internal consistency and reliability, with alphas ranging from 0.81 to 0.85. All fit indices were greater than 0.93, implying a good fit between each model and our data. In the model comparisons, the Marteau and Bekker scale provided a more robust fit to data obtained during pregnancy and the early postpartum period. At 12 months postpartum, the Chlan et al. form demonstrated the best fit of the three versions. The shortened scales appear to have acceptable psychometric properties. Brief scales have the potential to provide an economical means of assessing perinatal anxiety and can be considered as equivalent alternatives to the full-scale version.
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157
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Bielas H, Arck P, Bruenahl C, Walitza S, Grünblatt E. Prenatal stress increases the striatal and hippocampal expression of correlating c‐FOS and serotonin transporters in murine offspring. Int J Dev Neurosci 2014; 38:30-5. [DOI: 10.1016/j.ijdevneu.2014.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/25/2014] [Accepted: 07/25/2014] [Indexed: 12/16/2022] Open
Affiliation(s)
- H. Bielas
- University Clinics of Child and Adolescent PsychiatryUniversity of ZurichNeumünsterallee 98032ZurichSwitzerland
- Department of Psychosomatics and PsychiatryUniversity Children's Hospital ZurichZurichSwitzerland
| | - P. Arck
- Laboratory for Experimental Feto‐Maternal MedicineUniversity Medical Center HamburgHamburgGermany
| | - C.A. Bruenahl
- Department of Psychosomatic Medicine and PsychotherapyUniversity Medical Center HamburgHamburgGermany
| | - S. Walitza
- University Clinics of Child and Adolescent PsychiatryUniversity of ZurichNeumünsterallee 98032ZurichSwitzerland
- Neuroscience Center ZurichUniversity of Zurich and ETH ZurichSwitzerland
| | - E. Grünblatt
- University Clinics of Child and Adolescent PsychiatryUniversity of ZurichNeumünsterallee 98032ZurichSwitzerland
- Neuroscience Center ZurichUniversity of Zurich and ETH ZurichSwitzerland
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158
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Abstract
Fetal development is a critical period for shaping the lifelong health of an individual. However, the fetus is susceptible to internal and external stimuli that can lead to adverse long-term health consequences. Glucocorticoids are an important developmental switch, driving changes in gene regulation that are necessary for normal growth and maturation. The fetal hypothalamic-pituitary-adrenal (HPA) axis is particularly susceptible to long-term programming by glucocorticoids; these effects can persist throughout the life of an organism. Dysfunction of the HPA axis as a result of fetal programming has been associated with impaired brain growth, altered behaviour and increased susceptibility to chronic disease (such as metabolic and cardiovascular disease). Moreover, the effects of glucocorticoid-mediated programming are evident in subsequent generations, and transmission of these changes can occur through both maternal and paternal lineages.
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Affiliation(s)
- Vasilis G Moisiadis
- Department of Physiology, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Stephen G Matthews
- Departments of Obstetrics and Gynaecology, Medicine and Physiology, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
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159
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Negrón-Oyarzo I, Neira D, Espinosa N, Fuentealba P, Aboitiz F. Prenatal Stress Produces Persistence of Remote Memory and Disrupts Functional Connectivity in the Hippocampal-Prefrontal Cortex Axis. Cereb Cortex 2014; 25:3132-43. [PMID: 24860018 DOI: 10.1093/cercor/bhu108] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Prenatal stress is a risk factor for the development of neuropsychiatric disorders, many of which are commonly characterized by an increased persistence of aversive remote memory. Here, we addressed the effect of prenatal stress on both memory consolidation and functional connectivity in the hippocampal-prefrontal cortex axis, a dynamical interplay that is critical for mnemonic processing. Pregnant mice of the C57BL6 strain were subjected to restraint stressed during the last week of pregnancy, and male offspring were behaviorally tested at adulthood for recent and remote spatial memory performance in the Barnes Maze test under an aversive context. Prenatal stress did not affect the acquisition or recall of recent memory. In contrast, it produced the persistence of remote spatial memory. Memory persistence was not associated with alterations in major network rhythms, such as hippocampal sharp-wave ripples (SWRs) or neocortical spindles. Instead, it was associated with a large decrease in the basal discharge activity of identified principal neurons in the medial prefrontal cortex (mPFC) as measured in urethane anesthetized mice. Furthermore, functional connectivity was disrupted, as the temporal coupling between neuronal discharge in the mPFC and hippocampal SWRs was decreased by prenatal stress. These results could be relevant to understand the biological basis of the persistence of aversive remote memories in stress-related disorders.
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Affiliation(s)
- Ignacio Negrón-Oyarzo
- Departamento de Psiquiatría, Facultad de Medicina, Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David Neira
- Departamento de Psiquiatría, Facultad de Medicina, Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nelson Espinosa
- Departamento de Psiquiatría, Facultad de Medicina, Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Fuentealba
- Departamento de Psiquiatría, Facultad de Medicina, Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile Fundación San Juan de Dios, Barcelona, Spain
| | - Francisco Aboitiz
- Departamento de Psiquiatría, Facultad de Medicina, Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
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160
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Segretin MS, Lipina SJ, Hermida MJ, Sheffield TD, Nelson JM, Espy KA, Colombo JA. Predictors of cognitive enhancement after training in preschoolers from diverse socioeconomic backgrounds. Front Psychol 2014; 5:205. [PMID: 24659975 PMCID: PMC3952047 DOI: 10.3389/fpsyg.2014.00205] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 02/23/2014] [Indexed: 11/13/2022] Open
Abstract
The association between socioeconomic status and child cognitive development, and the positive impact of interventions aimed at optimizing cognitive performance, are well-documented. However, few studies have examined how specific socio-environmental factors may moderate the impact of cognitive interventions among poor children. In the present study, we examined how such factors predicted cognitive trajectories during the preschool years, in two samples of children from Argentina, who participated in two cognitive training programs (CTPs) between the years 2002 and 2005: the School Intervention Program (SIP; N = 745) and the Cognitive Training Program (CTP; N = 333). In both programs children were trained weekly for 16 weeks and tested before and after the intervention using a battery of tasks assessing several cognitive control processes (attention, inhibitory control, working memory, flexibility and planning). After applying mixed model analyses, we identified sets of socio-environmental predictors that were associated with higher levels of pre-intervention cognitive control performance and with increased improvement in cognitive control from pre- to post-intervention. Child age, housing conditions, social resources, parental occupation and family composition were associated with performance in specific cognitive domains at baseline. Housing conditions, social resources, parental occupation, family composition, maternal physical health, age, group (intervention/control) and the number of training sessions were related to improvements in specific cognitive skills from pre- to post-training.
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Affiliation(s)
- M. Soledad Segretin
- Unidad de Neurobiología Aplicada, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Ciudad Autonoma de Buenos AiresBuenos Aires, Argentina
| | - Sebastián J. Lipina
- Unidad de Neurobiología Aplicada, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Ciudad Autonoma de Buenos AiresBuenos Aires, Argentina
| | - M. Julia Hermida
- Unidad de Neurobiología Aplicada, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Ciudad Autonoma de Buenos AiresBuenos Aires, Argentina
| | - Tiffany D. Sheffield
- Office of Research, University of NebraskaLincoln, NE, USA
- Department of Psychology, University of NebraskaLincoln, NE, USA
| | - Jennifer M. Nelson
- Office of Research, University of NebraskaLincoln, NE, USA
- Department of Psychology, University of NebraskaLincoln, NE, USA
| | - Kimberly A. Espy
- Department of Psychology, University of NebraskaLincoln, NE, USA
- Department of Psychology, University of OregonEugene, OR, USA
| | - Jorge A. Colombo
- Unidad de Neurobiología Aplicada, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Ciudad Autonoma de Buenos AiresBuenos Aires, Argentina
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161
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Bock J, Rether K, Gröger N, Xie L, Braun K. Perinatal programming of emotional brain circuits: an integrative view from systems to molecules. Front Neurosci 2014; 8:11. [PMID: 24550772 PMCID: PMC3913903 DOI: 10.3389/fnins.2014.00011] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 01/17/2014] [Indexed: 02/06/2023] Open
Abstract
Environmental influences such as perinatal stress have been shown to program the developing organism to adapt brain and behavioral functions to cope with daily life challenges. Evidence is now accumulating that the specific and individual effects of early life adversity on the functional development of brain and behavior emerge as a function of the type, intensity, timing and the duration of the adverse environment, and that early life stress (ELS) is a major risk factor for developing behavioral dysfunctions and mental disorders. Results from clinical as well as experimental studies in animal models support the hypothesis that ELS can induce functional “scars” in prefrontal and limbic brain areas, regions that are essential for emotional control, learning and memory functions. On the other hand, the concept of “stress inoculation” is emerging from more recent research, which revealed positive functional adaptations in response to ELS resulting in resilience against stress and other adversities later in life. Moreover, recent studies indicate that early life experiences and the resulting behavioral consequences can be transmitted to the next generation, leading to a transgenerational cycle of adverse or positive adaptations of brain function and behavior. In this review we propose a unifying view of stress vulnerability and resilience by connecting genetic predisposition and programming sensitivity to the context of experience-expectancy and transgenerational epigenetic traits. The adaptive maturation of stress responsive neural and endocrine systems requires environmental challenges to optimize their functions. Repeated environmental challenges can be viewed within the framework of the match/mismatch hypothesis, the outcome, psychopathology or resilience, depends on the respective predisposition and on the context later in life.
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Affiliation(s)
- Jörg Bock
- PG "Epigenetics and Structural Plasticity", Institute of Biology, Otto von Guericke University Magdeburg Magdeburg, Germany ; Center for Behavioral Brain Sciences Magdeburg, Germany
| | - Kathy Rether
- PG "Epigenetics and Structural Plasticity", Institute of Biology, Otto von Guericke University Magdeburg Magdeburg, Germany ; Department of Zoology/Developmental Neurobiology, Institute of Biology, Otto von Guericke University Magdeburg Magdeburg, Germany
| | - Nicole Gröger
- Department of Zoology/Developmental Neurobiology, Institute of Biology, Otto von Guericke University Magdeburg Magdeburg, Germany
| | - Lan Xie
- PG "Epigenetics and Structural Plasticity", Institute of Biology, Otto von Guericke University Magdeburg Magdeburg, Germany ; Department of Zoology/Developmental Neurobiology, Institute of Biology, Otto von Guericke University Magdeburg Magdeburg, Germany
| | - Katharina Braun
- Center for Behavioral Brain Sciences Magdeburg, Germany ; Department of Zoology/Developmental Neurobiology, Institute of Biology, Otto von Guericke University Magdeburg Magdeburg, Germany
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162
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Votava-Smith JK, Glickstein JS, Simpson LL, Williams IA. Comparison of method of conception in fetuses undergoing echocardiography at a tertiary referral center. Prenat Diagn 2014; 34:445-9. [PMID: 24496858 DOI: 10.1002/pd.4327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 01/11/2014] [Accepted: 01/12/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We compared the proportion of conception with and without in vitro fertilization (IVF) in fetuses with and without congenital heart disease (CHD). METHODS This was a retrospective review of fetal echocardiograms at Columbia University from 2007 to 2010, to identify the mode of conception. RESULTS Echocardiography was performed on 2828 fetuses, and 2761 (97.6%) had the method of conception documented. CHD was diagnosed in 22.4%, consisting predominantly of complex CHD. The proportion of IVF conception was lower in fetuses with CHD (6.9% CHD vs 10.3% no CHD, OR = 0.65 [95% CI 0.46-0.92], p = 0.01). IVF fetuses were conceived by elder mothers and were more likely part of a multiple gestation than those without IVF. In a multivariate model controlling for maternal age and multiple gestation, IVF was not associated with CHD diagnosis (OR = 1.1 [95% CI 0.77-1.7], p = 0.51). CONCLUSION At a tertiary referral center, fetuses with CHD were not more likely to be conceived by IVF after controlling for maternal age and multiple gestation. These results differ from those of several previous reports, which may be related to our study population, and the exclusion of isolated atrial shunts and patent ductus arteriosus, which are normal fetal findings.
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Affiliation(s)
- Jodie K Votava-Smith
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA
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163
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O'Connor TG, Monk C, Fitelson EM. Practitioner review: maternal mood in pregnancy and child development--implications for child psychology and psychiatry. J Child Psychol Psychiatry 2014; 55:99-111. [PMID: 24127722 PMCID: PMC3982916 DOI: 10.1111/jcpp.12153] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The empirical base suggesting a link between prenatal maternal anxiety, stress or depression and cognitive, behavioral, and biological outcomes in the infant and child has increased dramatically in the past 10 years. METHODS In this review, we consider the relevance of prenatal maternal mood for child mental health practitioners; the empirical base for a likely causal impact of the link between prenatal anxiety, depression, or stress and child outcomes; the degree to which the available evidence is sufficient for informing or altering clinical practice; and the possible role of prenatal interventions for promoting child health and development. A selective review of PubMed, Cochrane Library and other sources was undertaken. FINDINGS Clinically significant links between maternal prenatal distress and child behavioral and cognitive outcomes have been reported; predictions to stress physiology, immunology, and neurodevelopment have been reported but the effect sizes and clinical significance is less clear. Several candidate mechanisms have been proposed, with some supporting evidence. Many behavioral treatments for prenatal maternal distress exist, but their application to promoting child health is largely unknown. CONCLUSIONS Research on maternal prenatal distress is a good example of translational research and offers a strong paradigm for promoting interdisciplinary clinical research on child health and development.
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164
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Brunst KJ, Enlow MB, Kannan S, Carroll KN, Coull BA, Wright RJ. Effects of Prenatal Social Stress and Maternal Dietary Fatty Acid Ratio on Infant Temperament: Does Race Matter? ACTA ACUST UNITED AC 2014; 4. [PMID: 25328835 PMCID: PMC4197958 DOI: 10.4172/2161-1165.1000167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Infant temperament predicts a range of developmental and behavioral outcomes throughout childhood. Both maternal fatty acid intake and psychosocial stress exposures during pregnancy may influence infant temperament. Furthermore, maternal race may modify prenatal diet and stress effects. The goals of this study are to examine the joint effects of prenatal diet and stress and the modifying effects of race on infant behavior. METHODS Analyses included N=255 mother-infant dyads, primarily minorities (21% Blacks; 42% Hispanics), enrolled in an urban pregnancy cohort. Maternal prenatal stress was indexed by a negative life events (NLEs) score on the Crisis in Family Systems-Revised survey. Prenatal total daily intakes of polyunsaturated fatty acids (PUFAs) (n3, n6) were estimated from a food frequency questionnaire; n3:n6 ratios were calculated. Mothers completed the Infant Behavior Questionnaire-Revised (IBQ-R), a measure of infant temperament, when the children were 6 months old. Three commonly used dimensions were derived: Orienting & Regulation, Extraversion, and Negative Affectivity. Associations among prenatal stress, maternal n3:n6 ratio, and race/ethnicity on infant temperament, controlling for maternal education and age and child sex, were examined. RESULTS Among Blacks, prenatal stress effects on infant Orienting & Regulation scores were modified by maternal n3:n6 ratios (p=0.03): As NLEs increased, lower n3:n6 ratios predicted lower infant Orienting & Regulation scores, whereas higher n3:n6 ratios attenuated the effect of prenatal stress. There were no main or interaction effects predicting Extraversion or Negative Affectivity. CONCLUSIONS An optimal PUFA ratio may protect the fetus from stress effects on infant behavior, particularly among Blacks. These findings may have implications for later neurodevelopment and social functioning predicted by early temperamental characteristics.
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Affiliation(s)
- Kelly J Brunst
- Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Michelle Bosquet Enlow
- Boston Children's Hospital, Department of Psychiatry, Program for Behavioral Science and Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, AT-120.3, Mailstop BCH 3199, Boston, MA 02115, USA
| | - Srimathi Kannan
- Human Nutrition and Dietetics, College of Agricultural Sciences, Southern Illinois University, 1205 Lincoln Drive, Carbondale, IL 62901, USA
| | - Kecia N Carroll
- Department of Pediatrics, Vanderbilt University School of Medicine, 1161 21st Avenue, Nashville, TN 37232, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Rosalind J Wright
- Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA ; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, New York, NY 10029, USA
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Mina TH, Reynolds RM. Mechanisms linking in utero stress to altered offspring behaviour. Curr Top Behav Neurosci 2014; 18:93-122. [PMID: 24577734 DOI: 10.1007/7854_2014_291] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Development in utero is recognised as a determinant of health in later life, a concept known as early life 'programming'. Several studies in humans have now shown a link between in utero stressors of maternal stress, anxiety and depression and adverse behavioural outcomes for the offspring including poorer cognitive function and behavioural and emotional problems. These behaviours are observed from the very early neonatal period and appear to persist through to adulthood. Underlying mechanisms are not known but overexposure of the developing foetus to glucocorticoids has been proposed. Dysregulation of the maternal and offspring hypothalamic-pituitary-adrenal (HPA) axis has been proposed as a mechanism linking in utero stress with offspring behavioural outcomes. Studies suggest that altered circulating levels of maternal cortisol during pregnancy and/or changes in placental gene expression or methylation, which result in increased glucocorticoid transfer to the developing foetus, are linked to changes in offspring behaviour and in activity of the offspring HPA axis. Further understanding of the underlying pathways and identification of any gestation of vulnerability are needed to help design interventions to reduce in utero stress and improve behavioural outcomes in the offspring.
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Affiliation(s)
- Theresia H Mina
- Endocrinology Unit, Queen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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166
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Infant cortisol and behavioral habituation to weekly maternal separations: links with maternal prenatal cortisol and psychosocial stress. Psychoneuroendocrinology 2013; 38:2863-74. [PMID: 24103888 DOI: 10.1016/j.psyneuen.2013.07.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/09/2013] [Accepted: 07/23/2013] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Our aim was to examine infants' behavioral and physiological stress responses to three weekly maternal separations, in relation to maternal prenatal psychosocial stress and cortisol. The hypothesis was that more prenatal stress and higher cortisol concentrations would predict smaller decreases in negative behavior and cortisol responses over the separations (i.e. less habituation). METHODS General and pregnancy-related feelings of stress and anxiety, as well as circadian cortisol levels, were measured in 107 mothers in the third trimester of pregnancy. At 9 months of age, infants were subjected to three weekly 1-h maternal separations in their homes. Salivary cortisol was obtained from the infants prior to the separation and at 35, 75, and 90 min after the mother had left. For each separation, the area under the curve to the ground (AUCg) was calculated to measure the infants' cortisol response, and the sum of the time spent crying and fussing was calculated to measure the infants' behavioral response. RESULTS Maternal pregnancy cortisol awakening response (CAR) significantly predicted infants' cortisol and behavioral responses. A lower CAR was related to a decreasing cortisol response, while a higher CAR was related to a stable cortisol response over all separations, as well as to less crying and fussing over all separations. CONCLUSIONS Increased maternal prenatal stress, as measured by the CAR, is related to altered behavioral and cortisol responses to a repeated stressor in the 9-month-old infant. These responses might result in prolonged periods with high cortisol levels that may affect the child's development.
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Henderson J, Redshaw M. Anxiety in the perinatal period: antenatal and postnatal influences and women’s experience of care. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2013.835037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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168
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Weikum WM, Brain U, Chau CMY, Grunau RE, Boyce WT, Diamond A, Oberlander TF. Prenatal serotonin reuptake inhibitor (SRI) antidepressant exposure and serotonin transporter promoter genotype (SLC6A4) influence executive functions at 6 years of age. Front Cell Neurosci 2013; 7:180. [PMID: 24130516 PMCID: PMC3795328 DOI: 10.3389/fncel.2013.00180] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/24/2013] [Indexed: 11/21/2022] Open
Abstract
Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants and maternal depression may affect prefrontal cognitive skills (executive functions; EFs) including self-control, working memory and cognitive flexibility. We examined long-term effects of prenatal SRI exposure on EFs to determine whether effects are moderated by maternal mood and/or genetic variations in SLC6A4 (a gene that codes for the serotonin transporter [5-HTT] central to the regulation of synaptic serotonin levels and behavior). Children who were exposed to SRIs prenatally (SRI-exposed N = 26) and non-exposed (N = 38) were studied at age 6 years (M = 6.3; SD = 0.5) using the Hearts & Flowers task (H&F) to assess EFs. Maternal mood was measured during pregnancy (3rd trimester) and when the child was age 6 years (Hamilton Depression Scale). Parent reports of child behavior were also obtained (MacArthur Health & Behavior Questionnaire). Parents of prenatally SRI-exposed children reported fewer child externalizing and inattentive (ADHD) behaviors. Generalized estimate equation modeling showed a significant 3-way interaction between prenatal SRI exposure, SLC6A4 variant, and maternal mood at the 6-year time-point on H&F accuracy. For prenatally SRI-exposed children, regardless of maternal mood, the H&F accuracy of children with reduced 5HTT expression (a short [S] allele) remained stable. Even with increasing maternal depressive symptoms (though all below clinical threshold), EFs of children with at least one short allele were comparable to children with the same genotype whose mothers reported few if any depressive symptoms—in this sense they showed resilience. Children with two long (L) alleles were more sensitive to context. When their mothers had few depressive symptoms, LL children showed extremely good EF performance—better than any other group. When their mothers reported more depressive symptoms, LL children's EF performance was worse than that of any other group. In the face of a mother with a more depressed mood, EFs were best preserved in children prenatally exposed to SRIs and with at least one short SLC6A4 allele. Yet, prenatally-exposed LL children hold out promise of possibly superior EF if their mother's mood remains euthymic or improves.
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Affiliation(s)
- Whitney M Weikum
- Pediatrics, Child and Family Research Institute, University of British Columbia Vancouver, BC, Canada
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169
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Is there a viability-vulnerability tradeoff? Sex differences in fetal programming. J Psychosom Res 2013; 75:327-35. [PMID: 24119938 PMCID: PMC3796732 DOI: 10.1016/j.jpsychores.2013.07.009] [Citation(s) in RCA: 244] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 06/30/2013] [Accepted: 07/14/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE In this paper we evaluate the evidence for sex differences in fetal programming within the context of the proposed viability-vulnerability tradeoff. METHODS We briefly review the literature on the factors contributing to primary and secondary sex ratios. Sex differences in fetal programming are assessed by summarizing previously published sex difference findings from our group (6 studies) and also new analyses of previously published findings in which sex differences were not reported (6 studies). RESULTS The review and reanalysis of studies from our group are consistent with the overwhelming evidence of increasing risk for viability among males exposed to environmental adversity early in life. New evidence reported here support the argument that females, despite their adaptive agility, also are influenced by exposure to early adversity. Two primary conclusions are (i) female fetal exposure to psychobiological stress selectively influences fear/anxiety, and (ii) the effects of female fetal exposure to stress persist into preadolescence. These persisting effects are reflected in increased levels of anxiety, impaired executive function and neurological markers associated with these behaviors. CONCLUSIONS A tacit assumption is that females, with their adaptive flexibility early in gestation, escape the consequences of early life exposure to adversity. We argue that the consequences of male exposure to early adversity threaten their viability, effectively culling the weak and the frail and creating a surviving cohort of the fittest. Females adjust to early adversity with a variety of strategies, but their escape from the risk of early mortality and morbidity has a price of increased vulnerability expressed later in development.
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170
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Reynolds RM, Labad J, Buss C, Ghaemmaghami P, Räikkönen K. Transmitting biological effects of stress in utero: implications for mother and offspring. Psychoneuroendocrinology 2013; 38:1843-9. [PMID: 23810315 DOI: 10.1016/j.psyneuen.2013.05.018] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 05/29/2013] [Indexed: 12/15/2022]
Abstract
The developing foetus makes adaptations to an adverse in utero environment which may lead to permanent changes in structure and physiology, thus 'programming' the foetus to risk of ill health in later life. Epidemiological studies have shown associations between low birth weight, a surrogate marker of an adverse intrauterine environment, and a range of diseases in adult life including cardiometabolic and psychiatric disease. These associations do not apply exclusively to low birth weight babies but also to newborns within the normal birth weight range. Early life stress, including stressors in the prenatal and early postnatal period, is a key factor that can have long-term effects on offspring health. Animal studies show this is mediated through changes in the maternal and foetal hypothalamic-pituitary-adrenal axes resulting in foetal exposure to excess glucocorticoids. Data in humans are more limited but support that the biological effects of stress in utero may be transmitted through changes in glucocorticoid action or metabolism. Common contemporary physical and social stressors of maternal obesity and socio-economic deprivation impact on the maternal response to pregnancy and the prevailing hormonal milieu that the developing foetus will be exposed to. Prenatal stress may also be compounded by early postnatal stresses such as childhood maltreatment with resultant adverse effects for the offspring. Understanding of the mechanisms whereby these stressors are transmitted from mother to foetus will not only improve our knowledge of normal foetal development but will also help identify novel pathways for early intervention either in the periconceptional, pregnancy or the early postpartum period.
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Affiliation(s)
- Rebecca M Reynolds
- Endocrinology Unit, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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171
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Corwin EJ, Guo Y, Pajer K, Lowe N, McCarthy D, Schmiege S, Weber M, Pace T, Stafford B. Immune dysregulation and glucocorticoid resistance in minority and low income pregnant women. Psychoneuroendocrinology 2013; 38:1786-96. [PMID: 23541234 PMCID: PMC4082825 DOI: 10.1016/j.psyneuen.2013.02.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/19/2013] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
Abstract
Chronic prenatal stress contributes to poor birth outcomes for women and infants. Importantly, poor birth outcomes are most common among minority and low income women. To investigate underlying mechanisms, we tested the hypothesis that chronic stress related to minority or low income status is associated with glucocorticoid resistance as indicated by disruption in the cytokine-glucocorticoid feedback circuit. Home visits were conducted during which 3rd trimester pregnant women completed stress and depression surveys and provided blood for pro- and anti-inflammatory cytokines. Saliva was collected 5 times the preceding day for diurnal cortisol levels. For statistical analyses, women were grouped 3 ways, by race, income, and the presence or absence of either of those risk factors; this last group was labeled high or low general risk. Immune regulation was evaluated by evidence of a functioning negative feedback relationship between cytokines and cortisol. Of 96 participants, 18 were minority, 22 of low income, and 29 either minority or low income (high general risk). Pearson partial correlation identified a significant negative relationship between cortisol area under the curve (AUC) and pro- to anti-inflammatory cytokine ratios in the low general risk women (i.e., Caucasian, higher income) including IFNγ/IL10 (r=-0.73, p<0.0001), IL6/IL10 (r=-0.38, p=0.01), IL1β/IL10 (r=-0.44, p=0.004) and TNFα/IL10 (r=-0.41; p=0.005); no such correlations existed in the high general risk women (i.e., minority, low income) for (IFNγ/IL10: r=-0.25, p=0.43; IL6/IL10: r=0.12, p=0.70; IL1 β/IL10: r=0.05, p=0.87; TNFα/IL10: r=0.10; p=0.75), suggestive of glucocorticoid resistance. Cortisol levels throughout the day also were higher in minority and high general risk groups (p<0.05). Without cytokine glucocorticoid feedback, a pregnant woman's ability to regulate inflammation is limited, potentially contributing to adverse maternal and infant outcomes.
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Affiliation(s)
- Elizabeth J. Corwin
- Emory University, Nell Hodgson Woodruff School of Nursing and Department of Physiology, United States
,Corresponding author. Tel.: +1 404 712 9805., (E.J. Corwin).
| | - Ying Guo
- Emory University, Rollins School of Public Health, United States
| | | | - Nancy Lowe
- University of Colorado Denver, College of Nursing, United States
| | - Donna McCarthy
- The Ohio State University, College of Nursing, United States
| | - Sarah Schmiege
- University of Colorado Denver, College of Nursing, United States
| | - Mary Weber
- University of Colorado Denver, School of Nursing, United States
| | - Thaddeus Pace
- Emory University, College of Medicine, United States
| | - Brian Stafford
- University of Colorado Denver, College of Medicine, United States
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173
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Lipina S, Segretin S, Hermida J, Prats L, Fracchia C, Camelo JL, Colombo J. Linking childhood poverty and cognition: environmental mediators of non-verbal executive control in an Argentine sample. Dev Sci 2013; 16:697-707. [PMID: 24033575 DOI: 10.1111/desc.12080] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 04/12/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Sebastián Lipina
- Unidad de Neurobiología Aplicada (UNA, CEMIC-CONICET); Buenos Aires; Argentina
| | - Soledad Segretin
- Unidad de Neurobiología Aplicada (UNA, CEMIC-CONICET); Buenos Aires; Argentina
| | - Julia Hermida
- Unidad de Neurobiología Aplicada (UNA, CEMIC-CONICET); Buenos Aires; Argentina
| | - Lucía Prats
- Unidad de Neurobiología Aplicada (UNA, CEMIC-CONICET); Buenos Aires; Argentina
| | - Carolina Fracchia
- Unidad de Neurobiología Aplicada (UNA, CEMIC-CONICET); Buenos Aires; Argentina
| | | | - Jorge Colombo
- Unidad de Neurobiología Aplicada (UNA, CEMIC-CONICET); Buenos Aires; Argentina
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174
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Walker MG, Windrim C, Ellul KN, Kingdom JCP. Web-based education for placental complications of pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:334-339. [PMID: 23660041 DOI: 10.1016/s1701-2163(15)30961-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether a web-based education strategy could improve maternal knowledge of placental complications of pregnancy and reduce maternal anxiety in high risk-pregnancies. METHODS Prospective study in the Placenta Clinic at Mount Sinai Hospital, Toronto, Ontario. Maternal demographics and Internet usage were recorded at the patient's baseline appointment. Placental knowledge was determined using structured verbal and illustrative assessments. The six-item State-Trait Anxiety Inventory (STAI) was administered to assess baseline maternal anxiety. Women were asked to visit the Placenta Clinic website for a minimum of 15 minutes before their follow-up appointment, at which time their placental knowledge and STAI assessments were repeated. RESULTS Eighteen women were included in the study. Patient knowledge at the baseline appointment was generally poor (median score 10.5 out of a maximum score of 27, range 1 to 22), with major deficits in basic placental knowledge, placenta previa/increta, and preeclampsia. At the follow-up appointment, placental knowledge was significantly improved (median score 23, range 10 to 27; P < 0.001). Educational status (high school or less vs. college or more) had no effect on either baseline knowledge or knowledge improvement. Maternal anxiety at baseline (median score 12 out of a maximum score of 24, range 6 to 23) was significantly reduced at the follow-up appointment (median score 8.5, range 6 to 20; P = 0.005). CONCLUSION Deficits in maternal knowledge of placental complications of pregnancy in high-risk pregnant women were substantial but easily rectified with a disease-targeted web-based educational resource. This intervention significantly improved patient knowledge and significantly reduced maternal anxiety.
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Affiliation(s)
- Melissa G Walker
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto ON
| | - Catherine Windrim
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto ON
| | - Katie N Ellul
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto ON
| | - John C P Kingdom
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto ON
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175
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McMahon CA, Boivin J, Gibson FL, Hammarberg K, Wynter K, Saunders D, Fisher J. Pregnancy-specific anxiety, ART conception and infant temperament at 4 months post-partum. Hum Reprod 2013; 28:997-1005. [DOI: 10.1093/humrep/det029] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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176
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Sullivan EL, Nousen EK, Chamlou KA. Maternal high fat diet consumption during the perinatal period programs offspring behavior. Physiol Behav 2012; 123:236-42. [PMID: 23085399 DOI: 10.1016/j.physbeh.2012.07.014] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 07/20/2012] [Accepted: 07/30/2012] [Indexed: 12/16/2022]
Abstract
The environment that a developing offspring experiences during the perinatal period is markedly influenced by maternal health and diet composition. Evidence from both epidemiological studies and animal models indicates that maternal diet and metabolic status play a critical role in programming the neural circuitry that regulates behavior, resulting in long-term consequences for offspring behavior. Maternal diet and metabolic state influence the behavior of offspring directly by impacting the intrauterine environment and indirectly by modulating maternal behavior. The mechanisms by which maternal diet and metabolic profile shape the perinatal environment remain largely unknown, but recent research has found that increases in inflammatory cytokines, nutrients (glucose and fatty acids), and hormones (insulin and leptin) affect the environment of the developing offspring. Offspring exposed to maternal obesity and high fat diet consumption during development are more susceptible to developing mental health and behavioral disorders such as anxiety, depression, attention deficit hyperactivity disorder, and autism spectrum disorders. Recent evidence suggests that this increased risk for behavioral disorders is driven by modifications in the development of neural pathways involved in behavioral regulation. In particular, research indicates that the development of the serotonergic system is impacted by exposure to maternal obesity and high fat diet consumption, and this disruption may underlie many of the behavioral disturbances observed in these offspring. Given the high rates of obesity and high fat diet consumption in pregnant women, it is vital to examine the influence that maternal nutrition and metabolic profile have on the developing offspring.
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Affiliation(s)
- Elinor L Sullivan
- Department of Biology, University of Portland, Portland, OR, USA; Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA.
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177
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Buss C, Entringer S, Wadhwa PD. Fetal programming of brain development: intrauterine stress and susceptibility to psychopathology. Sci Signal 2012; 5:pt7. [PMID: 23047922 DOI: 10.1126/scisignal.2003406] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The fetal brain is highly plastic and is not only receptive to but requires cues from its environment to develop properly. Based on an understanding of evolutionary biology, developmental plasticity, and life history theory, one can predict that stressors are an important environmental condition that may influence brain development. In fact, the available empirical evidence appears to support the notion that exposure to excess stress in intrauterine life has the potential to adversely affect short- and long-term neurodevelopmental outcomes with implications for altered susceptibility for mental health disorders in childhood and adult life. In this presentation, we provide a rationale for proposing that endocrine and inflammatory stress mediators are key candidate pathways for programming brain development. These mediators are responsive to a diverse set of intrauterine perturbations and alter key signaling pathways critical for brain development, including but not limited to mammalian target of rapamycin, Wnt (wingless), Sonic hedgehog, and reelin signaling. We suggest that recent advances in neuroimaging and other methods now afford us an unprecedented opportunity to advance our understanding of this important topic. Additionally, we provide empirical evidence from two recently published papers for fetal programming of human brain development. We conclude by suggesting some future directions for expanding this field of research.
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Affiliation(s)
- Claudia Buss
- Department of Pediatrics, University of California, Irvine, School of Medicine, Irvine, CA 92697, USA.
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Abstract
The objective of this study is to review and summarize available evidence regarding the impact of amphetamines on pregnancy, the newborn infant and the child. Amphetamines are neurostimulants and neurotoxins that are some of the most widely abused illicit drugs in the world. Users are at high risk of psychiatric co-morbidities, and evidence suggests that perinatal amphetamine exposure is associated with poor pregnancy outcomes, but data is confounded by other adverse factors associated with drug-dependency. Data sources are Government data, published articles, conference abstracts and book chapters. The global incidence of perinatal amphetamine exposure is most likely severely underestimated but acknowledged to be increasing rapidly, whereas exposure to other drugs, for example, heroin, is decreasing. Mothers known to be using amphetamines are at high risk of psychiatric co-morbidity and poorer obstetric outcomes, but their infants may escape detection, because the signs of withdrawal are usually less pronounced than opiate-exposed infants. There is little evidence of amphetamine-induced neurotoxicity and long-term neurodevelopmental impact, as data is scarce and difficult to extricate from the influence of other factors associated with children living in households where one or more parent uses drugs in terms of poverty and neglect. Perinatal amphetamine-exposure is an increasing worldwide concern, but robust research, especially for childhood outcomes, remains scarce. We suggest that exposed children may be at risk of ongoing developmental and behavioral impediment, and recommend that efforts be made to improve early detection of perinatal exposure and to increase provision of early-intervention services for affected children and their families.
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179
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Systematic review of yoga for pregnant women: current status and future directions. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:715942. [PMID: 22927881 PMCID: PMC3424788 DOI: 10.1155/2012/715942] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 06/08/2012] [Indexed: 11/28/2022]
Abstract
Objectives. Yoga is used for a variety of immunological, neuromuscular, psychological, and pain conditions. Recent studies indicate that it may be effective in improving pregnancy, labour, and birth outcomes. The purpose of this paper is to evaluate the existing literature on yoga for pregnancy. Methods. Six databases were searched using the terms “yoga AND pregnancy” and “yoga AND [post-natal OR post-partum]”. Trials were considered if they were controlled and evaluated a yoga intervention. All studies were evaluated for methodological quality according to the Jadad scale and the Delphi List. Results. Six trials were identified: three were randomized controlled trials (RCTs) and three were controlled trials (CTs). The methodological quality and reporting ranged from 0–5 on the Jadad scale and from 3–6 on the Delphi List. Findings from the RCT studies indicate that yoga may produce improvements in stress levels, quality of life, aspects of interpersonal relating, autonomic nervous system functioning, and labour parameters such as comfort, pain, and duration. Conclusions. The findings suggest that yoga is well indicated for pregnant women and leads to improvements on a variety of pregnancy, labour, and birth outcomes. However, RCTs are needed to provide more information regarding the utility of yoga interventions for pregnancy.
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180
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Davis EP, Sandman CA. Prenatal psychobiological predictors of anxiety risk in preadolescent children. Psychoneuroendocrinology 2012; 37:1224-33. [PMID: 22265195 PMCID: PMC3356791 DOI: 10.1016/j.psyneuen.2011.12.016] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 12/17/2011] [Accepted: 12/17/2011] [Indexed: 12/17/2022]
Abstract
Experimental animal models have demonstrated that one of the primary consequences of prenatal stress is increased fear and anxiety in the offspring. Few prospective human studies have evaluated the consequences of prenatal stress on anxiety during preadolescence. The purpose of this investigation is to determine the consequences of prenatal exposure to both maternal biological stress signals and psychological distress on anxiety in preadolescent children. Participants included 178 mother-child pairs. Maternal psychological distress (general anxiety, perceived stress, depression and pregnancy-specific anxiety) and biological stress signals were evaluated at 19, 25, and 31 gestational weeks. Anxiety was evaluated in the children at 6-9 years of age using the Child Behavior Checklist. Analyses revealed that prenatal exposure to elevated maternal cortisol, depression, perceived stress and pregnancy-specific anxiety was associated with increased anxiety in children. These associations remained after considering obstetric, sociodemographic and postnatal maternal psychological distress; factors that could influence child development. When all of the prenatal measures were considered together, cortisol and pregnancy-specific anxiety independently predicted child anxiety. Children exposed to elevated prenatal maternal cortisol and pregnancy-specific anxiety were at an increased risk for developing anxiety problems during the preadolescent period. This project identifies prenatal risk factors associated with lasting consequences for child mental health and raises the possibility that reducing maternal distress during the prenatal period will have long term benefits for child well-being.
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Affiliation(s)
- Elysia Poggi Davis
- Women and Children's Health and Well-Being Project, Department of Psychiatry & Human Behavior, University of California, Irvine, Orange, CA 92868, USA.
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181
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Dipietro JA. Maternal stress in pregnancy: considerations for fetal development. J Adolesc Health 2012; 51:S3-8. [PMID: 22794531 PMCID: PMC3402207 DOI: 10.1016/j.jadohealth.2012.04.008] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 11/25/2022]
Abstract
There is significant current interest in the degree to which prenatal exposures, including maternal psychological factors, influence child outcomes. Studies that detect an association between prenatal maternal psychological distress and child developmental outcomes are subject to a number of interpretative challenges in the inference of causality. Some of these are common to many types of prenatal exposures that must necessarily rely on observational designs. Such challenges include the correlation between prenatal and postnatal exposures and the potential role of other sources of shared influence, such as genetic factors. Others are more specific to this area of research. These include confounding between maternal report of child outcomes and the maternal psychological attributes under study, difficulties in distinguishing maternal stress from more ubiquitous aspects of maternal personality, and the lack of association between cortisol and measures of maternal psychological stress. This article considers these methodological issues and offers an additional methodology focused on fetal neurobehavior for discerning potential mechanisms that may mediate associations between maternal psychological functioning and the developing fetal nervous system.
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Affiliation(s)
- Janet A Dipietro
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
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182
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Sandman CA, Davis EP. Neurobehavioral risk is associated with gestational exposure to stress hormones. Expert Rev Endocrinol Metab 2012; 7:445-459. [PMID: 23144647 PMCID: PMC3493169 DOI: 10.1586/eem.12.33] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The developmental origins of disease or fetal programming model predict that early exposures to threat or adverse conditions have lifelong consequences that result in harmful outcomes for health. The maternal endocrine 'fight or flight' system is a source of programming information for the human fetus to detect threats and adjust their developmental trajectory for survival. Fetal exposures to intrauterine conditions including elevated stress hormones increase the risk for a spectrum of health outcomes depending on the timing of exposure, the timetable of organogenesis and the developmental milestones assessed. Recent prospective studies, reviewed here, have documented the neurodevelopmental consequences of fetal exposures to the trajectory of stress hormones over the course of gestation. These studies have shown that fetal exposures to biological markers of adversity have significant and largely negative consequences for fetal, infant and child emotional and cognitive regulation and reduced volume in specific brain structures.
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Affiliation(s)
- Curt A Sandman
- Department of Psychiatry & Human Behavior, Women and Children’s Health and Well-Being Project, University of California, Irvine, Orange, CA, USA
| | - Elysia Poggi Davis
- Department of Psychiatry & Human Behavior, Women and Children’s Health and Well-Being Project, University of California, Irvine, Orange, CA, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
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Buss C, Entringer S, Swanson JM, Wadhwa PD. The Role of Stress in Brain Development: The Gestational Environment's Long-Term Effects on the Brain. CEREBRUM : THE DANA FORUM ON BRAIN SCIENCE 2012; 2012:4. [PMID: 23447790 PMCID: PMC3574809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
During gestation, the fetal brain develops dramatically as structures and connections form, providing the foundation for all future development. The fetal environment plays a critical role in these early neural processes, for better or for worse. Scientists now know that exposure to maternal stress can sometimes have deleterious effects on the fetus, depending on the cause, timing, duration, and intensity of stress. Fortunately, postnatal interventions, such as a secure parent-infant bond and an enriched environment, can buffer the potential negative consequences.
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Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affective problems. Proc Natl Acad Sci U S A 2012; 109:E1312-9. [PMID: 22529357 DOI: 10.1073/pnas.1201295109] [Citation(s) in RCA: 407] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Stress-related variation in the intrauterine milieu may impact brain development and emergent function, with long-term implications in terms of susceptibility for affective disorders. Studies in animals suggest limbic regions in the developing brain are particularly sensitive to exposure to the stress hormone cortisol. However, the nature, magnitude, and time course of these effects have not yet been adequately characterized in humans. A prospective, longitudinal study was conducted in 65 normal, healthy mother-child dyads to examine the association of maternal cortisol in early, mid-, and late gestation with subsequent measures at approximately 7 y age of child amygdala and hippocampus volume and affective problems. After accounting for the effects of potential confounding pre- and postnatal factors, higher maternal cortisol levels in earlier but not later gestation was associated with a larger right amygdala volume in girls (a 1 SD increase in cortisol was associated with a 6.4% increase in right amygdala volume), but not in boys. Moreover, higher maternal cortisol levels in early gestation was associated with more affective problems in girls, and this association was mediated, in part, by amygdala volume. No association between maternal cortisol in pregnancy and child hippocampus volume was observed in either sex. The current findings represent, to the best of our knowledge, the first report linking maternal stress hormone levels in human pregnancy with subsequent child amygdala volume and affect. The results underscore the importance of the intrauterine environment and suggest the origins of neuropsychiatric disorders may have their foundations early in life.
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Brunton PJ, Holmes MC. Stress, brains and bairns: reviews from the 4th International Conference on the Parental Brain. Stress 2011; 14:577-80. [PMID: 21995524 DOI: 10.3109/10253890.2011.629557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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