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Parenti M, Melough MM, Lapehn S, MacDonald J, Bammler T, Firsick EJ, Choi HY, Derefinko KJ, Enquobahrie DA, Carroll KN, LeWinn KZ, Bush NR, Zhao Q, Sathyanarayana S, Paquette AG. Associations Between Prenatal Vitamin D and Placental Gene Expression. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.10.593571. [PMID: 38765981 PMCID: PMC11100832 DOI: 10.1101/2024.05.10.593571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Vitamin D is a hormone regulating gene transcription. Prenatal vitamin D has been linked to immune and vascular function in the placenta, a key organ of pregnancy. To date, studies of vitamin D and placental gene expression have focused on a limited number of candidate genes. Transcriptome-wide RNA sequencing can provide a more complete representation of the placental effects of vitamin D. Objective We investigated the association between prenatal vitamin D levels and placental gene expression in a large, prospective pregnancy cohort. Methods Participants were recruited in Shelby County, Tennessee in the Conditions Affecting Neurocognitive Development and Learning in Early childhood (CANDLE) study. Vitamin D level (plasma total 25-hydroxyvitatmin D, [25(OH)D]) was measured at mid-pregnancy (16-28 weeks' gestation) and delivery. Placenta samples were collected at birth. RNA was isolated and sequenced. We identified differentially expressed genes (DEGs) using adjusted linear regression models. We also conducted weighted gene co-expression network analysis (WGCNA). Results The median 25(OH)D of participants was 21.8 ng/mL at mid-pregnancy (N=774, IQR: 15.4-26.5 ng/mL) and 23.6 ng/mL at delivery (N=753, IQR: 16.8-29.1 ng/mL). Placental expression of 25 DEGs was associated with 25(OH)D at mid-pregnancy, but no DEG was associated with 25(OH)D at delivery. DEGs were related to energy metabolism, cytoskeletal function, and RNA transcription. Using WGCNA, we identified 2 gene modules whose expression was associated with 25(OH)D at mid-pregnancy and 1 module associated with 25(OH)D at delivery. These modules were enriched for genes related to mitochondrial and cytoskeletal function, and were regulated by transcription factors including ARNT2, BHLHE40, FOSL2, JUND, and NFKB1. Conclusions Our results indicate that 25(OH)D during mid-pregnancy, but not at delivery, is associated with placental gene expression at birth. Future research is needed to investigate a potential role of vitamin D in programming placental mitochondrial metabolism, intracellular transport, and transcriptional regulation during pregnancy.
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Affiliation(s)
- Mariana Parenti
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Melissa M. Melough
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, DE, United States
| | - Samantha Lapehn
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, WA, United States
| | - James MacDonald
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Theo Bammler
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Evan J. Firsick
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Hyo Young Choi
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Karen J. Derefinko
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, United States
- Department of Pharmacology, Addiction Science, and Toxicology, University of Tennessee Health Sciences Center, Memphis, TN, United States
| | | | - Kecia N. Carroll
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Qi Zhao
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Alison G. Paquette
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, WA, United States
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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Mancuso RA, Ross KM, Accortt E, Coussons-Read M, Okun ML, Irwin J, Carroll J, Hobel CJ, Schetter CD. Prenatal mood and anxiety disorders and associated cytokine changes. J Affect Disord 2024; 347:635-644. [PMID: 38070749 DOI: 10.1016/j.jad.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/11/2023] [Accepted: 12/02/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND We examined whether women with prenatal mood and anxiety disorders would exhibit differential pro- and anti-inflammatory marker trajectories during the prenatal and postpartum periods compared to women without these disorders. METHODS Approximately 179 pregnant women participated in a longitudinal study conducted in two urban areas. Blood samples for inflammatory markers were collected at six study visits. The Structured Clinical Interview for the DSM-IV (SCID) was administered to participants scoring above cutoffs on anxiety and depression. Pregnant women with SCID Axis I diagnoses of mood and/or anxiety disorders were compared to other participants on inflammatory markers. Multilevel modeling tested associations between SCID diagnoses and within-person interleukin (IL)6 and IL10 trajectories. RESULTS Prenatal SCID diagnoses were associated with linear, quadratic and cubic change in IL6 from prenatal to postpartum timepoints. Women with a prenatal SCID diagnosis had steeper decreases and increases in IL6 during prenatal and postpartum periods. SCID diagnoses were associated with lower IL10 in mid-pregnancy to postpartum (b = -0.078, SE = 0.019; p = .015). LIMITATIONS Future studies would benefit from a larger sample size and a larger number of participants with SCID diagnoses. Future research should also examine whether different prenatal Axis 1 diagnoses are associated with different patterns of immune response in pregnancy. CONCLUSIONS Pregnant women with prenatal mood and anxiety disorders had greater fluctuations in IL6 across prenatal and postpartum periods and lower IL10 through pregnancy and postpartum. They may have different proinflammatory states that remain after birth without a reciprocal anti-inflammatory response.
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Affiliation(s)
- Roberta A Mancuso
- Department of Psychology and Neuroscience, Regis University, Denver, CO, USA.
| | - Kharah M Ross
- Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada
| | - Eynav Accortt
- Reproductive Psychology Program, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mary Coussons-Read
- Department of Psychology, University of Colorado - Colorado Springs, Colorado Springs, CO, USA
| | - Michele L Okun
- Sleep and Biobehavioral Health Research Laboratory, University of Colorado - Colorado Springs, Colorado Springs, CO, USA
| | - Jessica Irwin
- Department of Psychology, University of La Verne, La Verne, CA, USA
| | - Judith Carroll
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Calvin J Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Sanders AFP, Tirado B, Seider NA, Triplett RL, Lean RE, Neil JJ, Miller JP, Tillman R, Smyser TA, Barch DM, Luby JL, Rogers CE, Smyser CD, Warner BB, Chen E, Miller GE. Prenatal exposure to maternal disadvantage-related inflammatory biomarkers: associations with neonatal white matter microstructure. Transl Psychiatry 2024; 14:72. [PMID: 38307841 PMCID: PMC10837200 DOI: 10.1038/s41398-024-02782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/04/2024] Open
Abstract
Prenatal exposure to heightened maternal inflammation has been associated with adverse neurodevelopmental outcomes, including atypical brain maturation and psychiatric illness. In mothers experiencing socioeconomic disadvantage, immune activation can be a product of the chronic stress inherent to such environmental hardship. While growing preclinical and clinical evidence has shown links between altered neonatal brain development and increased inflammatory states in utero, the potential mechanism by which socioeconomic disadvantage differentially impacts neural-immune crosstalk remains unclear. In the current study, we investigated associations between socioeconomic disadvantage, gestational inflammation, and neonatal white matter microstructure in 320 mother-infant dyads over-sampled for poverty. We analyzed maternal serum levels of four cytokines (IL-6, IL-8, IL-10, TNF-α) over the course of pregnancy in relation to offspring white matter microstructure and socioeconomic disadvantage. Higher average maternal IL-6 was associated with very low socioeconomic status (SES; INR < 200% poverty line) and lower neonatal corticospinal fractional anisotropy (FA) and lower uncinate axial diffusivity (AD). No other cytokine was associated with SES. Higher average maternal IL-10 was associated with lower FA and higher radial diffusivity (RD) in corpus callosum and corticospinal tracts, higher optic radiation RD, lower uncinate AD, and lower FA in inferior fronto-occipital fasciculus and anterior limb of internal capsule tracts. SES moderated the relationship between average maternal TNF-α levels during gestation and neonatal white matter diffusivity. When these interactions were decomposed, the patterns indicated that this association was significant and positive among very low SES neonates, whereby TNF-α was inversely and significantly associated with inferior cingulum AD. By contrast, among the more advantaged neonates (lower-to-higher SES [INR ≥ 200% poverty line]), TNF-α was positively and significantly associated with superior cingulum AD. Taken together, these findings suggest that the relationship between prenatal cytokine exposure and white matter microstructure differs as a function of SES. These patterns are consistent with a scenario where gestational inflammation's effects on white matter development diverge depending on the availability of foundational resources in utero.
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Affiliation(s)
- Ashley F P Sanders
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Brian Tirado
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Nicole A Seider
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Regina L Triplett
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Rachel E Lean
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jeffrey J Neil
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - J Philip Miller
- Division of Biostatistics, Institute for Informatics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Tara A Smyser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, MO, 63130, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Barbara B Warner
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Newborn Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Edith Chen
- Institute for Policy Research, Northwestern University, Evanston, IL, 60208, USA
- Department of Psychology, Northwestern University, Evanston, IL, 60208, USA
| | - Gregory E Miller
- Institute for Policy Research, Northwestern University, Evanston, IL, 60208, USA
- Department of Psychology, Northwestern University, Evanston, IL, 60208, USA
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Myers M, Gumusoglu S, Brandt D, Stroud A, Hunter SK, Vignato J, Nuckols V, Pierce GL, Santillan MK, Santillan DA. A role for adverse childhood experiences and depression in preeclampsia. J Clin Transl Sci 2024; 8:e25. [PMID: 38384900 PMCID: PMC10880014 DOI: 10.1017/cts.2023.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction Adverse childhood experiences (ACEs) are a measure of childhood adversity and are associated with life-long morbidity. The impacts of ACEs on peripartum health including preeclampsia, a common and dangerous hypertensive disorder of pregnancy, remain unclear, however. Therefore, we aimed to determine ACE association with peripartum psychiatric health and prevalence of preeclampsia using a case-control design. Methods Clinical data were aggregated and validated using a large, intergenerational knowledgebase developed at our institution. Depression symptoms were measured by standard clinical screeners: the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS). ACEs were assessed via survey. Scores were compared between participants with (N = 32) and without (N = 46) prior preeclampsia. Results Participants with ACE scores ≥4 had significantly greater odds of preeclampsia than those with scores ≤ 3 (adjusted odds ratio = 6.71, 95% confidence interval:1.13-40.00; p = 0.037). Subsequent speculative analyses revealed that increased odds of preeclampsia may be driven by increased childhood abuse and neglect dimensions of the ACE score. PHQ-9 scores (3.73 vs. 1.86, p = 0.03), EPDS scores (6.38 vs. 3.71, p = 0.01), and the incidence of depression (37.5% vs. 23.9%, p = 0.05) were significantly higher in participants with a history of preeclampsia versus controls. Conclusions Childhood sets the stage for life-long health. Our findings suggest that ACEs may be a risk factor for preeclampsia and depression, uniting the developmental origins of psychiatric and obstetric risk.
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Affiliation(s)
- Monica Myers
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, USA
| | - Serena Gumusoglu
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, USA
- Iowa Neuroscience Institute, Iowa City, USA
| | - Debra Brandt
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, USA
| | - Amy Stroud
- Department of Psychiatry, University of Iowa, Iowa City, USA
| | - Stephen K. Hunter
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, USA
| | - Julie Vignato
- College of Nursing, University of Iowa, Iowa City, USA
| | - Virginia Nuckols
- Department of Health and Human Physiology, University of Iowa, Iowa City, USA
| | - Gary L. Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, USA
- Department of Internal Medicine, University of Iowa, Iowa City, USA
| | - Mark K. Santillan
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, USA
- Iowa Neuroscience Institute, Iowa City, USA
| | - Donna A. Santillan
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, USA
- Iowa Neuroscience Institute, Iowa City, USA
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Chen HJ, Galley JD, Verosky BG, Yang FT, Rajasekera TA, Bailey MT, Gur TL. Fetal CCL2 signaling mediates offspring social behavior and recapitulates effects of prenatal stress. Brain Behav Immun 2024; 115:308-318. [PMID: 37914098 PMCID: PMC10872760 DOI: 10.1016/j.bbi.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/03/2023] Open
Abstract
Maternal stress during pregnancy is prevalent and associated with increased risk of neurodevelopmental disorders in the offspring. Maternal and offspring immune dysfunction has been implicated as a potential mechanism by which prenatal stress shapes offspring neurodevelopment; however, the impact of prenatal stress on the developing immune system has yet to be elucidated. Furthermore, there is evidence that the chemokine C-C motif chemokine ligand 2 (CCL2) plays a key role in mediating the behavioral sequelae of prenatal stress. Here, we use an established model of prenatal restraint stress in mice to investigate alterations in the fetal immune system, with a focus on CCL2. In the placenta, stress led to a reduction in CCL2 and Ccr2 expression with a concomitant decrease in leukocyte number. However, the fetal liver exhibited an inflammatory phenotype, with upregulation of Ccl2, Il6, and Lbp expression, along with an increase in pro-inflammatory Ly6CHi monocytes. Prenatal stress also disrupted chemokine signaling and increased the number of monocytes and microglia in the fetal brain. Furthermore, stress increased Il1b expression by fetal brain CD11b+ microglia and monocytes. Finally, intra-amniotic injections of recombinant mouse CCL2 partially recapitulated the social behavioral deficits in the adult offspring previously observed in the prenatal restraint stress model. Altogether, these data suggest that prenatal stress led to fetal inflammation, and that fetal CCL2 plays a role in shaping offspring social behavior.
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Affiliation(s)
- Helen J Chen
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Medical Scientist Training Program, The Ohio State University, Columbus, OH, United States
| | - Jeffrey D Galley
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Branden G Verosky
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Medical Scientist Training Program, The Ohio State University, Columbus, OH, United States
| | - Felix T Yang
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Medical Scientist Training Program, The Ohio State University, Columbus, OH, United States
| | - Therese A Rajasekera
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Michael T Bailey
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Center for Microbial Pathogenesis, The Research Institute, Nationwide Children's Hospital, Columbus, OH, United States; Biosciences Division, College of Dentistry, The Ohio State University, Columbus, OH, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tamar L Gur
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Medical Scientist Training Program, The Ohio State University, Columbus, OH, United States; Department of Obstetrics & Gynecology, The Ohio State University Wexner Medical Center, Columbus OH, United States.
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Keenan-Devlin L, Miller GE, Ernst LM, Freedman A, Smart B, Britt JL, Singh L, Crockett AH, Borders A. Inflammatory markers in serum and placenta in a randomized controlled trial of group prenatal care. Am J Obstet Gynecol MFM 2023; 5:101200. [PMID: 37875178 DOI: 10.1016/j.ajogmf.2023.101200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Racial and socioeconomic disparities in preterm birth and small for gestational age births are growing in the United States, increasing the burden of morbidity and mortality particularly among Black women and birthing persons and their infants. Group prenatal care is one of the only interventions to show potential to reduce the disparity, but the mechanism is unclear. OBJECTIVE The goal of this project was to identify if group prenatal care, when compared with individual prenatal care, was associated with a reduction in systemic inflammation during pregnancy and a lower prevalence of inflammatory lesions in the placenta at delivery. STUDY DESIGN The Psychosocial Intervention and Inflammation in Centering Study was a prospective cohort study that exclusively enrolled participants from a large randomized controlled trial of group prenatal care (the Cradle study, R01HD082311, ClinicalTrials.gov: NCT02640638) that was performed at a single site in Greenville, South Carolina, from 2016 to 2020. In the Cradle study, patients were randomized to either group prenatal care or individual prenatal care, and survey data were collected during the second and third trimesters. The Psychosocial Intervention and Inflammation in Centering Study cohort additionally provided serum samples at these 2 survey time points and permitted collection of placental biopsies for inflammatory and histologic analysis, respectively. We examined associations between group prenatal care treatment and a composite of z scored serum inflammatory biomarkers (C-reactive protein, interleukin-6, interleukin-1 receptor antagonist, interleukin-10, and tumor necrosis factor α) in both the second and third trimesters and the association with the prevalence of acute and chronic maternal placental inflammatory lesions. Analyses were conducted using the intent to treat principle, and the results were also examined by attendance of visits in the assigned treatment group (modified intent to treat and median or more number of visits) and were stratified by race and ethnicity. RESULTS A total of 1256 of 1375 (92%) Cradle participants who were approached enrolled in the Psychosocial Intervention and Inflammation in Centering Study, which included 54% of all the Cradle participants. The Psychosocial Intervention and Inflammation in Centering Study cohort did not differ from the Cradle cohort by demographic or clinical characteristics. Among the 1256 Psychosocial Intervention and Inflammation in Centering Study participants, 1133 (89.6%) had placental data available for analysis. Among those, 549 were assigned to group prenatal care and 584 of 1133 were assigned to individual prenatal care. In the intent to treat and modified intent to treat cohorts, participation in group prenatal care was associated with a higher serum inflammatory score, but it was not associated with an increased prevalence of placental inflammatory lesions. In the stratified analyses, group prenatal care was associated with a higher second trimester inflammatory biomarker composite (modified intent to treat: B=1.17; P=.02; and median or more visits: B=1.24; P=.05) among Hispanic or Latine participants. CONCLUSION Unexpectedly, group prenatal care was associated with higher maternal serum inflammation during pregnancy, especially among Hispanic or Latine participants.
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Affiliation(s)
- Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders).
| | - Gregory E Miller
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, IL (Dr Miller)
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL (Dr Ernst); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders)
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders)
| | - Britney Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders)
| | - Jessica L Britt
- Department of Obstetrics and Gynecology, Prisma Health, Greenville, SC (Dr Britt)
| | - Lavisha Singh
- Department of Biostatistics, NorthShore University HealthSystem, Evanston, IL (Ms. Singh)
| | - Amy H Crockett
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health/University of South Carolina School of Medicine Greenville, Greenville SC (Dr Crockett)
| | - Ann Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders)
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7
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Simanek AM, Xiong M, Woo JMP, Zheng C, Zhang YS, Meier HCS, Aiello AE. Association between prenatal socioeconomic disadvantage, adverse birth outcomes, and inflammatory response at birth. Psychoneuroendocrinology 2023; 153:106090. [PMID: 37146471 PMCID: PMC10807729 DOI: 10.1016/j.psyneuen.2023.106090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 05/07/2023]
Abstract
Prenatal socioeconomic disadvantage is associated with inflammation in mid- to late-life, yet whether a pro-inflammatory phenotype is present at birth and the role of adverse birth outcomes in this pathway remains unclear. We utilized data on prenatal socioeconomic disadvantage at the individual- (i.e., mother's and father's education level, insurance type, marital status, and Women, Infants, and Children benefit receipt) and census-tract level as well as preterm (< 37 weeks gestation) and small-for-gestational-age (SGA) (i.e., < 10th percentile of sex-specific birth weight for gestational age) birth status, and assessed inflammatory markers (i.e., C-reactive protein, serum amyloid p, haptoglobin, and α-2 macroglobulin) in archived neonatal bloodspots from a Michigan population-based cohort of 1000 neonates. Continuous latent variables measuring individual- and combined individual- and neighborhood-level prenatal socioeconomic disadvantage were constructed and latent profile analysis was used to create a categorical inflammatory response variable (high versus low) based on continuous inflammatory marker levels. Structural equation models were used to estimate the total and direct effect of prenatal socioeconomic disadvantage on the inflammatory response at birth as well as indirect effect via preterm or SGA birth (among term neonates only), adjusting for mother's age, race/ethnicity, body mass index, smoking status, comorbidities, and antibiotic use/infection as well as grandmother's education level. There was a statistically significant total effect of both individual- and combined individual- and neighborhood-level prenatal socioeconomic disadvantage on high inflammatory response among all neonates as well as among term neonates only, and a positive but not statistically significant direct effect in both groups. The indirect effects via preterm and SGA birth were both negative, but not statistically significant. Our findings suggest prenatal socioeconomic disadvantage contributes to elevated neonatal inflammatory response, but via pathways outside of these adverse birth outcomes.
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Affiliation(s)
- Amanda M Simanek
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
| | - Meng Xiong
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jennifer M P Woo
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Cheng Zheng
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yuan S Zhang
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Helen C S Meier
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Allison E Aiello
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
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8
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Harriett LE, Eary RL, Prickett SA, Romero J, Maddrell RG, Keenan-Devlin LS, Borders AEB. Adaptation of Screening Tools for Social Determinants of Health in Pregnancy: A Pilot Project. Matern Child Health J 2023:10.1007/s10995-023-03732-2. [PMID: 37316688 DOI: 10.1007/s10995-023-03732-2] [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: 05/22/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Social determinants of health (SDOH) and stress during pregnancy may contribute to adverse pregnancy outcomes. The objective of this in the field pilot project was to develop a comprehensive screening tool by combining existing validated screeners. Additionally, implement use of this tool within routine prenatal visits and assess feasibility. METHODS Pregnant patients accessing prenatal care at a single site of an urban Federally Qualified Health Center were recruited during prenatal visits to complete a Social Determinants of Health in Pregnancy Tool (SIPT). SIPT combines a series of questions from existing and well-validated tools and consists of five domains: (1) perceived stress, (2) relationship and family stress, (3) domestic violence, (4) substance abuse, and (5) financial stress. RESULTS Between April 2018 and March 2019, 135 pregnant participants completed SIPT. Ninety-one percent of patients scored positive on at least one screener, 54% to three or more screeners. CONCLUSIONS Despite guidelines to screen for SDOH during pregnancy there is no universal tool. Our pilot project demonstrated the concurrent use of adapted screening tools where participants reported at least one area of potential stress, and that linking to resources at the time of a visit is plausible. Future work should examine if screening and point of care linkages of services improves maternal child outcomes.
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Affiliation(s)
- Lauren E Harriett
- PCC Community Wellness Center, 115 North Parkside Avenue, Chicago, IL, 60644, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd., K Building, 2nd Floor, Suite 400F, Dallas, TX, 75390, USA.
| | - Sarah A Prickett
- Department of Family and Community Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd., K Building, 2nd Floor, Suite 400F, Dallas, TX, 75390, USA
| | - Janedelie Romero
- Department of Obstetrics and Gynecology, NorthShore University Health System, Chicago, IL, USA
| | - Rebecca G Maddrell
- A.L. Burdick Family Medicine Center, 3 Erie Court Suite 6160, Oak Park, IL, 60302, USA
| | - Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University Health System and Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University Health System and Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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Inflammation and the Potential Implication of Macrophage-Microglia Polarization in Human ASD: An Overview. Int J Mol Sci 2023; 24:ijms24032703. [PMID: 36769026 PMCID: PMC9916462 DOI: 10.3390/ijms24032703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Autism spectrum disorder (ASD) is a heterogeneous collection of neurodevelopmental disorders, difficult to diagnose and currently lacking treatment options. The possibility of finding reliable biomarkers useful for early identification would offer the opportunity to intervene with treatment strategies to improve the life quality of ASD patients. To date, there are many recognized risk factors for the development of ASD, both genetic and non-genetic. Although genetic and epigenetic factors may play a critical role, the extent of their contribution to ASD risk is still under study. On the other hand, non-genetic risk factors include pollution, nutrition, infection, psychological states, and lifestyle, all together known as the exposome, which impacts the mother's and fetus's life, especially during pregnancy. Pathogenic and non-pathogenic maternal immune activation (MIA) and autoimmune diseases can cause various alterations in the fetal environment, also contributing to the etiology of ASD in offspring. Activation of monocytes, macrophages, mast cells and microglia and high production of pro-inflammatory cytokines are indeed the cause of neuroinflammation, and the latter is involved in ASD's onset and development. In this review, we focused on non-genetic risk factors, especially on the connection between inflammation, macrophage polarization and ASD syndrome, MIA, and the involvement of microglia.
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10
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Hall MB, Willis DE, Rodriguez EL, Schwarz JM. Maternal immune activation as an epidemiological risk factor for neurodevelopmental disorders: Considerations of timing, severity, individual differences, and sex in human and rodent studies. Front Neurosci 2023; 17:1135559. [PMID: 37123361 PMCID: PMC10133487 DOI: 10.3389/fnins.2023.1135559] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Epidemiological evidence suggests that one's risk of being diagnosed with a neurodevelopmental disorder (NDD)-such as autism, ADHD, or schizophrenia-increases significantly if their mother had a viral or bacterial infection during the first or second trimester of pregnancy. Despite this well-known data, little is known about how developing neural systems are perturbed by events such as early-life immune activation. One theory is that the maternal immune response disrupts neural processes important for typical fetal and postnatal development, which can subsequently result in specific and overlapping behavioral phenotypes in offspring, characteristic of NDDs. As such, rodent models of maternal immune activation (MIA) have been useful in elucidating neural mechanisms that may become dysregulated by MIA. This review will start with an up-to-date and in-depth, critical summary of epidemiological data in humans, examining the association between different types of MIA and NDD outcomes in offspring. Thereafter, we will summarize common rodent models of MIA and discuss their relevance to the human epidemiological data. Finally, we will highlight other factors that may interact with or impact MIA and its associated risk for NDDs, and emphasize the importance for researchers to consider these when designing future human and rodent studies. These points to consider include: the sex of the offspring, the developmental timing of the immune challenge, and other factors that may contribute to individual variability in neural and behavioral responses to MIA, such as genetics, parental age, the gut microbiome, prenatal stress, and placental buffering.
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11
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Camerota M, Wylie AC, Goldblum J, Wideman L, Cheatham CL, Propper CB. Testing a cascade model linking prenatal inflammation to child executive function. Behav Brain Res 2022; 431:113959. [PMID: 35690156 PMCID: PMC10652221 DOI: 10.1016/j.bbr.2022.113959] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/21/2022] [Accepted: 06/06/2022] [Indexed: 01/08/2023]
Abstract
Inflammation during pregnancy is beginning to be understood as a risk factor predicting poor infant health and neurodevelopmental outcomes. The long-term sequelae associated with exposure to prenatal inflammation are less well established. The current study examined associations between maternal inflammation during pregnancy, markers of infant neurodevelopment (general cognitive ability, negative affect, and sleep quality), and preschool executive function (EF) in a longitudinal sample of 40 African American mother-infant dyads. Mothers completed a blood draw in the third trimester of pregnancy to measure plasma levels of C-reactive protein (CRP) and pro-inflammatory cytokines (e.g., interleukin 6 [IL-6], tumor necrosis factor-alpha [TNF-α]). When infants were 6 months of age, we assessed general cognitive ability via the Bayley-III, negative affect via the Still-Face Paradigm, and sleep quality via actigraphy monitoring. When children were 4 years of age, we assessed their EF ability using four tasks from the EF Touch battery. Elevated levels of maternal CRP, IL-6, and TNF-α were associated with poorer infant general cognitive ability. Although there were no direct effects of prenatal inflammation on preschool EF, we observed an indirect relationship between IL-6 and preschool EF ability via infant general cognitive ability. Our findings suggest that prenatal inflammation may have long-lasting, cascading implications for child neurodevelopment. Implications of these findings for health disparities in women and children of color are discussed.
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Affiliation(s)
- Marie Camerota
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States
| | - Amanda C Wylie
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Jessica Goldblum
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina at Greensboro, United States
| | - Carol L Cheatham
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States; Nutrition Research Institute, University of North Carolina at Chapel Hill, United States
| | - Cathi B Propper
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States.
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12
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Terpenoid Backbone Biosynthesis among Pig Hippocampal Pathways Impacted by Stressors. Genes (Basel) 2022; 13:genes13050814. [PMID: 35627199 PMCID: PMC9141200 DOI: 10.3390/genes13050814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/29/2022] [Indexed: 12/13/2022] Open
Abstract
Neurogenomic changes induced by maternal immune activation (MIA) during gestation and the social stress of weaning can alter brain plasticity in the hippocampus of offspring. The present study furthers the understanding of how these stressors impact hippocampus gene networks. The hippocampus transcriptome was profiled in pigs that were either exposed to MIA or not and were weaned or nursed. Overall, 1576 genes were differentially expressed (FDR-adjusted p-value < 0.05 and |log2 (fold change between pig groups)| > 1.2) in response to the main and interacting effects of MIA, weaning, and sex. Functional analysis identified 17 enriched immunological and neurological pathways in the Kyoto Encyclopedia of Genes and Genomes database. The enrichment of the terpenoid backbone biosynthesis pathway was characterized by genes under-expressed in MIA relative to non-MIA exposed, males relative to females, and weaned relative to nursed pigs. On the other hand, the enrichment of drug addiction pathways was characterized by gene over-expression in MIA relative to non-exposed pigs. Our results indicate that weaning and sex can modify the effects of MIA on the offspring hippocampus. This knowledge can aid in precise identification of molecular targets to reduce the prolonged effects of pre- and postnatal stressors.
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13
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Han VX, Jones HF, Patel S, Mohammad SS, Hofer MJ, Alshammery S, Maple-Brown E, Gold W, Brilot F, Dale RC. Emerging evidence of Toll-like receptors as a putative pathway linking maternal inflammation and neurodevelopmental disorders in human offspring: A systematic review. Brain Behav Immun 2022; 99:91-105. [PMID: 34562595 DOI: 10.1016/j.bbi.2021.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/21/2021] [Accepted: 09/18/2021] [Indexed: 02/07/2023] Open
Abstract
Inflammation is increasingly recognised to play a major role in gene-environment interactions in neurodevelopmental disorders (NDDs). The effects of aberrant immune responses to environmental stimuli in the mother and in the child can affect neuroimmune signalling that is central to brain development. Toll-like receptors (TLR) are the best known innate immune pattern and danger recognition sensors to various environmental threats. In animal models, maternal immune activation (MIA), secondary to inflammatory factors including maternal gestational infection, obesity, diabetes, and stress activate the TLR pathway in maternal blood, placenta, and fetal brain, which correlate with offspring neurobehavioral abnormalities. Given the central role of TLR activation in animal MIA models, we systematically reviewed the human evidence for TLR activation and response to stimulation across the maternal-fetal interface. Firstly, we included 59 TLR studies performed in peripheral blood of adults in general population (outside of pregnancy) with six chronic inflammatory factors which have epidemiological evidence for increased risk of offspring NDDs, namely, obesity, diabetes mellitus, depression, low socio-economic status, autoimmune diseases, and asthma. Secondly, eight TLR studies done in human pregnancies with chronic inflammatory factors, involving maternal blood, placenta, and cord blood, were reviewed. Lastly, ten TLR studies performed in peripheral blood of individuals with NDDs were included. Despite these studies, there were no studies which examined TLR function in both the pregnant mother and their offspring. Increased TLR2 and TLR4 mRNA and/or protein levels in peripheral blood were common in obesity, diabetes mellitus, depression, autoimmune thyroid disease, and rheumatoid arthritis. To a lesser degree, TLR 3, 7, 8, and 9 activation were found in peripheral blood of humans with autoimmune diseases and depression. In pregnancy, increased TLR4 mRNA levels were found in the peripheral blood of women with diabetes mellitus and systemic lupus erythematosus. Placental TLR activation was found in mothers with obesity or diabetes. Postnatally, dysregulated TLR response to stimulation was found in peripheral blood of individuals with NDDs. This systematic review found emerging evidence that TLR activation may represent a mechanistic link between maternal inflammation and offspring NDD, however the literature is incomplete and longitudinal outcome studies are lacking. Identification of pathogenic mechanisms in MIA could create preventive and therapeutic opportunities to mitigate NDD prevalence and severity.
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Affiliation(s)
- Velda X Han
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Khoo-Teck Puat-National University Children's Medical Institute, National University Health System, Singapore; School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Hannah F Jones
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Neuroservices, Starship Children's Hospital, Auckland, New Zealand
| | - Shrujna Patel
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Shekeeb S Mohammad
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Markus J Hofer
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, Australia; The Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Sarah Alshammery
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Medical Sciences, The University of Sydney, Sydney, Australia; Molecular Neurobiology Research Laboratory, Kids Research, Children's Hospital at Westmead, and The Children's Medical Research Institute, Westmead, New South Wales, Australia
| | - Emma Maple-Brown
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Medical Sciences, The University of Sydney, Sydney, Australia; Molecular Neurobiology Research Laboratory, Kids Research, Children's Hospital at Westmead, and The Children's Medical Research Institute, Westmead, New South Wales, Australia
| | - Wendy Gold
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Molecular Neurobiology Research Laboratory, Kids Research, Children's Hospital at Westmead, and The Children's Medical Research Institute, Westmead, New South Wales, Australia
| | - Fabienne Brilot
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Medical Sciences, The University of Sydney, Sydney, Australia; The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Molecular Neurobiology Research Laboratory, Kids Research, Children's Hospital at Westmead, and The Children's Medical Research Institute, Westmead, New South Wales, Australia
| | - Russell C Dale
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Brain and Mind Centre, The University of Sydney, Sydney, Australia.
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14
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Keenan-Devlin L, Smart BP, Grobman W, Adams E, Freedman A, Buss C, Entringer S, Miller GE, Borders AEB. The intersection of race and socioeconomic status is associated with inflammation patterns during pregnancy and adverse pregnancy outcomes. Am J Reprod Immunol 2021; 87:e13489. [PMID: 34958140 DOI: 10.1111/aji.13489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Preterm birth rates are higher among individuals of lower socioeconomic status and non-White race, which is possibly related to life-course stressors. It is important to better understand the underlying mechanisms of these health disparities, and inflammation is a possible pathway to explain the disparities in birth outcomes. OBJECTIVE In this study, we aimed to determine whether patterns of inflammation differed by maternal race and socioeconomic status. STUDY DESIGN 744 participants in a multi-site, prospective study of pregnancy and birth outcomes provided biological and psychological data between 12'0-20'6 weeks gestation. Participants with recent infection, fever, antibiotics or steroid treatment were excluded. Cytokines including INFɣ, IL-10, IL-13, IL-6, IL-8, and TNFα, and the acute phase protein CRP were measured in serum and values and were log-transformed for normality when appropriate and a non-orthogonal rotation (Oblimid) was performed to allow the extracted factor to inter-correlate. IFNγ, IL-8, IL-10, IL-6, TNF-a, and IL-13 loaded onto Inflammatory Factor 1 (IF-1), while CRP and IL-6 loaded onto Inflammatory Factor 2 (IF-2). Race and education were collected via self-report during an in-person study visit. Multivariable models were used to determine the association of race and SES with IF-1 and IF-2 during the second trimester, and a mediation model to examine if inflammation is on the causal pathway. Models were adjusted for study site, prenatal age, pre-pregnancy BMI, smoking during pregnancy, and gestational age at the time of blood collection. RESULTS 605 participants were included in our final analysis, with 61.2 % of low or moderate SES, and 35.5% identifying as a person of color (POC). Identifying as a POC, being of low and moderate SES, and being both low-SES and POC or Moderate-SES and POC were associated with higher odds of preterm birth and lower birth weight percentile infants. Low SES POC participants had significantly higher IF-1 and IF-2 scores when compared to high-SES White participants. Additionally, higher IF-1and IF-2 were associated with shorter gestation. In the mediation analysis, we observed a significant direct effect of race/SES on preterm birth, however the results did not support an indirect pathway where IF-1 or IF-2 acted as mediators. CONCLUSION Maternal race and SES are significantly associated with inflammatory biomarkers during pregnancy, and when race and SES are considered in combination, they are stronger predictors of adverse pregnancy outcomes than when evaluated separately. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL
| | - Britney P Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - William Grobman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine; Center for Healthcare Studies - Institute for Public Health and Medicine, Northwestern University, Chicago, IL
| | - Emma Adams
- Institute for Policy Research, Northwestern University, Evanston, IL
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Institute for Policy Research, Northwestern University, Evanston, IL
| | - Claudia Buss
- UC Irvine Development, Health and Disease Research Program, University of California Irvine; Department of Medical Psychology, Charité, University Medicine Berlin, Germany
| | - Sonja Entringer
- Department of Medical Psychology, Charité, University Medicine Berlin, Germany
| | - Gregory E Miller
- Department of Psychology, Northwestern University, Institute for Policy Research, Northwestern University, Evanston, IL
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine; Center for Healthcare Studies-Institute for Public Health and Medicine, Northwestern University, Evanston, IL
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15
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Ross KM, Dunkel Schetter C, Carroll JE, Mancuso RA, Breen EC, Okun ML, Hobel C, Coussons-Read M. Inflammatory and immune marker trajectories from pregnancy to one-year post-birth. Cytokine 2021; 149:155758. [PMID: 34773858 DOI: 10.1016/j.cyto.2021.155758] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/10/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pregnancy is an immunomodulatory state, with reported systematic changes in inflammatory and immune activity by pregnancy stage. Published data are inconsistent as to how inflammatory and immune markers change and recover across pregnancy and the postpartum period, or the sociodemographic, health and pregnancy-related factors that could affect biomarker trajectories. The purpose of this study is to describe inflammatory and immune marker trajectories from pregnancy to a year post-birth, and to test associations with sociodemographic, health and pregnancy-related variables. METHODS A sample of 179 pregnant women were assessed three times during pregnancy (between 8 and 36 weeks gestation) and three times during the postpartum period (between 1 and 12 months). Maternal sociodemographic characteristics, health, and pregnancy factors were obtained at study entry. Blood samples from each assessment were assayed for interleukin(IL)-6, tumor necrosis factor(TNF)α, IL-8, IL-10, and interferon(IFN)γ. Multilevel modelling was used to characterize biomarker trajectories and associations with sociodemographic and health variables. RESULTS Distinct trajectories over time emerged for each biomarker. Male pregnancies were associated with higher TNFα, IL-10, and IFNγ; higher pre-pregnancy BMI was associated with higher IL-6 and IFNγ. Nulliparity was associated with greater increases in IL-6 and TNFα. CONCLUSIONS Patterns observed for inflammatory and immune markers from pregnancy to a year postpartum support the hypothesis that the maternal immune system changes systematically across pregnancy and through an extended postpartum period. Parity, pre-pregnancy BMI and child sex are associated with inflammatory marker patterns over time. These results contribute to our understanding of how immune system activity changes from pregnancy to the post-birth period, and the factors that could affect those changes.
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Affiliation(s)
- Kharah M Ross
- Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada.
| | | | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Roberta A Mancuso
- Department of Psychology and Neuroscience, Regis University, Denver, CO, USA
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Michele L Okun
- University of Colorado - Colorado Springs, Colorado Springs, CO, USA
| | - Calvin Hobel
- Cedars-Sinai Medical Centre, Los Angeles, CA, USA
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Ramphal B, Pagliaccio D, Dworkin JD, Herbstman J, Noble KG, Margolis AE. Timing-specific associations between income-to-needs ratio and hippocampal and amygdala volumes in middle childhood: A preliminary study. Dev Psychobiol 2021; 63:e22153. [PMID: 34674248 DOI: 10.1002/dev.22153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 01/23/2023]
Abstract
It is well known that financial disadvantage is associated with alterations in brain development in regions critical to socioemotional well-being such as the hippocampus and the amygdala. Yet little is known about whether family income at different points in development is differentially associated with these structures. Furthermore, little is known about which environmental factors statistically mediate associations between income and subcortical structure. Using a longitudinal birth cohort and linear mixed-effects models, we identified associations between income-to-needs ratio (INR) at 6 timepoints throughout childhood and hippocampal and amygdala volumes at age 7-9 years (n = 41; 236 INR measurements; 41 brain measurements). Mediation analysis identified environmental sequelae of income that statistically accounted for INR-brain associations. Lower INR prior to age 4 was associated with smaller hippocampal volumes, whereas lower INR prior to age 2 was associated with smaller right amygdala volume. These associations were mediated by unmet basic needs (e.g., food, housing). These findings delineate the temporal specificity of associations between income and hippocampal and amygdala structures.
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Affiliation(s)
- Bruce Ramphal
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - David Pagliaccio
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jordan D Dworkin
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Julie Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Kimberly G Noble
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Amy E Margolis
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Abstract
Animal and humans exposed to stress early in life are more likely to suffer from long-term behavioral, mental health, metabolic, immune, and cardiovascular health consequences. The hypothalamus plays a nodal role in programming, controlling, and regulating stress responses throughout the life course. Epigenetic reprogramming in the hippocampus and the hypothalamus play an important role in adapting genome function to experiences and exposures during the perinatal and early life periods and setting up stable phenotypic outcomes. Epigenetic programming during development enables one genome to express multiple cell type identities. The most proximal epigenetic mark to DNA is a covalent modification of the DNA itself by enzymatic addition of methyl moieties. Cell-type-specific DNA methylation profiles are generated during gestational development and define cell and tissue specific phenotypes. Programming of neuronal phenotypes and sex differences in the hypothalamus is achieved by developmentally timed rearrangement of DNA methylation profiles. Similarly, other stations in the life trajectory such as puberty and aging involve predictable and scheduled reorganization of DNA methylation profiles. DNA methylation and other epigenetic marks are critical for maintaining cell-type identity in the brain, across the body, and throughout life. Data that have emerged in the last 15 years suggest that like its role in defining cell-specific phenotype during development, DNA methylation might be involved in defining experiential identities, programming similar genes to perform differently in response to diverse experiential histories. Early life stress impact on lifelong phenotypes is proposed to be mediated by DNA methylation and other epigenetic marks. Epigenetic marks, as opposed to genetic mutations, are reversible by either pharmacological or behavioral strategies and therefore offer the potential for reversing or preventing disease including behavioral and mental health disorders. This chapter discusses data testing the hypothesis that DNA methylation modulations of the HPA axis mediate the impact of early life stress on lifelong behavioral and physical phenotypes.
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Affiliation(s)
- Moshe Szyf
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada.
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18
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Aschbacher K, Hagan M, Steine IM, Rivera L, Cole S, Baccarella A, Epel ES, Lieberman A, Bush NR. Adversity in early life and pregnancy are immunologically distinct from total life adversity: macrophage-associated phenotypes in women exposed to interpersonal violence. Transl Psychiatry 2021; 11:391. [PMID: 34282132 PMCID: PMC8289995 DOI: 10.1038/s41398-021-01498-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
Early childhood and pregnancy are two sensitive periods of heightened immune plasticity, when exposure to adversity may disproportionately increase health risks. However, we need deeper phenotyping to disentangle the impact of adversity during sensitive periods from that across the total lifespan. This study examined whether retrospective reports of adversity during childhood or pregnancy were associated with inflammatory imbalance, in an ethnically diverse cohort of 53 low-income women seeking family-based trauma treatment following exposure to interpersonal violence. Structured interviews assessed early life adversity (trauma exposure ≤ age 5), pregnancy adversity, and total lifetime adversity. Blood serum was assayed for pro-inflammatory (TNF-a, IL-1ß, IL-6, and CRP) and anti-inflammatory (IL-1RA, IL-4, and IL-10) cytokines. CD14+ monocytes were isolated in a subsample (n = 42) and gene expression assayed by RNA sequencing (Illumina HiSeq 4000; TruSeq cDNA library). The primary outcome was a macrophage-associated M1/M2 gene expression phenotype. To evaluate sensitivity and specificity, we contrasted M1/M2 gene expression with a second, clinically-validated macrophage-associated immunosuppressive phenotype (endotoxin tolerance) and with pro-inflammatory and anti-inflammatory cytokine levels. Adjusting for demographics, socioeconomic status, and psychopathology, higher adversity in early life (ß = .337, p = 0.029) and pregnancy (ß = .332, p = 0.032) were each associated with higher M1/M2 gene expression, whereas higher lifetime adversity (ß = -.341, p = 0.031) was associated with lower immunosuppressive gene expression. Adversity during sensitive periods was uniquely associated with M1/M2 imbalance, among low-income women with interpersonal violence exposure. Given that M1/M2 imbalance is found in sepsis, severe COVID-19 and myriad chronic diseases, these findings implicate novel immune mechanisms underlying the impact of adversity on health.
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Affiliation(s)
- Kirstin Aschbacher
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA.
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, USA.
- The Institute for Integrative Health, San Francisco, USA.
| | - Melissa Hagan
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
- Department of Psychology, College of Science & Engineering, San Francisco State University, San Francisco, USA
| | - Iris M Steine
- Department of Psychology, University of California, Berkeley, USA
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Luisa Rivera
- Department of Anthropology, Emory University, Atlanta, Georgia
| | - Steve Cole
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | | | - Elissa S Epel
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Alicia Lieberman
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Nicole R Bush
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
- Center for Health and Community, University of California, San Francisco, USA
- Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco, USA
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19
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Oldenburg KS, Eaves LA, Smeester L, Santos HP, O'Shea TM, Fry RC. Development of the genomic inflammatory index (GII) to assess key maternal antecedents associated with placental inflammation. Placenta 2021; 111:82-90. [PMID: 34182215 DOI: 10.1016/j.placenta.2021.06.010] [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: 02/19/2021] [Revised: 04/21/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Placental inflammation is associated with a variety of adverse health outcomes, including poor pregnancy outcomes as well as later in life health. The current clinical methodologies for evaluating placental histology for inflammation are limited in their sensitivity. The objective of this study was to develop a genomic inflammatory index (GII) that can be utilized as a biomarker to effectively quantify and evaluate placental inflammation. METHODS RNA-sequencing of n = 386 placentas from the Extremely Low Gestational Age Newborn (ELGAN) cohort was conducted. Transcriptional data for a biologically-targeted set of 14 genes, selected for their established role in pro-inflammatory signaling pathways, were aggregated to construct the GII. Multiple linear regression models were used to examine relationships between 47 perinatal factors and the GII. RESULTS The GII demonstrated a nine-fold difference across subjects and displayed positive trends with other indicators of placental inflammation. Significant differences in the GII were observed for race where women who self-identified as Black displayed higher levels of placental inflammation than those who self-identified as White women (p < 0.001). Additionally, married Black women showed reduced placental inflammation compared to those who were unmarried (beta value: 0.828, p-value: 0.032). Placentas from women who were treated with steroids during the delivery of the infant displayed higher GII levels than those who were not (p = 0.023). DISCUSSION Overall, the GII demonstrated an association between various perinatal factors and placental inflammation. It is anticipated that the GII will provide a novel genomics tool for quantifying placental inflammation, allowing for further investigation of causes, and ultimately the prevention, of inflammation in the placenta.
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Affiliation(s)
- Kirsi S Oldenburg
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren A Eaves
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Smeester
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hudson P Santos
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Biobehavioral Laboratory, School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - T Michael O'Shea
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca C Fry
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
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20
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Childhood disadvantage, neurocognitive development and neuropsychiatric disorders: Evidence of mechanisms. Curr Opin Psychiatry 2021; 34:306-323. [PMID: 33587493 PMCID: PMC9458466 DOI: 10.1097/yco.0000000000000701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Children living in socioeconomically disadvantaged households have excess risks of neurodevelopmental and neuropsychiatric problems. The purpose of this review is to synthesize evidence for mechanisms that may contribute to these excess risks. RECENT FINDINGS The majority of the 60 studies included in our review focused on children's neurocognitive development and behavioural problems. About half conducted mediation analyses of factors in the family and neighbourhood environments, including access to resources (e.g. cognitive inputs within the home environment) and exposure to stressors (e.g. negative parenting practices), as well as neurobiological embedding of childhood disadvantage. In addition, many studies conducted moderation analyses of factors that were hypothesized to interact with (i.e. exacerbate or mitigate) the harmful effects of childhood disadvantage. SUMMARY Many of the factors that contribute to the excess risk of neurodevelopmental and neuropsychiatric problems among children in disadvantaged households are potentially modifiable (e.g. cognitively stimulating materials, parental language input, cultural resources, parental stress and psychopathology, negative parenting, neighbourhood violence). If their causality is ultimately established, they could be targets for the prevention and reduction of disparities. The continued search for mechanisms should not detract from work to reduce and hopefully eliminate children's exposure to disadvantage.
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21
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Bangma JT, Hartwell H, Santos HP, O'Shea TM, Fry RC. Placental programming, perinatal inflammation, and neurodevelopment impairment among those born extremely preterm. Pediatr Res 2021; 89:326-335. [PMID: 33184498 PMCID: PMC7658618 DOI: 10.1038/s41390-020-01236-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/02/2020] [Accepted: 10/08/2020] [Indexed: 01/30/2023]
Abstract
Individuals born extremely preterm are at significant risk for impaired neurodevelopment. After discharge from the neonatal intensive care, associations between the child's well-being and factors in the home and social environment become increasingly apparent. Mothers' prenatal health and socioeconomic status are associated with neurodevelopmental outcomes, and emotional and behavioral problems. Research on early life risk factors and on mechanisms underlying inter-individual differences in neurodevelopment later in life can inform the design of personalized approaches to prevention. Here, we review early life predictors of inter-individual differences in later life neurodevelopment among those born extremely preterm. Among biological mechanisms that mediate relationships between early life predictors and later neurodevelopmental outcomes, we highlight evidence for disrupted placental processes and regulated at least in part via epigenetic mechanisms, as well as perinatal inflammation. In relation to these mechanisms, we focus on four prenatal antecedents of impaired neurodevelopment, namely, (1) fetal growth restriction, (2) maternal obesity, (3) placental microorganisms, and (4) socioeconomic adversity. In the future, this knowledge may inform efforts to detect and prevent adverse outcomes in infants born extremely preterm. IMPACT: This review highlights early life risk factors and mechanisms underlying inter-individual differences in neurodevelopment later in life. The review emphasizes research on early life risk factors (fetal growth restriction, maternal obesity, placental microorganisms, and socioeconomic adversity) and on mechanisms (disrupted placental processes and perinatal inflammation) underlying inter-individual differences in neurodevelopment later in life. The findings highlighted here may inform efforts to detect and prevent adverse outcomes in infants born extremely preterm.
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Affiliation(s)
- Jacqueline T Bangma
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hadley Hartwell
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hudson P Santos
- Biobehavioral Laboratory, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Michael O'Shea
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca C Fry
- Biobehavioral Laboratory, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Curriculum in Toxicology and Environmental Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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22
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Gałecka M, Bliźniewska-Kowalska K, Maes M, Su KP, Gałecki P. Update on the neurodevelopmental theory of depression: is there any 'unconscious code'? Pharmacol Rep 2020; 73:346-356. [PMID: 33385173 PMCID: PMC7994228 DOI: 10.1007/s43440-020-00202-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022]
Abstract
Depression is currently one of the most common psychiatric disorders and the number of patients receiving antidepressant treatment is increasing every year. Therefore, it is essential to understand the underlying mechanisms that are associated with higher prevalence of depression. The main component leading to the change in functioning, in the form of apathy, anhedonia, lack of motivation and sleep disturbances, is stress. This is the factor that in recent decades—due to the civilization speed, dynamic technological development as well as competitiveness and competition in relationships—significantly affects the psychophysical condition, which results in an increase in the prevalence of civilization diseases, including depression. To understand the mechanism of susceptibility to this disease, one should consider the significant role of the interaction between immune and nervous systems. Their joint development from the moment of conception is a matrix of later predispositions, both associated with the mobilization of the proinflammatory pathways (TNFα, IL-1β, IL-6) and associated with psychological coping with stress. Such an early development period is associated with epigenetic processes that are strongly marked in prenatal development up to 1 year of age and determinate the characteristic phenotype for various forms of pathology, including depression. Regarding the inflammatory hypothesis of depression, interleukin 17 (IL-17), among other proinflammatory cytokines, might play an important role in the development of depressive disorders. It is secreted by Th17 cells, crossed the placental barrier and acts on the brain structures of the fetus by increasing IL-17 receptor levels and affecting the intensity of its signaling in the brain.
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Affiliation(s)
- Małgorzata Gałecka
- Department of Psychotherapy, Medical University of Lodz, Aleksandrowska 159, 91-229, Lodz, Poland.
| | | | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kuan-Pin Su
- An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Piotr Gałecki
- Department of Adult Psychiatry, Medical University of Lodz, Lodz, Poland
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23
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Carroll JE, Rentscher KE, Cole SW, Luo JJ, Ramilo O, Webber S, Lamkin DM, Christian LM. Sleep disturbances and inflammatory gene expression among pregnant women: Differential responses by race. Brain Behav Immun 2020; 88:654-660. [PMID: 32360438 PMCID: PMC7526416 DOI: 10.1016/j.bbi.2020.04.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 12/27/2022] Open
Abstract
Excessive inflammation in pregnancy predicts adverse birth outcomes, including shortened gestational length and lower birthweight, with African American women at greater risk. As substantial racial disparities in sleep quality, and evidence that African Americans have increased vulnerability for sleep-induced inflammatory dysregulation, sleep may be a critical, modifiable health behavior that contributes to racial disparities in birth outcomes. The present study examined sleep disturbance as a predictor of genome-wide transcriptome profiles of peripheral blood samples from 103 pregnant women (33 African American, 70 white) assessed at 18.7 ± 7.2 weeks gestation. We hypothesized that pregnant women with significant sleep disturbances would have gene expression profiles indicating over-expression of inflammatory pathways, with greater effects among African American compared to white women. Promoter-based bioinformatics analyses of differentially expressed genes indicated greater activation of NF-кB, AP1, and CREB transcription factors among African American women with sleep disturbances (all p < 0.05), and enhanced activation of AP1, but not NF-кB and reduced CREB activity among white women with sleep disturbances (p < 0.05). Differences in glucocorticoid receptor (GR) activity were also observed, in which African American women with sleep disturbances had reduced GR activity (p < 0.05), but white women with sleep disturbances showed a trend for enhanced GR activity (p = 0.11). Similarly, Interferon Response Factor (IRF) activity was reduced in African American women while increased in white women with sleep disturbances (p < 0.05). The current study provides novel evidence for gene expression related to inflammation, glucocorticoids, and anti-viral immunity among pregnant women with sleep disturbances, with differential effects by race. African Americans showed greater breadth and magnitude in these proinflammatory and anti-viral pathways than whites, with divergence in anti-inflammatory glucocorticoid, proinflammatory adrenergic-mediated cAMP, and anti-viral interferon responses. These data elucidate the role of sleep disturbances in intracellular inflammatory and anti-viral immunity in pregnancy and provide a potential target for intervention.
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Affiliation(s)
- Judith E Carroll
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA.
| | - Kelly E Rentscher
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Steven W Cole
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - James J Luo
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Octavio Ramilo
- Department of Psychiatry & Behavioral Health and The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shannon Webber
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Donald M Lamkin
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Lisa M Christian
- Department of Psychiatry & Behavioral Health and The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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24
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Chen HJ, Antonson AM, Rajasekera TA, Patterson JM, Bailey MT, Gur TL. Prenatal stress causes intrauterine inflammation and serotonergic dysfunction, and long-term behavioral deficits through microbe- and CCL2-dependent mechanisms. Transl Psychiatry 2020; 10:191. [PMID: 32546752 PMCID: PMC7297973 DOI: 10.1038/s41398-020-00876-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
Prenatal stress (PNS) is associated with neuropsychiatric disorders in offspring, including anxiety, depression, and autism spectrum disorders. There is mounting evidence that these behavioral phenotypes have origins in utero. Maternal microbes, inflammation, and serotonergic dysfunction have been implicated as potential mediators of the behavioral consequences of PNS; whether and how these systems interact is unclear. Here, we examine the effects of PNS in utero using late-gestation maternal restraint stress in wild-type (WT), germ-free (GF), and CCL2-/- genetic knock-out (KO) mice. In WT mice, PNS leads to placental and fetal brain inflammation, including an elevation in the chemokine CCL2. This inflammation is largely absent in GF mice, indicating the critical role of maternal microbes in mediating immune processes in utero. Furthermore, PNS in the absence of CCL2 failed to increase pro-inflammatory cytokine IL-6 in the fetal brain. PNS offspring also exhibited deficits in sociability and anxiety-like behavior that were absent in CCL2-/- PNS offspring. Tryptophan and serotonin (5-HT) were elevated in the WT PNS placenta, but not in CCL2-/- and GF animals. Altogether, these findings suggest that a complex interaction between maternal microbes, inflammation, and serotonin metabolism regulates the emergence of behavioral abnormalities following PNS.
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Affiliation(s)
- Helen J. Chen
- grid.412332.50000 0001 1545 0811Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Adrienne M. Antonson
- grid.412332.50000 0001 1545 0811Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.261331.40000 0001 2285 7943Biosciences Division, College of Dentistry, The Ohio State University, Columbus, OH USA
| | - Therese A. Rajasekera
- grid.412332.50000 0001 1545 0811Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.261331.40000 0001 2285 7943Environmental Health Sciences Division, College of Public Health, The Ohio State University, Columbus, OH USA
| | - Jenna M. Patterson
- grid.412332.50000 0001 1545 0811Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Michael T. Bailey
- grid.412332.50000 0001 1545 0811Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.261331.40000 0001 2285 7943Biosciences Division, College of Dentistry, The Ohio State University, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Center for Microbial Pathogenesis, The Research Institute, Nationwide Children’s Hospital, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Tamar L. Gur
- grid.412332.50000 0001 1545 0811Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH USA
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25
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Leszko M, Keenan-Devlin L, Adam EK, Buss C, Grobman W, Simhan H, Wadhwa P, Mroczek DK, Borders A. Are personality traits associated with smoking and alcohol use prior to and during pregnancy? PLoS One 2020; 15:e0232668. [PMID: 32421742 PMCID: PMC7233577 DOI: 10.1371/journal.pone.0232668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/20/2020] [Indexed: 11/23/2022] Open
Abstract
Cigarette smoking and alcohol consumption during pregnancy can have detrimental effects on the developing fetus, including fetal alcohol syndrome and low birth weight. Surprisingly little is known about the association of personality traits with smoking and alcohol consumption in the specific subpopulation of pregnant women. This study analyzed data from a geographically diverse sample of 603 pregnant women, aged 18 years and older, who provided information regarding their smoking and drinking habits before and during pregnancy. We compared women who consumed alcohol or smoked cigarettes before pregnancy with women who quit or continued smoking or drinking during pregnancy. Associations between personality and maladaptive behaviors prior to and during pregnancy were modeled using logistic regression. The study revealed that women who scored high on openness to experience were significantly more likely to continue alcohol consumption during pregnancy (OR = 1.07, 95% CI 1.01, 1.14, p = .02). This association was maintained after adjusting for potential confounds. This study demonstrated a significant relationship between personality traits and women's likelihood of continued alcohol consumption prior to and during pregnancy. Understanding personality-based determinants of health-detrimental behavior is important in order to design interventions that aim at decreasing rates of maladaptive health behaviors among pregnant women.
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Affiliation(s)
- Magdalena Leszko
- Department of Psychology, University of Szczecin, Szczecin, Poland
| | - Lauren Keenan-Devlin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL, United States of America
| | - Emma K. Adam
- Institute for Policy Research, Evanston, IL, United States of America
- School of Education and Social Policy, Northwestern University, Evanston, IL, United States of America
| | - Claudia Buss
- Health and Disease Research Program, University of California Irvine, Irvine, CA, United States of America
- Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Evanston, IL, United States of America
- Center for Healthcare Studies, Institute for Public Health and Medicine, Chicago, IL, United States of America
| | - Hyagriv Simhan
- Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa, United States of America
- Division of Obstetrical Services, Magee Women’s Hospital, Pittsburgh, Pa, United States of America
| | - Pathik Wadhwa
- Health and Disease Research Program, University of California Irvine, Irvine, CA, United States of America
| | - Daniel K. Mroczek
- Department of Psychology, Northwestern University, Weinberg College of Arts & Sciences, Evanston, IL, United States of America
| | - Ann Borders
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL, United States of America
- Center for Healthcare Studies, Institute for Public Health and Medicine, Chicago, IL, United States of America
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26
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Peñalver Bernabé B, Maki PM, Dowty SM, Salas M, Cralle L, Shah Z, Gilbert JA. Precision medicine in perinatal depression in light of the human microbiome. Psychopharmacology (Berl) 2020; 237:915-941. [PMID: 32065252 DOI: 10.1007/s00213-019-05436-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/11/2019] [Indexed: 12/17/2022]
Abstract
Perinatal depression is the most common complication of pregnancy and affects the mother, fetus, and infant. Recent preclinical studies and a limited number of clinical studies have suggested an influence of the gut microbiome on the onset and course of mental health disorders. In this review, we examine the current state of knowledge regarding genetics, epigenetics, heritability, and neuro-immuno-endocrine systems biology in perinatal mood disorders, with a particular focus on the interaction between these factors and the gut microbiome, which is mediated via the gut-brain axis. We also provide an overview of experimental and analytical methods that are currently available to researchers interested in elucidating the influence of the gut microbiome on mental health disorders during pregnancy and postpartum.
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Affiliation(s)
- Beatriz Peñalver Bernabé
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States.
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Shannon M Dowty
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Mariana Salas
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Lauren Cralle
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Zainab Shah
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jack A Gilbert
- Scripts Oceanographic Institute, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
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27
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Population-based RNA profiling in Add Health finds social disparities in inflammatory and antiviral gene regulation to emerge by young adulthood. Proc Natl Acad Sci U S A 2020. [PMID: 32041883 DOI: 10.1073/pnas.1821367117/-/dcsupplemental] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Health in later life varies significantly by individual demographic characteristics such as age, sex, and race/ethnicity, as well as by social factors including socioeconomic status and geographic region. This study examined whether sociodemographic variations in the immune and inflammatory molecular underpinnings of chronic disease might emerge decades earlier in young adulthood. Using data from 1,069 young adults from the National Longitudinal Study of Adolescent to Adult Health (Add Health)-the largest nationally representative and ethnically diverse sample with peripheral blood transcriptome profiles-we analyzed variation in the expression of genes involved in inflammation and type I interferon (IFN) response as a function of individual demographic factors, sociodemographic conditions, and biobehavioral factors (smoking, drinking, and body mass index). Differential gene expression was most pronounced by sex, race/ethnicity, and body mass index (BMI), but transcriptome correlates were identified for every demographic dimension analyzed. Inflammation-related gene expression showed the most pronounced variation as a function of biobehavioral factors (BMI and smoking) whereas type I IFN-related transcripts varied most strongly as a function of individual demographic characteristics (sex and race/ethnicity). Bioinformatic analyses of transcription factor and immune-cell activation based on transcriptome-wide empirical differences identified additional effects of family poverty and geographic region. These results identify pervasive sociodemographic differences in immune-cell gene regulation that emerge by young adulthood and may help explain social disparities in the development of chronic illness and premature mortality at older ages.
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28
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Cole SW, Shanahan MJ, Gaydosh L, Harris KM. Population-based RNA profiling in Add Health finds social disparities in inflammatory and antiviral gene regulation to emerge by young adulthood. Proc Natl Acad Sci U S A 2020; 117:4601-4608. [PMID: 32041883 PMCID: PMC7060722 DOI: 10.1073/pnas.1821367117] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Health in later life varies significantly by individual demographic characteristics such as age, sex, and race/ethnicity, as well as by social factors including socioeconomic status and geographic region. This study examined whether sociodemographic variations in the immune and inflammatory molecular underpinnings of chronic disease might emerge decades earlier in young adulthood. Using data from 1,069 young adults from the National Longitudinal Study of Adolescent to Adult Health (Add Health)-the largest nationally representative and ethnically diverse sample with peripheral blood transcriptome profiles-we analyzed variation in the expression of genes involved in inflammation and type I interferon (IFN) response as a function of individual demographic factors, sociodemographic conditions, and biobehavioral factors (smoking, drinking, and body mass index). Differential gene expression was most pronounced by sex, race/ethnicity, and body mass index (BMI), but transcriptome correlates were identified for every demographic dimension analyzed. Inflammation-related gene expression showed the most pronounced variation as a function of biobehavioral factors (BMI and smoking) whereas type I IFN-related transcripts varied most strongly as a function of individual demographic characteristics (sex and race/ethnicity). Bioinformatic analyses of transcription factor and immune-cell activation based on transcriptome-wide empirical differences identified additional effects of family poverty and geographic region. These results identify pervasive sociodemographic differences in immune-cell gene regulation that emerge by young adulthood and may help explain social disparities in the development of chronic illness and premature mortality at older ages.
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Affiliation(s)
- Steven W Cole
- School of Medicine, University of California, Los Angeles, CA 90095;
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA 90095
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA 90095
| | - Michael J Shanahan
- Department of Sociology, University of Zürich, CH 8050 Zürich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zürich, CH 8050 Zürich, Switzerland
| | - Lauren Gaydosh
- Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN 37235
- Public Policy Studies, Department of Political Science, Vanderbilt University, Nashville, TN 37235
| | - Kathleen Mullan Harris
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516;
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
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Duman EA, Atesyakar N, Ecevitoglu A. Multilevel Impact of Prenatal Risk and Protective Factors on Stress Biology and Infant Development: Study protocol of BABIP prospective birth cohort from Turkey. Brain Behav Immun Health 2020; 1:100005. [PMID: 38377425 PMCID: PMC8474236 DOI: 10.1016/j.bbih.2019.100005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022] Open
Abstract
Prenatal environment has long-lasting effects on offspring development and health. Research on prenatal stress identified various mechanisms of these effects, from changes in epigenetic and gene expression profiles to Maternal-Placental-Fetal (MPF) stress biology. There is also evidence for the role of additional risk and protective factors influencing the impact of prenatal stress on maternal and infant outcomes. Considering these findings, we present the study protocol of BABIP, a prospective birth cohort from Turkey. The aim of the project is to investigate the effect of prenatal stress on MPF stress biology (i.e. neuroendocrine, immune and metabolic systems), differential DNA methylation and gene expression patterns, and infant birth and developmental outcomes. We are recruiting 150 pregnant women and their babies for a longitudinal project with 4 time points: 20-24 (T1) and 30-34 (T2) weeks of pregnancy, and 1-month (T3) and 4-months (T4) after giving birth. Maternal early and prenatal environment (prenatal stress, early life stress, psychosocial resources, and health-related behaviors) are assessed during pregnancy with MPF stress biology, DNA methylation and gene expression measures. Infant birth outcomes, DNA methylation and development are assessed postpartum. BABIP is the first prospective birth cohort from Turkey with extensive measures on prenatal environment and health. Through investigating the multilevel impact of prenatal stress and related risk and protective factors during and after pregnancy, BABIP will contribute to our understanding of the mechanisms by which prenatal environment influences infant development and health. Being the first such cohort from Turkey, it may also allow identification of prenatal risk and protective factors specific to the context and population in Turkey.
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Affiliation(s)
- Elif Aysimi Duman
- Department of Psychology, Bogazici University, Istanbul, Turkey
- Center for Life Sciences and Technologies, Bogazici University, Istanbul, Turkey
| | - Nilay Atesyakar
- Department of Psychology, Bogazici University, Istanbul, Turkey
| | - Alev Ecevitoglu
- Department of Psychology, Bogazici University, Istanbul, Turkey
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Walsh K, McCormack CA, Webster R, Pinto A, Lee S, Feng T, Krakovsky HS, O'Grady SM, Tycko B, Champagne FA, Werner EA, Liu G, Monk C. Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes. Proc Natl Acad Sci U S A 2019; 116:23996-24005. [PMID: 31611411 PMCID: PMC6883837 DOI: 10.1073/pnas.1905890116] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Maternal prenatal stress influences offspring neurodevelopment and birth outcomes including the ratio of males to females born; however, there is limited understanding of what types of stress matter, and for whom. Using a data-driven approach with 27 variables from questionnaires, ambulatory diaries, and physical assessments collected early in the singleton pregnancies of 187 women, 3 latent profiles of maternal prenatal stress emerged that were differentially associated with sex at birth, birth outcomes, and fetal neurodevelopment. Most women (66.8%) were in the healthy group (HG); 17.1% were in the psychologically stressed group (PSYG), evidencing clinically meaningful elevations in perceived stress, depression, and anxiety; and 16% were in the physically stressed group (PHSG) with relatively higher ambulatory blood pressure and increased caloric intake. The population normative male:female secondary sex ratio (105:100) was lower in the PSYG (2:3) and PHSG (4:9), and higher in the HG (23:18), consistent with research showing diminished male births in maternal stress contexts. PHSG versus HG infants were born 1.5 wk earlier (P < 0.05) with 22% compared to 5% born preterm. PHSG versus HG fetuses had decreased fetal heart rate-movement coupling (P < 0.05), which may indicate slower central nervous system development, and PSYG versus PHSG fetuses had more birth complications, consistent with previous findings among offspring of women with psychiatric illness. Social support most strongly differentiated the HG, PSYG, and PHSG groups, and higher social support was associated with increased odds of male versus female births. Stress phenotypes in pregnant women are associated with male vulnerability and poor fetal outcomes.
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Affiliation(s)
- Kate Walsh
- Ferkauf Graduate School of Psychology, Yeshiva University, The Bronx, NY 10461
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Clare A McCormack
- Center for Science and Society, Columbia University, New York, NY 10027
| | - Rachel Webster
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Anita Pinto
- Data Science, Columbia University, New York, NY 10027
| | - Seonjoo Lee
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY 10032
- Department of Biostatistics (in Psychiatry), Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Tianshu Feng
- Department of Biostatistics (in Psychiatry), Mailman School of Public Health, Columbia University, New York, NY 10032
| | - H Sloan Krakovsky
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Sinclaire M O'Grady
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Benjamin Tycko
- Hackensack-Meridian Health Center for Discovery and Innovation, Nutley, NJ 07110
| | - Frances A Champagne
- Department of Psychiatry, Columbia University, New York, NY 10032
- Department of Psychology, University of Texas at Austin, Austin, TX 78712
| | - Elizabeth A Werner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Grace Liu
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032;
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
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31
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Socio-Economic Position Under the Microscope: Getting ‘Under the Skin’ and into the Cells. CURR EPIDEMIOL REP 2019. [DOI: 10.1007/s40471-019-00217-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Matoba N, Yallapragada S, Davis MM, Ernst LM, Collins JW, Mestan KK. Racial differences in placental pathology among very preterm births. Placenta 2019; 83:37-42. [PMID: 31477205 DOI: 10.1016/j.placenta.2019.06.385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/15/2019] [Accepted: 06/25/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION African American women are at higher risk for preterm birth compared to white women, but no placental pathology has characterized this disparity. The objective of this study was to examine the association of race with placental pathology among very preterm births. METHODS We conducted an eight-year retrospective cohort study of very preterm infants born at ≤32 weeks at Northwestern Prentice Women's Hospital in Chicago, Illinois. Archived placental slides underwent standardized masked histopathologic review. Logistic regression was performed for placental pathology, adjusting for available relevant covariates and stratified by infant sex and gestational age. RESULTS Placentas were available for 296 white and 224 African American mother-infant pairs among births at ≤32 weeks gestation. Compared to placentas from white births, the adjusted OR (aOR) for acute inflammation in placentas from African American births was 1.95 (95% CI 0.87-4.37), the aOR for chronic inflammation was 3.35 (1.49-7.54), the aOR for fetal vascular pathology was 0.82 (0.29-2.32), and the aOR for maternal vascular pathology was 1.01 (0.51-1.99). Stratified analysis showed associations between all placental pathologies and race among male births. Across gestational age groups (<28 and ≥ 28 weeks), the association between race and placental pathology was present for chronic inflammation and fetal vascular pathology. DISCUSSION Race is associated with placental pathology, and in particular, with chronic inflammation among very preterm births. The effect is modified by infant sex and gestational age. Placental histopathology may be useful markers for understanding the biological processes that shape disparities in pregnancy outcomes.
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Affiliation(s)
- Nana Matoba
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Ave., Chicago, IL, 60611, United States.
| | - Sushmita Yallapragada
- Division of Neonatology, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd., Dallas, TX, United States
| | - Matthew M Davis
- Division of Academic General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Ave., Chicago, IL, United States
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, Northshore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, United States
| | - James W Collins
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Ave., Chicago, IL, 60611, United States
| | - Karen K Mestan
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Ave., Chicago, IL, 60611, United States
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Profiles of gene expression in maternal blood predict offspring birth weight in normal pregnancy. J Dev Orig Health Dis 2019; 10:676-682. [PMID: 31204630 DOI: 10.1017/s2040174419000175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The association between lower birth weight and increased disease risk in adulthood has drawn attention to the physiological processes that shape the gestational environment. We implement genome-wide transcriptional profiling of maternal blood samples to identify subsets of genes and associated transcription control pathways that predict offspring birth weight. Female participants (N = 178, mean = 27.0 years) in a prospective observational birth cohort study were contacted between 2009 and 2014 to identify new pregnancies. An in-home interview was scheduled for early in the third trimester (mean = 30.3 weeks) to collect pregnancy-related information and a blood sample, and birth weight was measured shortly after delivery. Transcriptional activity in white blood cells was determined with a whole-genome gene expression direct hybridization assay. Fifty transcripts were differentially expressed in association with offspring birth weight, with 18 up-regulated in relation to lower birth weight, and 32 down-regulated. Examination of transcription control pathways identified increased activity of NF-κB, AP-1, EGR1, EGR4, and Gfi families, and reduced the activity of CEBP, in association with lower birth weight. Transcript origin analyses identified non-classical CD16+ monocytes, CD1c+ myeloid dendritic cells, and neutrophils as the primary cellular mediators of differential gene expression. These results point toward a systematic regulatory shift in maternal white blood cell activity in association with lower offspring birth weight, and they suggest that analyses of gene expression during gestation may provide insight into regulatory and cellular mechanisms that influence birth outcomes.
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Chen HJ, Gur TL. Intrauterine Microbiota: Missing, or the Missing Link? Trends Neurosci 2019; 42:402-413. [PMID: 31053242 PMCID: PMC6604064 DOI: 10.1016/j.tins.2019.03.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/21/2019] [Accepted: 03/19/2019] [Indexed: 12/29/2022]
Abstract
The intrauterine environment provides a key interface between the mother and the developing fetus during pregnancy, and is a target for investigating mechanisms of fetal programming. Studies have demonstrated an association between prenatal stress and neurodevelopmental disorders. The role of the intrauterine environment in mediating this effect is still being elucidated. In this review, we discuss emerging preclinical and clinical evidence suggesting the existence of microbial communities in utero. We also outline possible mechanisms of bacterial translocation to the intrauterine environment and immune responses to the presence of microbes or microbial components. Lastly, we overview the effects of intrauterine inflammation on neurodevelopment. We hypothesize that maternal gestational stress leads to disruptions in the maternal oral, gut, and vaginal microbiome that may lead to the translocation of bacteria to the intrauterine environment, eliciting an inflammatory response and resulting in deficits in neurodevelopment.
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Affiliation(s)
- Helen J Chen
- Department of Neuroscience, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Tamar L Gur
- Department of Psychiatry and Behavioral Health, Wexner Medical Center at The Ohio State University, Columbus, OH, USA; Department of Neuroscience, Wexner Medical Center at The Ohio State University, Columbus, OH, USA; Department of Obstetrics and Gynecology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA; Institute of Behavioral Medicine Research, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
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35
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Early adversity and the regulation of gene expression: Implications for prenatal health. Curr Opin Behav Sci 2019; 28:111-118. [PMID: 31815157 DOI: 10.1016/j.cobeha.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Early life, including prenatal development and childhood, is a period of sensitivity, with potential for developmental programming under conditions of adversity. The intergenerational effects of early adversity have received attention, most often studied in relation to fetal development according to maternal exposures. Less often considered but critically important is the effect of early adversity on future prenatal risk (e.g., risk for preeclampsia, preterm birth), which threatens the health of mother and infant. The body's ability to turn collections of genes "on" or "off" across a range of tissues via receptor-driven transcription factors and epigenetic mechanisms (i.e., chemical modifications to the genome) in response to the perceived environment may help to explain such associations. This review aims to summarize discoveries surrounding the effects of early adversity on gene expression, emphasizing prenatal populations. First, we review findings from gene expression studies examining the effects of early adversity on various tissues known to contribute to prenatal health in adulthood. Next, we review several gene regulatory mechanisms thought to underlie differences in gene expression. Finally, we discuss potential implications for prenatal risk among early adversity-exposed mothers according to our current understanding of the biology that contributes to the development of prenatal syndromes.
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36
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Leviton A, Allred EN, Dammann O, Joseph RM, Fichorova RN, O’Shea TM, Kuban KCK. Socioeconomic status and early blood concentrations of inflammation-related and neurotrophic proteins among extremely preterm newborns. PLoS One 2019; 14:e0214154. [PMID: 30913246 PMCID: PMC6435168 DOI: 10.1371/journal.pone.0214154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/07/2019] [Indexed: 02/07/2023] Open
Abstract
The main objective of this study was to evaluate the relationship between mother’s socioeconomic disadvantage and blood concentrations of inflammation-related proteins among extremely preterm newborns (<28 weeks gestation), a group at heightened risk of cognitive impairment when exposed to systemic inflammation. We measured the concentrations of 27 inflammatory and neurotrophic proteins in blood specimens collected a week apart during the first postnatal month from 857 extremely preterm newborns in the United States. We classified children according to 3 indicators/correlates of socioeconomic disadvantage, mother’s eligibility for government-provided medical care insurance (Medicaid), mother’s formal education level, and mother’s IQ approximated with the Kaufman Brief Intelligence Test– 2. The risks of a top-quartile concentration of each protein on each of 5 days a week apart, on two occasions during the first two postnatal weeks, and during the next two weeks were modeled as functions of each indicator of socioeconomic disadvantage. The risks of top quartile concentrations of multiple (2–5) inflammation-related proteins on multiple days during the first two weeks were increased for each of the 3 indicators of socioeconomic disadvantage, while the risks of top quartile concentrations of selected neurotrophic proteins were reduced. Adjustment for socioeconomic disadvantage did not alter the relationships between protein concentrations and both low IQ and low working memory 10 years later. Among extremely preterm newborns, indicators of socioeconomic disadvantage are associated with modestly increased risk of systemic inflammation in postnatal blood during the first postnatal month and with a slightly reduced risk of a neurotrophic signal, but do not confound relationships between protein concentrations and outcomes.
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Affiliation(s)
- Alan Leviton
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Elizabeth N. Allred
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Olaf Dammann
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Robert M. Joseph
- Boston University School of Medicine, Boston, MA, United States of America
| | - Raina N. Fichorova
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - T. Michael O’Shea
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Karl C. K. Kuban
- Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America
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37
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Hantsoo L, Kornfield S, Anguera MC, Epperson CN. Inflammation: A Proposed Intermediary Between Maternal Stress and Offspring Neuropsychiatric Risk. Biol Psychiatry 2019; 85:97-106. [PMID: 30314641 PMCID: PMC6309506 DOI: 10.1016/j.biopsych.2018.08.018] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/03/2018] [Accepted: 08/22/2018] [Indexed: 02/02/2023]
Abstract
During pregnancy, programming of the fetal central nervous system establishes vulnerabilities for emergence of neuropsychiatric phenotypes later in life. Psychosocial influences during pregnancy, such as stressful life events and chronic stress, correlate with offspring neuropsychiatric disorders and inflammation, respectively. Stress promotes inflammation, but the role of inflammation as a mediator between maternal psychosocial stress and offspring neuropsychiatric outcomes has not been extensively studied in humans. This review summarizes clinical evidence linking specific types of stress to maternal inflammatory load during pregnancy. We propose that inflammation is a mediator in the relationship between psychosocial stress and offspring neuropsychiatric outcomes, potentially influenced by poor maternal glucocorticoid-immune coordination. We present relevant experimental animal research supporting this hypothesis. We conclude that clinical and preclinical research supports the premise that stress-induced maternal immune activation contributes in part to prenatal programming of risk. Programming of risk is likely due to a combination of vulnerabilities, including multiple or repeated inflammatory events; timing of such events; poor maternal regulation of inflammation; genetic vulnerability; and lifestyle contributors.
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Affiliation(s)
- Liisa Hantsoo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Sara Kornfield
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Montserrat C Anguera
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - C Neill Epperson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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38
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Sow environment during gestation: part I. Influence on maternal physiology and lacteal secretions in relation with neonatal survival. Animal 2019; 13:1432-1439. [DOI: 10.1017/s1751731118002987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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39
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Minakova E, Warner BB. Maternal immune activation, central nervous system development and behavioral phenotypes. Birth Defects Res 2018; 110:1539-1550. [PMID: 30430765 DOI: 10.1002/bdr2.1416] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022]
Abstract
Maternal immune activation (MIA) refers to a maternal immune system triggered by infectious or infectious-like stimuli. A cascade of cytokines and immunologic alterations are transmitted to the fetus, resulting in adverse phenotypes most notably in the central nervous system. Epidemiologic studies implicate maternal infections in a variety of neuropsychiatric disorders, most commonly autism spectrum disorders and schizophrenia. In animal models, MIA causes neurochemical and anatomic changes in the brain that correspond to those found in humans with the disorders. As our understanding of the interactions between environment, genetics, and immune system grows, the role of alternative, noninfectious risk factors, such as prenatal stress, obesity, and the gut microbiome also becomes clearer. This review considers how infectious and noninfectious etiologies activate the maternal immune system. Their impact on fetal programming and neuropsychiatric disorders in offspring is examined in the context of human and animal studies.
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Affiliation(s)
- Elena Minakova
- Department of Pediatrics, School of Medicine, Washington University in St Louis, Saint Louis, Missouri
| | - Barbara B Warner
- Department of Pediatrics, School of Medicine, Washington University in St Louis, Saint Louis, Missouri
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40
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Breen MS, Wingo AP, Koen N, Donald KA, Nicol M, Zar HJ, Ressler KJ, Buxbaum JD, Stein DJ. Gene expression in cord blood links genetic risk for neurodevelopmental disorders with maternal psychological distress and adverse childhood outcomes. Brain Behav Immun 2018; 73:320-330. [PMID: 29791872 PMCID: PMC6191930 DOI: 10.1016/j.bbi.2018.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/11/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022] Open
Abstract
Prenatal exposure to maternal stress and depression has been identified as a risk factor for adverse behavioral and neurodevelopmental outcomes in early childhood. However, the molecular mechanisms through which maternal psychopathology shapes offspring development remain poorly understood. We applied transcriptome-wide screens to 149 umbilical cord blood samples from neonates born to mothers with posttraumatic stress disorder (PTSD; n = 20), depression (n = 31) and PTSD with comorbid depression (n = 13), compared to carefully matched trauma exposed controls (n = 23) and healthy mothers (n = 62). Analyses by maternal diagnoses revealed a clear pattern of gene expression signatures distinguishing neonates born to mothers with a history of psychopathology from those without. Co-expression network analysis identified distinct gene expression perturbations across maternal diagnoses, including two depression-related modules implicated in axon-guidance and mRNA stability, as well as two PTSD-related modules implicated in TNF signaling and cellular response to stress. Notably, these disease-related modules were enriched with brain-expressed genes and genetic risk loci for autism spectrum disorder and schizophrenia, which may imply a causal role for impaired developmental outcomes. These molecular alterations preceded changes in clinical measures at twenty-four months, including reductions in cognitive and socio-emotional outcomes in affected infants. Collectively, these findings indicate that prenatal exposure to maternal psychological distress induces neuronal, immunological and behavioral abnormalities in affected offspring and support the search for early biomarkers of exposures to adverse in utero environments and the classification of children at risk for impaired development.
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Affiliation(s)
- Michael S Breen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetic and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Aliza P Wingo
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA; Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA
| | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Kirsten A Donald
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa; Department of Paediatrics and Child Health and MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Mark Nicol
- Division of Medical Microbiology, Department of Pathology, University of Cape Town and National Health Laboratory Service, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health and MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Kerry J Ressler
- Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA; McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Joseph D Buxbaum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetic and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa.
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Doll KM. Investigating Black-White disparities in gynecologic oncology: Theories, conceptual models, and applications. Gynecol Oncol 2018; 149:78-83. [PMID: 29605054 DOI: 10.1016/j.ygyno.2017.10.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/22/2017] [Accepted: 10/02/2017] [Indexed: 10/17/2022]
Abstract
Within gynecologic oncology are two of the top five widest Black-White mortality gaps among all cancer diagnoses in the United States. A rich body of work from the social sciences, including anthropology, sociology and social epidemiology, have broadened the understanding of and research approaches to the study of health and healthcare inequity experienced by Black Americans. Yet, these intellectual advancements in understanding are virtually absent from the gynecologic oncology literature. The goal of this analytic essay will be to introduce three current frameworks of studying racial inequity: The Ecosocial Theory of Disease Distribution, The Fundamental Cause Theory, and The Public Health Critical Race Praxis. Applications of each conceptual model to gynecologic oncology are illustrated. The Ecosocial Theory, in particular the concept of embodiment, can be used to design and interpret racial differences in molecular and genetic studies. The Fundamental Cause Theory explains the relationship of socioeconomic position with the evolving treatability of a given disease over time, and provides understanding to the contrast in racial disparities within ovarian, endometrial, and cervical cancers. The Public Health Critical Race Praxis is an iterative methodology that helps frame how to study the impact of racism on healthcare delivery. Different analytic approaches that account for the interaction of race and socioeconomic factors are reviewed. Finally, considerations for racial equity research in gynecologic oncology are proposed.
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Affiliation(s)
- Kemi M Doll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, University of Washington, United States; Seattle Cancer Care Alliance, United States.
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42
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Leviton A, Joseph RM, Allred EN, O’Shea TM, Taylor HG, Kuban KKC. Antenatal and Neonatal Antecedents of Executive Dysfunctions in Extremely Preterm Children. J Child Neurol 2018; 33:198-208. [PMID: 29322860 PMCID: PMC5807158 DOI: 10.1177/0883073817750499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
To find out why children born extremely preterm are at heightened risk of executive dysfunctions, the authors assessed 716 children who were 10 years old born extremely preterm whose IQ was ≥ 70. A working memory dysfunction (n = 169), an inhibition dysfunction (n = 360), a switching dysfunction (355), and all 3 (executive dysfunction; n = 107) were defined on the basis of Z-scores ≤ -1 on the Differential Ability Scales-II Working Memory composite, and/or on the NEPSY-II Inhibition-Inhibition and Inhibition-Switching subtests. All risk profiles include an indicator of socioeconomic disadvantage. The risk profile of each of the 3 individual dysfunctions includes an indicator of the newborn's immaturity, and the risk profiles of the inhibition dysfunction and switching dysfunction also include an indicator of inflammation. Only the switching dysfunction was associated with fetal growth restriction. The risk factors for executive dysfunction can be subsumed under the 4 themes of socioeconomic disadvantage, immaturity/vulnerability, inflammation, and fetal growth restriction.
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Affiliation(s)
- Alan Leviton
- Boston Children’s Hospital and Harvard Medical School,
Boston MA, USA
| | | | | | - T. Michael O’Shea
- University of North Carolina School of Medicine, Chapel Hill NC,
USA
| | - H. Gerry Taylor
- Nationwide Children’s Hospital and The Ohio State
University, Columbus, OH, USA
| | - Karl KC Kuban
- Boston Medical Center and Boston University School of Medicine,
Boston, MA, USA
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Brenhouse HC, Danese A, Grassi-Oliveira R. Neuroimmune Impacts of Early-Life Stress on Development and Psychopathology. Curr Top Behav Neurosci 2018; 43:423-447. [PMID: 30003509 DOI: 10.1007/7854_2018_53] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Maltreatment and trauma in childhood, termed early-life stress (ELS), has long-term effects on the immune system. ELS impacts immune signaling at the time of exposure but also disrupts the developmental trajectory of certain immunological processes, both in the periphery and in the brain. One consequence of these early alterations is a heightened immune response to stressors later in life. However, chronic and sustained inflammatory response can also lead to excitotoxicity and prevent typical brain development. In this chapter, we discuss current progress toward understanding the contribution of neuroimmune signaling to ELS-attributable dysfunction or maladaptation with a focus on postnatal experiences. To do so we first present an operational definition of ELS. Then, we offer a brief overview of the immune system and neuroimmune development, followed by a section discussing the interaction between immunity, childhood trauma, and mental disorders in humans. We present evidence from animal models about immune alterations after ELS and discuss the ways in which ELS-induced immune changes ultimately affect brain and behavior, as well as the importance of individual differences and future directions in this field. Taken together, we submit that when encountered with ELS, some core brain circuits could develop differently via various mechanisms involving dysfunctional immune reprograming. However, given the remarkable plasticity of both the brain and the immune system, many of the deleterious effects of ELS may be mitigated with interventions that account for sex and target neuroimmune interactions over the lifespan.
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Affiliation(s)
| | - Andrea Danese
- Social, Genetic, and Developmental Psychiatry Centre, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Rodrigo Grassi-Oliveira
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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Stress and the HPA Axis: Balancing Homeostasis and Fertility. Int J Mol Sci 2017; 18:ijms18102224. [PMID: 29064426 PMCID: PMC5666903 DOI: 10.3390/ijms18102224] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/17/2017] [Accepted: 10/21/2017] [Indexed: 12/25/2022] Open
Abstract
An organism’s reproductive fitness is sensitive to the environment, integrating cues of resource availability, ecological factors, and hazards within its habitat. Events that challenge the environment of an organism activate the central stress response system, which is primarily mediated by the hypothalamic–pituitary–adrenal (HPA) axis. The regulatory functions of the HPA axis govern the cardiovascular and metabolic system, immune functions, behavior, and reproduction. Activation of the HPA axis by various stressors primarily inhibits reproductive function and is able to alter fetal development, imparting a biological record of stress experienced in utero. Clinical studies and experimental data indicate that stress signaling can mediate these effects through direct actions in the brain, gonads, and embryonic tissues. This review focuses on the mechanisms by which stress activation of the HPA axis impacts fertility and fetal development.
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