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Unger KG, Sanapo L, Bourjeily G, Salmoirago-Blotcher E, Bublitz MH. The Impact of Mindfulness Treatment on Maternal Inflammation and Fetal Neurodevelopment Among Participants with Histories of Hypertensive Disorders. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:85-89. [PMID: 37751286 PMCID: PMC10801677 DOI: 10.1089/jicm.2023.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
This was a secondary analysis of a prenatal mindfulness training (MT) RCT versus treatment as usual (TAU) on neutrophil-to-lymphocyte ratio (NLR), a measure of maternal inflammation, and fetal head circumference. Fifteen participants were randomized to MT and 14 to TAU. NLR in third trimester was significantly lower in the MT group (F = 7.11, p = 0.019) relative to those in TAU. Higher NLR values in second (r = -0.644, p = 0.013) and third trimesters (r = -0.601, p = 0.030) were associated with lower fetal HC%. There was no group difference in fetal HC%. A future, fully powered study is needed to replicate these findings. Clinical Trials Number: NCT03679117.
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Affiliation(s)
- Katherine G. Unger
- The Miriam Hospital, Women's Medicine Collaborative, Providence, Rhode Island, USA
- Department of Neuroscience, Brown University, Providence, Rhode Island, USA
| | - Laura Sanapo
- The Miriam Hospital, Women's Medicine Collaborative, Providence, Rhode Island, USA
- Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ghada Bourjeily
- The Miriam Hospital, Women's Medicine Collaborative, Providence, Rhode Island, USA
- Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Elena Salmoirago-Blotcher
- Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Margaret H. Bublitz
- The Miriam Hospital, Women's Medicine Collaborative, Providence, Rhode Island, USA
- Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Besral B, Misrawati M, Afiyanti Y, Ismail RI, Arifin H. MIESRA mHealth: Marital satisfaction during pregnancy. PLoS One 2023; 18:e0289061. [PMID: 37616290 PMCID: PMC10449122 DOI: 10.1371/journal.pone.0289061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/11/2023] [Indexed: 08/26/2023] Open
Abstract
The transition of a pregnant woman's role often causes emotional changes that have an impact on marital satisfaction. We develop MIESRA mHealth and evaluate its impact on satisfaction of husband-wife relationship during pregnancy. A quasi-experimental study was conducted on 82 couples of pregnant women and divided into control, single, and paired group. We implemented MIESRA mHealth for four weeks. In the couple group, the wife did mindfulness based on the information in the MIESRA mHealth together with her husband. In a single group, the wife sees the video as an initial guide to doing mindfulness. In the control group, respondents received programme interventions from hospitals which included education and consultation with obstetricians. Husband-wife relationship is evaluated using Compatibility of Husband-and-Wife Relationships / Kesesuaian Hubungan Suami Istri (KHSI) questionnaire and the generalised estimating equations (GEE) was used to analyse the data. The women's KHSI scores in the couple and single intervention groups (β = -7.46, p = 0.002; β = -9.11, p = 0.001) were better than the control group. The husbands' KHSI scores in the paired and individual intervention groups (β = -7.04, p<0.001; β = -3.74, p = 0.024) were better than the control group. Nursing interventions to build emotional bonds between parents and foetuses based on mHealth can be a promising intervention for marital harmony during the perinatal period. MIESRA m-Health is a promising intervention on marital satisfaction during pregnancy and can be implemented as a part of the antenatal care programme to increase marital satisfaction.
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Affiliation(s)
- Besral Besral
- Department of Biostatistics, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Misrawati Misrawati
- Department of Maternity and Women Health, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Department of Maternity and Women Health, Faculty of Nursing, Universitas Riau, Pekanbaru, Indonesia
| | - Yati Afiyanti
- Department of Maternity and Women Health, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Raden Irawati Ismail
- Department of Psychiatrics, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
| | - Hidayat Arifin
- Department of Fundamental Nursing Care, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Study protocol of guided mobile-based perinatal mindfulness intervention (GMBPMI) - a randomized controlled trial. PLoS One 2022; 17:e0270683. [PMID: 35802637 PMCID: PMC9269359 DOI: 10.1371/journal.pone.0270683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Psychological distress is a common occurrence among women during the perinatal period. Maternal psychological distress (MPS) can also have a negative influence on neonatal outcomes such as infant health, child development or mother-child interaction. Hence, interventions to improve mental wellbeing during this period are vital. Mindfulness based intervention (MBI) has been found to be effective in reducing psychological distress. Delivery of MBI via the internet, making it accessible and inexpensive, is showing a promising positive effect in reducing psychological distress. A randomized control trial with sufficient power is required to confirm its positive effect among pregnant women. The positive effects of MBI have been found to be associated with heart rate variability (HRV) biofeedback; however, the efficacy of MBI on HRV has been rarely studied among pregnant women. Also, the potential association of HRV with MBI and psychological wellbeing needs further examination. This research aims to test the effectiveness of guided mobile-based perinatal mindfulness intervention (GMBPMI) among pregnant women experiencing psychological distress during the pre- and post-natal period, as well as examining the efficacy of GMBPMI on HRV. Method This study is a randomized controlled trial that follows a parallel design. Consenting pregnant women in their second trimester (between 12th and 20th week gestation) will be randomly assigned to an intervention group (GMBPMI) or a control group (psychoeducation). The intended sample size is 198, with 99 participants in each group. Three levels of outcomes will be measured at baseline, post intervention in both the intervention and control groups, and at 36-week gestation and five-week postpartum. The primary outcomes include maternal psychological stress, mindfulness and positive appraisal HRV. Secondary outcomes are psychological and physical wellbeing. Tertiary outcomes include obstetric and neonatal outcomes, and social support. Analyses will follow an intention-to-treat method and repeated measures MANOVA will be conducted to compare changes in primary and secondary outcomes. A series of mixed-effects models will be fitted to assess the mediation effects. Discussion This trial expects to increase understanding of GMBPMI on HRV and psychological wellbeing for pregnant women, with extended support in both pre-and post-natal periods. The study could also potentially provide evidence for delivery of cost-effective and accessible services to pregnant women. Trial registration ClinicalTrials.gov: NCT04876014, registered on 30 March 2021. Protocol Version 1.0., 10 May 2021.
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Noroña-Zhou AN, Coccia M, Epel E, Vieten C, Adler NE, Laraia B, Jones-Mason K, Alkon A, Bush NR. The Effects of a Prenatal Mindfulness Intervention on Infant Autonomic and Behavioral Reactivity and Regulation. Psychosom Med 2022; 84:525-535. [PMID: 35653611 PMCID: PMC9172888 DOI: 10.1097/psy.0000000000001066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/07/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Maternal health and wellness during pregnancy are associated with long-term health outcomes in children. The current study examined whether infants of women who participated in a mindfulness-based intervention during pregnancy that reduced levels of stress and depression, increased physical activity, and improved glucose tolerance differed on biobehavioral markers of psychopathological and physical health risk compared with infants of women who did not. METHODS Participants were 135 mother-infant dyads drawn from a racially and ethnically diverse, low-income sample experiencing high stress. The women participated in an intervention trial during pregnancy that involved assignment to either mindfulness-based intervention or treatment-as-usual (TAU). Infants of women from both groups were assessed at 6 months of age on sympathetic (preejection period), parasympathetic (respiratory sinus arrhythmia), and observed behavioral (negativity and object engagement) reactivity and regulation during the still face paradigm. Linear mixed-effects and generalized linear mixed-effects models were used to examine treatment group differences in infant outcomes. RESULTS Relative to those in the intervention group, infants in the TAU group showed a delay in sympathetic activation and subsequent recovery across the still face paradigm. In addition, infants in the intervention group engaged in higher proportions of self-regulatory behavior during the paradigm, compared with the TAU group. No significant effect of intervention was found for parasympathetic response or for behavioral negativity during the still face paradigm. CONCLUSIONS Findings provide evidence that maternal participation in a short-term, group mindfulness-based intervention during pregnancy is associated with the early development of salutary profiles of biobehavioral reactivity and regulation in their infants. Because these systems are relevant for psychopathology and physical health, prenatal behavioral interventions may benefit two generations.
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Affiliation(s)
- Amanda N. Noroña-Zhou
- From the Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences (Noroña-Zhou, Coccia, Epel, Adler, Bush), University of California, San Francisco, San Francisco; Division of Physical Sciences (Vieten), University of California, San Diego, San Diego, California; John W. Brick Mental Health Foundation (Vieten), Timonium, Maryland; Institute of Noetic Sciences (Vieten), Petaluma; Department of Pediatrics (Adler, Bush), University of California, San Francisco, San Francisco; School of Public Health (Laraia), University of California, Berkeley, Berkeley; Center for Health and Community, Weill Institute for Neurosciences (Jones-Mason), Department of Family Health Care Nursing (Alkon), and Department of Pediatrics, Division of Developmental Medicine (Bush), University of California, San Francisco, San Francisco, California
| | - Michael Coccia
- From the Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences (Noroña-Zhou, Coccia, Epel, Adler, Bush), University of California, San Francisco, San Francisco; Division of Physical Sciences (Vieten), University of California, San Diego, San Diego, California; John W. Brick Mental Health Foundation (Vieten), Timonium, Maryland; Institute of Noetic Sciences (Vieten), Petaluma; Department of Pediatrics (Adler, Bush), University of California, San Francisco, San Francisco; School of Public Health (Laraia), University of California, Berkeley, Berkeley; Center for Health and Community, Weill Institute for Neurosciences (Jones-Mason), Department of Family Health Care Nursing (Alkon), and Department of Pediatrics, Division of Developmental Medicine (Bush), University of California, San Francisco, San Francisco, California
| | - Elissa Epel
- From the Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences (Noroña-Zhou, Coccia, Epel, Adler, Bush), University of California, San Francisco, San Francisco; Division of Physical Sciences (Vieten), University of California, San Diego, San Diego, California; John W. Brick Mental Health Foundation (Vieten), Timonium, Maryland; Institute of Noetic Sciences (Vieten), Petaluma; Department of Pediatrics (Adler, Bush), University of California, San Francisco, San Francisco; School of Public Health (Laraia), University of California, Berkeley, Berkeley; Center for Health and Community, Weill Institute for Neurosciences (Jones-Mason), Department of Family Health Care Nursing (Alkon), and Department of Pediatrics, Division of Developmental Medicine (Bush), University of California, San Francisco, San Francisco, California
| | - Cassandra Vieten
- From the Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences (Noroña-Zhou, Coccia, Epel, Adler, Bush), University of California, San Francisco, San Francisco; Division of Physical Sciences (Vieten), University of California, San Diego, San Diego, California; John W. Brick Mental Health Foundation (Vieten), Timonium, Maryland; Institute of Noetic Sciences (Vieten), Petaluma; Department of Pediatrics (Adler, Bush), University of California, San Francisco, San Francisco; School of Public Health (Laraia), University of California, Berkeley, Berkeley; Center for Health and Community, Weill Institute for Neurosciences (Jones-Mason), Department of Family Health Care Nursing (Alkon), and Department of Pediatrics, Division of Developmental Medicine (Bush), University of California, San Francisco, San Francisco, California
| | - Nancy E. Adler
- From the Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences (Noroña-Zhou, Coccia, Epel, Adler, Bush), University of California, San Francisco, San Francisco; Division of Physical Sciences (Vieten), University of California, San Diego, San Diego, California; John W. Brick Mental Health Foundation (Vieten), Timonium, Maryland; Institute of Noetic Sciences (Vieten), Petaluma; Department of Pediatrics (Adler, Bush), University of California, San Francisco, San Francisco; School of Public Health (Laraia), University of California, Berkeley, Berkeley; Center for Health and Community, Weill Institute for Neurosciences (Jones-Mason), Department of Family Health Care Nursing (Alkon), and Department of Pediatrics, Division of Developmental Medicine (Bush), University of California, San Francisco, San Francisco, California
| | - Barbara Laraia
- From the Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences (Noroña-Zhou, Coccia, Epel, Adler, Bush), University of California, San Francisco, San Francisco; Division of Physical Sciences (Vieten), University of California, San Diego, San Diego, California; John W. Brick Mental Health Foundation (Vieten), Timonium, Maryland; Institute of Noetic Sciences (Vieten), Petaluma; Department of Pediatrics (Adler, Bush), University of California, San Francisco, San Francisco; School of Public Health (Laraia), University of California, Berkeley, Berkeley; Center for Health and Community, Weill Institute for Neurosciences (Jones-Mason), Department of Family Health Care Nursing (Alkon), and Department of Pediatrics, Division of Developmental Medicine (Bush), University of California, San Francisco, San Francisco, California
| | - Karen Jones-Mason
- From the Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences (Noroña-Zhou, Coccia, Epel, Adler, Bush), University of California, San Francisco, San Francisco; Division of Physical Sciences (Vieten), University of California, San Diego, San Diego, California; John W. Brick Mental Health Foundation (Vieten), Timonium, Maryland; Institute of Noetic Sciences (Vieten), Petaluma; Department of Pediatrics (Adler, Bush), University of California, San Francisco, San Francisco; School of Public Health (Laraia), University of California, Berkeley, Berkeley; Center for Health and Community, Weill Institute for Neurosciences (Jones-Mason), Department of Family Health Care Nursing (Alkon), and Department of Pediatrics, Division of Developmental Medicine (Bush), University of California, San Francisco, San Francisco, California
| | - Abbey Alkon
- From the Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences (Noroña-Zhou, Coccia, Epel, Adler, Bush), University of California, San Francisco, San Francisco; Division of Physical Sciences (Vieten), University of California, San Diego, San Diego, California; John W. Brick Mental Health Foundation (Vieten), Timonium, Maryland; Institute of Noetic Sciences (Vieten), Petaluma; Department of Pediatrics (Adler, Bush), University of California, San Francisco, San Francisco; School of Public Health (Laraia), University of California, Berkeley, Berkeley; Center for Health and Community, Weill Institute for Neurosciences (Jones-Mason), Department of Family Health Care Nursing (Alkon), and Department of Pediatrics, Division of Developmental Medicine (Bush), University of California, San Francisco, San Francisco, California
| | - Nicole R. Bush
- From the Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences (Noroña-Zhou, Coccia, Epel, Adler, Bush), University of California, San Francisco, San Francisco; Division of Physical Sciences (Vieten), University of California, San Diego, San Diego, California; John W. Brick Mental Health Foundation (Vieten), Timonium, Maryland; Institute of Noetic Sciences (Vieten), Petaluma; Department of Pediatrics (Adler, Bush), University of California, San Francisco, San Francisco; School of Public Health (Laraia), University of California, Berkeley, Berkeley; Center for Health and Community, Weill Institute for Neurosciences (Jones-Mason), Department of Family Health Care Nursing (Alkon), and Department of Pediatrics, Division of Developmental Medicine (Bush), University of California, San Francisco, San Francisco, California
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Doty MS, Chen HY, Ajishegiri O, Sibai BM, Blackwell SC, Chauhan SP. Daily meditation program for anxiety in individuals admitted to the antepartum unit: a multicenter randomized controlled trial (MEDITATE). Am J Obstet Gynecol MFM 2022; 4:100562. [PMID: 35031521 DOI: 10.1016/j.ajogmf.2022.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/26/2021] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inpatient antepartum women have higher levels of anxiety than outpatient. Former randomized trials using mindful meditation programs to decrease maternal anxiety have conflicting results; some studies showed a considerable decrease in anxiety levels, whereas others showed no difference. A paucity of trials exist using mindful meditation for maternal anxiety in the inpatient antepartum population; most studies focus on the outpatient clinic population. Because of inpatient acuity and anxiety factors, we conducted a randomized trial to target this population. OBJECTIVE This study aimed to compare anxiety levels on day 4 of either routine care or routine care plus a twice-daily application-based mindful meditation program in women admitted to the antepartum unit. STUDY DESIGN In a multisite randomized trial (ClinicalTrials.gov Identifier: NCT03737279), women admitted to the antepartum units were randomized to either routine care plus educational pamphlets (control arm) or routine care plus a twice-daily application-based mindful meditation program (intervention arm). The inclusion criteria were age of at least 18 years, gestational age of at least 23 weeks, planned inpatient care for >3 days from randomization, and care by our university physician team. The primary outcome was maternal state anxiety level (measured using the validated State-Trait Anxiety Inventory) on day 4 (randomization being day 1). The secondary outcomes included stress (measured using the Perceived Stress Scale) and depression (measured using the Edinburgh Depression Scale) on day 4, latency period from randomization to delivery, patient experience, number of meditation sessions, and total meditation time. A total of 56 women were needed for 90% power to detect a decrease in the primary outcome by 30% in the intervention group, compared with the control group. All women were observed using an intention-to-treat analysis. We compared the continuous variables using the Wilcoxon rank-sum test or t test and the categorical variables using the chi-squared test or the Fisher exact test. RESULTS From March 4, 2019, to December 20, 2019, 412 women were screened for eligibility, 77 women (18.7%) were found eligible, and 56 women (72.7%) were randomized with 28 women in each group. Of note, 96.4% of women completed at least 1 meditation session, and 39.3% of women completed all meditation sessions. The mean score of the anxiety level using the State-Trait Anxiety Inventory on day 4 was not significantly different (P=.24) between the control group (42.0±10.8) and meditation group (37.5±13.1). A decreased anxiety score from day 1 to day 4 was seen in both the control group and meditation group (-4.7 vs -9.4, respectively; P=.12). The rate of abnormal State-Trait Anxiety Inventory scores on day 4 was not significantly different between the control group and meditation group (62% vs 45%, respectively; P=.28). When asked about the experience with the research trial, 88.8% of women in the control group and 89.5% of women in the meditation group reported a positive experience. CONCLUSION Compared with the control group, a twice-daily application-based mindful meditation program for women admitted to the antepartum unit did not considerably decrease the anxiety score on day 4. However, >88% of women in both groups had a positive experience with the nonpharmacologic intervention.
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Affiliation(s)
- Morgen S Doty
- Obstetrix Maternal-Fetal Medicine Specialists of Houston, Houston, TX (Dr Doty).
| | - Han-Yang Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Dr Chen, Ms Ajishegiri, and Drs Sibai, Blackwell, and Chauhan)
| | - Oluwadare Ajishegiri
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Dr Chen, Ms Ajishegiri, and Drs Sibai, Blackwell, and Chauhan)
| | - Baha M Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Dr Chen, Ms Ajishegiri, and Drs Sibai, Blackwell, and Chauhan)
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Dr Chen, Ms Ajishegiri, and Drs Sibai, Blackwell, and Chauhan)
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Dr Chen, Ms Ajishegiri, and Drs Sibai, Blackwell, and Chauhan)
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Ostlund BD, Olavson K, Brown MA, Shakiba N, Saenz C, Crowell SE, Conradt E. Maternal mindfulness during pregnancy predicts newborn neurobehavior. Dev Psychobiol 2021; 63:e22131. [PMID: 34053072 PMCID: PMC8933861 DOI: 10.1002/dev.22131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 02/23/2021] [Accepted: 04/30/2021] [Indexed: 11/06/2022]
Abstract
Newborn neurobehavioral competencies portend a young child's abilities to modulate their arousal and attention in response to dynamic environmental cues. Although evidence suggests prenatal contributions to newborn neurobehavioral differences, no study to date has examined wellness-promoting traits, such as a pregnant woman's mindfulness, in this association. We examined whether a mother's mindfulness while pregnant related to neurobehavioral outcomes in her neonate, as well as whether maternal mindfulness moderated the link between prenatal maternal emotion dysregulation and newborn neurobehavior. Mothers (N = 162) reported on their mindfulness and emotion dysregulation while pregnant. Newborn arousal and attention were assessed at least 24 h after birth (M = 3.8 days, SD = 8.3) using the NICU Network Neurobehavioral Scale (NNNS). Highly mindful pregnant women reported lower levels of emotion dysregulation. Newborns of highly mindful mothers exhibited higher levels of arousal (e.g., excitability, motor activity) but did not differ in regards to attention at birth. Maternal emotion dysregulation while pregnant was associated with blunted newborn attention, but only among mothers who were less mindful. Our findings suggest that a mother's mindfulness while pregnant may influence her fetus' neurobehavioral development in ways that are evident at birth.
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Affiliation(s)
| | | | | | | | | | - Sheila E. Crowell
- Department of Psychology, University of Utah
- Department of Pediatrics, University of Utah
- Department of Psychiatry, University of Utah
| | - Elisabeth Conradt
- Department of Psychology, University of Utah
- Department of Pediatrics, University of Utah
- Department of Obstetrics and Gynecology, University of Utah
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Roubinov DS, Luecken LJ, Curci SG, Somers JA, Winstone LK. A prenatal programming perspective on the intergenerational transmission of maternal adverse childhood experiences to offspring health problems. AMERICAN PSYCHOLOGIST 2021; 76:337-349. [PMID: 33734799 PMCID: PMC7995605 DOI: 10.1037/amp0000762] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Decades of research indicate that individuals exposed to childhood adversity are at risk for poor physical and mental health across their life span. More recently, intergenerational transmission of trauma and prenatal programming frameworks suggest an even longer reach for adverse childhood experiences (ACEs), with consequences that extend to subsequent generations. Beyond the individual-level consequences typically observed by empirical studies of ACEs, mothers' experiences of early adversity may also compromise the maternal-child dyadic relationship. We propose a conceptual model whereby mothers' ACEs impact maternal-infant dyadic functioning and later biobehavioral health outcomes through heightened perinatal psychosocial risk. We provide support for the proposed paths and mechanistic processes in our model with data drawn from Las Madres Nuevas, a longitudinal study of low-income Mexican-origin families who participated in a series of home and laboratory visits from the prenatal period through early childhood. Higher ACEs exposure among Las Madres Nuevas participants was associated with numerous perinatal psychosocial risk factors, which predicted poorer mother-infant dyadic functioning. Compromised dyadic functioning during infancy was associated with later maternal mental health and child behavior problems. We conclude with discussion of prevention and treatment strategies that can buffer against proposed risk pathways, including perinatal assessment of maternal ACEs and psychosocial risk, perinatal treatment of maternal distress, and mother-infant therapy in the postpartum period. It is our hope that the proposed conceptual model will serve as a guide for future research to examine the lasting consequences of childhood adversities within and across generations among high-risk populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Rosa-Salva O, Mayer U, Versace E, Hébert M, Lemaire BS, Vallortigara G. Sensitive periods for social development: Interactions between predisposed and learned mechanisms. Cognition 2021; 213:104552. [PMID: 33402251 DOI: 10.1016/j.cognition.2020.104552] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/13/2022]
Abstract
We analysed research that makes use of precocial species as animal models to describe the interaction of predisposed mechanisms and environmental factors in early learning, in particular for the development of social cognition. We also highlight the role of sensitive periods in this interaction, focusing on domestic chicks as one of the main animal models for this field. In the first section of the review, we focus on the emergence of early predispositions to attend to social partners. These attentional biases appear before any learning experience about social stimuli. However, non-specific experiences occurring during sensitive periods of the early post-natal life determine the emergence of these predisposed mechanisms for the detection of social partners. Social predispositions have an important role for the development learning-based social cognitive functions, showing the interdependence of predisposed and learned mechanisms in shaping social development. In the second part of the review we concentrate on the reciprocal interactions between filial imprinting and spontaneous (not learned) social predispositions. Reciprocal influences between these two sets of mechanisms ensure that, in the natural environment, filial imprinting will target appropriate social objects. Neural and physiological mechanisms regulating the sensitive periods for the emergence of social predispositions and for filial imprinting learning are also described.
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Affiliation(s)
- Orsola Rosa-Salva
- Center for Mind/Brain Sciences, University of Trento, Piazza Manifattura 1, 38068 Rovereto, TN, Italy
| | - Uwe Mayer
- Center for Mind/Brain Sciences, University of Trento, Piazza Manifattura 1, 38068 Rovereto, TN, Italy
| | - Elisabetta Versace
- Center for Mind/Brain Sciences, University of Trento, Piazza Manifattura 1, 38068 Rovereto, TN, Italy; Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, 327 Mile End Road, London E1 4NS, United Kingdom
| | - Marie Hébert
- Center for Mind/Brain Sciences, University of Trento, Piazza Manifattura 1, 38068 Rovereto, TN, Italy
| | - Bastien S Lemaire
- Center for Mind/Brain Sciences, University of Trento, Piazza Manifattura 1, 38068 Rovereto, TN, Italy
| | - Giorgio Vallortigara
- Center for Mind/Brain Sciences, University of Trento, Piazza Manifattura 1, 38068 Rovereto, TN, Italy.
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McLean MA, Cobham VE, Simcock G. Prenatal Maternal Distress: A Risk Factor for Child Anxiety? Clin Child Fam Psychol Rev 2019; 21:203-223. [PMID: 29388042 DOI: 10.1007/s10567-017-0251-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The deleterious association between various types of prenatal maternal psychological distress (PNMS, anxiety, depression, psychological distress, stress) and childhood anxiety symptomatology (internalizing behaviors, anxiety symptoms) has been established using both retrospective and prospective longitudinal studies across varied demographic cohorts and throughout development. Yet, the existing literature cannot claim maternal distress during pregnancy to be a specific risk factor for anxiety symptomatology, as studies utilizing such observational designs are unable to adequately account for confounding of potential genetic factors and the postnatal environment. In this review, we examine studies that attempt to minimize such confounding and thus disentangle the unique intrauterine exposure effect of varying types of PNMS on childhood anxiety symptomatology. Such methodologies include paternal versus maternal comparison studies, sibling comparisons, prenatal cross-fostering designs and timing of exposure studies (including disaster studies). Of the identified studies, findings indicate that prenatal maternal distress is likely to constitute a risk factor for anxiety symptomatology, although more studies are needed to replicate current findings in order to determine whether there are clear differences in effects across specific types of PNMS and for specific subpopulations. We review the methodological limitations and strengths of the literature prior to exploring avenues of future research and implications for theory and clinical practice.
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Affiliation(s)
- Mia A McLean
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia.
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Gabrielle Simcock
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
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Lenz B, Eichler A, Schwenke E, Buchholz VN, Hartwig C, Moll GH, Reich K, Mühle C, Volz B, Titzmann A, Beckmann MW, Heinrich H, Kornhuber J, Fasching PA. Mindfulness-based Stress Reduction in Pregnancy: an App-Based Programme to Improve the Health of Mothers and Children (MINDFUL/PMI Study). Geburtshilfe Frauenheilkd 2018; 78:1283-1291. [PMID: 30686833 PMCID: PMC6337919 DOI: 10.1055/a-0677-2630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 01/01/2023] Open
Abstract
Unfavourable intrauterine environmental factors increase the risk of delivery complications as well as postpartum developmental and behavioural problems in children and adolescents with ongoing effects into older age. Biomarker studies show that maternal stress and the use of alcohol and tobacco during pregnancy are associated with a higher intrauterine testosterone exposure of the child. The antenatal testosterone load, in turn, is a risk factor for lasting adverse health effects which extend into adulthood. A 15-week, mindfulness-oriented, app-based programme for the reduction of stress as well as for the reduction of alcohol and tobacco use in pregnant women is established. In the monocentre, prospective, controlled, and investigator-blinded MINDFUL/PMI (Maternal Health and Infant Development in the Follow-up after Pregnancy and a Mindfulness Intervention) study, pregnant women carry out the programme. Its effect on antenatal testosterone exposure of the child is examined by assessing the index/ring finger length ratio and other biomarkers in the 1-year-old children. In addition, the programmeʼs effects on self-regulation, the developmental status and the mental health of the children at the age of one year will be investigated. Additional aspects of the course of the pregnancy and delivery represent exploratory study objectives. This longitudinal study project is intended to improve the understanding of the impact of intrauterine environmental factors on early childhood development and health. Maternal stress as well as alcohol and tobacco use during pregnancy are modifiable factors and represent potential preventive targets.
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Affiliation(s)
- Bernd Lenz
- Psychiatrische und Psychotherapeutische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anna Eichler
- Kinder- und Jugendabteilung für Psychische Gesundheit, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Eva Schwenke
- Frauenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Verena N Buchholz
- Psychiatrische und Psychotherapeutische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Charlotte Hartwig
- Frauenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Gunther H Moll
- Kinder- und Jugendabteilung für Psychische Gesundheit, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Karin Reich
- Psychiatrische und Psychotherapeutische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christiane Mühle
- Psychiatrische und Psychotherapeutische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Bernhard Volz
- Frauenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany.,Biostatistics and Data Management Unit, Frauenklinik des Universitätsklinikums Erlangen, Erlangen, Germany
| | - Adriana Titzmann
- Frauenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias W Beckmann
- Frauenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hartmut Heinrich
- Kinder- und Jugendabteilung für Psychische Gesundheit, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany.,kbo-Heckscher-Klinikum, München, Germany
| | - Johannes Kornhuber
- Psychiatrische und Psychotherapeutische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Peter A Fasching
- Frauenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
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Simcock G, Kildea S, Kruske S, Laplante DP, Elgbeili G, King S. Disaster in pregnancy: midwifery continuity positively impacts infant neurodevelopment, QF2011 study. BMC Pregnancy Childbirth 2018; 18:309. [PMID: 30053853 PMCID: PMC6062998 DOI: 10.1186/s12884-018-1944-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research shows that continuity of midwifery carer in pregnancy improves maternal and neonatal outcomes. This study examines whether midwifery group practice (MGP) care during pregnancy affects infant neurodevelopment at 6-months of age compared to women receiving standard hospital maternity care (SC) in the context of a natural disaster. METHODS This prospective cohort study included 115 women who were affected by a sudden-onset flood during pregnancy. They received one of two models of maternity care: MGP or SC. The women's flood-related objective stress, subjective reactions, and cognitive appraisal of the disaster were assessed at recruitment into the study. At 6-months postpartum they completed the Ages and Stages Questionnaire (ASQ-3) on their infants' communication, fine and gross motor, problem solving, and personal-social skills. RESULTS Greater maternal objective and subjective stress predicted worse infant outcomes. Even when controlling for maternal stress from the flood, infants of mothers who were in the MGP model of maternity care performed better than infants of mothers in SC on two of the five ASQ-3 domains (fine motor and problem solving) at 6-months of age. Furthermore, infants in the SC model were more likely to be identified as at risk for delayed development on these domains than infants in the MGP model of care. CONCLUSIONS Continuity of midwifery care has positive effects on infant neurodevelopment when mothers experience disaster-related stress in pregnancy, with significantly better outcomes on two developmental domains at 6 months compared to infants whose mothers received standard hospital care.
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Affiliation(s)
- Gabrielle Simcock
- Mater Research Institute-University of Queensland, Brisbane, QLD Australia
- School of Psychology, The University of Queensland, Brisbane, QLD Australia
| | - Sue Kildea
- Mater Research Institute-University of Queensland, Brisbane, QLD Australia
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, QLD Australia
| | - Sue Kruske
- Institute of Urban Indigenous Health, Brisbane, QLD Australia
| | - David P. Laplante
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health Institute, 6875 LaSalle Boulevard, Verdun, Quebec, H4H 1R3 Canada
| | - Guillaume Elgbeili
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health Institute, 6875 LaSalle Boulevard, Verdun, Quebec, H4H 1R3 Canada
| | - Suzanne King
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health Institute, 6875 LaSalle Boulevard, Verdun, Quebec, H4H 1R3 Canada
- Department of Psychiatry, McGill University, Montreal, QC Canada
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12
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Isgut M, Smith AK, Reimann ES, Kucuk O, Ryan J. The impact of psychological distress during pregnancy on the developing fetus: biological mechanisms and the potential benefits of mindfulness interventions. J Perinat Med 2017; 45:999-1011. [PMID: 28141546 DOI: 10.1515/jpm-2016-0189] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/05/2016] [Indexed: 02/03/2023]
Abstract
The in utero environment plays an essential role in shaping future growth and development. Psychological distress during pregnancy has been shown to perturb the delicate physiological milieu of pregnancy, and has been associated with negative repercussions in the offspring, including adverse birth outcomes, long-term defects in cognitive development, behavioral problems during childhood and high baseline levels of stress-related hormones. Fetal epigenetic programming, involving epigenetic processes, may help explain the link between maternal prenatal stress and its negative effects on the child. Given the potential long-term effects of early-life stress on a child's health, it is crucial to minimize maternal distress during pregnancy. A number of recent studies have examined the usefulness of mindfulness-based programs to reduce prenatal psychological stress and improve maternal psychological health, and these are reviewed here. Overall, the findings are promising, but more research is needed with large studies using randomized controlled study designs. It remains unclear whether or not such interventions could also improve child health outcomes, and whether these changes are modulated at the epigenetic level during fetal development. Further studies in this area are needed.
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13
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Erickson NL, Gartstein MA, Dotson JAW. Review of Prenatal Maternal Mental Health and the Development of Infant Temperament. J Obstet Gynecol Neonatal Nurs 2017; 46:588-600. [DOI: 10.1016/j.jogn.2017.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 01/17/2023] Open
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14
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Newman L, Judd F, Komiti A. Developmental implications of maternal antenatal anxiety mechanisms and approaches to intervention. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/20017022.2017.1309879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Louise Newman
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Fiona Judd
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Angela Komiti
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- Centre for Women’s Mental Health, The Royal Women’s Hospital, Parkville, VIC, Australia
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15
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Manipulation of Strength of Cerebral Lateralization via Embryonic Light Stimulation in Birds. LATERALIZED BRAIN FUNCTIONS 2017. [DOI: 10.1007/978-1-4939-6725-4_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Sanada K, Montero-Marin J, Alda Díez M, Salas-Valero M, Pérez-Yus MC, Morillo H, Demarzo MMP, García-Toro M, García-Campayo J. Effects of Mindfulness-Based Interventions on Salivary Cortisol in Healthy Adults: A Meta-Analytical Review. Front Physiol 2016; 7:471. [PMID: 27807420 PMCID: PMC5069287 DOI: 10.3389/fphys.2016.00471] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/03/2016] [Indexed: 01/04/2023] Open
Abstract
Objective: The aim of the present study was to elucidate the effects of Mindfulness-based interventions (MBIs) on salivary cortisol levels in healthy adult populations. Method: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), published between January 1980 and June 2015 in PubMed, EMBASE, PsycINFO and the Cochrane library. The PRISMA and Cochrane guidelines were followed. The pooled effect sizes were calculated with the random-effects model, using Hedges' g-values, and heterogeneity was measured using the I2 statistic. The contribution of different characteristics of participants and programmes were assessed by meta-regression models, using beta coefficients. Results: Five RCTs with 190 participants in total were included in this systematic review. The overall effect size (ES) for improving the state of health related to cortisol levels was moderately low (g = 0.41; p = 0.025), although moderate heterogeneity was found (I2 = 55; p = 0.063). There were no significant differences between active (g = 0.33; p = 0.202) and passive (g = 0.48; p = 0.279) controls, but significant differences were found when comparing standard (g = 0.81; p = 0.002) and raw (g = 0.03; p = 0.896) measures. The percentage of women in each study was not related to ES. Nevertheless, age (beta = −0.03; p = 0.039), the number of sessions (beta = 0.33; p = 0.007) and the total hours of the MBI (beta = 0.06; p = 0.005) were significantly related to ES, explaining heterogeneity (R2 = 1.00). Conclusions: Despite the scarce number of studies, our results suggest that MBIs might have some beneficial effect on cortisol secretion in healthy adult subjects. However, there is a need for further RCTs implemented in accordance with standard programmes and measurements of salivary cortisol under rigorous strategies in healthy adult populations.
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Affiliation(s)
- Kenji Sanada
- Primary Care, Aragon Health Sciences InstituteZaragoza, Spain; Department of Psychiatry, Showa University School of MedicineTokyo, Japan
| | - Jesus Montero-Marin
- Faculty of Health Sciences and Sports, University of ZaragozaZaragoza, Spain; The Primary Care Prevention and Health Promotion Research NetworkBarcelona, Spain
| | - Marta Alda Díez
- The Primary Care Prevention and Health Promotion Research NetworkBarcelona, Spain; Department of Psychiatry, Miguel Servet University Hospital, University of ZaragozaZaragoza, Spain
| | | | - María C Pérez-Yus
- Primary Care, Aragon Health Sciences InstituteZaragoza, Spain; The Primary Care Prevention and Health Promotion Research NetworkBarcelona, Spain
| | - Héctor Morillo
- Primary Care, Aragon Health Sciences InstituteZaragoza, Spain; The Primary Care Prevention and Health Promotion Research NetworkBarcelona, Spain
| | - Marcelo M P Demarzo
- Department of Preventive Medicine, "Mente Aberta" Brazilian Centre for Mindfulness and Health Promotion, Federal University of São PauloSão Paulo, Brazil; Hospital Israelita Albert EinsteinSão Paulo, Brazil
| | - Mauro García-Toro
- The Primary Care Prevention and Health Promotion Research NetworkBarcelona, Spain; Research Institute of Health Sciences, University of the Balearic IslandsPalma, Spain
| | - Javier García-Campayo
- The Primary Care Prevention and Health Promotion Research NetworkBarcelona, Spain; Department of Psychiatry, Miguel Servet University Hospital, University of ZaragozaZaragoza, Spain
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Clark CAC, Espy KA, Wakschlag L. Developmental pathways from prenatal tobacco and stress exposure to behavioral disinhibition. Neurotoxicol Teratol 2015; 53:64-74. [PMID: 26628107 DOI: 10.1016/j.ntt.2015.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 11/04/2015] [Accepted: 11/23/2015] [Indexed: 12/25/2022]
Abstract
Prenatal tobacco exposure (PTE) and prenatal stress exposure (PSE) both have been linked to externalizing behavior, although their effects generally have been considered in isolation. Here, we aimed to characterize the joint or interactive roles of PTE and PSE in early developmental pathways to behavioral disinhibition, a profile of cognitive and behavioral under-control that presages severe externalizing behavior. As part of a prospective, longitudinal study, 296 children were assessed at a mean age of 5 years. Exposures were assessed via repeated interviews across the prenatal period and bioassays of cotinine were obtained. Behavioral disinhibition was assessed using temperament measures in infancy, performance-based executive control tasks and measures of disruptive and inattentive behavior. PSE was associated with a higher probability of difficult temperament in infancy. Each exposure independently predicted poorer executive control at age 5 years. Difficult temperament and executive control difficulties in turn predicted elevated levels of disruptive behavior, although links from PTE and PSE to parent-reported attention problems were less robust. Children who experienced these prenatal exposures in conjunction with higher postnatal stress exposure showed the lowest executive control and highest levels of disruptive behavior. Findings highlight the compounding adverse impact of PTE and PSE on children's behavioral trajectories. Given their high concordance, prenatal health campaigns should target these exposures in tandem.
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Affiliation(s)
- C A C Clark
- Department of Psychology, University of Arizona, United States
| | - K A Espy
- Department of Psychology, University of Arizona, United States; Developmental Cognitive Neuroscience Laboratory, University of Nebraska-Lincoln, United States
| | - L Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Policy Research, Northwestern University, United States
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