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Tisseyre M, Collier M, Beeker N, Kaguelidou F, Treluyer JM, Chouchana L. In Utero Exposure to Antibiotics and Risk of Serious Infections in the First Year of Life. Drug Saf 2024; 47:453-464. [PMID: 38409516 DOI: 10.1007/s40264-024-01401-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION AND OBJECTIVE Given the high prevalence of antibiotic prescription during pregnancy in France and previous studies suggesting an increased risk of infection in offspring with such exposures, our study aimed to investigate the association between prenatal exposure to systemic antibiotics and serious infections in full-term infants during their first year of life. METHODS We conducted a retrospective population-based cohort study on singleton, full-term liveborn non-immunocompromised infants, using the French National Health Data System (SNDS) between 2012 and 2021. Systemic antibiotic dispensing in ambulatory care settings during pregnancy defined the exposure. Outcomes concerned serious infections (i.e., infections requiring hospitalization) in offspring identified between 3 and 12 months of life, hence excluding infections of maternal origin. Adjusted odds ratios (aORs) were estimated using logistic regression with multivariate models to control for potential confounders. RESULTS Of 2,836,630 infants included, 39.6% were prenatally exposed to systemic antibiotics. Infants prenatally exposed to antibiotics had a higher incidence of serious infections compared with unexposed infants {aOR 1.12 [95% confidence interval (95% CI) 1.11-1.13]}. Similar associations were observed according to the timing of exposure during pregnancy, antibiotic class, and site of infections. The strongest association was observed when infants were prenatally exposed to three or more antibiotic courses during pregnancy [aOR 1.21 (95% CI 1.19-1.24)]. Limitations include residual confounders, such as genetic susceptibility to infections and the role of the underlying pathogen agent. CONCLUSION Prenatal exposure to systemic antibiotics is very common and is associated with a weak yet significant associations with subsequent serious infectious events during the first year of life. While our study revealed associations, it is important to note that causation cannot be established, given the acknowledged limitations, including potential confounding by indication.
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Affiliation(s)
- Mylène Tisseyre
- Centre Régional de Pharmacovigilance, Service de Pharmacologie périnatale, pédiatrique et adulte, Hopital Cochin, Assistance Publique-Hopitaux de Paris (AP-HP), 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France.
| | - Mathis Collier
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Unité de Recherche Clinique, Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Nathanaël Beeker
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Unité de Recherche Clinique, Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Florentia Kaguelidou
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Centre d'Investigations Cliniques, INSERM CIC1426, Hôpital Robert Debré, APHP.Nord, Paris, France
| | - Jean-Marc Treluyer
- Centre Régional de Pharmacovigilance, Service de Pharmacologie périnatale, pédiatrique et adulte, Hopital Cochin, Assistance Publique-Hopitaux de Paris (AP-HP), 27, rue du Faubourg Saint Jacques, 75014, Paris, France
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Unité de Recherche Clinique, Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Laurent Chouchana
- Centre Régional de Pharmacovigilance, Service de Pharmacologie périnatale, pédiatrique et adulte, Hopital Cochin, Assistance Publique-Hopitaux de Paris (AP-HP), 27, rue du Faubourg Saint Jacques, 75014, Paris, France
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
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Mudiyanselage SB, Wanni Arachchige Dona S, Angeles MR, Majmudar I, Marembo M, Tan EJ, Price A, Watts JJ, Gold L, Abimanyi-Ochom J. The impact of maternal health on child's health outcomes during the first five years of child's life in countries with health systems similar to Australia: A systematic review. PLoS One 2024; 19:e0295295. [PMID: 38457392 PMCID: PMC10923423 DOI: 10.1371/journal.pone.0295295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/19/2023] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION The first five years of life is an important developmental period that establishes the foundation for future health and well-being. Mothers play a primary role in providing emotional and physical nourishment during early childhood. This systematic review aims to explore the association between maternal health and child health in the first five years of the child's life. MATERIALS AND METHODS As primary aims, we systematically synthesised published evidence relating to the first five years of life for associations between maternal health exposures (mental, physical and Health-Related Quality of Life (HRQoL) and child health outcomes (physical health, mental health, HRQoL and Health Service Use (HSU) /cost). As a secondary aim, we explored how the above associations vary between disadvantaged and non-disadvantaged populations. The search was limited to studies that published and collected data from 2010 to 2022. The systematic review was specific to countries with similar health systems to Australia. The search was conducted in MEDLINE, CINAHL, APA PsycINFO, GLOBAL HEALTH, and EMBASE databases. The quality of the included studies was assessed by The Effective Public Health Practice Project (EPHPP) tool. RESULTS Thirteen articles were included in the final synthesis from the identified 9439 articles in the primary search. Six (46%) explored the association between maternal mental health and child's physical health, two (15%) explored maternal and child's physical health, one (8%) explored maternal and child's mental health, one (8%) explored maternal physical health and child's HRQoL, and three (23%) explored maternal mental health and child's HSU. We found an association between maternal health and child health (physical and mental) and HSU outcomes but no association between maternal health and child's overall HRQoL. The results for disadvantaged communities did not show any difference from the general population. DISCUSSION AND CONCLUSION Our review findings show that maternal health influences the child's health in the first five years. However, the current evidence is limited, and the findings were primarily related to a specific maternal or child's health condition. There was no evidence of associations of child health outcomes in healthy mothers. There is an extensive research gap investigating maternal health exposures and child outcomes in quality of life and overall health.
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Affiliation(s)
- Shalika Bohingamu Mudiyanselage
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Sithara Wanni Arachchige Dona
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Mary Rose Angeles
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Ishani Majmudar
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Miriam Marembo
- Department of Econometrics and Business Statistics, Monash University, Clayton, Victoria, Australia
- Department of Education, Victoria, Melbourne, Australia
| | - Eng Joo Tan
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anna Price
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer J. Watts
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Lisa Gold
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Julie Abimanyi-Ochom
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
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Louchet M, Tisseyre M, Kaguelidou F, Treluyer JM, Préta LH, Chouchana L. Drug-induced fetal and offspring disorders, beyond birth defects. Therapie 2024; 79:205-219. [PMID: 38008599 DOI: 10.1016/j.therap.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/09/2023] [Indexed: 11/28/2023]
Abstract
Studies on drug utilization in western countries disclosed that about nine over ten women use at least one or more drugs during pregnancy. Determining whether a drug is safe or not in pregnant women is a challenge of all times. As a developing organism, the fetus is particularly vulnerable to effects of drugs used by the mother. Historically, research has predominantly focused on birth defects, which represent the most studied adverse pregnancy outcomes. However, drugs can also alter the ongoing process of pregnancy and impede the general growth of the fetus. Finally, adverse drug reactions can theoretically damage all developing systems, organs or tissues, such as the central nervous system or the immune system. This extensive review focuses on different aspects of drug-induced damages affecting the fetus or the newborn/infant, beyond birth defects, which are not addressed here.
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Affiliation(s)
- Margaux Louchet
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France; Service de gynécologie-obstétrique, Fédération hospitalo-universitaire PREMA, hôpital Louis-Mourier, AP-HP Nord - Université Paris Cité, 75000 Paris, France
| | - Mylène Tisseyre
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France; Centre régional de pharmacovigilance, service de pharmacologie périnatale, pédiatrique et adulte, hôpitaux Cochin-Necker, AP-HP Centre - Université Paris Cité, 75000 Paris, France
| | - Florentia Kaguelidou
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France; Centre d'investigation clinique pédiatrique, Inserm CIC 1426, hôpital Robert-Debré, AP-HP Nord - Université Paris Cité, 75000 Paris, France
| | - Jean-Marc Treluyer
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France; Centre régional de pharmacovigilance, service de pharmacologie périnatale, pédiatrique et adulte, hôpitaux Cochin-Necker, AP-HP Centre - Université Paris Cité, 75000 Paris, France
| | - Laure-Hélène Préta
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France
| | - Laurent Chouchana
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France; Centre régional de pharmacovigilance, service de pharmacologie périnatale, pédiatrique et adulte, hôpitaux Cochin-Necker, AP-HP Centre - Université Paris Cité, 75000 Paris, France.
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Gimunová M, Paludo AC, Bernaciková M, Bienertova-Vasku J. The effect of space travel on human reproductive health: a systematic review. NPJ Microgravity 2024; 10:10. [PMID: 38238348 PMCID: PMC10796912 DOI: 10.1038/s41526-024-00351-1] [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: 08/24/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
With increasing possibilities of multi-year missions in deep space, colonizing other planets, and space tourism, it is important to investigate the effects of space travel on human reproduction. This study aimed to systematically review and summarize the results of available literature on space travel, microgravity, and space radiation, or Earth-based spaceflight analogues impact on female and male reproductive functions in humans. This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Space Biomedicine Systematic Review methods. The search was performed using three databases: PubMed, Web of Science, and Medline Complete. During the database search, 364 studies were identified. After the study selection process, 16 studies were included in the review. Five studies included female participants, and the findings show an increased risk of thromboembolism in combined oral contraceptive users, decreased decidualization, functional insufficiency of corpus luteum, and decreased progesterone and LH levels related to space travel or its simulation. Male participants were included in 13 studies. In males, reproductive health considerations focused on the decrease in testosterone and sex hormone-binding globulin levels, the ratio of male offspring, sperm motility, sperm vitality, and the increase in sperm DNA fragmentation related to space travel or its simulation. Results of this systematic review highlight the need to focus more on the astronaut's reproductive health in future research, as only 16 studies were found during the literature search, and many more research questions related to reproductive health in astronauts still need to be answered.
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Affiliation(s)
- Marta Gimunová
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic.
| | - Ana Carolina Paludo
- Department of Sport Performance and Exercise Testing, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Martina Bernaciková
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Julie Bienertova-Vasku
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
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5
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Preis H, Wang W, St. Denis I, Zhu W, Mahaffey B, Lobel M. Anxiety trajectories from pregnancy to one-year postpartum and their contributors during the COVID-19 pandemic. J Reprod Infant Psychol 2023:1-13. [PMID: 38111259 PMCID: PMC11182884 DOI: 10.1080/02646838.2023.2293914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Anxiety in the peripartum period (pregnancy through one-year postpartum) has negative impacts on mothers and infants. During the COVID-19 pandemic, high rates of anxiety were reported worldwide, but trajectories for how these symptoms change longitudinally in the peripartum period remain unknown. METHODS A total of 1,411 women who were pregnant during the second U.S. COVID-19 surge completed four study questionnaires between December 2020 and March 2022, including assessments of anxiety symptoms (GAD-7) and individual and community-level contributors. Latent Class Growth Mixture Models (LCGMM) were used to identify anxiety trajectories, and multinomial logistic regression was used to identify contributors to class membership. RESULTS Three classes of anxiety symptom trajectories were identified. Class 1 (n = 956, 67.8%) experienced minimal/mild anxiety throughout the peripartum period. Class 2 (n = 362, 25.7%) experienced initial moderate anxiety that remained stable. Class 3 (n = 93, 6.6%) experienced initial moderate anxiety that increased to severe in the postpartum period. Stress and history of mental health diagnosis contributed to higher initial levels of anxiety and ongoing social support contributed to lower levels of anxiety. In addition, financial insecurity increased the risk of belonging to Class 3. CONCLUSIONS Screening for anxiety symptoms and psychosocial vulnerabilities in the peripartum period is vital, as is early intervention. This is especially the case among women with limited financial and social resources who may experience chronic or worsening anxiety as they transition to parenthood.
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Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University
| | - Weihao Wang
- Department of Applied Mathematics and Statistics, Stony Brook University
| | | | - Wei Zhu
- Department of Applied Mathematics and Statistics, Stony Brook University
| | - Brittain Mahaffey
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University
| | - Marci Lobel
- Department of Psychology, Stony Brook University
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University
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Li J, Zhai M, Liu D, Wei L, Liu X, Wang Q, Yu B, Yan H. Pilot study of relationship between prenatal stress during the COVID-19 pandemic and social-emotional development of 12-month-old children: the mediation effects of home environment. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02292-8. [PMID: 37668698 DOI: 10.1007/s00787-023-02292-8] [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: 04/25/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
There is increasing evidence that prenatal stress elevates the risk of children's social-emotional development, but the mechanisms underlying this association are unclear. Home environment provides learning opportunities and stimulation required for children's early development and can be influenced by prenatal maternal stress. This study aimed to examine whether home environment can mediate the association between prenatal stress during the pandemic of coronavirus disease 2019 (COVID-19) and their offspring's social-emotional problems thereafter. A pilot sample was derived from 2020 to 2021 Maternal and Child Health Cohort study (N = 82) with the pregnant women recruited during the COVID-19 lockdown period in 2020. Prenatal stress was assessed using the Perceived Stress Scale. Home environment was measured using the Child Home Nurture Environment Scales. Mother-reported toddler social-emotional problems were assessed at 12 months of age. The mediation model was used for data analysis. The mean scores of social-emotional problems, which include externalizing, internalizing, dysregulation, and competence, were 10.98 (5.08), 14.72 (6.49), 15.15 (6.31), and 36.73 (10.26), respectively. Prenatal stress, home environment, and social-emotional problems were significantly related (P < 0.05). Home environment significantly mediated the association between prenatal stress and social-emotional problems with the indirect effect [95% CI] of 0.06 [0.01, 0.14] for externalizing behaviors, 0.10 [0.00, 0.24] for internalizing behaviors, - 0.15 [- 0.31, - 0.01] for competence, 0.08 [0.01, 0.17] and 0.08 [0.01, 0.21] for dysregulation. These findings suggest that prenatal stress may affect offspring's social-emotional problems through the home environment. Screening for prenatal stress and promoting supportive home environment may be potential strategies for social-emotional problems interventions in children.
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Affiliation(s)
- Jiayu Li
- School of Public Health, Wuhan University, No.115 Dong Hu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Mengxi Zhai
- School of Public Health, Wuhan University, No.115 Dong Hu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Dan Liu
- School of Public Health, Wuhan University, No.115 Dong Hu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Liqing Wei
- School of Public Health, Wuhan University, No.115 Dong Hu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Xin Liu
- School of Public Health, Wuhan University, No.115 Dong Hu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Qiwen Wang
- School of Public Health, Wuhan University, No.115 Dong Hu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Bin Yu
- School of Public Health, Wuhan University, No.115 Dong Hu Road, Wuhan, 430071, Hubei, People's Republic of China.
| | - Hong Yan
- School of Public Health, Wuhan University, No.115 Dong Hu Road, Wuhan, 430071, Hubei, People's Republic of China.
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Noroña-Zhou A, Coccia M, Sullivan A, O’Connor TG, Collett BR, Derefinko K, Renner LM, Loftus CT, Roubinov D, Carroll KN, Nguyen RHN, Karr CJ, Sathyanarayana S, Barrett ES, Mason WA, LeWinn KZ, Bush NR. A Multi-Cohort Examination of the Independent Contributions of Maternal Childhood Adversity and Pregnancy Stressors to the Prediction of Children's Anxiety and Depression. Res Child Adolesc Psychopathol 2023; 51:497-512. [PMID: 36462137 PMCID: PMC10017630 DOI: 10.1007/s10802-022-01002-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Women's social experiences can have long-term implications for their offspring's health, but little is known about the potential independent contributions of multiple periods of stress exposures over time. This study examined associations of maternal exposure to adversity in childhood and pregnancy with children's anxiety and depression symptoms in a large, sociodemographically diverse sample. Participants were 1389 mother-child dyads (child age M = 8.83 years; SD = 0.66; 42% Black, 42% White; 6% Hispanic) in the ECHO-PATHWAYS Consortium's three U.S. pregnancy cohorts. Women reported their exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE). Children self-reported on their symptoms of anxiety and depression at age 8-9 years. Regression analyses estimated associations between maternal stressors and children's internalizing problems, adjusting for confounders, and examined child sex as a modifier. Exploratory interaction analyses examined whether geospatially-linked postnatal neighborhood quality buffered effects. In adjusted models, PSLE counts positively predicted levels of children's anxiety and depression symptoms ([ßAnxiety=0.08, 95%CI [0.02, 0.13]; ßDepression=0.09, 95%CI [0.03, 0.14]); no significant associations were observed with CTE. Each additional PSLE increased odds of clinically significant anxiety symptoms by 9% (95%CI [0.02, 0.17]). Neither sex nor neighborhood quality moderated relations. Maternal stressors during pregnancy appear to have associations with middle childhood anxiety and depression across diverse sociodemographic contexts, whereas maternal history of childhood adversity may not. Effects appear comparable for boys and girls. Policies and programs addressing prevention of childhood internalizing symptoms may benefit from considering prenatal origins and the potential two-generation impact of pregnancy stress prevention and intervention.
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Affiliation(s)
- Amanda Noroña-Zhou
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
- Department of Pediatrics, UCSF, San Francisco, CA USA
- Center for Health and Community, UCSF, San Francisco, CA USA
| | - Michael Coccia
- Center for Health and Community, UCSF, San Francisco, CA USA
| | - Alexis Sullivan
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, Department of Obstetrics & Gynecology, University of Rochester, Rochester, NY USA
| | - Brent R. Collett
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle Children’s Research Institute, Seattle, WA USA
| | - Karen Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | | | - Christine T. Loftus
- Department of Occupational and Environmental Health Sciences, University of Washington, Seattle, WA USA
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
| | - Kecia N. Carroll
- Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Ruby H. N. Nguyen
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN USA
| | - Catherine J. Karr
- Department of Occupational and Environmental Health Sciences, Department of Pediatrics, University of Washington, Seattle, WA USA
| | - Sheela Sathyanarayana
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle Children’s Research Institute, Seattle, WA USA
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Environmental and Occupational Health Sciences Institute, Rutgers University, New Brunswick, NJ USA
| | - W. Alex Mason
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
| | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
- Department of Pediatrics, UCSF, San Francisco, CA USA
- Center for Health and Community, UCSF, San Francisco, CA USA
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8
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Moore N, Abouhala S, Maleki P, Kheyfets A, Carvalho K, Amutah-Onukagha N. The Efficacy of Provider-Based Prenatal Interventions to Reduce Maternal Stress: A Systematic Review. Womens Health Issues 2023; 33:300-311. [PMID: 37019762 DOI: 10.1016/j.whi.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/08/2023] [Accepted: 02/24/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Exposure to stress during the prenatal period is often associated with adverse maternal and neonatal health outcomes and is increasing in prevalence in the United States. Health care providers play a crucial role in addressing and mitigating this stress, but there is a lack of consensus in effective interventions. This review evaluates the effectiveness of prenatal provider-based interventions that reduce stress for pregnant people, especially those who are disproportionately affected by stress. METHODS A search of relevant English-language literature was conducted using PubMed, CINAHL, Web of Science, Embase, and PyscInfo. Inclusion criteria were 1) the target population was pregnant people, 2) the intervention was delivered within the U.S. health care system, and 3) the study intervention had the goal of reducing stress (stress-reducing intervention). RESULTS A total of 3,562 records were identified in the search and 23 were included in analysis. The four identified categories for provider-led stress-reducing prenatal interventions included in the review are 1) skills-building, 2) mindfulness, 3) behavioral therapy, and 4) group support. Findings suggest an increased overall likelihood of mood and maternal stress improvement among pregnant people who complete provider-based stress-reducing interventions, especially group-based therapies that integrated resource allocation, skills-building, mindfulness, and/or behavioral therapy into an intersectional program. However, the efficacy of each type of intervention varies by category and type of maternal stress targeted. CONCLUSIONS Although few studies demonstrated a significant reduction in stress for pregnant people, this review highlights the critical need for increased research and attention to stress-reducing interventions in the prenatal period, especially as it pertains to minoritized populations.
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Affiliation(s)
- Nichole Moore
- Tufts University School of Medicine, Boston, Massachusetts.
| | | | - Pegah Maleki
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anna Kheyfets
- Tufts University School of Medicine, Boston, Massachusetts
| | - Keri Carvalho
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Ndidiamaka Amutah-Onukagha
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
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9
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Perinatal and early childhood biomarkers of psychosocial stress and adverse experiences. Pediatr Res 2022; 92:956-965. [PMID: 35091705 DOI: 10.1038/s41390-022-01933-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/15/2021] [Accepted: 11/26/2021] [Indexed: 01/23/2023]
Abstract
The human brain develops through a complex interplay of genetic and environmental influences. During critical periods of development, experiences shape brain architecture, often with long-lasting effects. If experiences are adverse, the effects may include the risk of mental and physical disease, whereas positive environments may increase the likelihood of healthy outcomes. Understanding how psychosocial stress and adverse experiences are embedded in biological systems and how we can identify markers of risk may lead to discovering new approaches to improve patient care and outcomes. Biomarkers can be used to identify specific intervention targets and at-risk children early when physiological system malleability increases the likelihood of intervention success. However, identifying reliable biomarkers has been challenging, particularly in the perinatal period and the first years of life, including in preterm infants. This review explores the landscape of psychosocial stress and adverse experience biomarkers. We highlight potential benefits and challenges of identifying risk clinically and different sub-signatures of stress, and in their ability to inform targeted interventions. Finally, we propose that the combination of preterm birth and adversity amplifies the risk for abnormal development and calls for a focus on this group of infants within the field of psychosocial stress and adverse experience biomarkers. IMPACT: Reviews the landscape of biomarkers of psychosocial stress and adverse experiences in the perinatal period and early childhood and highlights the potential benefits and challenges of their clinical utility in identifying risk status in children, and in developing targeted interventions. Explores associations between psychosocial stress and adverse experiences in childhood with prematurity and identifies potential areas of assessment and intervention to improve outcomes in this at-risk group.
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Roubinov D, Browne D, LeWinn KZ, Lisha N, Mason WA, Bush NR. Intergenerational transmission of maternal childhood adversity and depression on children's internalizing problems. J Affect Disord 2022; 308:205-212. [PMID: 35429520 PMCID: PMC9357423 DOI: 10.1016/j.jad.2022.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 03/17/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Childhood trauma exacts a lasting toll on one's own mental health and the health of one's offspring; however, limited research has examined the pathways through which this intergenerational transmission occurs. This study aimed to identify the transactions and mechanisms that link maternal early life trauma, maternal depressive symptoms, and children's internalizing symptoms. METHOD A pregnancy cohort of N = 1462 mothers (66% Black, 32% White, 2% Other race) reported their childhood trauma exposure and depressive symptoms during pregnancy. Maternal depressive and children's internalizing symptoms were measured repeatedly when offspring were 12, 24, 36, and 48-60 months of age. A path model tested the transactional associations between maternal and child symptomatology and mediation of maternal childhood trauma on offspring symptoms via maternal depressive symptoms. RESULTS Mothers' childhood trauma history was related to greater prenatal and postnatal (12 and 24 months) maternal depressive symptoms, which were prospectively associated with offspring internalizing problems at 36 and 48-60 months. Child-directed effects on maternal depressive symptoms were not observed. The association of maternal trauma on children's internalizing at 36 months was mediated by maternal depressive symptoms at 24 months. LIMITATIONS Assessments of the key study variables were provided by mothers. Childhood trauma was evaluated retrospectively. CONCLUSION Women's experiences of adversity in childhood have persistent and cumulative effects on their depression during the transition to parenthood, which is associated with risk for children's internalizing. Given the two-generation influence of maternal childhood trauma exposure, attending to its impact may protect both caregivers and their children.
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Affiliation(s)
- Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States.
| | - Dillon Browne
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; Centre for Mental Health Research & Treatment, University of Waterloo, Waterloo, Ontario, Canada
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States
| | - Nadra Lisha
- Department of General Internal Medicine, University of California, San Francisco, CA, United States
| | - W Alex Mason
- University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States; Department of Pediatrics, University of California, San Francisco, United States
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Fox K, Vadiveloo M, McCurdy K, Benjamin-Neelon SE, Østbye T, Tovar A. Maternal Stress and Excessive Weight Gain in Infancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5743. [PMID: 35565137 PMCID: PMC9105332 DOI: 10.3390/ijerph19095743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 12/03/2022]
Abstract
Rapid weight gain in infancy increases the risk of developing obesity early in life and contributes significantly to racial and ethnic disparities in childhood obesity. While maternal perceived stress is associated with childhood obesity, little is known about the impact it has on infant weight gain. Therefore, this study explores the impact of maternal perceived stress on change in weight-for-length (WFL) z-scores and the risk of rapid weight gain in infancy. We conducted a secondary data analysis of the longitudinal Nurture birth cohort (n = 666). Most mothers in the cohort were non-Hispanic/Latinx Black (71.6%). About one-half of mothers had a body mass index (BMI) greater than 25 prior to pregnancy, were unemployed, and had a low income. Most infants in the cohort were born full-term and were of normal weight. Data were collected at 3-, 6-, 9-, and 12-months postpartum. At each assessment, mothers completed the Cohen’s Perceived Stress Scale (PSS), and research assistants weighed and measured each infant. Tertiles were used to compare mothers with high and low perceived stress. A mixed model analysis of repeated measures assessed the associations between baseline perceived stress and the change in infant WFL z-scores over time. Log-binomial models assessed the association between baseline perceived stress and rapid weight gain, defined as a change in WFL z-score > 0.67 standard deviations from three to twelve months. Just under one-half of the infants (47%) experienced rapid weight gain between three and twelve months of age. Birthweight for gestational age (RR = 1.18, 95% CI = 1.08−1.29, p-value = 0.004), gestational age at birth (RR = 1.07, 95% CI = 1.01−1.14, p-value = 0.031), and weeks breastfed (0.99, 95% CI 0.99−1.00, p-value 0.044) were associated with risk of rapid weight gain in unadjusted analyses. WFL z-scores increased significantly over time, with no effect of perceived stress on change in WFL z-score or risk of rapid weight gain. Rapid weight gain in infancy was prevalent in this sample of predominately Black infants in the Southeastern US. We did not find evidence to support the hypothesis that maternal perceived stress influenced the risk of rapid weight gain. More work is needed to identify and assess the risk factors for rapid weight gain in infancy and to understand the role that maternal stress plays in the risk of childhood obesity so that prevention efforts can be targeted.
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Affiliation(s)
- Katelyn Fox
- Department of Nutrition and Food Science, University of Rhode Island, Kingston, RI 02881, USA;
| | - Maya Vadiveloo
- Department of Nutrition and Food Science, University of Rhode Island, Kingston, RI 02881, USA;
| | - Karen McCurdy
- Department of Human Development and Family Science, University of Rhode Island, Kingston, RI 02881, USA;
| | - Sara E. Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA;
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA;
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12
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Huffhines L, Coe JL, Busuito A, Seifer R, Parade SH. Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health. Infant Ment Health J 2022; 43:474-492. [PMID: 35513001 PMCID: PMC9177799 DOI: 10.1002/imhj.21985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022]
Abstract
Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.
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Affiliation(s)
- Lindsay Huffhines
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Bradley/Hasbro Children's Research Center, E.P. Bradley Hospital, East Providence, Rhode Island, USA
| | - Jesse L Coe
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Bradley/Hasbro Children's Research Center, E.P. Bradley Hospital, East Providence, Rhode Island, USA
| | - Alex Busuito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ronald Seifer
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Bradley/Hasbro Children's Research Center, E.P. Bradley Hospital, East Providence, Rhode Island, USA.,Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephanie H Parade
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Bradley/Hasbro Children's Research Center, E.P. Bradley Hospital, East Providence, Rhode Island, USA
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13
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Ahmad SI, Shih EW, LeWinn KZ, Rivera L, Graff JC, Mason WA, Karr CJ, Sathyanarayana S, Tylavsky FA, Bush NR. Intergenerational Transmission of Effects of Women's Stressors During Pregnancy: Child Psychopathology and the Protective Role of Parenting. Front Psychiatry 2022; 13:838535. [PMID: 35546925 PMCID: PMC9085155 DOI: 10.3389/fpsyt.2022.838535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 12/22/2022] Open
Abstract
Objective Experiences of stress and adversity, such as intimate partner violence, confer risk for psychiatric problems across the life span. The effects of these risks are disproportionately borne by women and their offspring-particularly those from communities of color. The prenatal period is an especially vulnerable period of fetal development, during which time women's experiences of stress can have long-lasting implications for offspring mental health. Importantly, there is a lack of focus on women's capacity for resilience and potential postnatal protective factors that might mitigate these intergenerational risks and inform intervention efforts. The present study examined intergenerational associations between women's prenatal stressors and child executive functioning and externalizing problems, testing maternal parenting quality and child sex as moderators, using a large, prospective, sociodemographically diverse cohort. Methods We used data from 1,034 mother-child dyads (64% Black, 30% White) from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) pregnancy cohort within the ECHO PATHWAYS consortium. Women's prenatal stressors included stressful life events (pSLE) and intimate partner violence (pIPV). Measures of child psychopathology at age 4-6 included executive functioning and externalizing problems. Parenting behaviors were assessed by trained observers, averaged across two sessions of mother-child interactions. Linear regression models were used to estimate associations between women's prenatal stressors and child psychopathology, adjusting for confounders and assessing moderation effects by maternal parenting quality and child sex. Results Women's exposures to pSLE and pIPV were independently associated with child executive functioning problems and externalizing problems in fully-adjusted models. Maternal parenting quality moderated associations between pSLE and both outcomes, such that higher parenting quality was protective for the associations between women's pSLE and child executive functioning and externalizing problems. No moderation by child sex was found. Discussion Findings from this large, sociodemographically diverse cohort suggest women's exposures to interpersonal violence and major stressful events-common for women during pregnancy-may prenatally program her child's executive functioning and externalizing problems. Women's capacity to provide high quality parenting can buffer this intergenerational risk. Implications for universal and targeted prevention and early intervention efforts to support women's and children's wellbeing are discussed.
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Affiliation(s)
- Shaikh I. Ahmad
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Emily W. Shih
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Luisa Rivera
- Department of Anthropology, Emory University, Atlanta, GA, United States
| | - J. Carolyn Graff
- College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, United States
- Center on Developmental Disabilities, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - W. Alex Mason
- Department of Preventative Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Catherine J. Karr
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Frances A. Tylavsky
- Department of Preventative Medicine, The University of Tennessee Health Science Center, Memphis, TN, 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
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14
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Bolte EE, Moorshead D, Aagaard KM. Maternal and early life exposures and their potential to influence development of the microbiome. Genome Med 2022; 14:4. [PMID: 35016706 PMCID: PMC8751292 DOI: 10.1186/s13073-021-01005-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/16/2021] [Indexed: 02/07/2023] Open
Abstract
At the dawn of the twentieth century, the medical care of mothers and children was largely relegated to family members and informally trained birth attendants. As the industrial era progressed, early and key public health observations among women and children linked the persistence of adverse health outcomes to poverty and poor nutrition. In the time hence, numerous studies connecting genetics ("nature") to public health and epidemiologic data on the role of the environment ("nurture") have yielded insights into the importance of early life exposures in relation to the occurrence of common diseases, such as diabetes, allergic and atopic disease, cardiovascular disease, and obesity. As a result of these parallel efforts in science, medicine, and public health, the developing brain, immune system, and metabolic physiology are now recognized as being particularly vulnerable to poor nutrition and stressful environments from the start of pregnancy to 3 years of age. In particular, compelling evidence arising from a diverse array of studies across mammalian lineages suggest that modifications to our metagenome and/or microbiome occur following certain environmental exposures during pregnancy and lactation, which in turn render risk of childhood and adult diseases. In this review, we will consider the evidence suggesting that development of the offspring microbiome may be vulnerable to maternal exposures, including an analysis of the data regarding the presence or absence of a low-biomass intrauterine microbiome.
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Affiliation(s)
- Erin E Bolte
- Translational Biology and Molecular Medicine Graduate Program, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
- Medical Scientist Training Program, Baylor College of Medicine, Houston, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, USA
| | - David Moorshead
- Immunology & Microbiology Graduate Program, Baylor College of Medicine, Houston, USA
- Medical Scientist Training Program, Baylor College of Medicine, Houston, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, USA
| | - Kjersti M Aagaard
- Translational Biology and Molecular Medicine Graduate Program, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
- Immunology & Microbiology Graduate Program, Baylor College of Medicine, Houston, USA.
- Medical Scientist Training Program, Baylor College of Medicine, Houston, USA.
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, USA.
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, USA.
- Department of Molecular & Cell Biology, Baylor College of Medicine, Houston, USA.
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, USA.
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15
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Le K, Nguyen M. Desert locust swarms and child health. ECONOMICS AND HUMAN BIOLOGY 2022; 44:101094. [PMID: 34915232 DOI: 10.1016/j.ehb.2021.101094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/25/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
This study evaluates how in-utero exposure to an insect pest invasion, particularly, the outbreak of desert locust swarms, affects early childhood health in Africa and Asia over the past three decades (1990-2018). Employing the difference-in-differences model, we find that children being prenatally exposed to the outbreak have their height-for-age, weight-for-height, and weight-for-age z-scores lower by 0.159, 0.148, and 0.155 standard deviations, respectively, compared to unexposed children. Our heterogeneity analyses show that the health setbacks disproportionately fall on children of disadvantaged backgrounds, i.e., those born to lower-educated mothers, poorer mothers, and rural mothers. To the extent that poor health in early life exerts long-lasting irreversible consequences over the life cycle, the study calls for effective measures to minimize the pernicious effects of the desert locust swarm outbreak.
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Affiliation(s)
- Kien Le
- Faculty of Economics and Public Management, Ho Chi Minh City Open University, Viet Nam.
| | - My Nguyen
- Faculty of Economics and Public Management, Ho Chi Minh City Open University, Viet Nam.
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16
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Senter CC, Bush NR, Loftus CT, Szpiro AA, Fitzpatrick AL, Carroll KN, LeWinn KZ, Mason WA, Sathyanarayana S, Akingbade OA, Karr CJ. Maternal Stressful Life Events during Pregnancy and Atopic Dermatitis in Children Aged Approximately 4-6 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9696. [PMID: 34574621 PMCID: PMC8470006 DOI: 10.3390/ijerph18189696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 12/02/2022]
Abstract
The prevalence of atopic dermatitis (AD) in children has steadily increased over time, yet it remains largely unknown how maternal factors during pregnancy are associated with child AD. Few studies have specifically assessed the relationship between prenatal stress and child AD, with inconsistent findings. In this prospective cohort study following 426 mother-child dyads from pregnancy to middle childhood, women reported stressful life events (SLEs) experienced during the 12 months before delivery and AD outcomes in children aged approximately 4-6 years, including current, location-specific, and ever AD. We used Poisson regression to estimate risk ratios (RRs) and corresponding 95% confidence intervals (CIs) associated with a 1-unit increase in prenatal SLEs, adjusting for potential confounders. We also assessed whether the association between prenatal SLEs and child AD was modified by child sex, history of maternal atopy, or prenatal maternal resilient coping. The mean (standard deviation) of prenatal SLEs reported in the overall sample was 1.4 (1.6), with 37.1% of women reporting none. A 1-unit increase in prenatal SLEs was not significantly associated with current AD (RR: 1.08, 95% CI: 0.89, 1.31), location-specific AD (RR: 1.09, 95% CI: 0.78, 1.52), or ever AD (RR: 0.97, 95% CI: 0.87, 1.09). We did not find evidence of effect modification. Findings from this study suggest no association between prenatal SLEs and AD in middle childhood, although larger longitudinal studies with enhanced case definition and higher variability of SLE experience may more fully inform this question.
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Affiliation(s)
- Camilla C. Senter
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA; (A.L.F.); (C.J.K.)
| | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94143, USA; (N.R.B.); (K.Z.L.)
- Department of Pediatrics, University of California, San Francisco, CA 94143, USA
| | - Christine T. Loftus
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA; (C.T.L.); (S.S.); (O.A.A.)
| | - Adam A. Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA;
| | - Annette L. Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA; (A.L.F.); (C.J.K.)
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Kecia N. Carroll
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94143, USA; (N.R.B.); (K.Z.L.)
| | - W. Alex Mason
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA; (C.T.L.); (S.S.); (O.A.A.)
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Oluwatobiloba A. Akingbade
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA; (C.T.L.); (S.S.); (O.A.A.)
| | - Catherine J. Karr
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA; (A.L.F.); (C.J.K.)
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA; (C.T.L.); (S.S.); (O.A.A.)
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
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Cianfarani S, Pampanini V. The Impact of Stress on Health in Childhood and Adolescence in the Era of the COVID-19 Pandemic. Horm Res Paediatr 2021; 96:83-87. [PMID: 34261075 PMCID: PMC8339036 DOI: 10.1159/000517460] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is posing many challenges to global health. Efforts from the whole scientific community have shed light on the pathogenetic mechanisms and the clinical features of SARS-CoV-2 infection as well as on potential therapeutic strategies. SUMMARY The consequences of stress related to social isolation and anxiety generated by the pandemic on mental and physical health are collateral effects that are yet poorly investigated.
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Affiliation(s)
- Stefano Cianfarani
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS “Bambino Gesù” Children's Hospital, Rome, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Valentina Pampanini
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS “Bambino Gesù” Children's Hospital, Rome, Italy
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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18
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Perzow SED, Hennessey EMP, Hoffman MC, Grote NK, Davis EP, Hankin BL. Mental health of pregnant and postpartum women in response to the COVID-19 pandemic. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100123. [PMID: 33649750 PMCID: PMC7904453 DOI: 10.1016/j.jadr.2021.100123] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic has been uniquely challenging for pregnant and postpartum women. Uncontrollable stress amplifies risk for maternal depression and anxiety, which are linked to adverse mother and child outcomes. This study examined change in internalizing symptoms from before to during the COVID-19 pandemic among pregnant and postpartum women longitudinally, and investigated moderation by loneliness and other contextual risk factors. Methods 135 women (Mage = 31.81; 26% Latina, 55% non-Hispanic White, 11% Black; 39% low-income) enrolled in an existing prospective study completed self-report questionnaires including the EPDS and STAI-short form during early pregnancy, prior to COVID-19, and during COVID-19. Results Depressive symptoms were higher during COVID-19 compared to pre-COVID-19 and just as high as during early pregnancy. Anxiety symptoms were higher during COVID-19 compared to both pre-COVID-19 and early pregnancy. Higher loneliness was associated with increased depressive symptoms during COVID-19. Greater COVID-19 specific adversity was linked to greater increases in internalizing symptoms during COVID-19. Lower income-to-needs-ratio most strongly predicted symptoms during early pregnancy. Limitations The present study is longitudinal, but the correlational nature of the data precludes causal conclusions regarding the effect of the pandemic on mental health. Conclusion Longitudinal analyses suggest the COVID-19 pandemic resulted in increased internalizing symptoms among diverse pregnant and postpartum women. Interpersonal and contextual factors exacerbate risk and the impact of the pandemic on women's mental health. Identifying mothers at-risk for depression and anxiety may increase treatment utilization, mitigate fetal and infant exposure to maternal depression and anxiety, and help prevent adverse child outcomes.
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Affiliation(s)
| | | | - M Camille Hoffman
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, USA
| | - Nancy K Grote
- University of Washington, School of Social Work, USA
| | - Elysia Poggi Davis
- University of Denver, Department of Psychology, USA.,University of California, Irvine Department of Psychiatry and Human Behavior, USA
| | - Benjamin L Hankin
- The University of Illinois at Urbana-Champaign, Department of Psychology, USA
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19
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Mollard E, Kupzyk K, Moore T. Postpartum stress and protective factors in women who gave birth in the United States during the COVID-19 pandemic. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211042190. [PMID: 34465268 PMCID: PMC8414615 DOI: 10.1177/17455065211042190] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/23/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has caused considerable stress throughout the world. Little is known about how postpartum women who gave birth during the early months of the pandemic were impacted. The purpose of this study was to explore and describe the associations between potential risk, protective factors, and psychological distress among postpartum women who gave birth during the early months of the COVID-19 pandemic. METHODS Postpartum women over the age of 18 years who gave birth in the US hospitals between March and July of 2020 and spoke English completed a survey about their experiences. Demographic and health variables were measured via self-report. Stress was measured using the Perceived Stress Scale-10. Mastery was measured with the Pearlin Mastery Scale. Resilience was measured with the Connor-Davidson Resilience Scale-2. RESULTS This study included 885 women. Participants had higher stress and lower resilience relative to pre-pandemic norms. Participants had high levels of depression, anxiety, and stress. Women who had an infant admitted to the neonatal intensive care unit had more stress. Income, full-time employment, and partnered relationships were associated with lower stress. Resilience and mastery were related to lower stress, depression, and anxiety. Black, Indigenous, or People of Color women showed higher stress and lower resiliency. Single women were likely to report lower levels of mastery than partnered women. CONCLUSION Stress, depression, and anxiety were high in postpartum women in this study. Income, partnered relationships, and employment security, along with protective traits such as mastery and resilience, may reduce the impact of stress on postpartum women in a pandemic. Care models should be modified to support women during a pandemic. Health disparities exist in postpartum stress. Future interventions should focus on building resiliency and mastery and ensuring appropriate resources are available to postpartum women in a pandemic.
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Affiliation(s)
- Elizabeth Mollard
- College of Nursing, University of
Nebraska Medical Center, Lincoln, NE, USA
| | - Kevin Kupzyk
- College of Nursing, University of
Nebraska Medical Center, Omaha, NE, USA
| | - Tiffany Moore
- College of Nursing, University of
Nebraska Medical Center, Omaha, NE, USA
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