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Kok EY, Kaur S, Mohd Shukri NH, Abdul Razak N, Takahashi M. Maternal dietary and environmental factors associated with infant circadian rhythm, growth, and temperament: Research protocol for a prospective cohort study. Nutr Health 2024:2601060241246354. [PMID: 38584399 DOI: 10.1177/02601060241246354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Introduction: Emerging evidence has been explored to determine the factors affecting the development of infant circadian rhythm. While fetal programming happens during the pregnancy period, external environmental cues and infant nutritional programming can have substantial effects on the infant circadian rhythm. Understanding prenatal and postnatal factors determining infant circadian rhythm can improve future interventions in optimizing maternal and infant health. Methods: This is a prospective observational cohort study, targeting 216 pregnant women from government maternity clinics in Kuala Lumpur, Malaysia. Pregnant women will be recruited at third trimester (baseline), and follow up at 3 months, and 6 months. A subsample will be collected for salivary cortisol analysis to determine circadian rhythm of the mother and infant at third trimester and 3 months. Data of eating misalignment, light exposure, chronotype, infant temperament, sleep quality, and mood will be collected via validated questionnaires. Anthropometric data and birth outcomes will be collected from antenatal and postnatal health records. Summary: Studies on infant circadian rhythm development have yet to be explored and established, hence this study presents a novel approach to identify the factors from prenatal to postnatal periods on infant circadian rhythm and its influence on growth and temperament. Findings from this study will provide insights in the critical timing which has larger effects on infant circadian rhythm development for future interventions to be conducted.
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Affiliation(s)
- Ee Yin Kok
- Faculty of Applied Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Satvinder Kaur
- Faculty of Applied Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Nurul Husna Mohd Shukri
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | | | - Masaki Takahashi
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
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Hennessey EMP, Swales DA, Markant J, Hoffman MC, Hankin BL, Davis EP. Maternal anxiety during pregnancy predicts infant attention to affective faces. J Affect Disord 2024; 344:104-114. [PMID: 37802320 PMCID: PMC10841611 DOI: 10.1016/j.jad.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/24/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Prenatal maternal anxiety is a known influence on offspring development. General anxiety and pregnancy-related anxiety (a distinct type of anxiety encompassing fears associated with pregnancy) are associated with offspring socioemotional development, with potential consequences for later emotional and behavioral problems. This study examines whether maternal pregnancy-related and general anxiety relate to infant attention to affective faces, a process which plays an integral role in early socioemotional development. METHODS Participants included 86 mothers and their 6-month-old infants (56.3 % female). Mothers completed measures of pregnancy-related and general anxiety three times through gestation. Infants' attention to affective faces was assessed with an eye-tracking task during which a series of face pairs were presented (happy, angry, or sad face paired with a neutral face). Overall attention measures included attention-holding (total looking time) and attention-orienting (latency to faces); affect-biased attention measures included proportion of total looking time to emotional faces and latency difference score. RESULTS Higher maternal pregnancy-related anxiety across gestation predicted decreased infant attention-holding to affective faces [F(1,80) = 7.232, p = .009, partial η2 = 0.083]. No differences were found in infant attention-orienting or affect-biased attention. LIMITATIONS Reliance on a correlational study design precludes the ability to make causal inferences. CONCLUSIONS Maternal pregnancy-related anxiety is an important predictor of child outcomes. We provide novel evidence that pregnancy-related anxiety predicts infant attention to emotional faces, behaviors which have important implications for socioemotional development. Providers may consider pregnancy-related anxiety as a target for screening and treatment that may benefit both pregnant individual and offspring.
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Affiliation(s)
| | - Danielle A Swales
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julie Markant
- Department of Psychology & Tulane Brain Institute, Tulane University, New Orleans, LA, USA
| | - M Camille Hoffman
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Benjamin L Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO, USA; Department of Pediatrics, University of California, Irvine, CA, USA
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3
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Cortisol reactivity and negative affect among preterm infants at 12 months during a mother-infant interaction task. Infant Behav Dev 2023; 70:101784. [PMID: 36401957 DOI: 10.1016/j.infbeh.2022.101784] [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: 05/05/2022] [Revised: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to investigate correlates of preterm (PT) infant's cortisol reactivity and the association to infant negative affect, during a mother-infant interaction procedure. Participants included 48 infants born prematurely (gestational age < 37 weeks) and their mothers, assessed when infants were 12 months old corrected for prematurity. The examined variables comprised both neonatal and environmental dimensions including maternal interactive behavior. Infant negative affect and maternal interactive behavior were assessed with a standardized mother-infant interaction task. A baseline infant saliva sample was collected before the interaction began, and a second sample after the interaction episodes ended. Results revealed that decrease of infant's cortisol concentration was significantly associated with the exposure to more sensitive, and less intrusive maternal behaviors. However, once controlled for neonatal risk, family SES and maternal psychological distress, the associations were rendered non-significant. Although the association between cortisol reactivity and negative affect trended toward significance, maternal intrusiveness was the only significant predictor of observed infant negative affect. Findings suggest the importance of primary relational experiences on PT infants' early regulatory competencies.
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Cheng Z, Zhou ST, Zhang XH, Fu Q, Yang Y, Ji WB, Liu HG. Effects of early intermittent maternal separation on behavior, physiological, and growth performance in piglets. J Anim Sci 2023; 101:skad122. [PMID: 37094606 PMCID: PMC10195192 DOI: 10.1093/jas/skad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/20/2023] [Indexed: 04/26/2023] Open
Abstract
In pig production, the management of piglets by batch lactation due to the increase in litter sizes of sows may result in intermittent early neonatal maternal separation (NMS). We speculated that NMS may affect the piglets cognitive growth performance and health. To determine the extent of the effect, 12 litters of crossbred piglets (Large White × Duroc × Min-pig) were used in this trial. Piglets in the control (Con) group (n = 6) were given a standard feeding method during lactation. Piglets in the experimental group (n = 6) were subjected to the NMS model, in which sows were led out of the enclosure with food every day (8:00-11:00 and 13:00-16:00) starting from postnatal day (PND) 7. During the separation, the piglets were supplemented with milk. All experimental piglets were weaned on PND 35. The piglets were observed for aggression, play, mutual sniffing, and exploratory behavior on PNDs 7, 8, 21, 22, 34, 35, 38, 39, 51, 52, 64, and 65. Physiological indicators, namely serum adrenaline, cortisol, interleukin (IL)-1β, IL-4, IL-6, and tumor necrosis factor (TNF)-α were measured on PNDs 35, 38, and 65, while piglet growth performance was evaluated during suckling and 1 month after weaning. The results showed that aggressive behavior in the MS group was significantly higher than that in the Con group (P < 0.05). Playful and mutual sniffing behaviors in the MS group were significantly lower than those in the Con group except for PNDs 38 and 39 (P < 0.05). Active exploratory behavior in the MS group was significantly higher than that in the Con group on PNDs 7 and 8, and PNDs 21 and 22 (P < 0.05). The frequency of belly-nosing behavior was significantly higher in the MS group than that in the Con group except for PNDs 64 and 65 (P < 0.05). Compared with the Con group, epinephrine, IL-1β, IL-6, and TNF-α concentrations on PNDs 35, 38, and 65 were significantly increased in the MS group (P < 0.01), while IL-4 concentration was significantly decreased (PND 35: P < 0.05; PNDs 38 and 65: P < 0.01). Compared with the Con group, the piglet diarrhea rate in the MS group during suckling was significantly increased (P < 0.01), the weaning weight was significantly decreased (P < 0.05), and it had no significant effect on the body weight at the end of the trial (P > 0.05). In conclusion, the early intermittent NMS created stress and affected the growth performance of piglets during suckling. However, the growth rate was improved by compensatory measures during late weaning.
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Affiliation(s)
- Zheng Cheng
- College of Animal Science and Technology, Northeast Agricultural University, Changjiang, Harbin, Heilongjiang, P.R. China
| | - Si-Tong Zhou
- College of Animal Science and Technology, Northeast Agricultural University, Changjiang, Harbin, Heilongjiang, P.R. China
| | - Xiao-Hong Zhang
- College of Animal Science and Technology, Northeast Agricultural University, Changjiang, Harbin, Heilongjiang, P.R. China
| | - Qin Fu
- College of Animal Science and Technology, Northeast Agricultural University, Changjiang, Harbin, Heilongjiang, P.R. China
| | - Yue Yang
- College of Animal Science and Technology, Northeast Agricultural University, Changjiang, Harbin, Heilongjiang, P.R. China
| | - Wen-Bo Ji
- College of Animal Science and Technology, Northeast Agricultural University, Changjiang, Harbin, Heilongjiang, P.R. China
| | - Hong-Gui Liu
- College of Animal Science and Technology, Northeast Agricultural University, Changjiang, Harbin, Heilongjiang, P.R. China
- Key Laboratory of Swine Facilities Engineering, Ministry of Agriculture and Rural Affairs, Changjiang, Harbin, Heilongjiang, P.R. China
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5
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Reid BM, Sokol N, Aubuchon-Endsley NL, Stroud LR. Maternal prenatal cortisol and the interaction of income and pre-pregnancy body mass index are independently associated with newborn cortisol. Dev Psychobiol 2023; 65:e22354. [PMID: 36567656 PMCID: PMC9940703 DOI: 10.1002/dev.22354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/21/2022] [Accepted: 10/30/2022] [Indexed: 12/14/2022]
Abstract
While extensive research has supported the developmental programming hypothesis regarding contributions of prenatal psychosocial or nutritional adversity to offspring stress physiology, fewer studies consider both exposures together with maternal stress physiology. This study examined newborn cortisol output during a stressor as a function of maternal pre-pregnancy health status and nutritional history (pre-pregnancy body mass index [PPBMI]), economic resources (household income), and maternal cortisol awakening response (mCAR) in late pregnancy. Participants were 102 mother-infant pairs from an economically and racial/ethnically diverse sample. Offspring salivary cortisol response to a neurobehavioral exam was assessed at 1 month. Income and maternal PPBMI were positively associated with mCAR in late pregnancy. mCAR was positively related to 1-month newborn cortisol response. The interaction of income and PPBMI was positively associated with newborn cortisol output during an exam at 1-month. Mothers with the highest PPBMI and lowest income had offspring with higher cortisol responses than offspring of mothers with higher income and lower PPBMI. There was no evidence of indirect mediation effects of predictors (PPBMI, income, and interaction) on infant cortisol via mCAR. The differential effects of the interaction of PPBMI and income suggest that these exposures influence infant cortisol output in the context of one another, independent of maternal pregnancy cortisol.
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Affiliation(s)
- Brie M. Reid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Natasha Sokol
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | | | - Laura R. Stroud
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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Jarrar Q, Ayoub R, Alhussine K, Goh KW, Moshawih S, Ardianto C, Goh BH, Ming LC. Prolonged Maternal Separation Reduces Anxiety State and Increases Compulsive Burying Activity in the Offspring of BALB/c Mice. J Pers Med 2022; 12:1921. [PMID: 36422097 PMCID: PMC9699014 DOI: 10.3390/jpm12111921] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The elevated plus maze (EPM) and the marble burying (MB) tests are common behavioral tests used for behavioral phenotyping in mouse models for neurodevelopmental disorders. However, the behavioral effects of maternal separation (MS), a standard paradigm for early life stress in animals, in both the EPM and MB tests remain incompletely known. OBJECTIVES This study aimed to investigate the behavioral effects of prolonged MS in the offspring of mice using the EPM and MB tests. METHODS Male BALB/c mice were isolated from their mothers for 4 h each day during the first 30 days after birth. On day 50 postnatal, groups of separated and non-separated mice (n = 18/each group) were subjected to the EPM and MB tests for comparative behavioral evaluations. In addition, the locomotor activity of mice was evaluated using the actophotometer test. RESULTS The findings of the EPM test revealed that separated mice exhibited anxiolytic-like behaviors, as evidenced by a significant increase in the latency to closed arms and the time spent in the open arms compared with non-separated mice. Separated mice also showed compulsive burying activity in the MB test, as determined by a significant increase in the number of buried marbles. The results of the actophotometer test did not show any significant change in locomotor activity. CONCLUSIONS Prolonged MS caused the adult offspring of mice to exhibit a decrease in anxiety state and increased compulsive burying activity, which were not associated with a change in locomotor activity. Further investigations with validated tests are needed to support these findings.
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Affiliation(s)
- Qais Jarrar
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman 11622, Jordan
| | - Rami Ayoub
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman 11622, Jordan
| | - Kawther Alhussine
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman 11622, Jordan
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai 71800, Malaysia
| | - Said Moshawih
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei Darussalam
| | - Chrismawan Ardianto
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Bey Hing Goh
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Petaling Jaya 47500, Malaysia
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Long Chiau Ming
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei Darussalam
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya 60115, Indonesia
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7
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Tyborowska A, Gruber K, Beijers R, Kühn S, Roelofs K, de Weerth C. No evidence for association between late pregnancy maternal cortisol and gray matter volume in a healthy community sample of young adolescents. Front Neurosci 2022; 16:893847. [PMID: 36117621 PMCID: PMC9470950 DOI: 10.3389/fnins.2022.893847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
A compelling amount of animal and human research has shown that perceived maternal stress during pregnancy can affect the neurodevelopment of the offspring. Prenatal maternal cortisol is frequently proposed as the biological key mechanism underlying this link; however, literature that investigates the effects of prenatal cortisol on subsequent neurodevelopment in humans is scarce. By using longitudinal data from a relatively large community sample of mother-child dyads (N = 73), this pre-registered study prospectively examined the role of maternal prenatal cortisol concentrations on subsequent individual differences in gray matter volume (GMV) and hippocampal subfield volumes at the onset of puberty of the offspring (12 years of age). Two markers of cortisol, that is, evening cortisol and circadian decline over the day, were used as indicators of maternal physiological stress during the last trimester of pregnancy. The results indicate that prenatal maternal cortisol levels were not associated with GMV or hippocampal subfield volumes of the children. These findings suggest that late pregnancy maternal cortisol may not be related to the structural development of the offspring's brain, at least not in healthy community samples and at the onset of puberty. When examining the influence of prenatal stress on offspring neurodevelopment, future investigations should delineate gestational timing effects of the cortisol exposure, cortisol assessment method, and impact of additional biomarkers, as these were not investigated in this study.
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Affiliation(s)
- Anna Tyborowska
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Katharina Gruber
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roseriet Beijers
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Simone Kühn
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Roelofs
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Nazzari S, Fearon P, Rice F, Molteni M, Frigerio A. Maternal caregiving moderates the impact of antenatal maternal cortisol on infant stress regulation. J Child Psychol Psychiatry 2022; 63:871-880. [PMID: 34787327 DOI: 10.1111/jcpp.13532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emerging evidence suggests that antenatal exposure to maternal stress signals affects the development of the infant stress response systems. Animal studies indicate that maternal sensitive caregiving can reverse some of these effects. However, the generalizability of these findings to humans is unknown. This study investigated the role of maternal caregiving in the association between multiple markers of maternal antenatal stress and infant stress regulation. METHODS The sample consisted of 94 mother-infant (N = 47 males, mean postnatal weeks = 12; SD = 1.84) dyads. Maternal levels of Interleukin-6, C-Reactive Protein (CRP), diurnal cortisol and alpha amylase, depressive and anxiety symptoms were assessed in late pregnancy (mean gestational age = 34.76; SD = 1.12), whereas postnatal symptomatology, caregiving, and infant cortisol response to the inoculation were evaluated at 3 months. RESULTS Hierarchical linear models (HLMs) showed a significant interaction between maternal antenatal cortisol, caregiving, and time on infant cortisol reactivity, while controlling for gender, maternal age, and postnatal depression. Specifically, higher levels of maternal antenatal cortisol were associated with greater cortisol response only among infants of less emotionally available mothers. All other markers of antenatal stress were not significantly associated with infant cortisol reactivity either independently or in interaction with maternal caregiving. CONCLUSIONS Albeit preliminary, results provide the first evidence in humans that maternal sensitive caregiving may eliminate the association between antenatal maternal cortisol and infant cortisol regulation.
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Affiliation(s)
- Sarah Nazzari
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Frances Rice
- Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Section of Child and Adolescent Psychiatry, Cardiff University, Cardiff, UK
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Alessandra Frigerio
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
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Naya CH, Toledo-Corral CM, Chavez T, Lerner D, Lurvey N, Eckel SP, Peterson AK, Grubbs BH, Dunton GF, Breton CV, Bastain TM. Third trimester cortisol is positively associated with gestational weight gain in pregnant women with class one obesity. Int J Obes (Lond) 2022; 46:366-373. [PMID: 34718334 PMCID: PMC9012147 DOI: 10.1038/s41366-021-01009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVE Prevalence of pre-pregnancy obesity and excessive gestational weight gain (GWG) are higher among women of color with low SES. Dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis and its end-product, cortisol, during pregnancy is hypothesized to be associated with excessive GWG. However, past studies have produced inconsistent findings and often did not include health disparities populations. This study examined the association between pre-pregnancy body mass index (BMI), third trimester diurnal cortisol, and GWG in low-income, predominantly Hispanic women. SUBJECTS/METHODS The MADRES study is an ongoing prospective cohort study of primarily Hispanic, low-income pregnant women and their children in Los Angeles, California. Data from 176 participants were included in this study. Total cortisol secretion (area under the curve, AUC) was quantified using four salivary cortisol samples (awakening, 30 min after awakening, afternoon, and bedtime) that were collected at home on one day during the third trimester of pregnancy. Moderation of the association between total cortisol and GWG by pre-pregnancy BMI was tested using multiple linear regression with a multiplicative interaction term. RESULTS There was no association between total cortisol secretion and GWG overall (p = 0.82), but the association between total cortisol and GWG was stronger for women with class 1 pre-pregnancy obesity compared to women with normal pre-pregnancy BMI (interaction term p = 0.04). CONCLUSIONS Results suggest that obesity status before pregnancy may be exacerbating the physiological impact of cortisol on GWG.
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Affiliation(s)
- Christine H. Naya
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Claudia M. Toledo-Corral
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA,Department of Health Sciences, California State University Northridge, Northridge, CA, USA
| | - Thomas Chavez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | | | | | - Sandrah P. Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Alicia K. Peterson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Brendan H. Grubbs
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Genevieve F. Dunton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA,Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
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Caparros-Gonzalez RA, Lynn F, Alderdice F, Peralta-Ramirez MI. Cortisol levels versus self-report stress measures during pregnancy as predictors of adverse infant outcomes: a systematic review. Stress 2022; 25:189-212. [PMID: 35435113 DOI: 10.1080/10253890.2022.2059348] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Systematically review existing evidence to (1) identify the association between self-report stress and cortisol levels measured during pregnancy; and, (2) assess their association with adverse infant outcomes to determine which is the better predictor. A systematic review was conducted in accordance with PRISMA guidelines. Search terms focused on pregnancy, psychological stress and cortisol. Nine electronic databases were searched, in addition to reference lists of relevant papers. Eligibility criteria consisted of studies that included measurement of self-reported psychological stress, cortisol and assessed their associations with any infant-related outcome. Further limits included studies published in English or Spanish with human female participants. A meta-regression was not feasible due to differences in study samples, measurement tools employed, types of cortisol assessed and outcomes reported. A narrative synthesis was provided. 28 studies were eligible for inclusion. Convergent validity between self-report measures and cortisol was reported by three studies (range r = 0.12-0.41). Higher levels of self-report stress were significantly associated with intrauterine growth restriction (fetal biparietal diameter, low fetal head circumference, abdominal circumference), low gestational age at birth, low anthropometric measures (birth length, head circumference, length of the neonate), poor infant neurodevelopment (cognitive development) and potentially pathogenic gut microbiota (Clostridiaceae Clostridium, Haemophilus) in six studies. Higher cortisol levels were significantly associated with intrauterine growth restriction (fetal biparietal diameter, low fetal head circumference, abdominal circumference), low gestational age at birth, low infant birth weight, poor infant neurodevelopment (attention scores on the Network Neurobehavioral Scale) and low levels of potentially protective gut microbiota (Lactobacillus, Slackia and Actinobaculum) in 13 studies. Of the studies that assessed which type of measure was a better predictor of infant outcomes (n = 6), there was agreement that cortisol levels were statistically better at predicting adverse outcomes than self-reported stress. Self-report stress measures appear to be modest predictors of adverse infant outcomes in comparison to cortisol. A number of methodological limitations need to be addressed in future studies to help understand the relationship between cortisol and self-reported stress and how they are related to adverse infant outcomes.
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Affiliation(s)
- Rafael A Caparros-Gonzalez
- Faculty of Health Sciences, Department of Nursing, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Fiona Lynn
- Medical Biology Center, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Thomason ME, Hect JL, Waller R, Curtin P. Interactive relations between maternal prenatal stress, fetal brain connectivity, and gestational age at delivery. Neuropsychopharmacology 2021; 46:1839-1847. [PMID: 34188185 PMCID: PMC8357800 DOI: 10.1038/s41386-021-01066-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
Studies reporting significant associations between maternal prenatal stress and child outcomes are frequently confounded by correlates of prenatal stress that influence the postnatal rearing environment. The major objective of this study is to identify whether maternal prenatal stress is associated with variation in human brain functional connectivity prior to birth. We utilized fetal fMRI in 118 fetuses [48 female; mean age 32.9 weeks (SD = 3.87)] to evaluate this association and further addressed whether fetal neural differences were related to maternal health behaviors, social support, or birth outcomes. Community detection was used to empirically define networks and enrichment was used to isolate differential within- or between-network connectivity effects. Significance for χ2 enrichment was determined by randomly permuting the subject pairing of fetal brain connectivity and maternal stress values 10,000 times. Mixtures modelling was used to test whether fetal neural differences were related to maternal health behaviors, social support, or birth outcomes. Increased maternal prenatal negative affect/stress was associated with alterations in fetal frontoparietal, striatal, and temporoparietal connectivity (β = 0.82, p < 0.001). Follow-up analysis demonstrated that these associations were stronger in women with better health behaviors, more positive interpersonal support, and lower overall stress (β = 0.16, p = 0.02). Additionally, magnitude of stress-related differences in neural connectivity was marginally correlated with younger gestational age at delivery (β = -0.18, p = 0.05). This is the first evidence that negative affect/stress during pregnancy is reflected in functional network differences in the human brain in utero, and also provides information about how positive interpersonal and health behaviors could mitigate prenatal brain programming.
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Affiliation(s)
- Moriah E Thomason
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA.
- Department of Population Health, New York University Medical Center, New York, NY, USA.
- Neuroscience Institute, NYU Langone Health, New York, NY, USA.
| | - Jasmine L Hect
- Medical Scientist Training Program, University of Pittsburgh & Carnegie Mellon University, Pittsburgh, PA, USA
| | - Rebecca Waller
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Irwin JL, Meyering AL, Peterson G, Glynn LM, Sandman CA, Hicks LM, Davis EP. Maternal prenatal cortisol programs the infant hypothalamic-pituitary-adrenal axis. Psychoneuroendocrinology 2021; 125:105106. [PMID: 33340919 PMCID: PMC9743740 DOI: 10.1016/j.psyneuen.2020.105106] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
One of the key proposed agents of fetal programming is exposure to maternal glucocorticoids. Experimental animal studies provide evidence that prenatal exposure to elevated maternal glucocorticoids has consequences for hypothalamic-pituitary-adrenal (HPA) axis functioning in the offspring. There are very few direct tests of maternal glucocorticoids, such as cortisol, during human pregnancy and associations with infant cortisol reactivity. The current study examined the link between maternal prenatal cortisol trajectories and infant cortisol reactivity to the pain of inoculation in a sample of 152 mother-infant (47.4% girls) pairs. The results from the current study provide insight into fetal programming of the infant HPA axis, demonstrating that elevated prenatal maternal cortisol is associated with a larger infant cortisol response to challenge at both 6 and 12 months of age.
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Affiliation(s)
- Jessica L Irwin
- Department of Psychology, University of La Verne, La Verne, CA 91750, United States; Department of Psychology, Chapman University, Orange, CA 92866, United States.
| | - Amy L Meyering
- Department of Psychology, University of Denver, Denver, CO 80208, United States
| | - Gage Peterson
- Department of Psychology, Chapman University, Orange, CA 92866, United States
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA 92866, United States; Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697, United States
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697, United States
| | - Laurel M Hicks
- Renée Crown Wellness Institute, University of Colorado, Boulder, CO 80302, United States
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO 80208, United States; Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697, United States
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13
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Hair cortisol levels in pregnancy as a possible determinant of fetal sex: a longitudinal study. J Dev Orig Health Dis 2021; 12:902-907. [PMID: 33407972 DOI: 10.1017/s2040174420001300] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stress during pregnancy has been widely studied and associated to different variables, usually with negative results for the health of the mother and the newborn, such as having a higher risk of suffering postpartum depression, premature birth, obstetrics complications or low birthweight, among others. However, there are not many lines of research that study the role that the sex of the baby plays on this specific stress and vice versa. Thus, the main objective was to analyse the relationship between the sex of the offspring and the stress of the mothers in the first trimester of pregnancy. In order to achieve this, 108 women had their biological stress measured (trough hair cortisol levels) and psychological stress evaluated (the Prenatal Distress Questionnaire (PSS), the Perceived Stress Scale (PDQ) and the Stress Vulnerability Inventory (IVE)). The results revealed significant differences in maternal hair cortisol levels in the first trimester based on the sex of the baby they had given birth to (t = -2.04; P < 0.05): the concentration of the hormone was higher if the baby was a girl (164.36:54.45-284.87 pg/mg) than if it was a boy (101.13:37.95-193.56 pg/mg). These findings show that the sex of the future baby could be conditioned, among many other variables, by the mother´s stress levels during conception and first weeks of pregnancy. Further research is needed in this area to support our findings.
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14
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Takegata M, Matsunaga A, Ohashi Y, Toizumi M, Yoshida LM, Kitamura T. Prenatal and Intrapartum Factors Associated With Infant Temperament: A Systematic Review. Front Psychiatry 2021; 12:609020. [PMID: 33897486 PMCID: PMC8060501 DOI: 10.3389/fpsyt.2021.609020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Temperament involves individual variations in behavioural tendencies of emotional responses and reactions to stimuli after birth. Because 'foetal programming' is a strong hypothesis in developing temperament, prenatal and intrapartum factors may be significant determinants of infant temperament. This systematic literature review aims to elucidate the evidence of prenatal and intrapartum predictors, including genetic, biological, environmental, socio-demographic, psychological, and obstetric factors of parents and their child. Methods: Relevant articles were searched using MEDLINE, PubMed, and SCOPUS. The inclusion criteria were (a) original research article, (b) written in English, (c) assessed the temperament of infants 12 months old or younger as an outcome variable, and (d) investigated prenatal and intrapartum factorial variables of infant temperament. Following the PRISMA guideline, the articles found in the three databases were screened and selected according to the inclusion and exclusion criteria before the final review. Results: Finally, 35 articles were reviewed. This systematic review identified a variety of prenatal and intrapartum factors that were significantly associated with infant temperament: (1) genetic and biological factors: certain genotypes, maternal cortisol and ACTH, and CRHs, (2) environmental factors: substance use such as tobacco, alcohol, and illegal drugs, (3) socio-demographic factor: lower-income, (4) psychological factors: depression or anxiety, eating disorders, personality types of mothers, and domestic violence, and (5) obstetric factors: foetal growth (birth weight), hypertension in mothers, nausea (emesis), and preterm birth. Conclusion: The findings support gene-environment interaction and biological mechanisms for developing infant temperament, suggesting the importance of ensuring a safe and comfortable environment for pregnant mothers, unborn infants, and families during pregnancy and delivery.
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Affiliation(s)
- Mizuki Takegata
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Kitamura Institute of Mental Health Tokyo, Tokyo, Japan
| | - Asami Matsunaga
- Kitamura Institute of Mental Health Tokyo, Tokyo, Japan.,Kitamura KOKORO Clinic Mental Health, Tokyo, Japan.,Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yukiko Ohashi
- Faculty of Nursing, Josai International University, Togane, Japan
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Lay Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Toshinori Kitamura
- Kitamura Institute of Mental Health Tokyo, Tokyo, Japan.,Kitamura KOKORO Clinic Mental Health, Tokyo, Japan.,T. and F. Kitamura Foundation for Studies and Skill Advancement in Mental Health, Tokyo, Japan.,Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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15
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Spry EA, Aarsman SR, Youssef GJ, Patton GC, Macdonald JA, Sanson A, Thomson K, Hutchinson DM, Letcher P, Olsson CA. Maternal and paternal depression and anxiety and offspring infant negative affectivity: A systematic review and meta-analysis. DEVELOPMENTAL REVIEW 2020. [DOI: 10.1016/j.dr.2020.100934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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16
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Riis JL, Granger DA, Woo H, Voegtline K, DiPietro JA, Johnson SB. Long-Term Associations Between Prenatal Maternal Cortisol and Child Neuroendocrine-Immune Regulation. Int J Behav Med 2020; 27:267-281. [PMID: 31506880 DOI: 10.1007/s12529-019-09814-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Advancing understanding of the developmental origins of neuroendocrine-immune (NEI) functioning is key to elucidating the biological mechanisms involved in health and disease risk across the lifespan. This study examined whether prenatal maternal hypothalamic-pituitary-adrenal (HPA) activity moderates child NEI relations and explored the consistency of this moderating effect across gestation. METHODS Pregnant women participated in five prenatal study visits from 24 to 38 weeks gestation. At each visit, women provided a saliva sample. In a 5-year follow-up study, children (nfemale = 25, nmale=20) provided four saliva samples and participated in behavioral assessments and challenge tasks. Prenatal maternal saliva samples were assayed for cortisol. Child saliva samples were assayed for cortisol and cytokines (IL-1β, IL-6, IL-8, TNFα) as indices of HPA and inflammatory activity. Multilevel mixed-effects models examined the moderation of child NEI relations by prenatal maternal cortisol. RESULTS Among males, average prenatal maternal cortisol did not moderate child NEI relations. Among females, average prenatal maternal cortisol moderated some child NEI relations with higher prenatal cortisol associated with more positive cortisol-cytokine relations at age five. When examined by gestational time point, there were more significant NEI moderation effects by maternal cortisol from later gestation (≥ 30 weeks) than earlier. CONCLUSIONS The findings suggest prenatal maternal HPA activity may moderate child NEI functioning. Additional research conducted with more heterogeneous and larger samples is needed to fully understand these relations. Furthering our knowledge of NEI development has important research and clinical implications, particularly for understanding and addressing conditions with inflammatory pathophysiologies, such as depression and cardiovascular disease.
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Affiliation(s)
- Jenna L Riis
- School of Social Ecology, University of California, Irvine, Irvine, CA, USA.
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, USA.
| | - Douglas A Granger
- School of Social Ecology, University of California, Irvine, Irvine, CA, USA
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Han Woo
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Janet A DiPietro
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sara B Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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17
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The role of HPA-axis function during pregnancy in the intergenerational transmission of maternal adverse childhood experiences to child behavior problems. Dev Psychopathol 2020; 33:284-300. [PMID: 32124709 DOI: 10.1017/s0954579419001767] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The current study aimed to understand the mediating and/or moderating role of prenatal hypothalamic-pituitary-adrenal (HPA) axis function in the association between maternal adverse childhood experiences (ACEs) and child internalizing and externalizing behavior problems at age 4. The influence of timing and child sex were also explored. Participants were 248 mother-child dyads enrolled in a prospective longitudinal cohort study (the Alberta Pregnancy Outcomes and Nutrition Study). Maternal ACEs were retrospectively assessed while maternal self-reported depression and diurnal salivary cortisol were assessed prospectively at 6-26 weeks gestation (T1) and 27-37 weeks gestation (T2). Maternal report of child internalizing and externalizing problems was assessed at 4 years (T3). Results revealed that there was a negative indirect association between maternal ACEs and child internalizing behavior via a higher maternal cortisol awakening response (CAR). Maternal diurnal cortisol slope moderated the association between maternal ACEs and child behavior problems. Some of these effects were dependent on child sex, such that higher ACEs and a flatter diurnal slope at T1 was associated with more internalizing behavior in female children and more externalizing behavior in male children. There were timing effects such that the mediating and moderating effects were strongest at T1.
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18
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Caparros-Gonzalez RA, Romero-Gonzalez B, Gonzalez-Perez R, Lucena-Prieto L, Perez-Garcia M, Cruz-Quintana F, Peralta-Ramirez MI. Maternal and Neonatal Hair Cortisol Levels Are Associated with Infant Neurodevelopment at Six Months of Age. J Clin Med 2019; 8:jcm8112015. [PMID: 31752272 PMCID: PMC6912650 DOI: 10.3390/jcm8112015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/11/2019] [Accepted: 11/17/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Maternal stress during pregnancy can affect fetal development during certain sensitive periods. Objective: To longitudinally assess maternal hair cortisol levels during pregnancy, and the postpartum along with neonatal hair cortisol levels that could be associated with infant neurodevelopment at six months of age. Methods: A sample of 41 pregnant women longitudinally assessed during the first, second, and third trimester and the postpartum, along with their 41 full-term neonates participated in this study. Hair cortisol levels were assessed from participants. Infant neurodevelopment was assessed by means of the Bayley Scale of Infants Development, Third Edition at age six months. Results: Maternal hair cortisol levels in the first and second trimester accounted for 24% and 23%, respectively, of variance of infant gross motor development (p < 0.05). Maternal hair cortisol levels during the postpartum accounted for 31% of variance of infant cognitive development (p < 0.05), and 25% of variance of infant gross motor development (p < 0.05). Neonatal hair cortisol levels accounted for 28% of variance of infant gross motor development (p < 0.05). Conclusions: The preconception and prenatal time are sensitive periods related to infant neurodevelopment along with the cortisol levels surrounding the fetus while in the womb. Pregnant women could be assessed for hair cortisol levels while attending a prenatal appointment.
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Affiliation(s)
- Rafael A. Caparros-Gonzalez
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, 18011 Granada, Spain; (M.P.-G.); (F.C.-Q.); (M.I.P.-R.)
| | - Borja Romero-Gonzalez
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, 18011 Granada, Spain; (M.P.-G.); (F.C.-Q.); (M.I.P.-R.)
- Personality, Assessment and Psychological Treatment Department, University of Granada, 18071 Granada, Spain
- Correspondence:
| | - Raquel Gonzalez-Perez
- Department of Pharmacology, CIBERehd, Instituto de Investigacion Biosanitaria ibs.GRANADA, School of Pharmacy, University of Granada, 18011 Granada, Spain;
| | - Lidia Lucena-Prieto
- Department of Obstetrics & Gynecology, Delivery Ward, Hospital of Antequera, Antequera, 29200 Malaga, Spain;
| | - Miguel Perez-Garcia
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, 18011 Granada, Spain; (M.P.-G.); (F.C.-Q.); (M.I.P.-R.)
- Personality, Assessment and Psychological Treatment Department, University of Granada, 18071 Granada, Spain
| | - Francisco Cruz-Quintana
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, 18011 Granada, Spain; (M.P.-G.); (F.C.-Q.); (M.I.P.-R.)
- Personality, Assessment and Psychological Treatment Department, University of Granada, 18071 Granada, Spain
| | - Maria Isabel Peralta-Ramirez
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, 18011 Granada, Spain; (M.P.-G.); (F.C.-Q.); (M.I.P.-R.)
- Personality, Assessment and Psychological Treatment Department, University of Granada, 18071 Granada, Spain
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19
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Nazzari S, Fearon P, Rice F, Dottori N, Ciceri F, Molteni M, Frigerio A. Beyond the HPA-axis: Exploring maternal prenatal influences on birth outcomes and stress reactivity. Psychoneuroendocrinology 2019; 101:253-262. [PMID: 30497017 DOI: 10.1016/j.psyneuen.2018.11.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 01/16/2023]
Abstract
Accumulating evidence suggests that antenatal maternal stress is associated with altered behavioral and physiological outcomes in the offspring, however, whether this association is causal and the underlying biological mechanisms remain largely unknown. While the most studied mediator of maternal stress influences on the fetus has generally been cortisol, alternative novel markers of stress or inflammation warrant further consideration. The current investigation explored the influence of variations in self-reported symptoms of distress, stress hormones and inflammatory markers on infant birth outcomes and early stress regulation. The sample consisted of 104 pregnant women (mean gestational age = 34.76; SD = 1.12) and their healthy newborns. Maternal self-reported symptoms of depression and anxiety were evaluated through the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory and levels of serum Interleukine-6 (IL-6), C-Reactive Protein (CRP), salivary cortisol and alpha amylase (sAA) were measured in late pregnancy. Newborns' cortisol and behavioral response to the heel-stick was assessed 48-72 hours after birth. The associations between maternal stress measures and infant birth outcomes and stress reactivity, adjusted for potential confounders, were examined through hierarchical linear regressions and hierarchical linear models. Higher maternal IL-6 levels were associated with smaller head circumference at birth, while diurnal sAA levels were positively associated with birthweight. Maternal diurnal cortisol was related to newborn's stress reactivity: a flatter infant cortisol response to the heel-stick was associated with greater maternal cortisol increases after awakening during pregnancy, while greater infant behavioural reactivity was related to a flatter maternal diurnal cortisol profile. The observational nature of these data does not allow for causal inferences but the current findings illustrate that antenatal factors related to alterations in maternal stress and immune response systems are associated with fetal growth and neonatal stress reactivity. This may have implications for later health and psychological outcomes.
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Affiliation(s)
- S Nazzari
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy.
| | - P Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - F Rice
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - N Dottori
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - F Ciceri
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - M Molteni
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - A Frigerio
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
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20
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Parade SH, Newland RP, Bublitz MH, Stroud LR. Maternal witness to intimate partner violence during childhood and prenatal family functioning alter newborn cortisol reactivity. Stress 2019; 22:190-199. [PMID: 30676172 PMCID: PMC6685200 DOI: 10.1080/10253890.2018.1501019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Witnessing intimate partner violence (IPV) during childhood is a risk factor for mental health problems across the lifespan. Less is known about the intergenerational consequences of witnessing IPV, and if the current family climate buffers intergenerational effects of witnessing violence. The mother's experience of witnessing IPV against her own mother during childhood, prenatal family dysfunction, and prenatal perceived stress were examined as predictors of offspring cortisol in the first month of life (N = 218 mother-infant dyads). Mothers reported on witnessing IPV in their childhoods, prenatal family dysfunction, and prenatal perceived stress in pregnancy. At 2 days and again at 1 month postpartum, infants engaged in a neurobehavioral exam to assess infant cortisol reactivity. Infants whose mothers witnessed IPV in childhood exhibited alterations in their baseline cortisol and their cortisol reactivity at 1 month of age, whereas family dysfunction during pregnancy was associated with baseline cortisol and cortisol reactivity at 2 days of age. Prenatal perceived stress was not associated with infant cortisol at 2 days or 1 month. Prenatal family dysfunction and perceived stress did not moderate effects of the mother's experience of witnessing IPV. Results support the view that maternal experiences in childhood and during pregnancy exert intergenerational effects on the HPA stress response system.
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Affiliation(s)
- Stephanie H. Parade
- Bradley Research Center, E.P. Bradley Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - Rebecca P. Newland
- Bradley Research Center, E.P. Bradley Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - Margaret H. Bublitz
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - Laura R. Stroud
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
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21
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Korja R, Nolvi S, Kataja EL, Scheinin N, Junttila N, Lahtinen H, Saarni S, Karlsson L, Karlsson H. The courses of maternal and paternal depressive and anxiety symptoms during the prenatal period in the FinnBrain Birth Cohort study. PLoS One 2018; 13:e0207856. [PMID: 30557345 PMCID: PMC6296666 DOI: 10.1371/journal.pone.0207856] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 11/07/2018] [Indexed: 01/09/2023] Open
Abstract
Maternal prenatal symptoms of depression and anxiety have been suggested to impose differential effects on later offspring development, depending on their characteristics, such as timing, intensity and persistence. Paternal symptoms have been less investigated. While knowledge on these trajectory characteristics is essential for improved comprehension of prenatal stress, prospective studies including both expecting parents have been scarce. We aim at identifying and comparing the trajectories of prenatal depressive and anxiety symptoms in both parents in a pregnancy cohort design. The sample included 3202 mothers and 2076 fathers who were recruited to the FinnBrain Birth Cohort study (www.finnbrain.fi). Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and general anxiety by the anxiety scale of the Symptom Checklist -90 (SCL-90) repeatedly at 14, 24, and 34 gestational weeks. Five differential depressive and four anxiety symptom trajectories were identified across pregnancy both in mothers and in fathers. The trajectories of consistently low depressive or anxiety symptoms were associated with higher educational level in both parents, and with nulliparity and non-smoking during pregnancy in mothers. Parents with consistently high or increasing levels of symptoms had more often prenatal SSRI medication. The congruences between elevated depressive and anxiety symptoms at any point in pregnancy, as well as parental trajectories within families were low. However, in this population-based sample, the self-reported symptom levels of both parents were generally very low. Variance in timing and persistence of parent-reported prenatal depressive and anxiety symptoms is potentially important, while symptom trajectories are very similar in mothers and fathers. These differential symptom trajectories and the significance of their correlates should be acknowledged when studying prenatal stress exposures and the related outcomes in children.
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Affiliation(s)
- Riikka Korja
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku, Department of Psychology, Turku, Finland
| | - Saara Nolvi
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
| | - Eeva-Leena Kataja
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku, Department of Psychology, Turku, Finland
| | - Noora Scheinin
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
| | - Niina Junttila
- University of Turku, Department of Teacher Education, Turku, Finland
| | - Henna Lahtinen
- University of Turku, Department of Psychology, Turku, Finland
| | - Suoma Saarni
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
- Helsinki University Hospital, Department of Psychiatry, Helsinki, Finland
| | - Linnea Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku and Turku University Hospital, Institute of Clinical Medicine, Department of Child Psychiatry, Turku, Finland
| | - Hasse Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
- University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
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22
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Prenatal stress and models explaining risk for psychopathology revisited: Generic vulnerability and divergent pathways. Dev Psychopathol 2018; 30:1041-1062. [PMID: 30068410 DOI: 10.1017/s0954579418000354] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The present review revisits three hypothesized models that potentially could explain how prenatal maternal stress influences fetal development, birth outcomes, and subsequent developmental psychopathology. These models were mostly based on animal models, and new evidence for these models from human studies is evaluated. Furthermore, divergent trajectories from prenatal exposure to adversities to offspring affected outcomes are reviewed, including the comparison of studies on prenatal maternal stress with research on maternal substance use and maternal malnutrition during pregnancy. Finally, new directions in research on the mechanism underlying prenatal stress effects on human offspring is summarized. While it is concluded that there is abundant evidence for the negative associations between prenatal maternal stress and offspring behavioral, brain, and psychopathological outcomes in humans, there is no consistent evidence for specific mechanisms or specific outcomes in relation to stress exposure in utero. Rather, principles of multifinality and equifinality best describe the consequences for the offspring, suggesting a generic vulnerability and different pathways from prenatal adversities to developmental psychopathology, which complicates the search for underlying mechanisms. New and promising directions for research are provided to get a better understanding of how prenatal stress gets under the skin to affect fetal development.
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Cattane N, Richetto J, Cattaneo A. Prenatal exposure to environmental insults and enhanced risk of developing Schizophrenia and Autism Spectrum Disorder: focus on biological pathways and epigenetic mechanisms. Neurosci Biobehav Rev 2018; 117:253-278. [PMID: 29981347 DOI: 10.1016/j.neubiorev.2018.07.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/11/2018] [Accepted: 07/01/2018] [Indexed: 12/15/2022]
Abstract
When considering neurodevelopmental disorders (NDDs), Schizophrenia (SZ) and Autism Spectrum Disorder (ASD) are considered to be among the most severe in term of prevalence, morbidity and impact on the society. Similar features and overlapping symptoms have been observed at multiple levels, suggesting common pathophysiological bases. Indeed, recent genome-wide association studies (GWAS) and epidemiological data report shared vulnerability genes and environmental triggers across the two disorders. In this review, we will discuss the possible biological mechanisms, including glutamatergic and GABAergic neurotransmissions, inflammatory signals and oxidative stress related systems, which are targeted by adverse environmental exposures and that have been associated with the development of SZ and ASD. We will also discuss the emerging role of the gut microbiome as possible interplay between environment, immune system and brain development. Finally, we will describe the involvement of epigenetic mechanisms in the maintenance of long-lasting effects of adverse environments early in life. This will allow us to better understand the pathophysiology of these NDDs, and also to identify novel targets for future treatment strategies.
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Affiliation(s)
- Nadia Cattane
- Biological Psychiatry Unit, IRCCS Fatebenefratelli San Giovanni di Dio, via Pilastroni 4, Brescia, Italy
| | - Juliet Richetto
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Fatebenefratelli San Giovanni di Dio, via Pilastroni 4, Brescia, Italy; Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, 125 Coldharbour Lane, SE5 9NU, London, UK.
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Korja R, Nolvi S, Grant KA, McMahon C. The Relations Between Maternal Prenatal Anxiety or Stress and Child's Early Negative Reactivity or Self-Regulation: A Systematic Review. Child Psychiatry Hum Dev 2017; 48:851-869. [PMID: 28124273 DOI: 10.1007/s10578-017-0709-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In the present review, we examine the association between maternal prenatal stress or anxiety and children's early negative reactivity or self-regulation. The review includes 32 studies that focus on pregnancy-related anxiety, state or trait anxiety, perceived stress, and stressful life events in relation to child's crying, temperament, or behavior during the first 2 years of life. We searched four electronic databases and 32 studies were selected based on the inclusion criteria. Twenty-three studies found an association between maternal prenatal anxiety or stress and a child's negative reactivity or self-regulation, and typically the effect sizes varied from low to moderate. The association was found regardless of the form of prenatal stress or anxiety and the trimester in which the prenatal stress or anxiety was measured. In conclusion, several forms of prenatal anxiety and stress may increase the risk of emotional and self-regulatory difficulties during the first 2 years of life.
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Affiliation(s)
- Riikka Korja
- The Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia. .,The FinnBrain Birth Cohort Study, Institute of Clinical Medicine, University of Turku, Turku, Finland. .,Department of Psychology, University of Turku, Turku, Finland.
| | - Saara Nolvi
- The FinnBrain Birth Cohort Study, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Kerry Ann Grant
- The Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Cathy McMahon
- The Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
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Mörelius E, Ivars K, Gustafsson PA, Theodorsson E, Nelson N. Salivary cortisol circadian rhythm in infants at psychosocial risk showed more variations than previous studies of healthy full-term infants. Acta Paediatr 2017; 106:2060-2061. [PMID: 28833477 DOI: 10.1111/apa.14023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E Mörelius
- Department of Social and Welfare Studies; Linköping University; Norrköping Sweden
| | - K Ivars
- Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - PA Gustafsson
- Center for Social and Affective Neuroscience; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - E Theodorsson
- Department of Clinical Chemistry; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - N Nelson
- Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
- Department of Quality and Patient Safety; Karolinska University Hospital; Stockholm Sweden
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26
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van den Heuvel MI, Henrichs J, Donkers FC, Van den Bergh BR. Children prenatally exposed to maternal anxiety devote more attentional resources to neutral pictures. Dev Sci 2017; 21:e12612. [DOI: 10.1111/desc.12612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 07/28/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Marion I. van den Heuvel
- Merrill Palmer Skillman Institute for Child and Family Development; Wayne State University; Detroit MI USA
| | - Jens Henrichs
- Midwifery Science; AVAG; Amsterdam Public Health Research Institute; VU University Medical Center; Amsterdam The Netherlands
| | - Franc C.L. Donkers
- Department of Cognitive Neuroscience; Maastricht University; Maastricht The Netherlands
| | - Bea R.H. Van den Bergh
- Health Psychology; University of Leuven; Leuven Belgium
- Department of Welfare; Public Health and Family; Flemish Government; Brussels Belgium
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27
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Do bacteria shape our development? Crosstalk between intestinal microbiota and HPA axis. Neurosci Biobehav Rev 2017; 83:458-471. [PMID: 28918360 DOI: 10.1016/j.neubiorev.2017.09.016] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/01/2017] [Accepted: 09/12/2017] [Indexed: 02/08/2023]
Abstract
The human body contains as many bacteria in the intestine as the total number of human body cells. These bacteria have a central position in human health and disease, and would also play a role in the regulation of emotions, behavior, and even higher cognitive functions. The Hypothalamic-Pituitary-Adrenal axis (HPA axis) is a major physiological stress system that produces cortisol. This hormone is involved in responding to environmental stress and also shapes many aspects of brain development. Both the HPA axis and the intestinal microbiota show rapid and profound developmental changes during the first years of life. Early environmental disturbances can affect the development of both systems. Early adversity, for example, is known to lead to later unbalances in both, as well as to psychopathological behavior and emotions. The goal of this theoretical review is to summarize current knowledge on the developmental crosstalk between the intestinal microbiota and the HPA axis, providing a basis for understanding the development and bidirectional communication between these two essential systems in human functioning.
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Bleker LS, Roseboom TJ, Vrijkotte TG, Reynolds RM, de Rooij SR. Determinants of cortisol during pregnancy - The ABCD cohort. Psychoneuroendocrinology 2017. [PMID: 28641158 DOI: 10.1016/j.psyneuen.2017.05.026] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Psychosocial stress during pregnancy has been proposed as a major contributor of glucocorticoid-mediated programming of the fetal hypothalamic-pituitary adrenal (HPA) axis, with later adverse health consequences. However, evidence linking maternal stress to maternal cortisol values during pregnancy is inconclusive. A possible explanation for this is that other maternal factors overshadow any potential effects of stress on cortisol levels. We studied a large cohort of pregnant women with extensive data on pregnancy characteristics to determine the respective contributions of biological, environmental and psychosocial stress factors to cortisol levels in pregnancy. METHODS We used data from 3039 women from the Amsterdam Born Children and their Development-study cohort. Serum cortisol was measured in blood, collected at the first prenatal visit, at different gestational ages (median=91days, range=40-256days), and at various time points during the day (median=11:45h, range=08:00-18:30h). We assessed associations between maternal serum cortisol in pregnancy and biological factors, lifestyle factors and stress factors, including depression, anxiety, pregnancy-related anxiety, work stress, parenting stress and fatigue. RESULTS In multivariable analysis, variables that were associated with higher cortisol levels in pregnancy were lower maternal age [1.5nmol/l, 95%CI (0.6-2.4)], being nulliparous [21.5 nmol/l (15.9-27.1)], lower pre-pregnancy body mass index (BMI) [1.3nmol/l (0.3-2.4)], higher C-reactive protein (CRP) [1.0nmol/l (0.4-1.5)], carrying a female fetus [9.2nmol/l (1.8-16.5)], non-smoking [14.2nmol/l (0.6-27.7)], sufficient sleep [8.5nmol/l (0.9-16.1)], and being unemployed [12.7nmol/l (2.2-23.2)]. None of the psychosocial stressors was significantly associated with serum cortisol levels in pregnancy. A total of 32% of all variance in cortisol was explained by gestational age, maternal age, time of day, parity, pre-pregnancy BMI, CRP, fetal sex, smoking behavior, self-reported sleep sufficiency, and employment. CONCLUSIONS Our data suggest that maternal cortisol during pregnancy is mainly affected by biological and lifestyle factors, but not by psychosocial factors. We suggest that psychosocial stress in pregnancy might program the fetus through other mechanisms than through altering maternal cortisol levels.
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Affiliation(s)
- Laura S Bleker
- Academic Medical Centre, Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, The Netherlands,.
| | - Tessa J Roseboom
- Academic Medical Centre, Department of Obstetrics Gynecology, Amsterdam, The Netherlands,; Academic Medical Centre, Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, The Netherlands
| | - Tanja G Vrijkotte
- Academic Medical Centre, Amsterdam Public Health research institute, Department of Public Health, Amsterdam, The Netherlands
| | - Rebecca M Reynolds
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Susanne R de Rooij
- Academic Medical Centre, Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, The Netherlands,; Academic Medical Centre, Amsterdam Public Health research institute, Department of Public Health, Amsterdam, The Netherlands
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Abstract
Hypothalamic-pituitary-adrenal (HPA) axis functioning is characterized by the baseline production of cortisol following a circadian rhythm, as well as by the superimposed production of cortisol in response to a stressor. However, it is relatively unknown whether the basal cortisol circadian rhythm is associated with the cortisol stress response in children. Since alterations in cortisol stress responses have been associated with mental and physical health, this study investigated whether the cortisol circadian rhythm is associated with cortisol stress responses in 6-year-old children. To this end, 149 normally developing children (Mage = 6.09 years; 70 girls) participated in an innovative social evaluative stress test that effectively provoked increases in cortisol. To determine the cortisol stress response, six cortisol saliva samples were collected and two cortisol stress response indices were calculated: total stress cortisol and cortisol stress reactivity. To determine children's cortisol circadian rhythm eight cortisol circadian samples were collected during two days. Total diurnal cortisol and diurnal cortisol decline scores were calculated as indices of the cortisol circadian rhythm. Hierarchical regression analyses indicated that higher total diurnal cortisol as well as a smaller diurnal cortisol decline, were both uniquely associated with higher total stress cortisol. No associations were found between the cortisol circadian rhythm indices and cortisol stress reactivity. Possible explanations for the patterns found are links with children's self-regulatory capacities and parenting quality.
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Affiliation(s)
- Sterre S H Simons
- a Developmental Psychology , Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands
| | - Antonius H N Cillessen
- a Developmental Psychology , Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands
| | - Carolina de Weerth
- a Developmental Psychology , Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands
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30
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Huizink A, Menting B, De Moor M, Verhage ML, Kunseler F, Schuengel C, Oosterman M. From prenatal anxiety to parenting stress: a longitudinal study. Arch Womens Ment Health 2017; 20. [PMID: 28634716 PMCID: PMC5599437 DOI: 10.1007/s00737-017-0746-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to explore how maternal mood during pregnancy, i.e., general anxiety, pregnancy-specific anxiety, and depression predicted parenting stress 3 months after giving birth, thereby shaping the child's early postnatal environmental circumstances. To this end, data were used from 1073 women participating in the Dutch longitudinal cohort Generations2, which studies first-time pregnant mothers during pregnancy and across the transition to parenthood. Women filled out the State Trait Anxiety Inventory (STAI), Pregnancy-Related Anxiety Questionnaire-revised (PRAQ-R), and Beck Depression Index (BDI) three times during pregnancy: at 12, 22, and 32 weeks gestational age. Three months postpartum, a parenting stress questionnaire was filled out yielding seven different parenting constructs. Latent scores were computed for each of the repeatedly measured maternal mood variables with Mplus and parenting stress constructs were simultaneously regressed on these latent scores. Results showed that trait anxiety and pregnancy-specific anxiety were uniquely related to almost all parenting stress constructs, taking depression into account. Early prevention and intervention to reduce maternal anxiety in pregnancy could hold the key for a more advantageous trajectory of early postnatal parenting.
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Affiliation(s)
- A.C. Huizink
- Department of Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands ,Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - B. Menting
- Department of Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands ,Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, The Netherlands
| | - M.H.M. De Moor
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - M. L. Verhage
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - F.C. Kunseler
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - C. Schuengel
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - M. Oosterman
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
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31
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Provenzi L, Giusti L, Montirosso R. Do infants exhibit significant cortisol reactivity to the Face-to-Face Still-Face paradigm? A narrative review and meta-analysis. DEVELOPMENTAL REVIEW 2016. [DOI: 10.1016/j.dr.2016.07.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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32
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Sexually dimorphic and interactive effects of prenatal maternal cortisol and psychological distress on infant cortisol reactivity. Dev Psychopathol 2016; 29:805-818. [PMID: 27426858 DOI: 10.1017/s0954579416000493] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In utero exposure to maternal psychological distress is a risk factor for developmental psychopathology, and these effects are believed to partially occur via dysregulation of the maternal and fetal hypothalamus-adrenal-pituitary axes. Nevertheless, only a few human studies have directly assessed the effects of prenatal cortisol exposure on infant cortisol reactivity, and none have investigated sex differences or potential interactions between prenatal cortisol and psychological distress. Here we report on a prospective longitudinal investigation (N = 236) of in utero exposure to maternal cortisol and distress in a relatively high socioeconomic status and low-risk population to determine whether these exposures interact in their effects on infant (M age = 3.0 months, range = 2.3-5.0 months, 51.9% male) cortisol reactivity and whether there are sex differences in these effects. Results revealed both sexually dimorphic and interactive effects of prenatal cortisol and distress, even after controlling for postnatal distress. In general, blunted reactivity in females was associated with exposure to high maternal distress and flattened patterns of diurnal maternal cortisol, whereas blunted reactivity in males was associated with exposure to steeper morning increases and daytime decreases in maternal cortisol. The findings suggest that sex differences in the effects of prenatal cortisol and distress on infant cortisol reactivity are a plausible mechanism by which maternal experiences during pregnancy contribute to sex differences in the development of psychopathology.
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Nolvi S, Karlsson L, Bridgett DJ, Korja R, Huizink AC, Kataja EL, Karlsson H. Maternal prenatal stress and infant emotional reactivity six months postpartum. J Affect Disord 2016; 199:163-70. [PMID: 27107891 DOI: 10.1016/j.jad.2016.04.020] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Maternal prenatal stress has been related to infant negative affect. However, it is still unclear how different sources of maternal prenatal stress such as depressive, anxiety and pregnancy-specific anxiety symptoms are associated with reactivity outcomes. This study aimed to test the associations between different sources of maternal prenatal stress and the aspects of infant emotional reactivity at six months. METHOD Our study population (n=282) was drawn from the FinnBrain Birth Cohort Study. Prenatal stress was measured by questionnaires on maternal depression, general anxiety and pregnancy-specific anxiety at three time points across pregnancy (gwk 14, 24, 34). Based on the symptom scores, the sample was divided into mothers with high stress during pregnancy (n=110) and mothers with low stress during pregnancy (n=172). Mother-reported infant emotional reactivity and its subscales were measured six months postpartum. RESULTS After controlling for background variables and maternal postnatal symptoms, overall negative emotional reactivity (β=0.20, p<0.01), and its aspects fearfulness (β=0.15, p=.057) and falling reactivity (β=-0.22, p<0.01), were predicted by only pregnancy-specific anxiety. No significant predictors were found for infant positive reactivity after adjusting for confounders. LIMITATIONS Mother reports of both maternal symptoms and infant reactivity were used, which might increase the risk of reporting bias. CONCLUSIONS The findings suggest that mothers experiencing stress should be provided intervention during pregnancy, and that screening should have a particular focus on pregnancy-related worries.
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Affiliation(s)
- Saara Nolvi
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland.
| | - Linnea Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, Turku University Hospital and University of Turku, Finland
| | - David J Bridgett
- Department of Psychology, Northern Illinois University, United States
| | - Riikka Korja
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Psychology, University of Turku, Finland
| | - Anja C Huizink
- Department of Clinical Developmental Psychology, VU University Amsterdam, Netherlands
| | - Eeva-Leena Kataja
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Psychology, University of Turku, Finland
| | - Hasse Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Psychiatry, University of Turku, Finland
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Kacenelenbogen N, Dramaix-Wilmet M, Schetgen M, Roland M, Godin I. Parental separation: a risk for the psychomotor development of children aged 28 to 32 months? A cross-sectional study. BMC Pediatr 2016; 16:89. [PMID: 27401899 PMCID: PMC4940882 DOI: 10.1186/s12887-016-0621-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/24/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Western countries, about a quarter of children are affected by parental separation and a number of authors have previously investigated how familial structure impacts children's health. The purpose of the work: to analyze the psychomotor development of children aged 28 to 32 months based on family structure (parents together or separated), independently of the influence of socio-economic environment that is well documented. To analyse the psychomotor development of children younger than 3 years based on family structure (parents together or separated) independently of the influence of socio-economic environment that is well documented. METHODS Cross-sectional study by examination of 28 871 children as part of a free preventive medicine consultation. The data came from an assessment conducted 28 to 32 months after birth during which information was collected about the psychomotor development: to perform a standing jump, dress themselves, draw a vertical line and circle, use the "I" pronoun, build a three-word sentence, and say their first name RESULTS Ten percent of the children had separated parents. Compared to parents who were together, when adjusting for the socioeconomic environment, as well as all potential confounders, the adjusted odds ratios (ORs) (95 % confidence interval [CI]) for children with separated parents, in terms of their ability to perform a standing jump, dress themselves, and draw a vertical line and circle were respectively 0.9 (0.7-1.1), 1.1 (0.9-1.2), 1.3 (1.1-1.4) and 1.2 (1.1-1.4). The adjusted ORs (95 % CI) for children's inability to say the "I" pronoun, build a three-word sentence, and say their first name were respectively 1.2 (1.1-1.3), 1.3 (1.2-1.5), and 1.2 (0.9-1.5). CONCLUSIONS After adjusting for sociocultural factors and other potential confounders, we observed that the children exhibited slower progression in psychomotor development, especially in language and graphic abilities when their parents were separated. While the implications of our study are somewhat limited, they do provide us with the necessary arguments enabling us to set up a prospective cohort study. Such a study should be able to better assess the impact of parental separation on the child's development, confirming our preliminary results.
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Affiliation(s)
- Nadine Kacenelenbogen
- Département de Médecine Générale, Université Libre de Bruxelles, Campus Facultaire Erasme, Route de Lennik 808/612, Bruxelles, 1070, Belgium.
- , Avenue Molière 179, Bruxelles, 1190, Belgium.
| | - Michèle Dramaix-Wilmet
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, Campus Erasme CP598, Route de Lennik 808, Bruxelles, 1070, Belgium
| | - M Schetgen
- Département de Médecine Générale, Université Libre de Bruxelles, Campus Facultaire Erasme, Route de Lennik 808/612, Bruxelles, 1070, Belgium
| | - M Roland
- Département de Médecine Générale, Université Libre de Bruxelles, Campus Facultaire Erasme, Route de Lennik 808/612, Bruxelles, 1070, Belgium
| | - Isabelle Godin
- Service d'Information Promotion Education Santé-SIPES, Ecole de santé publique, Université Libre de Bruxelles, Campus Erasme CP598, Route de Lennik 808, Brussels, B-1070, Belgium
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Development of the cortisol circadian rhythm in the light of stress early in life. Psychoneuroendocrinology 2015; 62:292-300. [PMID: 26352482 DOI: 10.1016/j.psyneuen.2015.08.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/10/2015] [Accepted: 08/25/2015] [Indexed: 12/28/2022]
Abstract
The secretion of the stress hormone cortisol follows a diurnal circadian rhythm. There are indications that this rhythm is affected by stress early in life. This paper addresses the development of the cortisol circadian rhythm between 1 and 6 years of age, and the role of maternal stress and anxiety early in the child's life on this (developing) rhythm. Participants were 193 healthy mother-child dyads from a community sample. Self-reported maternal stress and anxiety and physiological stress (saliva cortisol), were assessed prenatally (gestational week 37). Postnatally, self-reported maternal stress and anxiety were measured at 3, 6, 12, 30, and 72 months. Saliva cortisol samples from the children were collected on two days (four times each day) at 12, 30, and 72 months of age. The total amount of cortisol during the day and the cortisol decline over the day were determined to indicate children's cortisol circadian rhythm. Multilevel analyses showed that the total amount of cortisol decreased between 1 and 6 years. Furthermore, more maternal pregnancy-specific stress was related to higher total amounts of cortisol in the child. Higher levels of early postnatal maternal anxiety were associated with flatter cortisol declines in children. Higher levels of early postnatal maternal daily hassles were associated with steeper child cortisol declines over the day. These results indicated developmental change in children's cortisol secretion from 1 to 6 years and associations between maternal stress and anxiety early in children's lives and children's cortisol circadian rhythm in early childhood.
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36
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Neves BH, Menezes J, Souza MA, Mello-Carpes PB. Physical exercise prevents short and long-term deficits on aversive and recognition memory and attenuates brain oxidative damage induced by maternal deprivation. Physiol Behav 2015; 152:99-105. [PMID: 26403760 DOI: 10.1016/j.physbeh.2015.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/07/2015] [Accepted: 09/20/2015] [Indexed: 11/28/2022]
Abstract
It is known from previous research that physical exercise prevents long-term memory deficits induced by maternal deprivation in rats. But we could not assume similar effects of physical exercise on short-term memory, as short- and long-term memories are known to result from some different memory consolidation processes. Here we demonstrated that, in addition to long-term memory deficit, the short-term memory deficit resultant from maternal deprivation in object recognition and aversive memory tasks is also prevented by physical exercise. Additionally, one of the mechanisms by which the physical exercise influences the memory processes involves its effects attenuating the oxidative damage in the maternal deprived rats' hippocampus and prefrontal cortex.
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Affiliation(s)
- Ben-Hur Neves
- Physiology Research Group, Stress, Memory & Behavior Lab, Federal University of Pampa, BR 472, Km 592, Po Box 118, 97500-970 Uruguaiana, RS, Brazil
| | - Jefferson Menezes
- Physiology Research Group, Stress, Memory & Behavior Lab, Federal University of Pampa, BR 472, Km 592, Po Box 118, 97500-970 Uruguaiana, RS, Brazil
| | - Mauren Assis Souza
- Physiology Research Group, Stress, Memory & Behavior Lab, Federal University of Pampa, BR 472, Km 592, Po Box 118, 97500-970 Uruguaiana, RS, Brazil
| | - Pâmela B Mello-Carpes
- Physiology Research Group, Stress, Memory & Behavior Lab, Federal University of Pampa, BR 472, Km 592, Po Box 118, 97500-970 Uruguaiana, RS, Brazil; Graduate Program in Biological Sciences: Physiology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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37
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Shahhosseini Z, Pourasghar M, Khalilian A, Salehi F. A Review of the Effects of Anxiety During Pregnancy on Children's Health. Mater Sociomed 2015; 27:200-2. [PMID: 26236168 PMCID: PMC4499279 DOI: 10.5455/msm.2015.27.200-202] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/05/2015] [Indexed: 01/17/2023] Open
Abstract
Background: Although pregnancy is often portrayed as a time of great joy, that’s not the reality for all women. The adverse, long-term, stable, and sometimes, irreparable effects of anxiety during pregnancy can change pregnancy into an agonizing and unpleasant event of women’s life span. Aim: The aim of this study was to explore the adverse effects of anxiety in pregnancy on children’s health in order to promote child health. Methods: In this narrative review the researchers searched in public databases like Google Scholar general search engine, and then more specific: Science Direct, Scientific Information Database, Magiran, Irandoc, Pubmed, Scopus, Cochrane library, and Psych info using Medical Subject Headings (MeSH) keywords: anxiety, maternal anxiety, pregnancy, pregnancy outcome, control and prevention restricted to English / Persian language, during the 20 years ago. Then those articles written by renowned experts were selected. At first, a list of 60 papers generated from the initial search. Then reviewers studied titles and abstracts and finally, quality assessment of full text studies was performed by two independent reviewers. Researchers reviewed summary of all articles sought, ultimately used data from 25 full articles to compile this review paper. Results: The findings were classified into four groups Biological, Mental, Behavioral, and Medical effects of anxiety during pregnancy. Conclusions: The effects of anxiety during pregnancy on offspring’s health are serious and thought-provoking to which the need for identifying and screening of anxiety disorders in prenatal care is necessary.
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Affiliation(s)
- Zohreh Shahhosseini
- Department of Midwifery and Reproductive Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Pourasghar
- Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Khalilian
- Department of Biostatics, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fariba Salehi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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LeMoult J, Chen MC, Foland-Ross LC, Burley HW, Gotlib IH. Concordance of mother-daughter diurnal cortisol production: Understanding the intergenerational transmission of risk for depression. Biol Psychol 2015; 108:98-104. [PMID: 25862380 PMCID: PMC4426075 DOI: 10.1016/j.biopsycho.2015.03.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/14/2015] [Accepted: 03/31/2015] [Indexed: 11/24/2022]
Abstract
A growing body of research is demonstrating concordance between mother and child diurnal cortisol production. In the context of maternal history of depression, intergenerational concordance of cortisol production could contribute to hypercortisolemia in children of depressed mothers, which has been shown to increase risk for MDD. The current study is the first to examine concordance in diurnal cortisol production between mothers with a history of depression and their never-depressed, but high-risk, children. We collected salivary cortisol across 2 days from mothers with (remitted; RMD) and without (CTL) a history of recurrent episodes of depression and their never-depressed daughters. As expected, RMD mothers and their daughters both exhibited higher cortisol production than did their CTL counterparts. Moreover, both across and within groups, mothers' and daughters' cortisol production were directly coupled. These findings suggest that there is an intergenerational concordance in cortisol dysregulation that may contribute to hypercortisolemia in girls at familial risk for depression.
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Beijers R, Buitelaar JK, de Weerth C. Mechanisms underlying the effects of prenatal psychosocial stress on child outcomes: beyond the HPA axis. Eur Child Adolesc Psychiatry 2014; 23:943-56. [PMID: 24875898 DOI: 10.1007/s00787-014-0566-3] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/19/2014] [Indexed: 02/07/2023]
Abstract
Accumulating evidence from preclinical and clinical studies indicates that maternal psychosocial stress and anxiety during pregnancy adversely affect child outcomes. However, knowledge on the possible mechanisms underlying these relations is limited. In the present paper, we review the most often proposed mechanism, namely that involving the HPA axis and cortisol, as well as other less well-studied but possibly relevant and complementary mechanisms. We present evidence for a role of the following mechanisms: compromised placental functioning, including the 11β-HSD2 enzyme, increased catecholamines, compromised maternal immune system and intestinal microbiota, and altered health behaviors including eating, sleep, and exercise. The roles of (epi)genetics, the postnatal environment and the fetus are also discussed. We conclude that maternal prenatal psychosocial stress is a complex phenomenon that affects maternal emotions, behavior and physiology in many ways, and may influence the physiology and functioning of the fetus through a network of different pathways. The review concludes with recommendations for future research that helps our understanding of the mechanisms by which maternal prenatal stress exerts its effect on the fetus.
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Affiliation(s)
- Roseriet Beijers
- Department of Developmental Psychology, Behavioral Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE, Nijmegen, The Netherlands,
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Mina TH, Reynolds RM. Mechanisms linking in utero stress to altered offspring behaviour. Curr Top Behav Neurosci 2014; 18:93-122. [PMID: 24577734 DOI: 10.1007/7854_2014_291] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Development in utero is recognised as a determinant of health in later life, a concept known as early life 'programming'. Several studies in humans have now shown a link between in utero stressors of maternal stress, anxiety and depression and adverse behavioural outcomes for the offspring including poorer cognitive function and behavioural and emotional problems. These behaviours are observed from the very early neonatal period and appear to persist through to adulthood. Underlying mechanisms are not known but overexposure of the developing foetus to glucocorticoids has been proposed. Dysregulation of the maternal and offspring hypothalamic-pituitary-adrenal (HPA) axis has been proposed as a mechanism linking in utero stress with offspring behavioural outcomes. Studies suggest that altered circulating levels of maternal cortisol during pregnancy and/or changes in placental gene expression or methylation, which result in increased glucocorticoid transfer to the developing foetus, are linked to changes in offspring behaviour and in activity of the offspring HPA axis. Further understanding of the underlying pathways and identification of any gestation of vulnerability are needed to help design interventions to reduce in utero stress and improve behavioural outcomes in the offspring.
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Affiliation(s)
- Theresia H Mina
- Endocrinology Unit, Queen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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