Transformative Role of Epigenetics in Child Development Research: Commentary on the Special Section

Community midwifery: a primary health care approach to care during pregnancy for Aboriginal and Torres Strait Islander women

Comprehensive primary health care is integral to meaningful client-centred care, with nurses and midwives central to partnership approaches with individuals, families and communities. A primary health model of antenatal care is needed for Aboriginal and Torres Strait Islander women in rural and remote areas, where complex social determinants of health impact on pregnancy outcomes, early years and lifelong health. Staff experiences from a community midwifery-led antenatal program in a remote Western Australian setting were explored, with the aim of investigating program impacts from health service providers' perspectives. Interviews with 19 providers, including community midwives, child health nurses, program managers, a liaison officer, doctors and community agency staff, examined elements comprising a culturally safe community antenatal program for Aboriginal and Torres Strait Islander women, exploring program benefits and challenges. Thematic analysis derived five themes: Organisational and Accessibility Factors; Culturally Appropriate Support; Staff Availability and Competencies; Collaboration; and Sustainability. The ability of program staff to work in culturally safe partnerships with clients in collaboration with community agencies was essential to building meaningful and sustainable antenatal strategies. Midwifery primary health care competencies were viewed as a strong enabling factor, with potential to reduce health disparities in accordance with Australian Government and research recommendations.

Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation

Autism spectrum disorders (ASD) are an emergent public health problem, placing significant burden upon the individual, family and health system. ASD are polygenetic spectrum disorders of neural connectome development, in which one or more feedback loops amplify small genetic, structural, or functional variations in the very early development of motor and sensory-motor pathways. These perturbations trigger a 'butterfly effect' of unpredictable cascades of structural and functional imbalances in the global neuronal workspace, resulting in atypical behaviors, social communication, and cognition long-term. The first 100 days post-term are critically neuroplastic and comprise an injury-sensitive developmental window, characterized by a neural biomarker, the persistence of the cortical subplate, and a behavioral biomarker, the crying diathesis. By the time potential diagnostic signs are identified, from 6 months of age, ASD neuropathy is already entrenched. The International Society for Autism Research Special Interest Group has called for pre-emptive intervention, based upon rigorous theoretical frames, and real world translation and evaluation. This paper responds to that call. It synthesizes heterogenous evidence concerning ASD etiologies from both psychosocial and biological research literatures with complexity science and evolutionary biology, to propose a theoretical framework for pre-emptive intervention. This paper hypothesizes that environmental factors resulting from a mismatch between environment of evolutionary adaptedness and culture initiate or perpetuate early motor and sensory-motor lesions, triggering a butterfly effect of multi-directional cascades of atypical developmental in the complex adaptive system of the parent and ASD-susceptible infant. Chronic sympathetic nervous system/hypothalamic-pituitary-adrenal axis hyperarousal and disrupted parent-infant biobehavioral synchrony are the key biologic and behavioral mechanisms perpetuating these atypical developmental cascades. A clinical translation of this evidence is proposed, for application antenatally and in the first 6 months of life, as pre-emptive intervention for ASD.

Lack of social support as measured by the Family Resource Scale screening tool is associated with early adverse cognitive outcome in extremely low birth weight children

OBJECTIVE

Extremely low birth weight children are at high risk for cognitive impairment.

STUDY DESIGN

Cognitive outcome of extremely low birth weight children participating in a Neonatal Research Network, randomized trial was evaluated at 18 and 30 months corrected age using the Bayley Scales of Infant Development, 2nd ed. Family resources and social support were assessed using a Family Resource Scale parent questionnaire. Regression analysis was used to determine independent demographic, medical, and family resource factors influencing longitudinal cognitive outcome.

RESULT

Higher Family Resource Scale scores at 18 months were associated with greater improvement in cognitive scores between 18 and 30 months. Cognitive outcome was most adversely affected in children whose families had the least resources and social support. The adverse effect of poor social support was independent of family income.

CONCLUSION

Poor interpersonal social support has an independent, adverse impact on cognitive outcomes of extremely low birth weight infants.

Written in the Body?: Healing the Epigenetic Molecular Wounds of Complex Trauma Through Empathy and Kindness

While research on the biological/genetic approach to trauma transmission has become increasingly abundant over the past 15 years, this research has been primarily limited to scientific research journals and has not yet significantly appeared in practice journals, graduate programs, clinical settings, or policy decisions. This paper aims to develop a bridge across disciplines, integrating a review of biological science literature with mental health literature to provide a multidisciplinary overview of the role of epigenetic mechanisms in the transmission of complex trauma. Such a multidisciplinary overview is important in allowing professionals across disciplines to approach their work with a more complete understanding of the way in which ecological systems shape trauma transmission and healing. While encouraging collaboration between researchers and providers across fields, this paper argues that to heal the person, one must first work to heal the environment.

An epigenetic pathway approach to investigating associations between prenatal exposure to maternal mood disorder and newborn neurobehavior

Following recent advances in behavioral and psychiatric epigenetics, researchers are increasingly using epigenetic methods to study prenatal exposure to maternal mood disorder and its effects on fetal and newborn neurobehavior. Despite notable progress, various methodological limitations continue to obscure our understanding of the epigenetic mechanisms underpinning prenatal exposure to maternal mood disorder on newborn neurobehavioral development. Here we detail this problem, discussing limitations of the currently dominant analytical approaches (i.e., candidate epigenetic and epigenome-wide association studies), then present a solution that retains many benefits of existing methods while minimizing their shortcomings: epigenetic pathway analysis. We argue that the application of pathway-based epigenetic approaches that target DNA methylation at transcription factor binding sites could substantially deepen our mechanistic understanding of how prenatal exposures influence newborn neurobehavior.

Development of Preferences for Differently Aged Faces of Different Races

Children's experiences with differently aged faces changes in the course of development. During infancy, most faces encountered are adult, however as children mature, exposure to child faces becomes more extensive. Does this change in experience influence preference for differently aged faces? The preferences of children for adult versus child, and adult versus infant faces were investigated. Caucasian 3- to 6-year-olds and adults were presented with adult/child and adult/infant face pairs which were either Caucasian or Asian (race consistent within pairs). Younger children (3 to 4 years) preferred adults over children, whereas older children (5 to 6 years) preferred children over adults. This preference was only detected for Caucasian faces. These data support a "here and now" model of the development of face age processing from infancy to childhood. In particular, the findings suggest that growing experience with peers influences age preferences and that race impacts on these preferences. In contrast, adults preferred infants and children over adults when the faces were Caucasian or Asian, suggesting an increasing influence of a baby schema, and a decreasing influence of race. The different preferences of younger children, older children, and adults also suggest discontinuity and the possibility of different mechanisms at work during different developmental periods.

In utero Exposure to Germinated Brown Rice and Its GABA Extract Attenuates High-Fat-Diet-Induced Insulin Resistance in Rat Offspring

BACKGROUND

Numerous studies have reported on the influence of diet on insulin resistance. Our study provides insight into the effect of germinated brown rice (GBR) and γ-aminobutyric acid (GABA) on early environment-driven programming and susceptibility to insulin resistance in rat offspring.

METHODS

Male rat offspring from female Sprague-Dawley rats fed with a high-fat diet (HFD) alone, HFD + GBR, or HFD + GABA extract throughout pregnancy and lactation were weaned 4 weeks after delivery and followed up for 8 weeks. A biochemical analysis and an assessment of the hepatic expression of insulin signaling genes were performed.

RESULTS

The results showed that intrauterine exposure to HFD caused metabolic perturbations in rat offspring which gravitated towards insulin resistance even though the rat offspring did not consume an HFD. GBR and GABA attenuated the HFD-induced changes by underlying regulation of the insulin signaling genes.

CONCLUSIONS

The results suggest that intake of GBR and GABA during pregnancy and lactation can influence the programming of genes in rat offspring, thereby enhancing insulin sensitivity.

Social Inequality in Population Developmental Health: An Equity and Justice Issue

The conceptual framework for this chapter focuses on outcomes in developmental health as a key indicator of equity. Not all disparities in developmental health are indicators of a failure of equity and justice, but those that are clearly linked to social patterns in theoretically coherent and empirically substantial ways serve as a powerful diagnostic tool. They are especially diagnostic when they point to social factors that are remediable, especially in comparison to societies in which such social disparities are sharply lower (Keating, Siddiqi, & Nguyen, 2013). In this chapter, I review the theoretical links and empirical evidence supporting this central claim and propose that there is strong evidence for the following critical links: (a) there is a compelling empirical connection between disparities in social circumstances and disparities in developmental health outcomes, characterized as a social gradient effect; (b) "drilling down" reveals the core biodevelopmental mechanisms that yield the social disparities that emerge across the life course; (c) in turn, life course effects on developmental health have an impact on societies and populations that are revealed by "ramping up" the research to consider international comparisons of population developmental health; and (d) viewing this integrated evidence through the lens of equity and justice helps to break the vicious cycle that reproduces social inequality in a distressingly recurring fashion.