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Yang Z, Shao C, Tang C. Risk Factors of Perinatal Negative Mood and Its Influence on Prognosis: A Retrospective Cohort Study. Psychol Res Behav Manag 2024; 17:853-865. [PMID: 38444720 PMCID: PMC10913804 DOI: 10.2147/prbm.s451843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
Background Maternal anxiety or depression in the perinatal period has a high prevalence. The negative emotion during the puerpera is unfavorable to the process of childbirth and also affects the recovery and the quality of life in postpartum patients significantly. The present study aimed to elucidate the risk factors of negative emotion in perinatal women and its influence on prognosis to provide a reference for improving maternal prognosis. Methods Initially, 350 expectant mothers were randomly enrolled in the present study between August 2021 and August 2022. Among these, after applying the established inclusion and exclusion criteria, 314 patients were eventually selected. The independent risk factors of negative emotion and poor prognosis were analyzed through binary logistics regression and multiple linear regression. Follow-up was conducted via telephone, email, and a follow-up visit one month after discharge. Results Among the included patients, 18 (5.7%) had prenatal anxiety, 16 (5.1%) had prenatal depression, 31 (9.9%) had postnatal anxiety, and 28 (8.9%) had postnatal depression. Perinatal negative emotional risk factors include age, marital relationship, regular prenatal examination, E2 level, 5-HT level before and after delivery, family monthly income, neonatal health, breastfeeding time, intrapartum hemorrhage, constipation and other complications. The development of postpartum negative emotions is a risk factor for maternal prognosis. Conclusion The results showed that the risk factors of perinatal depression and anxiety were complex. In order to improve the quality of life of pregnant women, maintain their long-term emotional stability, and promote their postpartum recovery, it may be considered to promote the use of screening tools to identify women at risk of anxiety and depression before and after delivery, and timely psychological counseling for patients with high risk factors to promote their mental health.
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Affiliation(s)
- Zheng Yang
- Department of Obstetrics, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China
| | - Cuixiang Shao
- Department of Obstetrics, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China
| | - Chen Tang
- Department of Obstetrics, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China
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2
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Lugo-Candelas C, Talati A, Glickman C, Hernandez M, Scorza P, Monk C, Kubo A, Wei C, Sourander A, Duarte CS. Maternal Mental Health and Offspring Brain Development: An Umbrella Review of Prenatal Interventions. Biol Psychiatry 2023; 93:934-941. [PMID: 36754341 PMCID: PMC10512172 DOI: 10.1016/j.biopsych.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
The idea that risk for psychiatric disorders may be transmitted intergenerationally via prenatal programming places interest in the prenatal period as a critical moment during which intervention efforts may have a strong impact, yet studies testing whether prenatal interventions also protect offspring are limited. The present umbrella review of systematic reviews and meta-analyses (SRMAs) of randomized controlled trials aimed to synthesize the available evidence and highlight promising avenues for intervention. Overall, the literature provides mixed and limited evidence in support of prenatal interventions. Thirty SRMAs were included. Of the 23 SRMAs that reported on prenatal depression interventions, 16 found a significant effect (average standard mean difference = -0.45, SD = 0.25). Similarly, 13 of the 20 SRMAs that reported on anxiety outcomes documented significant reductions (average standard mean difference = -0.76, SD = 0.95 or -0.53/0.53 excluding one outlier). Only 4 SRMAs reported child outcomes, and only 2 (of 10) analyses showed significant effects of prenatal interventions (massage and telephone support on neonatal resuscitation [relative risk = 0.43] and neonatal intensive care unit admissions [relative risk = 0.91]). Notably missing, perhaps due to our strict inclusion criteria (inclusion of randomized controlled trials only), were interventions focusing on key facets of prenatal health (e.g., whole diet, sleep). Structural interventions (housing, access to health care, economic security) were not included, although initial success has been documented in non-SRMAs. Most notably, none of the SRMAs focused on offspring mental health or neurodevelopmental outcomes. Given the possibility that interventions deployed in this period will positively impact the next generation, randomized trials that focus on offspring outcomes are urgently needed.
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Affiliation(s)
- Claudia Lugo-Candelas
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ardesheer Talati
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Caila Glickman
- New York State Psychiatric Institute, New York, New York
| | - Mariely Hernandez
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Pamela Scorza
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Catherine Monk
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ai Kubo
- Division of Research, Kaiser Permanente, Oakland, California
| | - Chiaying Wei
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Andre Sourander
- Department of Child Psychiatry, Turku University Hospital, Turku University, Turku, Finland
| | - Cristiane S Duarte
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.
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3
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DiPiero M, Rodrigues PG, Gromala A, Dean DC. Applications of advanced diffusion MRI in early brain development: a comprehensive review. Brain Struct Funct 2023; 228:367-392. [PMID: 36585970 PMCID: PMC9974794 DOI: 10.1007/s00429-022-02605-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Abstract
Brain development follows a protracted developmental timeline with foundational processes of neurodevelopment occurring from the third trimester of gestation into the first decade of life. Defining structural maturational patterns of early brain development is a critical step in detecting divergent developmental trajectories associated with neurodevelopmental and psychiatric disorders that arise later in life. While considerable advancements have already been made in diffusion magnetic resonance imaging (dMRI) for pediatric research over the past three decades, the field of neurodevelopment is still in its infancy with remarkable scientific and clinical potential. This comprehensive review evaluates the application, findings, and limitations of advanced dMRI methods beyond diffusion tensor imaging, including diffusion kurtosis imaging (DKI), constrained spherical deconvolution (CSD), neurite orientation dispersion and density imaging (NODDI) and composite hindered and restricted model of diffusion (CHARMED) to quantify the rapid and dynamic changes supporting the underlying microstructural architectural foundations of the brain in early life.
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Affiliation(s)
- Marissa DiPiero
- Department of Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | | | - Alyssa Gromala
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Douglas C Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA.
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, 53705, USA.
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, 53705, USA.
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4
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Lautarescu A, Bonthrone AF, Pietsch M, Batalle D, Cordero-Grande L, Tournier JD, Christiaens D, Hajnal JV, Chew A, Falconer S, Nosarti C, Victor S, Craig MC, Edwards AD, Counsell SJ. Maternal depressive symptoms, neonatal white matter, and toddler social-emotional development. Transl Psychiatry 2022; 12:323. [PMID: 35945202 PMCID: PMC9363426 DOI: 10.1038/s41398-022-02073-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/01/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Maternal prenatal depression is associated with increased likelihood of neurodevelopmental and psychiatric conditions in offspring. The relationship between maternal depression and offspring outcome may be mediated by in-utero changes in brain development. Recent advances in magnetic resonance imaging (MRI) have enabled in vivo investigations of neonatal brains, minimising the effect of postnatal influences. The aim of this study was to examine associations between maternal prenatal depressive symptoms, infant white matter, and toddler behaviour. 413 mother-infant dyads enrolled in the developing Human Connectome Project. Mothers completed the Edinburgh Postnatal Depression Scale (median = 5, range = 0-28, n = 52 scores ≥ 11). Infants (n = 223 male) (median gestational age at birth = 40 weeks, range 32.14-42.29) underwent MRI (median postmenstrual age at scan = 41.29 weeks, range 36.57-44.71). Fixel-based fibre metrics (mean fibre density, fibre cross-section, and fibre density modulated by cross-section) were calculated from diffusion imaging data in the left and right uncinate fasciculi and cingulum bundle. For n = 311, internalising and externalising behaviour, and social-emotional abilities were reported at a median corrected age of 18 months (range 17-24). Statistical analysis used multiple linear regression and mediation analysis with bootstrapping. Maternal depressive symptoms were positively associated with infant fibre density in the left (B = 0.0005, p = 0.003, q = 0.027) and right (B = 0.0006, p = 0.003, q = 0.027) uncinate fasciculus, with left uncinate fasciculus fibre density, in turn, positively associated with social-emotional abilities in toddlerhood (B = 105.70, p = 0.0007, q = 0.004). In a mediation analysis, higher maternal depressive symptoms predicted toddler social-emotional difficulties (B = 0.342, t(307) = 3.003, p = 0.003), but this relationship was not mediated by fibre density in the left uncinate fasciculus (Sobel test p = 0.143, bootstrapped indirect effect = 0.035, SE = 0.02, 95% CI: [-0.01, 0.08]). There was no evidence of an association between maternal depressive and cingulum fibre properties. These findings suggest that maternal perinatal depressive symptoms are associated with neonatal uncinate fasciculi microstructure, but not fibre bundle size, and toddler behaviour.
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Affiliation(s)
- Alexandra Lautarescu
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK.
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Maximilian Pietsch
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - J-Donald Tournier
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Daan Christiaens
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Joseph V Hajnal
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Andrew Chew
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Shona Falconer
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Suresh Victor
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Neonatal Unit, Evelina London Children's Hospital, London, UK
| | - Michael C Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Female Hormone Clinic, South London and Maudsley National Health Service Foundation Trust, London, UK
| | - A David Edwards
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Neonatal Unit, Evelina London Children's Hospital, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- EPSRC/Wellcome Centre for Medical Engineering, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
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5
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de Rooij SR. Are Brain and Cognitive Reserve Shaped by Early Life Circumstances? Front Neurosci 2022; 16:825811. [PMID: 35784851 PMCID: PMC9243389 DOI: 10.3389/fnins.2022.825811] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/13/2022] [Indexed: 01/22/2023] Open
Abstract
When growing older, many people are faced with cognitive deterioration, which may even amount to a form of dementia at some point in time. Although neuropathological signs of dementia disorders can often be demonstrated in brains of patients, the degree to which clinical symptoms are present does mostly not accurately reflect the amount of neuropathology that is present. Sometimes existent pathology even goes without any obvious clinical presentation. An explanation for this phenomenon may be found in the concept of reserve capacity. Reserve capacity refers to the ability of the brain to effectively buffer changes that are associated with normal aging processes and to cope with pathological damage. A larger reserve capacity has been suggested to increase resilience against age-associated cognitive deterioration and dementia disorders. Traditionally, a division has been made between brain reserve, which is based on morphological characteristics of the brain, and cognitive reserve, which is based on functional characteristics of the brain. The present review discusses the premises that brain and cognitive reserve capacity are shaped by prenatal and early postnatal factors. Evidence is accumulating that circumstances during the first 1,000 days of life are of the utmost importance for the lifelong health of an individual. Cognitive deterioration and dementia disorders may also have their origin in early life and a potentially important pathway by which the early environment affects the risk for neurodegenerative diseases is by developmental programming of the reserve capacity of the brain. The basic idea behind developmental programming of brain and cognitive reserve is explained and an overview of studies that support this idea is presented. The review is concluded by a discussion of potential mechanisms, synthesis of the evidence and relevance and future directions in the field of developmental origins of reserve capacity.
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Affiliation(s)
- Susanne R. de Rooij
- Epidemiology and Data Science, University of Amsterdam, Amsterdam, Netherlands
- Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
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6
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The Impact of Maternal Prenatal Stress Related to the COVID-19 Pandemic during the First 1000 Days: A Historical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084710. [PMID: 35457577 PMCID: PMC9029063 DOI: 10.3390/ijerph19084710] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has a major impact on society, particularly affecting its vulnerable members, including pregnant women and their unborn children. Pregnant mothers reported fear of infection, fear of vertical transmission, fear of poor birth and child outcomes, social isolation, uncertainty about their partner's presence during medical appointments and delivery, increased domestic abuse, and other collateral damage, including vaccine hesitancy. Accordingly, pregnant women's known vulnerability for mental health problems has become a concern during the COVID-19 pandemic, also because of the known effects of prenatal stress for the unborn child. The current narrative review provides a historical overview of transgenerational effects of exposure to disasters during pregnancy, and the role of maternal prenatal stress. We place these effects into the perspective of the COVID-19 pandemic. Hereby, we aim to draw attention to the psychological impact of the COVID-19 pandemic on women of reproductive age (15-49 year) and its potential associated short-term and long-term consequences for the health of children who are conceived, carried, and born during this pandemic. Timely detection and intervention during the first 1000 days is essential to reduce the burden of transgenerational effects of the COVID-19 pandemic.
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7
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Fixel-based Analysis of Diffusion MRI: Methods, Applications, Challenges and Opportunities. Neuroimage 2021; 241:118417. [PMID: 34298083 DOI: 10.1016/j.neuroimage.2021.118417] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 07/11/2021] [Accepted: 07/20/2021] [Indexed: 12/13/2022] Open
Abstract
Diffusion MRI has provided the neuroimaging community with a powerful tool to acquire in-vivo data sensitive to microstructural features of white matter, up to 3 orders of magnitude smaller than typical voxel sizes. The key to extracting such valuable information lies in complex modelling techniques, which form the link between the rich diffusion MRI data and various metrics related to the microstructural organization. Over time, increasingly advanced techniques have been developed, up to the point where some diffusion MRI models can now provide access to properties specific to individual fibre populations in each voxel in the presence of multiple "crossing" fibre pathways. While highly valuable, such fibre-specific information poses unique challenges for typical image processing pipelines and statistical analysis. In this work, we review the "Fixel-Based Analysis" (FBA) framework, which implements bespoke solutions to this end. It has recently seen a stark increase in adoption for studies of both typical (healthy) populations as well as a wide range of clinical populations. We describe the main concepts related to Fixel-Based Analyses, as well as the methods and specific steps involved in a state-of-the-art FBA pipeline, with a focus on providing researchers with practical advice on how to interpret results. We also include an overview of the scope of all current FBA studies, categorized across a broad range of neuro-scientific domains, listing key design choices and summarizing their main results and conclusions. Finally, we critically discuss several aspects and challenges involved with the FBA framework, and outline some directions and future opportunities.
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8
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Kirkovski M, Fuelscher I, Hyde C, Donaldson PH, Ford TC, Rossell SL, Fitzgerald PB, Enticott PG. Fixel Based Analysis Reveals Atypical White Matter Micro- and Macrostructure in Adults With Autism Spectrum Disorder: An Investigation of the Role of Biological Sex. Front Integr Neurosci 2020; 14:40. [PMID: 32903660 PMCID: PMC7438780 DOI: 10.3389/fnint.2020.00040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Atypical white matter (WM) microstructure is commonly implicated in the neuropathophysiology of autism spectrum disorder (ASD). Fixel based analysis (FBA), at the cutting-edge of diffusion-weighted imaging, can account for crossing WM fibers and can provide indices of both WM micro- and macrostructure. We applied FBA to investigate WM structure between 25 (12 males, 13 females) adults with ASD and 24 (12 males, 12 females) matched controls. As the role of biological sex on the neuropathophysiology of ASD is of increasing interest, this was also explored. There were no significant differences in WM micro- or macrostructure between adults with ASD and matched healthy controls. When data were stratified by sex, females with ASD had reduced fiber density and cross-section (FDC), a combined metric comprised of micro- and macrostructural measures, in the corpus callosum, a finding not detected between the male sub-groups. We conclude that micro- and macrostructural WM aberrations are present in ASD, and may be influenced by biological sex.
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Affiliation(s)
- Melissa Kirkovski
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia.,Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, VIC, Australia
| | - Ian Fuelscher
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Christian Hyde
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Peter H Donaldson
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Talitha C Ford
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, Melbourne, VIC, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, VIC, Australia.,Epworth Centre for Innovation in Mental Health, Epworth Health Care and Central Clinical School Monash University, Melbourne, VIC, Australia
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia.,Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, VIC, Australia
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9
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Bleker LS, Milgrom J, Sexton-Oates A, Parker D, Roseboom TJ, Gemmill AW, Holt CJ, Saffery R, Connelly A, Burger H, de Rooij SR. Cognitive Behavioral Therapy for Antenatal Depression in a Pilot Randomized Controlled Trial and Effects on Neurobiological, Behavioral and Cognitive Outcomes in Offspring 3-7 Years Postpartum: A Perspective Article on Study Findings, Limitations and Future Aims. Front Psychiatry 2020; 11:34. [PMID: 32116849 PMCID: PMC7031203 DOI: 10.3389/fpsyt.2020.00034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE OF ARTICLE In a previous pilot randomized controlled trial including 54 pregnant women with depression, maternal mood improved after Cognitive Behavioural Therapy (CBT) compared to treatment as usual (TAU), showing medium to large effect sizes. The effect persisted up to 9 months postpartum, with infant outcomes also showing medium to large effects favoring CBT in various child domains. This perspective article summarizes the results of a follow-up that was performed approximately 5 years later in the same cohort, assessing the effects of antenatal Cognitive Behavioural Therapy for depression and anxiety on child buccal cell DNA-methylation, brain morphology, behavior and cognition. FINDINGS Children from the CBT group had overall lower DNA-methylation compared to children from the TAU group. Mean DNA-methylation of all NR3C1 promoter-associated probes did not differ significantly between the CBT and TAU groups. Children from the CBT group had a thicker right lateral occipital cortex and lingual gyrus. In the CBT group, Voxel-Based-Morphometry analysis identified one cluster showing increased gray matter concentration in the right medial temporal lobe, and fixel-based analysis revealed reduced fiber-bundle-cross-section in the Fornix, the Optical Tract, and the Stria Terminalis. No differences were observed in full-scale IQ or Total Problems Score. When the total of hypotheses tests in this study was considered, differences in DNA-methylation and brain measurements were no longer significant. SUMMARY Our explorative findings suggest that antenatal depression treatment decreases overall child DNA-methylation, increases cortical thickness, and decreases white matter fiber-bundle cross-section in regions involved in cognitive function and the stress response. Nevertheless, larger studies are warranted to confirm our preliminary conclusion that CBT in pregnancy alters neurobiological outcomes in children. Clinical relevance remains unclear as we found no effects of antenatal CBT on child behavior or cognition (yet).
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Affiliation(s)
- Laura S. Bleker
- Academic Medical Centre, Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, Netherlands
- Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, Netherlands
| | - Jeannette Milgrom
- Parent-Infant Research Institute, Austin Health, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Alexandra Sexton-Oates
- Murdoch Children’s Research Institute—Cancer and Disease Epigenetics, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Donna Parker
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Tessa J. Roseboom
- Academic Medical Centre, Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, Netherlands
- Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, Netherlands
| | - Alan W. Gemmill
- Parent-Infant Research Institute, Austin Health, Melbourne, VIC, Australia
| | | | - Richard Saffery
- Murdoch Children’s Research Institute—Cancer and Disease Epigenetics, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Alan Connelly
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Huibert Burger
- University Medical Center Groningen, Department of General Practice, University of Groningen, Groningen, Netherlands
- Academic Medical Centre, Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
| | - Susanne R. de Rooij
- Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, Netherlands
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10
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Bleker LS, de Rooij SR, Roseboom TJ. Prenatal Psychological Stress Exposure and Neurodevelopment and Health of Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193657. [PMID: 31569453 PMCID: PMC6801715 DOI: 10.3390/ijerph16193657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Laura S Bleker
- Department of Obstetrics and Gynaecology, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Susanne R de Rooij
- Department of Obstetrics and Gynaecology, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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