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Jacobson MH, Hamra GB, Monk C, Crum RM, Upadhyaya S, Avalos LA, Bastain TM, Barrett ES, Bush NR, Dunlop AL, Ferrara A, Firestein MR, Hipwell AE, Kannan K, Lewis J, Meeker JD, Ruden DM, Starling AP, Watkins DJ, Zhao Q, Trasande L. Prenatal Exposure to Nonpersistent Environmental Chemicals and Postpartum Depression. JAMA Psychiatry 2024; 81:67-76. [PMID: 37728908 PMCID: PMC10512164 DOI: 10.1001/jamapsychiatry.2023.3542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/20/2023] [Indexed: 09/22/2023]
Abstract
Importance Postpartum depression (PPD) affects up to 20% of childbearing individuals, and a significant limitation in reducing its morbidity is the difficulty in modifying established risk factors. Exposure to synthetic environmental chemicals found in plastics and personal care products, such as phenols, phthalates, and parabens, are potentially modifiable and plausibly linked to PPD and have yet to be explored. Objective To evaluate associations of prenatal exposure to phenols, phthalates, parabens, and triclocarban with PPD symptoms. Design, Setting, and Participants This was a prospective cohort study from 5 US sites, conducted from 2006 to 2020, and included pooled data from 5 US birth cohorts from the National Institutes of Health Environmental Influences on Child Health Outcomes (ECHO) consortium. Participants were pregnant individuals with data on urinary chemical concentrations (phenols, phthalate metabolites, parabens, or triclocarban) from at least 1 time point in pregnancy and self-reported postnatal depression screening assessment collected between 2 weeks and 12 months after delivery. Data were analyzed from February to May 2022. Exposures Phenols (bisphenols and triclosan), phthalate metabolites, parabens, and triclocarban measured in prenatal urine samples. Main Outcomes and Measures Depression symptom scores were assessed using the Edinburgh Postnatal Depression Scale (EPDS) or the Center for Epidemiologic Studies Depression Scale (CES-D), harmonized to the Patient-Reported Measurement Information System (PROMIS) Depression scale. Measures of dichotomous PPD were created using both sensitive (EPDS scores ≥10 and CES-D scores ≥16) and specific (EPDS scores ≥13 and CES-D scores ≥20) definitions. Results Among the 2174 pregnant individuals eligible for analysis, nearly all (>99%) had detectable levels of several phthalate metabolites and parabens. PPD was assessed a mean (SD) of 3 (2.5) months after delivery, with 349 individuals (16.1%) and 170 individuals (7.8%) screening positive for PPD using the sensitive and specific definitions, respectively. Linear regression results of continuous PROMIS depression T scores showed no statistically significant associations with any chemical exposures. Models examining LMW and HMW phthalates and di (2-ethylhexyl) phthalate had estimates in the positive direction whereas all others were negative. A 1-unit increase in log-transformed LMW phthalates was associated with a 0.26-unit increase in the PROMIS depression T score (95% CI, -0.01 to 0.53; P = .06). This corresponded to an odds ratio (OR) of 1.08 (95% CI, 0.98-1.19) when modeling PPD as a dichotomous outcome and using the sensitive PPD definition. HMW phthalates were associated with increased odds of PPD (OR, 1.11; 95% CI, 1.00-1.23 and OR, 1.10; 95% CI, 0.96-1.27) for the sensitive and specific PPD definitions, respectively. Sensitivity analyses produced stronger results. Conclusions and Relevance Phthalates, ubiquitous chemicals in the environment, may be associated with PPD and could serve as important modifiable targets for preventive interventions. Future studies are needed to confirm these observations.
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Affiliation(s)
- Melanie H. Jacobson
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Ghassan B. Hamra
- Johns Hopkins University, Department of Epidemiology, Baltimore, Maryland
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, Division of Behavioral Medicine, New York State Psychiatric Institute, New York, New York
| | - Rosa M. Crum
- Johns Hopkins University, Department of Epidemiology, Baltimore, Maryland
| | | | - Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Emily S. Barrett
- Rutgers School of Public Health, Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey
- University of Rochester Medical Center School of Medicine and Dentistry, Rochester, New York
| | - Nicole R. Bush
- Department of Psychiatry, University of California, San Francisco
- Department of Pediatrics, University of California, San Francisco
| | - Anne L. Dunlop
- Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Morgan R. Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, Division of Behavioral Medicine, New York State Psychiatric Institute, New York, New York
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kurunthachalam Kannan
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Johnnye Lewis
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque
| | - John D. Meeker
- University of Michigan, Department of Environmental Health Sciences, Ann Arbor
| | - Douglas M. Ruden
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Anne P. Starling
- Center for Lifecourse Epidemiology of Adiposity and Diabetes, University of Colorado Anschutz Medical Campus, Aurora
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Deborah J. Watkins
- University of Michigan, Department of Environmental Health Sciences, Ann Arbor
| | - Qi Zhao
- The University of Tennessee Health Science Center, Memphis
| | - Leonardo Trasande
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Division of Environmental Medicine, NYU Grossman School of Medicine, New York, New York
- NYU Wagner School of Public Service, New York, New York
- NYU College of Global Public Health, New York, New York
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2
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Firestein MR, Shuffrey LC. Candidate Pathways Underlying Exposure to the COVID-19 Pandemic and Early Child Development-Risk and Resilience. JAMA Netw Open 2023; 6:e2343770. [PMID: 37971744 DOI: 10.1001/jamanetworkopen.2023.43770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Affiliation(s)
- Morgan R Firestein
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Lauren C Shuffrey
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York
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3
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Firestein MR, Shuffrey LC, Hu Y, Kyle M, Hussain M, Bianco C, Hott V, Hyman SP, Kyler M, Rodriguez C, Tejeda Romero M, Tzul Lopez H, Alcántara C, Amso D, Austin J, Bain JM, Barbosa J, Battarbee AN, Bruno A, Ettinger S, Factor-Litvak P, Gilboa S, Goldman S, Gyamfi-Bannerman C, Maniatis P, Marsh R, Morrill T, Mourad M, Muhle R, Newes-Adeyi G, Noble KG, O’Reilly KC, Penn AA, Reichle L, Sania A, Semenova V, Silver WG, Smotrich G, Tita AT, Tottenham N, Varner M, Welch MG, Zork N, Garey D, Fifer WP, Stockwell MS, Monk C, Dawood F, Dumitriu D. Assessment of Neurodevelopment in Infants With and Without Exposure to Asymptomatic or Mild Maternal SARS-CoV-2 Infection During Pregnancy. JAMA Netw Open 2023; 6:e237396. [PMID: 37036706 PMCID: PMC10087058 DOI: 10.1001/jamanetworkopen.2023.7396] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Importance Associations between prenatal SARS-CoV-2 exposure and neurodevelopmental outcomes have substantial public health relevance. A previous study found no association between prenatal SARS-CoV-2 infection and parent-reported infant neurodevelopmental outcomes, but standardized observational assessments are needed to confirm this finding. Objective To assess whether mild or asymptomatic maternal SARS-CoV-2 infection vs no infection during pregnancy is associated with infant neurodevelopmental differences at ages 5 to 11 months. Design, Setting, and Participants This cohort study included infants of mothers from a single-site prospective cross-sectional study (COVID-19 Mother Baby Outcomes [COMBO] Initiative) of mother-infant dyads and a multisite prospective cohort study (Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI]) of pregnant individuals. A subset of ESPI participants was subsequently enrolled in the ESPI COMBO substudy. Participants in the ongoing COMBO study were enrolled beginning on May 26, 2020; participants in the ESPI study were enrolled from May 7 to November 3, 2021; and participants in the ESPI COMBO substudy were enrolled from August 2020 to March 2021. For the current analysis, infant neurodevelopment was assessed between March 2021 and June 2022. A total of 407 infants born to 403 mothers were enrolled (204 from Columbia University Irving Medical Center in New York, New York; 167 from the University of Utah in Salt Lake City; and 36 from the University of Alabama in Birmingham). Mothers of unexposed infants were approached for participation based on similar infant gestational age at birth, date of birth, sex, and mode of delivery to exposed infants. Exposures Maternal symptomatic or asymptomatic SARS-CoV-2 infection. Main Outcomes and Measures Infant neurodevelopment was assessed using the Developmental Assessment of Young Children, second edition (DAYC-2), adapted for telehealth assessment. The primary outcome was age-adjusted standard scores on 5 DAYC-2 subdomains: cognitive, gross motor, fine motor, expressive language, and receptive language. Results Among 403 mothers, the mean (SD) maternal age at delivery was 32.1 (5.4) years; most mothers were of White race (240 [59.6%]) and non-Hispanic ethnicity (253 [62.8%]). Among 407 infants, 367 (90.2%) were born full term and 212 (52.1%) were male. Overall, 258 infants (63.4%) had no documented prenatal exposure to SARS-CoV-2 infection, 112 (27.5%) had confirmed prenatal exposure, and 37 (9.1%) had exposure before pregnancy or at an indeterminate time. In adjusted models, maternal SARS-CoV-2 infection during pregnancy was not associated with differences in cognitive (β = 0.31; 95% CI, -2.97 to 3.58), gross motor (β = 0.82; 95% CI, -1.34 to 2.99), fine motor (β = 0.36; 95% CI, -0.74 to 1.47), expressive language (β = -1.00; 95% CI, -4.02 to 2.02), or receptive language (β = 0.45; 95% CI, -2.15 to 3.04) DAYC-2 subdomain scores. Trimester of exposure and maternal symptom status were not associated with DAYC-2 subdomain scores. Conclusions and Relevance In this study, results of a novel telehealth-adapted observational neurodevelopmental assessment extended a previous finding of no association between prenatal exposure to maternal SARS-CoV-2 infection and infant neurodevelopment. Given the widespread and continued high prevalence of COVID-19, these data offer information that may be helpful for pregnant individuals who experience asymptomatic or mild SARS-CoV-2 infections.
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Affiliation(s)
- Morgan R. Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Yunzhe Hu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Margaret Kyle
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Maha Hussain
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Catherine Bianco
- Department of Psychology, Columbia University, New York, New York
| | - Violet Hott
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Sabrina P. Hyman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Mia Kyler
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Rodriguez
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Melanie Tejeda Romero
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Helen Tzul Lopez
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | | | - Dima Amso
- Department of Psychology, Columbia University, New York, New York
| | - Judy Austin
- Heilbrunn Department of Population and Family Health, Columbia University Irving Medical Center, New York, New York
| | - Jennifer M. Bain
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Jennifer Barbosa
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ashley N. Battarbee
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham
| | - Ann Bruno
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Sharon Ettinger
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Suzanne Gilboa
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sylvie Goldman
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California
| | - Panagiotis Maniatis
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel Marsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | | | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Rebecca Muhle
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | | | - Kimberly G. Noble
- Department of Behavioral Sciences, Teachers College, Columbia University, New York, New York
| | - Kally C. O’Reilly
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Anna A. Penn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | | | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Vera Semenova
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wendy G. Silver
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Grace Smotrich
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Alan T. Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham
| | - Nim Tottenham
- Department of Psychology, Columbia University, New York, New York
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Martha G. Welch
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Noelia Zork
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Donna Garey
- Department of Pediatrics, Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Melissa S. Stockwell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
- Heilbrunn Department of Population and Family Health, Columbia University Irving Medical Center, New York, New York
| | - Catherine Monk
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Fatimah Dawood
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dani Dumitriu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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4
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Bianco C, Sania A, Kyle MH, Beebe B, Barbosa J, Bence M, Coskun L, Fields A, Firestein MR, Goldman S, Hane A, Hott V, Hussain M, Hyman S, Lucchini M, Marsh R, Mollicone I, Myers M, Ofray D, Pini N, Rodriguez C, Shuffrey LC, Tottenham N, Welch MG, Fifer W, Monk C, Dumitriu D, Amso D. Pandemic beyond the virus: maternal COVID-related postnatal stress is associated with infant temperament. Pediatr Res 2023; 93:253-259. [PMID: 35444294 PMCID: PMC9020754 DOI: 10.1038/s41390-022-02071-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/30/2021] [Accepted: 03/26/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Studies have shown that infant temperament varies with maternal psychosocial factors, in utero illness, and environmental stressors. We predicted that the pandemic would shape infant temperament through maternal SARS-CoV-2 infection during pregnancy and/or maternal postnatal stress. To test this, we examined associations among infant temperament, maternal prenatal SARS-CoV-2 infection, maternal postnatal stress, and postnatal COVID-related life disruptions. METHODS We tested 63 mother-infant dyads with prenatal maternal SARS-CoV-2 infections and a comparable group of 110 dyads without infections. To assess postnatal maternal stress, mothers completed the Perceived Stress Scale 4 months postpartum and an evaluation of COVID-related stress and life disruptions 6 months postpartum. Mothers reported on infant temperament when infants were 6-months-old using the Infant Behavior Questionnaire-Revised (IBQ-R) Very Short Form. RESULTS Maternal SARS-CoV-2 infection during pregnancy was not associated with infant temperament or maternal postnatal stress. Mothers with higher self-reported postnatal stress rated their infants lower on the Positive Affectivity/Surgency and Orienting/Regulation IBQ-R subscales. Mothers who reported greater COVID-related life disruptions rated their infants higher on the Negative Emotionality IBQ-R subscale. CONCLUSIONS Despite no effect of prenatal maternal SARS-CoV-2 infection, stress and life disruptions incurred by the COVID-19 pandemic were associated with infant temperament at 6-months. IMPACT SARS-CoV-2 infection during pregnancy is not associated with postnatal ratings of COVID-related life disruptions, maternal stress, or infant temperament. Postnatal ratings of maternal stress during the COVID-19 pandemic are associated with normative variation in maternal report of infant temperament at 6 months of age. Higher postnatal ratings of maternal stress are associated with lower scores on infant Positive Affectivity/Surgency and Orienting/Regulation at 6 months of age. Higher postnatal ratings of COVID-related life disruptions are associated with higher scores on infant Negative Emotionality at 6 months of age.
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Affiliation(s)
- Catherine Bianco
- grid.21729.3f0000000419368729Department of Psychology, Columbia University, New York, NY USA
| | - Ayesha Sania
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Margaret H. Kyle
- grid.239585.00000 0001 2285 2675Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Beatrice Beebe
- grid.413734.60000 0000 8499 1112Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY USA
| | - Jennifer Barbosa
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Mary Bence
- grid.239585.00000 0001 2285 2675Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Lerzan Coskun
- grid.239585.00000 0001 2285 2675Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Andrea Fields
- grid.21729.3f0000000419368729Department of Psychology, Columbia University, New York, NY USA
| | - Morgan R. Firestein
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Sylvie Goldman
- grid.239585.00000 0001 2285 2675Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, NY USA
| | - Amie Hane
- grid.21729.3f0000000419368729Department of Psychology, Columbia University, New York, NY USA ,grid.268275.c0000 0001 2284 9898Department of Psychology, Williams College, Williamstown, MA USA
| | - Violet Hott
- grid.239585.00000 0001 2285 2675Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Maha Hussain
- grid.239585.00000 0001 2285 2675Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Sabrina Hyman
- grid.239585.00000 0001 2285 2675Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Maristella Lucchini
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Rachel Marsh
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Isabelle Mollicone
- grid.239585.00000 0001 2285 2675Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Michael Myers
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Dayshalis Ofray
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Nicolo Pini
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Cynthia Rodriguez
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Lauren C. Shuffrey
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Nim Tottenham
- grid.21729.3f0000000419368729Department of Psychology, Columbia University, New York, NY USA
| | - Martha G. Welch
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA ,grid.239585.00000 0001 2285 2675Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA ,grid.239585.00000 0001 2285 2675Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY USA
| | - William Fifer
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA ,grid.239585.00000 0001 2285 2675Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Catherine Monk
- grid.239585.00000 0001 2285 2675Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA ,grid.239585.00000 0001 2285 2675Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY USA
| | - Dani Dumitriu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA. .,Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
| | - Dima Amso
- grid.21729.3f0000000419368729Department of Psychology, Columbia University, New York, NY USA
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5
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Shuffrey LC, Lucchini M, Morales S, Sania A, Hockett C, Barrett E, Carroll KN, Cioffi CC, Dabelea D, Deoni S, Dunlop AL, Deutsch A, Fifer WP, Firestein MR, Hedderson MM, Jacobson M, Kelly RS, Kerver JM, Mason WA, Mirzakhani H, O'Connor TG, Trasande L, Weiss S, Wright R, Zhu Y, Crum RM, Lee S, Elliott AJ, Monk C. Gestational diabetes mellitus, prenatal maternal depression, and risk for postpartum depression: an Environmental influences on Child Health Outcomes (ECHO) Study. BMC Pregnancy Childbirth 2022; 22:758. [PMID: 36209070 PMCID: PMC9548153 DOI: 10.1186/s12884-022-05049-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/14/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Prior research has demonstrated bidirectional associations between gestational diabetes mellitus (GDM) and perinatal maternal depression. However, the association between GDM, prenatal depression, and postpartum depression (PPD) has not been examined in a prospective cohort longitudinally. METHODS Participants in the current analysis included 5,822 women from the National Institutes of Health's Environmental influences on Child Health Outcomes (ECHO) Research Program: N = 4,606 with Neither GDM nor Prenatal Maternal Depression (Reference Category); N = 416 with GDM only; N = 689 with Prenatal Maternal Depression only; and N = 111 with Comorbid GDM and Prenatal Maternal Depression. The PROMIS-D scale was used to measure prenatal and postnatal maternal depressive symptoms. Primary analyses consisted of linear regression models to estimate the independent and joint effects of GDM and prenatal maternal depression on maternal postpartum depressive symptoms. RESULTS A higher proportion of women with GDM were classified as having prenatal depression (N = 111; 21%) compared to the proportion of women without GDM who were classified as having prenatal depression (N = 689; 13%), however this finding was not significant after adjustment for covariates. Women with Comorbid GDM and Prenatal Maternal Depression had significantly increased postpartum depressive symptoms measured by PROMIS-D T-scores compared to women with Neither GDM nor Prenatal Maternal Depression (mean difference 7.02, 95% CI 5.00, 9.05). Comorbid GDM and Prenatal Maternal Depression was associated with an increased likelihood of PPD (OR 7.38, 95% CI 4.05, 12.94). However, women with GDM only did not have increased postpartum PROMIS-D T-scores or increased rates of PPD. CONCLUSIONS Our findings underscore the importance of universal depression screening during pregnancy and in the first postpartum year. Due to the joint association of GDM and prenatal maternal depression on risk of PPD, future studies should examine potential mechanisms underlying this relation.
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Affiliation(s)
- Lauren C Shuffrey
- Department of Psychiatry, Division of Developmental Neuroscience, Columbia University Irving Medical Center, NYSPI, Pardes Rm 4932, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Maristella Lucchini
- Department of Psychiatry, Division of Developmental Neuroscience, Columbia University Irving Medical Center, NYSPI, Pardes Rm 4932, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Santiago Morales
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Ayesha Sania
- Department of Psychiatry, Division of Developmental Neuroscience, Columbia University Irving Medical Center, NYSPI, Pardes Rm 4932, 1051 Riverside Drive, New York, NY, 10032, USA
| | | | - Emily Barrett
- Rutgers School of Public Health, Environmental and Occupational Health Sciences Institute, Piscataway, NJ, USA
| | | | - Camille C Cioffi
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sean Deoni
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Anne L Dunlop
- Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - William P Fifer
- Department of Psychiatry, Division of Developmental Neuroscience, Columbia University Irving Medical Center, NYSPI, Pardes Rm 4932, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Morgan R Firestein
- Department of Psychiatry, Division of Developmental Neuroscience, Columbia University Irving Medical Center, NYSPI, Pardes Rm 4932, 1051 Riverside Drive, New York, NY, 10032, USA
| | | | - Melanie Jacobson
- Department of Pediatrics, Division of Environmental Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Rachel S Kelly
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jean M Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - W Alex Mason
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Thomas G O'Connor
- Department of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Scott Weiss
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Yeyi Zhu
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Rosa M Crum
- Johns Hopkins University, Baltimore, MD, USA
| | - Seonjoo Lee
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, NY, New York, USA
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
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6
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Lucchini M, Ordway MR, Kyle MH, Pini N, Barbosa JR, Sania A, Shuffrey LC, Firestein MR, Fernández CR, Fifer WP, Alcántara C, Monk C, Dumitriu D. Racial/ethnic disparities in infant sleep in the COVID-19 Mother Baby Outcomes (COMBO) study. Sleep Health 2022; 8:429-439. [PMID: 36038499 PMCID: PMC9411732 DOI: 10.1016/j.sleh.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Investigate racial and ethnic differences in infant sleep and examine associations with insurance status and parent-infant bedtime behavioral factors (PIBBF). METHODS Participants are part of the COVID-19 Mother Baby Outcomes (COMBO) Initiative, Columbia University. Data on infant sleep (night, day and overall sleep duration, night awakenings, latency, infant's sleep as a problem) were collected at 4 months postpartum. Regressions estimated associations between race/ethnicity, insurance status, PIBBF and infants' sleep. RESULTS A total of 296 infants were eligible (34.4% non-Hispanic White [NHW], 10.1% Black/African American [B/AA], 55.4% Hispanic). B/AA and Hispanic mothers were more likely to have Medicaid, bed/room-share, and report later infant bedtime compared to NHW mothers. Infants of B/AA mothers had longer sleep latency compared to NHW. Infants of Hispanic mothers slept less at night (∼70 ± 12 minutes) and more during the day (∼41 ± 12 minutes) and Hispanic mothers were less likely to consider infants' sleep as a problem compared to NHW (odds ratio 0.4; 95% confidence interval: 0.2-0.7). After adjustment for insurance status and PIBBF, differences by race/ethnicity for night and day sleep duration and perception of infant's sleep as a problem persisted (∼32 ± 14 minutes, 35 ± 15 minutes, and odds ratio 0.4; 95% confidence interval: 0.2-0.8 respectively). Later bedtime was associated with less sleep at night (∼21 ± 4 minutes) and overall (∼17 ± 5 minutes), and longer latency. Infants who did not fall asleep independently had longer sleep latency, and co-sleeping infants had more night awakenings. CONCLUSIONS Results show racial/ethnic differences in sleep in 4-month-old infants across sleep domains. The findings of our study suggest that PIBBF have an essential role in healthy infant sleep, but they may not be equitably experienced across racial/ethnic groups.
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Affiliation(s)
- Maristella Lucchini
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.
| | | | - Margaret H Kyle
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicolò Pini
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer R Barbosa
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Ayesha Sania
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren C Shuffrey
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Morgan R Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Cristina R Fernández
- New York-Presbyterian Hospital, New York, New York, USA; Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - William P Fifer
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | | | - Catherine Monk
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA; Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dani Dumitriu
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA; Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA; Sackler Institute, Zuckerman Institute, and the Columbia Population Research Center, Columbia University, New York, New York, USA.
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7
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Abstract
Importance The COVID-19 pandemic has prompted an unprecedented need to rapidly investigate the potential consequences for maternal mental health, infant and child development, and the mother-infant relationship. Observations Globally, the mental health of pregnant and postpartum individuals has worsened during the pandemic regardless of infection status, and these concerning changes have disproportionally affected racial and ethnic minoritized people from underserved populations. Early indicators of infant neurobehavioral outcomes suggest that while in utero exposure to a maternal SARS-CoV-2 infection is likely negligible, limited data are available regarding the neurodevelopmental consequences for the generation of infants born during the pandemic. High maternal depression and grief during the COVID-19 pandemic are associated with lower levels of self-reported maternal-infant bonding. Yet nearly all published reports of child neurodevelopmental outcomes and dyadic functioning in the context of the pandemic rely on self-reported and parent-reported measures, which are subject to bias. Conclusions and Relevance In the context of prior research, and considering the paucity of research on infant neurodevelopment following prenatal SARS-CoV-2 exposure and birth during the pandemic, robust scientific investigation is needed to detect indicators of compromised early outcomes that could inform widespread assessment and accessible intervention. We simultaneously caution against reflexive apprehension regarding the generation of children born during the COVID-19 pandemic.
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Affiliation(s)
- Morgan R Firestein
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Dani Dumitriu
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- New York State Psychiatric Institute, New York
| | - Catherine Monk
- New York State Psychiatric Institute, New York
- Division of Behavioral Medicine, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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8
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Affiliation(s)
- Morgan R Firestein
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Lauren C Shuffrey
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Dani Dumitriu
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York
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9
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Shuffrey LC, Firestein MR, Kyle MH, Fields A, Alcántara C, Amso D, Austin J, Bain JM, Barbosa J, Bence M, Bianco C, Fernández CR, Goldman S, Gyamfi-Bannerman C, Hott V, Hu Y, Hussain M, Factor-Litvak P, Lucchini M, Mandel A, Marsh R, McBrian D, Mourad M, Muhle R, Noble KG, Penn AA, Rodriguez C, Sania A, Silver WG, O’Reilly KC, Stockwell M, Tottenham N, Welch MG, Zork N, Fifer WP, Monk C, Dumitriu D. Association of Birth During the COVID-19 Pandemic With Neurodevelopmental Status at 6 Months in Infants With and Without In Utero Exposure to Maternal SARS-CoV-2 Infection. JAMA Pediatr 2022; 176:e215563. [PMID: 34982107 PMCID: PMC8728661 DOI: 10.1001/jamapediatrics.2021.5563] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Associations between in utero exposure to maternal SARS-CoV-2 infection and neurodevelopment are speculated, but currently unknown. OBJECTIVE To examine the associations between maternal SARS-CoV-2 infection during pregnancy, being born during the COVID-19 pandemic regardless of maternal SARS-CoV-2 status, and neurodevelopment at age 6 months. DESIGN, SETTING, AND PARTICIPANTS A cohort of infants exposed to maternal SARS-CoV-2 infection during pregnancy and unexposed controls was enrolled in the COVID-19 Mother Baby Outcomes Initiative at Columbia University Irving Medical Center in New York City. All women who delivered at Columbia University Irving Medical Center with a SARS-CoV-2 infection during pregnancy were approached. Women with unexposed infants were approached based on similar gestational age at birth, date of birth, sex, and mode of delivery. Neurodevelopment was assessed using the Ages & Stages Questionnaire, 3rd Edition (ASQ-3) at age 6 months. A historical cohort of infants born before the pandemic who had completed the 6-month ASQ-3 were included in secondary analyses. EXPOSURES Maternal SARS-CoV-2 infection during pregnancy and birth during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Outcomes were scores on the 5 ASQ-3 subdomains, with the hypothesis that maternal SARS-CoV-2 infection during pregnancy would be associated with decrements in social and motor development at age 6 months. RESULTS Of 1706 women approached, 596 enrolled; 385 women were invited to a 6-month assessment, of whom 272 (70.6%) completed the ASQ-3. Data were available for 255 infants enrolled in the COVID-19 Mother Baby Outcomes Initiative (114 in utero exposed, 141 unexposed to SARS-CoV-2; median maternal age at delivery, 32.0 [IQR, 19.0-45.0] years). Data were also available from a historical cohort of 62 infants born before the pandemic. In utero exposure to maternal SARS-CoV-2 infection was not associated with significant differences on any ASQ-3 subdomain, regardless of infection timing or severity. However, compared with the historical cohort, infants born during the pandemic had significantly lower scores on gross motor (mean difference, -5.63; 95% CI, -8.75 to -2.51; F1,267 = 12.63; P<.005), fine motor (mean difference, -6.61; 95% CI, -10.00 to -3.21; F1,267 = 14.71; P < .005), and personal-social (mean difference, -3.71; 95% CI, -6.61 to -0.82; F1,267 = 6.37; P<.05) subdomains in fully adjusted models. CONCLUSIONS AND RELEVANCE In this study, birth during the pandemic, but not in utero exposure to maternal SARS-CoV-2 infection, was associated with differences in neurodevelopment at age 6 months. These early findings support the need for long-term monitoring of children born during the COVID-19 pandemic.
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Affiliation(s)
- Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Morgan R. Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Margaret H. Kyle
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Andrea Fields
- Department of Psychology, Columbia University, New York, New York
| | | | - Dima Amso
- Department of Psychology, Columbia University, New York, New York
| | - Judy Austin
- Heilbrunn Department of Population and Family Health, Columbia University Irving Medical Center, New York, New York
| | - Jennifer M. Bain
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Jennifer Barbosa
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Mary Bence
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Catherine Bianco
- Department of Psychology, Columbia University, New York, New York
| | - Cristina R. Fernández
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Sylvie Goldman
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla
| | - Violet Hott
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Yunzhe Hu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Maha Hussain
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Arthur Mandel
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Rachel Marsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Danielle McBrian
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center New York, New York
| | - Rebecca Muhle
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Kimberly G. Noble
- Department of Neuroscience and Education, Teachers College, Columbia University, New York, New York
| | - Anna A. Penn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | | | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Wendy G. Silver
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Kally C. O’Reilly
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,New York State Psychiatric Institute, New York
| | - Melissa Stockwell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Nim Tottenham
- Department of Psychology, Columbia University, New York, New York
| | - Martha G. Welch
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Noelia Zork
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center New York, New York
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Catherine Monk
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Obstetrics and Gynecology, Columbia University Irving Medical Center New York, New York
| | - Dani Dumitriu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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10
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Lucchini M, Kyle MH, Sania A, Pini N, Babineau V, Firestein MR, Fernández CR, Shuffrey LC, Barbosa JR, Rodriguez C, Fifer WP, Alcántara C, Monk C, Dumitriu D. Postpartum sleep health in a multiethnic cohort of women during the COVID-19 pandemic in New York City. Sleep Health 2022; 8:175-182. [PMID: 34991997 PMCID: PMC8723759 DOI: 10.1016/j.sleh.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/13/2021] [Accepted: 10/18/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE/DESIGN Cross-sectional study to examine the determinants of sleep health among postpartum women during the COVID-19 pandemic in New York City (NYC). SETTING/PARTICIPANTS A subset of participants recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) cohort at Columbia University (N = 62 non-Hispanic White, N = 17 African American, N = 107 Hispanic). MEASUREMENTS Data on maternal sleep, COVID-19 infection during pregnancy, sociodemographic, behavioral, and psychological factors were collected via questionnaire at 4 months postpartum. Self-reported subjective sleep quality, latency, duration, efficiency, disturbances, and daytime dysfunction were examined as categorical variables (Pittsburgh Sleep Quality Index [PSQI]). Associations between sleep variables and COVID-19 status, time of the pandemic, sociodemographic, behavioral, and psychological factors were estimated via independent multivariable regressions. RESULTS Mothers who delivered between May-December 2020, who delivered after the NYC COVID-19 peak, experienced worse sleep latency, disturbances and global sleep health compared to those who delivered March-April 2020, the peak of the pandemic. Maternal depression, stress and COVID-19-related post-traumatic stress were associated with all sleep domains except for sleep efficiency. Maternal perception of infant's sleep as a problem was associated with worse global PSQI score, subjective sleep quality, duration, and efficiency. Compared to non-Hispanic White, Hispanic mothers reported worse global PSQI scores, sleep latency, duration and efficiency, but less daytime dysfunction. CONCLUSIONS These findings provide crucial information about sociodemographic, behavioral, and psychological factors contributing to sleep health in the postpartum period.
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Affiliation(s)
- Maristella Lucchini
- Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Margaret H. Kyle
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Ayesha Sania
- Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicolò Pini
- Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Vanessa Babineau
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Morgan R. Firestein
- Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Cristina R. Fernández
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren C. Shuffrey
- Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer R. Barbosa
- Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, New York, USA,Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | | | - William P. Fifer
- Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | | | - Catherine Monk
- Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA,Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dani Dumitriu
- Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, New York, USA,Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA,Sackler Institute, Zuckerman Institute, and the Columbia Population Research Center, Columbia University, New York, New York, USA,Corresponding author: Dani Dumitriu, Pardes Rm 4932, 1051 Riverside Dr., New York, NY 10032, USA
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11
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Firestein MR, Romeo RD, Winstead H, Goldman DA, Grobman WA, Haas D, Mercer B, Parker C, Parry S, Reddy U, Silver R, Simhan H, Wapner RJ, Champagne FA. Elevated prenatal maternal sex hormones, but not placental aromatase, are associated with child neurodevelopment. Horm Behav 2022; 140:105125. [PMID: 35131524 DOI: 10.1016/j.yhbeh.2022.105125] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 01/08/2023]
Abstract
Fetal exposure to testosterone may contribute to vulnerability for autism spectrum disorder (ASD). It is hypothesized that placental aromatase prevents fetal exposure to maternal testosterone, however, this pathway and the implications for child neurodevelopment have not been fully explored. We examined the relationships between prenatal maternal testosterone and estradiol at 19.2 ± 1.3 weeks, cord blood testosterone and estradiol at birth, placental aromatase mRNA expression, and neurodevelopment using the Social Communication Questionnaire (SCQ), the Behavioral Assessment System for Children, 3rd Edition (BASC-3), and the Empathizing Quotient for Children (EQ-C) at 4.5-6.5 years of age in a sample of 270 Nulliparous-Mothers-to-be (nuMoM2b) study participants. Maternal testosterone levels were positively associated with SCQ scores, but the association was not significant after adjusting for maternal age at delivery, nor was there a significant interaction with sex. Maternal estradiol levels were negatively associated with BASC-3 Clinical Probability scores among males (n = 139). We report a significant interaction effect of cord blood testosterone and fetal sex on both total SCQ scores and t-scores on the Developmental Social Disorders subscale. Placental aromatase was not associated with any neurodevelopmental or hormone measure, but under conditions of low placental aromatase expression, high maternal testosterone was positively associated with SCQ scores in males (n = 46). No other associations between hormone levels and neurodevelopment were significant. Our findings provide a foundation for further investigation of the mechanisms through which maternal sex hormones and placental steroidogenesis may affect fetal hormone production and neurobehavior.
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Affiliation(s)
- Morgan R Firestein
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| | - Russell D Romeo
- Departments of Psychology and Neuroscience and Behavior, Barnard College of Columbia University, New York, NY, USA
| | | | - Danielle A Goldman
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David Haas
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA
| | | | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Uma Reddy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Robert Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ronald J Wapner
- Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, NY, USA
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12
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Firestein MR, Kliman HJ, Sania A, Brink LT, Holzer PH, Hofmann KM, Milano KM, Pini N, Shuffrey LC, Odendaal HJ, Fifer WP. Trophoblast inclusions and adverse birth outcomes. PLoS One 2022; 17:e0264733. [PMID: 35231069 PMCID: PMC8887719 DOI: 10.1371/journal.pone.0264733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/15/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Trophoblast inclusions-cross sections of abnormal trophoblast bilayer infoldings-have previously been associated with aneuploidy, placenta accreta, and prematurity. This study was conducted to establish the relationship between trophoblast inclusions and a range of placental, pregnancy, and birth outcomes in a patient population with high smoking and alcohol exposure. Specifically, we sought to evaluate the association between the presence of trophoblast inclusions and 1) three primary birth outcomes: full-term birth, preterm birth, and stillbirth; 2) gestational age at delivery; and 3) specific placental pathologies. METHODS Two slides containing chorionic villi were evaluated from 589 placentas that were collected from Stellenbosch University in Cape Town, South Africa as part of the prospective, multicenter cohort Safe Passage Study of the Prenatal Alcohol and SIDS and Stillbirth Network. The subsample included 307 full-term live births, 212 preterm live births, and 70 stillbirths. RESULTS We found that the odds of identifying at least one trophoblast inclusion across two slides of chorionic villi was significantly higher for placentas from preterm compared to term liveborn deliveries (OR = 1.74; 95% CI: 1.22, 2.49, p = 0.002), with an even greater odds ratio for placentas from stillborn compared to term liveborn deliveries (OR = 4.95; 95% CI: 2.78, 8.80, p < 0.001). Gestational age at delivery was inversely associated with trophoblast inclusion frequency. Trophoblast inclusions were significantly associated with small for gestational age birthweight, induction of labor, villous edema, placental infarction, and inflammation of the chorionic plate. CONCLUSIONS The novel associations that we report warrant further investigation in order to understand the complex network of biological mechanisms through which the factors that lead to trophoblast inclusions may influence or reflect the trajectory and health of a pregnancy. Ultimately, this line of research may provide critical insights that could inform both clinical and research applications.
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Affiliation(s)
- Morgan R. Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America
- * E-mail: (MRF); (HJK)
| | - Harvey J. Kliman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail: (MRF); (HJK)
| | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Lucy T. Brink
- Faculty of Medicine and Health Science, Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Parker H. Holzer
- Department of Statistics & Data Science, Yale University, New Haven, Connecticut, United States of America
| | - Katherine M. Hofmann
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kristin M. Milano
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Hein J. Odendaal
- Faculty of Medicine and Health Science, Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, United States of America
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, United States of America
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13
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Firestein MR, Myers MM, Feder KJ, Ludwig RJ, Welch MG. Effects of Family Nurture Intervention in the NICU on Theory of Mind Abilities in Children Born Very Preterm: A Randomized Controlled Trial. Children (Basel) 2022; 9:children9020284. [PMID: 35205004 PMCID: PMC8870221 DOI: 10.3390/children9020284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/21/2023]
Abstract
Preterm infants are at risk for socioemotional deficits, neurodevelopmental disorders, and potentially theory of mind (ToM) deficits. Preterm infants enrolled in a randomized controlled trial in the neonatal intensive care unit (NICU) received Standard Care (SC) or Family Nurture Intervention (FNI). Children (N = 72; median age 61.8 ± 2.6 months; FNI: 35 (55%), SC:2 9 (45%)) completed a ToM task, of whom 64 (54% male; born to White (43.8%), Black (18.7%), and Hispanic (25.0%) mothers) contributed to this analysis. FNI and SC infants born extremely preterm to very preterm differed significantly: 78% (14 of 18) of FNI children passed vs. 30% (3 of 10) SC children (p = 0.01, effect size = 1.06). This large effect size suggests that FNI in the NICU may ameliorate deficits in social-cognitive skills of extreme to very preterm infants by school age.
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Affiliation(s)
- Morgan R Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Michael M Myers
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | | | - Robert J Ludwig
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Martha G Welch
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
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14
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Werchan DM, Hendrix CL, Ablow JC, Amstadter AB, Austin AC, Babineau V, Anne Bogat G, Cioffredi LA, Conradt E, Crowell SE, Dumitriu D, Fifer W, Firestein MR, Gao W, Gotlib IH, Graham AM, Gregory KD, Gustafsson HC, Havens KL, Howell BR, Humphreys KL, King LS, Kinser PA, Krans EE, Lenniger C, Levendosky AA, Lonstein JS, Marcus R, Monk C, Moyer S, Muzik M, Nuttall AK, Potter AS, Salisbury A, Shuffrey LC, Smith BA, Smith L, Sullivan EL, Zhou J, Thomason ME, Brito NH. Behavioral coping phenotypes and associated psychosocial outcomes of pregnant and postpartum women during the COVID-19 pandemic. Sci Rep 2022; 12:1209. [PMID: 35075202 PMCID: PMC8786860 DOI: 10.1038/s41598-022-05299-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022] Open
Abstract
The impact of COVID-19-related stress on perinatal women is of heightened public health concern given the established intergenerational impact of maternal stress-exposure on infants and fetuses. There is urgent need to characterize the coping styles associated with adverse psychosocial outcomes in perinatal women during the COVID-19 pandemic to help mitigate the potential for lasting sequelae on both mothers and infants. This study uses a data-driven approach to identify the patterns of behavioral coping strategies that associate with maternal psychosocial distress during the COVID-19 pandemic in a large multicenter sample of pregnant women (N = 2876) and postpartum women (N = 1536). Data was collected from 9 states across the United States from March to October 2020. Women reported behaviors they were engaging in to manage pandemic-related stress, symptoms of depression, anxiety and global psychological distress, as well as changes in energy levels, sleep quality and stress levels. Using latent profile analysis, we identified four behavioral phenotypes of coping strategies. Critically, phenotypes with high levels of passive coping strategies (increased screen time, social media, and intake of comfort foods) were associated with elevated symptoms of depression, anxiety, and global psychological distress, as well as worsening stress and energy levels, relative to other coping phenotypes. In contrast, phenotypes with high levels of active coping strategies (social support, and self-care) were associated with greater resiliency relative to other phenotypes. The identification of these widespread coping phenotypes reveals novel behavioral patterns associated with risk and resiliency to pandemic-related stress in perinatal women. These findings may contribute to early identification of women at risk for poor long-term outcomes and indicate malleable targets for interventions aimed at mitigating lasting sequelae on women and children during the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Dani Dumitriu
- Columbia University Irving Medical Center, New York, USA
| | - William Fifer
- Columbia University Irving Medical Center, New York, USA
| | | | - Wei Gao
- Cedars-Sinai Medical Center, Los Angeles, USA
| | | | | | | | | | | | - Brittany R Howell
- Department of Human Development and Family Science, Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Blacksburg, USA
| | | | | | | | | | | | | | | | | | - Catherine Monk
- Columbia University Irving Medical Center, New York, USA
| | - Sara Moyer
- Virginia Commonwealth University, Richmond, USA
| | | | | | | | | | | | - Beth A Smith
- University of Southern California, Los Angeles, USA
| | - Lynne Smith
- The Lundquist Institute at Harbor-UCLA, West Carson, USA
| | | | - Judy Zhou
- University of Southern California, Los Angeles, USA
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15
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Firestein MR, Romeo RD, Winstead H, Goldman DA, Grobman WA, Haas DM, Parry S, Reddy UM, Silver RM, Wapner RJ, Champagne FA. Hypertensive disorders during pregnancy and polycystic ovary syndrome are associated with child communication and social skills in a sex-specific and androgen-dependent manner. Front Endocrinol (Lausanne) 2022; 13:1000732. [PMID: 36246897 PMCID: PMC9559211 DOI: 10.3389/fendo.2022.1000732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/05/2022] [Indexed: 01/21/2023] Open
Abstract
Prenatal exposure to testosterone is implicated in the etiology of autism spectrum disorder (ASD). Hypertensive disorders of pregnancy and polycystic ovary syndrome are associated with both hyperandrogenism and increased risk for ASD. We examined whether increased maternal testosterone mediates the relationship between these hyperandrogenic disorders (HDs) during pregnancy and child communication and social skills. Maternal plasma was collected during the second trimester and parent-report measures of child communication and social skills were obtained at 4.5-6.5 years of age from 270 participants enrolled in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). Our retrospective frequency-matched cohort study design identified 58 mothers with one or both of the HDs and 58 matched controls. Women diagnosed with an HD who carried a female had higher testosterone levels compared to those carrying a male (t(56) = -2.70, p = 0.01). Compared to females controls, females born to women with an HD had significantly higher scores on the Social Communication Questionnaire (t(114) = -2.82, p =0.01). Maternal testosterone partially mediated the relationship between a diagnosis of an HD and SCQ scores among females. These findings point to sex-specific associations of two HDs - hypertensive disorders of pregnancy and polycystic ovary syndrome - on child communication and social skills and a mediating effect of maternal testosterone during pregnancy. Further research is needed to understand placental-mediated effects of maternal testosterone on child brain development and neurodevelopmental outcomes.
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Affiliation(s)
- Morgan R. Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Morgan R. Firestein,
| | - Russell D. Romeo
- Departments of Psychology and Neuroscience and Behavior, Barnard College of Columbia University, New York, NY, United States
| | - Hailey Winstead
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Danielle A. Goldman
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, United States
| | - William A. Grobman
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - David M. Haas
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, United States
| | - Uma M. Reddy
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States
| | - Ronald J. Wapner
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Frances A. Champagne
- Department of Psychology, University of Texas at Austin, Austin, TX, United States
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16
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Kliman HJ, Firestein MR, Hofmann KM, Milano KM, Holzer PH, Brink LT, Odendaal HJ, Fifer WP. Trophoblast inclusions in the human placenta: Identification, characterization, quantification, and interrelations of subtypes. Placenta 2021; 103:172-176. [PMID: 33152642 PMCID: PMC8448462 DOI: 10.1016/j.placenta.2020.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022]
Abstract
We sought to examine placentas enriched for trophoblast inclusions (TIs) in order to characterize, quantify, and examine the interrelations between subtypes of TIs to better understand their underlying biology. We examined a cohort of 600 placentas from deliveries between 200 and 430 weeks of gestation. Forty-five percent of the placentas had at least one TI in the two slides examined. Four percent of the placentas had 10 or more TIs and two placentas had more than 70 TIs. Four distinct TI subtypes were observed: inclusionoids (early forming inclusions), inclusions, calcified inclusions, and calcified bodies. We suggest this reflects a developmental trajectory of TI maturation, the timing of which might be useful when comparing TI expression to clinical outcomes.
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Affiliation(s)
- Harvey J Kliman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
| | - Morgan R Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Kristin M Milano
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Parker H Holzer
- Department of Statistics & Data Science, Yale University, New Haven, CT, USA
| | - Lucy T Brink
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Hein J Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa; Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA; Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
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17
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Firestein MR, Myers MM, Austin J, Stark RI, Barone JL, Ludwig RJ, Welch MG. Perinatal antibiotics alter preterm infant EEG and neurobehavior in the Family Nurture Intervention trial. Dev Psychobiol 2019; 61:661-669. [PMID: 30671945 DOI: 10.1002/dev.21820] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/22/2018] [Accepted: 11/25/2018] [Indexed: 02/06/2023]
Abstract
Early exposure to antibiotics has been shown to increase risk for poor neurobehavioral development, particularly with regard to attention deficit disorders. Clinically, electroencephalography (EEG) is increasingly used as a biomarker of these deficits. Less is known about the effects of antibiotics on neurobehavioral and neurophysiological outcomes in preterm infants, a population at particularly high risk for attention deficits and perinatal antibiotic exposure. This study examines the effects of perinatal antibiotic exposure on neonatal EEG and attention deficits as measured by the Child Behavior Checklist in 4- to 5-year-old children who were enrolled in an NICU-based randomized controlled trial comparing Family Nurture Intervention (FNI) to standard care. Antibiotic-exposed infants had increased attention problems and there was a main effect of antibiotic exposure such that exposed infants had higher EEG power. This effect was fourfold greater in infants who received standard NICU care compared to those who received the intervention, suggesting a buffering effect of the intervention. We hypothesize that the relationship between antibiotic exposure and altered neurodevelopment may be due to effects of antibiotics on the microbiome, and that FNI may buffer these adverse consequences.
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Affiliation(s)
| | - Michael M Myers
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Judy Austin
- Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Raymond I Stark
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Joseph L Barone
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Robert J Ludwig
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Martha G Welch
- Department of Pediatrics, Columbia University Medical Center, New York, New York.,Department of Psychiatry, Columbia University Medical Center, New York, New York.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
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18
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Firestein MR, Abellar R, Myers MM, Welch MG. Increased trophoblast inclusions in placentas from prematurely born infants: A potential marker of risk for preterm neurodevelopmental outcomes. Placenta 2017; 60:61-63. [PMID: 29208241 DOI: 10.1016/j.placenta.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/13/2017] [Accepted: 10/21/2017] [Indexed: 01/21/2023]
Abstract
Trophoblast inclusions (TIs) are placental abnormalities of the trophoblast bilayer. Present in 2-8% of full-term placentas, they are associated with poor neurodevelopment, including autism. Although previously unstudied, examination of chorionic villi from 108 preterm births revealed a ∼4 fold increase in the frequency of TIs (30.5%). Frequency of TIs was inversely related to gestational age (GA); 43% of placentas <30 weeks and 20% of placentas ≥32 weeks had TIs (χ2 = 4.41, p = 0.036). This increased prevalence in preterm infants suggests that TIs may indicate adverse intrauterine processes or undetected genetic abnormalities and could identify infants at risk for poor neurodevelopment.
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Affiliation(s)
| | - Rosanna Abellar
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Michael M Myers
- Department of Pediatrics, Columbia University Medical Center, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, 10032, USA
| | - Martha G Welch
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, 10032, USA; Department of Pediatrics, Columbia University Medical Center, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, 10032, USA
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19
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Welch MG, Firestein MR, Austin J, Hane AA, Stark RI, Hofer MA, Garland M, Glickstein SB, Brunelli SA, Ludwig RJ, Myers MM. Family Nurture Intervention in the Neonatal Intensive Care Unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial. J Child Psychol Psychiatry 2015; 56:1202-11. [PMID: 25763525 DOI: 10.1111/jcpp.12405] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preterm infants are at high risk for adverse neurodevelopmental and behavioral outcomes. Family Nurture Intervention (FNI) in the Neonatal Intensive Care Unit (NICU) is designed to counteract adverse effects of separation of mothers and their preterm infants. Here, we evaluate effects of FNI on neurobehavioral outcomes. METHODS Data were collected at 18 months corrected age from preterm infants. Infants were assigned at birth to FNI or standard care (SC). Bayley Scales of Infant Development III (Bayley-III) were assessed for 76 infants (SC, n = 31; FNI, n = 45); the Child Behavior Checklist (CBCL) for 57 infants (SC, n = 31; FNI, n = 26); and the Modified Checklist for Autism in Toddlers (M-CHAT) was obtained for 59 infants (SC, n = 33; FNI, n = 26). RESULTS Family Nurture Intervention significantly improved Bayley-III cognitive (p = .039) and language (p = .008) scores for infants whose scores were greater than 85. FNI infants had fewer attention problems on the CBCL (p < .02). FNI improved total M-CHAT scores (p < .02). Seventy-six percent of SC infants failed at least one of the M-CHAT items, compared to 27% of FNI infants (p < .001). In addition, 36% of SC infants versus 0% of FNI infants failed at least one social-relatedness M-CHAT item (p < .001). CONCLUSIONS Family Nurture Intervention is the first NICU intervention to show significant improvements in preterm infants across multiple domains of neurodevelopment, social-relatedness, and attention problems. These gains suggest that an intervention that facilitates emotional interactions between mothers and infants in the NICU may be key to altering developmental trajectories of preterm infants.
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Affiliation(s)
- Martha G Welch
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Morgan R Firestein
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Judy Austin
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amie A Hane
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Psychology, Williams College, Williamstown, MA, USA
| | - Raymond I Stark
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Myron A Hofer
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Marianne Garland
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | | | - Susan A Brunelli
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Robert J Ludwig
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Michael M Myers
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
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