Neural underpinnings of postpartum adaptation following traumatic delivery and implications for infant development

创伤性分娩后产后适应的神经基础及其对婴儿发育的影响

基本信息

批准号：
10330226
负责人：
Sharon Dekel
金额：
$ 11.15万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-01 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10330226
关键词：
Adopted Affect American Amygdaloid structure Antidepressive Agents Beginning of Life Behavior Biological Biological Factors Biological Markers Birth Brain Brain region Breast Feeding Caring Categories Child Child Development Child Health Child Rearing Child Welfare Childbirth Clinical assessments Color Complement Complex Corpus striatum structure Cues DSM-V Development Diagnosis Diagnostic Discrimination Distress Environmental Risk Factor Event Exposure to Failure Functional Magnetic Resonance Imaging Future Goals Hour Human Imagery Impairment Infant Infant Development Infant Health Infanticide Insula of Reil Intervention Investigation Knowledge Lead Learning Life Light Manuscripts Maternal Behavior Measures Medial Mediating Mental Health Mental disorders Methods Mission Modality Morbidity - disease rate Mothers National Institute of Child Health and Human Development Near-Death Experience Outcome Pathology Pharmaceutical Preparations Post-Traumatic Stress Disorders Postpartum Period Prefrontal Cortex Preparation Prevention Prognosis Protocols documentation Psychometrics Psychopathology Regulation Rewards Risk Scientific Advances and Accomplishments Secure Selection for Treatments Standardization Stimulus Symptoms Techniques Technology Therapeutic Intervention Time Traumatic Stress Disorders Underrepresented Minority Woman Work abuse neglect auditory stimulus behavioral impairment child neglect child physical abuse clinical care clinically relevant cost effective therapy ethnic discrimination improved neglect neural correlate neurobiological mechanism neuroimaging neuromechanism novel parent grant parent project perinatal health psychiatric symptom psychologic racial and ethnic racial and ethnic disparities racial discrimination relating to nervous system research clinical testing response sex stressor targeted treatment theories visual stimulus

项目摘要

PROJECT SUMMARY. Life threatening events surrounding childbirth and maternal psychiatric morbidity, are on the rise in the US and disproportionally affect under-represented minority women. Maternal psychiatric morbidity can adversely impact the health of child by undermining maternal bonding. Maternal bonding is the basis for secure attachment in the child, stimulating protection and nurturing crucial for the child’s development. Failure to achieve bonding in the early postpartum period can result in adverse developmental problems in the child and in extreme cases lead to abuse and neglect, the prevention of which is a stated NICHD mission. Currently, knowledge of the brain mechanisms mediating maternal mental illness and problems with maternal care is almost completely lacking. There is no study examining the maternal brain following traumatic childbirth. An important factor to consider is exposure to racial and ethnic discrimination that involves threat to the psychological integrity of the self and how this adversity is implicated in maternal mental illness and the underlying neural abnormalities. The proposed study is the first of its kind to use quantitative neuroimaging approaches to determine the neural basis of maternal response to a stressor and how this is altered in women suffering from childbirth-related posttraumatic stress disorder (CB-PTSD), a condition endorsed by nearly 1 out of 5 women who undergo traumatic childbirth. This study is also pioneer in attempting to reveal the association between racial and ethnic discrimination and brain responsiveness mediating optimal maternal care. Here, we will implement a valid protocol to determine the altered neural activity in mothers with CB-PTSD using functional neuroimaging. Commencing in the hours following parturition, we will identify 60 women at risk for CB-PTSD, among them women of color, and they will be assessed in the early postpartum for CB-PTSD symptoms and neural activation as visualized by fMRI evoked by childbirth imagery and infant distressed cues. Neural activations will be correlated with scores on measures of maternal behavior and child development and perceived racial/ethnic discrimination. Maternal CB-PTSD will be measured with psycho-diagnostics and psychometrics; maternal bonding will be quantified by psychometrics and observational assessment of the bonding behavior; and child development via standardized observational methods. We expect our findings will advance scientific knowledge of the neural mechanisms mediating impairments in maternal bonding in women suffering from postpartum psychopathology and discrimination. Identification of novel neural markers of maternal impairments in CB-PTSD in the very early postpartum could help distinguish CB-PTSD from other postpartum pathologies and encourage specialized psychological interventions. In conclusion, this study furthers the Agency’s mission for children to achieve healthy and productive lives. It may serve as a platform for future investigations of the complex interplay between maternal mental illness in the postpartum period, mother–infant bonding, and the underlying neurobiological mechanisms.

项目摘要围绕分娩和孕产妇精神疾病的危及生命的事件正在发生。美国的上升对代表性不足的少数族裔妇女产生了不成比例的影响。可能会破坏母性纽带，从而对孩子的健康产生不利影响。孩子的安全依恋，激发保护和养育对孩子的发展至关重要。在产后早期建立亲密关系可能会导致孩子出现不良发育问题，在极端情况下会导致虐待和忽视，防止这种情况的发生是 NICHD 目前的一项明确使命。对调节孕产妇精神疾病和孕产妇护理问题的大脑机制的了解几乎是完全缺乏对创伤性分娩后母亲大脑进行检查的研究。需要考虑的因素是遭受种族和民族歧视，这会对心理健全构成威胁自我以及这种逆境如何与母亲的精神疾病和潜在的神经异常有关。这项研究是同类研究中第一个使用定量神经影像方法来确定神经元的研究。母亲对压力源的反应的基础，以及在患有分娩相关问题的妇女中，这种反应是如何发生的创伤后应激障碍 (CB-PTSD)，近五分之一的女性接受过创伤后应激障碍 (CB-PTSD) 这项研究也是试图揭示种族和民族之间关系的先驱。歧视和大脑反应调节最佳孕产妇护理在这里，我们将实施有效的方法。使用功能神经影像学确定患有 CB-PTSD 的母亲的神经活动改变的方案。从产后几小时开始，我们将识别 60 名有 CB-PTSD 风险的女性，其中有色人种女性，她们将在产后早期接受 CB-PTSD 症状和神经激活评估正如由分娩图像和婴儿痛苦暗示引起的功能磁共振成像所显示的那样。与母亲行为和儿童发展的得分以及感知的种族/民族相关母亲 CB-PTSD 将通过心理诊断和心理测量进行测量；联系将通过心理测量和对联系行为和儿童的观察评估来量化；我们期望我们的发现能够促进科学知识的发展。介导产后妇女母性联系受损的神经机制 CB-PTSD 中母亲损伤的新型神经标志物的精神病理学和歧视的鉴定。产后早期可能有助于区分 CB-PTSD 与其他产后病症，并鼓励总之，这项研究进一步推进了该机构对儿童的使命：它可以作为未来研究复杂相互作用的平台。产妇产后精神疾病、母婴关系及其潜在因素之间的关系神经生物学机制。

项目成果

期刊论文数量（16）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Screening for Post-Traumatic Stress Disorder following Childbirth using the Peritraumatic Distress Inventory.

使用创伤后应激障碍筛查分娩后的创伤后应激障碍。

DOI：
10.1101/2023.04.23.23288976
发表时间：
2023
期刊：
medRxiv : the preprint server for health sciences
影响因子：
0
作者：
Jagodnik,KathleenM;Ein-Dor,Tsachi;Chan,SabrinaJ;Ashkenazy,AdiTitelman;Bartal,Alon;Dekel,Sharon
通讯作者：
Dekel,Sharon

Traumatic childbirth during COVID-19 triggers maternal psychological growth and in turn better mother-infant bonding.

DOI：
10.1016/j.jad.2022.06.076
发表时间：
2022-09-15
期刊：
JOURNAL OF AFFECTIVE DISORDERS
影响因子：
6.6
作者：
Babu, Mrithula S.;Chan, Sabrina J.;Ein-Dor, Tsachi;Dekel, Sharon
通讯作者：
Dekel, Sharon

Validation of childbirth-related posttraumatic stress disorder using psychophysiological assessment.

DOI：
10.1016/j.ajog.2022.05.051
发表时间：
2022-10
期刊：
American journal of obstetrics and gynecology
影响因子：
9.8
作者：
通讯作者：

Traumatic memories of childbirth relate to maternal postpartum posttraumatic stress disorder.

DOI：
10.1016/j.janxdis.2020.102342
发表时间：
2021-01
期刊：
Journal of anxiety disorders
影响因子：
10.3
作者：
Thiel F;Berman Z;Dishy GA;Chan SJ;Seth H;Tokala M;Pitman RK;Dekel S
通讯作者：
Dekel S

Increased traumatic childbirth and postpartum depression and lack of exclusive breastfeeding in Black and Latinx individuals.

DOI：
10.1002/ijgo.14280
发表时间：
2022-09
期刊：
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
影响因子：
3.8
作者：
Iyengar, Ananya S.;Ein-Dor, Tsachi;Zhang, Emily X.;Chan, Sabrina J.;Kaimal, Anjali J.;Dekel, Sharon
通讯作者：
Dekel, Sharon