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。围绕分娩和孕产妇的精神病发病率的危及生命的事件正在发生美国的崛起和不成比例的影响不足的少数族裔妇女。孕产妇的精神病发病率通过破坏材料粘合，可能会对儿童的健康产生不利影响。孕产妇的纽带是确保儿童的依恋，刺激保护并为孩子的成长培养至关重要。失败在产后早期实现联系可能会导致儿童的不利发育问题在极端情况下，导致滥用和忽视，预防它是NICHD任务。现在，了解介导物物精神疾病的大脑机制和遗产护理问题的知识几乎是完全缺乏。没有研究检查创伤性儿童外脑的大脑。一个重要的要考虑的因素是暴露于种族和种族歧视，涉及对心理完整性的威胁自我以及这种冒险如何在孕产妇精神疾病和潜在的神经异常中实施。拟议的研究是第一个使用定量神经影像学方法来确定神经元的研究母亲对压力源的反应以及与分娩有关的妇女如何改变创伤后应激障碍（CB-PTSD），该疾病由5名妇女中的近1个认可创伤性儿童出生。这项研究也是试图揭示种族与种族之间关联的先驱歧视和大脑响应能力介导了最佳的物物护理。在这里，我们将实施有效的使用功能性神经成像来确定CB-PTSD母亲的神经影像发生变化的方案。在分娩后的几个小时内，我们将确定60名有CB-PTSD风险的女性，其中包括有色女性，将在产后早期评估她们的CB-PTSD症状和神经激活正如fMRI看到的那样，由分娩图像和婴儿苦恼的提示引起。神经激活将是与孕产妇行为和儿童发展的衡量标准以及感知的种族/种族相关歧视。孕产妇CB-PTSD将通过心理诊断和心理计量学测量；母亲键合将通过心理计量学和粘结行为的观察评估来量化；和孩子通过标准化的观察方法开发。我们希望我们的发现将推进科学知识介导产后妇女的遗传粘结损害的神经机制心理病理学和歧视。鉴定CB-PTSD中母体损害的新神经标记在产后早期可以帮助将CB-PTSD与其他产后病理区分开，并鼓励专门的心理干预措施。总之，这项研究进一步推进了该机构的儿童使命实现健康和产品的生命。它可以作为对复杂相互作用的未来调查的平台在产后重大精神疾病之间神经生物学机制。

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.