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

• 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
• 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

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

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
• 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

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