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: 9979427
• 负责人: Sharon Dekel
• 金额: $ 25.2万
• 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 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979427
• 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 Abuse and Neglect; Child Development; Child Health; Child Rearing; Child Welfare; Childbirth; Clinical assessments; Complement; Complex; Corpus striatum structure; DSM-V; Development; Diagnosis; Diagnostic; Disease; Distress; Environmental Risk Factor; Exhibits; Facial Expression; Failure; Functional Magnetic Resonance Imaging; Future; Goals; Hour; Human; Impairment; Infant; Infant Development; Infant Health; Infanticide; Insula of Reil; Intervention; Investigation; Knowledge; Lead; Learning; Light; Maternal Behavior; Measurement; Measures; Medial; Mediating; Mental Health; Mental disorders; Methods; Mission; Modality; Mothers; National Institute of Child Health and Human Development; Near-Death Experience; Outcome; Pathology; Pharmaceutical Preparations; Post-Traumatic Stress Disorders; Postpartum Depression; Postpartum Period; Prefrontal Cortex; Prevention; Protocols documentation; Psychometrics; Psychopathology; Regulation; Reporting; Rewards; Risk; Scientific Advances and Accomplishments; Secure; Selection for Treatments; Standardization; Stimulus; Symptoms; Techniques; Technology; Therapeutic Intervention; Time; Traumatic Stress Disorders; Woman; Work; acute symptom; auditory stimulus; behavioral impairment; child neglect; child physical abuse; clinically relevant; cost; effective therapy; improved; neglect; neural correlate; neurobiological mechanism; neurofeedback; neuroimaging; neuromechanism; novel; outcome forecast; psychiatric symptom; psychologic; psychopharmacologic; relating to nervous system; research clinical testing; response; sex; societal costs; stressor; targeted treatment; theories; traumatic event; visual stimulus

PROJECT SUMMARY. Maternal bonding is the basis for secure attachment in the child, stimulating protection and nurturing crucial for the child’s socioemotional development. Failure to achieve bonding in the early postpartum period can result in adverse developmental problems in the child with heavy societal costs. Many women suffering from postpartum psychopathology exhibit poor maternal bonding, which, at its extreme, may lead to child abuse and neglect, the prevention of which is a stated NICHD mission. Understanding the underlying neural mechanism mediating postpartum maternal bonding impairment is crucial to achieve prevention. We propose to use quantitative neuroimaging approaches to determine the neural basis of maternal response to a child related stressor and how this is altered in the context of postpartum psychopathology. Recent and limited neuroimaging studies focused largely on postpartum maternal bonding in the context of postpartum depression with other conditions largely overlooked. One such disorder is childbirth-related posttraumatic stress disorder (CB-PTSD). CB-PTSD symptoms have been reported in up to 25% of mothers with the acute symptoms induced by birth related traumatic events including near-death experience. To date, there is very limited understanding of the biological and neural basis of CB-PTSD. In this study 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 who will be assessed in the early postpartum for CB-PTSD symptoms and neural activation as visualized by fMRI evoked by infant cry and distressed facial expression. Neural activations will be correlated with maternal bonding measurements and collected child developmental scores. 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 correlates mediating impairments in maternal bonding in women suffering from postpartum psychopathology. 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. This study will promote improved implementations of psychopharmacological and neurofeedback treatments, which are currently lacking. 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。孕产妇的粘结是儿童安全依恋的基础，刺激保护 并为孩子的社会情感发展培养至关重要。未能在早期实现联系 产后时期可能会导致社会成本繁重的儿童不良发育问题。许多 患有产后心理病理学的妇女暴露了贫穷的母子结合，这在极端情况下可能 导致虐待和忽视儿童，预防措施是NICHD任务。了解基础 介导产后材料粘结障碍的神经机制对于实现预防至关重要。我们 提出使用定量神经影像学方法来确定母体反应的神经bass的建议 与儿童相关的压力源，以及在产后心理病理学的背景下如何改变这种压力。最近和有限 神经影像学研究主要集中在产后抑郁症的产后材料上 其他条件在很大程度上被忽略了。一种这样的疾病是与分娩相关的创伤后应激障碍 （CB-PTSD）。 CB-PTSD症状已有多达25％的母亲有急性症状 按照与出生有关的创伤事件，包括近乎死亡的经历。迄今为止，理解非常有限 CB-PTSD的生物学和神经基础。在这项研究中，我们将实施一个有效的协议来确定 使用功能性神经影像学的母亲患有CB-PTSD的母亲的神经活性改变。在小时内表彰 分娩后，我们将确定60名在产后早期评估的CB-PTSD风险的女性 对于CB-PTSD症状和神经激活，fMRI被婴儿哭泣和苦恼的面部表现出来 表达。神经激活将与孕妇粘合测量和收集的儿童相关 发展分数。孕产妇CB-PTSD将通过心理诊断和心理计量学测量； 孕产妇的粘结将通过精神计量学和粘结行为的观察评估来量化； 和通过标准化观察方法发展儿童。我们希望我们的发现将进步科学 了解神经相交的人介导的危害损害 产后心理病理学。鉴定CB-PTSD中母体损害的新神经标记物 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。这项研究将促进改进的实施 目前缺乏心理药物和神经反馈治疗。总之，这项研究 进一步推进了该机构的使命，以实现健康和产品生活。它可以作为一个平台 未来对产后物物精神疾病之间复杂相互作用的复杂相互作用的调查，母亲 - 婴儿粘结和潜在的神经生物学机制。