Defining postpartum PTSD and its implications for maternal wellness and child development

定义产后创伤后应激障碍及其对孕产妇健康和儿童发展的影响

基本信息

批准号：
10684813
负责人：
Sharon Dekel
金额：
$ 69.43万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-16 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10684813
关键词：
Accidents Address Affect American American College of Obstetricians and Gynecologists Animal Model Behavioral Biological Biological Markers Birth Breast Feeding Caring Child Child Development Child Welfare Childbirth Chronic Clinical Cognition Cognitive Communication DSM-V Data Development Diagnosis Dimensions Discipline of obstetrics Disease Early Intervention Emotional Enhancers Epigenetic Process Ethnic Origin Exposure to Foundations Goals Growth Health Hour Imagery Impairment Infant Investigation Knowledge Knowledge acquisition Life Maternal Deprivation Maternal Health Maternal Mortality Measurement Measures Mediating Medical Medical Records Mental Depression Mental Health Mental Health Services Mental disorders Military Personnel Minority Women Mission Modification Morbidity - disease rate Mother-Child Relations Mothers Motor National Institute of Child Health and Human Development Neurotic Disorders Outcome Perception Perinatal Physiological Post-Traumatic Stress Disorders Postpartum Depression Postpartum Period Pregnancy Pregnant Women Preventive Procedures Productivity Provider Psyche structure Psychometrics Psychopathology Psychophysiology Quality of Care Recommendation Reduce health disparities Reproductive Process Risk Risk Factors Role Schedule Security Social support Standardization Stress Symptoms Testing Therapeutic Intervention Third Pregnancy Trimester Time Trauma Validation Well in self Woman Work antenatal assault candidate identification cohort combat cost early screening emotional distress ethnic health disparity experience health disparity improved infant temperament insight intergenerational longitudinal, prospective study low socioeconomic status maternal morbidity mental imagery neonatal period obstetrical complication patient stratification prepregnancy prevent programs prospective protective factors psychologic public health relevance racial discrimination racial health disparity response screening social determinants societal costs stem stressor tool trauma exposure traumatic event traumatic stress welfare

Accidents Address Affect American American College of Obstetricians and Gynecologists Animal Model Behavioral Biological Biological Markers Birth Breast Feeding Caring Child Child Development Child Welfare Childbirth Chronic Clinical Cognition Cognitive Communication DSM-V Data Development Diagnosis Dimensions Discipline of obstetrics Disease Early Intervention Emotional Enhancers Epigenetic Process Ethnic Origin Exposure to Foundations Goals Growth Health Hour Imagery Impairment Infant Investigation Knowledge Knowledge acquisition Life Maternal Deprivation Maternal Health Maternal Mortality Measurement Measures Mediating Medical Medical Records Mental Depression Mental Health Mental Health Services Mental disorders Military Personnel Minority Women Mission Modification Morbidity - disease rate Mother-Child Relations Mothers Motor National Institute of Child Health and Human Development Neurotic Disorders Outcome Perception Perinatal Physiological Post-Traumatic Stress Disorders Postpartum Depression Postpartum Period Pregnancy Pregnant Women Preventive Procedures Productivity Provider Psyche structure Psychometrics Psychopathology Psychophysiology Quality of Care Recommendation Reduce health disparities Reproductive Process Risk Risk Factors Role Schedule Security Social support Standardization Stress Symptoms Testing Therapeutic Intervention Third Pregnancy Trimester Time Trauma Validation Well in self Woman Work antenatal assault candidate identification cohort combat cost early screening emotional distress ethnic health disparity experience health disparity improved infant temperament insight intergenerational longitudinal, prospective study low socioeconomic status maternal morbidity mental imagery neonatal period obstetrical complication patient stratification prepregnancy prevent programs prospective protective factors psychologic public health relevance racial discrimination racial health disparity response screening social determinants societal costs stem stressor tool trauma exposure traumatic event traumatic stress welfare

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项目摘要

PROJECT SUMMARY. Maternal mental illness following childbirth is associated with substantial societal costs. Postpartum psychopathology is a leading contributor of maternal morbidity and mortality and can endanger the child’s wellbeing onward from birth. Deprivation of maternal care during the early neonatal period can induce long-term epigenetic alterations in a model animal, suggesting that postpartum mental illness can confer intergenerational risks. While efforts exist to reduce postpartum depression, childbirth-related posttraumatic stress disorder (CB-PTSD), a condition that is estimated to affect 240,000 American women each year, is underdiagnosed and undertreated. Risk factors for CB-PTSD remain elusive, and knowledge about the disorder’s course and impact on the child is almost entirely lacking. By generating important and substantive data, the central objective of this proposal is to serve as a first step towards addressing the clinical gap for a condition that should be amenable to early intervention. In this first of its kind longitudinal prospective study, we will study pregnant women during third trimester (Wk. 32), again in the hours following delivery and will follow them at repeated time points across the postpartum (PP) year, i.e., Day 1, Day 45, and Mos. 3, 6, and 12. Their infants will be studied at Mo. 6 and Mo. 12 PP. This schedule will allow us to examine risk for, and development of, CB-PTSD, as well as its influence on mother- infant bonding and early child development. Maternal CB-PTSD will be quantified using psychodiagnostic, psychometric, and psychophysiologic measures. Psychophysiological responsivity during mental imagery of the traumatic childbirth provides a potentially reliable biological marker of PTSD and can provide objective validation of the CB-PTSD diagnosis. Bonding will be quantified using psychometric assessments of maternal perceptions and an observational assessment of mother-child interaction at 6 mos. PP. Child outcomes will be quantified using a standardized child developmental observational procedure and standardized psychometrics at 12 mos. This study will offer new insights into the previously understudied posttraumatic dimension of postpartum psychopathology. Our work could suggest modifications of postpartum mental health care, which currently focuses on depression. Our findings may inform tools that can be used for early screening that may be the first step in implementing programs that can enhance the welfare of mother and child, thereby reducing the odds of developing a potentially preventable, costly posttraumatic disorder. In addition, the proposed study will further the NICHD missions that “women avoid harmful effects from reproductive processes and children achieve healthy and productive lives”.

项目摘要。分娩后母亲的精神疾病与大量社会成本有关。产后心理病理学是母性发病率和死亡率的主要贡献者，可能危害孩子从出生开始就开始健康。在新生儿初期，剥夺遗产护理可以诱发模型动物中的长期表观遗传改变，表明产后精神疾病可以召集代际风险。尽管存在减少产后抑郁症的努力，但与分娩有关应力障碍（CB-PTSD）每年估计会影响240,000名美国女性的疾病未经诊断和治疗未经诊断。 CB-PTSD的危险因素仍然难以捉摸，并且知道疾病的课程和对孩子的影响几乎完全缺乏。通过产生重要和实质性数据，该提案的核心目的是作为解决临床差距的第一步应该适应早期干预的条件。在同类纵向前瞻性研究中，我们将在三个月中研究孕妇（WK。 32），再次在交货后的几个小时内，将在产后重复的时间点（PP）跟随它们年份，即第1天，第45天和MOS。 3、6和12。他们的婴儿将在Mo. 6和Mo. 12 pp中进行研究。这日程安排将使我们能够检查CB-PTSD的风险和发展的风险，及其对母亲的影响婴儿纽带和早期儿童发育。孕产妇CB-PTSD将使用Psychodagnostic进行量化心理测量和心理生理措施。心理生理反应性在心理图像期间创伤性儿童外生提供了PTSD的潜在可靠的生物学标志物，可以提供客观验证 CB-PTSD诊断。将使用母体看法进行心理测量评估来量化键合以及在6 mos的母子相互作用的观察评估。 pp。儿童成果将被量化使用标准化的儿童发育观测程序和12 MOS的标准化心理计量学。这项研究将为产后的创伤后维度提供新的见解心理病理学。我们的工作可能暗示对产后心理保健的修改，目前专注于抑郁。我们的发现可能会告知可用于早期筛查的工具，这可能是第一个一步实施可以增强母子福利的计划，从而减少了几率产生一种可能预防的，昂贵的创伤后疾病。此外，拟议的研究将进一步 NICHD任务“女性避免复制过程和儿童实现有害影响健康和产品的生活”。