Fetal Origins of Mental Health: The Developmental Origins of Health and Disease Hypothesis
Fetal Origins of Mental Health: The Developmental Origins of Health and Disease Hypothesis
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DOI：
10.1176/appi.ajp.2016.16020138
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发表时间：
2017-04-01
影响因子：
17.7
通讯作者：
Meaney, Michael J.
中科院分区：
文献类型：
--
作者：
O'Donnell, Kieran J.;Meaney, Michael J.
胎儿生长和发育的质量可以预测一系列非传染性慢性疾病的风险。这些观察结果形成了“健康和疾病的发育起源”假说的基础，这表明危及胎儿生长的子宫内信号也以一种易患后期疾病的方式“编程”组织分化。胎儿的生长也预示着以后精神病理学的风险。这些发现与产前母亲的情绪健康同样预测了以后精神病理学的风险的研究结果平行。总之，这些发现形成了胎儿神经发育的综合模型的基础，该模型提出产前母体逆境通过与胎儿生长相关的生物学途径来编程神经发育。作者回顾了文献，发现这种综合模型的支持很少。母亲的焦虑、抑郁和压力都会影响神经发育，但与已知的压力介质（例如，糖皮质激素）或与胎儿生长有关。相反，受损的胎儿发育似乎建立了一种“化生”状态，增加了对出生后影响的敏感性。还有一个严重的问题是，将胎儿生长或母亲心理健康与神经发育结果联系起来的观察性研究未能解释潜在的遗传因素。最后，虽然观察到的胎儿生长和成人健康之间的关系已经获得了相当大的关注，这些协会的临床相关性仍有待确定。对于未来的心理健康的胎儿起源研究，既有相当大的希望，也有重要的挑战。
The quality of fetal growth and development predicts the risk for a range of noncommunicable, chronic illnesses. These observations form the basis of the "developmental origins of health and disease" hypothesis, which suggests that the intrauterine signals that compromise fetal growth also act to "program" tissue differentiation in a manner that predisposes to later illness. Fetal growth also predicts the risk for later psychopathology. These findings parallel studies showing that antenatal maternal emotional well-being likewise predicts the risk for later psychopathology. Taken together, these findings form the basis for integrative models of fetal neurodevelopment, which propose that antenatal maternal adversity operates through the biological pathways associated with fetal growth to program neurodevelopment. The authors review the literature and find little support for such integrated models. Maternal anxiety, depression, and stress all influence neurodevelopment but show modest, weak, or no associations with known stress mediators (e.g., glucocorticoids) or with fetal growth. Rather, compromised fetal development appears to establish a "meta-plastic" state that increases sensitivity to postnatal influences. There also remain serious concerns that observational studies associating either fetal growth or maternal mental health with neurodevelopmental outcomes fail to account for underlying genetic factors. Finally, while the observed relation between fetal growth and adult health has garnered considerable attention, the clinical relevance of these associations remains to be determined. There are both considerable promise and important challenges for future studies of the fetal origins of mental health.