Perinatal Maternal Mental Health, Fetal Programming and Child Development.
Perinatal Maternal Mental Health, Fetal Programming and Child Development.
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DOI：
10.3390/healthcare3041212
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发表时间：
2015-11-26
期刊：
影响因子：
--
通讯作者：
Galbally M
中科院分区：
文献类型：
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作者：
Lewis AJ;Austin E;Knapp R;Vaiano T;Galbally M
母亲在怀孕期间的精神障碍对儿童发育有明显的影响。本文就母体精神障碍通过编程效应影响胎儿发育的可能机制进行综述。这是一个复杂的领域，因为怀孕期间的心理健康症状在类型、时间和严重程度上各不相同，母亲的心理困扰往往伴随着较高的吸烟率、酗酒率、不良饮食和生活方式。研究现在开始检查最初在DOHaD框架内确定的胎儿编程机制，以检查母亲精神障碍如何影响胎儿发育。这些机制包括激素启动效应，如母体糖皮质激素升高，胎盘功能和灌注的改变，以及表观遗传机制。迄今为止，对抑郁症和焦虑症等高发精神障碍进行了调查，但很少有研究采用诊断措施，而且很少有研究检查精神分裂症、双相情感障碍、饮食失调和人格障碍等孕产妇精神障碍对胎儿发育的影响。下一波纵向研究需要集中在由胎儿规划的合理生物学机制驱动的具体假设上，并对儿童进行足够的随访，以检查发育脆弱性的早期表现。一旦确定，干预研究就可以有针对性地改变这些代际传播机制。
Maternal mental disorders over pregnancy show a clear influence on child development. This review is focused on the possible mechanisms by which maternal mental disorders influence fetal development via programming effects. This field is complex since mental health symptoms during pregnancy vary in type, timing and severity and maternal psychological distress is often accompanied by higher rates of smoking, alcohol use, poor diet and lifestyle. Studies are now beginning to examine fetal programming mechanisms, originally identified within the DOHaD framework, to examine how maternal mental disorders impact fetal development. Such mechanisms include hormonal priming effects such as elevated maternal glucocorticoids, alteration of placental function and perfusion, and epigenetic mechanisms. To date, mostly high prevalence mental disorders such as depression and anxiety have been investigated, but few studies employ diagnostic measures, and there is very little research examining the impact of maternal mental disorders such as schizophrenia, bipolar disorder, eating disorders and personality disorders on fetal development. The next wave of longitudinal studies need to focus on specific hypotheses driven by plausible biological mechanisms for fetal programming and follow children for a sufficient period in order to examine the early manifestations of developmental vulnerability. Intervention studies can then be targeted to altering these mechanisms of intergenerational transmission once identified.