Neural underpinnings of postpartum adaptation following traumatic delivery and implications for infant development

项目摘要。围绕分娩的危及生命的事件和产妇精神病发病率， 在美国，这一数字的上升对代表性不足的少数民族妇女产生了不利影响。产妇精神病发病率 可能会破坏母亲的亲密关系，从而对儿童的健康产生不利影响。母性纽带是 安全的依恋在儿童中，刺激保护和培育对儿童的发展至关重要。失败 在产后早期建立亲密关系可能会导致孩子的不良发育问题， 在极端的情况下，这会导致虐待和忽视，防止这种情况是国家排雷中心的一项明确使命。目前， 关于调节产妇精神疾病和产妇护理问题的大脑机制的知识几乎 完全缺乏。没有研究检查创伤性分娩后母亲的大脑。一个重要 需要考虑的因素是，受到种族和族裔歧视的影响，这涉及到对心理完整性的威胁 以及这种逆境如何与母亲的精神疾病和潜在的神经异常有关。 这项研究是第一次使用定量神经成像方法来确定神经功能。 产妇对压力源的反应的基础，以及这种反应在患有分娩相关疾病的妇女中是如何改变的 创伤后应激障碍（CB-PTSD），一种被近五分之一的女性证实的疾病， 创伤性分娩本研究也是试图揭示种族和民族之间联系的先驱 歧视和大脑反应调节最佳的产妇护理。在这里，我们将实现有效的 使用功能性神经成像确定CB-PTSD母亲神经活动改变的方案。 从分娩后的几个小时开始，我们将确定60名有CB-PTSD风险的妇女，其中包括 有色人种妇女，她们将在产后早期接受CB-PTSD症状和神经激活的评估 如通过由分娩意象和婴儿痛苦线索诱发的fMRI可视化。神经激活会 与母亲行为和儿童发育的测量分数以及感知的种族/民族 歧视母亲CB-PTSD将通过心理诊断学和心理测量学进行测量; 将通过心理测量学和对结合行为的观察评估来量化结合; 通过标准化的观察方法。我们希望我们的发现能促进科学知识的发展 的神经机制介导的损害，在母亲的债券在妇女患有产后 精神病理学和歧视CB-PTSD中母亲损伤的新神经标志物的鉴定 在产后早期，可以帮助区分CB-PTSD与其他产后病理，并鼓励 专门的心理干预。最后，本研究报告推动了工程处对儿童的使命， 实现健康和富有成效的生活。它可以作为未来调查复杂相互作用的平台 在产后期的母亲精神疾病，母婴联系，以及潜在的 神经生物学机制

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.