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

项目总结。围绕分娩和孕产妇精神疾病的生命威胁事件正在上演

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.