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

项目总结。围绕分娩和产妇精神疾病的危及生命的事件正在进行 美国的崛起不成比例地影响了未被充分代表的少数族裔女性。孕产妇精神疾病发病率 可能会破坏母亲之间的纽带，从而对儿童的健康产生不利影响。母性纽带是 确保对儿童的依恋，刺激对儿童发展至关重要的保护和养育。失败 在产后早期建立亲子关系会导致儿童的不良发育问题， 在极端情况下会导致滥用和忽视，防止滥用和忽视是NICHD的一项既定任务。目前， 对调节产妇精神疾病和产妇护理问题的大脑机制的了解几乎是 完全缺乏。目前还没有一项研究检测创伤分娩后产妇的大脑。一个重要的 要考虑的因素是受到种族和民族歧视，这涉及到对心理健康的威胁 以及这种逆境如何牵涉到母亲的精神疾病和潜在的神经异常。 这项拟议中的研究是第一次使用定量神经成像方法来确定神经 产妇对应激源反应的基础，以及与分娩相关的妇女如何改变这一点 创伤后应激障碍(CB-PTSD)，近五分之一的女性接受 创伤性分娩。这项研究也是试图揭示种族和民族之间的联系的先驱 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 使用功能神经成像来确定患有CB-PTSD的母亲的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风险的女性，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 这是由分娩图像和婴儿痛苦线索引起的功能磁共振成像所可视化的。神经激活将是 与母亲行为和儿童发展的衡量标准以及感知的种族/民族的得分相关 歧视。母亲的CB-PTSD将通过心理诊断学和心理测量学进行测量；母亲 结合将通过心理测量学和对结合行为的观察评估来量化；以及儿童 通过标准化的观测方法发展。我们希望我们的发现将推动科学知识的发展。 产后妇女母体关系受损的神经机制研究进展 精神变态和歧视。识别新生儿创伤后应激障碍母体损害的新神经标记物 在产后非常早的时候，可以帮助将CB-PTSD与其他产后病理区分开来，并鼓励 专门的心理干预。总而言之，这项研究进一步推动了该机构为儿童执行的使命 实现健康和富有成效的生活。它可以作为未来研究复杂相互作用的平台 产后母亲精神疾病、母婴关系和潜在的 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.