Maternal Stress and Fetal/Infant Development

最近的证据表明，人类胎儿受到对健康具有永久影响的深远影响。母亲的压力引发了一系列改变人类胎儿正常发育过程的事件。暴露于压力信号升高的人类胎儿在子宫内的学习能力受损，早产和低出生体重的风险增加了三倍。此外，早出生或小出生的婴儿中有多达一半有运动、感觉或认知障碍。这项为期五年的建议的主要目的是确定产前产妇压力和产妇神经内分泌反应对胎儿行为的影响，并评估200名妇女（一半盎格鲁人，一半西班牙人）的胎儿行为与婴儿发育之间的关系。具体目标是：(a)确定影响胎儿行为的主要压力因素和(b)婴儿发育。在怀孕期间，压力将被测量五次（访谈和问卷）。胎儿行为和发育将通过传统的胎儿生长测量和胎儿行为状态、运动（静止和挑战）、胎儿心率（FHR）的反应性和习惯化测量来量化。婴儿行为将通过贝利发育量表、神经运动状态检查和下丘脑-垂体-肾上腺（HPA）活动的基础和昼夜测量来评估：(c)确定母亲压力相关（HPA）轴的活动和紊乱对胎儿和婴儿行为以及婴儿HPA活动的影响。由于母性应激会改变胎鼠大脑中的肽受体和脑肽水平，并影响人类胎儿的行为和分娩结果，因此将在每次就诊时检测母性肽水平。母亲应激肽对婴儿行为和HPA活性的影响将在6周、6、12和24个月时测定。(d)描述胎儿行为与婴儿结局的关系。胎儿中枢神经系统活动（习惯化）的敏感测量将与当代胎儿在休息和挑战后的行为测量相结合，以描述胎儿成熟。这些指标将被纳入预测婴儿神经运动发育的模型中。该项目旨在通过检查压力的时间和持续时间，通过调查与产前压力有关的生物机制，特别是HPA和胎盘轴，以及通过对婴儿产前压力的发育后果的纵向研究，确定对胎儿有害的母亲压力条件。

Recent evidence indicates that the human fetus is exposed to profound influences that have permanent implications for health. Maternal stress initiates a cascade of events that alter normal developmental processes in the human fetus. Human fetuses exposed to elevated stress signals have impaired learning in utero and are at three-fold increased risk for preterm birth and low birth weight. Moreover, as many as one-half of the infants born early or small, have motor, sensory or cognitive handicaps. The primary aim of this five-year proposal is to determine the influence of prenatal maternal stress and maternal neuroendocrine responses on fetal behavior and to assess the relationship between fetal behavior and infant development in a sample of 200 women (one-half Anglo, one-half Hispanic). The specific aims are to: (a) Identify the primary stress factors that influence fetal behavior and (b) infant development. Stress will be measured (interviews and questionnaires) five times during pregnancy. Fetal behavior and development will be quantified by conventional measures of fetal growth and by measures of fetal behavioral state, movement (at rest and challenge), reactivity and habituation of fetal heart rate (FHR). Infant behavior will be assessed with the Bayley scales of Development, the Neuromotor Status Examination and by basal and circadian measures of hypothalamic-pituitary-adrenal (HPA) activity: (c) Determine the influence of maternal stress-related (HPA) axis activity and disregulation on fetal and infant behavior and infant HPA activity. Because maternal stress alters peptide receptors and brain peptide levels in the fetal rat brain and because it influences human fetal behavior and birth outcomes, maternal peptide levels will be assayed from blood obtained at each visit. The influence of maternal stress peptides on infant behavior and HPA activity will be determined at six weeks, six, twelve and twenty-four months. (d) Describe the relationship between fetal behavior and infant outcome. A sensitive measure of fetal CNS activity (habituation) will be integrated with contemporary measures of fetal behavior at rest and after challenge, to describe fetal maturation. These measures will be entered into models to predict infant neuromotor development. This project is designed to identify maternal stressful conditions that are harmful to the fetus by examination of the timing and duration of stress, by investigation of biological mechanisms related to prenatal stress, specifically the HPA and placental axis and by longitudinal studies of developmental consequences of prenatal stress in the infant.