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

创伤性分娩后产后适应的神经基础及其对婴儿发育的影响

• 批准号: 9979427
• 负责人: Sharon Dekel
• 金额: $ 25.2万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979427
• 关键词: Adopted; Affect; American; Amygdaloid structure; Antidepressive Agents; Beginning of Life; Behavior; Biological; Biological Factors; Biological Markers; Birth; Brain; Brain region; Breast Feeding; Caring; Categories; Child; Child Abuse and Neglect; Child Development; Child Health; Child Rearing; Child Welfare; Childbirth; Clinical assessments; Complement; Complex; Corpus striatum structure; DSM-V; Development; Diagnosis; Diagnostic; Disease; Distress; Environmental Risk Factor; Exhibits; Facial Expression; Failure; Functional Magnetic Resonance Imaging; Future; Goals; Hour; Human; Impairment; Infant; Infant Development; Infant Health; Infanticide; Insula of Reil; Intervention; Investigation; Knowledge; Lead; Learning; Light; Maternal Behavior; Measurement; Measures; Medial; Mediating; Mental Health; Mental disorders; Methods; Mission; Modality; Mothers; National Institute of Child Health and Human Development; Near-Death Experience; Outcome; Pathology; Pharmaceutical Preparations; Post-Traumatic Stress Disorders; Postpartum Depression; Postpartum Period; Prefrontal Cortex; Prevention; Protocols documentation; Psychometrics; Psychopathology; Regulation; Reporting; Rewards; Risk; Scientific Advances and Accomplishments; Secure; Selection for Treatments; Standardization; Stimulus; Symptoms; Techniques; Technology; Therapeutic Intervention; Time; Traumatic Stress Disorders; Woman; Work; acute symptom; auditory stimulus; behavioral impairment; child neglect; child physical abuse; clinically relevant; cost; effective therapy; improved; neglect; neural correlate; neurobiological mechanism; neurofeedback; neuroimaging; neuromechanism; novel; outcome forecast; psychiatric symptom; psychologic; psychopharmacologic; relating to nervous system; research clinical testing; response; sex; societal costs; stressor; targeted treatment; theories; traumatic event; visual stimulus

PROJECT SUMMARY. Maternal bonding is the basis for secure attachment in the child, stimulating protection and nurturing crucial for the child’s socioemotional development. Failure to achieve bonding in the early postpartum period can result in adverse developmental problems in the child with heavy societal costs. Many women suffering from postpartum psychopathology exhibit poor maternal bonding, which, at its extreme, may lead to child abuse and neglect, the prevention of which is a stated NICHD mission. Understanding the underlying neural mechanism mediating postpartum maternal bonding impairment is crucial to achieve prevention. We propose to use quantitative neuroimaging approaches to determine the neural basis of maternal response to a child related stressor and how this is altered in the context of postpartum psychopathology. Recent and limited neuroimaging studies focused largely on postpartum maternal bonding in the context of postpartum depression with other conditions largely overlooked. One such disorder is childbirth-related posttraumatic stress disorder (CB-PTSD). CB-PTSD symptoms have been reported in up to 25% of mothers with the acute symptoms induced by birth related traumatic events including near-death experience. To date, there is very limited understanding of the biological and neural basis of CB-PTSD. In this study 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 who will be assessed in the early postpartum for CB-PTSD symptoms and neural activation as visualized by fMRI evoked by infant cry and distressed facial expression. Neural activations will be correlated with maternal bonding measurements and collected child developmental scores. 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 correlates mediating impairments in maternal bonding in women suffering from postpartum psychopathology. 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. This study will promote improved implementations of psychopharmacological and neurofeedback treatments, which are currently lacking. 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.

项目摘要。母亲的结合是孩子安全依恋的基础，刺激保护 和养育对孩子的社会情感发展至关重要。早期未能实现粘合 产后期可能导致儿童出现不利的发育问题，造成沉重的社会代价。许多 患有产后精神病理学的妇女表现出很差的母性结合，在极端情况下， 导致虐待和忽视儿童，防止这种情况是国家排雷中心的一项明确使命。了解潜在的 神经机制介导产后母亲的债券受损是至关重要的，以实现预防。我们 建议使用定量神经影像学方法来确定母体对一种药物反应的神经基础。 儿童相关的压力源，以及如何在产后精神病理学的背景下改变。近期和有限 神经影像学研究主要集中在产后抑郁症背景下的产后母亲联系 而其他的情况则被忽略了。其中一种是与分娩有关的创伤后应激障碍 （CB-PTSD）。据报道，高达25%的母亲出现了CB-PTSD症状， 与出生有关的创伤事件，包括濒死体验。到目前为止，人们对 CB-PTSD的生物和神经基础在这项研究中，我们将实现一个有效的协议，以确定 CB-PTSD母亲的神经活动改变，使用功能性神经成像。几小时后开始 分娩后，我们将确定60名有CB-PTSD风险的女性，并在产后早期对其进行评估 对于CB-PTSD症状和神经激活，通过婴儿哭泣和面部痛苦引起的fMRI可视化 表情神经激活将与母亲的联系测量和收集的儿童 发展分数母亲CB-PTSD将采用心理诊断学和心理测量学进行测量; 通过心理测量学和对联结行为的观察评估来量化母性联结; 和儿童发展的研究。我们希望我们的发现能推动科学 了解神经相关因素介导的妇女患有母亲的联系障碍， 产后精神病理学CB-PTSD中母亲损伤的新神经标志物的鉴定 产后早期可以帮助区分CB-PTSD与其他产后病理， 专门的心理干预。这项研究将促进更好地执行 精神药理学和神经反馈治疗，目前缺乏。总之，这项研究 促进工程处的使命，使儿童过上健康和有所作为的生活。它可以作为平台， 未来的调查，产妇精神疾病之间的复杂相互作用，在产后期间，母亲， 婴儿的联系，以及潜在的神经生物学机制。