Maternal Stress, Human Milk Composition, and Neurodevelopmental and Feeding Outcomes

项目总结/摘要 早产和新生儿重症监护室（NICU）的婴儿住院情况有充分的记录 对母亲来说是压力事件。虽然母乳对促进最佳健康至关重要， 早产儿的神经发育，母亲产后压力对母亲泌乳的影响， 喂养结果和乳汁成分尚未得到系统的检验。这一提议的目的是 独立之路奖是对哺乳和喂养结果的详细检查， 早产儿在新生儿重症监护室与生物系统的方法来了解母乳检查 假设母亲压力与喂养结果和受损标志物有关， 早产儿的神经发育，并改变母乳和婴儿肠道的方式影响早产儿 神经发育拟议的研究直接与尤妮斯肯尼迪施莱佛国家研究所， 儿童健康和人类发展的科学优先事项，以减少神经发育 通过了解营养/喂养和微生物组，优化早产儿的结局， 了解母乳成分与母体特征的关系。在K99阶段， 将对NICU中的感知、生物和已知母体压力源进行测量， 评估与母亲泌乳和喂养结果（产奶量、母亲自己的乳汁与捐赠者的乳汁）的关系 牛奶与早产儿配方奶粉）（目标1）。婴儿还将接受神经发育测试， NICU出院前和矫正年龄4个月时的脑电图，以评估两者之间的关系 母亲压力和早产儿神经发育结果之间的关系（目的2）。职业发展活动 K99阶段，包括应激生理学和婴儿神经发育方面的培训， NICU中早产儿的哺乳/喂养结果，以及评估母乳的学习技术 和婴儿肠道组成数据及其解释将在良好的研究环境中进行， 明尼苏达大学公共卫生学院流行病学和社区卫生部， 提供所需的技能，成功地检查产妇压力与 母乳和早产儿肠道组成在R 00阶段。靶向和非靶向代谢 方法和微生物分析将用于阐明人乳和 早产儿肠道组成与母体应激和早产儿神经发育（目的3）。拟议 研究为未来旨在减轻孕产妇死亡影响的临床干预奠定了基础。 通过社会心理支持和/或营养补充来缓解产后压力， 成功开展独立研究事业的基础数据，重点是促进营养 为早产儿提供最佳神经发育的实践。

PROJECT SUMMARY/ABSTRACT Preterm birth and the hospitalization of infants in the neonatal intensive care unit (NICU) are well-documented as stressful events for mothers. Although maternal milk is critically important to promote optimal health and neurodevelopment for preterm infants, the effects of maternal postnatal stress on maternal lactation and feeding outcomes and milk composition have not been systematically examined. The goal of this proposed Pathway to Independence Award is to pair a detailed examination of lactation and feeding outcomes for preterm infants in the NICU with a biological systems approach to understanding human milk to examine the hypothesis that maternal stress is associated with feeding outcomes and markers of impaired neurodevelopment for preterm infants and alters human milk and infant gut profiles in ways that affect preterm neurodevelopment. The proposed research directly aligns with the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s scientific priorities to reduce the incidence of neurodevelopmental disorders, optimize outcomes for preterm infants by understanding nutrition/feeding and the microbiome, and to understand human milk composition in relationship with maternal characteristics. During the K99 phase, measurement of perceived, biological, and known maternal stressors in the NICU will be conducted and assessed in relation to maternal lactation and feeding outcomes (milk production, mothers’ own milk vs donor milk vs preterm formula) (Aim 1). Infants will also undergo neurodevelopmental testing via electroencephalogram before NICU discharge and at 4 months corrected age to assess the relationship between maternal stress and preterm neurodevelopmental outcomes (Aim 2). Career development activities in the K99 phase, including training in stress physiology and infant neurodevelopment, developing expertise in lactation/feeding outcomes for preterm infants in the NICU, and learning techniques for assessing human milk and infant gut composition data and their interpretation will take place in the excellent research environment at the University of Minnesota School of Public Health Division of Epidemiology and Community Health and will provide the skills needed to successfully examine associations of maternal stress with characteristics of maternal milk and preterm infant gut composition in the R00 phase. Targeted and untargeted metabolic approaches and microbial analyses will be used to elucidate the relationships between human milk and preterm gut composition with maternal stress and preterm neurodevelopmental (Aim 3). The proposed research lays the groundwork for future clinical interventions designed to mitigate the effects of maternal postnatal stress through psychosocial support and/or nutritional supplementation and will also provide foundational data for the successful launch of an independent research career focused on promoting nutritional practices which yield optimal neurodevelopment for preterm infants.