Impact of Perinatal Pandemic-Related Stress on the Early Caregiving Environment, Infant Functioning, DNA Methylation, and Telomere Length

摘要 怀孕标志着家庭面临的挑战增加，这些家庭可能会因疾病而加剧 已知可增强应激反应并扰乱情绪调节，如创伤后应激障碍 (创伤后应激障碍)。对于这些已经脆弱的人群来说，2020年的大流行可能会构成三重灾难， 目前尚不清楚，但可能对照料环境和婴儿结局产生有害影响。在第一个 3个月的时间里，新冠肺炎大流行深刻影响了个人、家庭和 世界各地的社区，有初步证据表明，艾滋病的患病率和严重性有所增加 心理健康问题。因此，了解创伤后应激障碍和流行病相关压力对家庭的影响 在疫情期间出生的儿童对于确定和推动新的预防和预防方法至关重要 干预，特别是在类似危机期间。目前的研究试图招募不同的女性和 他们的伴侣在新冠肺炎疫情期间处于怀孕的最后两个三个月。第一阶段 研究将涉及对这些人的大规模调查(N=2,000)，以评估围产期应激暴露 发生在大流行的背景下。第二阶段将涉及从第一阶段调查中选择个人以 建立围产期大流行相关应激暴露高(n=200)和低(n=200)的两个亚组 参与全面和纵向评估方案，包括面谈、亲子关系 互动、婴儿应激范例和生物样本收集。目标是：(1)以人为本 围产期大流行相关经历的潜在类别分析，以确定不同类型的独特特征 和压力暴露的数量，并与种族/民族、照顾者报告的感知存在差异关联 压力、情绪失调、创伤后应激障碍、父母养育和婴儿失调(应激反应和 情绪/行为问题)在大型第一阶段调查队列中(N=2,000)；(2)比较婴儿和高龄儿童 和较低的围产期大流行相关压力，并检查照顾者情绪失调、创伤后应激障碍和 在纵向阶段2队列(N=400)中，响应性父母教育是这种关系的潜在中介；以及 (3)识别DNA的不同甲基化区域以及端粒长度的差异和随时间的变化 围产期高应激组与低应激组的新生儿。评估程序将整合经验和 在考虑对后代的影响时，母亲和伴侣的功能。这项工作将会取得成果 大流行相关压力、照顾者情绪失调和创伤后应激障碍如何影响的机械洞察力 照料环境和婴儿结局的多个方面，预计将直接为围产期提供信息 随着新冠肺炎大流行的持续及其后遗症的展开，公共卫生干预。

ABSTRACT Pregnancy marks a time of increased challenges among families that may be exacerbated by conditions known to enhance stress reactivity and disrupt emotion regulation, such as posttraumatic stress disorder (PTSD). For this already vulnerable population, the 2020 pandemic may constitute a trifecta of calamities, with currently unknown, but likely deleterious effects on the caregiving environment and infant outcomes. In the first three-month period, the COVID-19 pandemic has had a profound impact on individuals, families, and communities across the world, with preliminary evidence for an increase in the prevalence and severity of mental health problems. As such, understanding the impact of PTSD and pandemic-related stress on families with children born during the pandemic is critical for identifying and driving novel approaches to prevention and intervention, especially during similar crises. The current study seeks to recruit a diverse cohort of women and their partners who were in the final two trimesters of pregnancy during the COVID-19 pandemic. Phase 1 of the study will involve a large-scale survey (N=2,000) of these individuals to assess perinatal stress exposure occurring in the context of the pandemic. Phase 2 will involve selecting individuals from the Phase 1 survey to establish two subgroups with high (n=200) and low (n=200) perinatal pandemic-related stress exposure to participate in a comprehensive and longitudinal assessment protocol, including interviews, parent-child interactions, an infant stress paradigm, and biological sample collection. Aims are to: (1) use person-centered latent class analysis of perinatal pandemic-related experiences to identify unique profiles that vary on the types and quantity of stress exposure and differentially associate with race/ethnicity, caregiver-reported perceived stress, emotion dysregulation, PTSD, parenting, and infant dysregulation (stress-reactivity and emotional/behavioral problems) in the large Phase 1 survey cohort (N=2,000); (2) Compare infants with high and low perinatal pandemic-related stress and examine caregiver emotion dysregulation, PTSD, and responsive parenting as potential mediators of this relationship in the longitudinal Phase 2 cohort (N=400); and (3) identify differentially methylated regions of DNA and differences in telomere length and changes over time in infants in high v. low perinatal stress groups. Assessment procedures will integrate the experiences and functioning of both the mother and partner when considering implications for offspring. This work will yield mechanistic insight on how pandemic-related stress, caregiver emotion dysregulation, and PTSD influence multiple aspects of the caregiving environment and infant outcomes and is expected to directly inform perinatal public health interventions as the COVID-19 pandemic continues and its sequelae unfold.