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更多挑战的时刻，这些挑战可能会因条件而加剧 已知会增强应激反应并扰乱情绪调节，如创伤后应激障碍 （PTSD）。对于这一已经脆弱的人群来说，2020年的大流行可能构成三重灾难， 目前尚不清楚，但可能对分娩环境和婴儿结局产生有害影响。上 在三个月的时间里，COVID-19大流行对个人、家庭和 初步证据表明， 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 对确定和推动新的预防办法至关重要， 特别是在类似的危机中。目前的研究试图招募一批不同的妇女， 他们的伴侣在COVID-19大流行期间处于怀孕的最后两个三个月。第1阶段 研究将涉及对这些个体的大规模调查（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， 建立高（n=200）和低（n=200）围产期流行病相关应激暴露的两个亚组， 参与全面和纵向评估协议，包括面谈，亲子 互动，婴儿压力范例和生物样本收集。目标是：（1）以人为本 对围产期流行病相关经历进行潜在类别分析，以确定因类型而异的独特特征 和压力暴露的数量，并与种族/民族差异相关，无论谁报告的感知 压力，情绪失调，创伤后应激障碍，养育和婴儿失调（压力反应和 （2）在大型第一阶段调查队列（N= 2，000）中，比较高 和低围产期流行病相关的压力，并检查照顾者情绪失调，创伤后应激障碍， 在纵向2期队列（N=400）中，反应型父母作为这种关系的潜在中介;以及 (3)鉴定DNA的差异甲基化区域和端粒长度的差异以及随时间的变化 围产期压力高与低的婴儿。评估程序将结合经验， 在考虑对后代的影响时，母亲和伴侣的功能。这项工作将产生 关于流行病相关压力、照顾者情绪失调和创伤后应激障碍如何影响 分娩环境和婴儿结局的多个方面，预计将直接告知围产期 随着COVID-19大流行的持续及其后遗症的展开，公共卫生干预措施。

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.