Impact of treating perinatal depression on infant HPA axis function

摘要 在全球范围内，大约20%的儿童在生命的最初几年内遭受母亲抑郁症的影响， 在整个生命过程中，身体和发育结果都很差。确定可以减轻 母亲抑郁症对儿童的负面影响是减少健康差距的关键，因此， 一个重要的公共卫生优先事项。然而，对儿童发展的可衡量影响可能不会立即显现 因此，非常需要确定临时效果指标。这些指标将 提供有关干预的因果影响的早期信息，并指出生物机制 通过这些干预措施塑造未来的儿童发展。HPA轴是一个强大的生物标志物， 越来越多的证据表明，HPA轴生物标志物与母亲的抑郁症 和婴儿的大脑发育。在巴基斯坦进行的一项群集随机对照试验中， 来自104对母婴的毛发来源的生物标志物数据（皮质醇和DHEA），以确定是否治疗孕产妇 抑郁症可改变婴儿HPA轴功能，并检查婴儿HPA轴功能在多大程度上预测 未来的发展成果。该试验的干预措施是一个同行交付版本的思考健康 为妊娠晚期抑郁症妇女提供的方案。研究样本还包括一个 在怀孕期间没有抑郁症的妇女的子集，作为低风险对照组。母子 对产后36个月的患者进行随访，结果数据集包含丰富的与以下相关的数据： 母亲的健康、社会人口因素、养育子女以及产后3至36个月的儿童发育。 随机设计使我们能够评估干预对婴儿皮质醇和DHEA的因果影响。的 感兴趣的主要结果是36个月大时的儿童认知和社会情感发展指标。 该项目的具体目标是（1）评估围产期抑郁干预对 婴儿头发中的皮质醇;（2）检查12个月大的婴儿皮质醇是否预示着24岁的儿童发育 和36个月;和（3）检查干预措施对婴儿DHEA水平的影响及其联系 12个月时的婴儿DHEA与24和36个月时的儿童发育结果之间的关系。结果 从这项研究将提高我们对母亲的心理健康在儿童发展中的作用的理解， 有助于确定重要指标，以改善早期干预评估。

ABSTRACT Globally, about 20% of children are exposed to maternal depression in the first years of life, increasing risk for poor physical and developmental outcomes over the life course. Identifying interventions that can mitigate the negative consequences of maternal depression on children is key to reducing health disparities and is therefore a major public health priority. However, measurable impacts on child development may not emerge immediately after an intervention and so there is a great need to identify interim indicators of effect. Such indicators would provide early information about the intervention’s causal impact, as well as point to the biological mechanism through which these interventions shape future child development. The HPA axis is a robust marker of biological responses to stress, and there is growing evidence linking HPA axis biomarkers to both maternal depression and infant brain development. Using a cluster Randomized Control Trial in Pakistan, this study leverages novel hair-derived biomarker data (cortisol and DHEA), from 104 mother-infant dyads, to determine if treating maternal depression can alter infant HPA axis function, and to examine to what extent infant HPA axis function predicts future development outcomes. The trial’s intervention is a peer-delivered version of the Thinking Healthy Programme provided to women identified as depressed in their 3rd trimester. The study sample also includes a subset of women who were not depressed during pregnancy, as a low-risk comparison group. The mother-child dyads are being followed through 36 months post-partum, and the resulting dataset is rich with data related to mothers’ health, sociodemographic factors, parenting, and child development from 3 to 36 months post-partum. The randomized design allows us to assess the intervention’s causal effects on infant cortisol and DHEA. The main outcomes of interest are child cognitive and socioemotional development indicators at 36 months of age. The specific aims of this project are to (1) evaluate the impact of a perinatal depression intervention on infant cortisol in hair; (2) examine whether infant cortisol at 12 months predicts child development at 24 and 36 months; and (3) examine the impact of the intervention on DHEA levels in infants and the link between infant DHEA at 12 months and child developmental outcomes at 24 and 36 months. The results from this study will improve our understanding of the role of maternal mental health in child development as well as help identify important indicators to improve early intervention evaluation.