Maternal stress and undernutrition: Interactive effects on newborn and child outcomes in Ethiopia”

项目摘要/摘要 母体产前应激和营养影响胎儿生长和孩子的长期结局。母性心理应激 和营养不良经常并存，并影响重叠的生物应激轴参与胎儿生长和 神经内分泌发育。尽管如此，关于孕期压力和营养对母体健康的交互作用还知之甚少 胎儿和儿童的长期结局。拟议的K99/R00研究将利用正在进行的 埃塞俄比亚农村“母婴健康营养和产前感染治疗”(ENAT)试验 母体产前应激与营养干预对胎儿和儿童结局的交互影响。Enat随机化 2390名孕妇接受“强化营养”套餐或“标准护理”，并收集有关产妇的数据。 怀孕期间的产前压力(科恩的感知压力量表)。现有的ENAT数据将用于确定 母亲产前应激和营养干预对新生儿出生体重的独立和交互影响(目标1， K99)。在R00期间，我将对产后36个月的埃纳特母子二人组进行一项新的随访研究 评估儿童对压力敏感的结果(目标2，R00)。具体地说，发展后续研究将评估 儿童结局与注意力、应激反应、记忆力和社会情绪功能有关。我还将使用 来自Enat的生物标本来检查母体和新生儿的端粒长度是否可以作为In-DNA的生物标记物。 与母亲产前应激和营养有关的BWAZ和儿童结局的子宫规划(目标3，R00)。我 假设母亲产前应激和营养干预将对新生儿和 童年的结局。我还假设母体和新生儿的端粒长度将作为产前的生物标志物 母体应激和营养的程序化效应。我的长期职业目标是领导独立的多学科 描述生物和心理社会因素影响胎儿和儿童发育的复杂方式的研究 在资源匮乏的环境中。这个奖项将使我获得母胎营养的基本科学知识。 和端粒生物学，高级神经发育评估的技术技能，包括眼球跟踪和 心电图学，以及低收入国家初级数据收集和研究管理的实用技能。 在R00期间，我将独立领导埃塞俄比亚农村地区的一项创新的儿童发展研究。建议数 研究与NICHD的目标一致，即改善妊娠结局，以最大限度地提高妇女和 并帮助所有儿童茁壮成长。拟议的研究将产生流行病学和生物学证据之间的联系 孕妇产前营养和应激与新生儿和儿童结局的关系对产前应激和 预测与学业成绩和心理健康相关的长期结果。我打算用这一知识来指导 关于对数百万贫困妇女进行产前和产后干预的公共卫生决定 在国内和全球，并制定未来的干预措施，以支持在资源匮乏的环境中的儿童发展。

PROJECT SUMMARY/ABSTRACT Maternal prenatal stress and nutrition influences fetal growth and long-term child outcomes. Maternal psychological stress and undernutrition frequently co-occur and affect overlapping biological stress axes involved in fetal growth and neuroendocrine development. Still, little is known about the interactive effects of maternal prenatal stress and nutrition on fetal and long-term child outcomes. The proposed K99/R00 research will leverage data from the ongoing “Enhancing Nutrition and Antenatal Infection Treatment for Maternal and Child Health” (ENAT) trial in rural Ethiopia to examine interactive effects of maternal prenatal stress and nutrition intervention on fetal and child outcomes. ENAT randomized 2390 pregnant women to receive an “enhanced nutrition” package or “standard care” and collected data on maternal prenatal stress (Cohen's Perceived Stress Scale) throughout pregnancy. Existing ENAT data will be used to determine independent and interactive effects of maternal prenatal stress and nutrition intervention on birthweight-for-age (Aim 1, K99). During the R00 I will conduct a new follow up study with ENAT mother-child dyads at 36 months postpartum to assess children's stress-sensitive outcomes (Aim 2, R00). Specifically, the developmental follow-up study will assess child outcomes related to attention, stress reactivity, memory, and socio-emotional functioning. I will also use biospecimens from ENAT to examine whether maternal and newborn telomere lengths can serve as biomarkers of in- utero programming of BWAZ and child outcomes in relation to maternal prenatal stress and nutrition (Aim 3, R00). I hypothesize that maternal prenatal stress and nutrition intervention will have main and interactive effects on newborn and childhood outcomes. I also hypothesize that maternal and newborn telomere length will serve as biomarkers for prenatal programing effects of maternal stress and nutrition. My long-term career goal is to lead independent multi-disciplinary research delineating the complex ways in which biological and psychosocial factors influence fetal and child development in low resource environments. This award would allow me to acquire basic science knowledge of maternal-fetal nutrition and telomere biology, technical skills in advanced neurodevelopmental assessments including eye-tracking and electrocardiography, and practical skills in primary data collection and research management in a low-income country. During the R00 I will independently lead an innovative child development research study in rural Ethiopia. The proposed research aligns with NICHD's goal to improve pregnancy outcomes to maximize the lifelong health of women and children and to help all children thrive. The proposed study will generate epidemiologic and biologic evidence linking maternal prenatal nutrition and stress with newborn and childhood outcomes that are sensitive to prenatal stress and predict long-term outcomes related to school achievement and mental health. I intend to use this knowledge to guide public health decisions regarding pre- and postnatal intervention for the millions of women living in poverty both domestically and globally and to develop future intervention to support child development in low resource settings.