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

项目概要/摘要 母亲产前压力和营养影响胎儿生长和长期儿童的结果。产妇心理应激 和营养不良经常同时发生，并影响与胎儿生长有关的重叠生物应激轴， 神经内分泌发育尽管如此，人们对母亲产前压力和营养的相互影响知之甚少， 胎儿和长期儿童结局。拟议的K99/R 00研究将利用正在进行的“增强 在埃塞俄比亚农村进行的”营养和生殖道感染治疗促进妇幼健康“试验， 母亲产前应激与营养干预对胎儿和儿童结局的交互作用ENAT随机化 2390名孕妇接受“强化营养”包或“标准护理”，并收集了关于孕产妇的数据。 科恩压力感知量表（Cohen's Perceived Stress Scale）现有的ENAT数据将用于确定 母亲产前压力和营养干预对出生体重的独立和交互作用（目的1， K99）。在R 00期间，我将在产后36个月时对ENAT母子配对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，R 00）。具体来说，发展后续研究将评估 与注意力、应激反应、记忆力和社会情感功能有关的儿童结果。我也会用 ENAT的生物标本，以检查母亲和新生儿端粒长度是否可以作为生物标志物， BWAZ的子宫规划以及与产妇产前压力和营养有关的儿童结果（目标3，R 00）。我 假设母亲产前压力和营养干预将对新生儿产生主要和交互作用， 童年的成果。我还假设母亲和新生儿端粒长度将作为产前诊断的生物标志物。 产妇压力和营养的影响。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 在低资源环境中。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，包括眼动追踪和 心电图，并在低收入国家的基本数据收集和研究管理的实用技能。 在R 00期间，我将在埃塞俄比亚农村独立领导一项创新的儿童发展研究。拟议 研究符合NICHD的目标，即改善妊娠结局，以最大限度地提高妇女的终身健康， 帮助所有儿童茁壮成长。这项研究将产生流行病学和生物学证据， 产妇产前营养和压力与新生儿和儿童的结果是敏感的产前压力， 预测与学业成绩和心理健康相关的长期结果。我打算用这些知识来指导 为数百万生活在贫困中的妇女提供产前和产后干预的公共卫生决定， 在国内和全球范围内，并制定未来的干预措施，以支持在低资源环境下的儿童发展。

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.