The Iowa Flood Study: Perinatal Effects of a Natural Disaster

爱荷华州洪水研究：自然灾害对围产期的影响

• 批准号: 7862340
• 负责人: MICHAEL William O'HARA
• 金额: $ 14.77万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-08 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7862340
• 关键词: 11-beta-Hydroxysteroid Dehydrogenases; Adrenal Glands; Adult; Affect; Animals; Anxiety; Autistic Disorder; Behavioral; Biological; Biological Assay; Biological Factors; Biological Markers; Biological Process; Birth; Blood; Blood flow; Blood specimen; Brain; Breast Feeding; Catecholamines; Characteristics; Child; Childhood; Cognitive; Collaborations; Complex; Complication; Corticotropin-Releasing Hormone; Corticotropin-Releasing Hormone Receptors; Data; Data Collection; Data Set; Development; Disasters; Discipline of obstetrics; Distress; Elements; Emotional; Event; Exposure to; Female; Fetal Growth Retardation; Fetus; Figs - dietary; Floods; Funding; Future; Gases; Genes; Genetic Predisposition to Disease; Gestational Age; Glucocorticoids; Glucose; Glucose Transporter; Goals; Grant; Growth; Healed; Human; Hydrocortisone; Hypothalamic structure; Immune system; Infant; Infant Behavior; Infant Development; Infant Health; Inflammatory; Intervention; Iowa; Link; Low Birth Weight Infant; Maternal Exposure; Maternal Health; Mediating; Mental Depression; Mental Health; Mental disorders; Midwestern United States; Modeling; Moods; Morphology; Mothers; Motor; Natural Disasters; Nature; Neurosecretory Systems; Newborn Infant; Nutrient; Outcome; Oxidative Stress; Pain; Perinatal; Pituitary Gland; Placenta; Placental Lactogen; Positioning Attribute; Post-Traumatic Stress Disorders; Postpartum Depression; Postpartum Period; Postpartum Women; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Process; Production; Prospective Studies; Protocols documentation; Psychosocial Factor; Public Health; Randomized; Reaction; Recording of previous events; Relative (related person); Research; Retrospective Studies; Risk; Salivary; Sampling; Schizophrenia; Social support; Socioeconomic Status; Stress; Students; Symptoms; System; Temperament; Testing; Time; TimeLine; Trauma; Umbilical Cord Blood; Umbilical cord structure; Weight; Woman; Work; biological adaptation to stress; biopsychosocial; coping; cytokine; demographics; experience; fetal; fetal blood; healing; human HGH-V protein; hypothalamic-pituitary-adrenal axis; immune function; indexing; infant outcome; male; maternal stress; offspring; oxygen transport; pregnant; prenatal; prenatal stress; protective effect; psychologic; psychosocial; public health relevance; response; sex; social; stressor; unborn child

DESCRIPTION (provided by applicant): Animal studies show that prenatal maternal stress (PNMS) results in maternal glucocorticoids passing the placental barrier and disrupting fetal brain development, particularly the hypothalamic-pituitary-adrenal axis. This in turn influences pregnancy outcomes and offspring development. To date, however, there have been no prospective studies of pregnant women exposed to a sudden-onset natural disaster that have been able to elucidate the biopsychosocial mechanisms responsible for the wide variety of consequences of prenatal stress seen in human and animal offspring. As such, the goal of this project is to increase our understanding of the mechanisms responsible for the effects of maternal exposure to varying levels of hardship, and the pregnant women's subjective reactions to these hardships, imposed by a severe, independent stressor: the U.S. Midwest floods of June 2008. We will determine the extent to which the effects of various components of disaster on the mother, the pregnancy and infant may be moderated by biological, psychological, and social factors on a sample of approximately 420 women who had either given birth shortly before the flooding, or who were pregnant during the flooding, or who became pregnant within 3 months after the flooding. An important element of this study is that pre-flood data are available on the psychological functioning, coping, and social support in 135 pregnant and postpartum women. Here, we propose to augment this on-going study with a new protocol involving two timelines. One data collection timeline will be linked to the flooding, and will assess symptoms of post-traumatic stress disorder (PTSD) and coping, and collect diurnal salivary cortisol, at recruitment, 6- and 12-months post-flood. A second timeline is linked to the pregnancy and involves data collection at recruitment, at 30-32 weeks gestation, delivery, and 6-months postpartum; these will assess maternal mood, biomarkers from maternal blood, and infant behavior over time. We predict that higher levels of PNMS will be associated with poorer maternal health outcomes (PTSD, postpartum depression). We also predict that higher levels of PNMS and higher pregnancy cortisol levels will be associated with more obstetric and newborn complications, poorer infant health, poorer neuromotor maturity at birth, blunted reactive cortisol levels, as well as more difficult temperament. We believe that placental functioning will be a central mechanism for these effects: prenatal stress will be associated with altered placental functioning which will be associated with poorer perinatal and infant outcomes. This RAPID grant will enable us to collect (and to a limited extent analyze) the most comprehensive data set ever obtained for studying the effects of an independent stressor on PTSD, postpartum depression, pregnancy outcomes and infant development. By obtaining a multitude of maternal and infant biomarkers and by evaluating the functioning of the placenta, we will be in a position to test a comprehensive biopsychosocial model of prenatal maternal stress. The results of this collaboration should point us towards interventions that will effectively limit the damage to mother and fetus when disasters occur. PUBLIC HEALTH RELEVANCE: The proposed research has significant relevance to public health because it will allow a more clear delineation of the effects of a significant independent stressor (flooding) on the course and outcome of pregnancy. This work will have implications for our understanding of biopsychosocial nature of the effects of stress on maternal mental health and infant health.

描述（由申请人提供）：动物研究表明，产前母体应激（PNMS）导致母体糖皮质激素通过胎盘屏障，破坏胎儿大脑发育，特别是下丘脑-垂体-肾上腺轴。这反过来又影响妊娠结局和后代发育。然而，到目前为止，还没有关于暴露于突发性自然灾害的孕妇的前瞻性研究能够阐明导致人类和动物后代产前压力的各种后果的生物心理社会机制。因此，这个项目的目标是增加我们对母亲暴露于不同程度的困难的影响的机制的理解，以及孕妇对这些困难的主观反应，这些困难是由一个严重的，独立的压力源施加的：2008年6月美国中西部的洪水。我们将确定灾害对母亲、怀孕和婴儿的各种影响在多大程度上可能被生物、心理和社会因素所缓和。我们选取了大约420名妇女作为样本，这些妇女要么在洪水发生前不久分娩，要么在洪水发生期间怀孕，要么在洪水发生后3个月内怀孕。本研究的一个重要组成部分是对135名孕妇和产后妇女的心理功能、应对和社会支持进行了洪水前的数据分析。在这里，我们建议用一个涉及两个时间表的新方案来扩大这项正在进行的研究。一个数据收集时间表将与洪水联系起来，并将评估创伤后应激障碍（PTSD）和应对的症状，并在招募时、洪水后6个月和12个月收集每日唾液皮质醇。第二个时间表与妊娠有关，涉及招募时、妊娠30-32周、分娩时和产后6个月的数据收集；这些将评估母亲的情绪、母亲血液中的生物标志物和婴儿随时间的行为。我们预测，较高水平的PNMS将与较差的孕产妇健康结果（创伤后应激障碍，产后抑郁症）相关。我们还预测，较高的PNMS水平和较高的妊娠皮质醇水平将与更多的产科和新生儿并发症、较差的婴儿健康、较差的出生时神经运动成熟度、迟钝的反应性皮质醇水平以及更困难的气质有关。我们认为胎盘功能将是这些影响的中心机制：产前应激将与胎盘功能改变有关，而胎盘功能改变将与较差的围产期和婴儿结局有关。这项RAPID拨款将使我们能够收集（并在有限范围内分析）迄今为止获得的最全面的数据集，用于研究独立压力源对创伤后应激障碍、产后抑郁症、妊娠结局和婴儿发育的影响。通过获得大量的母体和婴儿生物标志物，并通过评估胎盘的功能，我们将能够测试产前母体压力的综合生物心理社会模型。这种合作的结果应该为我们指明在灾难发生时有效限制对母亲和胎儿损害的干预措施。

项目成果

Peritraumatic Distress Mediates the Effect of Severity of Disaster Exposure on Perinatal Depression: The Iowa Flood Study.

• DOI: 10.1002/jts.22056
• 发表时间: 2015-12
• 期刊: Journal of traumatic stress
• 影响因子: 3.3
• 作者: Brock RL;O'Hara MW;Hart KJ;McCabe-Beane JE;Williamson JA;Brunet A;Laplante DP;Yu C;King S
• 通讯作者: King S