The influence of maternal childhood maltreatment on the neural and endocrinological determinants of maternal caregiving

儿童虐待（CM）是一种有害的压力源，普遍存在，对暴露个体造成毁灭性的短期和长期健康后果。越来越多的证据表明，暴露于CM的后果不仅限于暴露者，还可能传染给下一代。接触cm的母亲的子女患精神和身体健康障碍的风险增加。暴露于cm的母亲的后代在婴儿期和儿童期经历的不利环境，包括不理想的母亲照顾，被认为是代际传播的主要途径。暴露于CM的母亲有更高的养育问题风险，这构成了后代不良心理和身体健康发展的一个公认的风险因素。考虑到敏感的养育方式，母亲必须能够理解孩子的暗示并做出适当的反应。同理心（分享他人的感受）和心理理论（ToM，他人心理状态的表征）因此被认为是敏感育儿的主要决定因素。与怀孕有关的内分泌变化塑造了这些育儿行为。在这种情况下，特别令人感兴趣的是雌激素。雌激素影响母体大脑中与妊娠相关的神经变化，从而促进敏感的育儿。动物模型表明，早期生活压力会降低雌激素敏感性。如果人类也是如此，那么暴露于cm的女性雌激素敏感性较低，我们将在当前的研究中验证这一假设，cm相关的雌激素敏感性降低可能会抑制为母亲做准备的移情和ToM的适应性围产期变化。为了研究CM相关的妊娠生理差异，这些差异可能会驱动共情和汤姆的适应性神经变化，从而对母亲的敏感性产生影响，本项目提出以下问题：1)CM的严重程度是否在行为和神经层面与共情和汤姆相关，这种关联是否在CM和敏感育儿之间起到中介作用？2)妊娠期CM相关的雌激素敏感性变异是否介导CM与共情和ToM（行为和神经水平）之间的关联，进而影响育儿行为？3)我们能否确定内分泌和神经模式或临床特征，预测cm暴露母亲对不敏感父母的脆弱性和复原力？在这个项目中，我们力求促进对接触CM的妇女及其后代的公共保健。通过识别CM暴露的母亲在不敏感的养育过程中的复原力和脆弱性因素，我们将有助于制定未来的干预和预防计划，以帮助有养育问题风险的妇女抵消CM经历对其养育行为的负面影响。

Childhood maltreatment (CM) represents a pernicious stressor with widespread prevalence and devastating short- and long-term health consequences for the exposed individual. Growing evidence suggests that the consequences of exposure to CM are not restricted to the exposed person alone but may also get transmitted to the next generation. Children of CM-exposed mothers are at increased risk for mental and physical health disorders. Unfavorable circumstances experienced during infancy and childhood by the offspring of CM-exposed mothers, including suboptimal maternal caregiving, have been postulated as the primary pathways of intergenerational transmission. Mothers exposed to CM carry a higher risk for parenting problems, which constitute a well-established risk factor for adverse mental and physical health development in the offspring. To allow for sensitive parenting, mothers must be able to understand their children’s cues and to react appropriately. Empathy (the sharing of others’ feelings) and theory of mind (ToM, the representation of others’ mental states) have therefore been discussed as major determinants of sensitive parenting. Pregnancy-related endocrine changes shape these parenting behaviors. Of particular interest in this context is estrogen. Estrogen influences the pregnancy-related neural changes in the maternal brain that facilitate sensitive parenting. Animal models suggest that early life stress can reduce estrogen sensitivity. If the same is true in humans and CM-exposed women have lower estrogen sensitivity, a hypothesis we will test in the current study, the CM-associated reduced estrogen sensitivity may inhibit adaptive peripartal changes in empathy and ToM that prepare for motherhood. To characterize CM-related differences in pregnancy physiology that may drive adaptive neural changes underlying empathy and ToM with consequences for maternal sensitivity, we ask the following questions in the present project: 1) Is the severity of CM associated with empathy and ToM at the behavioral and neural level, and does this association mediate the relationship between CM and sensitive parenting? 2) Does CM-associated variation in estrogen sensitivity during pregnancy mediate the association between CM and empathy and ToM (behavioral and neural level) and, consequently, parenting behavior? 3) Can we identify endocrine and neural patterns or clinical profiles predicting vulnerability versus resilience towards insensitive parenting among CM-exposed mothers? In this project, we seek to promote public health care for women exposed to CM and their offspring. By identifying resilience and vulnerability factors of insensitive parenting in CM-exposed mothers, we will contribute to shaping future interventions and prevention programs to help women at risk of parenting problems to counteract the negative effect of their CM experiences on their own parenting behavior.