4/5 The Cumulative Risk of Substance Exposure and Early Life Adversity on Child Health Development and Outcomes

项目摘要/摘要 除了新冠肺炎带来的严重健康威胁外，这场全球大流行还戏剧性地 增加了许多人的心理痛苦。对于那些特别容易受到伤害的人 在与压力相关的疾病方面，新冠肺炎代表着一个前所未有的挑战。个人直接 和间接受病毒影响的人被迫经历一系列困难，包括社会 与世隔绝，经济不安全，以及对自己和亲人的健康和安全的不确定性。高 在心理脆弱群体名单上的是孕妇。心理上的困扰可能是 围绕新冠肺炎S垂直传播的不确定性和潜在的 母体窘迫对胎儿大脑发育的影响 许多研究报告称，孕期母亲的压力与 儿童发育受阻。母体心理应激源对胎儿和婴儿的影响 发育已经在多个层面上得到证实，包括胎儿大脑成熟障碍， MiRNA表达和DNA甲基化的改变，以及发育改变的风险增加 结果和神经精神障碍(Babenko，2015；Bick&Nelson，2016；Hackman等人，2010； Nelson，2020；Lupien等人，2019；McEwen，2012,2017；Vanderberg等人，2017；LaPlante等人，2015； Wu等人，2020)。先前的研究支持那些经历过细菌或病毒感染的母亲 怀孕期间感染和压力升高更有可能让青春期的孩子确诊 患有抑郁症(Murphy等人，2017年)。同样，2001年接触过产前感染的儿童 H1N1病毒表现出轻微的发育延迟(Borren等人，2018年)。 对于确定新冠肺炎接触和相关产前应激对婴儿的影响程度至关重要 发展，以便提供适当的治疗和干预措施。 在波士顿儿童医院，我们处于独特的地位，可以在现有资金的基础上继续发展(R34 (DA050289)对新冠肺炎阳性妇女所生婴儿进行研究。在我们位于波士顿的协作型 集团，我们估计在接下来的6个月里，我们应该能够招募75名孕妇，限制 我们只去了一家哈佛附属医院--布里格姆妇女医院(BWH)。我们的计划是 在分娩前对这些妇女进行一些问卷调查。在出生时，我们将与 妇产科团队决定就寻求同意对其母亲进行核磁共振检查的事宜与哪些母亲接触 新生儿，以及两次对波士顿儿童医院PI实验室的后续访问。

Project Summary/Abstract Beyond the grave health threats posed by COVID-19, this world-wide pandemic has also dramatically increased psychological distress among much of the population. For those particularly vulnerable to stress-related disorders, COVID-19 represents an unprecedented challenge. Individuals both directly and indirectly affected by the virus are forced to navigate through a range of hardships, including social isolation, financial insecurity, and uncertainty about the health and safety of self and loved ones. High on the list of psychologically vulnerable groups are pregnant women. Psychological distress may be compounded both by the uncertainty surrounding COVID-19's vertical transmission and by the potential effects of maternal distress on fetal brain development. Numerous studies have reported strong associations between maternal stress during pregnancy and disruptions in child development. The effects of maternal psychological stressors on fetal and infant development have been demonstrated across multiple levels, including disrupted fetal brain maturation, alterations in miRNA expression and DNA methylation, and increased risks for altered developmental outcomes and neuropsychiatric disorders (Babenko, 2015; Bick & Nelson, 2016; Hackman et al., 2010; Nelson, 2020; Lupien et al., 2019; McEwen, 2012, 2017; Vanderberg et al., 2017; Laplante et al., 2015; Wu et al., 2020). Previous work supports that mothers who experienced either a bacterial or viral infection and elevated stress during pregnancy were more likely to have an adolescent child diagnosed with depression (Murphy et al., 2017). Similarly, children exposed to a prenatal infection of the 2001 H1N1 virus displayed slightly delayed development (Borren et al, 2018).With these findings in mind, it is critical to determine the extent to which a COVID-19 exposure and related prenatal stress affects infant development in order to provide appropriate treatment and interventions. At Boston Children's Hospital, we are in the unique position to build on our current funding (R34 DA050289) to study infants born to COVID-19-positive women. Among our Boston-based collaborative group, we estimate that over the next 6 months we should be able to enroll 75 pregnant women, limiting ourselves to just one Harvard-affiliated hospital, Brigham and Women's Hospital (BWH). Our plan is to administer a number of questionnaires to these women prior to giving birth. At birth, we will work with the OB team to decide which mothers to approach about seeking consent to perform an MRI on their newborns, as well as 2 follow up visits to the PI's lab at Boston Children's Hospital.