Perinatal Testosterone in Infant Health, Mother-Infant Interaction and Developmen

描述（由申请人提供）：早产率和婴儿死亡率从1990年到2006年持续上升，高于其他29个国家。毫不奇怪，极低出生体重（VLBW，出生体重小于1500克）早产儿有更多的健康和发育问题，这些问题在男性VLBW早产儿中更常见。男性极低出生体重早产儿也经历较少的积极母婴互动，这是有问题的，因为积极的母婴互动作为一个重要的保护因素，以改善与早产相关的负面健康和发育结果。这些协会提出了重要的问题：“除了性别社会化之外，还有什么因素可以解释男性VLWB早产儿对健康问题，次优母婴互动和婴儿发育不良的脆弱性？这些因素是否源于生物学？“基于公认的男性大脑发育和社会关系脆弱性的性别差异理论，本研究假设围产期睾酮通过对婴儿认知/运动发育产生负面影响来影响婴儿健康和母婴互动。该项目的目的是探讨围产期睾酮与以下因素之间的潜在关系：（1）婴儿健康，（2）母婴互动，以及（3）基于生物学（围产期睾酮）-压力（围产期和母体皮质醇）-发育（婴儿认知/运动技能）关联的婴儿发育。如果这些生物学和发育的关系，在母亲VLBW早产儿对建立，拟议的研究结果可能会突出的重要性，护理干预措施，旨在减少压力VLBW早产儿，特别是男性的母亲。 本研究的具体目的是确定围产期睾酮水平与以下因素之间的关系：（1）婴儿健康，通过出生体重、胎龄、Apgar评分、健康问题的存在和体重增加来衡量（目标1），（2）控制婴儿特征后的母婴互动（性别和族裔）和母亲（年龄，种族，教育和婚姻状况），以及婴儿气质和母亲抑郁症状（目标2），和（3）婴儿认知/运动发育后，控制母婴互动（目标3）。唾液和血浆睾酮和皮质醇水平测量的母亲VLBW早产儿对的生物学意义进行了讨论，解释，并应用于预测婴儿的发展之间的PI，儿科医生，儿科内分泌学家和儿科发育心理学家的协作方式。该R21的数据将在未来的R 01干预研究中进行进一步研究。在未来的努力中，我们计划衡量减轻压力护理干预的有效性。 公共卫生相关性：拟议的研究旨在检验产前睾酮水平是影响以下方面的重要生物学因素的假设：（1）婴儿健康，（2）母婴互动，和（3）婴儿认知/运动发育。一旦建立了母亲和极低出生体重（VLBW）早产儿对的这些生物学和发育关系，研究结果可能会突出旨在减轻VLBW早产儿母亲（尤其是男性）压力的护理干预的重要性。

DESCRIPTION (provided by applicant): The rates of preterm birth and infant mortality have been increasing continuously from 1990 to 2006 and are higher than 29 other countries. Not surprisingly, very-low-birthweight (VLBW, birthweights less than 1500 grams) preterm infants have more health and developmental problems and these problems are more common in male VLBW preterm infants. Male VLBW preterm infants also experience less positive mother-infant interaction, which is problematic because positive mother-infant interactions function as an important protective factor to ameliorate negative health and developmental outcomes associated with prematurity. These associations raise important questions: "What factors beyond gender socialization explain the vulnerability of male VLWB preterm infants to health problems, sub-optimal mother-infant interactions, and poor infant development? Are these factors biological in origin?" Based on well-accepted theories of gender differences with male vulnerability in brain development and social relationships, this study hypothesizes that perinatal testosterone influences infant health and mother- infant interactions by negatively affecting infant cognitive/motor development. The purpose of the proposed project is to explore the potential relationships between perinatal testosterone and; (1) infant health, (2) mother-infant interactions, and (3) infant development based on biological (perinatal testosterone) - stress (perinatal and maternal cortisol) - development (infant cognitive/motor skills) association. If these biological and developmental relationships in mother-VLBW preterm pairs are established, the outcome of the proposed study may highlight the importance of nursing interventions designed to reduce stress among mothers of VLBW preterm infant, especially males. The specific aims of the present study are to determine the relationships between perinatal testosterone levels and: (1) infant health as measured by birthweight, gestational age, Apgar score, presence of health problems, and weight gain (Aim 1), (2) mother-infant interactions after controlling for characteristics of infant (gender and ethnicity) and mother (age, ethnicity, education, and marital status), as well as infant temperament and maternal depressive symptoms (Aim 2), and (3) infant cognitive/motor development after controlling for mother-infant interactions (Aim 3). Biological significance of saliva and plasma testosterone and cortisol levels measured in mother-VLBW preterm infant pairs will be discussed, interpreted, and applied to predict infant development in a collaborative manner amongst the PI, a neonatologist, a pediatric endocrinologist, and a pediatric developmental psychologist. The data from this R21 will lead to further investigations in a future R01 in intervention study. In this all-out effort in the future, we plan to measure the effectiveness of stress-reducing nursing intervention. PUBLIC HEALTH RELEVANCE: The proposed studies are designed to test the hypothesis that prenatal testosterone level is an important biological factor that influence; (1) infant health, (2) mother-infant interactions, and (3) infant cognitive/motor development. Once these biological and developmental relationships in mother and very-low birthweight (VLBW) preterm infant pairs are established, the outcomes of the study may highlight the importance of nursing interventions designed to reduce stress among mothers of VLBW preterm infants, especially males.