Defining postpartum PTSD and its implications for maternal wellness and child development

项目总结。产妇分娩后的精神疾病与巨大的社会成本有关。 产后精神病理学是导致产妇发病率和死亡率的主要因素，并可能危及 孩子从出生起的幸福。在新生儿早期被剥夺母亲照顾可能会导致 模型动物的长期表观遗传学改变，表明产后精神疾病可以提供 代际风险。虽然存在减少产后抑郁症的努力，但与分娩相关的创伤后 据估计，每年有24万美国女性患有应激障碍(CB-PTSD)。 诊断不足，治疗不足。CB-PTSD的危险因素仍然难以捉摸，而且关于 障碍的进程和对儿童的影响几乎完全缺乏。通过产生重要和实质性的 数据，这项建议的中心目标是作为解决临床差距的第一步 应该能够接受早期干预的状况。 在这类第一个纵向前瞻性研究中，我们将研究妊娠晚期妇女(wk. 32)，在分娩后的几个小时内再次出现，并将在产后重复的时间点跟随它们(PP) 年份，即第1天、第45天和月。3、6和12岁。他们的婴儿将在墨尔本大学接受研究。6和莫氏。12点。这 时间表将允许我们检查CB-PTSD的风险和发展，以及它对母亲的影响。 婴儿结合和儿童早期发展。母亲的慢性精神创伤后应激障碍将使用心理诊断方法进行量化， 心理测量学和心理生理学测量。心理表象过程中的心理生理反应 创伤分娩为创伤后应激障碍提供了一个潜在可靠的生物学标记物，并可提供客观的验证 关于CB-PTSD的诊断。结合将通过对母亲感知的心理测量评估来量化 以及6个月时母子互动的观察性评估。PP.孩子们的结果将被量化 在12个月时使用标准化的儿童发育观察程序和标准化的心理测量学。 这项研究将为以前对产后创伤后维度的研究提供新的见解 精神变态学。我们的工作可能会对产后心理保健提出修改建议，目前 聚焦于抑郁症。我们的发现可能会为可用于早期筛查的工具提供参考，这可能是第一次 采取步骤实施可增进母亲和儿童福利的方案，从而降低 发展出一种潜在的可预防的、代价高昂的创伤后精神障碍。此外，拟议的研究还将进一步 NICHD的使命是“妇女避免生殖过程和儿童带来的有害影响” 健康和富有成效的生活“。

PROJECT SUMMARY. Maternal mental illness following childbirth is associated with substantial societal costs. Postpartum psychopathology is a leading contributor of maternal morbidity and mortality and can endanger the child’s wellbeing onward from birth. Deprivation of maternal care during the early neonatal period can induce long-term epigenetic alterations in a model animal, suggesting that postpartum mental illness can confer intergenerational risks. While efforts exist to reduce postpartum depression, childbirth-related posttraumatic stress disorder (CB-PTSD), a condition that is estimated to affect 240,000 American women each year, is underdiagnosed and undertreated. Risk factors for CB-PTSD remain elusive, and knowledge about the disorder’s course and impact on the child is almost entirely lacking. By generating important and substantive data, the central objective of this proposal is to serve as a first step towards addressing the clinical gap for a condition that should be amenable to early intervention. In this first of its kind longitudinal prospective study, we will study pregnant women during third trimester (Wk. 32), again in the hours following delivery and will follow them at repeated time points across the postpartum (PP) year, i.e., Day 1, Day 45, and Mos. 3, 6, and 12. Their infants will be studied at Mo. 6 and Mo. 12 PP. This schedule will allow us to examine risk for, and development of, CB-PTSD, as well as its influence on mother- infant bonding and early child development. Maternal CB-PTSD will be quantified using psychodiagnostic, psychometric, and psychophysiologic measures. Psychophysiological responsivity during mental imagery of the traumatic childbirth provides a potentially reliable biological marker of PTSD and can provide objective validation of the CB-PTSD diagnosis. Bonding will be quantified using psychometric assessments of maternal perceptions and an observational assessment of mother-child interaction at 6 mos. PP. Child outcomes will be quantified using a standardized child developmental observational procedure and standardized psychometrics at 12 mos. This study will offer new insights into the previously understudied posttraumatic dimension of postpartum psychopathology. Our work could suggest modifications of postpartum mental health care, which currently focuses on depression. Our findings may inform tools that can be used for early screening that may be the first step in implementing programs that can enhance the welfare of mother and child, thereby reducing the odds of developing a potentially preventable, costly posttraumatic disorder. In addition, the proposed study will further the NICHD missions that “women avoid harmful effects from reproductive processes and children achieve healthy and productive lives”.