Chair(s):
- Dr. Elysia Davis – University of Denver, Denver, USA
- Dr. Laura Glynn – Chapman University, Orange, USA
Symposium Presenters
- Elysia Poggi Davis, University of Denver, USA
- Kimberly D’Anna-Hernandez, Marquette University
- Mariann Howland, Institute of Child Development, University of Minnesota
- Laura Glynn, Chapman University
Full Description of the Symposium
This symposium presents a series of studies leveraging the power of experimental rodent work and human randomized clinical trials to develop efficacious large-scale screening and intervention programs to benefit maternal-child health and address needs of marginalized populations. The first presentation, by Dr. Davis, tests the benefits of reducing maternal prenatal depression on both maternal and child outcomes including preterm birth and brain development applying a randomized clinical trial (RCT) design and then presents work leveraging these findings to implement a universal community informed prevention program. The second presentation, by Dr. D’Anna-Hernandez, addresses the effect of racism and discrimination within obstetric care on maternal anxiety and depression and then applies a cross-species approach to explore underlying biological mechanisms. The third presentation, by Howland, explores prenatal psychosis and mania, which are understudied and underdiagnosed in perinatal populations, and evaluates underlying biological mechanisms and plausible tools for screening as well as links to parenting behaviors and child development. The final talk, by Dr. Glynn, presents implementation of a novel screening tool based on experimental rodent work identifying biological pathways by which unpredictability gets under the skin. This presentation then discusses applications of this research to develop screening tools developed with input from parents and community stakeholders to address unpredictability in children’s early environment. Together the talks in this symposium address critical issues in maternal-child health applying cross-species research to better understand causality and mechanisms and to develop prevention and intervention programs to serve the needs of marginalized communities.
Abstract for Presentation 1
THE INTERGENERATIONAL BENEFITS OF REDUCING PRENATAL MATERNAL DEPRESSION: A RANDOMIZED CLINICAL TRIAL
Elysia Poggi Davis1, Catherine H. Demers2, Robert J. Gallop3, Nancy K. Grote4, M. Camille Hoffman2 & Benjamin L. Hankin5
1University of Denver, 2University of Colorado, 3Westchester University, 4University of Washington, 5University of Illinois, Urbana Champaign
Depression is one of the most common perinatal complications with far-reaching implications for both mother and offspring. Despite this clear public health problem, there is a dearth of evidence based efficacious prenatal interventions designed to reach underserved populations. The Care Project implements a randomized clinical trial (RCT) to test a culturally sensitive psychotherapy intervention (brief interpersonal therapy) (MomCare) developed to address many of the barriers to care experienced by pregnant individuals and to benefit maternal and child health. This RCT included 234 pregnant participants [119 enhanced usual care (EUC) and 115 active treatment, (MomCare)]. Depression diagnosis (MDD, SCID-5) and symptoms (Symptom Checklist; SCL-20) were evaluated at baseline and longitudinally throughout gestation to characterize depression trajectories. Gestational dating was assessed to characterize birth outcomes, and magnetic resonance imaging (MRI) was performed with newborns to characterize brain development. Individuals receiving the MomCare intervention showed a significantly steeper decrease in depression symptoms over pregnancy relative to the EUC groups (medium effect size D=0.50, 95%CI 0.16-0.84). Notably, reduced prenatal depression trajectories resulting from the MomCare intervention led to longer gestational length, specifically more babies born full term, and alterations in hippocampal volume. Findings from this RCT reveal that providing effective mental health support not only reduces prenatal depression, but also exerts intergenerational benefits for offspring including increasing full term births and benefiting brain maturation. Building on this evidence we developed and implemented universal perinatal depression prevention at a community hospital in Denver. This community informed program, La Luz, is designed to increase accessibility to marginalized populations. La Luz, is integrated into obstetric care and offered virtually and in person in both English and Spanish. To date, 298 pregnant individuals have enrolled illustrating feasibility of implementation of this program. Implementation of efficacious accessible psychosocial intervention can yield intergenerational benefits.
Funding: This research was supported by the NIH (R01 HL155744, R01 MH109662, R21 MH124026, P50 MH096889).
Abstract for Presentation 2
FROM MOTHERS TO MICE: THE ROLE OF OBSTETRIC RACISM AND AROUSAL-RELATED NEUROPEPTIDES IN POSTPARTUM MENTAL HEALTH DISPARITIES
Kimberly D’Anna-Hernandez, Marquette University
Maternal depression and anxiety are debilitating disorders associated with long-term consequences for mother/child dyad. Rates of maternal depression and anxiety are 2-5 times higher in racial/ethnic minority populations, including in Latinx and Black populations. Since race itself is a social construct with no biological disease risk, research has turned to racism and discrimination to understand disparities in perinatal mental health. In addition, racism in the medical field has a long history, contributing to unfounded race corrections in obstetric procedures (i.e., VBAC) and the incorrect belief that pain tolerance differs by skin color. Thus, it is important to address if obstetric racism is associated with perinatal mental disparities that last into the postnatal period and the potential mechanism by which this occurs. Both Latinx (n=50) and Black (n=200) postpartum women were surveyed on measures of discrimination and obstetric racism (satisfaction with, mistreatment by and respect by providers and general healthcare discrimination) along with postpartum depression, anxiety and stress symptoms. Women who reported less satisfaction with perinatal medical providers, also reported more healthcare discrimination (r=-0.580, p<0.001) and less respect by providers (r=0.786, p<0.001). Similarly, more healthcare discrimination was associated with more maternal depressive symptoms (r=0.403, p=0.011), perceived stress (r-0.435, p=0.006), and less social support (-0.363, p=0.023). Lastly, more maternal anxiety symptoms were associated with more medical mistrust (r=-0.390, p=0.016) and less respect by prenatal providers (r=-0.426, p=0.007). The biological mechanism of the experience of obstetric racism is unknown, however, the experience of discriminatory and racist actions is associated with increased behavioral vigilance and arousal, the mechanism of which is challenging to measure in humans. Our lab has performed studies on arousal and vigilance related neuropeptides (i.e. hypocretin; HCRT) in mouse models of maternal behavior and found that lactating dams with both high and low levels of HCRT are less likely to defend their offspring, lick and groom pups and retrieve them in an unfamiliar environment, all behaviors associated with depressive-like symptoms. Together this data suggests that experiences of obstetric racism during pregnancy may pose a unique risk for perinatal mental health disparities and cross-disciplinary work can help understand how racism “gets under the skin” to affect perinatal mental health with consequences for mother/child dyads.
Abstract for Presentation 3
A DIMENSIONAL APPROACH TO PERINATAL MANIA AND PSYCHOSIS: IMPLICATIONS FOR PREVENTION AND INTERVENTION
Mariann A. Howland & Hannah Klimas, Institute of Child Development, University of Minnesota
Clear and compelling evidence links childbirth with heightened risk for mania and psychosis. Research is limited to perinatal women with categorical diagnoses, despite consensus that symptoms of mania and psychosis are fully continuous in the general population. As with perinatal depression and anxiety, subthreshold symptoms of perinatal mania and psychosis are likely to be empirically and clinically meaningful. Further, these symptoms are often missed with current screening methods. This prospective, longitudinal study examined the prevalence, course, and correlates of dimensionally-assessed symptoms of mania and psychosis in a general sample of 168 individuals giving birth for the first time. Across 4 timepoints from late pregnancy through 2 months postpartum, symptoms were measured with validated questionnaires. At 2 months postpartum, mother-infant interaction and infant development were characterized with standardized observational protocols. Dried blood spot cytokine and hair cortisol levels were determined at 3 timepoints. As hypothesized, mania and psychosis showed dimensionality and significant longitudinal change. Manic symptoms peaked in the immediate postpartum, while symptoms of psychosis declined from late pregnancy to 2 months postpartum. In support of the second hypothesis, higher scores on a mania/psychosis composite were uniquely associated with less optimal maternal behavior, even after accounting for depression/anxiety and other key covariates. Symptoms of maternal mania/psychosis also were associated with lower infant cognitive development. Perinatal maternal hormonal and immune markers were unrelated to symptom dimensions. Findings suggest that subclinical symptoms of mania and psychosis are a critical yet currently underdetected feature of perinatal mental health that impacts parenting behaviors and child cognitive development and is in need of further investigation.
Abstract for Presentation 4
BENCH TO BEDSIDE: THE TRANSLATIONAL POTENTIAL OF EARLY LIFE UNPREDICTABILITY TO ENHANCE CHILD MENTAL HEALTH
Laura M Glynn1, Sabrina R Liu2, Hal S Stern3, Charles V Golden4, Michael A Wiess4, Candice Taylor Lucas3, Louis Ehwerhemuepha4 & Tallie Z Baram3
1Chapman University, 2California State University San Marcos, 3University of California, Irvine, 4Children’s Hospital of Orange County
Growing evidence supports exposure to unpredictability as a novel from of early life adversity affecting mental and physical health across the lifespan. The importance of this dimension of early experience is further underscored by a robust non-human animal model enabling causal testing of neurobiological mechanisms. Taken together, the evidence from both human and preclinical animal models provides strong impetus to begin to address unpredictability in the lives of children. Here we describe a first attempt to implement screening for unpredictability in pediatric primary care with a brief version of the Questionnaire of Unpredictability in Childhood (QUIC-5). Guided by input from key community stakeholders (parents, allied health care professionals and pediatricians), we implemented screening in 19 clinics affiliated with the Children’s Hospital of Orange County and have now administered the QUIC to more than 50,000 child-caregiver dyads. Binary logistic regressions were used to determine whether QUIC scores predict mental health diagnoses abstracted from medical records. Preliminary results indicate that exposure to more unpredictability assessed both by caregiver and by child self-report associates with increased risk of child anxiety, depression, ADHD, suicide/self-injury, externalizing disorders, substance use, and sleep disorders. The associations were patterned in a cumulative manner, such that each increasing score associated with a higher odds ratio. These promising findings indicate that screening for unpredictability in primary care is feasible, acceptable and provides actionable information about child psychopathology. Next steps include providing evidence to support targeted interventions aimed at increasing predictability in the early environment to enhance child health and development.