69 research outputs found
Stress during Pregnancy and Offspring Pediatric Disease: A National Cohort Study
No full textBackground: Identifying risk factors for adverse health outcomes in children is important. The intrauterine environment plays a pivotal role for health and disease across life. Objectives: To conduct a comprehensive study to determine whether common psychosocial stress during pregnancy is a risk factor of a wide spectrum of pediatric diseases in the offspring. Methods: The study was conducted in a population-based sample of mothers with live singleton births (N=66203, 71.4% of those eligible) from the Danish National Birth Cohort, using prospective data. We estimated the association between maternal stress during pregnancy (classified based on two a priori defined indicators of common stress forms, life stress and emotional stress) and offspring diseases during childhood (grouped into 16 categories of ICD-10 diagnoses based on data from national registries), controlling for maternal stress after pregnancy. Results: Median age at end of follow-up was 6.2 (3.6-8.9) years. Life stress (highest compared to lowest quartile) was associated with an increased risk of conditions originating in the perinatal period [odds ratio (OR)=1.13; 95% confidence interval (CI)=1.06-1.21] and congenital malformations (OR=1.17; CI=1.06-1.28), and of the first diagnosis of infection [hazard ratio (HR)=1.28; CI=1.17-1.39], mental disorders (age 0-2.5 years: HR=2.03; CI=1.32-3.14), eye (age 0-4.5 years: HR=1.27; CI=1.06-1.53), ear (HR=1.36; CI=1.23-1.51), respiratory (HR=1.27; CI=1.19-1.35), digestive (HR=1.23; CI=1.11-1.37), skin (HR=1.24; CI=1.09-1.43), musculoskeletal (HR=1.15; CI=1.01-1.30), and genitourinary diseases (HR=1.25; CI=1.08-1.45). Emotional stress was associated with an increased risk for the first diagnosis of infection (HR=1.09; CI=1.01-1.18) and a decreased risk for the first diagnosis of endocrine (HR=0.81; CI=0.67-0.99), eye (HR=0.84; CI=0.71-0.99), and circulatory diseases (age 0-3 years: HR=0.63; CI=0.42-0.95). Conclusions: Maternal life stress during pregnancy be a common risk factor for impaired child health. The results suggest new approaches to reduce childhood diseases
Effects of intrauterine exposure to synthetic glucocorticoids on fetal, newborn, and infant hypothalamic-pituitary-adrenal axis function in humans: a systematic review
No full textBACKGROUND: Synthetic glucocorticoids are commonly used in reproductive medicine. Fetal organ systems are highly sensitive to changes in the intrauterine environment, including overexposure to glucocorticoids. Structural and functional alterations resulting from such changes may persist throughout life and have been associated with diverse diseases. One system that could be particularly sensitive to fetal glucocorticoid overexposure is the hypothalamic-pituitary-adrenal (hpa) axis. Many human studies have investigated this possibility, but a systematic review to identify consistent, emergent findings is lacking. METHODS: We systematically review 49 human studies, assessing the effects of intrauterine exposure to synthetic glucocorticoids on fetal, neonate, and infant hpa function. RESULTS: Study quality varied considerably, but the main findings held true after restricting the analyses to higher-quality studies: intrauterine exposure to synthetic glucocorticoids reduces offspring hpa activity under unstimulated conditions after pain but not pharmacological challenge. Although reduced unstimulated hpa function appears to recover within the first 2 wk postpartum, blunted hpa reactivity to pain is likely to persist throughout the first 4 months of life. There is some evidence that the magnitude of the effects is correlated with the total amount of glucocorticoids administered and varies with the time interval between glucocorticoid exposure and hpa assessment. CONCLUSIONS: This systematic review has allowed the demonstration of the way in which intrauterine exposure to various regimens of synthetic glucocorticoids affects various forms of hpa function. As such, it guides future studies in terms of which variables need to be focused on in order to further strengthen the understanding of such therapy, whilst continuing to profit from its clinical benefits
Cortisol awakening response in infants during the first six postnatal months and its relation to birth outcome
No full textContext: The rise of cortisol concentrations after awakening is well documented in adults and children and commonly used as easily accessible marker of hypothalamic-pituitary-adrenal (HPA) reactivity.
Objective: The purpose of this study was to demonstrate the existence of a salivary cortisol awakening response (CAR) in infants, and to estimate its association with birth outcome.
Setting: The study was conducted in the general community.
Participants: Healthy infants up to six months age (N=64).
Main outcome measures: Mothers were instructed to collect their infant’s saliva immediately and 30 min after awakening on two days within 45 days, irrespective of awakening time. Information on birth outcome was collected from medical records and questionnaires.
Results: Linear mixed models analysis revealed a significant rise of infant salivary cortisol concentrations within 30 minutes after awakening (b=0.128, SE=0.024, t61=5.31, p<0.001), which was quite stable across the two sampling days (r=0.40, p=0.002). The infant CAR was predicted by length of gestation (t61=2.43, p=0.018).
Conclusions: The current data demonstrate the existence of a CAR in infants as early as during the first six postnatal months; its relationship with length of gestation supports its usefulness for questions related to developmental neuroscience. Therefore, the infant CAR emerges as non-invasive biomarker of HPA axis dynamics at this early stage of life, with relevance for future research and potential clinical applications
Maternal psychosocial stress during pregnancy and placenta weight: evidence from a national cohort study
No full textTo study in a large-scale cohort with prospective data the associations between psychosocial stress during pregnancy and placenta weight at birth. Animal data suggest that the placenta is involved in stress-related fetal programming.; We defined a priori two types of psychosocial stress during pregnancy, life stress (perceived burdens in major areas of life) and emotional symptoms (e.g. anxiety). We estimated the associations of maternal stress during pregnancy with placenta weight at birth, controlled for length of gestation, by predicting gestational age- and sex-specific z-scores of placenta weight through multiple regression analysis, adjusted for potential confounders (N?=?78,017 singleton pregnancies). Life stress (per increase in stress score by 1, range: 0-18) during pregnancy was associated with increased placenta weight at birth (z-score, reported in 10(-3); B, 14.33; CI, 10.12-18.54). In contrast, emotional symptoms during pregnancy were not associated with placenta weight at birth.; Maternal life stress but not emotional symptoms during pregnancy was associated with increased placenta weight at birth; yet, the association-estimate was rather small. Our results may contribute to a better understanding of the role of the placenta in the regulation of intrauterine processes in response to maternal stress
Fetal origins of pediatric disease : fetoplacental plasticity and intrauterine programming by stress and glucocorticoids
No full textReal-time fMRI neurofeedback and smartphone-based interventions to modulate mental functions
No full textOur brains are constantly changing on a molecular level depending on the demands thrown at them by our environments, behavior, and thoughts. This neuronal plasticity allows us to voluntarily influence mental functions.
Taking conscious control over mental functions goes potentially back millenia, but it was psychotherapy since the early 20th century which moulded this concept into a concrete form to target specific mental disorders.
Mental disorders constitute a large burden on modern societies. Stress-related disorders like anxiety and depression particularly make up a large part of this burden and new ways to treat or prevent them are highly desirable, since traditional approaches are not equally helpful to every person affected.
This might be because the infrastructure is not available where the person lives, their schedules and obligations or financial means do not enable them to seek help or they simply do not respond to traditional forms of treatment.
Technological advances bring forth new potential approaches to modulate mental functions and allow using additional information to tailor an intervention better to an individual patient.
The focus of this dissertation lies on two promising approaches to cognitively intervene and modulate mental functions: real-time functional magnetic resonance imaging neurofeedback (rtfMRInf) on one hand and smartphone-based interventions (SBIs) on the other.
To investigate various aspects of both these methods in the context of stress and in relation to personalized interventions, we designed and conducted two experiments with a main rtfMRInf intervention, and also with ambulatory training of mental strategies, which participants accessed on their mobile phones.
The four publication this thesis entails, are related to this topic as follows:
The first publication focuses on rtfMRInf effects on the physiological stress response, exploring whether neurofeedback could reduce stress-related changes in brain activity and blood pressure.
The second publication focuses on rtfMRInf effects on psychological measures related to the stress response, namely on arousal and mood, based on data from self-report by the participants.
The third publication focuses on rtfMRInf methodology itself, looking at complex connectivity data between major neural networks.
Finally, the fourth publication focuses on personalized prediction of intervention success of an SBI using data from previous training days
Selbstfokussierte Aufmerksamkeit in der sozialen Angststörung - Zusammenhänge zwischen negativem Selbstbild, kulturellem Kontext und Aufmerksamkeitsvariabilität
No full textPsychotherapy: Quo vadis?
No full textBackground: The science and practice of psychotherapy is continuously developing. The goal of this article is to describe new impulses, guiding current advancements in the field. Methods: This paper provides a selective narrative review, synthesizing and condensing relevant literature identified through various sources, including MEDLINE, EMBASE, PsycINFO, and "Web of Science", as well as citation tracking, to elaborate key developments in the field of psychotherapy Results: We describe several dynamics: 1) Following up the so-called "third wave of cognitive behavioral therapy", new interventions arise that have at their core fostering interpersonal virtues, such as compassion, forgiveness, and gratitude; 2) Based on technological quantum leaps, new interventions arise that exploit current developments in the field of new media, information, and communication technologies, as well as brain imaging, such as digital interventions for mental disorders and new forms of neurofeedback; 3) Inspired by the field of positive psychology, there is a revival of the promotion of strength and resilience in therapeutic contexts; 4) In light of the new paradigm "precision medicine", the issue of differential and adaptive indication of psychotherapy, addressed with new methods, regains relevance and drives a new field of "precision psychotherapy". 5) Last but not least, the "embodied turn" opens the door for body psychotherapy to gain relevance in academic psychotherapy. Conclusion: These and further developments, such as the use of systemic and network approaches as well as machine learning techniques, outline the vivid activities in the field of psychotherapy
Fetal Programming of Hypothalamic-Pituitary-Adrenal Axis by Synthetic Glucocorticoids
No full textMajor physiological systems, such as the hypothalamic-pituitary-adrenal (hpa) axis, are susceptible to certain intrauterine exposures of the fetus. These exposures may lead to long-term programming, with potential consequences for the individual throughout life. One such exposure is the administration of synthetic glucocorticoids that are commonly used in different medical fields. This chapter focuses on fetal programming of hpa axis by synthetic glucocorticoids. It introduces the pharmacological and physiological background of this topic, summarizes major findings from human and animal studies, and addresses potential biological mechanisms and the clinical relevance of such programming. In humans, exposure to synthetic glucocorticoids in utero reduces fetal and, in some cases, postnatal hpa activity under basal conditions, and following stress. Data from animal studies indicate that lifelong hpa axis dysregulation, rather than either static hypoactivity or hyperactivity of hpa axis, is a common consequence of early exposure to synthetic glucocorticoids. The mechanisms of glucocorticoid-induced changes in hpa axis function are complex, including possible alterations at subcortical and cortical levels of the brain. Emerging evidence indicates that early dysregulation of hpa axis is adverse, possibly leading to compromised development and health in the short term. It is as yet unclear as to whether long-term health disturbances are to be expected. More randomized human follow-up studies are needed to better understand the short- and long-term effects of intrauterine exposure to synthetic glucocorticoids on hpa axis and potential short- and long-term consequences on health and development.</jats:p
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