Nath Anita, Murthy Gudlavalleti Venkata Satyanarayana, Babu Giridhara R, Di Renzo Gian Carlo
Wellcome Trust DBT India Alliance Intermediate fellow in clinical and public health, Indian Institute of Public Health-Bengaluru Campus, Public Health Foundation of India, SIHFW Campus, First Cross, Magadi road, Bengaluru, Karnataka, 560023, India.
Indian Institute of Public Health Hyderabad-Bengaluru Campus, South, Public Health Foundation of India, Plot # 1, Rd Number 44, Masthan Nagar, Kavuri Hills, Madhapur, Hyderabad, Telangana, 500033, India.
BMC Psychiatry. 2017 Jul 17;17(1):255. doi: 10.1186/s12888-017-1424-x.
The mental health status of a pregnant woman and its consequent impact on foetal well being is not given much importance compared to the risk imposed by obstetric complications and medical conditions. Maternal psychological distress is a major public health problem and needs timely detection and intervention to prevent any adverse pregnancy outcome. There is ample evidence from literature that justifies the association of prenatal maternal mental stress and elevated cortisol with delayed infant motor and cognitive development; evidence from India being rather limited. The study aim is to prospectively assess the association of maternal psychological distress and cortisol level with motor and cognitive development of the infant.
A sample of 2612 eligible pregnant women who have been registered for antenatal care at selected public sector hospitals in Bengaluru will be recruited after obtaining written informed consent. They will be assessed for the presence of maternal psychological distress in the form of depression and anxiety using appropriate scales and saliva samples will be collected for cortisol estimation during early, mid and late pregnancy. Follow up visits after delivery will be done on day 10, 3 months, 8 months and 12 months. The Bayley Scales of Infant and Toddler Development [BSID] (Third edition) will be used to measure both motor and mental milestones in terms of Psychomotor Development Index (PDI) and Mental Development Index (MDI). Logistic regression model will be used to determine the association between the exposure variables and outcomes which will be reported as Odd's Ratio (OR) and 95% confidence intervals (CI).
Our study findings could add to the growing evidence that maternal psychological distress during pregnancy adversely influences growth and development in the offspring and subsequent development of the child. While maternal anxiety and depression can be measured by using self reporting instruments, estimation of maternal endogenous cortisol levels could serve as a biomarker of prenatal psychological stress. Findings from this study could be used to focus upon the burden of mental health problems during pregnancy and to consider steps to scale up prenatal mental health services in health care settings.
与产科并发症和疾病所带来的风险相比，孕妇的心理健康状况及其对胎儿健康的影响并未得到足够重视。孕产妇心理困扰是一个重大的公共卫生问题，需要及时检测和干预，以预防任何不良妊娠结局。文献中有大量证据证明产前母亲心理压力和皮质醇升高与婴儿运动和认知发育延迟之间存在关联；而来自印度的证据相当有限。本研究的目的是前瞻性评估孕产妇心理困扰和皮质醇水平与婴儿运动和认知发育之间的关联。
在获得书面知情同意后，将招募2612名在班加罗尔选定的公立医院登记进行产前护理的符合条件的孕妇作为样本。将使用适当的量表评估她们是否存在以抑郁和焦虑形式表现的孕产妇心理困扰，并在孕早期、中期和晚期收集唾液样本以估计皮质醇水平。产后将在第10天、3个月、8个月和12个月进行随访。贝利婴幼儿发展量表（第三版）[BSID]将用于根据心理运动发展指数（PDI）和心理发展指数（MDI）来测量运动和心理里程碑。将使用逻辑回归模型来确定暴露变量与结局之间的关联，结果将以优势比（OR）和95%置信区间（CI）报告。
我们的研究结果可能会进一步证明，孕期母亲心理困扰会对后代的生长发育以及儿童的后续发展产生不利影响。虽然母亲的焦虑和抑郁可以通过自我报告工具进行测量，但母亲内源性皮质醇水平的估计可以作为产前心理压力的生物标志物。本研究的结果可用于关注孕期心理健康问题的负担，并考虑采取措施扩大医疗保健机构中的产前心理健康服务。
