Georgetown School of Medicine, Washington, DC, USA.
Division of Neonatology, Children's National Health System, Washington, DC, USA.
Acta Paediatr. 2021 Jun;110(6):1741-1749. doi: 10.1111/apa.15766. Epub 2021 Feb 12.
The main objective is to review the available evidence in the literature for developmental origins of neuropsychiatric diseases and their underlying mechanisms. We also probe emerging cutting-edge prenatal MR imaging tools and their future role in advancing our understanding the prenatal footprints of neuropsychiatric disorders.
Both human and animal studies support early intrauterine origins of neuropsychiatric disease, particularly autism spectrum disorders (ASD), attention and hyperactivity disorders, schizophrenia, depression, anxiety and mood disorders. Specific mechanisms of intrauterine injury include infection, inflammation, hypoxia, hypoperfusion, ischaemia polysubstance use/abuse, maternal mental health and placental dysfunction.
There is ample evidence to suggest developmental vulnerability of the foetal brain to intrauterine exposures that increases and individual's risk for neuropsychiatric disease, especially the risk of ASD, depression and anxiety. Elucidating the exact timing and mechanisms of injury can be difficult and require novel, non-invasive approaches to the study emerging structural and functional brain development of the foetus. Clinical care should both emphasise maternal health during pregnancy, as well as close, continued monitoring for at risk offspring throughout young adulthood for the early identification and treatment of neuropsychiatric diseases.
本文旨在综述神经精神疾病的发育起源及其潜在机制的现有文献证据。我们还探讨了新兴的前沿产前磁共振成像工具及其在深入了解神经精神疾病产前特征方面的未来作用。
人类和动物研究均支持神经精神疾病,尤其是自闭症谱系障碍(ASD)、注意力和多动障碍、精神分裂症、抑郁症、焦虑症和心境障碍的早期宫内起源。宫内损伤的特定机制包括感染、炎症、缺氧、低灌注、缺血、多种物质使用/滥用、孕产妇心理健康和胎盘功能障碍。
有充分的证据表明胎儿大脑对宫内暴露的发育易感性增加了个体患神经精神疾病的风险,尤其是 ASD、抑郁症和焦虑症的风险。阐明损伤的确切时间和机制可能很困难,需要采用新的、非侵入性方法来研究胎儿正在出现的结构和功能大脑发育。临床护理不仅应强调妊娠期间的孕产妇健康,还应在整个青年期对高危后代进行密切、持续的监测,以便早期发现和治疗神经精神疾病。