Frenquelli Roberto, Ratcliff Marc, Villar de Onis Jimena, Fernandes Michelle, Barros Fernando C, Hirst Jane E, Papageorghiou Aris T, Kennedy Stephen H, Villar Jose
Master Program in Child Psychoanalysis and Neuropsychological, Developmental Psychology Unit, Faculty of Psychology, National University of Rosario, Rosario, Argentina.
Faculty of Psychology and Educational Science, Centre Jean Piaget, University of Geneva, Geneva, Switzerland.
Front Neurosci. 2022 Apr 18;16:856886. doi: 10.3389/fnins.2022.856886. eCollection 2022.
Complex perinatal syndromes (CPS) affecting pregnancy and childhood, such as preterm birth, and intra- and extra-uterine growth restriction, have multiple, diverse contexts of complexity and interaction that determine the short- and long-term growth, health and development of all human beings. Early in life, genetically-guided somatic and cerebral development occurs alongside a psychism "," with the neural structures subjected to the effects of the intra- and extra-uterine environments in preparation for optimal postnatal functioning. Different trajectories of fetal cranial and abdominal growth have been identified before 25 weeks' gestation, tracking differential growth and neurodevelopment at 2 years of age. Similarly, critical time-windows exist in the first 5-8 months of postnatal life because of interactions between the newborn and their environment, mother/care-givers and feeding practices. Understanding these complex relational processes requires abandoning classical, linear and mechanistic interpretations that are placed in rigid, artificial biological silos. Instead, we need to conduct longitudinal, interdisciplinary research and integrate the resulting new knowledge into clinical practice. An ecological-systemic approach is required to understand early human growth and development, based on a dynamic multidimensional process from the molecular or genomic level to the socio-economic-environmental context. For this, we need theoretical and methodological tools that permit a global understanding of CPS, delineating temporal trajectories and their conditioning factors, updated by the incorporation of new scientific discoveries. The potential to optimize human growth and development across chronological age and geographical locations - by implementing interventions or "treatments" during periods of greatest instability or vulnerability - should be recognized. Hence, it is imperative to take a holistic view of reproductive and perinatal issues, acknowledging at all levels the complexity and interactions of CPS and their sensitive periods, laying the foundations for further improvements in growth and development of populations, to maximize global human potential. We discuss here conceptual issues that should be considered for the development and implementation of such a strategy aimed at addressing the perinatal health problems of the new millenium.
影响妊娠和儿童期的复杂围产期综合征（CPS），如早产、宫内和宫外生长受限，具有多种不同的复杂情况和相互作用，这些决定了所有人的短期和长期生长、健康及发育。在生命早期，基因引导的躯体和大脑发育与心理活动同步进行，神经结构会受到宫内和宫外环境的影响，为出生后最佳功能做准备。在妊娠25周前就已确定胎儿头颅和腹部生长的不同轨迹，可追踪2岁时的差异生长和神经发育情况。同样，由于新生儿与其环境、母亲/照顾者及喂养方式之间的相互作用，出生后最初5 - 8个月存在关键时间窗。理解这些复杂的关系过程需要摒弃置于僵化、人为生物孤立状态的经典、线性和机械性解释。相反，我们需要开展纵向、跨学科研究，并将由此产生的新知识整合到临床实践中。需要一种生态系统方法来理解人类早期生长和发育，其基于从分子或基因组水平到社会经济环境背景的动态多维度过程。为此，我们需要理论和方法工具，以便全面理解CPS，描绘时间轨迹及其制约因素，并通过纳入新的科学发现进行更新。应认识到通过在最不稳定或最脆弱时期实施干预或“治疗”来优化不同年龄和地理位置人群生长和发育的潜力。因此，必须对生殖和围产期问题持整体观点，在各个层面承认CPS及其敏感期的复杂性和相互作用，为进一步改善人群生长和发育奠定基础，以最大化全球人类潜力。我们在此讨论在制定和实施旨在解决新千年围产期健康问题的此类战略时应考虑的概念性问题。
