Kang Zoe, Lebov Jill, Hamad Ana Paula, Kousa Youssef
Center for Precision Medicine and Genomics Research, Children's National Hospital, Washington, DC, USA.
RTI International, Social, Scientific, and Environmental Systems, Research Triangle Park, Durham, NC, USA.
Pediatr Res. 2025 Jul 25. doi: 10.1038/s41390-025-04292-7.
Brain development is a complex process that proceeds from the embryonic stage into young adulthood. During the first three years, the brain rapidly develops and lays the groundwork for downstream structures. Social determinants of health (SDOH), including the wider set of forces and systems that shape everyday life, can have detrimental effects on the structure and function of the developing brain. Differences in the distribution of resources and governance at the global, national, and local levels, can create health disparities in infectious disease proliferation within and between communities and countries. Social determinants of infectious disease and brain development have been thoroughly researched independently, yet research on the interactions between these outcomes is limited. Here, we review the potential that social, economic, and environmental factors can coalesce to mitigate or exacerbate the effects of virally induced brain injury by either buffering against or adding to neurological disability. We synthesize research concerning SDOH, brain development, and viral infection and the interconnectedness between these important global health issues. We find that the same SDOH that impact brain development can also increase the risk of viral infection during pregnancy and adverse sequelae in the fetus, including damage to the developing brain, which can contribute to lifelong effects that reinforce health inequities. IMPACT: Synthesizes the relationship between prenatal social determinants of health and prenatal viral infections, social determinants and brain outcomes, and their interrelationships. This review highlights the need to conduct further research to understand the pathway of these factors and quantify the contributions of each factor to the neurodevelopmental trajectory of a child exposed to prenatal viral infections. Details the social and environmental conditions that increase vulnerability to prenatal brain injury and decrease resilience to neurological developmental interruptions.
大脑发育是一个复杂的过程,从胚胎阶段持续到青年期。在最初的三年里,大脑迅速发育并为下游结构奠定基础。健康的社会决定因素(SDOH),包括塑造日常生活的更广泛的力量和系统,可能会对发育中的大脑的结构和功能产生不利影响。全球、国家和地方层面资源分配和治理的差异,可能会在社区和国家内部及之间造成传染病扩散方面的健康差距。传染病和大脑发育的社会决定因素已分别得到充分研究,但关于这些结果之间相互作用的研究有限。在此,我们综述社会、经济和环境因素可能结合起来减轻或加剧病毒诱导的脑损伤影响的可能性,这些因素要么缓冲神经功能障碍,要么加重神经功能障碍。我们综合了关于健康的社会决定因素、大脑发育和病毒感染以及这些重要全球健康问题之间相互联系的研究。我们发现,影响大脑发育的相同健康的社会决定因素也会增加孕期病毒感染的风险以及胎儿的不良后遗症,包括对发育中大脑的损害,这可能导致终身影响,加剧健康不平等。影响:综合了产前健康的社会决定因素与产前病毒感染之间的关系、社会决定因素与大脑结果之间的关系及其相互关系。本综述强调需要进行进一步研究,以了解这些因素的作用途径,并量化每个因素对暴露于产前病毒感染的儿童神经发育轨迹的影响。详细说明了增加产前脑损伤易感性和降低对神经发育中断恢复力的社会和环境条件。