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      Prenatal Developmental Origins of Future Psychopathology: Mechanisms and Pathways

      1 , 2 , 3 , 1 , 3 , 1 , 3
      Annual Review of Clinical Psychology
      Annual Reviews

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          Abstract

          The developmental origins of health and disease hypothesis applied to neurodevelopmental outcomes asserts that the fetal origins of future development are relevant to mental health. There is a third pathway for the familial inheritance of risk for psychiatric illness beyond shared genes and the quality of parental care: the impact of pregnant women's distress—defined broadly to include perceived stress, life events, depression, and anxiety—on fetal and infant brain–behavior development. We discuss epidemiological and observational clinical data demonstrating that maternal distress is associated with children's increased risk for psychopathology: For example, high maternal anxiety is associated with a twofold increase in the risk of probable mental disorder in children. We review several biological systems hypothesized to be mechanisms by which maternal distress affects fetal and child brain and behavior development, as well as the clinical implications of studies of the developmental origins of health and disease that focus on maternal distress. Development and parenting begin before birth.

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          Neurocircuitry of stress: central control of the hypothalamo-pituitary-adrenocortical axis.

          Integration of the hypothalamo-pituitary-adrenal stress response occurs by way of interactions between stress-sensitive brain circuitry and neuroendocrine neurons of the hypothalamic paraventricular nucleus (PVN). Stressors involving an immediate physiologic threat ('systemic' stressors) are relayed directly to the PVN, probably via brainstem catecholaminergic projections. By contrast, stressors requiring interpretation by higher brain structures ('processive' stressors) appear to be channeled through limbic forebrain circuits. Forebrain limbic sites connect with the PVN via interactions with GABA-containing neurons in the bed nucleus of the stria terminalis, preoptic area and hypothalamus. Thus, final elaboration of processive stress responses is likely to involve modulation of PVN GABAergic tone. The functional and neuroanatomical data obtained suggest that disease processes involving inappropriate stress control involve dysfunction of processive stress pathways.
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            Maternal infection requiring hospitalization during pregnancy and autism spectrum disorders.

            Exposure to prenatal infection has been suggested to cause deficiencies in fetal neurodevelopment. In this study we included all children born in Denmark from 1980, through 2005. Diagnoses of autism spectrum disorders (ASDs) and maternal infection were obtained through nationwide registers. Data was analyzed using Cox proportional hazards regression. No association was found between any maternal infection and diagnosis of ASDs in the child when looking at the total period of pregnancy: adjusted hazard ratio = 1.14 (CI: 0.96-1.34). However, admission to hospital due to maternal viral infection in the first trimester and maternal bacterial infection in the second trimester were found to be associated with diagnosis of ASDs in the offspring, adjusted hazard ratio = 2.98 (CI: 1.29-7.15) and adjusted hazard ratio = 1.42 (CI: 1.08-1.87), respectively. Our results support prior hypotheses concerning early prenatal viral infection increasing the risk of ASDs.
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              Of human bonding: newborns prefer their mothers' voices

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                Author and article information

                Journal
                Annual Review of Clinical Psychology
                Annu. Rev. Clin. Psychol.
                Annual Reviews
                1548-5943
                1548-5951
                May 07 2019
                May 07 2019
                : 15
                : 1
                : 317-344
                Affiliations
                [1 ]Department of Psychiatry, Columbia University, New York, NY 10032, USA;
                [2 ]Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
                [3 ]New York State Psychiatric Institute, New York, NY 10032, USA;,
                Article
                10.1146/annurev-clinpsy-050718-095539
                7027196
                30795695
                de28da5a-ef2e-421e-a84f-76c0e55c341b
                © 2019
                History

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