Premature Birth of Newborn Clinical Trial
Official title:
The Effect of Perinatal Stress on the Development of Preterm Infants
In this project, the investigators will study a cohort of preterm infants, together with
their parents, during NICU hospitalization and follow their developmental trajectory until
the age of two.
An important first scientific goal of the project is to identify objective stress markers
that can be obtained easily and non-invasively in preterm infants during NICU
hospitalization. This will include the development of novel techniques to measure stress
related heart rate variability (HRV) and EEG maturation, as well as sleep stage markers for
preterm infants.
Secondly, the investigators will study the emotional and bonding processes in parents of
preterm infants. Parental distress in terms of depressive symptoms, anxiety, perceived stress
and parent-infant bonding will be measured at multiple measuring points. This will enable the
validation of psychometric instruments in the specific population of parents of preterm
infants. Also, the investigators can investigate the effect and predictive value of the
course of parental depression, anxiety and stress scores on child's developmental outcome and
on parent-infant bonding and attachment.
Thirdly, studies on epigenetic changes due to prenatal stress are still scarce in humans. In
this study, the investigators will include a cohort of mothers experiencing profound prenatal
stress due to preterm labor, which will complement the earlier work that has been carried out
in a low-risk population. The investigators expect more profound changes in methylation state
of the NR3C1 and other promotor regions in their cohort of mothers exposed to important
prenatal stress. Secondly, the methylation of oxytocin receptor regions will be studied in
relation to attachment and bonding.
An important overall goal of the project is to develop a Perinatal Stress Calculator that
studies the value of the different neonatal, endocrinological, psychological and
physiological stress-related parameters to predict differences in psychomotor, cognitive,
behavioral, and emotional development. This longitudinal study design will enable the
investigators to use the perinatal stress calculator to study the relation between the
perinatal stress parameters and later developmental disabilities such as motor impairment,
cognitive deficits, language delay but also social and behavioral problems such as
attentional deficits and emotional self-regulation dysfunction.
Project goals and their impact on societal challenges:
Objective 1: The first goal of the project is to identify objective stress markers that can
be obtained easily and non-invasively in preterm infants during NICU hospitalization. This
will include the development of novel techniques to measure stress related heart rate
variability (HRV) and EEG maturation, as well as sleep stage markers. On a societal and
economical level, reliable measures of the degree of distress in a hospitalized preterm
infant will enable the evaluation of the direct effects of stress-reducing interventions such
as NICU architecture changes and early intervention programs in cost benefit analyses. (Work
package 1)
Objective 2: Second, the investigators aim to study the emotional and bonding processes in
parents of preterm infants. Parental distress in terms of depressive symptoms, anxiety,
perceived stress and parent-infant bonding will be measured at multiple time points. This
will lead to the validation of psychometric instruments in the specific population of parents
of preterm infants. Also, the investigators will investigate the effect and predictive value
of the course of parental depression, anxiety and stress on children's developmental outcome
and on parent-infant bonding and attachment. Knowledge about the short and long term risks of
parental emotional distress are important to implement sufficient and tailored support to
parents. (Work package 2)
Objective 3: Third, studies on epigenetic changes due to prenatal stress are still scarce in
humans. Recently, preliminary evidence was found that prenatal stress affects the methylation
state of the NR3C1promotor regions (Hompes et al., 2013). In this study, the investigators
will include a cohort of mothers experiencing profound prenatal stress due to preterm labor,
which will complement the earlier work that has been carried out in a low-risk population.
The investigators expect more profound changes in methylation state of the NR3C1 and other
promotor regions in this cohort. The methylation of oxytocin receptor genes will also be
studied in relation to attachment and bonding. On a societal level, knowledge about the
impact of adverse maternal psychological well-being during pregnancy on the epigenome is
important, for example to justify prevention campaigns. (Work package 3)
Overall objective: An important overall goal of the project is to develop a Perinatal Stress
Calculator that combines the values of the different neonatal, endocrinological,
psychological and physiological stress-related parameters to predict differences in
psychomotor, cognitive, behavioural, and emotional development (Work package 5). This
prospective longitudinal study design will enable the investigators to use the perinatal
stress calculator to study the relation between the perinatal stress parameters and later
developmental disabilities such as motor impairment, cognitive deficits, and language delay
but also social and behavioural problems such as attentional deficits and emotional
self-regulation dysfunction (Work package 4). The investigators will not only be able to
weigh perinatal infant characteristics in the model, but also parental characteristics such
as distress, resilience and personality as well as bonding and attachment measures. On a
societal and economic level, the results of the project will be important for health policy
decision-making. Improved prediction of the developmental trajectory of preterm infants could
lead to earlier and targeted interventions to decrease maladaptive outcomes.
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