Cinzia Niolu Trasmissione intergenerazionale del trauma
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Trasmissione intergenerazionale del trauma
Cinzia Niolu
Associato di Psichiatria
Dipartimento di Medicina dei Sistemi Università di Roma “Tor Vergata”
Responsabile UOS SPDC Fondazione Policlinico Tor Vergata
Responsabile Sportello SOS mamma Fondazione Policlinico Tor Vergata
Presidente Società Italiana Psichiatria SIP LazioGenetica dei disturbi mentali
Cluster genetici diversi danno origine a
traiettorie, percorsi fenotipici diversi
However, such relations are unable to
explain the vast majority of the inter-individual variation
in the populationGene-Environment interaction
Inter-individual variations in
physical, cognitive and
socioemotional growth have been
traditionally examined under
the conceptual framework of
gene–environment (G x E)
interactions
(Dick et al., 2010; Gershon et al., 2011)In che modo i fattori ambientali e sociali condizionano
l’espressione genica e lo sviluppo cellulare?
EPIGENETICS
L'epigenetica è definita come lo studio dei
cambiamenti ereditabili nell'espressione genica
che non sono causati da cambiamenti nella
sequenza del DNA (Waterland & Michels, 2007).
Waddington's model of the epigenetic landscapeIpotesi: Status fetale meta-plastico
che aumenta la vulnerabilità alle
influenze post-natali
O’Donnell KJ et al., 2017Biological and social determinants of neurodevelopment
across life course
The Lancet Commission on
global mental health and
sustainable development October 9, 2018CHROMATIN VARIATIONS and
TRANSGENERATIONAL INHERITANCE
A major class of
epigenetic mechanism is
thought to involve
persistent
changes in chromatin
structure. Most, if not
all, transcriptional
regulatory events cause
changes to chromatin
structure and
composition, which
result from the
recruitment of
chromatin-modifying
enzymes by transcription
factors and by the
transcriptional
machinery itself.CHROMATIN VARIATIONS and
TRANSGENERATIONAL INHERITANCE
DNA methylation, histone modifications and non-coding RNAs are the three
known epigenetic marks that have been implicated in transgenerational
inheritance of the modified traits.Transgenerational and Intergenerational transmission
• Adult exposure
• In utero exposure
• Post-natal exposure
INTERGENERATIONAL
TRANSMISSION
TRANSGENERATIONAL
TRANSMISSION
Klengel et al, 2015From STRESS THEORY to the Stress theory posits that organisms
will mount, and continue to express,
INTERGENERATIONAL TRANSMISSION of stress a biobehavioral response to an
environmental challenge as long as
the challenge or stressor is present
(Selye, 1956)
LEVELS OF TRANSMISSION
Parental stress can be transmitted via:
• GAMETES,
• GESTATIONAL UTERINE ENVIRONMENT,
• EARLY POSTNATAL CARE
Stress effects that are inherited via an
‘intergenerational transmission’ mode
are reflected in offspring biological
changes, including neuroendocrine,
epigenetic, and neuroanatomical
changes.
Bowers, Yehuda 2016From STRESS THEORY to the
INTERGENERATIONAL TRANSMISSION of stress
The influence on a child’s response to stress may begin before birth as a result of
in utero exposure to maternal stress hormones – NOT their own experiences of
adversity
Yehuda et al., J Clin Endocrinol Metab. 2005 Jul;90(7):4115-8.Women pregnant on 9/11 with PTSD had lower cortisol levels
and so did their 7 month old infants
PTSD- (n=46)
800 PTSD+ (n=52)
Salivary Cortisol
600
400
200
0
Mothers Babies
Yehuda et al., J Clin Endocrinol Metab. 2005 Jul;90(7):4115-8.Urinary 24hr cortisol levels were lower
in Holocaust offspring with parental PTSD
80
70
High Risk
60
Cortisol (ug/day)
/day)
Group
50
40
30
20
10
0
Comparison No Parental Parental PTSD; Parental PTSD;
PTSD; No PTSD No PTSD
PTSD
n=15 n=11 n=10 n=14
Yehuda et al., Am J Psychiatry. 2000From STRESS THEORY to the
INTERGENERATIONAL TRANSMISSION of stress
>
Injection of sperm RNAs
• Serum of the traumatized animals, from these males into
Several miRNAs • Serum of the traumatized animales’ progeny when adult fertilized wild-type oocytes
were affected • Brain of the traumatized animals, reproduced the behavioral
• Brain of the traumatized animales’ progeny when adult and metabolic alterations in
• Sperm of traumatized males the resulting offspring
These results strongly suggest that sncRNAs are sensitive to environmental factors in early life, and contribute to the
inheritance of trauma-induced phenotypes across generations.F1
F0
F2
• On the elevated plus maze, F2 MSUS mice had a shorter
latency to first enter an open arm than F2 controls.
• They spent more time in the bright compartment of the
light-dark box, and had depressive-like behaviors on the
forced swim test.
• Since early stress can be a strong metabolic dysregulator,
glucose metabolism has been examined. Insulin in serum was
normal in F1 MSUS animals, but lower than controls in F2
MSUS progeny.
MSUS:maternal separation combined with unpredictable maternal stressOffspring effects may be mediated, in part, by epigenetic changes in parental germ cells resulting from acquired parental stress exposures throughout life. Germ cells in both females and males can be affected by trauma exposure, but the critical periods for affecting oocytes and sperm may differ. Accordingly, the nature of the effects may differ in oocytes and sperm in relation to trauma exposure.
Trasmissione intergenerazionale del trauma:
complicanze e aspetti correlati
Trauma e Nutrizione
Trauma e Uso di Sostanze
Trauma e Depressione PerinataleTrasmissione intergenerazionale del trauma:
complicanze e aspetti correlati
Trauma e Nutrizione
Trauma e Uso di Sostanze
Trauma e Depressione PerinataleTRAUMA E MALNUTRIZIONE: De Hongerwinter Uno dei più famosi “esperimenti naturali” in cui gli epidemiologi si sono accorti di questi effetti è stato il cosiddetto traumatico inverno della carestia in Olanda, nel 1944. Sul finire della seconda guerra mondiale, quando l’esercito tedesco bloccò l’accesso ai rifornimenti in alcuni territori dei Paesi Bassi, una parte della popolazione, complice un inverno durissimo, patì gravemente le fame, arrivando a un introito giornaliero di non più di 500 calorie.
Exposure of TRAUMATC environmental factor: SEVERE FAMINE
pregnant
g0 Generation – exposed during pregnancy
women
to a severe
famine g1 Generation – exposed in utero
Higher risk for metabolic and
mental health diseases
HIGH: 1°-2° trimester
LOW: 3° trimester
g2 Generation – exposed by means of the
developing germ cells
Increased risk for metabolic
disorders but only in children
from at-risk F1 fathers
g3 Generation?PERICONCEPTIONAL EXPOSURE TO FAMINE
DNA methylation altered
60 years later
when women were exposed
lower methylation of the Insulin-like Growth Factor 2 (IGF2) locus very early in pregnancy but
(key factor in human growth and development) not in late gestationDoHAD - Developmental Origins of Adult Disease
In particolare, in relazione al benessere e alla salute del
bambini, è stato studiato un programma di condizionamento
biologico, denominato Developmental Origins of Adult
Disease (DoHAD), che individua le origini delle malattie
dell’adulto a partire dallo sviluppo infantile.
Negli studi di Barker nei quali veniva notato come durante la
carestia olandese della Seconda Guerra Mondiale, quando la
fame era diffusa tra la popolazione, i bambini nascevano più
piccoli per età gestazionale e da grandi avrebbero avuto un
rischio maggiore di sviluppare diabete di tipo II e sindrome
metabolica.
David Barker, epidemiologist
The Barker’s hypothesis – IL “FENOTIPO RISPARMIO”
L’ipotesi di Barker consisteva nel fatto che questi bambini, a causa delle cattive condizioni dietetiche, si erano abituati in utero a trattenere i nutrienti
come necessità adattativa all’ambiente altamente deficitario sul piano alimentare, creando una sorta di thrifty phenotype, “fenotipo risparmio”.
Questo fenotipo, ossia la tendenza a trattenere e conservare nel proprio corpo gli introiti calorici, determinava delle modificazioni metaboliche tali per
cui questi bambini, una volta divenuti adulti, erano a maggior rischio di obesità.>
Siracusano A, Ribolsi M 2018
MADRI POVERE, UNA CATTIVA NUTRIZIONE IN
GRAVIDANZA SONO FATTORI DI SVANTAGGIO E
DI RISCHIO PER IL NASCITUROTRAUMA AND OBESITY
The incidence of posttraumatic stress disorder
(PTSD) and obesity are on the rise, and evidence
continues to support the observation that
individuals who have symptoms of PTSD are
more likely to develop obesity in their
lifetime.
• GENETIC MECHANISMS The incidence of obesity in individuals with PTSD,
(eg, telomere length)
• GROWTH AND INFLAMMATORY MEDIATORS including war veterans, women, and children
(eg, IL-6, BDNF) exposed to trauma, is not solely attributable to
• CELLULAR MECHANISMS
(eg, mitochondrial and endoplasmic reticulum function) psychotropic medications, but actual
• ENDOCRINE MECHANISMS
pathophysiologic mechanisms have not been fully
(eg, glucocorticoid and RAAS pathways)
delineated.INTERGENERATIONAL TRANSMISSION OF OBESITY
>
(the Lancet 2016)
OFFSPRING’S RISK
• OBESITY
OBESE MOTHER • CORONARY HEART DISEASE
• STROKE
Mother and child, Botero 1995 • TYPE 2 DIABETES
• ASTHMA
changes in epigenetic • POORER COGNITION
processes
• HEDONIC BEHAVIORS
alterations in the gut
microbiome • NEURODEVELOPMENTAL DISORDERS
Buon compleanno Mr Grape, Film 1993GLOSSARY
Factors shaping
the neonatal
microbiome
Tamburrini et al, Nature Medicine 2016Microbiome, inflammation, epigenetic alterations,
and mental diseases: a fatidical interplay
INFLAMMATION
It was long believed that neonates are born with sterile gastrointestinal
tract (GIT) and the first microbial flora that colonizes humans’ GIT are
those from maternal vaginal canal, skin and large intestine MICROBIOME EPIGENOME
(Rook,Lowry, & Raison, 2014).
NUTRITION
RECENT STUDIES SHOWED THAT HUMANS START TO
ACQUIRE GUT BACTERIA WHILE THEY ARE IN UTERO
Like viruses, bacterial elements may pass through the
maternal digestive tract or other internal mucosa to colonize the
embryo’s digestive tract.
THE ACQUISITION OF GI FLORA IS INFLUENCED BY
MATERNAL DIET AND LIFESTYLE AND MAY BE
LINKED TO DEVELOPMENTAL DISORDERS IN NEONATESMaternal overnutrition and hedonic behaviors
MATERNAL TRAUMA MATERNAL OBESITY HEDONIC BEHAVIORS
IN OFFSPRING
“These altered hedonic behaviors are associated with reduced
striatal dopamine levels, suggesting that a hypodopaminergic state
of the mesolimbic reward system may be responsible for the higher
vulnerability to develop addictive-like behaviors and altered
metabolic phenotypes in the offspring”
Hypothalamic appetite HYPERPHAGIA
MATERNAL regulatory system
HIGH FAT
DIET FOOD
Mesolimbic reward system PREFERENCE
EDONIC
BEHAVIORSTrasmissione intergenerazionale del trauma:
complicanze e aspetti correlati
Trauma e Nutrizione
Trauma e Uso di Sostanze
Trauma e Depressione PerinataleTRAUMA AND SUBSTANCE ABUSE There is a strong, bidirectional link between substance abuse and traumatic experiences. Patients, teens in particular, with cooccurring substance use disorders(SUDs) and posttraumatic stress disorder (PTSD) have significant functional and psychosocial impairment. Common neurobiological foundations point to the reinforcing cycle of trauma symptoms, substance withdrawal, and substance use.
Effetti multigenerazionali dell’uso di sostanze
Epigenetic transgenerational inheritance may
provide a means by which parental drug use
can influence several generations of offspring.
Recent evidence suggests that parental drug
exposure produces behavioral, biochemical, and
neuroanatomical changes in future
generations.
YOHN et al, 2015BEHAVIORAL EFFECTS
YOHN et al, 2015NEUROCHEMICAL EFFECTS
STUCTURAL PHYSIOLOGICAL
EFFECTS
YOHN et al, 2015Trasmissione intergenerazionale del trauma:
complicanze e aspetti correlati
Trauma e Nutrizione
Trauma e Uso di Sostanze
Trauma e Depressione PerinatalePerinatal Depression Depression during pregnancy is an
emerging field in terms of understanding
Women are MORE THAN TWICE as susceptible the pathophysiology of the disease and
to depression as men; determining adequate treatment
Perinatal depression is highly prevalent:
10-20% How big is the problem?
• First trimester: 7.4%
1 out of 5 pregnant women will have a mental health problem during their
pregnancy, and in the year after they have a baby
• Second trimester: 12.8%
• Third trimester: 12.0%
5 out of 100 women will develop a serious mental health problem
• Postpartum: 13% at 3 months postpartum 4 out of 1000 women who have a baby will need admission to
hospital for their mental health problems
The Royal College of Psychiatrists, 2015
Philippe et al 2016, ACOG 2015Valutazione dei Fattori di Rischio e Stratificazione - TRAUMA
Il nostro studio
“Ruolo dei life stress events, resilienza e livelli di citochine
proinfiammatorie: uno studio pilota”
St udio pr omosso dall’Associazione Volont ar i per PTV onlus che ha gent ilment e aut or izzat o
l’ut ilizzo dei dat i.
“GRUPPI DI RICERCA INTER UNIVERSITARI
SULLA PSICOPATOLOGIA PERINATALE Pat r ocinat o dalla Societ à It aliana di Psichiat r ia Regione Lazio.
DELLA DIADE MADRE-BAMBINO” U.O.C. Psichiat r ia, Fondazione PTV, Dir et t or e: Pr of. A. Sir acusano
In collabor azione con: UOS I giene M ent ale delle r elazioni affet t iv e e del post - par t um ,
Policlinico Um ber t o I di Roma, Univer sit à La Sapienza, Roma.
U.O.C. Ginecologia, Fondazione Policlinico Tor Ver gat a Roma, Dir et t or e: Pr of. E. Piccione.
Dipar t im ent o di M edicina di Labor at or io, Fondazione PTV, Dir et t or e: Pr of. S. Ber nar diniValutazione dei Fattori di Rischio e Stratificazione - TRAUMA
Il nostro studio Metodi
“Ruolo dei life stress events, resilienza e livelli di citochine
proinfiammatorie: uno studio pilota”
20 DPN, LSE
Cara eris che del campione:
St udio pr omosso dall’Associazione Volont ar i per PTV onlus che ha gent ilment e aut or izzat o 40 DPN 20 DPN,nLSE
l’ut ilizzo dei dat i. 80 DONNE
Pat r ocinat o dalla Societ à I t aliana di Psichiat r ia Regione Lazio.
U.O.C. Psichiat r ia, Fondazione PTV, Dir et t or e: Pr of. A. Sir acusano
In collabor azione con: UOS I giene M ent ale delle r elazioni affet t ive e del post - par t um ,
Policlinico Umber t o I di Roma, Univer si t à La Sapienza, Roma.
U.O.C. Ginecologia, Fondazione Policlinico Tor Ver gat a Roma, Dir et t or e: Pr of. E. Piccione. 20 HS in gravidanza
Dipar t iment o di M edicina di Labor at or io, Fondazione PTV, Di r et t or e: Pr of. S. Ber nar dini 40 HS
20 HS non in gravidanza
Obiettivi
1- Indagare la relazione esistente tra eventi traumatici e sintomi depressivi perinatali (DPN);
2-Indagare relazione tra resilienza, DPN e indici biologici;
3- Indagare relazione tra indici biologici, DPN e eventi traumaticiValutazione dei Fattori di Rischio e Stratificazione - TRAUMA
Le pazienti con diagnosi di DPN che avevano in
anamnesi uno o più eventi traumatici presentavano
una sintomatologia depressiva più severa
I traumi più rappresentati nel campione di donne con
diagnosi di DPN erano le esperienze di Abuso
psicologico, Abuso sessuale, Emotional NeglectValutazione dei Fattori di Rischio e Stratificazione - TRAUMA
Le pazienti con diagnosi di DPN che avevano in
anamnesi uno o più eventi traumatici presentavano
punteggi più bassi di resilienza.
Le pazienti con diagnosi di DPN si differenziavano dal
gruppo di controllo in termini di indici biologici
(VES e TNFa)Valutazione dei Fattori di Rischio e Stratificazione - TRAUMA
Risultati 6: Resilienza come fattore protettivo
I livelli sierici di BDNF erano
direttamente proporzionali ai
P< 0.05
punteggi di resilienza
Niolu et al Unpublished dataTRAUMA E
DEPRESSIONE
PERINATALE
DISREGOLAZIONE
IMPATTO SUL INFIAMMATORIA
NEONATO IL-1, IL-2, IL-6, IL-17,
• Disregolazione infiammatoria TNFa, IFNb,
• Dist del neurosviluppo
• Basso peso alla nascita cortisolo, PCR, VES
• Ridotta aspettativa di vitaFigli di donne sane e donne con depressione in
gravidanza seguiti fino ai 25aa
- Link tra depressione pre-natale e alterazione dei
parametri immunologici (CICATRICE BIOLOGICA) nella
prole all’età di 25 aa (effetto persistente e
indipendente da episodi depressivi o traumi life-time)
- livelli più alti di hs-CRP: rischio cardiovascolare
Origini fetali della salute e del
rischio di malattia• Neonates’ functional connectivity patterns
predicted the degree to which their mother
experienced inflammation while pregnant.
•
• Systemic maternal inflammation during
pregnancy,operationalized as IL-6 level, predicted
these children’s performance on a memory game
at age twoArch Womens Ment Health. 2016 Oct;19(5):927-35.
DISTURBO DELLA SVILUPPERÀ UNO
DEPRESSIONE STILE DI
RELAZIONE
MATERNA ATTACCAMENTO
MADRE-BAMBINO
INSICURO
Alhusen JL et al., 2013
• Donne con attaccamento evitante e sintomi depressivi: rischio di ritardo dello sviluppo nella prole
• Donne con stile di attaccamento sicuro in gravidanza: assenza di ritardo di sviluppo nella prole
L’attaccamento insicuro si trasmette di madre in figlio e
media la trasmissione transgenerazionale della depressioneWhat about the mother-fetus bonding?
> SU COSA INCIDE UNA SCARSA QUALITÁ
DI ATTACCAMENTO MATERNO-FETALE?
• S le di vita sano in gravidanza (uso di tabacco, alcol, • Dist. D’Ansia
sostanze)
i • Dist. Dell’Umore (Depressione, Irritabilità)
• Esercizio fisc o • Comportamen di abuso sul feto
• Ricerca di informazioni su gravidanza, parto e cura del • A accamento madre-bambino insicuro/
disorganizzato
neonato
• Ritardo di sviluppo
Alhusen et al 2009MAAS-Fa ori psicopatologici/Depressione
30
La qualità dell’a accamento
20 Materno-fetale correla inversamente
EPDS
con la gravità della sintomatologia
depressiva presente
10
r = -0,786
PTrasmissione transgenerazionale della Relazione di Attaccamento
TRAUMA
Attaccamento Madre-
DEPRESSIONE
bambino/Padre-
bambino
Attaccamento
Materno-fetale
Attaccamento
TRASMISSIONE Madre-bambino
TRANSGENERAZIONALEIl progetto SOS MOOD
“MOOD of MOthers and Offspring
Development”:
linee di ricerca e risultati preliminari
UOC Neuropsichiatria Infantile - Direttore Prof. Paolo Curatolo
UOC Psichiatria e Psicologia Clinica - Direttore Prof. Alberto Siracusano
Policlinico “Tor Vergata”
Università degli studi di Roma “Tor Vergata”
Progetto promosso da: Volontari Policlinico “Tor Vergata”OBJECTIVES (1) 1) to longitudinally evaluate possible long-term effects of maternal perinatal depression on socio-communicative and behavioral phenotype of the offspring with a specific focus on the increase of ASD risk.
OBJECTIVES (2)
2) to characterize the CLINICAL PHENOTYPE of: Offspring of Perinatal
Depressed women
pharmacologically
Treated during
pregnancy
(O-PND*Treat)
Offspring NOT
exposed to drug
treatment
(O-PND*NonTreat).Methods: MOTHERS
• 30 mothers enrolled
• Sportello “SOS Mamma” Policlinico Tor Vergata –
open from April 2012
• Psychiatric clinical evaluation of the women was
performed
PRENATAL PERIOD
II TRIMESTER OF PREGNANCY
EPDS EPDS ≥ 12: Perinatal Depression
10 item Edinburgh Perinatal
Depression Scale EPDS 9-11: Probable Depression
Cox et al, 1987Preliminary Sample: Mothers N7
YES
Pharmacological
Treatment
16 women
Mean age: 37 yrs
N4
NO
Pharmacological
EPDS ≥ 12: N 11 women PND Treatment
EPDS < 12: N 5 women No PNDMethods: Offspring
Standardized clinical assessment of the children at a mean age of 5 years:
CHILD EVALUATION: PARENTAL QUESTIONNAIRES:
o Griffiths III/Wechsler Scale (WPPSI-III; o Social Responsiveness Scale (SRS)
WISC-IV) o Behavioural features (Conners’
o Autism Diagnostic Observation Parents; Child Behaviour
Schedule Second Edition (ADOS-2) Checklist)
o Parental Stress Index (PSI)Results (1)
16 women
16 children
Mean age: 37 yrs
Mean age: 5 yrs
EPDS ≥ 12: N 11 women PND 2 ASD
EPDS < 12: N 5 women No PND 1 ASDResults (2) 7 Children EXPOSED to
medication (5 M 2 F)
mean age 4 yrs
N7
16 women YES
Mean age: 37 yrs (DS…) Pharmacological
Treatment
EPDS ≥ 12: N 11 women PND
N4
NO
Pharmacological
Treatment
EPDS < 12: N 5 women No PND 1 ASD 4 Children NON-EXPOSED to
medication (5 M 2 F)
mean age 4 yrs
2 ASDResults OFFSPRING O-PND vs O-No-PND
Results (3): O-PND vs O-No-PND
No significant statistical difference emerged, between the
offspring of PND (O-PND) and the children of No-PND (O-No
PND), in the level of Autistic Symptoms (ADOS-2) and
Socio-Communicative Difficulties (SRS)
ADOS-2
SRS
16
15 90
14
13
12 75
11
10 60
9 O- No PND O- No PND
8
7 O-PND 45
6 O-PND
5
4 30
3 SRS Social
2
1 Responsiveness
0 Scale (mean tot T
ADOS Total Score (mean
score)
score)
• Mean ADOS Total Score: O-PND 4,00 vs O-No PND 3,00 • Mean SRS Total Score: O-PND 58,50 vs O-No PND 52,60
• Mean ADOS Calibrated Severity Score CSS : 2,11 O-PND vs 2,20 O-
No PNDResults OFFSPRING O-PND*NoTreat vs O-PND*Treat
Results (4): O-PND*NoTreat vs O-PND*Treat
16
15
14
Children of mothers with PND who did not
13
12
11
received pharmacological treatment during
10
9
8
O- PND*Treat pregnancy (O-PND*NoTreat) scored higher
7 O-PND*NonTreat
6
5 compared to offspring of pharmacologically
4
3
2 treated women (O-PND*Treat) on ADOS Total
1
0
ADOS Total Score (mean
Score (mean: OPD-NT 6,00 vs OPD-T2,86) and on
score)
CSS (mean: 3,67 OPD-NT vs 1,33 OPD-T)
10
A 9
8
D 7
O 6 O- PND*Treat
O-PND*NonTreat
5
S 4
2 3
2
1
O-PND-NoTreat scored higher on ADOS TOTAL and ados
CSS (mean score)
CSSResults (5): O-PND*NoTreat vs O-PND*Treat
Children of mothers with PND who did not receive
pharmacological treatment during pregnancy
(O-PND*NoTreat) scored higher compared to SRS
offspring of pharmacologically treated women
(O-PND*Treat) on SRS total score (mean: 64,00 90
OPD-NT vs 56,14 OPD-T) 75
O- PND*Treat
60 O-PND*NonTreat
45
30
SRS (mean total score)Results (6): O-PND*NoTreat vs O-PND*Treat
CONNERS parents Children of mothers with PND who
100
did not receive pharmacological
95
90 treatment during pregnancy (O-
85
80 PND*NoTreat) scored higher
75
compared to offspring of
70
65 pharmacologically treated women
60 O- PND*Treat
55
(O-PND*Treat) on Defiant (mean:
50 O-PND*NonTreat 53,67 OPD-NT vs 46,71 OPD-T)
45
40 Hyperkinetic behaviours (mean:
35
Conners' Hyperkine c Conners' Defiant score Conners' Ina en on score 63,33 OPD-NT vs 52,00 OPD-T) and
behaviours score (mean T (mean T score) (mean T score)
score) Inattention score of Conners’ (mean
68,00 OPD-NT vs 48,57 OPD-T)Results: Parental Stress Index
pnd-treat vs pnd-no treatResults (7): pnd-treat vs pnd-no treat
Parental STRESS Index
Mothers with PND who received pharmacological
136
treatment during pregnancy (O-PND*Treat) scored
116
96
PND*Treat higher compared to offspring of pharmacologically not
PND*NonTreat
76
treated women (O-PND*NoTreat) on PSI Total score
56
(mean: 46,3 OPD-NT vs 81,43 OPD-T)
36
Parental Stress Index
PND-Treat mothers reported more PARENTAL STRESS
INDEXCONCLUSIONS on Preliminary results
• Not a significant increased risk of autism in the children of women affected by Perinatal
Depression compared to offspring of healthy control mothersCONCLUSIONS on Preliminary results
• A different clinical phenotype came out within the offspring of women affected by Perinatal Depression
and exposed to psychotropic medications during pregnancy compared to offspring not prenatally
exposed to pharmacotherapy:
o lower sub-threshold autistic symptoms and less defiant-inattentive-hyperkinetic behaviours
emerged within offspring exposed to psychotropic medications in pre-natal period.CONCLUSIONS on Preliminary results
• Women pharmacologically treated during pregnancy, later reported higher
Parental Stress IndexCONCLUSIONS on Preliminary results
• Paucity of the Sample
• Hypothesis: medication as a regulator of the inflammation related to
Depression?
• Importance of Perinatal Depression Treatment
• Analysis of Confounding FactorsGrazie per l’attenzione niolu@med.uniroma2.it
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