Moving the dial on prenatal stress mechanisms of neurodevelopmental vulnerability to mental health problems: A personalized prevention proof of concept

Abstract

Prenatal stress exposure increases vulnerability to virtually all forms of psychopathology. Based on this robust evidence base, we propose a “Mental Health, Earlier” paradigm shift for prenatal stress research, which moves from the documentation of stress‐related outcomes to their prevention, with a focus on infant neurodevelopmental indicators of vulnerability to subsequent mental health problems. Achieving this requires an expansive team science approach. As an exemplar, we introduce the Promoting Healthy Brain Project (PHBP), a randomized trial testing the impact of the Wellness‐4‐2 personalized prenatal stress‐reduction intervention on stress‐related alterations in infant neurodevelopmental trajectories in the first year of life. Wellness‐4‐2 utilizes bio‐integrated stress monitoring for just‐in‐time adaptive intervention. We highlight unique challenges and opportunities this novel team science approach presents in synergizing expertise across predictive analytics, bioengineering, health information technology, prevention science, maternal–fetal medicine, neonatology, pediatrics, and neurodevelopmental science. We discuss how innovations across many areas of study facilitate this personalized preventive approach, using developmentally sensitive brain and behavioral methods to investigate whether altering children's adverse gestational exposures, i.e., maternal stress in the womb, can improve their mental health outlooks. In so doing, we seek to propel developmental SEED research towards preventive applications with the potential to reduce the pernicious effect of prenatal stress on neurodevelopment, mental health, and wellbeing.

Intergenerational Transmission of Effects of Women's Stressors During Pregnancy: Child Psychopathology and the Protective Role of Parenting

“…Moreover, our novel findings show that prenatal risks for child psychopathology are not uniform across families and may be buffered by strengthening and supporting the caregiving environment in the home. Interventions that provide additional support to families—both during the prenatal and postnatal period—and that include strategies and resources to strengthen caregiver-child relationships can play a key role in promoting caregiver and child resilience—even in the context of adversity ( 114 ). Indeed, caregiver wellbeing and behavior is key to promoting the development of child self-regulation skills, and could help prevent the development of later psychopathology ( 32 , 54 , 63 ).…”

Predicting the Next-Day Perceived and Physiological Stress of Pregnant Women by Using Machine Learning and Explainability: Algorithm Development and Validation

“…From the model output, we calculated total consecutive stress minutes from all 1-minute–level classification results. A day was labeled as physiologically stress positive if the total number of consecutive stress minutes was >50%, based on previously published literature [ 45 ].…”

Development and feasibility of a Configurable Assessment Messaging Platform for Interventions (CAMPI).

“…We illustrate CAMPI’s capabilities in three case studies used to establish feasibility. Case Study 1 ( Wellness-4-2 ) was selected to illustrate a-just-in time adaptive intervention (Nahum-Shani et al, 2018) deployed using CAMPI (Wakschlag et al, 2020). Case Study 2 ( txt2protect ) was used to deploy brief behavioral intervention content, collect data, and deliver appointment reminders (Gerend et al, 2020).…”

“…Machine learning methods are employed to indicate when a woman meets the “stressed” threshold and prompt a just-in-time adaptive intervention containing customized messaging including skills reinforcement, self-monitoring, and homework reminders. Participants (pregnant women; n = 15) piloted the system and provided preliminary acceptability and feasibility of CAMPI-delivered EMAs as a method for remote monitoring of maternal stress response (Wakschlag et al, 2020).…”

“…Wellness-4-2 is an adaptation of the Mothers and Babies perinatal depression prevention intervention (Tandon et al, 2011(Tandon et al, , 2014 designed to reduce maternal distress during pregnancy and reduce adverse impact on infant neurodevelopment (Wakschlag et al, 2020). The 12-week intervention incorporates self-reported stress ratings collected via EMA and heart rate data measured via a novel wireless, wearable biosensor (nPoint Wearable System, MC10 Inc.) that measures electrocardiogram (ECG) data.…”