36 results on '"Birit F P Broekman"'
Search Results
2. Internalizing problems are associated with oral health-related quality of life in early childhood: Outcomes from an Asian multi-ethnic prospective birth cohort.
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Ruth Choe, Yu Fan Sim, Catherine H L Hong, Sameema Mohideen, Ranjani Nadarajan, Fabian Yap, Lynette P-C Shek, Chin-Ying Stephen Hsu, Birit F P Broekman, and Joao N Ferreira
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Medicine ,Science - Abstract
Oral health status ideally warrants for a holistic biopsychosocial approach to health and wellness. Little is known about the impact of behavioral problems on oral health-related quality of life (OHRQoL) in children due to the paucity of studies in early childhood, particularly in Asian multi-ethnic populations. This study evaluated the relationship between early child's socioemotional factors and OHRQoL, as well as its association with orofacial pain (OFP) and early childhood caries (ECC) in the Asian GUSTO birth cohort. Mother-child dyads were postnatally assessed at 3 time points. The Child Behavior Checklist (CBCL) was used to assess the child's socioemotional and behavioral problems at age 4-4.5 years together with other validated questionnaires to evaluate maternal anxiety and depression. ECC detection was performed at age 5, and OHRQoL (primary) and OFP (secondary) outcomes were assessed at age 6 from a total of 555 mother-child dyads. After a univariate regression analysis was performed to identify potential predictors and confounders, a multivariate regression model was run with predisposing factors (CBCL internalization and externalization problems, OFP, ECC) and adjusted for confounders (maternal psychosocial states, maternal education) to determine associations with OHRQoL. Results showed an association between CBCL internalization scores and poorer OHRQoL (RR = 1.03, p = 0.033, 95% CI 1.01 to 1.05), although the limited risk ratio may not have a practical applicability in psychosocially healthy children, alike the majority of those evaluated in this cohort. The average OHRQoL overall score among children with OFP was 2.39 times more than those without OFP (OR = 2.39, p < 0.001, 95% CI 2.00 to 2.86). Thus, in early childhood, OFP, and to lesser extent internalizing behaviors, may negatively impact OHRQoL. This study therefore highlights the complex relationship between OHRQoL and its predisposing socioemotional and somatic pain factors, and demands further investigations in clinically relevant populations.
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- 2021
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3. Evaluation of a child food reward task and its association with maternal feeding practices.
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Jia Ying Toh, Phaik Ling Quah, Chun Hong Wong, Wen Lun Yuan, Izzuddin M Aris, Keri McCrickerd, Keith M Godfrey, Yap-Seng Chong, Lynette P Shek, Kok Hian Tan, Fabian Yap, Michael J Meaney, Ciarán G Forde, Yung Seng Lee, Birit F P Broekman, and Mary F F Chong
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Medicine ,Science - Abstract
Food reward is defined as the momentary value of a food to the individual at the time of ingestion and is characterised by two psychological processes-"liking" and "wanting". We aimed to validate an age-appropriate food reward task to quantify implicit wanting of children from the GUSTO cohort (n = 430). At age 5 years, child appetitive traits and maternal feeding practices were reported by mothers via questionnaires. At age 6, a write-for-food task based on the child's preference for food or toy rewards was undertaken in laboratory conditions. Child BMI and skinfold measurements were taken at age 7. Convergent validity of the food reward task was assessed by associating with child appetitive traits, where enjoyment of food/food responsiveness (OR: 1.51; 95% CI: 1.06, 2.15) and emotional overeating (OR: 1.64; 95% CI: 1.09, 2.48) were positively associated with high food reward in children. Criterion validity was tested by associating with child BMI, however no significant relationships were observed. Multivariable logistic regression analysis with maternal feeding practices revealed that children whose mother tend to restrict unhealthy food (OR: 1.37; 95% CI: 1.03, 1.82) and girls whose mothers taught them about nutrition (OR: 2.09; 95% CI: 1.19, 3.67) were more likely to have high food reward. No further significant associations were observed between food reward, other appetitive traits and feeding practices. Despite the lack of association with child weight status, this study demonstrated the value of the write-for-food task to assess food reward in children and presented sex-specific associations with maternal feeding practices.
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- 2021
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4. Family planning decision-making in relation to psychiatric disorders in women: a qualitative focus group study
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Shahenda A. I. H. Ahmad, Jorina Holtrop, Monique J. M. van den Eijnden, Nini H. Jonkman, Maria G. van Pampus, Odile A. van den Heuvel, Birit F. P. Broekman, and Noralie N. Schonewille
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Family planning ,Unintended pregnancies ,Psychiatric disorders ,Decision-making ,Qualitative research ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Recent studies revealed an elevated likelihood of unintended pregnancies among women with psychiatric disorders compared to their counterparts without such vulnerability. Despite the importance of understanding family planning decision-making in this group, qualitative inquiries are lacking. This study explored family planning decisions among women with psychiatric disorders. Methods Utilizing a qualitative approach, three focus group discussions were conducted with purposive sampling: women with a history of unintended pregnancies (N = 3), women without children (N = 5), and women with a history of intended pregnancies (N = 9), all of whom had self-reported psychiatric disorders. Using thematic framework analysis, we investigated the themes “Shadow of the past,” reflecting past experiences, and “Shadow of the future,” reflecting future imaginaries, building upon the existing “Narrative Framework.” Results The Narrative Framework formed the foundation for understanding family planning among women with psychiatric disorders. The retrospective dimension of focus group discussions provided opportunities for reflective narratives on sensitive topics, revealing emotions of regret, grief and relief. Childhood trauma, adverse events, and inadequate parenting enriched the "Shadow of the past". The “Shadow of the present” was identified as a novel theme, addressing awareness of psychiatric disorders and emotions toward psychiatric stability. Social influences, stigma, and concerns about transmitting psychiatric disorders shaped future imaginaries in the shadow of the future. Conclusions This study enlightens how family planning decision-making in women with psychiatric disorders might be complex, as marked by the enduring impact of past experiences and societal influences in this sample. These nuanced insights underscore the necessity for tailored support for women with psychiatric disorders.
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- 2024
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5. The Influence of Gestational Diabetes on Neurodevelopment of Children in the First Two Years of Life: A Prospective Study.
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Shirong Cai, Anqi Qiu, Birit F P Broekman, Eric Qinlong Wong, Peter D Gluckman, Keith M Godfrey, Seang Mei Saw, Shu-E Soh, Kenneth Kwek, Yap-Seng Chong, Michael J Meaney, Michael S Kramer, Anne Rifkin-Graboi, and GUSTO study group
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Medicine ,Science - Abstract
OBJECTIVE:Analyze the relation of gestational diabetes and maternal blood glucose levels to early cognitive functions in the first two years of life. METHODS:In a prospective Singaporean birth cohort study, pregnant women were screened for gestational diabetes at 26-28 weeks gestation using a 75-g oral glucose tolerance test. Four hundred and seventy three children (n = 74 and n = 399 born to mothers with and without gestational diabetes respectively) underwent neurocognitive assessments at 6, 18, and/or 24 month, including electrophysiology during an attentional task and behavioral measures of attention, memory and cognition. RESULTS:Gestational diabetes is related to left hemisphere EPmax amplitude differences (oddball versus standard) at both six (P = 0.039) and eighteen months (P = 0.039), with mean amplitudes suggesting offspring of mothers with gestational diabetes exhibit greater neuronal activity to standard stimuli and less to oddball stimuli. Associations between 2-hour maternal glucose levels and the difference in EPmax amplitude were marginal at 6 months [adjusted β = -0.19 (95% CI: -0.42 to +0.04) μV, P = 0.100] and significant at 18 months [adjusted β = -0.27 (95% CI: -0.49 to -0.06) μV, P = 0.014], and the EPmax amplitude difference (oddball-standard) associated with the Bayley Scales of Infant and toddler Development-III cognitive score at 24 months [β = 0.598 (95% CI: 0.158 to 1.038), P = 0.008]. CONCLUSION:Gestational diabetes and maternal blood glucose levels are associated with offspring neuronal activity during an attentional task at both six and eighteen months. Such electrophysiological differences are likely functionally important, having been previously linked to attention problems later in life.
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- 2016
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6. Pre- and Post-Natal Maternal Depressive Symptoms in Relation with Infant Frontal Function, Connectivity, and Behaviors.
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Ni Ni Soe, Daniel J Wen, Joann S Poh, Yue Li, Birit F P Broekman, Helen Chen, Yap Seng Chong, Kenneth Kwek, Seang-Mei Saw, Peter D Gluckman, Michael J Meaney, Anne Rifkin-Graboi, and Anqi Qiu
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Medicine ,Science - Abstract
This study investigated the relationships between pre- and early post-natal maternal depression and their changes with frontal electroencephalogram (EEG) activity and functional connectivity in 6- and 18-month olds, as well as externalizing and internalizing behaviors in 24-month olds (n = 258). Neither prenatal nor postnatal maternal depressive symptoms independently predicted neither the frontal EEG activity nor functional connectivity in 6- and 18-month infants. However, increasing maternal depressive symptoms from the prenatal to postnatal period predicted greater right frontal activity and relative right frontal asymmetry amongst 6-month infants but these finding were not observed amongst 18-month infants after adjusted for post-conceptual age on the EEG visit day. Subsequently increasing maternal depressive symptoms from the prenatal to postnatal period predicted lower right frontal connectivity within 18-month infants but not among 6-month infants after controlling for post-conceptual age on the EEG visit day. These findings were observed in the full sample and the female sample but not in the male sample. Moreover, both prenatal and early postnatal maternal depressive symptoms independently predicted children's externalizing and internalizing behaviors at 24 months of age. This suggests that the altered frontal functional connectivity in infants born to mothers whose depressive symptomatology increases in the early postnatal period compared to that during pregnancy may reflect a neural basis for the familial transmission of phenotypes associated with mood disorders, particularly in girls.
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- 2016
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7. Gestational age and neonatal brain microstructure in term born infants: a birth cohort study.
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Birit F P Broekman, Changqing Wang, Yue Li, Anne Rifkin-Graboi, Seang Mei Saw, Yap-Seng Chong, Kenneth Kwek, Peter D Gluckman, Marielle V Fortier, Michael J Meaney, Anqi Qiu, and GUSTO Study Group
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Medicine ,Science - Abstract
Understanding healthy brain development in utero is crucial in order to detect abnormal developmental trajectories due to developmental disorders. However, in most studies neuroimaging was done after a significant postnatal period, and in those studies that performed neuroimaging on fetuses, the quality of data has been affected due to complications of scanning during pregnancy. To understand healthy brain development between 37-41 weeks of gestational age, our study assessed the in utero growth of the brain in healthy term born babies with DTI scanning soon after birth.A cohort of 93 infants recruited from maternity hospitals in Singapore underwent diffusion tensor imaging between 5 to 17 days after birth. We did a cross-sectional examination of white matter microstructure of the brain among healthy term infants as a function of gestational age via voxel-based analysis on fractional anisotropy.Greater gestational age at birth in term infants was associated with larger fractional anisotropy values in early developing brain regions, when corrected for age at scan. Specifically, it was associated with a cluster located at the corpus callosum (corrected p
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- 2014
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8. Neonatal admission after lithium use in pregnant women with bipolar disorders: a retrospective cohort study
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Noralie N. Schonewille, Pleun A. Terpstra, Maria E. N. van den Heuvel, Maria G. Van Pampus, Odile A. van den Heuvel, and Birit F. P. Broekman
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Lithium ,Bipolar disorder ,Adverse neonatal outcomes ,Psychiatry ,Pregnancy ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 ,Neurophysiology and neuropsychology ,QP351-495 - Abstract
Abstract Background Lithium is the preferred treatment for pregnant women with bipolar disorders (BD), as it is most effective in preventing postpartum relapse. Although it has been prescribed during pregnancy for decades, the safety for neonates and obstetric outcomes are a topic of ongoing scientific debate as previous research has yielded contradicting outcomes. Our study aims to compare (re)admission rates and reasons for admissions in neonates born to women with bipolar disorders (BD) with and without lithium exposure. Methods A retrospective observational cohort study was conducted in a Dutch secondary hospital (two locations in Amsterdam). Women with BD who gave birth after a singleton pregnancy between January 2011 and March 2021 and their neonates were included. Outcomes were obtained by medical chart review of mothers and neonates and compared between neonates with and without lithium exposure. The primary outcome was admission to a neonatal ward with monitoring, preterm birth, small for gestational age (SGA), 5-minute Apgar scores, neonatal asphyxia, and readmission ≤ 28 days. Results We included 93 women with BD, who gave birth to 117 live-born neonates: 42 (36%) exposed and 75 (64%) non-exposed to lithium. There were no significant differences in neonatal admission with monitoring (16.7 vs. 20.0%, p = 0.844). Additionally, preterm birth (7.1 vs. 5.3%), SGA (0.0 vs. 8.0%), 5-minute Apgar scores (means 9.50 vs. 9.51), neonatal asphyxia (4.8 vs. 2.7%) and readmission (4.8 vs. 5.3%) were comparable. Overall, 18.8% of BD offspring was admitted. Women with BD had high rates of caesarean section ( 29.1%), gestational diabetes (12.8%) and hypertensive disorders of pregnancy (8.5%). Conclusions In a sample of neonates all born to women with BD using various other psychotropic drugs, exposure to lithium was not associated with greater risk of neonatal admission to a ward with monitoring compared to non-exposure to lithium, questioning the necessity for special measures after lithium exposure. However, offspring of women with BD was admitted regularly and women with BD have high obstetric risk which require clinical and scientific attention.
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- 2023
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9. Associations between sleep trajectories up to 54 months and cognitive school readiness in 4 year old preschool children
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Elaine Kwang Hsia Tham, Hai-Yan Xu, Xiuju Fu, Rick Siow Mong Goh, Peter D. Gluckman, Yap-Seng Chong, Fabian Yap, Lynette Pei-Chi Shek, Oon Hoe Teoh, Joshua Gooley, Daniel Yam-Thiam Goh, Nora Schneider, Michael J. Meaney, Shirong Cai, and Birit F. P. Broekman
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sleep trajectories ,school readiness ,preschool children ,cognitive development ,infant sleep ,Psychology ,BF1-990 - Abstract
PurposeThis study explores the association between the duration and variation of infant sleep trajectories and subsequent cognitive school readiness at 48–50 months.MethodsParticipants were 288 multi-ethnic children, within the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Caregiver-reported total, night and day sleep durations were obtained at 3, 6, 9, 12, 18, 24 using the Brief Infant Sleep Questionnaire and 54 months using the Child Sleep Habits Questionnaire. Total, night and day sleep trajectories with varying durations (short, moderate, or long) and variability (consistent or variable; defined by standard errors) were identified. The cognitive school readiness test battery was administered when the children were between 48 and 50 months old. Both unadjusted adjusted analysis of variance models and adjusted analysis of covariance models (for confounders) were performed to assess associations between sleep trajectories and individual school readiness tests in the domains of language, numeracy, general cognition and memory.ResultsIn the unadjusted models, children with short variable total sleep trajectories had poorer performance on language tests compared to those with longer and more consistent trajectories. In both unadjusted and adjusted models, children with short variable night sleep trajectories had poorer numeracy knowledge compared to their counterparts with long consistent night sleep trajectories. There were no equivalent associations between sleep trajectories and school readiness performance for tests in the general cognition or memory domains. There were no significant findings for day sleep trajectories.ConclusionFindings suggest that individual differences in longitudinal sleep duration patterns from as early as 3 months of age may be associated with language and numeracy aspects of school readiness at 48–50 months of age. This is important, as early school readiness, particularly the domains of language and mathematics, is a key predictor of subsequent academic achievement.
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- 2023
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10. Associations Between Eczema and Attention Deficit Hyperactivity Disorder Symptoms in Children
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Evelyn Xiu Ling Loo, Delicia Shu Qin Ooi, Minyee Ong, Le Duc Huy Ta, Hui Xing Lau, Michelle Jia Yu Tay, Qai Ven Yap, Yiong Huak Chan, Elizabeth Huiwen Tham, Anne Eng Neo Goh, Hugo Van Bever, Oon Hoe Teoh, Johan Gunnar Eriksson, Yap Seng Chong, Peter Gluckman, Fabian Kok Peng Yap, Neerja Karnani, Jia Xu, Karen Mei Ling Tan, Kok Hian Tan, Bee Wah Lee, Michael Kramer, Lynette Pei-chi Shek, Michael J. Meaney, and Birit F. P. Broekman
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atopy ,attention deficit hyperactivity disorder ,cytokines ,eczema ,gut microbiome dysbiosis ,Pediatrics ,RJ1-570 - Abstract
BackgroundEpidemiological studies suggest a link between eczema and attention deficit hyperactivity disorder (ADHD), but underlying mechanisms have not been examined.ObjectiveWe aim to investigate the association between eczema and subsequent ADHD symptoms in the Growing Up in Singapore Towards healthy Outcomes cohort and explore the role of pro-inflammatory cytokines and gut microbiome.MethodsThe modified International Study of Asthma and Allergies in Childhood questionnaire and Computerized Diagnostic Interview Schedule for Children Version IV were administered to assess reported eczema within the first 18 months and presence of ADHD symptoms at 54 months, respectively. Skin prick testing at 18 months, cytokines in maternal blood during pregnancy and cord blood and the mediating role of the gut microbiome at 24 months were assessed.ResultsAfter adjusting for confounders, eczema with or without a positive skin prick test was associated with doubling the risk of ADHD symptoms. No differences in maternal and cord blood cytokines were observed in children with and without eczema, or children with and without ADHD. Gut microbiome dysbiosis was observed in children with eczema and children with ADHD. Children with eczema also had lower gut bacterial Shannon diversity. However, the relationship between eczema and ADHD was not mediated by gut microbiome.ConclusionEarly life eczema diagnosis is associated with a higher risk of subsequent ADHD symptoms in children. We found no evidence for underlying inflammatory mechanism or mediation by gut microbiome dysbiosis. Further research should evaluate other mechanisms underlying the link between eczema and ADHD.Clinical Trial Registration[https://clinicaltrials.gov/ct2/show/NCT01174875], identifier [NCT01174875].
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- 2022
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11. The Effect of Older Sibling, Postnatal Maternal Stress, and Household Factors on Language Development in Two to Four-Year-Old Children
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Naomi Havron, Irena Lovcevic, Michelle Z. L. Kee, Helen Chen, Yap Seng Chong, Mary Daniel, Birit F. P. Broekman, Sho Tsuji, Psychiatry, and APH - Mental Health
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Male ,Family Characteristics ,Child, Preschool ,Siblings ,Developmental and Educational Psychology ,Humans ,Mothers ,Sibling Relations ,Female ,Family Relations ,Life-span and Life-course Studies ,Language Development ,Demography - Abstract
Previous literature has shown that family structure affects language development. Here, factors relating to older siblings (their presence in the house, sex, and age gap), mothers (maternal stress), and household size and residential crowding were assessed to systematically examine the different roles of these factors. Data from mother-child dyads in a Singaporean birth cohort, (677-855 dyads; 52% males; 58% to 61% Chinese, 20% to 24% Malay, 17% to 19% Indian) collected when children were 24, 48, and 54 months old, were analyzed. There was a negative effect of having an older sibling, moderated by the siblings' age gap, but not by the older sibling's sex, nor household size or residential crowding. Maternal stress affected language outcomes in some analyses but not others. Implications for understanding the possible effects of family structure on language development are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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- 2022
12. Pre-Readers at the Alien Zoo: A Preregistered Study of the Predictors of Dyslexia and Linguistic Sound Symbolism in 6-year-olds.
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Fei Ting Woon, Yap-Seng Chong, Lourdes Mary Daniel, Birit F. P. Broekman, Shirong Cai, and Suzy J. Styles
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- 2018
13. Mid-pregnancy and postpartum maternal mental health and infant sleep in the first year of life
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Shirong Cai, Desiree Y. Phua, Elaine K. H. Tham, Daniel Y. T. Goh, Oon H. Teoh, Lynette P. C. Shek, Kok H. Tan, Fabian Yap, Yap‐Seng Chong, Helen Chen, Birit F. P. Broekman, Michael S. Kramer, Michael J. Meaney, Psychiatry, and APH - Mental Health
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Behavioral Neuroscience ,Cognitive Neuroscience ,General Medicine - Abstract
Perinatal depression and anxiety are common and associated with sleep problems in the offspring. Depression and anxiety are commonly comorbid, yet often studied independently. Our study used an integrative measure of anxiety and depressive symptoms to examine the associations of maternal mental health (mid-pregnancy and postnatal) with infant sleep during the first year of life. A total of 797 mother–child dyads from the ‘Growing Up in Singapore Towards healthy Outcome’ cohort study provided infant sleep data at 3, 6, 9 and 12 months of age, using the caregiver reported Brief Infant Sleep Questionnaire. Maternal mental health was assessed at 26–28 weeks gestation and 3 months postpartum using the Edinburgh Postnatal Depression Scale, Beck Depression Inventory and State–Trait Anxiety Inventory. Bifactor modelling with the individual questionnaire items produced a general affect factor score that provided an integrated measure of anxiety and depressive symptoms. Linear mixed models were used to model the sleep outcomes, with adjustment for maternal age, education, parity, ethnicity, sex of the child and maternal sleep quality concurrent with maternal mental health assessment. We found that poorer mid-pregnancy, but not postpartum, maternal mental health was associated with longer wake after sleep onset duration across the first year of life (β = 49, 95% confidence interval 13–85 min). Poor maternal mental health during mid-pregnancy is linked to longer period of night awakening in the offspring during infancy. Interventions that aim to improve maternal antenatal mental health should examine infant sleep outcomes.
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- 2023
14. Nutrient trajectories during infancy and their associations with childhood neurodevelopment
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Jia Ying Toh, Shirong Cai, Shan Xuan Lim, Wei Wei Pang, Keith M. Godfrey, Lynette P. Shek, Kok Hian Tan, Fabian Yap, Yung Seng Lee, Yap-Seng Chong, Johan G. Eriksson, Birit F. P. Broekman, Anne Rifkin‑Graboi, Mary F. F. Chong, Psychiatry, and APH - Mental Health
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Nutrition and Dietetics ,Medicine (miscellaneous) - Abstract
Purpose: To examine the associations between infants' dietary nutrient trajectories and subsequent neurodevelopment during childhood in the Growing Up in Singapore Towards healthy Outcomes study.Methods: One-day food records were collected at ages 6, 9 and 12 months, whilst Bayley Scales of Infant and Toddler Development-III and Kaufman Brief Intelligence Test-2 were conducted at ages 24 and 54 months respectively. Nutrient trajectories were constructed using multi-level mixed modelling and associations with neurodevelopment (24 months: n = 484; 54 months: n = 444) were examined using adjusted multivariable linear regression.Results: At age 24 months, higher protein intake (at 6 months) and increasing rate of intake (from 6 to 12 months) were associated with higher fine motor score [β = 0.17 SD (95% CI 0.03, 0.31) and 0.62 SD (0.10, 1.14) respectively]. Higher fat intake was associated with higher receptive language score [0.04 SD (0.003, 0.07)], but increasing rate of intake was associated with lower expressive language [- 0.20 SD (- 0.39, - 0.01)] and fine motor [- 0.29 SD (- 0.48, - 0.10)] scores. Higher carbohydrate intake was associated with lower gross motor score [- 0.07 SD (- 0.14, - 0.005)], but increasing rate of intake was associated with higher receptive language [0.44 SD (0.08, 0.81)] and fine motor [0.56 SD (0.18, 0.93)] scores. Increasing rate of dietary fibre intake was associated with higher fine motor scores [0.63 SD (0.16, 1.10)]. No significant associations were observed with neurodevelopment at 54 months.Conclusion: Our findings provide greater understanding of how nutrition over time could have varying effects on child neurodevelopment.
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- 2023
15. The course of bipolar disorder in pregnant versus non-pregnant women
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Elise A M Knoppert-van der Klein, Robert M. Post, Anja Wmm Stevens, Stasja Draisma, Birit F P Broekman, Ralph W. Kupka, Willem A. Nolen, Peter J. J. Goossens, Adriaan Honig, Psychiatry, APH - Mental Health, APH - Methodology, and Clinical Cognitive Neuropsychiatry Research Program (CCNP)
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Neurophysiology and neuropsychology ,medicine.medical_specialty ,Neurology ,Life chart method ,Bipolar disorder ,Neurosciences. Biological psychiatry. Neuropsychiatry ,Pregnancy ,Medicine ,Biological Psychiatry ,reproductive and urinary physiology ,business.industry ,Obstetrics ,Research ,QP351-495 ,medicine.disease ,Non pregnant ,Psychiatry and Mental health ,Mood ,Cohort ,Observational study ,Course ,business ,Cohort study ,RC321-571 - Abstract
Background and rationale Although it has been suggested that pregnancy may influence the course of bipolar disorder (BD), studies show contradictory results. Until now, no studies included a finegrained validated method to report mood symptoms on a daily basis, such as the lifechart method (LCM). The aim of the present study is to investigate the course of BD during pregnancy by comparing LCM scores of pregnant and non-pregnant women. Methods Study design: Comparison of LCM scores of two prospective observational BD cohort studies, a cohort of pregnant women (n = 34) and a cohort of non-pregnant women of childbearing age (n = 52). Main study parameters are: (1) proportions of symptomatic and non-symptomatic days; (2) symptom severity, frequency, and duration of episodes; (3) state sequences, longitudinal variation of symptom severity scores. Results No differences in clinical course variables (symptomatic days, average severity scores, frequency, and duration of episodes in BD were found between pregnant and non-pregnant women. With a combination of State Sequence Analysis (SSA) and cluster analysis on the sequences of daily mood scores three comparable clusters were found in both samples: euthymic, moderately ill and severely ill. The distribution differences between pregnant and non-pregnant women were significant, with a majority of the pregnant women (68%) belonging to the moderately ill cluster and a majority of the non-pregnant women (46%) to the euthymic cluster. In pregnant women the average daily variation in mood symptoms as assessed with Shannon’s entropy was less than in non-pregnant women (respectively 0.43 versus 0.56). Conclusions Although the use of daily mood scores revealed no difference in overall course of BD in pregnant versus non-pregnant women, more pregnant than non-pregnant women belonged to the moderately ill cluster, and during pregnancy the variation in mood state was less than in non-pregnant women. Further research is necessary to clarify these findings.
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- 2021
16. Complications and Healthcare Consumption of Pregnant Women with a Migrant Background:Could There be an Association with Psychological Distress?
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Hanna M. Heller, Annemijn V. R. de Vries, Adriaan W. Hoogendoorn, Fedde Scheele, Willem J. Kop, Christianne J. M. de Groot, Adriaan Honig, Birit F. P. Broekman, Medical and Clinical Psychology, Psychiatry, APH - Mental Health, Obstetrics and gynaecology, APH - Methodology, IOO, Other Research, and Amsterdam Reproduction & Development (AR&D)
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Transients and Migrants ,Epidemiology ,Public Health, Environmental and Occupational Health ,Parturition ,Obstetrics and Gynecology ,Psychological Distress ,Cohort Studies ,Pregnancy Complications ,Pregnancy Complications/epidemiology ,Pregnancy ,Pediatrics, Perinatology and Child Health ,Humans ,Female ,Pregnant Women ,Pregnant Women/psychology ,Delivery of Health Care - Abstract
Objective Previous studies reported less prenatal healthcare consumption and more perinatal complications in women with a migrant background. Hence, we investigated in a country with free healthcare access whether women with a migrant background differed with respect to pregnancy complications, healthcare consumption and in terms of associations with psychological distress in comparison to native Dutch. Methods We included 324 native Dutch and 303 women with a migrant background, who visited two hospitals in Amsterdam for antenatal care between 2014 and 2015. Participants completed the Edinburgh Postnatal Depression Scale, the Hospital Depression and Anxiety Scale, and sociodemographic questions. Complications and healthcare consumption during pregnancy were extracted from medical records. Regression analyses were used with adjustment for covariates. Results Except for gestational diabetes [adjusted OR = 3.09; 95% CI = (1.51, 6.32)], no differences were found between groups in perinatal complications [OR = 1.15; 95% CI = (0.80, 1.64)], nor in healthcare consumption [OR = 0.87; 95% CI = (0.63, 1.19)]. Women with a migrant background reported more depressive symptoms [Cohen’s d = 0.25; 95% CI = (0.10, 0.41)], even after adjustment for socio-economic factors. Psychological distress was associated with more hospital admissions during pregnancy. When experiencing depressive symptoms, women with a migrant background had an increased risk to be admitted [OR = 1.11; 95% CI = (1.01, 1.21)]. Conclusions for Practice This cohort study found no differences in pregnancy-related complications, except for diabetes, nor different healthcare consumption, in women with a migrant background versus native Dutch, in a country with free health care access. However, women with a migrant background experienced more depressive symptoms, and when depressed their risk for hospital admission increased. Additional research is warranted to improve healthcare for this population.
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- 2022
17. Validation of Two Screening Tools for Anxiety in Hemodialysis Patients
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Els Nadort, Noëlle J. K. van Geenen, Robbert W. Schouten, Rosa E. Boeschoten, Prataap Chandie Shaw, Louis Jean Vleming, Marcel Schouten, Karima Farhat, Friedo W. Dekker, Patricia van Oppen, Carl E. H. Siegert, Birit F. P. Broekman, Psychiatry, APH - Mental Health, Internal medicine, and Amsterdam Neuroscience - Compulsivity, Impulsivity & Attention
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mass screening ,anxiety disorders ,renal dialysis ,Medicine (miscellaneous) - Abstract
Background: Symptoms of anxiety are often unrecognized and untreated in dialysis patients. We investigated the diagnostic accuracy of two widely used screening tools for anxiety in hemodialysis patients. Methods: For this cross-sectional validation study, chronic hemodialysis patients from eight dialysis centers in the Netherlands were included. The Beck Anxiety Inventory (BAI) and Hospital Anxiety and Depression Scale—Anxiety subscale (HADS-A) were validated by the Mini International Neuropsychiatric Inventory (MINI) diagnostic interview. Receiver operating characteristic curves were used to determine the optimal cut-off values. Results: Of 65 participants, 13 (20%) were diagnosed with one or more anxiety disorders on the MINI, of which 5 were included in the analysis. ROC curves showed a good diagnostic accuracy of the BAI and HADS-A. The optimal cut-off value for the BAI was ≥13 (sensitivity 100%, specificity 85%) and for the HADS-A was ≥10 (sensitivity 80%, specificity 100%). Conclusions: Based on our limited data, both the BAI and the HADS-A seem to be valid screening instruments for anxiety in hemodialysis patients that can be used in routine dialysis care. The HADS-A consists of fewer items and showed fewer false-positive results than the BAI, which might make it more useful in clinical practice.
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- 2022
18. Trajectories of reported sleep duration associate with early childhood cognitive development
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Shirong Cai, Elaine Kwang Hsia Tham, Hai-Yan Xu, Xiuju Fu, Rick Siow Mong Goh, Peter D Gluckman, Yap-Seng Chong, Fabian Yap, Lynette Pei-chi Shek, Oon Hoe Teoh, Joshua J Gooley, Daniel Yam-Thiam Goh, Michael J Meaney, Nora Schneider, Anne Rifkin-Graboi, and Birit F P Broekman
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Physiology (medical) ,Neurology (clinical) - Abstract
Study Objectives Examine how different trajectories of reported sleep duration associate with early childhood cognition. Methods Caregiver-reported sleep duration data (n = 330) were collected using the Brief Infant Sleep Questionnaire at 3, 6, 9, 12, 18, and 24 months and Children’s Sleep Habits Questionnaire at 54 months. Multiple group-based day-, night-, and/or total sleep trajectories were derived—each differing in duration and variability. Bayley Scales of Infant and Toddler Development-III (Bayley-III) and the Kaufman Brief Intelligence Test- 2 (KBIT-2) were used to assess cognition at 24 and 54 months, respectively. Results Compared to short variable night sleep trajectory, long consistent night sleep trajectory was associated with higher scores on Bayley-III (cognition and language), while moderate/long consistent night sleep trajectories were associated with higher KBIT-2 (verbal and composite) scores. Children with a long consistent total sleep trajectory had higher Bayley-III (cognition and expressive language) and KBIT-2 (verbal and composite) scores compared to children with a short variable total sleep trajectory. Moderate consistent total sleep trajectory was associated with higher Bayley-III language and KBIT-2 verbal scores relative to the short variable total trajectory. Children with a long variable day sleep had lower Bayley-III (cognition and fine motor) and KBIT-2 (verbal and composite) scores compared to children with a short consistent day sleep trajectory. Conclusions Longer and more consistent night- and total sleep trajectories, and a short day sleep trajectory in early childhood were associated with better cognition at 2 and 4.5 years.
- Published
- 2022
19. Experiences with Family Planning amongst Persons with Mental Health Problems: A Nationwide Patient Survey
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Noralie N. Schonewille, Monique J. M. van den Eijnden, Nini H. Jonkman, Anne A. M. W. van Kempen, Maria G. van Pampus, Francisca G. Goedhart, Odile A. van den Heuvel, Birit F. P. Broekman, Anatomy and neurosciences, Psychiatry, Amsterdam Neuroscience - Compulsivity, Impulsivity & Attention, Amsterdam Neuroscience - Neurodegeneration, and APH - Mental Health
- Subjects
childlessness ,taboo ,parenting ,Health, Toxicology and Mutagenesis ,Public Health, Environmental and Occupational Health ,family planning ,unintended pregnancies ,psychiatry ,mental health ,sexuality - Abstract
High rates of unintended pregnancies in patients with mental health problems reflect the unmet need for tailored family planning. This study aims to explore aspects of family planning that are especially challenging for patients experiencing health problems by obtaining the perspective of (former) patients and those with close relationships with the (former) patients. In August 2021, members of a Dutch national mental health panel, consisting of (former) patients and close ones, were invited to respond to a 34-question online survey that included questions on four domains: reproductive history, decision making, parenting, and sexuality. This study has revealed the severe and adverse impact of mental health problems across all of the four domains of reproductive health and family planning, which the questions specifically targeted. Based on these results, we recommend discussing family planning with all patients experiencing or at risk for mental health problems and their partners. These discussions should address a desire to have children, (involuntary) childlessness, uncertainties about parenting and sexuality, while remaining considerate of experienced taboos.
- Published
- 2023
20. Treatment of current depressive symptoms in dialysis patients: A systematic review and meta-analysis
- Author
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Carl E.H. Siegert, Robbert W. Schouten, Birit F. P. Broekman, Adriaan Honig, Patricia van Oppen, Els Nadort, and Simon H.S. Witte
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Population ,Psychological intervention ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Renal Dialysis ,law ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,education ,Dialysis ,Depression (differential diagnoses) ,education.field_of_study ,Intention-to-treat analysis ,Depression ,business.industry ,030227 psychiatry ,Psychotherapy ,Psychiatry and Mental health ,Strictly standardized mean difference ,Meta-analysis ,business ,Selective Serotonin Reuptake Inhibitors - Abstract
Objective: Symptoms of depression are highly prevalent and undertreated in dialysis patients. To aid clinicians in offering treatment to patients with depression, we conducted a systematic review and meta-analysis on the treatment of current depressive symptoms in dialysis patients. Methods: Nine databases were searched on January 8th 2020 for randomized controlled trials on the treatment of depressive symptoms in dialysis patients. In contradiction to previous reviews, we only included studies who selected patients with a score above a defined cut-off for depressive symptoms and used an inactive control group, to investigate the effectiveness of treatments in currently depressed patients. All interventions aimed to treat depressive symptoms were accepted for inclusion. Standardized mean differences were calculated in a random effect meta-analysis. Results: Seventeen studies were included in the systematic review (1640 patients). Nine studies could be included in the meta-analysis. A pooled analysis of 7 studies on psychotherapy showed a standardized mean difference of −0.48 [−0.87; −0.08], with a moderate heterogeneity (I2 = 52%, X2 = 12.56, p = .05). All studies on psychotherapy performed a per protocol analysis and scored high on potential bias. A pooled analysis of two studies on SSRI's showed no statistically significant improvement of depressive symptoms (SMD −0.57 [−6.17; 5.02], I2 = 71%, X2 = 0.2474, p = .06). Conclusions: Psychotherapy is a promising treatment for currently depressed dialysis patients, although quality of evidence is low. More evidence is needed regarding the efficacy of SSRI's, exercise therapy and dietary supplements in this population. PROSPERO: CRD42018073969
- Published
- 2020
21. Association of a Family Integrated Care Model with Paternal Mental Health Outcomes during Neonatal Hospitalization
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Nicole R. van Veenendaal, Sophie R. D. van der Schoor, Birit F. P. Broekman, Femke de Groof, Henriette van Laerhoven, Maartje E. N. van den Heuvel, Judith J. M. Rijnhart, J. Hans B. van Goudoever, Anne A. M. W. van Kempen, Pediatrics, Pediatric surgery, Psychiatry, APH - Mental Health, Epidemiology and Data Science, Graduate School, General Paediatrics, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ARD - Amsterdam Reproduction and Development, and Neonatology
- Subjects
Adult ,Male ,Parents ,Research ,Infant, Newborn ,General Medicine ,Pediatrics ,Cohort Studies ,Online Only ,Fathers ,Treatment Outcome ,Patient Education as Topic ,Professional-Family Relations ,Intensive Care Units, Neonatal ,Infant Care ,Humans ,Family Therapy ,Female ,Prospective Studies ,Parent-Child Relations ,Infant, Premature ,Original Investigation - Abstract
Key Points Question Is there an association between the neonatal care setting—a family integrated care (FICare) model in single family rooms with complete couplet-care for the mother-newborn dyad vs standard neonatal care in open bay units—and mental health and participation outcomes among fathers of preterm newborns? Findings In this cohort study of 263 fathers, fathers in the FICare model perceived less stress and participated more in caring for their newborns compared with those in standard care. Participation mediated the beneficial association of the FICare model on fathers’ depressive symptoms and parent-newborn bonding. Meaning These findings suggest that supporting fathers to actively participate in all aspects of care of preterm newborns should be encouraged regardless of the neonatal unit’s architectural design., This cohort study examines the association of a family integrated care model vs standard neonatal care with mental health outcomes among fathers of preterm neonates., Importance During newborn hospitalization in the neonatal unit, fathers often feel anxious and excluded from their child’s caregiving and decision-making. Few studies and interventions have focused on fathers’ mental health and their participation in neonatal care. Objective To study the association of a family integrated care (FICare) model (in single family rooms with complete couplet-care for the mother-newborn dyad) vs standard neonatal care (SNC) in open bay units with separate maternity care with mental health outcomes in fathers at hospital discharge of their preterm newborn and to study whether parent participation was a mediator of the association of the FICare model on outcomes. Design, Setting, and Participants This prospective, multicenter cohort study was conducted from May 2017 to January 2020 as part of the fAMily Integrated Care in the Neonatal Ward Study, at level-2 neonatal units in the Netherlands (1 using the FICare model and 2 control sites using SNC). Participants included fathers of preterm newborns admitted to participating units. Data analysis was performed from January to April 2021. Exposure FICare model in single family rooms with complete couplet-care for the mother-newborn dyad during maternity and/or neonatal care. Main Outcomes and Measures Paternal mental health was measured using the Parental Stress Scale: NICU, Hospital Anxiety and Depression Scale, Post-partum Bonding Questionnaire, Perceived (Maternal) Parenting Self-efficacy Scale, and satisfaction with care (EMpowerment of PArents in THe Intensive Care–Neonatology). Parent participation (CO-PARTNER tool) was assessed as a potential mediator of the association of the FICare model with outcomes with mediation analyses (prespecified). Results Of 309 families included in the fAMily Integrated Care in the Neonatal Ward Study, 263 fathers (85%) agreed to participate; 126 fathers were enrolled in FICare and 137 were enrolled in SNC. In FICare, 89 fathers (71%; mean [SD] age, 35.1 [4.8] years) responded to questionnaires and were analyzed. In SNC, 93 fathers (68%; mean [SD] age, 36.4 [5.5] years) responded to questionnaires and were analyzed. Fathers in FICare experienced less stress (adjusted β, −10.02; 95% CI, −15.91 to −4.13; P = .001) and had higher participation scores (adjusted odds ratio, 3.424; 95% CI, 0.860 to 5.988; P = .009) compared with those in SNC. Participation mediated the beneficial association of the FICare model with fathers’ depressive symptoms (indirect effect, −0.051; 95% CI, −0.133 to −0.003) and bonding with their newborns (indirect effect, −0.082; 95% CI, −0.177 to −0.015). Conclusions and Relevance These findings suggest that the FICare model is associated with decreased paternal stress at discharge and enables fathers to be present and participate more than SNC, thus improving paternal mental health. Supporting fathers to actively participate in all aspects of newborn care should be encouraged regardless of architectural design of the neonatal unit.
- Published
- 2022
22. Fear of childbirth in pregnancy was not increased during the COVID-19 pandemic in the Netherlands: a cross-sectional study
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Sanne J. M. Zilver, Yvette M. G. A. Hendrix, Birit F. P. Broekman, Robert A. de Leeuw, Christianne J. M. de Groot, Maria G. van Pampus, Psychiatry, APH - Mental Health, Obstetrics and gynaecology, Amsterdam Reproduction & Development, and Amsterdam Reproduction & Development (AR&D)
- Subjects
Adult ,Adolescent ,Cesarean Section ,Parturition ,Obstetrics and Gynecology ,COVID-19 ,General Medicine ,Fear ,Cross-Sectional Studies ,Pregnancy ,Surveys and Questionnaires ,Humans ,Female ,Pregnant Women ,Pandemics ,reproductive and urinary physiology ,Netherlands - Abstract
Introduction: Fear of childbirth is a well-known problem during pregnancy and can have implications for childbirth, including prolonged labor, use of epidural analgesia, obstetric complications, presence of traumatic stress symptoms, or request for an elective cesarean section. The coronavirus disease 2019 (COVID-19) pandemic has affected mental health and therefore could have increased fear of childbirth during the pandemic. The aim of this study was to investigate fear of childbirth during the pandemic in the Netherlands compared with a reference group from before the pandemic. Material and methods: We conducted a cross-sectional study to evaluate pregnant women during the first and second waves of COVID-19 compared with both each other and with pregnant women from before the pandemic. Participants were recruited through social media platforms, hospitals, and midwifery practices. Pregnant women aged ≥18 years who had mastered the Dutch language were eligible to participate. Fear of childbirth was measured with the Wijma Delivery Expectancy Questionnaire online using a cut-off score of ≥85 to indicate clinically relevant fear of childbirth. The primary outcome was the prevalence of fear of childbirth. We undertook additional analyses to specifically look at possible effect modification. Results: In total, 1102 pregnant women completed the questionnaire during the first wave of the pandemic, 731 during the second wave, and 364 before the pandemic. Fear of childbirth was present in 10.6%, 11.4%, and 18.4%, respectively. We considered possible effect modification, which indicated that age and parity had a significant influence. In participants during the first wave of COVID-19, nulliparous women had significantly lower odds (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.34–0.73; p < 0.01) of having a fear of childbirth than did the reference group. Both younger participants in the first wave (OR 0.59; 95% CI 0.37–0.93; p < 0.05) and older participants in the first wave (OR 0.44; 95% CI 0.28–0.71; p < 0.01) and the second wave (OR 0.36; 95% CI 0.21–0.62; p < 0.01) of COVID-19 had lower odds of fear of childbirth than the reference group. Conclusions: Pregnant women during the first and second waves of COVID-19 had lower fear of childbirth scores than pregnant women before the pandemic, indicating less fear of childbirth during the pandemic. This could be explained by an increased level of information, more time to consume information, and better work–life balance with more people working at home during the pandemic.
- Published
- 2022
23. The association between maternal stress and glucocorticoid rhythmicity in human milk
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Michelle Romijn, Birit F. P. Broekman, Martijn J J Finken, Joost Rotteveel, Luca J. L. van Tilburg, Koert M. Dolman, Bibian van der Voorn, Jonneke J. Hollanders, Paul de Goede, Annemieke C. Heijboer, Pediatrics, Endocrinology Laboratory, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Pediatric surgery, Laboratory Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Reproduction & Development (AR&D), Psychiatry, and APH - Mental Health
- Subjects
Adult ,Saliva ,Breast milk ,Hypothalamus–pituitary–adrenal axis ,Hydrocortisone ,Physiology ,Mothers ,030209 endocrinology & metabolism ,Article ,03 medical and health sciences ,0302 clinical medicine ,fluids and secretions ,Pregnancy ,Medicine ,Outpatient clinic ,Humans ,Chronic stress ,TX341-641 ,Circadian rhythm ,Glucocorticoids ,Glucocorticoid rhythm ,Nutrition and Dietetics ,Milk, Human ,Psychopathology ,business.industry ,Nutrition. Foods and food supply ,Area under the curve ,Circadian Rhythm ,Female ,Pregnant Women ,business ,030217 neurology & neurosurgery ,Glucocorticoid ,Stress, Psychological ,Food Science ,medicine.drug - Abstract
Background: Chronic stress is often accompanied by alterations in the diurnal rhythm of hypothalamus–pituitary–adrenal activity. However, there are limited data on the diurnal rhythmicity of breast milk glucocorticoids (GCs) among women with psychological distress. We compared mothers who sought consultation at an expertise center for pregnant women with an increased risk of psychological distress with control mothers for GC diurnal rhythmicity in milk and saliva obtained at the same time. Methods: We included 19 mothers who sought consultation at the psychiatry–obstetric–pediatric (POP) outpatient clinic and 44 control mothers. One month postpartum, mothers collected on average eight paired milk and saliva samples during a 24 h period. GC levels were measured using liquid chromatography–tandem mass spectrometry. GC rhythmicity parameters were determined with specialized software. Results: For both milk and saliva, no group differences regarding GC rhythms were found. Milk cortisol area under the curve with respect to the ground was lower in the POP group than in the control group (p = 0.02). GC levels in human milk and saliva were highly correlated within each group (p <, 0.001). Conclusion: Although there were no differences between groups in GC rhythmicity, the total amount of milk cortisol was lower in the POP group. Long-term follow-up is needed to address the impact of vertical transmission of breast milk GCs.
- Published
- 2021
24. Understanding the Link Between Allergy and Neurodevelopmental Disorders: A Current Review of Factors and Mechanisms
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Regena Xin Yi Chua, Michelle Jia Yu Tay, Delicia Shu Qin Ooi, Kewin Tien Ho Siah, Elizabeth Huiwen Tham, Lynette Pei-Chi Shek, Michael J. Meaney, Birit F. P. Broekman, and Evelyn Xiu Ling Loo
- Subjects
Allergy ,autism spectral disorder ,Review ,Bioinformatics ,medicine.disease_cause ,lcsh:RC346-429 ,Neurodevelopmental disorder ,mental disorders ,medicine ,Microbiome ,attention deficit and hyperactivity disorder ,lcsh:Neurology. Diseases of the nervous system ,mechanisms ,business.industry ,Immune dysregulation ,medicine.disease ,Comorbidity ,neurodevelopmental disorder ,allergic disease ,Neurology ,Autism spectrum disorder ,Anxiety ,Neurology (clinical) ,medicine.symptom ,business ,Dysbiosis - Abstract
Both allergic diseases and neurodevelopmental disorders are non-communicable diseases (NCDs) that not only impact on the quality of life and but also result in substantial economic burden. Immune dysregulation and inflammation are typical hallmarks in both allergic and neurodevelopmental disorders, suggesting converging pathophysiology. Epidemiological studies provided convincing evidence for the link between allergy and neurodevelopmental diseases such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Possible factors influencing the development of these disorders include maternal depression and anxiety, gestational diabetes mellitus, maternal allergic status, diet, exposure to environmental pollutants, microbiome dysbiosis, and sleep disturbances that occur early in life. Moreover, apart from inflammation, epigenetics, gene expression, and mitochondrial dysfunction have emerged as possible underlying mechanisms in the pathogenesis of these conditions. The exploration and understanding of these shared factors and possible mechanisms may enable us to elucidate the link in the comorbidity.
- Published
- 2021
25. Network Analyses of Maternal Pre- and Post-Partum Symptoms of Depression and Anxiety
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Desiree Y. Phua, Helen Chen, Yap Seng Chong, Peter D. Gluckman, Birit F. P. Broekman, Michael J. Meaney, Psychiatry, and APH - Mental Health
- Subjects
medicine.medical_specialty ,bridging symptoms ,lcsh:RC435-571 ,Psychological intervention ,03 medical and health sciences ,0302 clinical medicine ,positive mental health ,lcsh:Psychiatry ,Medicine ,Childbirth ,maternal psychopathology ,Depression (differential diagnoses) ,perinatal ,Original Research ,Psychiatry ,child development ,Pregnancy ,business.industry ,Public health ,medicine.disease ,Child development ,Mental health ,030227 psychiatry ,Psychiatry and Mental health ,Anxiety ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Background: Maternal mental health problems often develop prenatally and predict post-partum mental health. However, the circumstances before and following childbirth differ considerably. We currently lack an understanding of dynamic variation in the profiles of depressive and anxiety symptoms over the perinatal period. Methods: Depressive and anxiety symptoms were self-reported by 980 women at 26-week pregnancy and 3 months post-partum. We used network analysis of depressive and anxiety symptoms to investigate if the symptoms network changed during and after pregnancy. The pre- and post-partum depressive-anxiety symptom networks were assessed for changes in structure, unique symptom-symptom interactions, central and bridging symptoms. We also assessed if central symptoms had stronger predictive effect on offspring’s developmental outcomes outcomes at birth and 24, 54, and 72 months old than non-central symptoms. Bridging symptoms between negative and positive mental health were also assessed. Results: Though the depressive-anxiety network structures were stable during and after pregnancy, the post-partum network was more strongly connected. The central depressive-anxiety symptoms were also different between prenatal and post-partum networks. During pregnancy, central symptoms were mostly related to feeling worthless or useless; after pregnancy, central symptoms were mostly related to feeling overwhelmed or being punished. Central symptoms during pregnancy were associated with poorer developmental outcomes for the child. Anxiety symptoms were strongest bridging symptoms during and after pregnancy. The interactions between negative and positive mental health symptoms were also different during and after pregnancy. Conclusions: The differences between pre- and post-partum networks suggest that the presentation of maternal mental health problems varies over the peripartum period. This variation is not captured by traditional symptom scale scores. The bridging symptoms also suggest that anxiety symptoms may precede the development of maternal depression. Interventions and public health policies should thus be tailored to specific pre- and post-partum symptom profiles.
- Published
- 2020
26. General hospital specialists’ attitudes toward psychiatry: a cross-sectional survey in seven countries
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Victoria de Carvalho Pereira, Jane McCarthy, David B Menkes, Alexander Kursakov, Birit F P Broekman, Doron Amsalem, Xiaoping Wang, Klaas Nauta, Alexander Merkin, Jun Wang, Clarissa de Rosalmeida Dantas, I Wimalaratne, Anuprabha Wickramasinghe, Raz Gross, S.T. Kathriarachchi, Psychiatry, APH - Mental Health, Public and occupational health, Hematology laboratory, and VU University medical center
- Subjects
Male ,medicine.medical_specialty ,Referral ,Attitude of Health Personnel ,Cross-sectional study ,health services administration & management ,Specialty ,Hospitals, General ,Affect (psychology) ,General Practitioners ,Surveys and Questionnaires ,Acute care ,medicine ,Humans ,Seniority ,Psychiatry ,Chronic care ,business.industry ,General Medicine ,education & training (see medical education & training) ,Mental Health ,Cross-Sectional Studies ,Medicine ,Female ,Descriptive research ,business - Abstract
ObjectivePsychiatric comorbidities are common in physical illness and significantly affect health outcomes. Attitudes of general hospital doctors toward psychiatry are important as they influence referral patterns and quality of care. Little is known about these attitudes and their cultural correlates. The aim of this study was to identify attitudes toward psychiatry among general hospital specialists in relation to culture of the practice setting and other clinician factors (gender, age, seniority and specialty).MethodsA cross-sectional, descriptive study was carried out in seven countries (New Zealand, China, Sri Lanka, Russia, Israel, Brazil, the Netherlands). Data were collected from senior medical staff of various disciplines using an updated version of Mayou and Smith’s (1986) self-administered questionnaire.ResultsA total of 889 hospital doctors participated. While favourable attitudes toward both psychiatric consultation and management were endorsed by a majority, significant differences were also observed between countries. Subgroup differences were mostly confined to gender, acuity of practice setting and specialty. For example, female doctors in Russia (χ2=7.7, p=0.0056), China (χ2=9.2, p=0.0025) and the Netherlands (χ2=5.7, p=0.0174) endorsed more positive attitudes compared with their male counterparts, but this gender effect was not replicated in the total sample. Chronic care specialists were overall more inclined to manage patients’ emotional problems compared with those working in acute care (χ2=70.8, p (adjusted)ConclusionsThis study adds to evidence for the association of medical attitudes with individual clinician factors and demonstrates that the influence of these factors varies by country. Understanding these issues may help to overcome barriers and improve quality of care provided to general hospital patients.
- Published
- 2021
27. Neonatal neural networks predict children behavioral profiles later in life
- Author
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Chong-Yaw, Wee, Ta Anh, Tuan, Birit F P, Broekman, Min Yee, Ong, Yap-Seng, Chong, Kenneth, Kwek, Lynette Pei-Chi, Shek, Seang-Mei, Saw, Peter D, Gluckman, Marielle V, Fortier, Michael J, Meaney, and Anqi, Qiu
- Subjects
Male ,Brain Mapping ,Models, Statistical ,Support Vector Machine ,Models, Neurological ,Brain ,Child Behavior ,Gestational Age ,Nerve Fibers, Myelinated ,Diffusion Tensor Imaging ,Child, Preschool ,Neural Pathways ,Image Processing, Computer-Assisted ,Humans ,Female ,Research Articles - Abstract
This study aimed to examine heterogeneity of neonatal brain network and its prediction to child behaviors at 24 and 48 months of age. Diffusion tensor imaging (DTI) tractography was employed to construct brain anatomical network for 120 neonates. Clustering coefficients of individual structures were computed and used to classify neonates with similar brain anatomical networks into one group. Internalizing and externalizing behavioral problems were assessed using maternal reports of the Child Behavior Checklist (CBCL) at 24 and 48 months of age. The profile of CBCL externalizing and internalizing behaviors was then examined in the groups identified based on the neonatal brain network. Finally, support vector machine and canonical correlation analysis were used to identify brain structures whose clustering coefficients together significantly contribute the variation of the behaviors at 24 and 48 months of age. Four meaningful groups were revealed based on the brain anatomical networks at birth. Moreover, the clustering coefficients of the brain regions that most contributed to this grouping of neonates were significantly associated with childhood internalizing and externalizing behaviors assessed at 24 and 48 months of age. Specially, the clustering coefficient of the right amygdala was associated with both internalizing and externalizing behaviors at 24 months of age, while the clustering coefficients of the right inferior frontal cortex and insula were associated with externalizing behaviors at 48 months of age. Our findings suggested that neural organization established during fetal development could to some extent predict individual differences in behavioral‐emotional problems in early childhood. Hum Brain Mapp 38:1362–1373, 2017. © 2016 Wiley Periodicals, Inc.
- Published
- 2016
28. A suicidal pregnant patient's request for premature Cesarean section: Clinical and ethical challenges
- Author
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Claudia Chi, Yap Seng Chong, Eu Leong Yong, Le Ye Lee, Jia Ying Teng, Cornelia Yin Ing Chee, and Birit F. P. Broekman
- Subjects
Adult ,medicine.medical_specialty ,Poison control ,Suicide prevention ,Occupational safety and health ,Suicidal Ideation ,03 medical and health sciences ,0302 clinical medicine ,Borderline Personality Disorder ,Pregnancy ,Injury prevention ,medicine ,Humans ,Ethics, Medical ,030212 general & internal medicine ,Psychiatry ,Borderline personality disorder ,Suicidal ideation ,health care economics and organizations ,Depression (differential diagnoses) ,Depressive Disorder ,business.industry ,Cesarean Section ,Patient Preference ,medicine.disease ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Mood ,Female ,Pregnant Women ,medicine.symptom ,business - Abstract
We present the case of a 36-year-old lady with severe borderline personality disorder and depression, who made repeated requests for an immediate Cesarean section at 31 weeks of gestation. Her mood was extremely depressed and she had intense suicidal thoughts. She was worried that she would kill herself and the baby, therefore believing that early delivery would save the baby's life. This was a challenging case that required multidisciplinary collaboration, suicide risk assessment and detailed evaluation of mental capacity. The clinical and ethical dilemmas of this case are discussed by a team of psychiatrists, obstetricians and neonatologists.
- Published
- 2015
29. The influence of anxiety and depressive symptoms during pregnancy on birth size
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Birit F P, Broekman, Yiong-Huak, Chan, Yap-Seng, Chong, Kenneth, Kwek, Sung Sharon, Cohen, Charlotte Louise, Haley, Helen, Chen, Cornelia, Chee, Anne, Rifkin-Graboi, Peter D, Gluckman, Michael J, Meaney, and Seang-Mei, Saw
- Subjects
Adult ,Psychiatric Status Rating Scales ,Singapore ,Depression ,Infant, Newborn ,Mothers ,Gestational Age ,Anxiety ,Fetal Development ,Pregnancy Complications ,Asian People ,Pregnancy ,Risk Factors ,Surveys and Questionnaires ,Birth Weight ,Humans ,Female - Abstract
Mental health problems during pregnancy can influence fetal growth. However, studies examining the influence of maternal mental health across the normal range of birth outcomes are uncommon. This study examined the associations between symptoms of maternal depression and anxiety during pregnancy on birth size among term Asian infants.One thousand forty-eight Asian pregnant women from a cohort Growing Up in Singapore Towards Healthy Outcomes were recruited between 2009 to 2010 at two Singaporean maternity hospitals. At 26 weeks gestation, depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory II (BDI-II), and anxiety was measured with the Spielberger State-Trait Anxiety Inventory (STAI). Health personnel recorded birthweight, birthlength, gestational age, and head circumference at birth.Nine hundred forty-six women who delivered term infants had complete data. For this sample, the mean birthweight was 3146.6 g [standard deviation (SD) 399.0], the mean birthlength was 48.9 cm (SD 2.0). After controlling for several potential confounders, there was a significant negative association between STAI and birthlength [β = -0.248, confidence interval (CI) [-0.382, -0.115], P0.001] and a small negative association between EPDS and birthlength (β = -0.169, CI [-0.305, -0.033], P = 0.02). No associations were found between scores on the EPDS, BDI-II, and STAI with birthweight or head circumference.Our preliminary data suggest that among term infants, anxiety and depressive symptoms are not associated with birthweight, while anxiety and depressive symptoms are associated with a shorter birthlength.
- Published
- 2013
30. Stress, vulnerability and resilience, a developmental approach
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Birit F. P. Broekman and Psychiatry
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Biopsychosocial model ,cognition ,child development ,education.field_of_study ,media_common.quotation_subject ,Population ,medicine.disease ,Child development ,Mental health ,Stress disorders ,Nature versus nurture ,Developmental psychology ,behaviour ,Supplement 2, 2011 ,genotypes ,medicine ,Early childhood ,Psychological resilience ,Psychology ,education ,genes ,resilience ,Psychological trauma ,media_common ,PhD Summary - Abstract
Background: The origins of mental disorders arise often in childhood. Early life is a period of unique sensitivity with long lasting effects on mental health. However, the mechanisms for these effects remain unclear. Objective: This thesis describes a variety of studies using a developmental framework to promote greater understanding of the influence of nature (genotypes) and nurture (e.g., environmental risk and protective factors) on outcomes later in childhood. Method: The aim of this thesis is to investigate gene and environmental influences on behavioural, emotional, and cognitive outcomes in different samples from the Netherlands and Singapore, most derived from the general population. We assessed early life influences from a neurobiological, social, and a psychological perspective by using a biopsychosocial framework. Results: Our studies support the hypothesis that all experiences during life, including early experiences in utero, will influence the expression of genes and in the end the mental health of individuals. However, genotypes influencing stress responses are found to be ‘‘plastic,’’ which implies that they can be modulated by environmental experiences during life. In line with this, patterns of resilience are found to be contextdependent too. Conclusions: The model of ‘‘epigenetic programming’’ suggests the predictive power of the environment in utero and early childhood on mental health later in life. This association is probably determined by a neurodevelopmental pathway with individual differences in neural and endocrine responses to stress. Keywords: Stress disorders; genes; genotypes; resilience; cognition; behaviour; child development Mentors: Prof. Dr. F. Boer (The Bascule, Academic Medical Center, Amsterdam), Prof. Dr. Michael Meaney (Douglas Institute, McGill University, Montreal), Prof. Dr. M. Olff (center for psychological trauma, Academic Medical Centre, Amsterdam). Theses defended in Amsterdam, the Netherlands, October 14, 2011. (Published: 15 October 2011) Citation: European Journal of Psychotraumatology 2011, 2 : 7229 - DOI: 10.3402/ejpt.v2i0.7229
- Published
- 2011
31. The psychological impact of an adenoidectomy and adenotonsillectomy on young children
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Birit F. P. Broekman, Bas J.N. Schreuder, Frits Boer, Miranda Olff, Wytske Fokkens, Frédérique M.L. Tan, Psychiatry, APH - Mental Health, Amsterdam Neuroscience, Amsterdam Public Health, Adult Psychiatry, Amsterdam institute for Infection and Immunity, Ear, Nose and Throat, and Child Psychiatry
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Male ,Sleep Wake Disorders ,Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,media_common.quotation_subject ,Child Behavior Disorders ,Severity of Illness Index ,Adenoidectomy ,Cohort Studies ,Stress Disorders, Post-Traumatic ,Surveys and Questionnaires ,Severity of illness ,Medicine ,Humans ,Prospective Studies ,Vagal tone ,Prospective cohort study ,Temperament ,Nose ,media_common ,Tonsillectomy ,Response rate (survey) ,business.industry ,Infant ,General Medicine ,medicine.anatomical_structure ,Otorhinolaryngology ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,Cohort study - Abstract
Objective: Children react differently to surgeries. The purpose of this study is to examine the stress response in young children after an adenoidectomy and adenotonsillectomy, and whether child characteristics of behavioural and neurophysiological nature can predict this stress response. Methods: In this prospective cohort study 43 children, aged 2-7 years, scheduled for adenoidectomy or adenoitonsillectomy (response rate 43%) were recruited from the Ear, Nose and Throat Department of the Academic Medical Centre in Amsterdam, the Netherlands. Parents completed questionnaires about temperament 4 weeks before surgery, about behaviour and sleeping problems 4 weeks before and 6 weeks after surgery, and about posttraumatic stress symptoms 6 weeks after surgery. Neurophysiological measurements (cortisol and Respiratory Sinus Arrhythmia) were performed 4 weeks before, directly after and 6 weeks after surgery. Results were compared with a control group of healthy children. The data was analysed with paired t-tests and one-way repeated ANOVA. Results: Most children with an indication for an adenoidectomy and adenotonsillectomy had more behavioural and emotional problems before surgery then the control group. After surgery there was an improvement in behaviour and sleep, in respectively 75% and 68% of the children, especially in boys. Posttraumatic stress symptoms were rare. Emotional temperament was associated with more behavioural problems before surgery (r = 0.53, P = 0.02), after surgery (r = 0.38, P
- Published
- 2010
32. The influence of birth size on intelligence in healthy children
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Birit F. P. Broekman, Daniel Fung, Swee-Chye Quek, Michael J. Meaney, Yoon Phaik Ooi, Tien Yin Wong, Yen Ling Low, Yap Seng Chong, Peter D. Gluckman, Seang-Mei Saw, and Yiong-Huak Chan
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Male ,Cephalometry ,Birth weight ,Intelligence ,Statistics as Topic ,Gestational Age ,Cohort Studies ,Raven's Progressive Matrices ,Reference Values ,Medicine ,Birth Weight ,Humans ,Child ,Pregnancy ,Singapore ,Intelligence quotient ,business.industry ,Confounding ,Infant, Newborn ,Gestational age ,medicine.disease ,Health Surveys ,Body Height ,Pediatrics, Perinatology and Child Health ,Cohort ,Female ,business ,Infant, Premature ,Demography ,Cohort study - Abstract
OBJECTIVE. Birth parameters have been hypothesized to have an influence on IQ. However, studies within the range of normal birth size have been sparse. With this study we examined the associations between birth length, birth weight, head circumference, and gestational age within the normal birth size range in relation to childhood IQ in Asian children. METHODS. A cohort of 1979 of 2913 Asian children aged 7 to 9 years, recruited from 3 schools in Singapore, were followed yearly from 1999 onward. Birth parameters were recorded by health personnel. Childhood IQ was measured with the Raven's Standard Progressive Matrices at ages 8 to 12. RESULTS. The mean IQ score across the sample (n = 1645) was 114.2. After controlling for multiple confounders for every 1-cm increment in birth length, 1 kg in birth weight, or 1 cm in head circumference, there was a corresponding increase in IQ of 0.49 points (P for trend < .001), 2.19 points (P for trend = .007) and .62 points (P for trend = .003), respectively. These associations persisted even after exclusion of premature children and children with extreme weights and head circumferences. CONCLUSIONS. Longer birth length, higher birth weight, or larger head circumferences within the normal birth size range are associated with higher IQ scores in Asian children. Our results suggest that antenatal factors reflected in altered rates of growth but within the normative range of pregnancy experiences play a role in generating cognitive potential. This has implications for targeting early intervention and preventative programs.
- Published
- 2009
33. The genetic background to PTSD
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Frits Boer, Miranda Olff, and Birit F. P. Broekman
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Candidate gene ,medicine.medical_specialty ,Serotonin ,Cognitive Neuroscience ,Dopamine ,MEDLINE ,Nerve Tissue Proteins ,Stress Disorders, Post-Traumatic ,Behavioral Neuroscience ,Receptors, Glucocorticoid ,Neurotrophic factors ,mental disorders ,medicine ,Humans ,Neuropeptide Y ,Psychiatry ,gamma-Aminobutyric Acid ,Genetic association ,Brain-derived neurotrophic factor ,Neurotransmitter Agents ,Brain-Derived Neurotrophic Factor ,Brain ,Membrane Transport Proteins ,medicine.disease ,Posttraumatic stress ,Neuropsychology and Physiological Psychology ,Apolipoproteins ,Endophenotype ,Psychology ,Anxiety disorder - Abstract
Although extensive research has already been done on the genetic bases of psychiatric disorders, little is known about polygenetic influences in posttraumatic stress disorder (PTSD). This article reviews molecular genetic studies relating to PTSD that were found in a literature search in Medline, Embase and Web of Science. Association studies have investigated 8 major genotypes in connection with PTSD. They have tested hypotheses involving key candidate genes in the serotonin (5-HTT), dopamine (DRD2, DAT), glucocorticoid (GR), GABA (GABRB), apolipoprotein systems (APOE2), brain-derived neurotrophic factor (BDNF) and neuropeptide Y (NPY). The studies have produced inconsistent results, many of which may be attributable to methodological shortcomings and insufficient statistical power. The complex aetiology of PTSD, for which experiencing a traumatic event forms a necessary condition, makes it difficult to identify specific genes that substantially contribute to the disorder. Gene-finding strategies are difficult to apply. Interactions between different genes and between them and the environment probably make certain people vulnerable to developing PTSD. Gene-environmental studies are needed that focus more narrowly on specific, distinct endophenotypes and on influences from environmental factors.
- Published
- 2007
34. The course of bipolar disorder in pregnant versus non-pregnant women
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Anja W. M. M. Stevens, Stasja Draisma, Peter J. J. Goossens, Birit F. P. Broekman, Adriaan Honig, Elise A. M. Knoppert-van der Klein, Willem A. Nolen, Robert M. Post, and R. W. Kupka
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Bipolar disorder ,Course ,Pregnancy ,Life chart method ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 ,Neurophysiology and neuropsychology ,QP351-495 - Abstract
Abstract Background and rationale Although it has been suggested that pregnancy may influence the course of bipolar disorder (BD), studies show contradictory results. Until now, no studies included a finegrained validated method to report mood symptoms on a daily basis, such as the lifechart method (LCM). The aim of the present study is to investigate the course of BD during pregnancy by comparing LCM scores of pregnant and non-pregnant women. Methods Study design: Comparison of LCM scores of two prospective observational BD cohort studies, a cohort of pregnant women (n = 34) and a cohort of non-pregnant women of childbearing age (n = 52). Main study parameters are: (1) proportions of symptomatic and non-symptomatic days; (2) symptom severity, frequency, and duration of episodes; (3) state sequences, longitudinal variation of symptom severity scores. Results No differences in clinical course variables (symptomatic days, average severity scores, frequency, and duration of episodes in BD were found between pregnant and non-pregnant women. With a combination of State Sequence Analysis (SSA) and cluster analysis on the sequences of daily mood scores three comparable clusters were found in both samples: euthymic, moderately ill and severely ill. The distribution differences between pregnant and non-pregnant women were significant, with a majority of the pregnant women (68%) belonging to the moderately ill cluster and a majority of the non-pregnant women (46%) to the euthymic cluster. In pregnant women the average daily variation in mood symptoms as assessed with Shannon’s entropy was less than in non-pregnant women (respectively 0.43 versus 0.56). Conclusions Although the use of daily mood scores revealed no difference in overall course of BD in pregnant versus non-pregnant women, more pregnant than non-pregnant women belonged to the moderately ill cluster, and during pregnancy the variation in mood state was less than in non-pregnant women. Further research is necessary to clarify these findings.
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- 2021
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35. The placental lipidome of maternal antenatal depression predicts socio-emotional problems in the offspring
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Gerard Wong, Jacquelyn M. Weir, Priti Mishra, Kevin Huynh, Brunda Nijagal, Varsha Gupta, Birit F. P. Broekman, Mary Foong-Fong Chong, Shiao-Yng Chan, Kok Hian Tan, Dedreia Tull, Malcolm McConville, Philip C. Calder, Keith M. Godfrey, Yap Seng Chong, Peter D. Gluckman, Michael J. Meaney, Peter J. Meikle, and Neerja Karnani
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Abstract While maternal mental health strongly influences neurodevelopment and health in the offspring, little is known about the determinants of inter-individual variation in the mental health of mothers. Likewise, the in utero biological pathways by which variation in maternal mental health affects offspring development remain to be defined. Previous studies implicate lipids, consistent with a known influence on cognitive and emotional function, but the relevance for maternal mental health and offspring neurodevelopment is unclear. This study characterizes the placental and circulatory lipids in antenatal depression, as well as socio-emotional outcomes in the offspring. Targeted liquid chromatography-mass spectrometry covering 470 lipid species was performed on placenta from 186 women with low (n = 70) or high (n = 116) levels of antenatal depressive symptoms assessed using the Edinburgh Postnatal Depression Scale at 26 weeks’ gestation. Child socio-emotional outcomes were assessed from the Child Behavior Check List (CBCL) at 48 months. Seventeen placental lipid species showed an inverse association with antenatal EPDS scores. Specifically, lower levels of phospholipids containing LC-PUFAs: omega-3 docosapentaenoic acid (DPA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and omega-6 arachidonic acid (AA) were significantly associated with depressive symptoms. Additional measurement of LC-PUFA in antenatal plasma samples at mid-gestation confirmed the reduced circulation of these specific fatty acids in mothers. Reduced concentration of the placental phospholipids also predicted poorer socio-emotional outcomes in the offspring. This study provides new insights into the role of the materno-fetal lipid cross-talk as a mechanism linking maternal mental health to that of the offspring. These findings show the potential utility of nutritional approaches among pregnant women with depressive symptoms to reduce offspring risk for later socio-emotional problems.
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- 2021
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36. Television viewing and child cognition in a longitudinal birth cohort in Singapore: the role of maternal factors
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Ramkumar Aishworiya, Shirong Cai, Helen Y. Chen, Desiree Y. Phua, Birit F. P. Broekman, Lourdes Mary Daniel, Yap Seng Chong, Lynette P. Shek, Fabian Yap, Shiao-Yng Chan, Michael J. Meaney, and Evelyn C. Law
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Television ,Screen time ,Media exposure ,Maternal mental health ,Maternal education ,Child cognition ,Pediatrics ,RJ1-570 - Abstract
Abstract Background Although infant media exposure has received attention for its implications on child development, upstream risk factors contributing to media exposure have rarely been explored. The study aim was to examine the relationship between maternal risk factors, infant television (TV) viewing, and later child cognition. Methods We used a prospective population-based birth cohort study, Growing Up in Singapore Towards healthy Outcomes (GUSTO), with 1247 pregnant mothers recruited in their first trimester. We first explored the relationship of infant TV exposure at 12 months and the composite IQ score at 4.5 years, as measured by the Kaufman Brief Intelligence Test, Second Edition (KBIT-2). Multivariable linear regressions were adjusted for maternal education, maternal mental health, child variables, birth parameters, and other relevant confounders. We then examined the associations of maternal risk factors with the amount of daily TV viewing of 12-month-old infants. Path analysis followed, to test a conceptual model designed a priori to test our hypotheses. Results The average amount of TV viewing at 12 months was 2.0 h/day (SD 1.9). TV viewing in hours per day was a significant exposure variable for composite IQ (ß = − 1.55; 95% CI: − 2.81 to − 0.28) and verbal IQ (ß = − 1.77; 95% CI: − 3.22 to − 0.32) at 4.5 years. Our path analysis demonstrated that lower maternal education and worse maternal mood (standardized ß = − 0.27 and 0.14, respectively, p 0.99, AIC 15249.82, RMSEA
- Published
- 2019
- Full Text
- View/download PDF
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