Achtsamkeitsbasierte Stressreduktion in der Schwangerschaft: ein App-basiertes Programm zur Verbesserung der Gesundheit von Müttern und Kindern (MINDFUL/PMI-Studie)

Zusammenfassung

Ungünstige intrauterine Umweltfaktoren erhöhen das Risiko für Geburtskomplikationen sowie postpartale Entwicklungs- und Verhaltensauffälligkeiten bei den Kindern und Jugendlichen mit permanenten Auswirkungen bis ins höhere Alter. Biomarkerstudien zeigen, dass mütterlicher Stress und Konsum von Alkohol und Tabak während der Schwangerschaft mit höherer intrauteriner Testosteronexposition des Kindes assoziiert sind. Die pränatale Testosteronlast ist wiederum ein Risikofaktor für anhaltende und bis ins Erwachsenenalter reichende Gesundheitsbeeinträchtigungen. Es wird ein 15-wöchiges, achtsamkeitsorientiertes, App-basiertes Programm zur Reduktion von Stress sowie zur Verminderung von Alkohol- und Tabakkonsum bei schwangeren Frauen etabliert. In der monozentrischen, prospektiven, kontrollierten und untersucherverblindeten MINDFUL/PMI (Maternal Health and Infant Development in the Follow-up after Pregnancy and a Mindfulness Intervention)-Studie führen schwangere Frauen das Programm durch. Dabei wird der Effekt auf die pränatale Testosteronexposition des Kindes untersucht, die mit dem Zeige-/Ringfingerlängenverhältnis und weiteren Biomarkern bei den 1-jährigen Kindern erhoben wird. Außerdem soll beforscht werden, wie sich das Programm auf die Selbstregulation, den Entwicklungstand und die psychische Gesundheit der Kinder im Alter von einem Jahr auswirkt. Weitere Aspekte des Schwangerschafts- und Geburtsverlaufs stellen explorative Studienziele dar. Dieses longitudinale Studienprojekt soll das Verständnis der Bedeutung intrauteriner Umweltfaktoren für die frühe kindliche Entwicklung und Gesundheit verbessern. Mütterlicher Stress sowie Alkohol- und Tabakkonsum während der Schwangerschaft sind modifizierbare Faktoren und stellen potenzielle präventive Ansatzpunkte dar.

Schlüsselwörter

Schwangerschaft - Stress - Alkohol - Tabak - Testosteron - 2D : 4D - Zeige-/Ringfingerlängenverhältnis - Achtsamkeit

^* Die Autoren haben gleichermaßen beigetragen.

• References/Literatur

• 1 Stone SL, Diop H, Declercq E. et al. Stressful events during pregnancy and postpartum depressive symptoms. J Womens Health (Larchmt) 2015; 24: 384-393
• 2 Stein A, Pearson RM, Goodman SH. et al. Effects of perinatal mental disorders on the fetus and child. Lancet 2014; 384: 1800-1819
• 3 Lilliecreutz C, Larén J, Sydsjö G. et al. Effect of maternal stress during pregnancy on the risk for preterm birth. BMC Pregnancy Childbirth 2016; 16: 5
• 4 Baibazarova E, van de Beek C, Cohen-Kettenis PT. et al. Influence of prenatal maternal stress, maternal plasma cortisol and cortisol in the amniotic fluid on birth outcomes and child temperament at 3 months. Psychoneuroendocrinology 2013; 38: 907-915
• 5 Glover V. Prenatal stress and its effects on the fetus and the child: possible underlying biological mechanisms. Adv Neurobiol 2015; 10: 269-283
• 6 Talge NM, Neal C, Glover V. et al. Antenatal maternal stress and long-term effects on child neurodevelopment: how and why?. J Child Psychol Psychiatry 2007; 48: 245-261
• 7 Davis EP, Glynn LM, Schetter CD. et al. Prenatal exposure to maternal depression and cortisol influences infant temperament. J Am Acad Child Adolesc Psychiatry 2007; 46: 737-746
• 8 Nolvi S, Karlsson L, Bridgett DJ. et al. Maternal prenatal stress and infant emotional reactivity six months postpartum. J Affect Disord 2016; 199: 163-170
• 9 Huizink AC, de Medina PGR, Mulder EJH. et al. Psychological measures of prenatal stress as predictors of infant temperament. J Am Acad Child Adolesc Psychiatry 2002; 41: 1078-1085
• 10 Chan KP. Prenatal meditation influences infant behaviors. Infant Behav Dev 2014; 37: 556-561
• 11 van den Heuvel MI, Johannes MA, Henrichs J. et al. Maternal mindfulness during pregnancy and infant socio-emotional development and temperament: the mediating role of maternal anxiety. Early Hum Dev 2015; 91: 103-108
• 12 Bergmann KE, Bergmann RL, Ellert U. et al. Perinatale Einflussfaktoren auf die spätere Gesundheit. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 2007; 50: 670-676
• 13 Popova S, Lange S, Probst C. et al. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Lancet Glob Health 2017; 5: e290-e299
• 14 Alvik A, Torgersen AM, Aalen OO. et al. Binge alcohol exposure once a week in early pregnancy predicts temperament and sleeping problems in the infant. Early Hum Dev 2011; 87: 827-833
• 15 Nulman I, Rovet J, Kennedy D. et al. Binge alcohol consumption by non-alcohol-dependent women during pregnancy affects child behaviour, but not general intellectual functioning; a prospective controlled study. Arch Womens Ment Health 2004; 7: 173-181
• 16 Burger PH, Goecke TW, Fasching PA. et al. [How does maternal alcohol consumption during pregnancy affect the development of attention deficit/hyperactivity syndrome in the child]. Fortschr Neurol Psychiatr 2011; 79: 500-506
• 17 Polańska K, Jurewicz J, Hanke W. Smoking and alcohol drinking during pregnancy as the risk factors for poor child neurodevelopment – a review of epidemiological studies. Int J Occup Med Environ Health 2015; 28: 419-443
• 18 Flak AL, Su S, Bertrand J. et al. The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis. Alcohol Clin Exp Res 2014; 38: 214-226
• 19 Abraham M, Alramadhan S, Iniguez C. et al. A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis. PLoS One 2017; 12: e0170946
• 20 McEvoy CT, Spindel ER. Pulmonary effects of maternal smoking on the fetus and child: effects on lung development, respiratory morbidities, and life long lung health. Paediatr Respir Rev 2017; 21: 27-33
• 21 Holz NE, Boecker R, Baumeister S. et al. Effect of prenatal exposure to tobacco smoke on inhibitory control: neuroimaging results from a 25-year prospective study. JAMA Psychiatry 2014; 71: 786-796
• 22 Brook JS, Brook DW, Whiteman M. The influence of maternal smoking during pregnancy on the toddlerʼs negativity. Arch Pediatr Adolesc Med 2000; 154: 381-385
• 23 Wiebe SA, Fang H, Johnson C. et al. Determining the impact of prenatal tobacco exposure on self-regulation at 6 months. Dev Psychol 2014; 50: 1746-1756
• 24 Berenbaum SA, Bryk KK, Nowak N. et al. Fingers as a marker of prenatal androgen exposure. Endocrinology 2009; 150: 5119-5124
• 25 Zheng Z, Cohn MJ. Developmental basis of sexually dimorphic digit ratios. Proc Natl Acad Sci U S A 2011; 108: 16289-16294
• 26 Talarovičová A, Kršková L, Blažeková J. Testosterone enhancement during pregnancy influences the 2D:4D ratio and open field motor activity of rat siblings in adulthood. Horm Behav 2009; 55: 235-239
• 27 Lilley T, Laaksonen T, Huitu O. et al. Maternal corticosterone but not testosterone level is associated with the ratio of second-to-fourth digit length (2D:4D) in field vole offspring (Microtus agrestis). Physiol Behav 2010; 99: 433-437
• 28 Rizwan S, Manning JT, Brabin BJ. Maternal smoking during pregnancy and possible effects of in utero testosterone: evidence from the 2D:4D finger length ratio. Early Hum Dev 2007; 83: 87-90
• 29 Lenz B, Mühle C, Braun B. et al. Prenatal and adult androgen activities in alcohol dependence. Acta Psychiatr Scand 2017; 136: 96-107
• 30 Barrett ES, Swan SH. Stress and androgen activity during fetal development. Endocrinology 2015; 156: 3435-3441
• 31 Huber SE, Zoicas I, Reichel M. et al. Prenatal androgen receptor activation determines adult alcohol and water drinking in a sex-specific way. Addict Biol 2018; 23: 904-920
• 32 Brown ECZ, Steadman CJ, Lee TM. et al. Sex differences and effects of prenatal exposure to excess testosterone on ventral tegmental area dopamine neurons in adult sheep. Eur J Neurosci 2015; 41: 1157-1166
• 33 Rapoza KA. Does life stress moderate/mediate the relationship between finger length ratio (2D4D), depression and physical health?. Pers Indiv Differ 2017; 113: 74-80
• 34 Eichler A, Heinrich H, Moll GH. et al. Digit ratio (2D:4D) and behavioral symptoms in primary-school aged boys. Early Hum Dev 2018; 119: 1-7
• 35 Joyce CW, Kelly JC, Chan JC. et al. Second to fourth digit ratio confirms aggressive tendencies in patients with boxers fractures. Injury 2013; 44: 1636-1639
• 36 OʼBriain DE, Dawson PH, Kelly JC. et al. Assessment of the 2D:4D ratio in aggression-related injuries in children attending a paediatric emergency department. Ir J Med Sci 2017; 186: 441-445
• 37 Martel MM, Gobrogge KL, Breedlove SM. et al. Masculinized finger-length ratios of boys, but not girls, are associated with attention-deficit/hyperactivity disorder. Behav Neurosci 2008; 122: 273-281
• 38 Kornhuber J, Zenses EM, Lenz B. et al. Low 2D:4D values are associated with video game addiction. PLoS One 2013; 8: e79539
• 39 Bouna-Pyrrou P, Mühle C, Kornhuber J. et al. Internet gaming disorder, social network disorder and laterality: handedness relates to pathological use of social networks. J Neural Transm (Vienna) 2015; 122: 1187-1196
• 40 Lenz B, Thiem D, Bouna-Pyrrou P. et al. Low digit ratio (2D:4D) in male suicide victims. J Neural Transm (Vienna) 2016; 123: 1499-1503
• 41 Lenz B, Kornhuber J. Cross-national gender variations of digit ratio (2D:4D) correlate with life expectancy, suicide rate, and other causes of death. J Neural Transm (Vienna) 2018; 125: 239-246
• 42 Lenz B, Röther M, Bouna-Pyrrou P. et al. The androgen model of suicide completion. Prog Neurobiol 2018;
• 43 Masuya Y, Okamoto Y, Inohara K. et al.. Sex-different abnormalities in the right second to fourth digit ratio in Japanese individuals with autism spectrum disorders. Mol Autism 2015; 6: 34
• 44 Al-Zaid FS, Alhader AA, Al-Ayadhi LY. The second to fourth digit ratio (2D:4D) in Saudi boys with autism: A potential screening tool. Early Hum Dev 2015; 91: 413-415
• 45 Mendes PHC, Martelli DRB, de Melo Costa S. et al. Comparison of digit ratio (2D:4D) between Brazilian men with and without prostate cancer. Prostate Cancer Prostatic Dis 2016; 19: 107-110
• 46 Bunevicius A, Tamasauskas S, Deltuva VP. et al. Digit ratio (2D:4D) in primary brain tumor patients: A case-control study. Early Hum Dev 2016; 103: 205-208
• 47 Han C, Bae H, Lee YS. et al. The ratio of 2nd to 4th digit length in Korean alcohol-dependent patients. Clin Psychopharmacol Neurosci 2016; 14: 148-152
• 48 Kornhuber J, Erhard G, Lenz B. et al. Low digit ratio 2D:4D in alcohol dependent patients. PLoS One 2011; 6: e19332
• 49 Lenz B, Bouna-Pyrrou P, Mühle C. et al. Low digit ratio (2D:4D) and late pubertal onset indicate prenatal hyperandrogenziation in alcohol binge drinking. Prog Neuropsychopharmacol Biol Psychiatry 2018; 86: 370-378
• 50 Dunn C, Hanieh E, Roberts R. et al. Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on womenʼs psychological distress and well-being in the perinatal period. Arch Womens Ment Health 2012; 15: 139-143
• 51 Muthukrishnan S, Jain R, Kohli S. et al. Effect of mindfulness meditation on perceived stress scores and autonomic function tests of pregnant Indian women. J Clin Diagn Res 2016; 10: CC05-CC08
• 52 Guardino CM, Dunkel Schetter C, Bower JE. et al. Randomised controlled pilot trial of mindfulness training for stress reduction during pregnancy. Psychol Health 2014; 29: 334-349
• 53 Goodman JH, Guarino A, Chenausky K. et al. CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Arch Womens Ment Health 2014; 17: 373-387
• 54 Zilcha-Mano S, Langer E. Mindful attention to variability intervention and successful pregnancy outcomes. J Clin Psychol 2016; 72: 897-907
• 55 Karyadi KA, VanderVeen JD, Cyders MA. A meta-analysis of the relationship between trait mindfulness and substance use behaviors. Drug Alcohol Depend 2014; 143: 1-10
• 56 Cavicchioli M, Movalli M, Maffei C. The clinical efficacy of mindfulness-based treatments for alcohol and drugs use disorders: a meta-analytic review of randomized and nonrandomized controlled trials. Eur Addict Res 2018; 24: 137-162
• 57 Arabin B, Baschat AA. Pregnancy: an underutilized window of opportunity to improve long-term maternal and infant health-an appeal for continuous family care and interdisciplinary communication. Front Pediatr 2017; 5: 69
• 58 Wu CS, Nohr EA, Bech BH. et al. Health of children born to mothers who had preeclampsia: a population-based cohort study. Am J Obstet Gynecol 2009; 201: 269.e1-269.e10
• 59 Fejzo MS, Magtira A, Schoenberg FP. et al. Neurodevelopmental delay in children exposed in utero to hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 2015; 189: 79-84
• 60 Bartel S, Costa SD, Kropf S. et al. Pregnancy outcomes in maternal neuropsychiatric illness and substance abuse. Geburtsh Frauenheilk 2017; 77: 1189-1199
• 61 Auger N, Fraser WD, Schnitzer M. et al. Recurrent pre-eclampsia and subsequent cardiovascular risk. Heart 2017; 103: 235-243
• 62 Klein EM, Brähler E, Dreier M. et al. The German version of the Perceived Stress Scale – psychometric characteristics in a representative German community sample. BMC Psychiatry 2016; 16: 159
• 63 Michalak J, Heidenreich T, Ströhle G. et al. German version of the Mindful Attention and Awareness Scale (MAAS) – psychometric features of a mindfulness questionnaire. Z Klin Psychol Psychother 2008; 37: 200-208
• 64 Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry 1982; 4: 33-47
• 65 Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med 1985; 8: 163-190
• 66 Kabat-Zinn J, Massion AO, Kristeller J. et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry 1992; 149: 936-943
• 67 Plews DJ, Scott B, Altini M. et al. Comparison of heart-rate-variability recording with smartphone photoplethysmography, polar H7 chest strap, and electrocardiography. Int J Sports Physiol Perform 2017; 12: 1324-1328
• 68 Bush K, Kivlahan DR. McDonell MB et al. for the Ambulatory Care Quality Improvement Project (ACQUIP). The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med 1998; 158: 1789-1795
• 69 Latza U, Hoffmann E, Terschüren C. et al. Erhebung, Quantifizierung und Analyse der Rauchexposition in epidemiologischen Studien. Berlin: Robert Koch-Institut; 2005
• 70 Sobell LC, Brown J, Leo GI. et al. The reliability of the Alcohol Timeline Followback when administered by telephone and by computer. Drug Alcohol Depend 1996; 42: 49-54
• 71 Cox JL, Chapman G, Murray D. et al. Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. J Affect Disord 1996; 39: 185-189
• 72 Bergant AM, Nguyen T, Heim K. et al. [German language version and validation of the Edinburgh postnatal depression scale]. Dtsch Med Wochenschr 1998; 123: 35-40
• 73 Huizink AC, Delforterie MJ, Scheinin NM. et al. Adaption of pregnancy anxiety questionnaire-revised for all pregnant women regardless of parity: PRAQ-R2. Arch Womens Ment Health 2016; 19: 125-132
• 74 Gartstein MA, Rothbart MK. Studying infant temperament via the Revised Infant Behavior Questionnaire. Infant Behav Dev 2003; 26: 64-86
• 75 Vonderlin E, Ropeter A, Pauen S. Assessment of temperament with the Infant Behavior Questionnaire Revised (IBQ-R) – the psychometric properties of a German version. Z Kinder-Jugendpsychiatr Psychother 2012; 40: 307-314
• 76 Bayley N. Bayley Scales of Infant and Toddler Development – Third Edition. German adaptation: Reuner G, Rosenkranz J. Frankfurt a. M.: Pearson Assessment & Information GmbH; 2014
• 77 Achenbach TM, Ruffle TM. The Child Behavior Checklist and related forms for assessing behavioral/emotional problems and competencies. Pediatr Rev 2000; 21: 265-271