Social determinants of child development and mental health

Eunice Kennedy Shriver National Institute Of Child Health & Human Development

Investigators

Linked publications, trials & patents

Abstract

Our work as 2 overarching aims: 1) Investigate prenatal and early life mechanisms for socioeconomic and racial/ethnic disparities in child health and development Maternal immune activity during pregnancy has been repeatedly linked to neuropsychiatric disorders in offspring. To the extent that maternal inflammation during pregnancy causes deviations from typical neurodevelopmental trajectories in offspring that result in elevated risk of neuropsychiatric disorders such as schizophrenia, autism, and major depressive disorder, it is unlikely that neurocognitive functioning in childhood would remain otherwise intact. However, much less is known regarding the role of immune markers at specific points during gestation in children's neurocognitive development. This is important because impairments in neurocognitive function in domains of intellectual ability, language, and higher order cognitive processes might serve as early markers of vulnerability to lifetime risk of neuropsychiatric disorders. We are therefore investigating the associations between fetal exposure to biomarkers of maternal immune activity throughout gestation and children's neurocognitive development up to age 7 years. Participants in the current study are mother-child pairs enrolled in the United States Collaborative Perinatal Project (CPP) between 1959 and 1966. The CPP was designed to examine the relationships between perinatal events and neurological outcomes among the offspring of 55,908 pregnancies. Offspring were followed through age 7, with approximately 70% retention for the duration of the study. Maternal serum was extracted from blood collected serially during pregnancy from the time of study registration through delivery and stored for later use. The Erie-Niagara & Rhode Island Children’s Health Equity & Development Study (ENRICHED) builds the foundation for a long-term cohort study on children’s development across socioeconomic and racial/ethnic groups that will provide evidence on mechanisms leading to disparities through children’s entry into school and therefore predictive of school readiness, one of the most important factors in long-term educational success. ENRICHED includes a comprehensive set of social exposures potentially related to disparities, focuses on parental psychopathology as a main factor, and addresses limitations of previous studies that have not fully considered paternal as well as maternal psychopathology nor measured psychopathology using phenotypically validated approaches. ENRICHED evaluates the extent to which disparities arise from socioeconomically linked exposures across multiple domains: from neighborhoods to families and from the social and physical environments to individual physiology and behavior. It has been suggested repeatedly that one’s zip code carries more predictive power for health than one’s genetic code, and this may particularly apply to early child development. Accordingly, ENRICHED addresses the need for research to identify the contributors to disparities across multiple levels of causation. 2) Investigate life course pathways underlying health disparities during adolescence and adulthood The promise of life course research is that, if successful, it will reveal new opportunities for interventions to reverse the course of earlier established downward trajectories. Further, it can shift the course of future trajectories by supporting resiliency and health-related behaviors to promote well-being. In addition to taking steps toward primary prevention of health disparities, interventions during later sensitive periods of the life course may prove beneficial for population health. Our research in this area involves two projects. First, leveraging unique data collected as part of the 7-wave NEXT Generation Health Study (NEXT), we extended our work on disparities from childhood into adolescence and emerging adulthood. Second, we completed our linkage study of the CPP-offspring cohort to the National Death Index with the aim of investigating the long-term reach of early childhood risk factors for both suicide mortality and all-cause premature mortality in middle adulthood. This study investigates the prenatal, socioeconomic, behavioral, cognitive, and neurologic risks for completed suicide. It also includes a nested case-control study to investigate the contributions of gestational immune activity to the fetal origins of suicide.