Maternal Stress, Milk Composition, and Preterm Neurodevelopment

Study Overview
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Brief Summary
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This study explores the associations between maternal stress, breastmilk composition, and feeding and neurodevelopment for preterm infants in the NICU and at 4 months corrected age.

Detailed Description
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The proposed study will address our novel hypothesis that maternal stress is associated with feeding outcomes and markers of impaired neurodevelopment for preterm infants and alters human milk and infant gut profiles in ways that affect preterm neurodevelopment. Mothers and their preterm infants (28-32 weeks gestation at birth) will be recruited to determine if: (1) variation in postnatal stress among mothers of very preterm infants relates to the total volume or proportion of maternal milk provided to her infant in the NICU and if (2) variation in maternal postnatal stress relates to her preterm infant's neurocognitive status at NICU discharge and 4 months corrected age. This project also involves collection/storage of maternal milk and infant fecal samples for multi-omics analyses. More specifically, the study will address: (3A) Is maternal postnatal stress associated with the metabolomic and microbiome characteristics of the infant's gut and/or the milk composition?, and (3B) Do milk composition differences relate to infant neurodevelopment? The aims of the proposed study contribute to our overarching research goal, which is to improve neurodevelopmental health for preterm infants by building the health and resilience of the mother-milk-infant triad.

Official Title
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Maternal Stress, Human Milk Composition, and Neurodevelopmental and Feeding Outcomes

Conditions
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Prematurity

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: preterm infant born between 28 0/7 and 32 6/7 weeks' gestation mother of preterm infant meeting criteria and a) 18 to 45 years of age at the time of delivery and b) pre-gravid or first trimester BMI between 18.5 to 40 kg/m^2 Exclusion Criteria: infants: major congenital anomalies, anticipated death, positive blood culture at birth, hypoxic ischemic encephalopathy, grade IV intraventricular hemorrhage, or plan to transfer care before discharge (35-37 weeks postmenstrual age). mothers: a) alcohol consumption >1 drink per week or any tobacco consumption during pregnancy, b) history/current Type I or II diabetes or gestational diabetes mellitus, c) known congenital metabolic, endocrine disease or congenital illness affecting infant feeding/growth

Ages Eligible for Study
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Minimum Age: 28 Weeks
Maximum Age: 32 Weeks

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maternal milk production inpatient | total volume (mL) | 28-35 weeks postmenstrual age | 
| Maternal milk production 4 months corrected age | total volume (mL) | 4 months corrected age | 
| Maternal milk proportion inpatient | Proportion of maternal milk vs donor milk/formula (%) | 28-35 weeks postmenstrual age | 
| Maternal milk proportion 4 months corrected age | Proportion of maternal milk vs donor milk/formula (%) | 4 months corrected age | 
| Infant Neurodevelopment inpatient | event related potentials (ERP) | 35-37 weeks postmenstrual age | 
| Infant Neurodevelopment 4 months corrected age | event related potentials (ERP) | 4 months corrected age | 
| Infant Neurodevelopment 4 months corrected age | visual evoked potentials (VEP) | 4 months corrected age | 
| Infant gut microbiome inpatient | Microbial diversity of fecal samples | 28-35 weeks postmenstrual age | 
| Infant gut microbiome 4 months corrected age | Microbial diversity of fecal samples | 4 months corrected age | 
| Milk microbiome inpatient | Microbial diversity of milk samples | 28-35 weeks postmenstrual age | 
| Milk microbiome 4 months corrected age | Microbial diversity of milk samples | 4 months corrected age | 
| Milk metabolome inpatient | Concentration of untargeted and targeted metabolites | 28-35 weeks postmenstrual age | 
| Milk metabolome 4 months corrected age | Concentration of untargeted and targeted metabolites | 4 months corrected gestational age |