Psychiatry Research and Motherhood at 6 to 8 (PRAM-P@6to8)

Study Overview
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Brief Summary
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The goal of this observational study is to examine the relationship between severe perinatal maternal mental illness and stress reactivity and general development of children aged 6 to 8 years. Mothers were previously recruited and assessed during pregnancy and their babies were assessed at 6 days, 8 weeks and 12 months post delivery. This follow-up will assess the occurrence of any psychiatric episodes (e.g., depression, mania, psychosis) in the intervening period. Assessments of the children will include evaluation of their response to a mildly stressful procedure, as well as their physical, cognitive and social-emotional development, and their mental health. Possible factors that may moderate the relationship between the mother's perinatal mental health and the child's stress reactivity and development, including the home environment, adversity, parent-child interaction and maternal and paternal (or co-parent) mental health will also be assessed.

Detailed Description
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The principle research question is does maternal stress system in pregnant women at risk of postpartum psychosis modify stress reactivity in children aged 6 to 8?. The stress system the investigators are studying is the endocrine system known as the hypothalamic-pituitary-adrenal (HPA) axis. The investigators measured levels of hormones from this system in blood and saliva in a sample of women at risk and not at risk of postpartum psychosis during pregnancy and measured cortisol in the saliva of their babies, before and after a stressful experience at 6 days, 8 weeks and 12 months of age. The investigators found that infants born to women at risk of postpartum psychosis (PP) who relapsed in the first 4 weeks post-delivery had altered HPA axis activity at 6 days post-birth, compared with infants born to women at risk who remained well in the postpartum period. The investigators now plan to examine whether levels of mothers' stress hormones associated with risk of postpartum psychosis during pregnancy are also associated with longer-lasting children's cortisol stress reactivity and diurnal rhythm of cortisol during middle childhood (ages 6 to 8). Genetic material will be extracted from the child's specimens to look at genes, epigenetics (DNA methylation) and changes in gene expression, specifically, changes in genes which might be relevant to the development of stress. Assessments of maternal endocrine and maternal and paternal / co-parent mood measures will be undertaken. Children's cortisol response to stress and cortisol diurnal rhythm will be carried out at ages 6 to 8 years, together with assessments of their growth, cognitive development, social-emotional functioning and mental health. The father or co-parent mental health, their relationship with the mother and their interaction/relationship with the child will also be measured to investigate whether these moderate any effects of maternal perinatal mental health on child development. Prospective participants (n=72) were recruited in pregnancy, to take part in a study entitled Risk factors of perinatal mental disorders: stress, electrophysiological and neuroimaging markers, also known as the Psychiatry Research and Motherhood - Psychosis (PRAM-P) study. Clinical assessments were undertaken in pregnancy and, following delivery, assessments of the infant and mother were undertaken at 6 days, 8 weeks and 12 months post delivery. At the final visit, 67 participants gave their written consent to be contacted at some time in the future to discuss the possibility of participating in a follow-up study.

Official Title
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Do Risk Factors for Postpartum Psychosis Alter Offspring Outcomes in Middle Childhood

Conditions
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Perinatal Psychiatry

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women who participated in the previous study (Risk factors of perinatal mental disorders: Stress, electrophysiological, and neuroimaging markers), who gave consent to be contacted again, together with their offspring, and the child's father/co-parent. Exclusion Criteria: Women who participated in the previous study who refused consent to be contacted again.
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Exposed Group<br>Women at risk of postpartum psychosis during pregnancy | |
| Unexposed Group<br>Women with no current or past history of psychiatric disorders during pregnancy | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Child Salivary Cortisol | Child stress response - salivary cortisol: saliva samples will be collected before and after a mild stressor test: Cold Pressor Test (CPT) to assess stress reactivity. | 6-8 years | 
| Child Salivary Cortisol | Child stress response - salivary cortisol: saliva samples will be collected before and after a mild stress test: MacArthur Story Stem battery (MSSB) to asses stress reactivity | 6-8 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Wechsler Intelligence Scale for Children (4th Edition) (WISC-IV) | Child Cognitive Development | 6-8 years | 
| Wechsler Individual Achievement Test Second UK Edition (WIAT-II UK) | Child Cognitive Development | 6-8 years | 
| Dimensional Change Card Sort Test (DCCS) | Child Cognitive Development | 6-8 years | 
| Depression Self-Rating Scale (DSRS) | Child Mental Health | 6-8 years | 
| State-Trait Anxiety Inventory for Children (STAIC) | Child Mental Health | 6-8 years | 
| Strengths and Difficulties Questionnaire (SDQ) | Child emotional/behavioural symptoms and mental health, parent-report. | 6-8 years | 
| Development and Well-Being Assessment (DAWBA). | Child emotional/behavioural symptoms and mental health, parent-report. | 6-8 years | 
| Juvenile Victimization Questionnaire (JVQ) | Child social-relational risk factors, parent-report. | 6-8 years | 
| Traumatic Events Screening Inventory (TESI) | Child social-relational risk factors, parent-report. | 6-8 years | 
| Child Rearing Practices Report (CRPR) | Child social-relational risk factors, parent-report. | 6-8 years | 
| The Security Scale | To assess the child's perceptions of attachment security to their mother | 6-8 years | 
| Anthropometric Measures | weight, height, waist circumference, waist-to-hip ratio, waist-to-height ratio, head circumference and digit ratio (2D-4D). | 6-8 years | 
| Etch-a-Sketch Task | Parent-child interaction: video-recording of three joint parent-child activities (Etch-a-Sketch, block puzzles and a card game). | 6-8 years |