Many studies, including some by the PI, reveal that cumulative risk - simultaneous exposure to multiple environmental, psychological, and biological risks - resulting from poverty leads to pervasive emotional and physical health problems as early as infancy. However, there remains a critical knowledge gap as to whether the effects of poverty and cumulative risk originate before birth. We propose that prenatal exposure to cumulative risk is a key pathway by which the adverse effects of poverty are transmitted to fetuses during gestation. Moreover, this prenatal exposure to cumulative risk may also perturb a mother?s neural adaptation to parenting, which further increases the infant?s likelihood of receiving harsh parenting postnatally. The proposed study is innovative because it utilizes a unique intergenerational and prospective design. In a total of 200 pregnant women (110 low-income and 90 middle-income), cumulative prenatal risk will be assessed in each trimester (12, 22, and 32 weeks gestation). Shortly after the infant?s birth, neuroimaging of the infant and the mother will be performed to assess fetal brain development (using MRI, DTI, resting-state fMRI) and maternal neural adaptation to parenting during pregnancy (using fMRI). The overall objective of the proposed study is to identify the prenatal pathways by which poverty perturbs neural outcomes of two generations - infants and their mothers. To achieve this objective, we will pursue three Aims.
Aim#1 - Identify the relations between poverty and cumulative prenatal risk. We propose that lower family income is associated with cumulative risk in environmental (stressful life events, poor quality home environment), psychological (perceived stress, negative mood) and biological (elevated cortisol, reduced oxytocin) systems during pregnancy.
Aim#2 - Identify the relations among poverty, cumulative prenatal risk, and brain morphology and connectivity in newborns. We propose that lower family income is associated with reduced volume, white matter integrity, and functional connectivity among the neural stress circuit of the amygdala, hippocampus, and prefrontal cortex among newborns. Cumulative prenatal risk mediates the link between low income and newborn neural outcomes.
Aim#3 - Identify the relations among poverty, cumulative prenatal risk, and neural adaptation to parenting in new mothers. We propose that cumulative prenatal risk mediates the links between family income and altered neural function for parental motivation and emotion regulation among new mothers. The proposed research is significant because it can offer scientific evidence to support prenatal intervention to reduce exposure to cumulative risk among low-income pregnant women. Compared to postnatal interventions with either mothers or infants, prenatal intervention is more effective and economical since it can potentially prevent poverty?s adverse effects in both generations by intervening with mothers only, prenatally. Furthermore, the current study will lay the groundwork for a new investigator?s research program for following a cohort of infants and their mothers starting from the first trimester of pregnancy to later developmental periods.

Public Health Relevance

The goal of the proposed study is to determine whether and how a new mother?s prenatal exposure to poverty could influence the development of her fetus's brain, as well as her own brain?s adaptation to parenthood during pregnancy. This study is relevant to public health because it aims to understand the specific prenatal pathways by which exposure to poverty before birth negatively influences health outcomes among children. Moreover, the study is relevant to the NICHD?s mission because such understanding can offer scientific evidence for prenatal interventions aimed at reducing maternal exposure to multiple prenatal risk factors in order to mitigate intergenerational transmission of income-related health inequality.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Biobehavioral Mechanisms of Emotion, Stress and Health Study Section (MESH)
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Miller, Brett
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University of Denver
Schools of Arts and Sciences
United States
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Kim, Pilyoung; Dufford, Alexander J; Tribble, Rebekah C (2018) Cortical thickness variation of the maternal brain in the first 6 months postpartum: associations with parental self-efficacy. Brain Struct Funct 223:3267-3277
Kim, Pilyoung; Capistrano, Christian G; Erhart, Andrew et al. (2017) Socioeconomic disadvantage, neural responses to infant emotions, and emotional availability among first-time new mothers. Behav Brain Res 325:188-196
Dufford, Alexander J; Kim, Pilyoung (2017) Family Income, Cumulative Risk Exposure, and White Matter Structure in Middle Childhood. Front Hum Neurosci 11:547