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How Many Are Too Much? Clinical and Epidemiological Considerations for the Era of Poly–Pre- and Postnatal Exposures Relevant for the Developing Brain

  • Claudia Buss
    Correspondence
    Address correspondence to Claudia Buss, Ph.D.
    Affiliations
    German Center for Child and Youth Health, Germany

    Department of Medical Psychology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

    Development, Health and Disease Research Program, University of California, Irvine, School of Medicine, Irvine, California

    Department of Pediatrics, University of California, Irvine, School of Medicine, Irvine, California
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  • Jon Genuneit
    Correspondence
    Jon Genuneit, M.Sc., Ph.D.
    Affiliations
    German Center for Child and Youth Health, Germany

    Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
    Search for articles by this author
      Empirical evidence from preclinical and epidemiological studies supports the critical role of the early environment for brain development. Against the background of genetic predisposition, environmental conditions thus have the potential to shape risk for mental health disorders (
      • De Asis-Cruz J.
      • Andescavage N.
      • Limperopoulos C.
      Adverse prenatal exposures and fetal brain development: Insights from advanced fetal magnetic resonance imaging.
      ). These conditions include variation in psychosocial circumstances and stress exposure, parental health and health-related behaviors, nutrition, physical activity, sleep, exposure to environmental chemicals, variation in the geophysical environment, and airborne exposures. Preclinical and epidemiological studies rarely consider all these exposures at once. Culprit exposures are singled out following adjustment for some of the remainder and—for most studies—without specification of a causal model. Simiarly, attempts for experimental verification in applied animal models rely on modification of a single exposure out of this vast array (e.g., stress). Certainly, these approaches build on theory and prior knowledge and are important to understand whether and how specific exposures may affect mental health. However, they may have limited validity for translation to the human context where these singular risk factors rarely exist in isolation. For instance, high stress in socially disadvantaged individuals is commonly accompanied by poor nutrition and a higher rate of exposure to environmental chemicals.
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