title: QF2011: a protocol to study the effects of the Queensland flood on pregnant women, their pregnancies, and their children's early development.
abstract: BACKGROUND
  Retrospective studies suggest that maternal exposure to a severe stressor during pregnancy increases the fetus' risk for a variety of disorders in adulthood. Animal studies testing the fetal programming hypothesis find that maternal glucocorticoids pass through the placenta and alter fetal brain development, particularly the hypothalamic-pituitary-adrenal axis. However, there are no prospective studies of pregnant women exposed to a sudden-onset independent stressor that elucidate the biopsychosocial mechanisms responsible for the wide variety of consequences of prenatal stress seen in human offspring. The aim of the QF2011 Queensland Flood Study is to fill this gap, and to test the buffering effects of Midwifery Group Practice, a form of continuity of maternity care.
  
  
  METHODS
  In January 2011 Queensland, Australia had its worst flooding in 30 years. Simultaneously, researchers in Brisbane were collecting psychosocial data on pregnant women for a randomized control trial (the M@NGO Trial) comparing Midwifery Group Practice to standard care. We invited these and other pregnant women to participate in a prospective, longitudinal study of the effects of prenatal maternal stress from the floods on maternal, perinatal and early childhood outcomes. Data collection included assessment of objective hardship and subjective distress from the floods at recruitment and again 12 months post-flood. Biological samples included maternal bloods at 36 weeks pregnancy, umbilical cord, cord blood, and placental tissues at birth. Questionnaires assessing maternal and child outcomes were sent to women at 6 weeks and 6 months postpartum. The protocol includes assessments at 16 months, 2½ and 4 years. Outcomes include maternal psychopathology, and the child's cognitive, behavioral, motor and physical development. Additional biological samples include maternal and child DNA, as well as child testosterone, diurnal and reactive cortisol.
  
  
  CONCLUSIONS
  This prenatal stress study is the first of its kind, and will fill important gaps in the literature. Analyses will determine the extent to which flood exposure influences the maternal biological stress response which may then affect the maternal-placental-fetal axis at the biological, biochemical, and molecular levels, altering fetal development and influencing outcomes in the offspring. The role of Midwifery Group Practice in moderating effects of maternal stress will be tested.
authors.affiliation: Douglas Mental Health University Institute, Montreal, Canada. suzanne.king@mcgill.ca.|McGill University, Montreal, Canada. suzanne.king@mcgill.ca.
authors.forename: Suzanne
authors.initials: S
authors.lastname: King
authors.affiliation: Mater Research Institute, Brisbane, Australia. sue.kildea@mater.uq.edu.au.|The University of Queensland, Brisbane, Australia. sue.kildea@mater.uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
authors.affiliation: University of New South Wales, Sydney, Australia. m.austin@unsw.edu.au.|St. John of God Health Care, Brisbane, Australia. m.austin@unsw.edu.au.
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Austin
authors.affiliation: Douglas Mental Health University Institute, Montreal, Canada. alain.brunet@mcgill.ca.|McGill University, Montreal, Canada. alain.brunet@mcgill.ca.
authors.forename: Alain
authors.initials: A
authors.lastname: Brunet
authors.affiliation: Mater Research Institute, Brisbane, Australia. vanessa@psy.uq.edu.au.|The University of Queensland, Brisbane, Australia. vanessa@psy.uq.edu.au.
authors.forename: Vanessa E
authors.initials: VE
authors.lastname: Cobham
authors.affiliation: Mater Research Institute, Brisbane, Australia. paul.dawson@mater.uq.edu.au.|The University of Queensland, Brisbane, Australia. paul.dawson@mater.uq.edu.au.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Dawson
authors.affiliation: Mater Health Services, Brisbane, Australia. mark.harris@mater.org.au.
authors.forename: Mark
authors.initials: M
authors.lastname: Harris
authors.affiliation: Mater Research Institute, Brisbane, Australia. elizabeth.hurrion@mater.org.au.|The University of Queensland, Brisbane, Australia. elizabeth.hurrion@mater.org.au.|Mater Health Services, Brisbane, Australia. elizabeth.hurrion@mater.org.au.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Hurrion
authors.affiliation: Douglas Mental Health University Institute, Montreal, Canada. david.laplante@douglas.mcgill.ca.
authors.forename: David P
authors.initials: DP
authors.lastname: Laplante
authors.affiliation: Mater Research Institute, Brisbane, Australia. brettbris@icloud.com.
authors.forename: Brett M
authors.initials: BM
authors.lastname: McDermott
authors.affiliation: Mater Research Institute, Brisbane, Australia. david.mcintyre@mater.org.au.|The University of Queensland, Brisbane, Australia. david.mcintyre@mater.org.au.
authors.forename: H David
authors.initials: HD
authors.lastname: McIntyre
authors.affiliation: University of Iowa, Iowa City, USA. mike-ohara@uiowa.edu.
authors.forename: Michael W
authors.initials: MW
authors.lastname: O'Hara
authors.affiliation: Douglas Mental Health University Institute, Montreal, Canada. norbert.schmitz@douglas.mcgill.ca.|McGill University, Montreal, Canada. norbert.schmitz@douglas.mcgill.ca.
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.affiliation: Mater Research Institute, Brisbane, Australia. helen.stapleton@mater.uq.edu.au.|The University of Queensland, Brisbane, Australia. helen.stapleton@mater.uq.edu.au.
authors.forename: Helen
authors.initials: H
authors.lastname: Stapleton
authors.affiliation: The University of Sydney, Sydney, Australia. sally.tracy@sydney.edu.au.|The Royal Hospital for Women, Randwick, Australia. sally.tracy@sydney.edu.au.
authors.forename: Sally K
authors.initials: SK
authors.lastname: Tracy
authors.affiliation: INRS - Institute Armand-Frappier (Université du Québec) and BioMed Research, Laval, Canada. cathy.vaillancourt@iaf.inrs.ca.
authors.forename: Cathy
authors.initials: C
authors.lastname: Vaillancourt
authors.affiliation: Université du Québec à Montréal (UQAM), Montreal, Canada. kelseydancause@gmail.com.
authors.forename: Kelsey N
authors.initials: KN
authors.lastname: Dancause
authors.affiliation: The University of Queensland, Brisbane, Australia. sue.kruske@uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kruske
authors.affiliation: University of New South Wales, Sydney, Australia. n.reilly@unsw.edu.au.|St. John of God Health Care, Brisbane, Australia. n.reilly@unsw.edu.au.
authors.forename: Nicole
authors.initials: N
authors.lastname: Reilly
authors.affiliation: Mater Research Institute, Brisbane, Australia. shoowillems@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Shoo
authors.affiliation: Mater Research Institute, Brisbane, Australia. gabrielle.simcock@mater.uq.edu.au.|The University of Queensland, Brisbane, Australia. gabrielle.simcock@mater.uq.edu.au.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Simcock
authors.affiliation: Université of Montréal, Montreal, Canada. annemarie.turcottetremblay@gmail.com.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Turcotte-Tremblay
authors.affiliation: Douglas Mental Health University Institute, Montreal, Canada. eyongping@gmail.com.
authors.forename: Erin
authors.initials: E
authors.lastname: Yong Ping
mesh_terms: D000328:Adult; D002648:Child; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D004190:Disasters; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D055868:Floods; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D011446:Prospective Studies; D011793:Queensland; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D013315:Stress, Psychological