Prenatal methadone exposure is associated with altered neonatal brain development
Prenatal methadone exposure is associated with altered neonatal brain development
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DOI：
10.1016/j.nicl.2017.12.033
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发表时间：
2018-01-01
影响因子：
4.2
通讯作者：
Boardman, James P.
中科院分区：
文献类型：
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作者：
Monnelly, Victoria J.;Anblagan, Devasuda;Boardman, James P.
美沙酮用于怀孕期间海洛因成瘾的药物辅助治疗。产前美沙酮暴露儿童的神经发育结果可能不理想。我们测试了一个假设，即母亲服用美沙酮会改变新生儿的大脑发育。20名美沙酮暴露的经后37周出生的新生儿和20名未暴露的对照组分别在平均经后39（+2）周和41（+1）周接受弥散性MRI检查。使用年龄优化的基于通道的空间统计（TBSS）管道对暴露和非暴露新生儿的分数各向异性（FA）数据进行体素统计比较。美沙酮暴露的新生儿在MRI上调整GA后，半瓣中央、下纵束束（ILF）和内外囊内FA均下降（p < 0.05， TFCE校正）。在美沙酮暴露的婴儿中，白质骨架的中位数FA降低了12%。美沙酮暴露组平均头围（HC） z评分较低(-0.52 (0.99)vs 1.15 (0.84), p < 0.001)；调整HC z-score后，内囊前后肢和ILF的FA仍然存在差异。病例中多种药物的使用是常见的。产前美沙酮暴露与主要白质束的微观结构改变有关，这种改变在出生时就存在，与头部生长无关。虽然这些发现不能归因于美沙酮本身，但数据表明，需要进一步研究以确定怀孕期间阿片类药物使用障碍的最佳管理。未来的研究应评估儿童预后，包括婴儿大脑发育和长期神经认知功能。
Methadone is used for medication-assisted treatment of heroin addiction during pregnancy. The neurodevelopmental outcome of children with prenatal methadone exposure can be sub-optimal. We tested the hypothesis that brain development is altered among newborn infants whose mothers were prescribed methadone.20 methadone-exposed neonates born after 37 weeks' postmenstrual age (PMA) and 20 non-exposed controls underwent diffusion MRI at mean PMA of 39(+2) and 41(+1) weeks, respectively. An age-optimized Tract-based Spatial Statistics (TBSS) pipeline was used to perform voxel-wise statistical comparison of fractional anisotropy (FA) data between exposed and non-exposed neonates.Methadone-exposed neonates had decreased FA within the centrum semiovale, inferior longitudinal fasciculi (ILF) and the internal and external capsules after adjustment for GA at MRI (p < 0.05, TFCE corrected). Median FA across the white matter skeleton was 12% lower among methadone-exposed infants. Mean head circumference (HC) z-scores were lower in the methadone-exposed group (-0.52 (0.99) vs 1.15 (0.84), p < 0.001); after adjustment for HC z-scores, differences in FA remained in the anterior and posterior limbs of the internal capsule and the ILF. Polydrug use among cases was common.Prenatal methadone exposure is associated with microstructural alteration in major white matter tracts, which is present at birth and is independent of head growth. Although the findings cannot be attributed to methadone per se, the data indicate that further research to determine optimal management of opioid use disorder during pregnancy is required. Future studies should evaluate childhood outcomes including infant brain development and long-term neurocognitive function.