The effect of the COVID-19 pandemic on alcohol use and psycho-somatic health in pregnant and postpartum women with intersecting vulnerabilities.

摘要/摘要 诊断胎儿酒精谱系障碍(FASD)的新临床指南将自我调节列为一项 受产前酒精暴露(PAE)影响的儿童的关键行为缺陷。有一个基本的 在生命早期对这种缺陷的潜在机制、谱系和严重性的认识差距，以及 识别它们的最佳分析方法。此外，产前应激和产后环境的影响 关于PAE诱导的改变，人们知之甚少。母体乙醇的主要关注点是神经发育， 婴儿和儿童健康2(ENRICH-2)研究是关于确定与PAE相关的神经行为缺陷 在生命的早期。这份行政副刊将使我们能够检查新冠肺炎大流行的共病影响 在这一队列中，酒精使用对孕产妇和婴儿的不良结局有影响。这份补充文件的长期目标是 是描述新冠肺炎大流行对包括饮酒在内的不良后果的心理社会影响， 在纵向出生队列研究中，从而为未来的干预研究提供了基础。的目标是 本补充品旨在综合评估新冠肺炎相关应激对孕妇和女性的影响。 产后妇女参加了ENRICH-2队列。我们将通过添加最先进的自我评估 报告的措施与实时生理数据集成，目前不是受资助的父母的一部分 学习。之所以提出这一补充意见，是因为人们对新冠肺炎的影响认识存在差距 大流行对孕妇和青少年的心理社会结局、饮酒和与压力相关的身体结局的影响 产后妇女是受影响不成比例的弱势群体。我们将解决这一知识差距 通过追求两个具体目标来评估新冠肺炎对母婴不良结局的影响 在RICH-2队列中：1)心理社会结果和饮酒，评估为与以下方面相关的新冠肺炎压力 暴露和症状、新冠肺炎大流行调整、情绪调节、母婴依恋以及 饮酒和2)以心率变异性和睡眠模式评估的生理结果， 通过可穿戴电子设备进行评估-在当前的社交距离环境中，这是一种特别新颖的方法。 这种方法具有很高的创新性，并将允许在以下环境中客观、实时地收集数据 长期的社会距离和与弱势群体面对面研究访问相关的挑战 人口。孕期和产后妇女新冠肺炎相关结局的详细特征 与COVID相关的社会隔离和其他困难对精神健康和酒精使用的影响，以及 对儿童神经发育结局的累积影响是非常显著的，以便制定 为早期有效干预以减轻对这些弱势群体的影响奠定了基础。

SUMMARY/ABSTRACT The new clinical guidelines for diagnosing Fetal Alcohol Spectrum Disorders (FASD) list self-regulation as one of the key behavioral deficits in children affected by prenatal alcohol exposure (PAE). There is a fundamental gap in knowledge about the underlying mechanisms, spectrum, and severity of such deficits early in life and the best analytical approaches to identify them. In addition, the effect of prenatal stress and postnatal environment on PAE-induced alterations is poorly understood. The primary focus of the parent Ethanol, Neurodevelopment, Infant, and Child Health 2 (ENRICH-2) study is on identification of neurobehavioral deficits associated with PAE early in life. This administrative supplement will allow us to examine the comorbid effect of COVID-19 pandemic and alcohol use on adverse maternal and infant outcomes in this cohort. The long-term goal of this supplement is to characterize the psycho-social effect of COVID-19 pandemic on adverse outcomes, including alcohol use, in a longitudinal birth cohort study, thus providing the foundation for future intervention studies. The objective of this supplement is to comprehensively evaluate the effect of COVID-19 related stress in pregnant and postpartum women enrolled in the ENRICH-2 cohort. We will evaluate this by adding state-of-the-art self- reported measures integrated with real-time physiological data that are not currently part of the funded parent study. The rationale for this supplement is driven by the gap in knowledge about the effect of the COVID-19 pandemic on psychosocial outcomes, alcohol use, and stress-related physical outcomes in pregnant and postpartum women, a vulnerable population disproportionately affected. We will address this gap in knowledge by pursuing two specific aims which evaluate the effect of COVID-19 on adverse maternal and infant outcomes in the ENRICH-2 cohort: 1) psychosocial outcomes and alcohol use, assessed as COVID-19 stress related to exposures and symptoms, COVID-19 pandemic adjustment, emotion regulation, mother-infant attachment, and alcohol consumption and 2) physiologic outcomes assessed as heart rate variability and sleep patterns, evaluated by wearable electronics – an approach particularly novel in the current social distancing environment. This approach is highly innovative, and will allow for the objective, real-time data collection in the climate of prolonged social distancing and challenges associated with face-to-face research visits in vulnerable populations. A detailed characterization of COVID-19 related outcomes in pregnant and postpartum women, effect of COVID-related social isolation and other hardships on mental health and alcohol use, as well as the cumulative effect on pediatric neurodevelopmental outcomes are highly significant in order to lay out the foundation for early effective interventions to mitigate the effects in these vulnerable populations.