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

总结/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其中之一 受产前酒精暴露（PAE）影响的儿童的关键行为缺陷。有一个根本 对生命早期这种缺陷的潜在机制、频谱和严重程度的认识存在差距， 最好的分析方法来识别它们。此外，产前压力和产后环境的影响 对PAE诱导的改变了解甚少。母公司乙醇，神经发育， 婴儿和儿童健康2（ENRICH-2）研究是关于识别与PAE相关的神经行为缺陷 在生命的早期。本行政补充文件将使我们能够研究COVID-19大流行的并发症影响 和酒精使用对不良母婴结局的影响。这种补充的长期目标 是描述COVID-19大流行对不良后果的心理社会影响，包括饮酒， 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 本补充材料旨在全面评估COVID-19相关压力对孕妇的影响， 入组ENRICH-2队列的产后妇女。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相结合，目前不是受资助的母公司的一部分 study.该补充的理由是由于对COVID-19影响的认识存在差距 流行病对心理社会结果、酒精使用和压力相关的身体结果的影响， 产后妇女是一个受到不成比例影响的弱势群体。我们将填补这一知识空白， 通过追求两个具体目标，评估COVID-19对母婴不良结局的影响， 在ENRICH-2队列中：1）心理社会结果和酒精使用，评估为与COVID-19压力相关的 暴露和症状，COVID-19大流行调整，情绪调节，母婴依恋， 饮酒和2）评估为心率变异性和睡眠模式的生理结果， 通过可穿戴电子设备进行评估-这是一种在当前社交距离环境中特别新颖的方法。 这种方法具有高度创新性，将允许在气候变化的情况下客观、实时地收集数据。 长期的社交距离和与面对面的研究访问相关的挑战 人口。孕妇和产后妇女COVID-19相关结局的详细描述， 与COVID相关的社会隔离和其他困难对心理健康和酒精使用的影响，以及 对儿童神经发育结局的累积效应非常显著， 为早期有效干预奠定基础，以减轻对这些弱势群体的影响。

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.