Psychosocial and neurobiological stress and opioid use trajectories following pregnancy

摘要 母体阿片类药物成瘾是一个重大的公共卫生问题，影响着两人的健康和福祉。 在怀孕期间和产后期间为母亲及其发育中的孩子提供服务。至关重要的是， 孕妇在怀孕期间和出生后使用阿片类药物的轨迹尚不清楚。新兴研究 表明怀孕期间和产后第一年心理社会压力水平的升高可能 解释阿片类药物复发的风险增加，与大量研究一致，这些研究记录了 压力在成瘾的开始和维持中的作用，以及一个新兴的工作机构， 特别是关于育儿压力和成瘾的在当前的应用程序中，我们将雇用一个短期的 采用纵向设计，探讨孕妇心理社会和父母教养压力的生物行为机制。 接受阿片类药物使用障碍药物辅助治疗（MAT）且人口统计学匹配的女性 未接受MAT的孕妇。在怀孕期间，我们将测量心理社会压力和母亲的耐受性 婴儿的痛苦以及渴望和戒断症状。分娩后，母亲会 完成每月一次的评估，以进一步描述心理社会和养育压力， 成瘾症状此外，母亲将在1个月和4个月时完成神经影像学评估 产后，以确定响应婴儿（和非婴儿）的痛苦线索的神经机制。我们 心理社会和养育压力的生物行为特征将被用于预测 MAT依从性。综上所述，该R01应用用于鉴定一种新的生物行为表型， 在怀孕和产后早期存在的心理社会和养育压力， 阿片类药物复发的风险增加。

Abstract Maternal opioid addiction is a significant public health concern, impacting the health and well-being of both mothers and their developing child during pregnancy and the postpartum period. Crucially, factors shaping maternal opioid use trajectories during pregnancy and after birth are not well understood. Emerging research indicates that elevated levels of psychosocial stress during pregnancy and the first year postpartum may explain increased risk for opioid relapse, consistent with a larger body of research that has documented the role of stress in the initiation and maintenance of addiction generally, and an emerging body of work focusing on parenting stress and addiction specifically. In the current application, we will employ a short-term longitudinal design to probe the biobehavioral mechanisms of psychosocial and parenting stress in pregnant women receiving medication assisted treatment (MAT) for opioid use disorder and demographically-matched pregnant women not receiving MAT. In pregnancy we will measure psychosocial stress and maternal tolerance of infant distress alongside characterizing craving and withdrawal symptoms. After delivery, mothers will complete monthly batteries of assessments to further characterize psychosocial and parenting stress and addiction symptoms. Additionally, mothers will complete neuroimaging assessments at 1 and 4 months postpartum to identify neural mechanisms of responding to infant (and non-infant) distress cues. Our biobehavioral characterization of psychosocial and parenting stress will then be employed in the prediction of MAT adherence. Taken together, this R01 application serves to identify a novel biobehavioral phenotype of psychosocial and parenting stress present in pregnancy and the early postpartum period that may confer increased risk for opioid relapse.