METHADONE, BUPRENORPHINE AND FETAL DEVELOPMENT

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Lauren M. Jansson, M.D. is currently the Director of Pediatrics at the Center for Addiction and Pregnancy (CAP) at Johns Hopkins in Baltimore, Md. CAP is an urban, multidisciplinary treatment program for pregnant opiate and/or cocaine dependent women and their families. A clinical Scientist Development Award is sought to further the applicant's understanding of substance exposed fetal neurobehavior with attendant clinical application to the newborn. In addition, clinical issues germaine to methadone maintenance and lactation will be studied. Specifically, the current proposal will allow Dr. Jansson to obtain general training in fetal neurobehavioral development at JHU School of Population and Family Health Science. She will also gain certification in NICU Network Neurobehavioral Scale (NNNS) administration through colleagues in Providence, R.I. Basic research training in study design, methodology development, data base management, and data analysis will be provided through mentorship from several faculty at JHU School of Medicine in the Departments of Psychiatry and Medicine. In addition, coursework in Maternal and Child Health as well as clinical trial and laboratory-based research will be completed, as will grant writing courses and seminars. Throughout the 5-year funding period, acquired skills and knowledge will be applied through the development and conduct of several small-scale research studies. Specifically, four studies are proposed to examine: (1) Fetal neurobehavior in methadone maintained pregnancies at peak versus trough plasma levels, (2) Fetal neurobehavior in high dose (greater than 60 mg) versus low dose (less than 40 mg) methadone maintained pregnancies. (3) Fetal neurobehavior in methadone versus buprenorphine maintained pregnancies, (4) Methadone maintenance and breastfeeding. Across studies 1-3, substance exposed fetal neurobehavioral status will be compared to infant neurobehavioral status post-delivery. Clinical correlates will be elucidated in an effort to better understand and improve medical care for opiate-exposed newborns. In particular, Dr. Jansson hopes to elucidate variables that identify infants at greatest risk for neurobehavioral problems. Upon completing the 5-year funding period, Dr. Jansson plans to have written an RO1 grant application to pursue research ideas identified during KO8 funding.