2/2 Optimizing access, engagement and assessment to elucidate prenatal influences on neurodevelopment: The Brains Begin Before Birth(B4 ) Midwest Consortium

项目摘要：美国阿片类药物危机的加速需要紧急的科学和公共 健康行动。产妇在围产期使用/滥用药物尤其有害，因为其影响 代际影响。尽管产前接触阿片类药物和其他物质 对神经发育的不利影响，神经成像和发育方面的进展- 灵敏表型测量现在能够表征典型和非典型脑， 前所未有的行为模式多层次追踪机制研究 从产前到童年的风险和复原力的决定因素和模式 需要一个大的，全国性的队列，占地区和种族/民族的差异。我们 我提议成立大脑开始于出生前（B4）中西部联盟，这是一个神经科学的合作组织， 华盛顿大学的物质使用、围产期心理健康和儿童福利科学家 医学院（WUSM）和神经科学，生物伦理学，儿科人口健康，孕产妇- 西北大学的胎儿和成瘾科学家。沿着科学 互补性，这个区域联盟的优势是它能够利用对比 伊利诺伊州（惩罚性）和密苏里州（非惩罚性）对产前阿片类药物使用的方法， 审查管辖权变化对科学的影响的特殊平台， 实践我们共同提供了一个框架，以应对三个主要挑战领域， 一项高质量、有代表性的国家多中心研究：（1）法律的/伦理：由NU生物伦理学牵头 和人口健康专家，我们提出了一个混合方法的方法来划定障碍， 并为科学参与使用阿片类药物的孕妇提供解决方案， （2）招聘/保留：由行为经济学专家领导 参与研究的方法和WUSM专家在护理协调，儿童福利和 移动的技术，我们使用创新的方法来测试 使用眼动追踪的招聘材料，并采用新颖的应用程序和护理协调方法 （3）成像/评估方法：由神经科学和 WUSM的物质使用专家和NU数据科学家，我们制定了最佳实践 建议通过以下方式制定知情协议：㈠对产前/围产期综合方案进行试点测试， 产妇物质/心理健康协议;（ii）获得MRI扫描的可行性数据， 新生儿戒断综合征，也测试其他发育成像模式（例如，脑电图， fNIRS），包括在社区环境中;以及（iii）应用最先进的流行病学风险 预测方法，以现存的财团数据，以确定方法和时间的关键 提供额外预测价值的评估。所有活动都利用广泛的社区 利益攸关方伙伴关系。我们的中心重点是产前-幼儿期， 该框架旨在为包括儿童后期在内的财团做出有意义的贡献。 从人口健康到神经科学的跨学科整合对于确保 一个大规模的国家努力描绘这种有害的流行病的影响和必然的风险， 对儿童和家庭健康和发展的影响可以充分实现。

PROJECT SUMMARY: The accelerating U.S. opioid crisis requires urgent scientific and public health action. Maternal perinatal use/abuse is particularly deleterious due to its reverberating intergenerational impact. Though prenatal exposure to opioids and other substances have adverse effects on neurodevelopment, advances in neuroimaging and developmentally- sensitive phenotypic measurement now enable characterization of typical and atypical brain- behavior pathways on an unprecedented scale. Mechanistic study that traces the multi-level determinants and patterns of risk and resilience from the prenatal period through childhood requires a large, national cohort that accounts for regional and racial/ethnic variation. We propose the Brains Begin Before Birth (B4) Midwest Consortium, a partnership of neuroscience, substance use, perinatal mental health and child welfare scientists at Washington University School of Medicine (WUSM) and neuroscience, bioethics, pediatric population health, maternal- fetal and addiction scientists at Northwestern University (NU). Along with scientific complementarity, a strength of this regional Consortium is its ability to leverage the contrasting approaches of Illinois (punitive) and Missouri (non-punitive) to prenatal opioid use, providing an exceptional platform for examining the impact of jurisdictional variations on science and practice. Together we provide a framework for addressing three major areas of challenge key to a high-quality, representative, national multi-site study: (1) Legal/Ethical: Led by NU bioethics and population health experts, we propose a mixed methods approach to delineating barriers and generating solutions to scientific engagement of opioid using pregnant women from varied jurisdictions; (2) Recruitment/Retention: Led by NU experts in behavioral economics approaches to research participation and WUSM experts in care coordination, child welfare and mobile technology, we use innovative methods to test differential effectiveness of messaging in recruitment materials using eye tracking, and employ novel apps and care coordination methods for retention enhancement; and (3) Imaging/Assessment Methods: Led by neuroscience and substance use experts at WUSM and an NU data scientist, we generate best practices recommendations for an informed protocol via: (i) pilot testing a comprehensive pre-/perinatal maternal substance/mental health protocol; (ii) obtaining feasibility data on MRI scans in neonatal abstinence syndrome, also testing other developmental imaging modalities (e.g., EEG, fNIRS), including in community settings; and (iii) applying state-of-the-art epidemiologic risk prediction methods to extant Consortium data to identify methods and timing of key assessments that provide added predictive value. All activities draw on extensive community stakeholder partnerships. Our central focus is the prenatal-early childhood period, with a framework designed to enable meaningful contributions to consortia including later childhood. Transdisciplinary integration spanning population health to neuroscience is essential to ensure that a large national effort delineating the impact of this pernicious epidemic and corollary risk on health and development of children and families can be fully realized.