Elucidating Mechanisms of Pregnancy's Protective Effect on Drug Abuse Using Integrated Data Analysis

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PROJECT SUMMARY/ABSTRACT The notable protective effect of pregnancy on women’s tobacco and other drug use is a common yet understudied phenomenon in which addictive processes are temporarily attenuated in the absence of treatment. Identifying underlying mechanisms would provide novel insights into how addictive processes could be more effectively disrupted. To accelerate progress towards this goal and overcome methodologic limitations of prior studies, we repurpose multiple existing datasets with unique features to accomplish our aims. Specifically, we will: 1. Utilize a within-person design to estimate the unique “effect” of pregnancy, and salient events of pregnancy, on smoking behavior within a single pregnancy. 2. Isolate and estimate the impact of general and parenting-related developmental influences on smoking by examining between-pregnancy differences in a subset of women who were assessed on two pregnancies. 3. Examine the role of prenatal reflective functioning, coded from existing gold-standard qualitative interviews, in pregnancy’s protective effect on smoking. Aims 1 & 2 will provide the first ever estimates of precisely when and how pregnancy interacts with smoking behavior, setting the stage for future work to specify novel intervention targets. As reflective functioning is known to be malleable in substance using pregnant women, understanding its role in pregnancy-associated change in smoking will provides the foundation for novel smoking cessation interventions. This innovative proposal blends hypotheses generated from Dr. Massey’s (MPI) day-to-day clinical work as an addiction psychiatrist with the cutting-edge quantitative and methodological expertise necessary to rigorously test these hypotheses provided by epidemiologist Dr. Allen (MPI). Cohorts to be integrated contain short-term (within pregnancy) and long-term (across multiple pregnancies) longitudinal data, state-of-the-art drug exposure measures, and both qualitative and quantitative maternal data contributed by an experienced team of established developmental scientists: Drs. Neiderhiser (Co-I), Eiden (Co-I), and Wakschlag (Co-I). As data were originally developed with NIDA’s support to examine drug-exposed children, they are uniquely suited to examine drugs alone, and in combination. Knowledge from this study is needed to improve and personalize prenatal interventions and to guide future investigations of exposure-related offspring outcomes. Elucidating mechanisms underlying pregnancy’s protective effect on drug use also informs a broader understanding of how social processes successfully compete with addictive processes.