Biological and Environmental Contributions to Healthy Baby Development in Diverse Population

怀孕期间暴露于虐待物质的儿童也是其他环境因素的高危人群。 与早期生活压力(ELS)相关。基础和临床研究表明，这些不同的暴露， 单独或合并，可扰乱大脑结构和功能的早期发育轨迹，并 给孩子带来健康风险。这份来自洛杉矶儿童医院的R34医疗计划拨款申请 (CHLA)/南加州大学(USC)将对#年第二阶段财团假说的产生至关重要 为了弄清复杂的环境因素是如何影响大脑发育和功能的--从胎儿 通过第一个十年的时期--塑造认知、社会和情感发展。存在以下风险因素 这个由诊所、CHLA、好莱坞长老会医院和AltaMed社区组成的园区为家庭提供服务 医疗中心，在加州是无与伦比的。在即将招募的家庭中，75%的家庭接受医疗补助，超过 50%的人低于联邦贫困水平，任何种族的西班牙裔/拉丁裔都很富裕。南加州大学-CHLA 调查团队和双语和跨文化研究人员在招聘方面带来了深度的专业知识 在怀孕期间和出生后早期，以及流行病学、神经成像、 神经生理学、发展心理学和行为儿科学，以及生物测量学。为了确保最大限度地 为了保护弱势群体并有效地招募和留住，该团队包括一个世界- 著名的社会/法律和医疗伦理专家，以补充我们的经验和社区合作伙伴关系。 对于第一阶段的治疗，将招募两个队列来满足年龄范围的目标。第一批将包括40名孕妇 妇女及其胎儿/婴儿测试不同研究访问时间表对数据质量的可行性和实用性 和主体负担。队列2将包括从我们正在进行的两个项目中的一个招募的10个母婴二人组 研究早期生活压力对发育的影响的纵向研究。将解决三个具体目标 Hear RFA的既定目标：目标1)制定战略，招募和保留种族和民族方面的 孕妇(及其胎儿)的不同样本，她们因不良环境风险而被过度抽样 滥用因素和对滥用物质的暴露；目标2)制定管理潜在的法律和 道德挑战，以确保母子二人组获得法律、社会和心理支持 根据需要提供服务；目标3)为计划的第二阶段研究--平衡确定最佳研究方案 需要高质量的纵向数据收集，同时需要将母子二人组的负担降至最低。 多学科方法包括胎儿、婴儿和幼儿核磁共振、高分辨率脑电 和眼睛跟踪，有希望的生物样本(儿童口腔拭子，尿液和血滴；母亲母乳，血液和 头发)，以及人口、身心健康、对母子二人组的社会支持以及行为- 儿童的认知测量。将充分吸取从征聘、留用和数据收集中吸取的经验教训 共享，以便为第二阶段的Hear倡议形成最佳的假设和研究设计。

Children exposed during pregnancy to substances of abuse are also at high-risk for other environmental factors associated with early life stress (ELS). Basic and clinical research shows that these various exposures, individually or in combination, can disrupt early developmental trajectories of brain structure and function and enduring health risk for the child. This R34 HEAL planning grant application from Children’s Hospital Los Angeles (CHLA)/University of Southern California (USC) will be vital for consortium hypothesis generation in Phase II in order to disentangle how complex environmental factors impact brain development and function - from fetal period through the first decade - to shape cognitive, social and emotional development. The risk factors for families served by this campus of clinics, CHLA, Hollywood Presbyterian Hospital and Altamed Community Medical Center, is unparalleled in California. Of the families to be recruited, >75% are on Medicaid, more than 50% are below the federal poverty level, and there is enrichment of Hispanic/Latinx of any race. The USC-CHLA team of investigators and bilingual and multi-cultural research staff bring a depth of expertise in recruitment during pregnancy and early postnatal, as well as experimental expertise in epidemiology, neuroimaging, neurophysiology, developmental psychology and behavioral pediatrics, and biomeasures. To ensure maximum protection of a vulnerable population and effective recruitment and retention, the team includes a world- renowned expert in social/legal and medical ethics to complement our experience and community partnerships. For HEAL Phase I, two cohorts will be recruited to meet age range goals. Cohort 1 will include 40 pregnant women and their fetuses/infants to test the feasibility and utility of different study visit schedules on data quality and subject burden. Cohort 2 will include 10 mother-toddler dyads recruited from one of our two ongoing longitudinal studies investigating the impact of early life stress on development. Three specific aims will address the stated goals of the HEAL RFA: Aim 1) to develop the strategies to recruit and retain a racially- and ethnically diverse sample of pregnant women (and their fetuses), who are oversampled for adverse environmental risk factors and exposure to substances of abuse; Aim 2) to develop the strategies for managing potential legal and ethical challenges to ensure that the mother-child dyads have access to legal, social and psychological support services as needed; Aim 3) to determine the optimal study protocol for the planned, phase II study – balancing the need for high quality, longitudinal data collection with the need to minimize burden on the mother-child dyads. The multidisciplinary approaches include fetal, infant and toddler MRI, high-resolution electroencephalography and eye-tracking, promising biosamples (child buccal swab, urine and blood drops; mother breastmilk, blood and hair), and demographic, physical and mental health, social support for mother/child dyads, and behavioral- cognitive measures in children. Lessons learned from recruitment, retention and data collection will be fully shared in order to form best hypotheses and research designs for the Phase II HEAL initiative.