1/2 - Optimizing access, engagement and assessment to elucidate prenatal influences on neurodevelopment: The Brains Begin Before Birth (B4) Midwest Consortium

美国阿片类药物危机的加速需要紧急的科学和公共卫生行动。 产妇在围产期使用/滥用药物尤其有害，因为其对代际的影响很大。虽然 产前暴露于阿片类药物和其他物质对神经发育有不良影响， 神经影像学和发育敏感的表型测量现在能够表征典型的 和非典型的大脑行为途径。多层次追踪机制研究 从产前到儿童期的风险和复原力的决定因素和模式， 说明区域和种族/民族差异的国家队列。我们认为大脑开始于出生之前 (B4)中西部联盟，神经科学，物质使用，围产期心理健康和儿童的伙伴关系 华盛顿大学医学院（WUSM）的福利科学家和神经科学、生物伦理学、儿科 人口健康，母胎和成瘾科学家在西北大学（NU）。沿着科学 作为一种互补性，该区域联合会的一个优势是能够利用 伊利诺伊州（惩罚性）和密苏里州（非惩罚性）对产前阿片类药物的使用，提供了一个特殊的平台， 审查管辖权变化对科学和实践的影响。我们共同提供了一个框架， 解决高质量、有代表性的国家多地点研究的三个主要挑战领域：（1） 法律的/伦理：由NU生物伦理学和人口健康专家领导，我们提出了一种混合方法， 为使用阿片类药物的孕妇的科学参与划定障碍并制定解决方案， 不同的司法管辖区;（2）招聘/保留：由行为经济学方法的NU专家领导， 研究参与和WUSM专家在护理协调，儿童福利和移动的技术，我们使用 创新的方法来测试不同的有效性的消息在招聘材料使用眼动跟踪， 并采用新的应用程序和护理协调方法来提高保留率;以及（3）成像/评估 方法：在WUSM的神经科学和物质使用专家以及NU数据科学家的带领下， （一）对产前/围产期产妇进行全面的试点测试， 物质/精神健康方案;（ii）获得新生儿戒断综合征MRI扫描的可行性数据， 还测试其他发育成像模式（例如，EEG、fNIRS），包括在社区环境中;以及 (iii)将最先进的流行病学风险预测方法应用于现存的联盟数据，以确定方法 以及提供额外预测价值的关键评估的时间安排。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，其框架旨在 使有意义的贡献财团，包括以后的童年。跨学科整合跨越 人口健康神经科学是必不可少的，以确保一个大的国家努力描绘这一影响， 可以充分认识到对儿童和家庭的健康和发展的有害流行病和随之而来的风险。

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.