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

项目概述：美国日益加剧的阿片类药物危机要求采取紧急的科学和公共卫生行动。 母体围产期使用/虐待尤其有害，因为它会对代际产生影响。尽管 产前接触阿片类药物和其他物质对神经发育有不利影响，进展 神经成像和发育敏感的表型测量现在能够表征典型的 以及史无前例的非典型大脑行为路径。多层次追溯的机制研究 从胎儿期到儿童期的风险和复原力的决定因素和模式需要大量、 考虑到区域和种族/民族差异的国家队列。我们认为大脑在出生前就开始了 (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合作伙伴关系 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 西北大学(NU)的人口健康、母婴和成瘾科学家。以及科学的 互补性，这个区域联盟的一个优势是它有能力利用 伊利诺伊州(惩罚性)和密苏里州(非惩罚性)产前阿片类药物使用，为 考察司法管辖差异对科学和实践的影响。我们共同提供了一个框架，用于 解决三个主要挑战领域是高质量、有代表性的国家多地点研究的关键：(1) 法律/伦理：在NU生物伦理学和人口健康专家的领导下，我们提出了一种混合方法来解决 从以下几个方面描述阿片类药物科学接触的障碍和解决方案 不同的司法管辖区；(2)招聘/保留：由NU行为经济学专家领导 研究参与和WUSM在护理协调、儿童福利和移动技术方面的专家，我们使用 使用眼球跟踪测试招聘材料中消息传递的不同有效性的创新方法， 并采用新的应用程序和护理协调方法来增强保留力；以及(3)成像/评估 方法：在WUSM的神经科学和物质使用专家和一名NU数据科学家的领导下，我们产生了最佳 通过：(1)对全面的产前/围产期产妇进行试点试验，为知情方案提出建议 物质/精神健康方案；(2)获得新生儿禁欲综合征核磁共振扫描的可行性数据， 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 (3)将最先进的流行病风险预测方法应用于现有的联合体数据，以确定方法 以及提供额外预测性价值的关键评估的时机。所有活动都需要广泛的社区参与 利益相关者伙伴关系。我们的中心重点是产前-幼儿期，其框架旨在 为包括儿童后期在内的财团作出有意义的贡献。跨学科整合 人口健康对于神经科学是至关重要的，以确保一项大规模的国家努力来描绘这一影响 可以充分认识到对儿童和家庭健康和发展的有害流行病和必然风险。

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.