Hormonal Response to Infant Caregiving: A Novel Strategy to Break the Opioid Relapse Cycle during the Postpartum Period

婴儿护理的荷尔蒙反应：打破产后阿片类药物复发周期的新策略

• 批准号: 10001201
• 负责人: Alicia M Allen
• 金额: $ 230.25万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-22 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10001201
• 关键词: Academic achievement; Address; Anxiety; Award; Behavioral; Cannabis; Child; Childbirth; Data; Discipline; Elements; Emotional; Family; Goals; Health; Hormonal; Hormone use; Hormones; Hydrocortisone; Infant; Intervention; Knowledge; Link; Measures; Mental Depression; Methodology; Methods; Monitor; Mothers; Motivation; Opioid; Outcome; Overdose; Oxytocin; Pattern; Postpartum Period; Predictive Analytics; Pregnancy; Prevalence; Prevention strategy; Progesterone; Prospective cohort study; Relapse; Research; Research Design; Risk; Risk Factors; Substance Use Disorder; Substance of Abuse; Time; Woman; Work; base; caregiving; foster care; high reward; high risk; illicit opioid; innovation; new technology; novel strategies; opioid use; opioid use disorder; postpartum health; prevent; psychosocial; relapse risk; response; social

PROJECT SUMMARY/ABSTRACT The prevalence of opioid use disorder (OUD) during pregnancy has increased by nearly 500% over the past 15 years. While pregnancy presents a strong motivation for seeking and complying with OUD treatment, the postpartum period is associated with a high risk for relapse. Indeed, up to 80% of women with OUD relapse to illicit opioid use within six months of delivery. Relapse leads to a wide range of negative health and social outcomes for both the infant, mother, and entire family, such as physical (e.g., fatal and non-fatal overdose, increased risk of substance use disorders in children), emotional (e.g., anxiety, depression), and social (e.g., foster care placement, poor academic achievement) consequences. Unfortunately, little research is available on how to prevent postpartum opioid relapse. A wide-range of hormones (e.g., cortisol, progesterone, oxytocin) have been linked to substance use disorders and infant caregiving activities. While hormones have the potential to significantly reduce the risk for postpartum relapse, methodological limitations (e.g., single hormone assessment, limited time assessment), content limitations (e.g., opioid use, polysubstance use), and a lack of dissemination of knowledge across disciplines are all limiting this use of this potentially highly impactful approach. Therefore, my overall goal is to use new technologies and methodologies to directly address the current limitations and enhance the cross-discipline dissemination of knowledge to utilize hormonal level(s)/pattern(s) to protect against opioid relapse during the high-risk postpartum period. To achieve this goal, this New Innovator Award will address four objectives: (1) measure hormones, infant caregiving activities, relapse risk factors, and OUD-related outcomes during the postpartum period using a prospective cohort study design, (2) identify hormonal level(s)/pattern(s) that are predictive of postpartum opioid use via with data-driven predictive analytics, (3) examine methods to elicit/identify targeted hormone level(s)/pattern(s) using specific infant caregiving activities, exogenous hormone delivery, and/or continuous/frequent hormone monitoring, and (4) preliminarily assess the link between the identified hormonal level(s)/pattern(s) and OUD-related outcomes. Upon completion of this high-risk/high-reward project, I will either (a) be able to rule out a hormonally-based intervention as an element of a comprehensive behavioral-psycho-social approach to prevent postpartum opioid relapse, or (b) have strong preliminary evidence for the use of hormone level(s)/pattern(s) to prevent postpartum opioid relapse. Further, this work will be ripe for expansion to other substances of abuse (e.g., cannabis), as well as application to other postpartum health issues (e.g., depression, anxiety).

项目摘要/摘要 在过去的15次中，怀孕期间阿片类药物使用障碍（OUD）的患病率增加了近500％ 年。虽然怀孕提出了寻求和遵守Oud治疗的强大动力，但 产后时期与复发的高风险有关。确实，多达80％的Oud妇女复发到 分娩后六个月内使用非法阿片类药物。复发导致广泛的负面健康和社会 婴儿，母亲和整个家庭的结果，例如身体（例如致命和非致命过量， 儿童，情感（例如焦虑，抑郁）和社交中使用药物使用障碍的风险增加（例如， 寄养护理安置，学术成就不佳）后果。不幸的是，很少有研究 如何预防产后阿片类药物复发。广泛的激素（例如皮质醇，孕酮，催产素） 与药物使用障碍和婴儿护理活动有关。荷尔蒙有潜力 为了显着降低产后复发的风险，方法论上的局限性（例如，单一激素 评估，有限的时间评估），内容限制（例如，阿片类药物使用，多核管使用）以及缺乏 跨学科的知识传播都限制了这种潜在影响力的这种使用 方法。因此，我的总体目标是使用新技术和方法直接解决 当前局限性并增强知识的跨学科传播以利用激素 在高危产后时期预防阿片类药物复发的水平/模式。为了实现这一目标， 该新的创新者奖将解决四个目标：（1）衡量激素，婴儿护理活动， 在产后期间使用前瞻性队列研究的复发危险因素和与OUD相关的结果 设计，（2）识别可预测产后阿片类药物使用的激素水平/模式通过数据驱动 预测分析，（3）使用特定 婴儿护理活动，外源激素递送和/或连续/频繁的激素监测，以及 （4）初步评估已确定的激素水平（S）/模式与与OUD相关的结果之间的联系。 完成这个高风险/高奖励项目后，我将（a）能够排除基于荷尔蒙的 干预作为一种综合行为 - 心理社会方法的元素，以防止产后阿片类药物 复发或（b）有强烈的初步证据证明使用激素水平/模式以防止产后 阿片类药物复发。此外，这项工作也将成熟，以扩展到其他滥用物质（例如大麻） 作为其他产后健康问题的应用（例如抑郁症，焦虑）。