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

项目总结/摘要 在过去的15年中，妊娠期间阿片类药物使用障碍（OUD）的患病率增加了近500%。 年虽然怀孕是寻求和遵守OUD治疗的强烈动机， 产后期间与复发的高风险相关。事实上，高达80%的OUD女性复发， 在分娩后六个月内非法使用阿片类药物。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，致命和非致命的过量， 儿童物质使用障碍的风险增加），情绪（例如，焦虑，抑郁），和社交（例如， 寄养安置，学业成绩差）的后果。不幸的是，很少有研究可用于 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养育活动有关。虽然激素有可能 为了显著降低产后复发的风险，方法上的限制（例如，单激素 评估、限时评估），内容限制（例如，阿片类药物使用，多物质使用），以及缺乏 跨学科的知识传播都限制了这种潜在的高度影响力的使用 approach.因此，我的总体目标是使用新技术和方法直接解决 目前的局限性，并加强知识的跨学科传播，利用激素 水平/模式，以防止高风险产后期间阿片类药物复发。为了实现这一目标， 这个新的创新者奖将解决四个目标：（1）测量激素，婴儿发育活动， 复发风险因素和产后OUD相关结局的前瞻性队列研究 设计，（2）通过数据驱动识别预测产后阿片类药物使用的激素水平/模式 预测分析，（3）检查方法，以引出/确定目标激素水平/模式，使用特定的 婴儿分娩活动、外源性激素输送和/或持续/频繁的激素监测，以及 (4)初步评估已确定的激素水平/模式与OUD相关结局之间的联系。 在完成这个高风险/高回报的项目后，我将（a）能够排除一个基于实践的 作为预防产后阿片类药物综合行为-心理-社会方法要素的干预 复发，或（B）有使用激素水平/模式预防产后 阿片类药物复发此外，这项工作的时机已经成熟，可以扩大到其他滥用物质（例如，大麻），以及 作为对其它产后健康问题的应用（例如，抑郁、焦虑）。

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).