Effects of Prenatal Opioid Exposure on Infant Autonomic Physiology

项目摘要/摘要 孕妇中阿片类药物依赖的日益普遍是一个主要的公共卫生问题， 部分原因是产前阿片类药物暴露与一系列不利的神经发育和 婴儿的医疗后果。产前阿片类药物暴露与非典型自主神经相关 系统(ANS)在生命的最初几天起作用，但在后来的发展中很少有调查。 此外，尽管产前阿片类药物暴露经常伴随着其他物质的暴露，但很少有 研究说明了接触多物质的原因。因此，产前阿片类药物暴露的独特影响 自主性功能还没有被很好地理解。[此外，尽管出生后的照料环境可能 作为产前调节因子的阿片类药物暴露对婴儿功能、父母养育质量的影响 阿片类药物暴露相对较少受到关注。]自主神经失调具有重要的意义 身心健康，因此确定产前阿片类药物暴露对婴儿ANS的影响程度 发挥作用，并确定这种效果的可修改的调节剂，是告知治疗的关键步骤。 根据国家卫生研究院的方案利益(即，Hear倡议)，拟议的研究将评估 产前阿片类药物暴露对6个月大婴儿ANS调节的影响[将审查父母养育方式 作为这一效果的可修改的调节因素的质量。]作为一个更大的随机对照试验的一部分，拟议的 研究将在一组接受药物辅助的女性中检查阿片类药物暴露的影响 治疗阿片依赖(如美沙酮)。]物质暴露信息将通过 怀孕期间和婴儿六个月时对母亲的验证性访谈(时间线回溯) 年长的。[育儿质量将通过视频记录的自由游戏活动的观察性编码进行评估，当 婴儿六个月大。]婴儿ANS功能的两个指标也将在6个月时收集： 呼吸性窦性心律失常(RSA)和心脏射血前期(PEP)。婴儿RSA和PEP将是 在休息时和对社交压力源的反应中进行测量(静脸范式)。拟议的研究将 确定产前阿片类药物暴露与婴儿6个月自主神经活动有关的程度 年龄，[并将考察父母的教育质量作为这一影响的调节因素。]因为接受药物辅助 孕期治疗(MAT)是目前阿片类药物依赖孕妇的护理标准， 了解产前阿片类药物暴露的影响，并确定这种影响的可塑性调节因素，是 确定治疗目标和为妇女及其婴儿制定治疗计划的关键步骤。这个 拟议的计划包括对申请者进行ANS、产前物质暴露、育儿、 和基于社区的研究。

PROJECT SUMMARY/ABSTRACT The increasing prevalence of opioid dependence among pregnant women is a major public health concern, partially because prenatal opioid exposure is associated with a range of adverse neurodevelopmental and medical outcomes for infants. Prenatal opioid exposure has been associated with atypical autonomic nervous system (ANS) functioning in the first days of life, but there have been few investigations later in development. Further, although prenatal opioid exposure is frequently accompanied by exposure to other substances, few studies account for polysubstance exposure. Thus, the unique effects of prenatal opioid exposure on autonomic functioning are not well understood. [In addition, although the postnatal caregiving environment may moderate the effect of opioid exposure on infant functioning, parenting quality as a moderator of prenatal opioid exposure has received relatively little attention.] Autonomic dysregulation has important implications for physical and mental health, so determining the degree to which prenatal opioid exposure affects infant ANS functioning, and identifying modifiable moderators of this effect, are critical steps to inform treatment. Consistent with NIH’s programmatic interests (i.e., the HEAL Initiative), the proposed study will assess the effect of prenatal opioid exposure on infant ANS regulation at six months of age [and will examine parenting quality as a modifiable moderator of this effect.] As part of a larger randomized controlled trial, the proposed study will [examine the effect of opioid exposure within a group of women receiving medication-assisted treatment for opioid dependence (e.g., methadone).] Substance exposure information will be collected with a validated interview (the Timeline Followback) with mothers during pregnancy and when infants are six months old. [Parenting quality will be assessed via observational coding of a video-recorded free play activity when infants are six months old.] Two indicators of infant ANS functioning will also be collected at six months: respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP). Infant RSA and PEP will be measured at rest and in response to a social stressor (the still-face paradigm). The proposed study will determine the degree to which prenatal opioid exposure is related to infant autonomic activity at six months of age, [and will examine parenting quality as a moderator of this effect.] Because receiving medication-assisted treatment (MAT) during pregnancy is the current standard of care for opioid-dependent pregnant women, understanding the impact of prenatal opioid exposure, and identifying malleable moderators of this effect, are critical steps to identify treatment targets and inform treatment planning for women and their infants. The proposed plan includes advanced training for the applicant in ANS, prenatal substance exposure, parenting, and community-based research.