METHADONE, BUPRENORPHINE AND FETAL DEVELOPMENT

医学博士Lauren M. Jansson目前是马里兰州巴尔的摩市约翰霍普金斯大学成瘾与妊娠中心（CAP）的儿科主任。CAP是一个城市多学科治疗计划，针对怀孕的阿片类药物和/或可卡因依赖妇女及其家庭。临床科学家发展奖旨在促进申请人对物质暴露胎儿神经行为的理解，并伴随新生儿的临床应用。此外，还将对美沙酮维持和泌乳相关的临床问题进行研究。具体来说，目前的提案将允许Jansson博士在JHU人口与家庭健康科学学院获得胎儿神经行为发育方面的一般培训。她还将通过罗德岛州普罗维登斯的同事获得NICU网络神经行为量表（NNNS）管理的认证。在研究设计、方法开发、数据库管理和数据分析方面的基础研究培训将由JHU医学院精神病学和医学系的几位教师提供。此外，将完成妇幼保健课程以及临床试验和实验室研究，还将提供写作课程和研讨会。在整个5年资助期内，将通过发展和进行几项小规模研究来应用所获得的技能和知识。具体来说，我们提出了四项研究来检验：(1)美沙酮使胎儿神经行为维持在血浆水平的峰值与低谷；(2)高剂量美沙酮（大于60 mg）与低剂量美沙酮（小于40 mg）使胎儿神经行为维持妊娠。(3)美沙酮与丁丙诺啡维持妊娠的胎儿神经行为；(4)美沙酮维持与母乳喂养。在研究1-3中，将物质暴露胎儿的神经行为状态与分娩后婴儿的神经行为状态进行比较。临床相关性将阐明，以努力更好地了解和改善医疗护理阿片类药物暴露的新生儿。特别是，杨森博士希望阐明那些识别出神经行为问题风险最高的婴儿的变量。在完成5年资助期后，Jansson博士计划撰写一份RO1资助申请，以开展KO8资助期间确定的研究思路。

Lauren M. Jansson, M.D. is currently the Director of Pediatrics at the Center for Addiction and Pregnancy (CAP) at Johns Hopkins in Baltimore, Md. CAP is an urban, multidisciplinary treatment program for pregnant opiate and/or cocaine dependent women and their families. A clinical Scientist Development Award is sought to further the applicant's understanding of substance exposed fetal neurobehavior with attendant clinical application to the newborn. In addition, clinical issues germaine to methadone maintenance and lactation will be studied. Specifically, the current proposal will allow Dr. Jansson to obtain general training in fetal neurobehavioral development at JHU School of Population and Family Health Science. She will also gain certification in NICU Network Neurobehavioral Scale (NNNS) administration through colleagues in Providence, R.I. Basic research training in study design, methodology development, data base management, and data analysis will be provided through mentorship from several faculty at JHU School of Medicine in the Departments of Psychiatry and Medicine. In addition, coursework in Maternal and Child Health as well as clinical trial and laboratory-based research will be completed, as will grant writing courses and seminars. Throughout the 5-year funding period, acquired skills and knowledge will be applied through the development and conduct of several small-scale research studies. Specifically, four studies are proposed to examine: (1) Fetal neurobehavior in methadone maintained pregnancies at peak versus trough plasma levels, (2) Fetal neurobehavior in high dose (greater than 60 mg) versus low dose (less than 40 mg) methadone maintained pregnancies. (3) Fetal neurobehavior in methadone versus buprenorphine maintained pregnancies, (4) Methadone maintenance and breastfeeding. Across studies 1-3, substance exposed fetal neurobehavioral status will be compared to infant neurobehavioral status post-delivery. Clinical correlates will be elucidated in an effort to better understand and improve medical care for opiate-exposed newborns. In particular, Dr. Jansson hopes to elucidate variables that identify infants at greatest risk for neurobehavioral problems. Upon completing the 5-year funding period, Dr. Jansson plans to have written an RO1 grant application to pursue research ideas identified during KO8 funding.