Prenatal Cigarette Exposure: The Role of Sleep and Parenting for Infant Outcomes

描述(申请人提供)：即使有所有已知的健康风险，最近的证据表明，高达15%的女性在怀孕期间吸烟，只有18%-25%的吸烟女性在发现自己怀孕时会戒烟。产前摄入尼古丁与许多严重的健康问题以及儿童时期的行为和认知障碍有关。因此，在模式变得稳定和更难改变之前，从生命的最初几个月识别和治疗处于危险中的儿童是非常重要的。不良结果可以通过适当的干预措施来减轻，但首先必须更仔细地研究产前暴露于不良社会情绪和认知结果和轨迹的具体机制。拟议的试点研究旨在阐明这些机制。将探索产前吸烟与婴儿9个月时的社会情绪和认知结果之间的途径，重点是婴儿睡眠的中介作用。此外，这项研究的目的是检验照顾婴儿的路径是否不同，并试图区分一般照顾行为(即敏感性)和睡前/夜间行为的影响，这可能通过其对婴儿睡眠质量的影响来影响结果。目前的研究将招募120名怀孕中期的妇女(80名吸烟者，40名不吸烟者)。孕妇将在怀孕期间评估吸烟和其他物质的使用情况，并将收集一段脐带进行分析(在出生时)，以评估产前尼古丁的暴露情况。此外，将分析婴儿唾液在每个年龄段目前暴露于环境烟草烟雾中的情况。3个月后，将在多个地点安装摄像机，以捕捉睡前和夜间的父母与婴儿的互动，以评估具体的照顾者做法和情绪可用性；婴儿将佩戴Actiwatch，记录睡眠期间的运动，持续7天；9个月时，将评估婴儿的生物行为功能(休息和挑战期间的行为、副交感、交感反应)和认知功能。最后，在3个月和9个月大的时候，照顾者和婴儿的互动将被录像在家里，以便以后对父母的养育行为进行编码。指导培训，在高危人群中进行拟议的前瞻性和纵向试点研究，以及利用尖端方法评估胎儿和 婴儿吸烟暴露和睡眠观察措施，将为在该奖项的最后几年提交R01赠款提案奠定坚实的基础。在此期间获得的知识也将为我为处于危险中的家庭制定干预措施的长期目标奠定基础。

DESCRIPTION (provided by applicant): Even with all of the known health risks, recent evidence suggests that up to 15% of women smoke during pregnancy and only 18-25% of women who smoke will stop when they find out they are pregnant. Prenatal consumption of nicotine has been correlated with a number of severe health issues, as well as behavioral and cognitive impairments in childhood. Therefore, it is of great importance to identify and treat children at risk from the early months of life before patterns become stable and more difficult to change. Adverse outcomes could be mitigated by appropriate interventions, but first the specific mechanisms that link prenatal exposure to poor social-emotional and cognitive outcomes and trajectories must be more closely examined. The proposed pilot study aims to elucidate such mechanisms. Pathways between prenatal exposure to cigarettes and infant social-emotional and cognitive outcomes at 9 months will be explored, with a focus on the mediating role of infant sleep. In addition, this study aims to examine whether paths differ for infants as a function of caregiving, and will attempt to differentiate between the effects of general caregiving behavior (i.e., sensitivity) and behavior at bedtime/through the night, which might influence outcomes via its effect on infant sleep quality. The current study will recruit 120 women during their second trimester of pregnancy (80 smokers, 40 non-smokers). Maternal cigarette and other substance use will be assessed during pregnancy, and a piece of the umbilical cord will be collected and analyzed (at birth) to evaluate prenatal exposure to nicotine. Moreover, infant saliva will be analyzed for current exposure to environmental tobacco smoke at each age. At 3 months, video cameras will be set-up in multiple locations to capture parent-infant interactions at bedtime and through the night to evaluate specific caregiver practices and emotional availability, and infants will wear an Actiwatch, to record movement during sleep, for seven days, and at 9 months infant biobehavioral functioning (behavioral, parasympathetic, sympathetic response at rest and during challenge) and cognitive functioning will be assessed. Finally, At 3 and 9 months of age caregiver-infant interactions will be video recorded in the home for later coding of parenting behavior. Mentored training in conducting the proposed prospective and longitudinal pilot study within this high-risk population, as well as utilizing cutting edge methods for assessing fetal and infant cigarette exposure and observational measures of sleep, will establish a strong foundation for submitting an R01 grant proposal in the latter years of this award. The knowledge gained over this period will also lay the groundwork for my long-term goal of developing interventions for families at risk.