2/2 Optimizing access, engagement and assessment to elucidate prenatal influences on neurodevelopment: The Brains Begin Before Birth(B4 ) Midwest Consortium

项目摘要：加速的美国阿片类药物危机需要迫切的科学和公众 健康行动。母体围产期使用/虐待尤其有害，因为它会引起反响 代际影响。尽管产前接触阿片类药物和其他物质 对神经发育的不利影响，神经成像和发育方面的进展- 灵敏的表型测量现在能够表征典型和非典型的大脑- 史无前例的行为路径。多层次追溯的机制研究 从产前到儿童期的风险和复原力的决定因素和模式 需要一个庞大的国家队列，考虑到区域和种族/民族的差异。我们 建议大脑在出生前就开始(B4)中西部联盟，一个神经科学的合作伙伴， 华盛顿大学的物质使用、围产期心理健康和儿童福利科学家 医学院(WUSM)和神经科学、生物伦理学、儿科人口健康、孕产妇- 西北大学(NU)的胎儿和成瘾科学家。以及科学的 互补性，这个地区联盟的一个优势是它有能力利用对比 伊利诺伊州(惩罚性)和密苏里州(非惩罚性)产前阿片类药物使用方法，提供 用于检查司法管辖差异对科学和技术的影响的特殊平台 练习一下。我们共同提供了一个框架，以解决以下三个主要领域的挑战 一项高质量、有代表性的全国性多站点研究：(1)法律/伦理：由NU生物伦理学领导 和人口健康专家，我们提出了一种混合方法来划定障碍 以及使用来自不同国家的孕妇产生阿片类药物科学参与的解决方案 司法管辖区；(2)招聘/保留：由国家行为经济学专家领导 参与研究的方法和WUSM在护理协调、儿童福利和医疗保健方面的专家 移动技术，我们使用创新的方法来测试消息传递在 使用眼球跟踪的招聘材料，并采用新的应用程序和护理协调方法 用于增强保持能力；以及(3)成像/评估方法：由神经科学和 WUSM的物质使用专家和一名NU数据科学家，我们生成最佳实践 关于知情方案的建议：(1)试行全面的产前/围产期检查 产妇物质/精神健康方案；(2)在#年获得核磁共振扫描的可行性数据 新生儿禁欲综合征，也测试其他发育成像模式(例如，EEG， 近红外光谱)，包括在社区环境中；和(3)应用最先进的流行病风险 预测方法对现有财团数据的关键识别方法和时机 提供额外预测性价值的评估。所有活动都需要广泛的社区参与 利益相关者伙伴关系。我们的主要关注点是产前-幼儿期，有一个 旨在为包括儿童后期在内的财团作出有意义贡献的框架。 从人口健康到神经科学的跨学科整合对于确保 描述这种有害流行病的影响和由此而来的风险的大规模国家努力 儿童和家庭的健康和发展才能得到充分实现。

PROJECT SUMMARY: The accelerating U.S. opioid crisis requires urgent scientific and public health action. Maternal perinatal use/abuse is particularly deleterious due to its reverberating intergenerational impact. Though prenatal exposure to opioids and other substances have adverse effects on neurodevelopment, advances in neuroimaging and developmentally- sensitive phenotypic measurement now enable characterization of typical and atypical brain- behavior pathways on an unprecedented scale. Mechanistic study that traces the multi-level determinants and patterns of risk and resilience from the prenatal period through childhood requires a large, national cohort that accounts for regional and racial/ethnic variation. We propose the Brains Begin Before Birth (B4) Midwest Consortium, a partnership of neuroscience, substance use, perinatal mental health and child welfare scientists at Washington University School of Medicine (WUSM) and neuroscience, bioethics, pediatric population health, maternal- fetal and addiction scientists at Northwestern University (NU). Along with scientific complementarity, a strength of this regional Consortium is its ability to leverage the contrasting approaches of Illinois (punitive) and Missouri (non-punitive) to prenatal opioid use, providing an exceptional platform for examining the impact of jurisdictional variations on science and practice. Together we provide a framework for addressing three major areas of challenge key to a high-quality, representative, national multi-site study: (1) Legal/Ethical: Led by NU bioethics and population health experts, we propose a mixed methods approach to delineating barriers and generating solutions to scientific engagement of opioid using pregnant women from varied jurisdictions; (2) Recruitment/Retention: Led by NU experts in behavioral economics approaches to research participation and WUSM experts in care coordination, child welfare and mobile technology, we use innovative methods to test differential effectiveness of messaging in recruitment materials using eye tracking, and employ novel apps and care coordination methods for retention enhancement; and (3) Imaging/Assessment Methods: Led by neuroscience and substance use experts at WUSM and an NU data scientist, we generate best practices recommendations for an informed protocol via: (i) pilot testing a comprehensive pre-/perinatal maternal substance/mental health protocol; (ii) obtaining feasibility data on MRI scans in neonatal abstinence syndrome, also testing other developmental imaging modalities (e.g., EEG, fNIRS), including in community settings; and (iii) applying state-of-the-art epidemiologic risk prediction methods to extant Consortium data to identify methods and timing of key assessments that provide added predictive value. All activities draw on extensive community stakeholder partnerships. Our central focus is the prenatal-early childhood period, with a framework designed to enable meaningful contributions to consortia including later childhood. Transdisciplinary integration spanning population health to neuroscience is essential to ensure that a large national effort delineating the impact of this pernicious epidemic and corollary risk on health and development of children and families can be fully realized.