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

项目摘要/摘要 在过去的15年中，怀孕期间阿片类药物使用障碍(OUD)的流行率增加了近500% 好几年了。虽然怀孕提供了寻求和遵守OUD治疗的强烈动机，但 产后期与复发的风险很高。事实上，高达80%的患有自闭症的女性复发 在交货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问题 对婴儿、母亲和整个家庭的结果，例如身体上的(例如，致命和非致命的过量服药， 儿童中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)后果。不幸的是，几乎没有关于这方面的研究 如何预防产后阿片类药物复发。多种激素(如皮质醇、黄体酮、催产素) 与物质使用障碍和婴儿照料活动有关。而荷尔蒙有可能 为了显著降低产后复发的风险，方法上的限制(例如，单一激素 评估、有限的时间评估)、内容限制(例如，阿片类药物的使用、多物质的使用)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的使用 接近。因此，我的总体目标是使用新技术和方法直接解决 目前限制和加强跨学科知识的传播，以利用激素 水平(S)/模式(S)，以防止阿片类药物在产后高危时期复发。为了实现这一目标， 这一新创新者奖将致力于四个目标：(1)测量荷尔蒙、婴儿护理活动、 一项前瞻性队列研究中的复发危险因素和产后妊娠结局 设计，(2)确定激素水平(S)/模式(S)，通过数据驱动预测产后阿片类药物的使用 预测分析，(3)研究使用特定激素水平(S)/模式(S)来诱导/识别目标激素水平的方法 婴儿照料活动、外源性激素释放和/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(S)/模式(S)与OUD相关结局之间的联系。 在这个高风险/高回报的项目完成后，我将能够(A)排除以激素为基础的 干预是预防产后阿片类药物综合行为-心理-社会方法的一个要素 复发，或(B)有强有力的初步证据表明使用激素水平(S)/模式(S)预防产后 阿片类药物复发。此外，这项工作扩大到其他滥用物质(例如大麻)的时机也将成熟 适用于其他产后健康问题(如抑郁症、焦虑症)。

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).