Intervening with Opioid-Dependent Mothers Living in Poverty: Effects on Mothers' and Infants' Behavioral and Biological Regulation

对生活在贫困中的阿片类药物依赖母亲进行干预：对母亲和婴儿行为和生物调节的影响

• 批准号: 10610855
• 负责人: Mary Dozier
• 金额: $ 63.9万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10610855
• 关键词: Affect; Age; Age Months; Attention; Autonomic nervous system; Behavior; Behavioral; Biological; Biology; Birth; Buffers; Caring; Child; Child Rearing; Dependence; Development; Early Intervention; Education; Face; Family; Female of child bearing age; Fingers; Frequencies; Home visitation; Hydrocortisone; Infant; Infant Behavior; Informal Social Control; Intervention; Mediating; Mothers; Nature; Neonatal Abstinence Syndrome; Opiate Addiction; Opioid; Outcome; Parents; Pattern; Pharmaceutical Preparations; Poverty; Pregnancy; Procedures; Production; Randomized; Regulation; Reporting; Rewards; Risk; Structure; Symptoms; Third Pregnancy Trimester; Treatment Efficacy; Withdrawal Symptom; Woman; biobehavior; chronic pain; efficacy evaluation; evidence base; fetal; fetal opioid exposure; high risk; infancy; infant outcome; intervention effect; maternal opioid use; medication-assisted treatment; men; neonate; neural; opioid exposure; opioid use; postnatal; prenatal; prescription opioid; programs; randomized, clinical trials; sex; steroid hormone; substance use

Opioid use has increased dramatically in recent years, with rates especially high among women living in poverty. Maternal opioid use combined with poverty renders children highly vulnerable to a host of short- and long-term challenges developing self-regulatory capabilities. In infancy, challenges in self- regulation can be seen in problems in the regulation of attachment behaviors, autonomic nervous system activity, and production of steroid hormones. Sensitive parenting is especially important for such children. Without intervention, many children born to opioid dependent mothers are unlikely to receive sensitive parenting. Early intervention is needed that helps these mothers provide sensitive care despite the challenges of substance use. In this project, we will assess the efficacy of a home visiting program adapted for mothers with opioid dependence who are living in poverty. Mothers on medication assisted treatment for opioid dependence during their third trimester of pregnancy will be randomized to this adapted home visiting program, modified Attachment and Biobehavioral Catch-up (mABC: N=100), or to a control condition of the same duration and frequency (modified Developmental education for Families, or mDEF: N=100). We will assess whether the mABC intervention engages the purported treatment mechanism, maternal sensitivity. Second, we examine whether the intervention has positive effects on infants’ regulation of cortisol production, autonomic nervous system activity, and attachment. Third, we examine whether maternal sensitivity mediates intervention effects on infant outcomes. An exploratory aim examines whether the intervention alters maternal neural activity related to the rewarding nature of babies versus drugs. Parental sensitivity will be assessed prenatally, and at infant ages of 1 week, and 3, 6, and 12 months of age, and maternal neural activity will be assessed prenatally and at infant age of 12 months. Infant cortisol will be assessed at 3, 6, and 12 months, autonomic nervous system regulation at 6 and 12 months of age, and attachment at 12 months. The mABC intervention is expected to affect child behavioral and biological outcomes with these effects mediated by maternal sensitivity.

近年来，阿片类药物的使用急剧增加，居住的女性的利率尤其很高 在贫困中。母亲阿片类药物的使用与贫困相结合，使儿童极易受到许多人的影响 短期和长期挑战发展自我调节能力。在婴儿期，自我挑战 在依恋行为，自主神经的调节中可以看出调节 系统活动和立体激素的产生。敏感的育儿尤其重要 这样的孩子。没有干预，许多因阿片类药物依赖母亲出生的孩子不太可能 接受敏感的育儿。需要早期干预，以帮助这些母亲提供敏感的 关心使用物质的挑战。在这个项目中，我们将评估房屋的效率 访问计划适用于生活在贫困中的阿片类药物依赖的母亲。母亲在 在怀孕三个月的阿片类药物依赖治疗中的药物辅助治疗将是 随机分配到这个改编的家庭访问计划，修改后的附件和生物狂热的追赶 （MABC：n = 100），或达到相同持续时间和频率的控制条件（修改） 家庭的发展教育或MDEF：n = 100）。我们将评估MABC是否 干预参与所谓的治疗机制，孕产妇的敏感性。其次，我们检查 干预措施是否对婴儿对皮质醇产生的调节，自主神经的调节有积极影响 神经系统活动和依恋。第三，我们检查孕产妇敏感性是否培养 干预对婴儿预后的影响。探索目的考试是干预措施是否改变 母体神经活动与婴儿与药物的奖励性质有关。父母的敏感性 将通过产前评估，婴儿年龄为1周，3、6和12个月，以及 孕产妇神经活动将在产前和婴儿12个月的婴儿中进行评估。婴儿皮质醇会 在3、6和12个月中评估，在6和12个月的自主神经系统调节 年龄和12个月的依恋。预计MABC干预将影响儿童的行为和 这些作用是由母体灵敏度介导的。