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

婴儿护理的荷尔蒙反应：打破产后阿片类药物复发周期的新策略

• 批准号: 10001201
• 负责人: Alicia M Allen
• 金额: $ 230.25万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-22 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10001201
• 关键词: Academic achievement; Address; Anxiety; Award; Behavioral; Cannabis; Child; Childbirth; Data; Discipline; Elements; Emotional; Family; Goals; Health; Hormonal; Hormone use; Hormones; Hydrocortisone; Infant; Intervention; Knowledge; Link; Measures; Mental Depression; Methodology; Methods; Monitor; Mothers; Motivation; Opioid; Outcome; Overdose; Oxytocin; Pattern; Postpartum Period; Predictive Analytics; Pregnancy; Prevalence; Prevention strategy; Progesterone; Prospective cohort study; Relapse; Research; Research Design; Risk; Risk Factors; Substance Use Disorder; Substance of Abuse; Time; Woman; Work; base; caregiving; foster care; high reward; high risk; illicit opioid; innovation; new technology; novel strategies; opioid use; opioid use disorder; postpartum health; prevent; psychosocial; relapse risk; response; social

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).

项目概要/摘要 过去 15 年，怀孕期间阿片类药物使用障碍 (OUD) 的患病率增加了近 500% 年。虽然怀孕是寻求和遵守 OUD 治疗的强烈动机，但 产后期与复发的高风险相关。事实上，高达 80% 的 OUD 女性会复发 分娩后六个月内非法使用阿片类药物。复发会导致广泛的健康和社会负面影响 对婴儿、母亲和整个家庭的结果，例如身体（例如致命和非致命的药物过量， 儿童物质使用障碍、情感障碍（例如焦虑、抑郁）和社交障碍（例如， 寄养安置、学业成绩不佳）后果。不幸的是，关于这方面的研究很少 如何预防产后阿片类药物复发。多种激素（例如皮质醇、黄体酮、催产素） 与物质使用障碍和婴儿护理活动有关。虽然荷尔蒙有潜力 为了显着降低产后复发的风险，方法学限制（例如单一激素 评估、限时评估）、内容限制（例如阿片类药物的使用、多物质使用）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力的使用 方法。因此，我的总体目标是利用新技术和方法来直接解决 当前的局限性并加强知识的跨学科传播以利用荷尔蒙 防止高风险产后期间阿片类药物复发的水平/模式。为了实现这一目标， 该新创新奖将解决四个目标：(1) 测量激素、婴儿护理活动、 使用前瞻性队列研究了解产后复发风险因素和 OUD 相关结果 设计，(2) 通过数据驱动确定可预测产后阿片类药物使用的激素水平/模式 预测分析，（3）检查使用特定的方法来引发/识别目标激素水平/模式 婴儿护理活动、外源性激素输送和/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/模式与 OUD 相关结果之间的联系。 完成这个高风险/高回报的项目后，我将 (a) 能够排除基于激素的 干预作为预防产后阿片类药物的综合行为-心理-社会方法的一个组成部分 复发，或 (b) 有强有力的初步证据表明可以使用激素水平/模式来预防产后 阿片类药物复发。此外，这项工作也将成熟地扩展到其他滥用物质（例如大麻） 适用于其他产后健康问题（例如抑郁、焦虑）。