Prenatal exposure to opioids and maternal dysregulated mood: Associations with maternal physiology and newborn neurobehavior

• In Event: Effects of Prenatal Substance Exposure and Postnatal Environment on Autonomic Physiology: From Pregnancy to Adolescence

Abstract

Opioid use among pregnant women has increased 242% in the last 10 years, resulting in substantial increases in prenatal opioid exposure since 2000. Multiple complex, interacting, physiological, psychosocial and teratogenic factors obscure our understanding of the impact of opioids on the developing newborn. The effect of prenatal opioid exposure on newborn neurobehavior is therefore difficult to disentangle from relevant co-exposures, ranging from polysubstance use to maternal dysregulated mood. Maternal emotion dysregulation is a transdiagnostic vulnerability for a variety of psychiatric disorders, including substance use disorders. Psychophysiological studies of emotion dysregulation include respiratory sinus arrhythmia (RSA), an index of parasympathetic nervous system functioning. Our aim is to examine the contribution of opioid use and emotion dysregulation on changes in RSA in response to an attachment-related stressor. We also examine how prenatal exposure to opioids and emotion dysregulation are related to newborn neurobehavior.

Data come from two cohorts. Women on medication assisted treatment for opioid use disorder (n = 32) were recruited from an OB/GYN clinic for women using substances during their second trimester of pregnancy. The second cohort of women (n = 162) had no substance use during pregnancy. This cohort was recruited for a prospective study on the intergenerational transmission of emotion dysregulation.

Emotion dysregulation was measured using the short form of the Difficulties in Emotion Regulation Scale (DERS). RSA was collected from pregnant women while they listened to a prenatal cry paradigm. RSA was derived from raw ECG waveforms recorded via a three-lead spot electrode pattern and collected and processed through MindWare HRV software. Newborn neurobehavior was assessed in both cohorts by the same examiners using the NICU Network Neurobehavioral Scale (NNNS).

A repeated measures ANOVA was conducted to test whether prenatal opioid use was related to changes in maternal RSA across a cry paradigm, controlling for maternal education, income, race, ethnicity, and gestational age at the time of the prenatal assessment. Mothers who used opioids during pregnancy had significantly lower RSA across all cry episodes compared to mothers who did not use opioids (F(1, 53) = 4.77, p = .03, partial eta-squared = .08; (Figure 1). Including maternal emotion dysregulation in the model revealed that women with low levels of emotion dysregulation showed a steeper decline in RSA from the baseline in response to all cry tasks compared to both women with high emotion dysregulation scores and women who used opioids while pregnant, b = -.16, p = .04 (Figure 2). The effect of prenatal opioid exposure was no longer significant, b = -.62, p = .54.

With respect to our newborn outcomes, regressions revealed that newborns whose mothers experienced more emotion dysregulation required less handling, b = .23, p = .01. Newborns with prenatal opioid exposure had poorer quality of movement, b = -.19, p = .04, fewer stress abstinence signs, b = -.19, p = .03, more hypertonicity, b = .25, p = .004, less hypotonicity, b = -.27, p = .002, and fewer asymmetrical reflexes, b = -.33, p <.001, compared to unexposed newborns.

Authors

• Liz Conradt, Duke University
  Presenting Author

• Sarah Priddy
  Non-Presenting Author

• Robert Vlisides-Henry, University of Utah
  Non-Presenting Author

• Parisa R. Kaliush, University of Utah
  Non-Presenting Author

• Brendan Dale Ostlund, Pennsylvania State University, University Park
  Non-Presenting Author

• Sarah Terrell, University of Utah
  Non-Presenting Author

• Celine Saenz, University of Utah
  Non-Presenting Author

• Sheila E Crowell, University of Utah
  Non-Presenting Author

• Marcela Smid, University of Utah Health
  Non-Presenting Author

• Eric Garland, University of Utah
  Non-Presenting Author