Preliminary Effects of Prenatal Opioid Exposure and an Attachment-Based Intervention on Infant Autonomic Physiology

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

Abstract

Early adversity such as prenatal substance exposure has been linked with physiological dysregulation in children, but less is known about the effects of prenatal opioid exposure in particular. In addition, little is known about effective interventions to promote physiological regulation among opioid-exposed infants. The current study presents preliminary effects of prenatal opioid exposure and an attachment-based intervention on autonomic nervous system (ANS) functioning on six-month-old infants.

Pregnant women receiving medication-assisted treatment (MAT) for opioid use disorder and comparison women reporting no prenatal opioid exposure were included as participants. Women receiving MAT were randomly assigned to receive the active intervention (modified Attachment and Biobehavioral Catch-up, mABC) or a control intervention (modified Developmental Education for Families, mDEF), both 12-session home-visiting programs. mABC focuses on increasing maternal sensitivity and nurturance, whereas mDEF focuses on promoting cognitive and motor development. Women reported their MAT and substance use during pregnancy in the Timeline Followback interview. At six months gestational age, mother-infant dyads completed the Still-Face Paradigm (SFP) while autonomic nervous system data were recorded. Infants’ respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP) were calculated for a resting baseline, reactivity to the still-face episode (Still Face – First Play), and recovery (Second Play – Still Face). The current sample included all 32 mother-infant dyads (mABC n = 12; mDEF n = 13; comparison n = 7) who had completed the six-month visit at the time of analysis.

We hypothesized that higher levels of prenatal opioid exposure would be associated with lower resting RSA and shorter resting PEP, as well as reduced RSA and PEP reactivity and recovery, than lower levels of opioid exposure. Secondarily, we hypothesized that infants in the mABC group would show higher resting RSA, longer resting PEP, greater RSA reactivity and recovery, and greater PEP reactivity and recovery than infants in the mDEF group.

Significant correlations were detected between resting PEP and days using MAT while pregnant (r = -.39, p = .03), as well as resting PEP and days using heroin while pregnant (r = .39, p = .03). We did not detect effects of MAT or heroin exposure on infant RSA. Receiving mABC was associated with significantly greater RSA (p = .004) and PEP reactivity (p = .01) to the SFP compared to receiving mDEF.

We found that prenatal opioid exposure was associated with resting PEP among 6-month-old infants. More research is needed to understand the functional implications of these effects, and whether these associations may be replicated in a larger sample and when accounting for the effects of other concurrent substance exposure (e.g., cigarettes). In addition, we found preliminary evidence that receiving mABC is associated with more normative physiological reactivity to the SFP than receiving mDEF. Taken together, results indicate that although prenatal opioid exposure may alter infant autonomic physiology, increasing postnatal sensitivity and nurturance may mitigate these effects.

Authors

• Alexandra Tabachnick, University of Illinois at Chicago
  Presenting Author

• Madelyn Labella, William and Mary
  Non-Presenting Author

• Rina D. Eiden, The Pennsylvania State University
  Non-Presenting Author

• Mary Dozier, University of Delaware
  Non-Presenting Author