Department of Psychiatry and Behavioral Health & Psychology, Stony Brook University Medical Center, Stony Brook, NY, USA.
Department of Psychiatry, Psychology and Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.
J Neuroendocrinol. 2019 Sep;31(9):e12770. doi: 10.1111/jne.12770. Epub 2019 Jul 29.
Between 1999 and 2014, the prevalence of opioid use disorder (OUD) among pregnant women quadrupled in the USA. The standard treatment for peripartum women with OUD is buprenorphine. However, the maternal behavior neurocircuit that regulates maternal behavior and mother-infant bonding has not been previously studied for human mothers receiving buprenorphine treatment for OUD (BT). Rodent research shows opioid effects on reciprocal inhibition between maternal care and defence maternal brain subsystems: the hypothalamus and periaqueductal gray, respectively. We conducted a longitudinal functional magnetic resonance imaging (fMRI) pilot study in humans to specifically examine resting-state functional connectivity (rs-FC) between the periaqueductal gray and hypothalamus, as well as to explore associations with maternal bonding for BT. We studied 32 mothers who completed fMRI scans at 1 month (T1) and 4 months postpartum (T2), including seven mothers receiving buprenorphine for OUD and 25 non-OUD mothers as a comparison group (CG). The participants underwent a 6-minute resting-state fMRI scan at each time point. We measured potential bonding impairments using the Postpartum Bonding Questionnaire to explore how rs-FC with periaqueductal gray is associated with bonding impairments. Compared to CG, BT mothers differed in periaqueductal gray-dependent rs-FC with the hypothalamus, amygdala, insular cortex and other brain regions at T1, with many of these differences disappearing at T2, suggesting potential therapeutic effects of continuing buprenorphine treatment. In contrast, the "rejection and pathological anger" subscale of the Postpartum Bonding Questionnaire at T1 and T2 was associated with the T1-to-T2 increases in periaqueductal gray-dependent rs-FC with the hypothalamus and amygdala. Preliminary evidence links maternal bonding problems for mothers with OUD early in the postpartum to connectivity between specific care and defence maternal brain circuits, which may be mitigated by buprenorphine treatment. This exploratory study supports a potential mechanism for investigating both the therapeutic benefits and risks of opioids for maternal care and bonding with infants.
1999 年至 2014 年间,美国孕妇阿片类药物使用障碍(OUD)的患病率增加了四倍。围产期患有 OUD 的女性的标准治疗方法是丁丙诺啡。然而,调节母婴行为和母婴联系的母体行为神经回路尚未在接受丁丙诺啡治疗 OUD(BT)的人类母亲中进行研究。啮齿动物研究表明,阿片类药物对母婴护理和防御母婴大脑子系统之间的相互抑制有影响:分别是下丘脑和导水管周围灰质。我们进行了一项纵向功能磁共振成像(fMRI)的初步研究,专门研究了围产期灰质和下丘脑之间的静息状态功能连接(rs-FC),并探索了与 BT 中母婴联系的关联。我们研究了 32 名母亲,她们在产后 1 个月(T1)和 4 个月(T2)完成了 fMRI 扫描,包括 7 名接受丁丙诺啡治疗 OUD 的母亲和 25 名非 OUD 母亲作为对照组(CG)。参与者在每个时间点都接受了 6 分钟的静息态 fMRI 扫描。我们使用产后联系问卷来测量潜在的联系受损,以探讨与围产期灰质相关的 rs-FC 如何与联系受损相关。与 CG 相比,BT 母亲在 T1 时与下丘脑、杏仁核、岛叶皮层和其他大脑区域的围产期灰质依赖 rs-FC 存在差异,其中许多差异在 T2 时消失,这表明继续丁丙诺啡治疗可能具有治疗效果。相比之下,产后联系问卷的“拒绝和病理性愤怒”子量表在 T1 和 T2 时与 T1 到 T2 期间围产期灰质与下丘脑和杏仁核的 rs-FC 增加有关。初步证据将 OUD 母亲产后早期的母婴联系问题与特定的母婴大脑回路的护理和防御联系起来,丁丙诺啡治疗可能会减轻这种联系。这项探索性研究支持了一种潜在的机制,用于研究阿片类药物对母婴护理和与婴儿联系的治疗益处和风险。