Department of Psychology, Wayne State University, Detroit, MI 48202, USA.
Neurotoxicol Teratol. 2021 Jul-Aug;86:106976. doi: 10.1016/j.ntt.2021.106976. Epub 2021 Apr 1.
Opioid Use Disorder (OUD) is a global epidemic also affecting women of reproductive age. A standard form of pharmacological treatment for OUD is Opioid Maintenance Therapy (OMT) and buprenorphine has emerged as the preferred treatment for pregnant women with OUD relative to methadone. However, the consequences of BUP exposure on the developing Maternal Brain Network and mother-infant dyad are not well understood. The maternal-infant bond is dependent on the Maternal Brain Network, which is responsible for the dynamic transition from a "nulliparous brain" to a "maternal brain". The Maternal Brain Network consists of regions implicated in maternal care (e.g., medial preoptic area, nucleus accumbens, ventral pallidum, ventral tegmentum area) and maternal defense (e.g., periaqueductal gray). The endogenous opioid system modulates many of the neurochemical changes in these areas during the transition to motherhood. Thus, it is not surprising that exogenous opioid exposure during pregnancy can be disruptive to the Maternal Brain Network. Though less drastic than misused opioids, OMTs may not be without risk of disrupting the neural and molecular structures of the Maternal Brain Network. This review describes the Maternal Brain Network as a framework for understanding how pharmacological differences in exogenous opioid exposure can disrupt the onset and maintenance of the maternal brain and summarizes opioid and OMT (in particular buprenorphine) use in the context of pregnancy and maternal behavior. This review also highlights future directions for evaluating exogenous opioid effects on the Maternal Brain Network in the hopes of raising awareness for the impact of the opioid crisis not only on exposed infants, but also on mothers and subsequent mother-infant bonds.
阿片类使用障碍（OUD）是一种全球性的流行疾病，也影响到育龄妇女。OUD 的标准药物治疗形式是阿片类维持治疗（OMT），与美沙酮相比，丁丙诺啡已成为治疗 OUD 孕妇的首选药物。然而，BUP 暴露对发育中的母体大脑网络和母婴对子的影响尚不清楚。母婴纽带依赖于母体大脑网络，该网络负责从“初产妇大脑”到“母亲大脑”的动态转变。母体大脑网络由与母婴护理相关的区域组成（例如，内侧视前区、伏隔核、腹侧苍白球、腹侧被盖区）和母婴防御（例如，导水管周围灰质）。内源性阿片系统调节了这些区域在向母亲转变过程中的许多神经化学变化。因此，怀孕期间外源性阿片类物质暴露会破坏母体大脑网络也就不足为奇了。尽管不如滥用阿片类药物那么剧烈，但 OMT 也可能会破坏母体大脑网络的神经和分子结构。本综述将母体大脑网络描述为一个框架，用于理解外源性阿片类物质暴露的药理学差异如何破坏母体大脑的起始和维持，并总结了阿片类药物和 OMT（特别是丁丙诺啡）在怀孕期间和母婴行为中的使用情况。本综述还强调了评估外源性阿片类物质对母体大脑网络影响的未来方向，希望提高人们对阿片类药物危机不仅对暴露婴儿，而且对母亲和随后的母婴纽带的影响的认识。
