Maylott Sarah E, Reese Sarah E, Zhou Anna M, Kaliush Parisa R, Terrell Sarah, Saenz Celine, Brown Lydia, Crowell Sheila E, Lester Barry, Smid Marcela C, Shakib Julie H, Garland Eric L, Conradt Elisabeth
Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
University of Montana, School of Social Work, Missoula, MT, USA.
Pediatr Res. 2025 Feb;97(3):1155-1165. doi: 10.1038/s41390-024-03399-7. Epub 2024 Aug 3.
Opioid use among pregnant women has more than quadrupled over the past 20 years; however, comorbid risk factors such as emotion dysregulation confound the developmental consequences of prenatal opioid use. Maternal respiratory sinus arrhythmia (RSA) may help to disentangle the comorbid risk factors of prenatal emotion dysregulation and substance use and isolate their consequences on newborn neurobehavior.
We examined maternal RSA in response to a mild, infant-related stress task in pregnant people (N = 192; 30 on medications for opioid use disorder) recruited from hospitals and a specialty prenatal clinic for substance use disorder.
Three latent profiles emerged based on maternal RSA reactivity. Mothers with RSA increasing (Profile 3; more nervous system dysregulation) had higher levels of emotion dysregulation than mothers with RSA decreasing (Profile 1; well-regulated nervous system responses) but were not more likely to use opioids. Additionally, RSA profiles were associated with newborn neurobehavior, including attention, regulation, handling, and arousal.
Given the variability in opioid use across RSA profiles and profile associations with newborn neurodevelopment, future studies should examine protective factors in pregnant individuals using opioids who show more flexible RSA responses.
Our study examined maternal psychophysiology and newborn outcomes in a unique population with high levels of emotion dysregulation and opioid use. Three profiles of maternal respiratory sinus arrythmia (RSA) reactivity were identified during pregnancy: decreasing, blunted, and increasing. The RSA increasing and blunted profiles were associated with higher emotion dysregulation than the decreasing profile. Most pregnant people on medications for opioid use disorder (65%) were grouped into the blunted profile, suggesting they might be more at risk for dysregulated RSA reactivity. Differences in RSA profiles were associated with newborn outcomes, with increasing and blunted RSA predicting more newborn neurobehavioral dysregulation.
在过去20年中，孕妇阿片类药物的使用量增长了四倍多；然而，诸如情绪失调等共病风险因素混淆了产前阿片类药物使用对发育的影响。母亲的呼吸性窦性心律不齐（RSA）可能有助于理清产前情绪失调和物质使用的共病风险因素，并分离它们对新生儿神经行为的影响。
我们在从医院和一家专门的产前物质使用障碍诊所招募的孕妇（N = 192；30人正在服用阿片类药物使用障碍的药物）中，检查了她们在应对一项与婴儿相关的轻度应激任务时的母亲RSA。
根据母亲RSA反应性出现了三种潜在模式。RSA增加的母亲（模式3；神经系统失调更严重）比RSA减少的母亲（模式1；神经系统反应调节良好）情绪失调水平更高，但使用阿片类药物的可能性并不更大。此外，RSA模式与新生儿神经行为有关，包括注意力、调节、应对和觉醒。
鉴于不同RSA模式下阿片类药物使用情况的差异以及模式与新生儿神经发育的关联，未来的研究应该考察使用阿片类药物且RSA反应更灵活的孕妇中的保护因素。
我们的研究在一个情绪失调和阿片类药物使用水平较高的独特人群中，考察了母亲的心理生理学和新生儿结局。孕期确定了三种母亲呼吸性窦性心律不齐（RSA）反应模式：减少、迟钝和增加。与减少模式相比,RSA增加和迟钝模式与更高的情绪失调相关。大多数服用阿片类药物使用障碍药物的孕妇（65%）被归为迟钝模式，这表明她们可能更易出现RSA反应失调的风险。RSA模式的差异与新生儿结局有关，RSA增加和迟钝预示着更多的新生儿神经行为失调。
