Cocaine addiction in mothers: potential effects on maternal care and infant development

Screening and early intervention for substance use during pregnancy: A retrospective case note review of antenatal care records

INTRODUCTION

Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care.

METHODS

A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital-based antenatal clinics, from July 2019-September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed.

RESULTS

The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e-cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients.

DISCUSSION AND CONCLUSIONS

Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e-cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services.

Brain circuits for maternal sensitivity and pain involving anterior cingulate cortex among mothers receiving buprenorphine treatment for opioid use disorder

Opioid-induced deficits in maternal behaviors are well-characterized in rodent models. Amid the current epidemic of opioid use disorder (OUD), prevalence among pregnant women has risen sharply. Yet, the roles of buprenorphine replacement treatment for OUD (BT/OUD) in the brain functions of postpartum mothers are unclear. Using functional magnetic resonance imaging (fMRI), we have developed an evolutionarily conserved maternal behavior neurocircuit (MBN) model to study human maternal care versus defensive/aggressive behaviors critical to mother-child bonding. The anterior cingulate gyrus (ACC) is not only involved in the MBN for mother-child bonding and attachment, but also part of an opioid sensitive "pain-matrix". The literature suggests that prescription opioids produce physical and emotional "analgesic" effects by disrupting specific resting-state functional connectivity (rs-FC) of ACC to regions related to MBN. Thus, in this longitudinal study, we report findings of overlapping MBN and pain matrix circuits, for mothers with chronic exposure of BT/OUD. A total of 32 mothers were studied with 6 min rs-FC at 1 month (T1) and 4 months postpartum (T2), including seven on BT/OUD and 25 non-BT/OUD mothers as a comparison group. We analyzed rs-FC between the insula, putamen, and the dorsal anterior cingulate cortex (DACC) and rostral ACC (RACC), as the regions of interest that mediate opioid analgesia. BT/OUD mothers, as compared to non-BT/OUD mothers, showed less left insula-RACC rs-FC but greater right putamen-DACC rs-FC at T1, with these between-group differences diminished at T2. Some of these rs-FC results were correlated with the scores of postpartum parental bonding questionnaire. We found time-by-treatment interaction effects on DACC and RACC-dependent rs-FC, potentially identifying brain mechanisms for beneficial effects of BT, normalizing dysfunction of maternal brain and behavior over the first four months postpartum. This study complements recent studies to ascertain how BT/OUD affects maternal behaviors, mother-child bonding, and intersubjectivity and reveals potential MBN/pain-matrix targets for novel interventions.

A randomized wait-list controlled trial to investigate the role of cognitive mechanisms in parenting interventions on mothers with substance use disorder

Background

Maternal substance use disorder (SUD) represents a risk condition for quality of parenting and child development. The current literature highlights the need to identify interventions that effectively enhance the quality of parenting and to better understand which mechanisms are involved in the process of change. The present study protocol describes a randomized wait-list controlled trial that aims to examine (1) the efficacy of the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) in improving the quality of parenting (i.e., sensitive parenting and sensitive discipline) in mothers with SUD, (2) whether the intervention affects parental cognitive mechanisms (i.e., attentional disengagement to infant negative emotions, inhibitory control confronted with children’s affective expression, and parental reflective functioning), and (3) whether changes in these processes act as mechanisms of change, mediating the effect of the VIPP-SD program on quality of parenting. Moreover, the study aims (4) to explore whether the VIPP-SD has an effect on parenting stress and (5) to compare mothers with SUD to low-risk mothers on the outcome measures.

Methods

The study will involve 40 mothers with SUD and 20 low-risk mothers of children aged between 14 months and 6 years old. Mothers in the SUD group will be randomly divided into two groups, one receiving the intervention (SUD experimental group) and one undergoing treatment as usual (SUD control group). All the mothers will be assessed pre-test and post-test. Quality of parenting will be assessed through observed parenting behaviors, whereas parental cognitive mechanisms will be assessed through neuropsychological tasks and self-report measures.

Discussion

The results of the study will reveal whether an intervention that has been proven effective in other at-risk samples is also effective in improving parenting behaviors in the context of SUD. The results will also provide insight into potential cognitive mechanisms involved in the process of change.

Trial registration

ISRCTN registry ISRCTN63070968. Registered on 25 June 2021. Retrospectively registered

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06420-8.

Developmental Pathways from Prenatal Substance Exposure to Reactive Aggression

Few studies have examined etiological pathways from prenatal substance exposure to adolescent reactive aggression. We tested a conceptual model that included hypothesized pathways from prenatal substance exposure to adolescent aggression via autonomic reactivity and violence exposure from infancy to early school age and maternal harshness across early childhood. The sample included 216 families (106 boys) who primarily self-identified as Black or Mixed Race. Results supported the hypothesized path from violence exposure across early childhood and early school age to school age autonomic reactivity and early adolescent reactive aggression. There was also a significant interaction effect of sympathetic and parasympathetic reactivity on adolescent reactive aggression, with sympathetic arousal and parasympathetic suppression at early school age associated with higher reactive relational and physical aggression in adolescence. Results emphasize the importance of early experiences and autonomic nervous system changes in contributing to the cascade of risk for reactive aggression in early adolescence.

Environmental Exposure during Pregnancy: Influence on Prenatal Development and Early Life: A Comprehensive Review

Preconception and prenatal exposure to environmental contaminants may affect future health. Pregnancy and early life are critical sensitive windows of susceptibility. The aim of this review was to summarize current evidence on the toxic effects of environment exposure during pregnancy, the neonatal period, and childhood. Alcohol use is related to foetal alcohol spectrum disorders, foetal alcohol syndrome being its most extreme form. Smoking is associated with placental abnormalities, preterm birth, stillbirth, or impaired growth and development, as well as with intellectual impairment, obesity, and cardiovascular diseases later in life. Negative birth outcomes have been linked to the use of drugs of abuse. Pregnant and lactating women are exposed to endocrine-disrupting chemicals and heavy metals present in foodstuffs, which may alter hormones in the body. Prenatal exposure to these compounds has been associated with pre-eclampsia and intrauterine growth restriction, preterm birth, and thyroid function. Metals can accumulate in the placenta, causing foetal growth restriction. Evidence on the effects of air pollutants on pregnancy is constantly growing, for example, preterm birth, foetal growth restriction, increased uterine vascular resistance, impaired placental vascularization, increased gestational diabetes, and reduced telomere length. The advantages of breastfeeding outweigh any risks from contaminants. However, it is important to assess health outcomes of toxic exposures via breastfeeding. Initial studies suggest an association between pre-eclampsia and environmental noise, particularly with early-onset pre-eclampsia. There is rising evidence of the negative effects of environmental contaminants following exposure during pregnancy and breastfeeding, which should be considered a major public health issue.

Neurobiology of peripartum mental illness

At least one in seven pregnant or recently postpartum women will experience a mental illness such as an anxiety disorder, depressive disorder, or substance use disorder. These mental illnesses have detrimental effects on the health of the mother, child, and family, but little is known about the hypothalamic and other neural correlates of maternal mental health concerns. The transition to parenthood alone is a time of remarkable neural plasticity, so it is perhaps not surprising that current research is showing that maternal mental illness has unique neural profiles. Furthermore, the neural systems affected by peripartum mental illness overlap and interact with the systems involved in maternal caregiving behaviors, and mother-infant interactions are, therefore, highly susceptible to disruption. This review discusses what we know about the unique neural changes occurring during peripartum mental illness and the role of the hypothalamus in these illnesses. With an improved understanding of the neural correlates of maternal mental health and disease, we will be better equipped to predict risk, develop effective treatments, and ultimately prevent suffering for millions of parents during this critical time in life.

Advancing preventive interventions for pregnant women who are opioid using via the integration of addiction and mental health research

Purpose of Review

This review examines how research focused on treatment for opioid use in perinatal populations and preventive interventions for postpartum psychopathology have remained separate, despite significant overlap.

Recent Findings

Guidelines for best practice in caring for pregnant women with opioid use disorder suggest the use of medication-assisted treatment with additional comprehensive care, including behavioral and mental health interventions. However, intervention research often mutually excludes these two populations, with studies of behavioral interventions for opioid use excluding women with psychopathology and research on preventive interventions for postpartum psychopathology excluding women who are substance using.

Summary

There is a limited evidence-base to inform the selection of appropriate preventive interventions for pregnant women with opioid use disorder that can address opioid use and/or treatment adherence and concurrent mental health risks. We argue it is critical to integrate research on pregnant women who are opioid using and preventive perinatal mental health interventions to catalyze pivotal change in how we address the opioid epidemic within this growing population.

Opioid Use in Pregnancy

PURPOSE OF REVIEW

Perinatal opioid use is a major public health problem and is associated with a number of deleterious maternal and fetal effects. We review recent evidence of perinatal outcomes and treatment of opioid use disorder (OUD) during pregnancy.

RECENT FINDINGS

Opioid exposure in pregnancy is associated with multiple obstetric and neonatal adverse outcomes, with the most common being neonatal opioid withdrawal syndrome (NOWS). Treatment with buprenorphine or methadone is associated with NOWS, but neither medication appears to have significant adverse effects on early childhood development. Buprenorphine appears to be superior to methadone in terms of incidence and severity of NOWS in exposed infants. The long-term effects of opioid exposure in utero have been inconclusive, but recent longitudinal studies point to potential differences in brain morphology that may increase vulnerability to future stressors. Maintenance therapy with methadone or buprenorphine remains the standard of care for pregnant women with OUD given its consistent superiority to placebo in terms of rates of illicit drug use and pregnancy outcomes. New non-pharmacologic management options for NOWS appear promising. Future research is needed to further evaluate the effects of opioid exposure in utero and determine the optimal delivery model for maintenance therapy.

Effects of opioids on the parental brain in health and disease

The epidemic of opioid use disorder (OUD) directly affects millions of women of child-bearing age. Unfortunately, parenting behaviors - among the most important processes for human survival - are vulnerable to the effects of OUD. The standard of care for pregnant women with OUD is opioid maintenance therapy (OMT), of which the primary objective is to mitigate addiction-related stress. The aim of this review is to synthesize current information specific to pregnancy and parenting that may be affected by OUD. We first summarize a model of the parental brain supported by animal research and human neuroimaging. We then review animal models of exogenous opioid effects on parental brain and behavior. We also present preliminary data for a unifying hypothesis that may link different effects of exogenous opioids on parenting across species and in the context of OMT. Finally, we discuss future directions that may inform research and clinical decision making for peripartum women with OUD.

Early processing (N170) of infant faces in mothers of children with autism spectrum disorder and its association with maternal sensitivity

Individuals with autism spectrum disorder (ASD) exhibit impaired adult facial processing, as shown by the N170 event-related potential. However, few studies explore such processing in mothers of children with ASD, and none has assessed the early processing of infant faces in these women. Moreover, whether processing of infant facial expressions in mothers of children with ASD is related to their response to their child's needs (maternal sensitivity [MS]) remains unknown. This study explored the N170 related to infant faces in a group of mothers of children with ASD (MA) and a reference group of mothers of children without ASD. For both emotional (crying, smiling) and neutral expressions, the MA group exhibited larger amplitudes of N170 in the right hemisphere, while the reference group showed similar interhemispheric amplitudes. This lateralization effect within the MA group was not present for nonfaces and was stronger in the mothers with higher MS. We propose that mothers of ASD children use specialized perceptual resources to process infant faces, and this specialization is mediated by MS. Our findings suggest that having an ASD child modulates mothers' early neurophysiological responsiveness to infant cues. Whether this modulation represents a biological marker or a response given by experience remains to be explored. Autism Research 2019, 12: 744-758. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: When mothers of children with autism spectrum disorder (ASD) see baby faces expressing emotions, they show a right-sided electrical response in the brain. This lateralization was stronger in mothers who were more sensitive to their children's needs. We conclude that having a child with ASD and being more attuned to their behavior generates a specialized pattern of brain activity when processing infant faces. Whether this pattern is biological or given by experience remains to be explored.

The Influences of Drug Abuse on Mother-Infant Interaction Through the Lens of the Biopsychosocial Model of Health and Illness: A Review

Women who abuse illicit drugs often engage in atypical parenting behaviors that interfere with the natural development of mother-infant interaction and attachment. Maternal caregiving deficits leave pronounced adverse consequences in the wake of drug abuse relapse, which often occurs and in early infancy. These are times when the child requires optimal parental care. The contemporary literature documents long-term implications of illicit drug-abuse in parenting on infants. However, factors that drive and sustain the influence of drug abuse on parent-infant outcomes remain elusive. This review adopts a biopsychosocial approach to synthesizing the existing state of knowledge on this issue. Mother-infant interaction is a dynamic socio-relational process that occurs at multiple levels of organization. As such, a biopsychosocial perspective enables us to uncover: (i) roles of specific physiological mechanisms and biological characteristics of atypical parenting in mothers who abuse drugs, (ii) the influence of drugs on maternal psychological state (i.e., beliefs regarding parenting practices, emotional regulation), and (iii) social relationships (i.e., relationships with spouse and other drug abusers) and contextual cues (i.e., triggers) that moderate non-optimal maternal caregiving. A comprehensive review of these key domains provides a nuanced understanding of how these several sources interdependently shape atypical parent-infant interaction amongst drug abusing mothers. Systematic elucidation of major factors underlying drug-abused maternal behaviors facilitates the development of targeted and more effective interventions.

Pathways Relating the Neurobiology of Attachment to Drug Addiction

Substance use disorders constitute a significant public health problem in North America and worldwide. Specifically, substance addictions in women during pregnancy or in the postpartum period have adverse effects not only on the mother, but also on mother-infant attachment and the child's subsequent development. Additionally, there is growing evidence suggesting that parental addiction may be transmitted intergenerationally, where the child of parents with addiction problems is more likely to experience addiction as an adult. The current review takes a developmental perspective and draws from animal and human studies to examine how compromised early experience, including insecure attachment, early abuse/neglect, and unresolved trauma, may influence the development of neurobiological pathways associated with addictions, ultimately increasing one's susceptibility to addictions later in life. We approach this from three different levels: molecular, neuroendocrine and behavioral; and examine the oxytocin affiliation system, dopamine reward system, and glucocorticoid stress response system in this regard. Increased understanding of these underlying mechanisms may help identify key targets for early prevention efforts and inform needed intervention strategies related to both insecure attachment and addiction.

Substance use in pregnancy: The medical challenge

Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.

Psychoactive drug exposure during breastfeeding: a critical need for preclinical behavioral testing

Breastfeeding women are excluded from clinical trials of psychoactive drugs because of ethical concerns. Animal testing, which often is predictive of adverse effects in humans, represents the only avenue available for assessing drug safety for human offspring exposed to drugs during lactation. I determined whether behavioral outcomes for children exposed during breastfeeding to antidepressants, anxiolytics, antipsychotics, anti-seizure medications, analgesics, sedatives, and marijuana can be predicted by rodent studies of offspring exposed to drugs during lactation. Animal data were available for only 10 of 80 CNS-active drugs canvassed. Behavioral deficits in adolescence or adulthood in rats and mice after various drug exposures during lactation included reductions in sexual behavior, increased anxiety, hyperactivity, and impaired learning and memory. Whether similar adverse effects will emerge in adulthood in children exposed to drugs during breastfeeding is unknown. Rodent research has the potential to forecast impairments in breastfed children long before information emerges from post-marketing reports and should be prioritized during preclinical drug evaluation by the FDA for new drugs and for drugs currently prescribed off-label for lactating women.

Prenatal substance exposure and offspring development: Does DNA methylation play a role?

The period of in utero development is one of the most critical windows during which adverse conditions and exposures may influence the growth and development of the fetus as well as its future postnatal health and behavior. Maternal substance use during pregnancy remains a relatively common but nonetheless hazardous in utero exposure. For example, previous epidemiological studies have associated prenatal substance exposure with reduced birth weight, poor developmental and psychological outcomes, and increased risk for diseases and behavioral disorders (e.g., externalizing behaviors like ADHD, conduct disorder, and substance use) later in life. Researchers are now learning that many of the mechanisms whereby adverse in utero exposures may affect key pathways crucial for proper fetal growth and development are epigenetic in nature, with the majority of work in humans considering DNA methylation specifically. This review will explore the research to date on epigenetic alterations tied to maternal substance use during pregnancy and will also discuss the possible role of DNA methylation in the robust relationship between maternal substance use and later behavioral and developmental sequelae in offspring.

Use of fast-scan cyclic voltammetry to assess phasic dopamine release in rat models of early postpartum maternal behavior and neglect

Maternal behavior (MB) is a complex response to infant cues, orchestrated by postpartum neurophysiology. Although mesolimbic dopamine contributes toward MB, little is known about real-time dopamine fluctuations during the postpartum period. Thus, we used fast-scan cyclic voltammetry to measure individual dopamine transients in the nucleus accumbens of early postpartum rats and compared them with dopamine transients in virgins and in postpartum females exposed to cocaine during pregnancy, which is known to disrupt MB. We hypothesized that dopamine transients are normally enhanced postpartum and support MB. In anesthetized rats, electrically evoked dopamine release was larger and clearance was faster in postpartum females than in virgins and gestational cocaine exposure blocked the change in clearance. In awake rats, control mothers showed more dopamine transients than cocaine-exposed mothers during MB. Salient pup-produced stimuli may contribute toward differences in maternal phasic dopamine by evoking dopamine transients; supporting the feasibility of this hypothesis, urine composition (glucose, ketones, and leukocytes) differed between unexposed and cocaine-exposed infants. These data, resulting from the novel application of fast-scan cyclic voltammetry to models of MB, support the hypothesis that phasic dopamine signaling is enhanced postpartum. Future studies with additional controls can delineate which aspects of gestational cocaine reduce dopamine clearance and transient frequency.

Mothers with substance addictions show reduced reward responses when viewing their own infant's face

Maternal addiction constitutes a major public health problem affecting children, with high rates of abuse, neglect, and foster care placement. However, little is known about the ways in which substance addiction alters brain function related to maternal behavior. Prior studies have shown that infant face cues activate similar dopamine-associated brain reward regions to substances of abuse. Here, we report on a functional MRI study documenting that mothers with addictions demonstrate reduced activation of reward regions when shown reward-related cues of their own infants. Thirty-six mothers receiving inpatient treatment for substance addiction were scanned at 6 months postpartum, while viewing happy and sad face images of their own infant compared to those of a matched unknown infant. When viewing happy face images of their own infant, mothers with addictions showed a striking pattern of decreased activation in dopamine- and oxytocin-innervated brain regions, including the hypothalamus, ventral striatum, and ventromedial prefrontal cortex-regions in which increased activation has previously been observed in mothers without addictions. Our results are the first to demonstrate that mothers with addictions show reduced activation in key reward regions of the brain in response to their own infant's face cues. Hum Brain Mapp 38:5421-5439, 2017. © 2017 Wiley Periodicals, Inc.

Altered functional connectivity to stressful stimuli in prenatally cocaine-exposed adolescents

BACKGROUND

Prenatal cocaine exposure (PCE) is linked to addiction and obesity vulnerability. Neural responses to stressful and appetitive cues in adolescents with PCE versus those without have been differentially linked to substance-use initiation. However, no prior studies have assessed cue-reactivity responses among PCE adolescents using a connectivity-based approach.

METHODS

Twenty-two PCE and 22 non-prenatally drug-exposed (NDE) age-, sex-, IQ- and BMI-matched adolescents participated in individualized guided imagery with appetitive (favorite-food), stressful and neutral-relaxing cue scripts during functional magnetic resonance imaging. Subjective favorite-food craving scores were collected before and after script exposure. A data-driven voxel-wise intrinsic connectivity distribution analysis was used to identify between-group differences and examine relationships with craving scores.

RESULTS

A group-by-cue interaction effect identified a parietal lobe cluster where PCE versus NDE adolescents showed less connectivity during stressful and more connectivity during neutral-relaxing conditions. Follow-up seed-based connectivity analyses revealed that, among PCE adolescents, the parietal seed was positively connected to inferior parietal and sensory areas and negatively connected to corticolimbic during both stress and neutral-relaxing conditions. For NDE, greater parietal connectivity to parietal, cingulate and sensory areas and lesser parietal connectivity to medial prefrontal areas were found during stress compared to neutral-relaxing cueing. Craving scores inversely correlated with corticolimbic connectivity in PCE, but not NDE adolescents, during the favorite-food condition.

CONCLUSIONS

Findings from this first data-driven intrinsic connectivity analysis of PCE influences on adolescent brain function indicate differences relating to PCE status and craving. These findings provide insight into the developmental impact of in utero drug exposure.

Cocaína durante la gestación y conducta materna postparto en ratones

El abuso materno de cocaína durante la gestación se relaciona con negligencia, maltrato y perturbación del vínculo madre- hijo, lo que incide directamente en el desarrollo de los infantes; por esto, las diversas problemáticas neuroconductuales de los hijos de padres drogodependientes podrían atribuirse a la inadecuada conducta materna o a la exposición prenatal a la droga. El objetivo de esta investigación fue analizar los efectos de la administración crónica de cocaína durante la gestación en la conducta materna postparto de ratones. Para esto se asignaron aleatoriamente 21 ratones CD1 hembras gestantes para la administración de solución salina y cocaína (25 mg/kg/día y 50 mg/kg/día), desde el octavo hasta el día veintiuno de gestación. Después del parto, durante 20 días (15 minutos diarios), se registró individualmente la frecuencia de presentación de 16 índices de conducta materna mediante un etograma. Se encontró que la cocaína afectó levemente la frecuencia de la conducta materna, aunque posiblemente afecte otros parámetros como la latencia, duración y secuencia de esta conducta.  

The Effects of Maternal Opium Abuse on Fetal Heart Rate using Non-Stress Test

BACKGROUND

Opium is one of the most commonly abused opiates in developing countries including Iran. Considering the importance of maternal health on the newborn, we aimed to assess the effect of opium abuse on fetal heart rate (FHR) characteristics in a sample of pregnant women in Zahedan, Southeast Iran.

METHODS

This cross-sectional study was done on 100 pregnant women referring to Ali-Ibn-Abi Talib Hospital in Zahedan, during 2011-2013. The participants were divided into two groups comprising of opium abusers and healthy individuals. The participants received 500cc intravenous fluid containing dextrose and then non-stress test results were recorded for 20 minutes.

RESULTS

We found no significant difference between the two groups with respect to their demographic characteristics. Fetal movements, variability, acceleration, and reactivity were significantly higher among addicted women (P<0.0001 for all). Periodic change was 9.8 times higher among opium abusers compared with the healthy women. Abnormal variability or oscillations of <15 beats/min, which indicates lack of beat-to-beat variability, was significantly higher in the fetuses of addicted mothers (P<0.0001).

CONCLUSION

Considering significant abnormal patterns in FHR characteristics among the opium abuser group, mothers addicted to opium need specific prenatal care.

Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions

Children's emotional and relational development can be negatively influenced by maternal substance abuse, particularly through a dysfunctional caregiving environment. Attachment Theory offers a privileged framework to analyze how drug addiction can affect the quality of adult attachment style, parenting attitudes and behaviors toward the child, and how it can have a detrimental effect on the co-construction of the attachment bond by the mother and the infant. Several studies, as a matter of fact, have identified a prevalence of insecure patterns among drug-abusing mothers and their children. Many interventions for mothers with Substance Use Disorders have focused on enhancing parental skills, but they have often overlooked the emotional and relational features of the mother-infant bond. Instead, in recent years, a number of protocols have been developed in order to strengthen the relationship between drug-abusing mothers and their children, drawing lessons from Attachment Theory. The present study reviews the literature on the adult and infant attachment style in the context of drug addiction, describing currently available treatment programs that address parenting and specifically focus on the mother-infant bond, relying on Attachment Theory.

Early adverse experience and substance addiction: dopamine, oxytocin, and glucocorticoid pathways

Substance addiction may follow a chronic, relapsing course and critically undermine the physical and psychological well-being of the affected individual and the social units of which the individual is a member. Despite the public health burden associated with substance addiction, treatment options remain suboptimal, with relapses often seen. The present review synthesizes growing insights from animal and human research to shed light upon developmental and neurobiological pathways that may increase susceptibility to addiction. We examine the dopamine system, the oxytocin system, and the glucocorticoid system, as they are particularly relevant to substance addiction. Our aim is to delineate how early adverse experience may induce long-lasting alterations in each of these systems at molecular, neuroendocrine, and behavioral levels and ultimately lead to heightened vulnerability to substance addiction. We further discuss how substance addiction in adulthood may increase the risk of suboptimal caregiving for the next generation, perpetuating the intergenerational cycle of early adverse experiences and addiction.

Attenuated neural response to emotional cues in cocaine-dependence: a preliminary analysis of gender differences

BACKGROUND

Cocaine users often report a loss of arousal for nondrug-related stimuli, which may contribute to their response to drug-related rewards. However, little is known about users' neural reactivity to emotional nondrug-related stimuli and the potential influence of gender.

OBJECTIVES

Test the hypotheses that cocaine-dependent individuals have an attenuated neural response to arousing stimuli relative to controls and that this difference is amplified in women.

METHODS

The brain response to typically arousing positive and negative images as well as neutral images from the International Affective Picture System was measured in 40 individuals (20 non-treatment seeking cocaine-dependent and 20 age- and gender-matched control participants; 50% of whom were women). Images were displayed for 4 s each in blocks of five across two 270-second runs. General linear models assessed within and between group activation differences for the emotional images.

RESULTS

Cocaine-dependent individuals had a significantly lower response to typically arousing positive and negative images than controls, with attenuated neural activity present in the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC). Analyses by gender revealed less mPFC/ACC activation among female users, but not males, for both positive and negative images.

CONCLUSION

The dampened neural response to typically arousing stimuli among cocaine-dependent polydrug users suggests decreased salience processing for nondrug stimuli, particularly among female users. This decreased responding is consistent with data from other substance using populations and suggests that this may be a general feature of addiction. Amplifying the neural response to naturally arousing nondrug-related reinforcers may present an opportunity for unique behavioral and brain stimulation therapies.

Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early

Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents' addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing EF and adopting a trauma-focused approach.

Substance use during pregnancy

Prenatal substance use is a critical public health concern that is linked with several harmful maternal and fetal consequences. The most frequently used substance in pregnancy is tobacco, followed by alcohol, cannabis and other illicit substances. Unfortunately, polysubstance use in pregnancy is common, as well as psychiatric comorbidity, environmental stressors, and limited and disrupted parental care, all of which can compound deleterious maternal and fetal outcomes. There are few existing treatments for prenatal substance use and these mainly comprise behavioral and psychosocial interventions. Contingency management has been shown to be the most efficacious of these. The purpose of this review is to examine the recent literature on the prenatal use of tobacco, alcohol, cannabis, stimulants, and opioids, including the effects of these on maternal and fetal health and the current therapeutic options.

The maternal brain and its plasticity in humans

This article is part of a Special Issue "Parental Care". Early mother-infant relationships play important roles in infants' optimal development. New mothers undergo neurobiological changes that support developing mother-infant relationships regardless of great individual differences in those relationships. In this article, we review the neural plasticity in human mothers' brains based on functional magnetic resonance imaging (fMRI) studies. First, we review the neural circuits that are involved in establishing and maintaining mother-infant relationships. Second, we discuss early postpartum factors (e.g., birth and feeding methods, hormones, and parental sensitivity) that are associated with individual differences in maternal brain neuroplasticity. Third, we discuss abnormal changes in the maternal brain related to psychopathology (i.e., postpartum depression, posttraumatic stress disorder, substance abuse) and potential brain remodeling associated with interventions. Last, we highlight potentially important future research directions to better understand normative changes in the maternal brain and risks for abnormal changes that may disrupt early mother-infant relationships.

Neuropeptidergic regulation of pair-bonding and stress buffering: Lessons from voles

This article is part of a Special Issue "SBN 2014". Interpersonal attachment is a critical component of the human experience. Pair-bonding ameliorates the severity of several mental and physical diseases. Thus, a better understanding of how the central nervous system responds to and encodes social-buffering during stress is a valuable research enterprise. The prairie vole (Microtus ochrogaster), as a laboratory animal model, provides the gold standard for the investigation of the neurobiology underlying attachment. Furthermore, emerging research in voles, additional laboratory rodents, transgenic mice, primates, and humans has provided novel insight into the neurochemical mechanisms underlying the therapeutic effects of social bonds reducing anxiety, depression, and drug abuse liability. In the present review, we highlight the work from this burgeoning field and focus on the role(s) of the neuropeptides oxytocin (OT), vasopressin (AVP), and corticotrophin releasing hormone (CRH) mediating stress buffering. Together, the data suggest that OT underlies social bonding to reduce stress-induced psychological illness while AVP and CRH facilitate arousal to enhance autonomic reactivity, increasing susceptibility to adverse mental and physical health.

Substance Use in the Perinatal Period

Perinatal substance use remains a major public health problem and is associated with a number of deleterious maternal and fetal effects. Polysubstance use in pregnancy is common and can potentiate adverse maternal and fetal outcomes. Tobacco is the most commonly used substance in pregnancy, followed by alcohol and illicit substances. The treatments for perinatal substance use are limited and consist mostly of behavioral and psychosocial interventions. Of these, contingency management has shown the most efficacy. More recently, novel interventions such as progesterone for postpartum cocaine use have shown promise. The purpose of this review is to examine the recent literature on the use of tobacco, alcohol, cannabis, stimulants, and opioids in the perinatal period, their effects on maternal and fetal health, and current treatments.

Brain Reward Pathway Dysfunction in Maternal Depression and Addiction: A Present and Future Transgenerational Risk

Two research areas that could benefit from a greater focus on the role of the reward pathway are maternal depression and maternal addiction. Both depression and addiction in mothers are mediated by deficiencies in the reward pathway and represent substantial risks to the health of offspring and future generations. This targeted review discusses maternal reward deficits in depressed and addicted mothers, neural, genetic, and epigenetic mechanisms, and the transgenerational transmission of these deficits from mother to offspring. Postpartum depression and drug use disorders may entail alterations in the reward pathway, particularly in striatal and prefrontal areas, which may affect maternal attachment to offspring and heighten the risk of transgenerational effects on the oxytocin and dopamine systems. Alterations may involve neural circuitry changes, genetic factors that impact monoaminergic neurotransmission, as well as growth factors such as BDNF and stress-associated signaling in the brain. Improved maternal reward-based preventative measures and treatments may be specifically effective for mothers and their offspring suffering from depression and/or addiction.

Maternal treatment with fluoxetine promotes testicular alteration in male rat pups

Fluoxetine (FLX) is a selective serotonin reuptake inhibitor (SSRI) antidepressant commonly prescribed during pregnancy and lactation. Pre- and post-partum depression, as well as SSRI treatment during these periods, may change maternal care, interfering with offspring development. Moreover, it is known that SSRIs may alter testes structure and function in offspring. The present study investigated the effects of maternal FLX exposure on maternal behaviour and testes function in offspring. Female Wistar rats were treated with 7.5mgkg-1 FLX or tap water (control group) by gavage from the Day 1 of pregnancy until 21 days after birth (postnatal Day (PND) 21). Maternal behaviour was evaluated and morphofunctional analyses of offspring testes were conducted on PND 21 and 50. There were no significant differences between the FLX-treated and control groups regarding maternal behaviour. Nor did maternal treatment with FLX have any effect on bodyweight gain, anogenital distance, day of preputial separation, testis weight and the gonadosomatic index in male offspring. However, there was a decreased number of Sertoli cells at both PND 21 and 50 in FLX-exposed male offspring. The findings of the present study demonstrate that maternal exposure to FLX can impair testicular function in weanling and pubertal animals.

Translational analysis of effects of prenatal cocaine exposure on human infant cries and rat pup ultrasonic vocalizations

Spectral and temporal features of human infant crying may detect neurobehavioral effects of prenatal cocaine exposure (PCE). Finding comparable measures of rodent ultrasonic vocalizations (USVs) would promote translational analyses by controlling the effects of correlated variables that confound human studies. To this end, two studies examined the sensitivity of similar acoustic structures in human infant and rat pup vocalizations to effects of PCE. In Study 1, cry sounds of 107 one month-old infants were spectrum analyzed to create a novel set of measures and to detect the presence of hyperphonation - a qualitative shift to an atypically high fundamental frequency (basic pitch) associated with neurobehavioral insult. Infants with PCE were compared to infants with prenatal polydrug-exposure (PPE) without cocaine and with infants in a standard comparison (SC) group with no prenatal drug exposure. In Study 2, USVs of 118 five day-old rat pups with either PCE, prenatal saline exposure or no prenatal exposures were spectrum analyzed to detect the presence of frequency shifts - acoustic features that have a frequency waveform similar to that of hyperphonation. Results of study 1 showed PCE had two sets of sex-dependent effects on human infants: PCE males had higher pitched cries with more dysphonation (turbulence); PCE females had longer pauses between fewer cry sounds that were of lower amplitude than comparison groups. PCE and PPE infants had more cries with hyperphonation than SC infants. In study 2, PCE pups had a greater percentage of USVs with shift in the acoustic structure than pups in the two control groups. As such, the novel measures of human infant crying and rat pup USVs were sensitive to effects of PCE. These studies provide the first known translational analysis of similar acoustic structures of vocalizations in two species to detect adverse effects of prenatal drug exposure.

Oxytocin reverses amphetamine-induced deficits in social bonding: evidence for an interaction with nucleus accumbens dopamine

Drug addiction has devastating consequences on social behaviors and can lead to the impairment of social bonding. Accumulating evidence indicates that alterations in oxytocin (OT) and dopamine (DA) neurotransmission within brain reward circuitry may be involved. We investigated this possibility, as well as the therapeutic potential of OT for drug-induced social deficits, using the prairie vole (Microtus ochrogaster)-a socially monogamous rodent that forms enduring pair bonds between adult mates. We demonstrate that repeated exposure to the commonly abused psychostimulant amphetamine (AMPH) inhibits the formation of partner preferences (an index of pair bonding) in female prairie voles. AMPH exposure also altered OT and DA neurotransmission in regions that mediate partner preference formation: it decreased OT and DA D2 receptor immunoreactivity in the medial prefrontal cortex (mPFC) and nucleus accumbens (NAcc), respectively, and increased NAcc DA levels. Administration of OT directly into the mPFC of AMPH-exposed voles restored partner preferences, and altered NAcc DA levels, and this effect was dependent on OT receptor activation. Together, these data suggest that repeated AMPH exposure impairs pair bonding through an OT-mediated mechanism, and that OT and DA systems within brain reward circuitry may interact to mediate the complex relationship between drug abuse and social bonding. Further, these results provide empirical support for the idea that the central OT system may represent an important target for the treatment of social deficits in addiction.

Alcohol and tobacco use among maltreated and non-maltreated adolescents in a birth cohort

AIMS

This study examines whether child maltreatment experience predicts adolescent tobacco and alcohol use.

METHODS

The subjects were participants in the Mater-University Study of Pregnancy (MUSP), a birth cohort of 7223, of whom 5158 (71.4%) were available for analysis at the 14-year follow-up. Child protection history was obtained from the state's child protection agency and confidentially linked. Exposure to reported child maltreatment was the primary predictor variable. The outcome variables were self-reported smoking and alcohol use. Associations were adjusted for potential confounders.

RESULTS

Reported child maltreatment was associated with early adolescent smoking [odds ratio (OR) 1.76, 95% confidence interval (CI) = 1.32-2.34] after adjustment for socio-demographic variables and coexisting alcohol use. Both neglect/emotional abuse (OR 2.03, 95% CI = 1.20-3.42) and neglect/emotional abuse that included physical abuse (OR 1.85, 95% CI = 1.19-2.88) were associated with smoking after full adjustment, including for coexisting alcohol use. After full adjustment, including coexisting smoking, only child neglect/emotional abuse predicted early adolescent alcohol use (OR 1.78, 95% CI = 1.06-2.97), but not the other types of maltreatment.

CONCLUSIONS

Reported child maltreatment predicts early adolescent smoking after adjusting for alcohol use, but does not predict alcohol use after adjustment for smoking. Both smoking and alcohol use are predicted by reported child neglect. Early adolescent smoking is also predicted by multi-type maltreatment that includes physical abuse.

Cocaine withdrawal influences paternal behavior and associated central expression of vasopressin, oxytocin and tyrosine hydroxylase in mandarin voles

Although the disruptive effects of cocaine on the maternal care are well known, little is known about paternal care in the context of cocaine abuse. Vasopressin (AVP), oxytocin (OT) and dopamine (DA) have been found to regulate paternal behavior and are also involved in cocaine abuse. Mandarin voles (Microtus mandarinus) are socially monogamous and display high levels of paternal care. Here, we investigated whether paternal behavior and associated central levels of AVP, OT and DA were altered following 24 h of withdrawal from 4 day administration of 20 mg/kg/day cocaine. Our data shows that vole fathers did not experience altered levels of locomotion during an open field test. However, compared to controls, cocaine attenuated licking/grooming and contact behavior and shortened the latency to crouching, contact and pup retrieval. Last, fewer AVP and OT immunoreactive neurons in the paraventricular nucleus and more tyrosine hydroxylase immunoreactive neurons in the ventral tegmental area were observed in cocaine-treated fathers. These results indicate that cocaine withdrawal disturbs the expression of partial paternal behavior by altering central levels of AVP, OT and DA.

Effect of prenatal cocaine on early postnatal thermoregulation and ultrasonic vocalization production

Prenatal cocaine exposure can alter the postnatal care received by rat pups. Such effects could be caused in part by alterations in pup-produced stimuli that elicit early postnatal maternal care. Pup ultrasonic vocalizations are thought to be a particularly salient stimulus, and when paired with other cues, may elicit maternal attention. Cocaine is known to acutely alter thermoregulatory and cardiac function, thus prenatal cocaine may affect vocalizations through altering these functions. The data presented here determine the impact of full term prenatal cocaine exposure, saline exposure, or no exposure on thermogenic capacity, cardiac function, and the resulting ultrasonic vocalizations across the early postnatal period (days 1–5). Results indicated that while sharing many similar characteristics with saline-exposed and untreated animals, prenatal cocaine exposure was associated with specific alterations in vocalization characteristics on postnatal day 1 (PND 1), including call amplitude. Furthermore, numerous spectral parameters of their vocalizations were found altered on PND 3, including rate, call duration, and frequency, while no alterations were found on PND 5. Additionally, cocaine-exposed pups also showed a reduced thermoregulatory capacity compared to saline animals and reduced cardiac mass compared to untreated animals on PND 5. Together, these findings indicate that prenatal cocaine may be altering the elicitation of maternal care through its impact on vocalizations and thermoregulation, and suggests a potential mechanism for these effects through cocaine's impact on developing stress systems.

Negative reward expectations in Borderline Personality Disorder patients: neurophysiological evidence

Borderline Personality Disorder (BPD) patients present profound disturbances in affect regulation and impulse control which could reflect a dysfunction in reward-related processes. The current study investigated these processes in a sample of 18 BPD patients and 18 matched healthy controls, using an event-related brain potentials methodology. Results revealed a reduction in the amplitude of the Feedback-Related Negativity of BPD patients, which is a neurophysiological index of the impact of negative feedback in reward-related tasks. This reduction, in the effect of negative feedback in BPD patients, was accompanied by a different behavioral pattern of risk choice compared to healthy participants. These findings confirm a dysfunctional reward system in BDP patients, which might compromise their capacity to build positive expectations of future rewards and decision making.

Prenatal and gestational cocaine exposure: Effects on the oxytocin system and social behavior with implications for addiction

Drug abuse during pregnancy is a major public health concern, with negative consequences throughout development. Prenatal cocaine exposure (PCE) in rats produces social behavior deficits with corresponding changes in neuroendocrine and monoaminergic signaling. The relevance of parental care in social behavior maturity cannot be ignored, and gestational exposure to cocaine severely disrupts parental care, thus impacting the early environment of the offspring. Oxytocin (Oxt) is critical in regulating social behaviors and central levels are disrupted following acute and chronic cocaine (CC) treatment in postpartum rat dams, coincident with deficits in maternal care. We will discuss studies aimed to determine the relative contribution of PCE and CC-induced deficits in maternal care to social behaviors and Oxt signaling across development. PCE results in decreased social (including parental) behaviors in adolescence and adulthood. PCE is also associated with increased aggression in adults. Rearing by CC-exposed mothers synergistically increases the behavioral effects of PCE. Rearing by CC-exposed mothers, but not PCE, disrupts Oxt levels and mRNA in regions relevant to social behavior, but does not affect receptors in postpartum adult offspring. Preliminary work indicates that PCE/CC rearing has dynamic effects on Oxt levels and receptors in neonatal rat pups, suggesting very early regulation of Oxt signaling. This work highlights how the interactive role of Oxt signaling and behavioral context throughout development can be derailed by drug abuse during pregnancy. The relevance of disrupted Oxt to intergenerational transmission of addiction is briefly discussed.

Biological contributions to addictions in adolescents and adults: prevention, treatment, and policy implications

PURPOSE

Despite significant advances in our understanding of the biological bases of addictions, these disorders continue to represent a huge public health burden that is associated with substantial personal suffering. Efforts to target addictions require consideration of how the improved biological understanding of addictions may lead to improved prevention, treatment, and policy initiatives.

METHOD

In this article, we provide a narrative review of current biological models for addictions with a goal of placing existing data and theories within a translational and developmental framework targeting the advancement of prevention, treatment, and policy strategies.

RESULTS

Data regarding individual differences, intermediary phenotypes, and main and interactive influences of genetic and environmental contributions in the setting of developmental trajectories that may be influenced by addictive drugs or behavior indicate complex underpinnings of addictions.

CONCLUSIONS

Consideration and further elucidation of the biological etiologies of addictions hold significant potential for making important gains and reducing the public health impact of addictions.

Developmental and behavioral consequences of prenatal cocaine exposure: a review

Substance use among pregnant women continues to be a major public health concern, posing potential risk to their drug-exposed children as well as burdens on society. This review is intended to discuss the most recent literature regarding the association between in utero cocaine exposure and developmental and behavioral outcomes from birth through adolescence across various domains of functioning (growth, neurobiology, intelligence, academic achievement, language, executive functioning, behavioral regulation and psychopathology). In addition, methodological limitations, associated biological, sociodemographic and environmental risk factors and future directions in this area of research are discussed. Given the large number of exposed children in the child welfare system and the increased need for medical, mental health and special education services within this population, more definitively documenting associations between prenatal cocaine exposure and later child outcomes is essential in order to be able to prospectively address the many significant public health, economic and public policy implications.

Depressive symptoms, substance abuse, and intimate partner violence among pregnant women of diverse ethnicities

This study examines the relationship between self-reported depressive symptoms, substance abuse and intimate partner violence among 602 African American, Hispanic, White, Asian American, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander pregnant women who are clients of the Augusta Partnership for Children, Inc., a nonprofit collaborative that works with agencies, organizations, and individuals to improve the lives of children and families in Augusta-Richmond County, Georgia. Descriptive statistics and significant relationships among selected variables using correlation and regression analyses were conducted. Findings are intended to inform strategies for community-based programs better to assist women of diverse ethnicities with addressing depression, substance abuse, and intimate partner violence during their pregnancies, with the ultimate aim of improving health and mental health outcomes for women and children.

Effects of cocaine on maternal behavior and neurochemistry

Drug addiction is a chronic relapsing disorder that involves drug seeking and abuse despite the negative social and health consequences. While the potential effects of cocaine on child development have been extensively studied over the last 30 years, few researchers have focused on the effects of cocaine on maternal behavior, which includes offspring care and maternal aggression towards an unfamiliar individual. In humans, maternal cocaine use can lead to child neglect, abuse, and disrupt the mother-child bond. While it has been argued the developmental effects of maternal cocaine use on children were initially overstated, it is clear that disruptions of typical maternal behavior (i.e. postpartum depression, anxiety disorders) are detrimental to the physical and emotional health of offspring. Cocaine use in mothers is commonly associated with psychological disorders, including depression and anxiety, and it is postulated that many of the negative effects of maternal cocaine use on offspring are mediated through changes in maternal behavior. This review will summarize research on cocaine and maternal behavior in animal and human studies, discuss potential mechanisms, and suggest therapeutic strategies for treating cocaine-affected maternal behavior which may improve the physical and behavioral health of both mother and child. The primary objective is to stimulate future communication, cooperation, and collaboration between researchers who use animals and humans to study cocaine and maternal behavior.

Synchrony and specificity in the maternal and the paternal brain: relations to oxytocin and vasopressin

OBJECTIVE

Research on the neurobiology of parenting has defined biobehavioral synchrony, the coordination of biological and behavioral responses between parent and child, as a central process underpinning mammalian bond formation. Bi-parental rearing, typically observed in monogamous species, is similarly thought to draw on mechanisms of mother-father synchrony.

METHOD

We examined synchrony in mothers' and fathers' brain response to ecologically valid infant cues. Thirty mothers and fathers, comprising 15 couples parenting 4- to 6-month-old infants, were visited at home, and infant play was videotaped. Parents then underwent functional magnetic resonance imaging scanning while observing own-infant compared with standard-infant videos. Coordination in brain response between mothers and fathers was assessed using a voxel-by-voxel algorithm, and gender-specific activations were also tested. Plasma oxytocin and arginine vasopressin, neuropeptides implicated in female and male bonding, were examined as correlates.

RESULTS

Online coordination in maternal and paternal brain activations emerged in social-cognitive networks implicated in empathy and social cognition. Mothers showed higher amygdala activations and correlations between amygdala response and oxytocin. Fathers showed greater activations in social-cognitive circuits, which correlated with vasopressin.

CONCLUSIONS

Parents coordinate online activity in social-cognitive networks that support intuitive understanding of infant signals and planning of adequate caregiving, whereas motivational-limbic activations may be gender specific. Although preliminary, these findings demonstrate synchrony in the brain response of two individuals within an attachment relationship, and may suggest that human attachment develops within the matrix of biological attunement and brain-to-brain synchrony between attachment partners.

Maternal oxytocin response during mother-infant interaction: associations with adult temperament

Oxytocin is a neuropeptide associated with social affiliation and maternal caregiving. However, its effects appear to be moderated by various contextual factors and stable individual characteristics. The purpose of this study was to investigate the relationship of self-reported state and trait measures (such as temperament, mood and affect) with peripheral oxytocin response in mothers. Fifty-five first-time mothers participated in a semi-structured procedure, during which time repeated peripheral oxytocin levels were measured before, during and after an episode of mother-infant interaction. The maternal oxytocin response was then calculated, based on the difference in oxytocin concentration between initial baseline and interaction phase. Mothers also completed state measures of positive and negative affect and depression, and trait measures of temperament, personality disturbance and depression across time. Regression analyses determined which factors were independently associated with maternal oxytocin response. The trait measure of adult temperament emerged as a significant predictor of oxytocin response. Two out of four Adult Temperament Questionnaire factor scales were independently associated with oxytocin response: Effortful Control was negatively associated, whereas Orienting Sensitivity was positively associated. No state measure significantly predicted oxytocin response. The results indicate that mothers who show an increased oxytocin response when interacting with their infants are more sensitive of moods, emotions and physical sensations; and less compulsive, schedule driven and task oriented. These findings link differences in individual temperament in new mothers with the peripheral oxytocin response, which may have implications in the pharmacologic treatment of disorders such as maternal neglect, post-partum depression and maternal addiction. This article is part of a Special Issue entitled Oxytocin, Vasopressin, and Social Behavior.

Corticostriatal-limbic gray matter morphology in adolescents with self-reported exposure to childhood maltreatment

OBJECTIVE

To study the relationship between self-reported exposure to childhood maltreatment (CM) and cerebral gray matter (GM) morphology in adolescents without psychiatric diagnoses.

DESIGN

Associations were examined between regional GM morphology and exposure to CM (measured using a childhood trauma self-report questionnaire for physical, emotional, and sexual abuse and for physical and emotional neglect).

SETTING

University hospital.

PARTICIPANTS

Forty-two adolescents without psychiatric diagnoses.

MAIN OUTCOME MEASURES

Correlations between childhood trauma self-report questionnaire scores and regional GM volume were assessed in voxel-based analyses of structural magnetic resonance images. Relationships among GM volume, subtypes of exposure to CM, and sex were explored.

RESULTS

Childhood trauma self-report questionnaire total scores correlated negatively (P < .005) with GM volume in prefrontal cortex, striatum, amygdala, sensory association cortices, and cerebellum. Physical abuse, physical neglect, and emotional neglect were associated with rostral prefrontal reductions. Decreases in dorsolateral and orbitofrontal cortices, insula, and ventral striatum were associated with physical abuse. Decreases in cerebellum were associated with physical neglect. Decreases in dorsolateral, orbitofrontal, and subgenual prefrontal cortices, striatum, amygdala, hippocampus, and cerebellum were associated with emotional neglect. Decreases in the latter emotion regulation regions were also associated with childhood trauma self-report questionnaire scores in girls, while caudate reductions (which may relate to impulse dyscontrol) were seen in boys.

CONCLUSIONS

Exposure to CM was associated with corticostriatal-limbic GM reductions in adolescents. Even if adolescents reporting exposure to CM do not present with symptoms that meet full criteria for psychiatric disorders, they may have corticostriatal-limbic GM morphologic alterations that place them at risk for behavioral difficulties. Vulnerabilities may be moderated by sex and by subtypes of exposure to CM.

Maternal neglect: oxytocin, dopamine and the neurobiology of attachment

Maternal neglect, including physical and emotional neglect, is a pervasive public health challenge with serious long-term effects on child health and development. I provide an overview of the neurobiological basis of maternal caregiving, aiming to better understand how to prevent and respond to maternal neglect. Drawing from both animal and human studies, key biological systems are identified that contribute to maternal caregiving behaviour, focusing on the oxytocinergic and dopaminergic systems. Mesocorticolimbic and nigrostriatal dopamine pathways contribute to the processing of infant-related sensory cues leading to a behavioural response. Oxytocin may activate the dopaminergic reward pathways in response to social cues. Human neuroimaging studies are summarised that demonstrate parallels between animal and human maternal caregiving responses in the brain. By comparing different patterns of human adult attachment, we gain a clearer understanding of how differences in maternal brain and endocrine responses may contribute to maternal neglect. For example, in insecure/dismissing attachment, which may be associated with emotional neglect, we see reduced activation of the mesocorticolimbic dopamine reward system in response to infant face cues, as well as decreased peripheral oxytocin response to mother-infant contact. We are currently testing whether the administration of intranasal oxytocin, as part of a randomised placebo controlled trial, may reverse some of these neurological differences, and potentially augment psychosocial and behavioural interventions for maternal neglect.

Prosocial effects of oxytocin and clinical evidence for its therapeutic potential

There has been unprecedented interest in the prosocial effects of the neuropeptide oxytocin in humans over the last decade. A range of studies has demonstrated correlations between basal oxytocin levels and the strength of social and bonding behaviors both in healthy individuals and in those suffering from psychiatric disorders. Mounting evidence suggests associations between polymorphisms in the oxytocin receptor gene and prosocial behaviors and there may also be important epigenetic effects. Many studies have now reported a plethora of prosocial effects of intranasal application of oxytocin, including the domains of trust, generosity, socially reinforced learning, and emotional empathy. The main focus of this review will be to summarize human preclinical work and particularly the rapidly growing number of clinical studies which have identified important links between oxytocin and a wide range of psychiatric disorders, and have now started to directly assess its therapeutic potential.

Contingency management with community reinforcement approach or twelve-step facilitation drug counseling for cocaine dependent pregnant women or women with young children

BACKGROUND

Cocaine abuse among women of child-bearing years is a significant public health problem. This study evaluated the efficacy of contingency management (CM), the community reinforcement approach (CRA), and twelve-step facilitation (TSF) for cocaine-dependent pregnant women or women with young children.

METHODS

Using a 2×2 study design, 145 cocaine dependent women were randomized to 24 weeks of CRA or TSF and to monetary vouchers provided contingent on cocaine-negative urine tests (CM) or non-contingently but yoked in value (voucher control, VC). Primary outcome measures included the longest consecutive period of documented abstinence, proportion of cocaine-negative urine tests (obtained twice-weekly), and percent days using cocaine (PDC) during treatment. Documented cocaine abstinence at baseline and 3, 6, 9 and 12 months following randomization was a secondary outcome.

FINDINGS

CM was associated with significantly greater duration of cocaine abstinence (p<.01), higher proportion of cocaine-negative urine tests (p<0.01), and higher proportion of documented abstinence across the 3-, 6-, 9- and 12-month assessments (p<0.05), compared to VC. The differences between CRA and TSF were not significant for any of these measures (all p values ≥0.75). PDC decreased significantly from baseline during treatment in all four groups (p<0.001) but did not differ significantly between CM and VC (p=0.10) or between TSF and CRA (p=0.23).

INTERPRETATION

The study findings support the efficacy of CM for cocaine dependent pregnant women and women with young children but do not support greater efficacy of CRA compared to TSF or differential efficacy of CM when paired with either CRA or TSF.

Cocaine alters dendritic spine density in cortical and subcortical brain regions of the postpartum and virgin female rat

Cocaine use during pregnancy induces profound neural and behavioral deficits in both mother and offspring. The present study was designed to compare the effects of cocaine exposure on spine density of postpartum and virgin female rat brains. Timed, pregnant, primiparous rats were injected with either cocaine (30 mg/kg) or saline, once daily, from gestational day 8 to 20. Twenty-four hours after giving birth, dam brains were processed for Golgi-impregnation. Virgin females were also injected with the same dose of cocaine or saline for 12 days and sacrificed 24 h after the last injection for comparison. Pregnant rats had significantly greater spine density in the medial amygdala (MeA) and medial preoptic area (MPOA) and lower spine density in CA1 than virgin females independent of cocaine treatment. Cocaine significantly increased dendritic spine density on the apical branch of pyramidal cells in the prefrontal cortex (PFC, 15%), both apical (13%) and basal (14.8%) branches of CA1 and cells in the MeA (28%) of pregnant rats. In the MPOA, cocaine administration resulted in a decrease in dendritic spine density (14%) in pregnant rats. In virgin females, cocaine had fewer effects but did increase dendritic spine density on both branches of CA1 neurons and in the MeA. The present study is the first to demonstrate that spine density differs between pregnant and virgin females and that pregnancy makes the brain more vulnerable to cocaine, which has important clinical implications.

Social behavior of offspring following prenatal cocaine exposure in rodents: a comparison with prenatal alcohol

Clinical and experimental reports suggest that prenatal cocaine exposure (PCE) alters the offsprings' social interactions with caregivers and conspecifics. Children exposed to prenatal cocaine show deficits in caregiver attachment and play behavior. In animal models, a developmental pattern of effects that range from deficits in play and social interaction during adolescence, to aggressive reactions during competition in adulthood is seen. This review will focus primarily on the effects of PCE on social behaviors involving conspecifics in animal models. Social relationships are critical to the developing organism; maternally directed interactions are necessary for initial survival. Juvenile rats deprived of play behavior, one of the earliest forms of non-mother directed social behaviors in rodents, show deficits in learning tasks and sexual competence. Social behavior is inherently complex. Because the emergence of appropriate social skills involves the interplay between various conceptual and biological facets of behavior and social information, it may be a particularly sensitive measure of prenatal insult. The social behavior surveyed include social interactions, play behavior/fighting, scent marking, and aggressive behavior in the offspring, as well as aspects of maternal behavior. The goal is to determine if there is a consensus of results in the literature with respect to PCE and social behaviors, and to discuss discrepant findings in terms of exposure models, the paradigms, and dependent variables, as well as housing conditions, and the sex and age of the offspring at testing. As there is increasing evidence that deficits in social behavior may be sequelae of developmental exposure alcohol, we compare changes in social behaviors reported for prenatal alcohol with those reported for prenatal cocaine. Shortcomings in the both literatures are identified and addressed in an effort to improve the translational value of future experimentation.