Abstract
While the prevalence of opioid use disorder (OUD) among pregnant women has multiplied in the United States in the last decade, buprenorphine treatment (BT) for peripartum women with OUD has been administered to reduce risks of repeated cycles of craving and withdrawal. However, the maternal behavior and bonding in mothers with OUD may be altered as the underlying maternal behavior neurocircuit (MBN) is opioid sensitive. In the regulation of rodent maternal behaviors such as licking and grooming, a series of opioid-sensitive brain regions are functionally connected, including the ventral pallidum (VP). In humans, these brain regions, interact with the supplementary motor area (SMA) to regulate maternal behaviors and are functionally dysregulated by opioids. It is unclear how these brain regions respond to the emotions of their child for mothers receiving BT. In this functional magnetic resonance imaging (fMRI) pilot study in 22 mothers within the first postpartum year, including six mothers receiving BT and 16 non-OUD mothers as a comparison group (CG), we devised a child face mirroring task in fMRI settings to assess maternal responses to pictures of facial expressions of own child and an unknown child in an empathic mirroring condition (Join) and a non-mirroring observation condition (Observe). In each condition, faces of neutral, ambiguous, distressed, and joyful expressions of each child were repeatedly displayed in a random order. The response of SMA during empathic mirroring (Join) vs. non-mirroring (Observe) of own child was reduced among BT/OUD vs. CG. Within MBN, the left VP, critical for parental sensitivity, had a similar deficit. This study outlines potential mechanisms for investigating the risks of deficits in the neural responses to actual maternal sensitivity and parenting behavior in mothers with OUD, and potential targets for interventions that reduce stress and augment maternal behavior and child outcome.
Highlights
Every day in the United States, approximately 200 people die after overdosing on opioids (CDC/NCHS, 2021)
We found that buprenorphine treatment (BT) showed lesser differential neural responses than comparison group (CG) in the supplementary motor area (SMA) ([2, 8, 60], 222 voxels, Z = 3.13, p = 0.045 Bonferroni family-wise s.v.c., Figure 4A) and the left pallidum ([−16, −4, −6], 23 voxels, Z = 4.26, p = 0.001 Bonferroni family-wise s.v.c., Figure 4B)
As depicted in the bar chart (Figure 5), in the SMA and left pallidum both, the CG group showed significant Join > Observe differential responses, but the BT group showed Join < Observe differential response. These results suggested that BT mothers may have altered emotional mirroring responses in brain regions important for parenting behaviors
Summary
Every day in the United States, approximately 200 people die after overdosing on opioids (CDC/NCHS, 2021). The incidence of pregnant women with opioid use disorder (OUD) quadruped from 1999 to 2014 (from 1.5/1,000 delivery hospitalizations to 6.5) (Haight et al, 2018). In this epidemic, 2.5% of pregnant women use opioids chronically (Krans and Patrick, 2016) such that about 100,000 postpartum women and their families are afflicted with OUD every year. Pregnant women with OUD may receive “gold standard” buprenorphine treatment (BT) for withdrawal (Jones et al, 2012; Nanda et al, 2015; Krans et al, 2016; Rosenthal et al, 2016; Zedler et al, 2016). Despite withdrawal reduction with BT, pregnant and postpartum women remain at high risk for problems, for which treatment is lacking. There is still little research on mother and child bonding and health with buprenorphine treatment for OUD (Salihu et al, 2019)
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