HBCD Study Will Answer Important Questions about Substance Use in Pregnancy

HBCD Study Will Answer Important Questions about Substance Use in Pregnancy

HBCD for ASAM, Michelle Freund, PhD, Director of the HBCD Study

It is during the first years of development that the first seeds of later psychological and cognitive health and wellbeing are sown. Yet we still know very little about brain development during this period of life.

The NIH-funded HEALthy Brain and Child Development (HBCD) Study will recruit a large sample of pregnant individuals from across the U.S. It will follow their children for a decade, using structural and functional brain imaging, biospecimens, medical and family history, and tools for assessing social, emotional, and cognitive development. This study is expected to yield an enormous amount of data about brain development and how prenatal substance exposure and both adverse and healthy environments influence development. It is knowledge that could guide the implementation of substance-use prevention strategies as well as inform pediatricians and policymakers in myriad ways.

A preliminary phase of the HBCD project initiated in 2019 explored some of the challenges anticipated with this unique study, including ethical and legal issues of recruiting and retaining people who use substances during pregnancy. It was decided that the study teams will include peer navigators to help participants manage their visits and help locate SUD treatment and other resources. Some of these navigators will be certified peer recovery specialists with lived addiction experience.

Even during the recruitment phase of the study, which is scheduled to begin in Fall, 2022, we expect to gain valuable insight into the challenges faced by pregnant individuals with SUD. One of those challenges is that these individuals may not be receiving adequate prenatal care that is available, because of stigma, fear of losing custody of their children, and other barriers. Despite the consensus of federal agencies and professional medical societies that supportive policies should be applied toward people who use drugs during pregnancy, most states continue to impose punitive policies that discourage care-seeking during this critical window of maternal and child health ¹.

Difficulties that HBCD researchers anticipate in recruiting study participants through healthcare settings will tell us a lot about the barriers faced by a highly marginalized group. Lessons learned in the first stages of the HBCD study could yield insights into how to better reach and engage these patients in clinical care—both obstetric care and addiction care. Over time, the study should also be able to capture outcomes related to the trajectory and quality of clinical care that mothers receive, and insights into how pharmacotherapy for opioid use disorder as well as treatment retention might impact fetal and child outcomes.

As our country begins to see the light at the end of the COVID tunnel, attention is returning to the ongoing opioid crisis, which includes not only growing numbers of overdoses but also growing numbers of infants with neonatal opioid withdrawal syndrome (NOWS) and other implications of prenatal drug exposure. HBCD will be a crucial source of information guiding prevention and healthcare in coming years.