Researchers to involve expectant moms in study of how opioids, other disruptors influence a child’s development

When Brittany Howell’s mother learned her daughter would be recruiting 300 pregnant women from across western Virginia and following them and their babies through age 10, she knew she had to start knitting.

Howell, an assistant professor at Fralin Biomedical Research Institute at VTC, is leading part of a nationwide National Institutes of Health (NIH) study to address the opioid crisis, which has disproportionately affected rural communities in the commonwealth. 

With a new, four-year, $5.7 million grant, Howell is leading a team of Virginia Tech researchers seeking to fill a knowledge gap: How do early exposure to opioids and other factors influence babies’ brain, physical, and behavioral development?

Howell will use neuroimaging and behavioral analysis to turn a wide-angle lens on infant brain development. She is joined by two other principal investigators at Virginia Tech: Martha Ann Bell, University Distinguished Professor and professor of psychology in the College of Science; and Kathy Hosig, associate professor in the Virginia-Maryland Regional College of Veterinary Medicine and director for the Virginia Tech Center for Public Health Practice and Research.

Their work is part of the nationwide HEALthy Brain and Child Development study, which involves several NIH institutes and centers, including the Helping End Addiction Longterm initiative. Researchers will follow 7,500 moms and their children across the United States to gather data on pregnancy, infant and child development, growth, and bio-specimens. 

The scientists will conduct infant and early childhood brain imaging, compile medical and family histories, and track social, emotional, and cognitive development. Findings will help identify factors that confer risk and those that support resilience as children grow.

According to the Virginia Department of Health, opioid overdoses sent more than 27 people a day to the commonwealth’s emergency departments in 2020. Localities in western Virginia have some of the highest rates of neonatal abstinence syndrome, postnatal drug withdrawal that can result from maternal use, not only of illicit opiates, but of lifesaving medications used to treat opioid use disorder. The statewide rate in 2020 was 5.7 per 1,000 birth hospitalizations; 10 localities in western Virginia had rates ranging from 25.4 to 85.1 birth hospitalizations per 1,000.

What began as a study to better understand the opioid crisis grew to consider the effects of COVID-19, the shifting legal environment for cannabis, the roles of stress and trauma, and other factors.

“The reality is that a lot of the women who are opioid dependent are experiencing other things, whether it’s nicotine or alcohol use or something else,” said Howell, who is also an assistant professor of human development and family science in the College of Liberal Arts and Human Sciences and an iTHRIV Scholar, part of the integrated Translational Research Institute of Virginia. 

Hosig’s expertise as a public health extension specialist will help with the critical early task of recruiting participants. She has longstanding relationships with local and state health departments, clinicians and community groups in far Southwest Virginia in support of federally funded projects, and is involved with leadership in Virginia Tech’s partnership with the University of Virginia and Carilion Clinic in the NIH-supported integrated Translational Health Research Institute of Virginia (iTHRIV).

The first batch of knit blankets from Howell’s mother arrived in July. More are on the way and will be added to the welcome gifts for new moms who enroll. The tangible gifts aren’t as important as the intangible message they send, Hosig said.

“What really matters is what it feels like to be with the people doing the research. That makes all the difference in whether they come back, and keep coming,” Hosig said.

The study covers costs such as time, transportation, and meals. Families are overnight guests in a hotel adjacent to the Health Sciences and Technology campus in Roanoke, where the Fralin Biomedical Research Institute is located for study appointments, which can involve surveys, behavioral testing, bio-specimen collection, and brain scans. The MRIs take place without sedation overnight. 

“That’s when babies sleep best and longest,” Howell said.

While all three have experience recruiting participants, the HEALthy Brain and Child Development study is on a different scale. Getting 300 people to come in one time is hard, but doable, Howell said. “This is getting 300 people to come in 12 times over the course of their child’s first 10 years. That’s a tough ask if you aren’t willing to talk to them about why it’s important.”

The goal is to provide parents, communities, clinicians, and researchers with answers. While there’s a lot of parenting information available within a few clicks, there’s not enough based on science. 

“The more we can provide that empirical evidence, the better,” Howell said. “I want to provide tools to parents to do what we are all trying to do anyway – to do what is best for our kids.”

It’s easier to enroll parents of a typically developing child who have more education and exposure to academic research. 

“When you’re talking about high-risk women, they make the assumption that they couldn’t possibly contribute,” Howell said. She has found that some study participants assume they don’t have enough to offer or enough education or they may be struggling as parents. “But that’s why we want them. If you talk to them and say, ‘We want to learn more so we can help other women going through what you’re going through,’ then there is no hesitation,” she said. “These women are ready to go.”

Bell expects to see significant individual differences. What she likes about the work is that it encompasses brain and behavioral development in babies not expected to have health problems, alongside babies experiencing high-risk situations. “To see specifically how development unfolds for any given circumstance, and then taking that information and figuring out what we can do in the future, as a profession, to help families and help children, that’s what I’m most excited about,” said Bell, who is also a professor of human development and family science in the College of Liberal Arts and Human Sciences.  “What can we figure out about these different circumstances, and how can we help children be successful in the long run?”

The researchers recently jumped on a Zoom call to introduce Virginia Tech and the Fralin Biomedical Research Institute to investigators in the consortium of 25 participating research sites. They share excitement in seeing this part of the commonwealth represented.  

While the emphasis is on understanding the impact of in utero substance exposure on outcomes, with data collected through neuroimaging, neurophysiology, behavioral and cognitive assessments, and collection of bio-specimens, the team see their work extending beyond what happens in a lab. 

“We’re building a community of science, where parents feel like they are contributing to the research, and where we’re informing, not only developmental scientists, but clinicians and communities,” Bell said. 

It may not be life changing for the families who participate, Hosig said. But they will interact with scientists, gain exposure to biomedical research, share their experience with others, and contribute to the process of scientific discovery. “In this part of the country, being involved with Virginia Tech really matters.”

“The best part is the relationships we develop with families,” Bell said. “To be able to watch the children grow and change over time, that is such a privilege.”