Brain development during the early years goes through rapid change with vulnerable periods where a variety
of environmental exposures can have a large and enduring impact in early neurodevelopment and long-term
health outcomes. Experiences will permanently modify brain structure and function through epigenetic changes
that contribute to individual differences, in addition to reciprocal interactions among brain plasticity and
autonomic neuroendocrine, metabolic, and immune functions. Few studies have addressed how early brain
development and trajectories are impacted by early experiences and potential biological interactions within a
diverse population inclusive of rural and minority populations. The central goal of the HEAL Initiative: HEALthy
Brain and Child Development study is to prospectively examine brain and behavioral development from birth
through childhood with emphasis on the impact of in utero substance exposure on outcome.
At the University of Alabama at Birmingham (UAB) and the University of Alabama (UA) we will enroll pregnant
women during their second trimester and follow their infants with a comprehensive multimodal data longitudinal
study. Strengths to UAB include the Comprehensive Addiction in Pregnancy Program (CAPP) that provides
prenatal care and support to pregnant women with history of substance use. UAB OB supports several prenatal
clinics within Jefferson and Blount County Departments of Health, neighborhood health centers, and the
Complications clinic. UAB is actively enrolling participants for the HEAL Outcomes of Babies with Opioid
exposure and the ACT NOW Weaning study. UAB is a site for the NICHD Maternal Fetal Medicine Network and
the NICHD Neonatal Research Network for >25 years, with long-standing, well-established and highly productive
collaborations with other centers. UA operates at the University Medical Center in Tuscaloosa that serves the
majority of the Medicaid recipients in the region as well as rural clinics in surrounding counties, including those
in the Alabama Black Belt. The UA team has expertise in neuroimaging, EEG, rural health, maternal health and
child development. Therefore, there is demonstrated adequacy of clinical, research, administrative and facilities
to accomplish this project. We clearly express our intent to participate in a cooperative manner with the other
research sites, the HDCC, HCAC, the NIH Program Scientist and the NIH Program Official in all aspects of
research in a manner consistent with the terms of the award.
Specific Aims: 1. Determine typical neurodevelopmental trajectories and typical range of variability of brain
development from birth through childhood in a diverse population. 2. Determine how early life exposure to
opioids, other substances, and other adverse environmental circumstances affect these trajectories. 3.
Determine how genetic influences interact with environmental factors to influence neurodevelopment.
Design: 300 mother/child dyads (100 with and 200 without history of drug exposure) with complete longitudinal
brain, behavioral and biological assessment in conjunction with other research sites within the HEAL Initiative.