From time to time, a few of the researchers in the HEALthy Brain and Child Development (HBCD) study find themselves working late into the evening on The University of New Mexico’s North Campus, keeping watch as an infant peacefully slumbers amid the clatter and clang of an MRI scan
Brain scans of babies as young as 30 days old are part and parcel of the ambitious multi-site research program funded by the National Institutes of Health, said Ludmila Bakhireva, MD, PhD, MPH, professor in the UNM College of Pharmacy and multiple principal investigator for the UNM arm of the study. The research team has learned to schedule the scans to coincide with a baby’s natural nap time, she said.
“It’s a very ambitious project,” she said. “It’s the largest-ever study of early brain development.” The HBCD study is recruiting as many as 7,500 maternal or caregiver-infant pairs from 27 sites across the U.S. and following them from birth through pre-teen years
The study has two primary goals, Bakhireva said. The first is to map out normal brain development over time in healthy infants. The MRI study conducted in the first month of life is repeated at three to nine months and again at nine to 15 months, then annually after that
“The second goal is to look at prenatal substance exposures, as well as environmental and social factors,” she said. In identifying the greatest impacts on child development, “the biggest challenge is to disentangle whether it is substance use or the social or economic milieu – hardship and challenges? They are very interrelated and it is very hard to disentangle these factors in a single-site study.”
We found a very strong association between maternal childhood adversity, impaired mental health and substance use during pregnancy, as well as effects on infant development
– Ludmila Bakhireva, MD, PhD, MPH, Professor, UNM College of Pharmacy
That’s why HBCD’s expected sample size is so large, Bakhireva said. “Hopefully, it will allow us to get to these questions, which for decades were kind of dim and unanswerable. We just passed the 4,000 mark for recruitment nationally, which is a major milestone.”
In addition to the MRI scans, the research protocol calls for the collection of blood, urine, saliva, stool and nail clippings, along with placental tissue, umbilical cord tissue and umbilical cord blood. The children also undergo regular videotaped cognitive and behavioral assessments, as well as measures of their brain wave activity
The UNM branch of the study is a collaboration with the Mind Research Network, led by MRN 3T Core Director Andrew Mayer, PhD, who also serves as multiple principal investigator. The MRN maintains an advanced research scanner in UNM’s Pete & Nancy Domenici Hall, Bakhireva said. Nine faculty members from across the UNM campus are involved, along with 15 staff members
Additional studies are conducted at UNM’s Interdisciplinary Substance Use and Brain Injury center. “We are using a state-of-the art facility to do EEG and behavioral assessments,” Bakhireva said. The team also conducts physiological measurements –including heart rate variability – a measure of cardiovascular fitness
The study also encompasses the health history of the children’s mothers. At UNM, which has received more than $8 million in funding to date, the HBCD study builds on previous research exploring how social determinants of health affect maternal mental health and predispose some women to substance use during pregnancy, she said. The UNM researchers are focusing on four substances of interest known to play a role in fetal development: alcohol, opioid drugs, cannabis and tobacco, she said.
“We found a very strong association between maternal childhood adversity, impaired mental health and substance use during pregnancy, as well as effects on infant development,” Bakhireva said. “Identifying mechanisms underpinning this relationship is fascinating to me, because I think it’s an area where we can really make a difference for the future if we can break the trans-generational transmission or link.”
The HBCD’s multifactorial framework of resilience factors could help identify the factors that have the biggest impact, both positive and negative, during specific, crucial windows of brain development, she said
“We know, for example, that adversity during the first three years of life has a much more prominent impact on long-term health outcomes for behavioral and somatic health, then, let’s say, adversity later in life. This is just one example of trying to map the most crucial windows of brain development.”
The more than 150 U.S. researchers who have helped guide the HBCD study since it was launched in 2021 have already published nearly 250 research papers – many with contributions from UNM scientists
One of those papers found that nearly 13% of the pregnant women in the study reported more than minimal alcohol use, Bakhireva said. “Among those who reported alcohol use, over a third reported poly-substance use,” she said. “This is important and striking in many ways, because alcohol use, even in small amounts, can affect neural development, and combining alcohol with substances like opioids or cannabis can multiply the risks.”
The team also analyzed data on prenatal exposure to cannabis and opioids to better understand their effects on pregnancy and newborn health. Preliminary analyses suggest measurable patterns in birth outcomes that warrant continued investigation. “Cannabis is often perceived by the public as less harmful,” Bakhireva said. “Our ongoing research aims to clarify how prenatal exposure – whether to cannabis or other substances – may influence birth weight and early brain development.”
The size of the HBCD birth cohort has given rise to multiple sub-studies. One, co-led by Bakhireva, created a bio-bank of delivery specimens – placentae, umbilical cord tissue and blood – for future study of the biological mechanisms that affect infant development
Bakhireva and her colleagues are examining how changes in maternal health affect fetal brain development through placental mechanisms. “We are finding that the placenta acts as a key mediator between prenatal exposures and child development, and understanding these pathways may lead to future treatment targets.”
To ensure a representative study population the researchers have recruited participants from different areas of the state, different races and ethnicities and varying socio-economic backgrounds, she said. “We actually have a very large representation of monolingual Spanish speakers, the largest number across all 27 sites.”
Bakhireva’s research has also identified some things that can ameliorate the risks and promote resilience
“In our UNM studies, we found women who received a high level of social support, whether from family, friends or government assistance programs, fare better,” she said. “It has a huge impact on maternal mental health and we see reduction in substance use
“So that’s one of the things we can really take to the next level in terms of policy implementation – providing additional social support to women in need during pregnancy and reducing substance use to improve maternal mental health and improve birth outcomes.”
Categories:Research,
College of Pharmacy
