Annual Research Review: Prenatal opioid exposure - a two-generation approach to conceptualizing neurodevelopmental outcomes.

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Opioid use during pregnancy impacts the health and well-being of two generations: the pregnant person and the child. The factors that increase risk for opioid use in the adult, as well as those that perpetuate risk for the caregiver and child, oftentimes replicate across generations and may be more likely to affect child neurodevelopment than the opioid exposure itself. In this article, we review the prenatal opioid exposure literature with the perspective that this is not a singular event but an intergenerational cascade of events. We highlight several mechanisms of transmission across generations: biological factors, including genetics and epigenetics and the gut-brain axis; parent-child mechanisms, such as prepregnancy experience of child maltreatment, quality of parenting, infant behaviors, neonatal opioid withdrawal diagnosis, and broader environmental contributors including poverty, violence exposure, stigma, and Child Protective Services involvement. We conclude by describing ways in which intergenerational transmission can be disrupted by early intervention.





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Conradt, Elisabeth, Marie Camerota, Sarah Maylott and Barry M Lester (2023). Annual Research Review: Prenatal opioid exposure - a two-generation approach to conceptualizing neurodevelopmental outcomes. Journal of child psychology and psychiatry, and allied disciplines. 10.1111/jcpp.13761 Retrieved from

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Elisabeth D Conradt

Associate Professor in Psychiatry and Behavioral Sciences

As a clinical and developmental psychologist, my mission is to promote infant and early childhood mental health. My scientific focus is to better understand the intergenerational transmission of risk for mental health problems. In the CAN lab we document how exposures the pregnant person had throughout the lifespan can impact the pregnancy, preterm birth risk, newborn neurodevelopment, and susceptibility for psychopathology. Emotion dysregulation is a transdiagnostic, early-emerging marker of risk for a wide range of psychiatric outcomes, including ADHD, mood, and bipolar disorder. We study how emotion dysregulation – a modifiable intervention target – emerges early in development to inform preventive intervention efforts that begin prenatally and in the first year of life. Pregnant people with emotion dysregulation are also susceptible to a wide range of health risk behaviors, including substance use. Another line of research involves understanding how prenatal substance exposure, in combination with associated environmental exposures, affects neurodevelopment and mental health outcomes in early childhood. The overarching goal of my research is to leverage this science to prevent intergenerational transmission of mental health problems.

I am Associate Professor in Psychiatry, and adjunct Associate Professor of Pediatrics at Duke University. Before coming to Duke, I was Associate Professor in the Department of Psychology, and adjunct Associate Professor in the Departments of Obstetrics & Gynecology and Pediatrics at the University of Utah. I received my PhD in Clinical Psychology at the University of Oregon and completed my clinical internship in Early Childhood Mental Health at the Children’s Hospital of Philadelphia. I have been continuously funded by the NIH since 2011 when I was awarded an F32 postdoctoral fellowship to examine the biological embedding of early life stress in children with prenatal substance exposure at Brown University. My work has been covered in media outlets like NPR and I have received multiple national and international early career research awards.

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