Dramatic increases in the rates of obesity have occurred in the United States (most states >20%). Women of reproductive age are part of this trend, with obesity during pregnancy associated with increases in inflammation, immune dysregulation, and other complications of pregnancy (e.g. pre-eclampsia, prematurity, diabetes, etc.). Infants can be macrosomic with more NICU admissions, congenital anomalies, and autism. These effects appear to be transgenerational with infants born to obese mothers having an increased risk of childhood and adult obesity. The immune dysregulation leads to increased infections, especially chorioamnionitis and funicitis which are associated with low Apgar scores, encephalopathy, seizures and cerebral palsy. Developing novel interventions to prevent obesity during pregnancy should have a significant impact on short and long term neurodevelopmental outcome. Misuse of opioids during pregnancy is also a significant problem in the US.
Neonatal abstinence syndrome (NAS) affects most infants exposed to opioids in utero and genetic factors influencing the incidence and severity of NAS have not been studied. We analysed single nucleotide polymorphisms (SNPs) and epigenetic changes in the mu opioid receptor (OPRM1) and catechol-O-methyltransferase (COMT) genes (pharmacogenetic modulators of opioid action) and correlated this with short term outcomes. Genetic variation and epigenetic changes do appear to influence the incidence and severity of NAS. The results of ongoing studies will enhance our understanding of the pathogenesis of NAS, define best treatment practices, promote early identification of those at highest risk for neurodevelopmental impairment, and facilitate targeted interventions to improve outcome in these high risk infants.