Oxytocin and Brain Responses in Maternal Addiction

Oxytocin and Brain Reward and Stress Responses to Infant Cues in Addicted Mothers

A prior study by the principal investigator of this project identified dopamine- and oxytocin-related brain pathways that showed a diminished response when addicted mothers viewed the faces of their own vs. unknown infants, compared with non-addicted mothers. These areas include the hypothalamus, striatum and ventromedial prefrontal cortex. In addition, the investigators plan to examine activation patterns within the salience network, which includes the anterior cingulate cortex and the anterior insula. Oxytocin, a neuropeptide with decreased blood levels seen in addicted mothers, is integrally involved in maternal brain and behavioral responses. When administered intranasally, the pilot data has shown enhanced activation of the striatum, prefrontal cortex (PFC) and amygdala.

The purpose of this study is to continue and expand upon the previous investigation of maternal addiction, by conducting a randomized, double-blinded, placebo controlled, crossover study of intranasal oxytocin on maternal brain responses. 150 mothers from the University of Iowa and the Yale Child Study Center will be enrolled (75 with a history of drug addiction and 75 matched control mothers), along with their 2 to 12-month-old infants, to participate in four study visits over a two-month period.

Study Overview

• Status: Terminated
• Conditions: Maternal Behavior; Maternal Addiction
• Intervention / Treatment: Drug: Oxytocin; Drug: Placebos; Procedure: Functional MRI scanning

Detailed Description

Maternal drug addiction constitutes a major public health problem for both women and affected children, with long lasting consequences on children's social, emotional and cognitive development. Current treatment strategies tend to focus on the mother and her current addiction, rather than her relationship with her child, and developmental processes that may perpetuate the addiction problems, such as unresolved childhood attachment trauma, neglect, and chronic stress. Unlike mothers who find engaging with their own infant to be a uniquely rewarding experience, mothers with addictions may be less able to respond appropriately to their infant's cues, finding them less intrinsically rewarding or salient, and more stress provoking.

Aim 1: To examine, in addicted mothers compared to non-addicted control mothers, the effect of intranasal oxytocin (OT) on functional MRI brain responses to reward-related cues: own vs. unknown happy infant faces.

Aim 2: To examine, in addicted mothers compared to non-addicted control mothers, the effect of intranasal OT on brain responses to stress-related cues: own vs. unknown sad infant faces and cries.

Aim 3: To examine the effect of intranasal OT on functional brain connectivity, including the striatum, PFC and amygdala. Specifically, exploring whether, after receiving intranasal OT compared to placebo, addicted mothers show increased functional connectivity between the amygdala and (i) the ventromedial PFC for own-happy infant faces, and (ii) the dorsolateral PFC and striatum for own-sad faces.

Aim 4: To explore how individual differences in adult attachment and mother-infant synchrony, sensation-seeking/risk-taking and stress/trauma exposure are associated with OT brain responses to infant faces.

Aim 5: To examine the effect of intranasal OT on activation of the salience network in addicted mothers, as well as connectivity patterns between these regions and the amygdala. We predict that there will be noticeable increase in activity in the salience network (dorsal anterior cingulate and anterior insula) after administering OT. We predict the addiction group will have a greater affect from the OT treatment than the control group.

• Study Type: Interventional
• Enrollment (Actual): 59
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Connecticut
    • New Haven, Connecticut, United States, 06520-7900
      • Yale Child Study Center
  • Iowa
    • Iowa City, Iowa, United States, 52242
      • University of Iowa

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 40 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria for addiction sample:

Drug-addicted subjects will be English speaking adult women who:

1. are being evaluated for treatment of their addiction or are currently enrolled in treatment programs;
2. have an infant <12 months;
3. meet criteria for substance abuse or dependence in the past year, as assessed by MINI International Neuropsychiatric Interview (MINI);
4. have a substance abuse history, including use during the most recent pregnancy;
5. are recommended at intake for drug-treatment services for substance abuse;
6. are 18 years to 40 years old; and
7. have been speaking English or enrolled in English-speaking school since age 8.

Inclusion Criteria for non-addicted mothers (controls):

Control subjects will be English-speaking adult women who:

1. have an infant <12 months of age;
2. do not meet criteria for past or present drug abuse or dependence;
3. are 18 years to 40 years old; and
4. have been speaking English or enrolled in English-speaking school since age 8.

Exclusion Criteria for addiction sample:

Potential drug-addicted subjects will be ineligible if they have:

1. severe psychiatric or substance-related symptoms requiring in-patient psychiatric hospitalization or detoxification for suicidality, homicidality, grave disability, physiological alcohol or drug withdrawal within the last 30 days;
2. past or present diagnosis of schizophrenia or other psychotic disorders;
3. metal implants or other contraindications for MRI scanning;
4. pending legal cases (e.g., outstanding arrest warrants or parental rights hearings) prohibiting them from completing the study;
5. current pregnancy or plans to become pregnant during the course of the study;
6. infants with clinical evidence of in utero drug effects, such as opiate withdrawal symptoms during the neonatal period, facial dysmorphism or intrauterine growth restriction (IUGR) or microcephaly;
7. infants with birth weight less than 3 lb. 5 oz.;
8. infants who have significant vision, hearing or motor problems (such as cerebral palsy) that cannot be corrected;
9. mothers who have significant vision or hearing problems that cannot be corrected;
10. out-of-home placement of infant for the past month or more than 50% of child's life;
11. delivered more than one baby during most recent pregnancy (twins, triplets, etc.).
12. exclusively breastfeeding

Exclusion criteria for non-addicted mothers:

Potential control subjects will be ineligible if they have:

1. positive drug toxicology screen at any point in the study;
2. drug abuse or dependence based on MINI in the past year or lifetime;
3. use of tobacco products in the past 2 years;
4. current hazardous alcohol use as ascertained by AUDIT score > 8;
5. present or past history of ambulatory detoxification;
6. severe psychiatric symptoms requiring inpatient psychiatric hospitalization for suicidality, homicidality, grave disability, physiological alcohol or drug withdrawal within the past 30 days;
7. past or present diagnosis of schizophrenia or other psychotic disorders;
8. metal implants or other contraindications for MRI scanning;
9. current pregnancy or plans to become pregnant during the course of the study;
10. infants with birth weight less than 3 lb. 5 oz.;
11. infants who have significant vision, hearing or motor problems that cannot be corrected (such as cerebral palsy);
12. mothers who have significant vision or hearing problems that cannot be corrected;
13. out-of-home placement of infant for the past month or more than 50% of child's life; and
14. delivered more than one baby during most recent pregnancy (twins, triplets, etc.).
15. exclusively breastfeeding

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Addicted; The addiction group will be scanned twice using functional magnetic resonance imaging (fMRI). Subjects will be randomly assigned to receive either the active comparator (intranasal oxytocin spray) or the placebo comparator before the first scanning session. For the second scan (approximately one month later), the subject will receive the other spray which she did not receive at the time of the first scan.	Drug: Oxytocin; All women will receive a nasal spray containing oxytocin.; Other Names: Pitocin; Syntocinon; Drug: Placebos; All women will receive a nasal spray containing a placebo solution.; Procedure: Functional MRI scanning; Study participants undergo two functional MRI scans.
Other: Control; The control group will be scanned twice using functional magnetic resonance imaging (fMRI). Subjects will be randomly assigned to receive either the active comparator (intranasal oxytocin spray) or the placebo comparator before the first scanning session. For the second scan (approximately one month later), the subject will receive the other spray which she did not receive at the time of the first scan.	Drug: Oxytocin; All women will receive a nasal spray containing oxytocin.; Other Names: Pitocin; Syntocinon; Drug: Placebos; All women will receive a nasal spray containing a placebo solution.; Procedure: Functional MRI scanning; Study participants undergo two functional MRI scans.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Effect of Intranasal Oxytocin on Brain fMRI Activation, Independent of Addiction Status (Hypotheses 1 and 2A).	Brain activation (blood-oxygen level dependent [BOLD] signal) in response to reward-related cues (own [O] vs. unknown [U] infant happy faces). Brain activation (BOLD signal) in response to stress-related cues (own [O] vs. unknown [U] infant sad faces). Specific regions of interests include the striatum and amygdala (for both happy and sad faces).	50 minutes after administration of oxytocin or placebo
Effect of Intranasal Oxytocin on Brain fMRI Activation in Addicted vs Controls Mothers (Hypotheses 1 and 2B)	Brain activation (BOLD signal) in response to reward-related cues (own [O] vs. unknown [U] infant happy faces). Specific region of interest includes the ventromedial prefrontal cortex (vmPFC) (interaction effect). Brain activation (BOLD signal) in response to stress-related cues (own vs. unknown infant sad faces). Specific region of interest includes the dorsolateral prefrontal cortex (dlPFC) (interaction effect).	50 minutes after administration of oxytocin or placebo

Collaborators and Investigators

• Sponsor: Lane Strathearn, MBBS PhD
• Collaborators: Yale University
• Investigators: Principal Investigator: Lane Strathearn, MBBS PhD, University of Iowa; Principal Investigator: Linda Mayes, MD, Yale University; Principal Investigator: Helena Rutherford, PhD, Yale University

Publications and helpful links

General Publications

• Rutherford HJ, Williams SK, Moy S, Mayes LC, Johns JM. Disruption of maternal parenting circuitry by addictive process: rewiring of reward and stress systems. Front Psychiatry. 2011 Jul 6;2:37. doi: 10.3389/fpsyt.2011.00037. eCollection 2011.
• SAMHSA, "Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings" (Substance Abuse and Mental Health Services Administration, Rockville, MD, 2012).
• Chaffin M, Kelleher K, Hollenberg J. Onset of physical abuse and neglect: psychiatric, substance abuse, and social risk factors from prospective community data. Child Abuse Negl. 1996 Mar;20(3):191-203. doi: 10.1016/s0145-2134(95)00144-1.
• Strathearn L, Li J, Fonagy P, Montague PR. What's in a smile? Maternal brain responses to infant facial cues. Pediatrics. 2008 Jul;122(1):40-51. doi: 10.1542/peds.2007-1566. Erratum In: Pediatrics. 2008 Sep;122(3):689.
• Kim S, Fonagy P, Allen J, Strathearn L. Mothers' unresolved trauma blunts amygdala response to infant distress. Soc Neurosci. 2014;9(4):352-63. doi: 10.1080/17470919.2014.896287. Epub 2014 Mar 17.
• L. C. Mayes, R. Feldman, R. Granger, The effects of polydrug use with and without cocaine on mother infant interaction at 3 and 6 months. Infant behavior & development 20, 489 (1997).
• Strathearn L, Mayes LC. Cocaine addiction in mothers: potential effects on maternal care and infant development. Ann N Y Acad Sci. 2010 Feb;1187:172-83. doi: 10.1111/j.1749-6632.2009.05142.x.
• Strathearn L, Mertens CE, Mayes L, Rutherford H, Rajhans P, Xu G, Potenza MN, Kim S. Pathways Relating the Neurobiology of Attachment to Drug Addiction. Front Psychiatry. 2019 Nov 8;10:737. doi: 10.3389/fpsyt.2019.00737. eCollection 2019.

Study record dates

Study Major Dates

• Study Start (Actual): May 5, 2017
• Primary Completion (Actual): May 17, 2021
• Study Completion (Actual): May 17, 2021

Study Registration Dates

• First Submitted: November 17, 2016
• First Submitted That Met QC Criteria: November 28, 2016
• First Posted (Estimated): December 1, 2016

Study Record Updates

• Last Update Posted (Actual): March 26, 2025
• Last Update Submitted That Met QC Criteria: March 24, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: intranasal oxytocin; maternal drug addiction; mother-infant attachment; unresolved trauma; maternal brain responses; mother-infant synchrony
• Additional Relevant MeSH Terms: Compulsive Behavior; Impulsive Behavior; Behavior, Addictive; Physiological Effects of Drugs; Reproductive Control Agents; Oxytocics; Oxytocin
• Other Study ID Numbers: 201601749

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The University of Iowa and Yale will compile data from both sites for data analysis purposes only. There is no plan to make individual participant data available.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No