The brain develops rapidly during pregnancy, through early childhood, and into adolescence, supporting a child’s cognitive and emotional development. This rapid growth also represents a highly vulnerable time where a variety of environmental exposures can have a large and enduring impact. Environmental exposures during pregnancy and infancy are also likely to have a significant impact on early brain development and long-term health outcomes.
For example, substance use during pregnancy, throughout breastfeeding, and while parenting has the potential to profoundly affect a child’s development in a variety of ways. The alarming increase in opioid use during pregnancy and the sharp rise in babies born with neonatal abstinence syndrome over the past decades show the urgent need to better understand the complex ways in which exposure to substances during pregnancy affects child health outcomes.1
Other environmental factors also concern scientists, such as exposure to toxins, structural racism, SARS-CoV-2 and pandemic-related stress, as well as access to healthcare. Research suggests these may influence child development, including brain growth and physical development.2-5 However, the scarcity of research on normal brain development from birth through adolescence from a large, diverse group of children has limited researchers’ ability to better understand how disruptions and experiences during early periods of growth impact individual development.
To better understand how these factors, alone and in combination, interact with genetics and other biological influences to affect a child’s mental and physical health over time, NIH is conducting the HEALthy Brain and Child Development (HBCD) Study.
What is the HBCD study?
The HEALthy Brain and Child Development (HBCD) Study is a large longitudinal study that will enroll around 7,500 pregnant volunteers from 25 research sites across the United States. The study will collect information about participants during pregnancy, at birth, and through early childhood. While most of the participants are expected to be recruited from the general population of pregnant people, a subset will include those whose babies were exposed during pregnancy or infancy to prescription and illicit opioids, cannabis (marijuana), stimulants, alcohol, and tobacco/nicotine; as well as participants from comparable environments who did not use substances during pregnancy. The HBCD Study is part of the National Institutes of Health (NIH) HEAL (Helping to End Addiction Long-termSM) Initiative, launched in April 2018 to investigate evidence-based ways to end the national opioid overdose crisis.
Why is it important to study brain development?
The brain undergoes rapid development prenatally, through early childhood and into adolescence. This rapid growth also represents a highly vulnerable period where a variety of biological and environmental factors can have a large and enduring impact.6-12 The HBCD study will allow scientists to better understand the complex interplay of biological and environmental factors that shape growing brains at the earliest stages.
What information will researchers collect?
Like the NIH’s Adolescent Brain Cognitive Development (ABCD) study, which is following more than 10,000 pre-adolescents through young adulthood, HBCD will collect a wide array of variables to chart the children’s development. Information collection will start in pregnancy, including a pregnant participant’s health history. Over the children’s first decade of life, scientists will collect data from regular, noninvasive medical imaging of their brains, as well as medical history; family history; biospecimens; and information on social, emotional, and cognitive development.
The study will also collect information related to COVID-19. For example, researchers at Oklahoma State University for Health Sciences conducted a feasibility study to assess the ability of pregnant people and new parents (both with and without histories of substance use disorders) to access treatment and mental health services during the COVID-19 crisis. Researchers at 17 HBCD sites across the country have been examining COVID-19’s impact on birth outcomes, parenting stress, and early childhood developmental milestones.
What can we learn from the HBCD study?
The HBCD study aims to help researchers:
- Better understand how the brain develops during pregnancy, infancy, and childhood.
- Discern how early exposure to opioids and other substances, including alcohol, tobacco, and cannabis, may affect development.
- Study how other environmental factors, including socioeconomic status, neighborhood safety, and family stability affect early development.
- Investigate the impact of traumatic events on brain development, including those resulting from the COVID-19 pandemic, parental loss, neglect, housing or food insecurity.
- Uncover risks for substance use, mental disorders, and other behavioral and developmental problems that emerge during childhood and adolescence, and protective factors that promote resilience and healthy development.
- Explore how interventions and services provided to pregnant participants, such as substance use disorder treatment or social/economic support, may help protect children from the adverse effects of exposure to drugs or other environmental stressors.
- Develop, improve, and validate brain imaging technologies for infants. These include magnetic resonance imaging (MRI) scans looking at the brain’s structure, and newer methods that assess brain function and the connections between brain regions that are important for optimal brain functioning.
How is the study funded?
The HBCD study is funded as a partnership between the NIH HEAL Initiative SM and 11 NIH Institutes, Centers, and Offices with an interest in understanding brain and child development.
- National Institute on Drug Abuse (NIDA)
- National Institute of Mental Health (NIMH)
- National Institute of Neurological Disorders and Stroke (NINDS)
- National Institute on Alcohol Abuse and Alcoholism (NIAAA)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- National Institute of Biomedical Imaging and Bioengineering (NIBIB)
- National Institute of Environmental Health Sciences (NIEHS)
- National Institute on Minority Health and Health Disparities (NIMHD)
- Environmental influences on Child Health Outcomes (ECHO) Program
- Office of Behavioral and Social Sciences Research (OBSSR)
- Office of Research on Women’s Health (ORWH)
- The NIH HEALthy Brain and Child Development Study
- Blog from NIDA Director Dr. Nora Volkow On the Purpose and Scope of the HCBD Study
- The NIH HEAL (Helping to End Addiction Long-TermSM) Initiative
- NIDA's Role in the NIH HEAL InitiativeSM
- NIH Research Spotlight: A New Way to Look at the Infant Brain
- Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004-2014. Pediatrics. 2018;141(4):e20173520. doi:10.1542/peds.2017-3520
- Provenzi L, Grumi S, Altieri L, et al. Prenatal maternal stress during the COVID-19 pandemic and infant regulatory capacity at 3 months: A longitudinal study [published online ahead of print, 2021 Jul 2]. Dev Psychopathol. 2021;1-9. doi:10.1017/S0954579421000766
- Lanphear BP, Vorhees CV, Bellinger DC. Protecting children from environmental toxins. PLoS Med. 2005;2(3):e61. doi:10.1371/journal.pmed.0020061
- Slopen N, Heard-Garris N. Structural Racism and Pediatric Health-A Call for Research to Confront the Origins of Racial Disparities in Health [published online ahead of print, 2021 Oct 11]. JAMA Pediatr. 2021;10.1001/jamapediatrics.2021.3594. doi:10.1001/jamapediatrics.2021.3594
- Rakesh D, Seguin C, Zalesky A, Cropley V, Whittle S. Associations Between Neighborhood Disadvantage, Resting-State Functional Connectivity, and Behavior in the Adolescent Brain Cognitive Development Study: The Moderating Role of Positive Family and School Environments. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021;6(9):877-886. doi:10.1016/j.bpsc.2021.03.008
- Gilmore JH, Knickmeyer RC, Gao W. Imaging structural and functional brain development in early childhood. Nat Rev Neurosci. 2018;19(3):123–137. doi:10.1038/nrn.2018.1
- Ismail FY, Fatemi A, Johnston MV. Cerebral plasticity: Windows of opportunity in the developing brain. Eur J Paediatr Neurol. 2017;21(1):23-48. doi:10.1016/j.ejpn.2016.07.007
- Pulli EP, Kumpulainen V, Kasurinen JH, et al. Prenatal exposures and infant brain: Review of magnetic resonance imaging studies and a population description analysis. Hum Brain Mapp. 2019;40(6):1987-2000. doi:10.1002/hbm.24480
- Ilyka D, Johnson MH, Lloyd-Fox S. Infant social interactions and brain development: A systematic review. Neurosci Biobehav Rev. 2021;130:448-469. doi:10.1016/j.neubiorev.2021.09.001
- Giedd JN, Blumenthal J, Jeffries NO, et al. Brain development during childhood and adolescence: a longitudinal MRI study. Nat Neurosci. 1999;2(10):861-863. doi:10.1038/13158
- Salzwedel A, Chen G, Chen Y, Grewen K, Gao W. Functional dissection of prenatal drug effects on baby brain and behavioral development. Hum Brain Mapp. 2020;41(17):4789-4803. doi:10.1002/hbm.25158
- Yeoh SL, Eastwood J, Wright IM, Morton R, Melhuish E, Ward M, Lee Oei J. Cognitive and motor outcomes of children with prenatal opioid exposure: A systematic review and meta-analysis. JAMA Netw Open. 2019;2(7):e197025. doi:10.1001/jamanetworkopen.2019.7025