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Min MO, Minnes S, Lang A, Albert JM, Kim JY, Singer LT. Pathways to adolescent sexual risk behaviors: Effects of prenatal cocaine exposure. Drug Alcohol Depend 2016; 161:284-91. [PMID: 26922281 PMCID: PMC4792807 DOI: 10.1016/j.drugalcdep.2016.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND To assess the impact of prenatal cocaine exposure (PCE) on adolescent sexual risk behaviors. Externalizing behavior, teen substance use, and early sexual intercourse were examined as pathways mediating the effects of PCE on sexual risk behaviors. METHODS Adolescents (N=364; 185 PCE, 179 non-cocaine exposure (NCE); 205 girls, 159 boys), primarily African-American and of low socioeconomic status, were prospectively enrolled in a longitudinal study at birth. Risky sexual behaviors were assessed at ages 15 and 17. Externalizing behavior at 12 years was assessed with the Youth Self-Report. Substance use, via self-report and biologic assays, and early (before age 15) sexual intercourse were assessed at age 15. Path analyses with the weighted least squares estimator with mean and variance adjustments were performed. RESULTS The final structural equation model-based path model, χ(2)=31.97 (df=27), p=.23, CFI=.99, TLI=.99, RMSEA=.021, WRMR=.695, indicated a direct effect of PCE on sexual risk behavior (β=.16, p=.02). Although PCE was related to greater externalizing behavior (β=.14, p=.009), which in turn, predicted early sexual intercourse (β=.16, p=.03), leading to sexual risk behavior (β=.44, p<.001), bootstrapping indicated a non-significant indirect effect (β=.01, p>.10). Substance use was correlated with early sexual intercourse (r=.60, p<.001) and predicted sexual risk behavior by age 17 (β=.31, p=.01). CONCLUSIONS Prenatal cocaine exposure was related to more engagement in sexual risk behaviors, suggesting the importance of reducing substance use among pregnant women as a means of prevention of offspring substance use and sexual risk behavior.
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Affiliation(s)
- Meeyoung O Min
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Cleveland, OH, United States.
| | - Sonia Minnes
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Cleveland, OH, United States
| | - Adelaide Lang
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Cleveland, OH, United States
| | - Jeffrey M Albert
- School of Medicine, Department of Epidemiology and Biostatistics, Cleveland, OH, United States
| | - June-Yung Kim
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Cleveland, OH, United States
| | - Lynn T Singer
- Departments of Environmental Health Sciences, Psychiatry & Pediatrics, Cleveland, OH, United States
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Sahker E, McCabe JE, Arndt S. Differences in successful treatment completion among pregnant and non-pregnant American women. Arch Womens Ment Health 2016; 19:79-86. [PMID: 25824855 DOI: 10.1007/s00737-015-0520-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 03/17/2015] [Indexed: 11/29/2022]
Abstract
The present study explores characteristics of successful substance abuse treatment completion of pregnant women through an analysis of retrospective outcomes data. Women without prior treatment admissions, aged 18-44, and not in methadone maintenance therapy were included (N = 678,782). Chi-square tests analyzed significant differences; logistic regression provided predictive probabilities; odds ratios (OR) and risk differences with 95 % confidence intervals represent the effect sizes and clinically meaningful differences. Pregnant women were less likely to successfully complete treatment than non-pregnant women (χ (2) = 321.33, df = 1, p < 0.0001), though the difference was not clinically meaningful (risk difference = 4.75, 95 % confidence interval (CI) = 4.23-5.26). Aside from criminal justice agencies, "other community agencies" refer the greatest percentage of pregnant women to treatment (risk difference = 6.37, 95 % CI = 5.89-6.84). Pregnant women successfully complete treatment more than non-pregnant women in only non-intensive outpatient settings (χ (2) = 10,182.48, df = 7, p < 0.0001). Further attention to referral source and treatment setting for pregnant women may improve successful treatment completion by targeting needs of pregnant women. Referring to non-intensive outpatient and residential hospital treatment settings may help to ameliorate prenatal substance abuse treatment contingent on the primary problem substance.
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Affiliation(s)
- Ethan Sahker
- Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, 100 MTP4, Iowa City, IA, 52245-5000, USA.,Department of Psychological and Quantitative Foundations, Counseling Psychology, College of Education, University of Iowa, Iowa City, IA, USA
| | - Jennifer E McCabe
- Department of Psychology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, USA
| | - Stephan Arndt
- Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, 100 MTP4, Iowa City, IA, 52245-5000, USA. .,Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. .,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA.
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53
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D'Apolito K. Neonatal Abstinence Syndrome: A Growing Problem. Neonatal Netw 2016; 35:263-264. [PMID: 27636688 DOI: 10.1891/0730-0832.35.5.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Minkoff H, Marshall MF. Fetal Risks, Relative Risks, and Relatives' Risks. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:3-11. [PMID: 26832079 DOI: 10.1080/15265161.2015.1120791] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Several factors related to fetal risk render it more or less acceptable in justifying constraints on the behavior of pregnant women. Risk is an unavoidable part of pregnancy and childbirth, one that women must balance against other vital personal and family interests. Two particular issues relate to the fairness of claims that pregnant women are never entitled to put their fetuses at risk: relative risks and relatives' risks. The former have been used-often spuriously-to advance arguments against activities, such as home birth, that may incur risk; the latter implicate the nature of relationships in determining the acceptability of coercing or precluding activities. Motivated reasoning by clinicians and judges leads to inaccurate risk assessments, and judgments based on false claims to objectivity. Such judgments undermine the moral and legal standing of pregnant women and do not advance the interests of fetuses, pregnant women, families, or states.
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Gautam P, Warner TD, Kan EC, Sowell ER. Executive function and cortical thickness in youths prenatally exposed to cocaine, alcohol and tobacco. Dev Cogn Neurosci 2015; 16:155-165. [PMID: 25743199 PMCID: PMC4522382 DOI: 10.1016/j.dcn.2015.01.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 01/19/2015] [Accepted: 01/23/2015] [Indexed: 12/30/2022] Open
Abstract
Small and detrimental, albeit inconsistent, effects of prenatal cocaine exposure (PCE) during early childhood have been reported. The teratogenic effects of prenatal alcohol (PAE) and tobacco exposure (PTE) on neurobehavior are more firmly established than PCE. We tested if co-exposure to all three drugs could be related to greater differences in brain structure than exposure to cocaine alone. Participants (n=42, PCE=27; age range=14-16 years) received an executive function battery prior to a T1-weighted 3T structural MRI scan. Cortical thickness was measured using FreeSurfer (v5.1). Fetal drug exposure was quantified through maternal self-reports usage during pregnancy. Using general linear modeling, we found no main effects of PCE on cortical thickness, but significant main effects of PAE and PTE in superior and medial frontal regions, after co-varying for the effects of age, sex, and each drug of exposure. Significant alcohol-by-tobacco interactions, and significant cocaine-by-alcohol interactions on cortical thickness in medial parietal and temporal regions were also observed. Poly-drug exposure and cognitive function also showed significant interactions with cortical thickness: lower cortical thickness was associated with better performance in PCE-exposed adolescents. Results suggest that although children with PCE have subtle but persistent brain cortical differences until mid-to-late adolescence.
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Affiliation(s)
- Prapti Gautam
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA, United States
| | - Tamara D Warner
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Eric C Kan
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA, United States
| | - Elizabeth R Sowell
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA, United States; Department of Neurology, University of California at Los Angeles, Los Angeles, CA, United States.
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Li Z, Coles CD, Lynch ME, Luo Y, Hu X. Longitudinal changes of amygdala and default mode activation in adolescents prenatally exposed to cocaine. Neurotoxicol Teratol 2015; 53:24-32. [PMID: 26577285 DOI: 10.1016/j.ntt.2015.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 10/29/2015] [Accepted: 11/09/2015] [Indexed: 12/30/2022]
Abstract
Prenatal cocaine exposure (PCE) is associated with long-term and negative effect on arousal regulation. Recent neuroimaging studies have examined brain mechanisms related to arousal dysregulation with cross-sectional experimental designs; but longitudinal changes in the brain, reflecting group differences in neurodevelopment, have never been directly examined. To directly assess the interaction of PCE and neurodevelopment, the present study used a longitudinal design to analyze functional magnetic resonance imaging (fMRI) data collected from 33 adolescents (21 with PCE and 12 non-exposed controls) while they performed the same working memory task with emotional distracters at two points in time. The mean age of participants was 14.3 years at time_1 and 16.7 years at time_2. With confounding factors statistically controlled, the fMRI data revealed significant exposure-by-time interaction in the activations of the amygdala and default mode network (DMN). For the control adolescents, brain activations associated with emotional arousal (amygdala) and cognitive effort (DMN) were both reduced at time_2 as compared to that at time_1. However, these activation reductions were not observed in the PCE group, indicating persistently high levels of emotional arousal and cognitive effort. In addition, correlations between longitudinal changes in the brain and in behavior have shown that adolescents with persistently high emotional arousal were more likely in need of high cognitive effort; and their cognitive performance was more likely to be affected by distractive challenges. The present results complement and extend previous findings from cross-sectional studies with further evidence supporting the view of PCE associated long-term teratogenic effects on arousal regulation.
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Affiliation(s)
- Zhihao Li
- Institute of Affective and Social Neuroscience, Shenzhen University, Shenzhen 518060, Guangdong, PR China; Biomedical Imaging Technology Center, Department of Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta 30322, GA, USA.
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta 30322, GA, USA
| | - Mary Ellen Lynch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta 30322, GA, USA
| | - Yuejia Luo
- Institute of Affective and Social Neuroscience, Shenzhen University, Shenzhen 518060, Guangdong, PR China
| | - Xiaoping Hu
- Biomedical Imaging Technology Center, Department of Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta 30322, GA, USA.
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Konijnenberg C. Methodological Issues in Assessing the Impact of Prenatal Drug Exposure. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2015; 9:39-44. [PMID: 26604776 PMCID: PMC4640424 DOI: 10.4137/sart.s23544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/29/2015] [Accepted: 10/02/2015] [Indexed: 01/30/2023]
Abstract
Prenatal drug exposure is a common public health concern that can result in perinatal complications, birth defects, and developmental disorders. The growing literature regarding the effects of prenatal exposure to specific drugs such as tobacco, alcohol, cocaine, and heroin is often conflicting and constantly changing. This review discusses several reasons why the effects of prenatal drug exposure are so difficult to determine, including variations in dose, timing, duration of exposure, polydrug use, unreliable measures of drug exposure, latent or “sleeper” effects, genetic factors, and socioenvironmental influences. In addition to providing research guidelines, this review also aims to help clinicians and policy makers to identify the strengths and weaknesses in studies investigating the effects of prenatal drug exposure. This knowledge may be used to make better informed decisions regarding the appropriate treatment for pregnant, drug-dependent women and their children.
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Messiah SE, Ludwig DA, Vidot DC, Accornero VH, Lipshultz SE, Miller TL, Xue L, Bandstra ES. Prenatal Cocaine Exposure and Cardiometabolic Disease Risk Factors in 18- to 20-Year-Old African Americans. Ethn Dis 2015; 25:419-26. [PMID: 26672966 DOI: 10.18865/ed.25.4.419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The long-term effects of prenatal cocaine exposure (PCE) on physical health are largely unknown. No human studies support or refute a relationship between PCE and the long-term risk for cardiovascular and/or metabolic disease. We investigated the association of PCE on primary cardiometabolic disease risk factors in African Americans (AA) aged 18 to 20 years. DESIGN Cohort, longitudinal, prospective. SETTING Miami-Dade County, Florida, and the University of Miami Miller School of Medicine/Jackson Memorial Medical Center. PARTICIPANTS Healthy full-term inner-city AA adolescents (aged 18 to 20 years, n=350) previously enrolled at birth from 1990-1993. MAIN OUTCOME MEASURES Fasting serum insulin, glucose, lipids, and high-sensitivity C-reactive protein; systolic and diastolic blood pressures; and the components and prevalence of the metabolic syndrome. RESULTS There were no PCE-associated differences in cardiometabolic disease risk factors including the metabolic syndrome and its individual components in AAs aged 18 to 20 years. CONCLUSIONS The results of our study do not support an association between PCE and increased cardiometabolic disease risk in AAs aged 18 to 20 years. Whether PCE is associated with cardiovascular or metabolic disease in adulthood would require further investigation.
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Affiliation(s)
- Sarah E Messiah
- 1. Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Leonard M. Miller School of Medicine
| | - David A Ludwig
- 1. Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Leonard M. Miller School of Medicine
| | - Denise C Vidot
- 2. Division of Epidemiology, Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine
| | - Veronica H Accornero
- 3. Division of Neonatology, Department of Pediatrics, University of Miami Leonard M. Miller School of Medicine
| | - Steven E Lipshultz
- 4. Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan
| | - Tracie L Miller
- 1. Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Leonard M. Miller School of Medicine
| | - Lihua Xue
- 3. Division of Neonatology, Department of Pediatrics, University of Miami Leonard M. Miller School of Medicine
| | - Emmalee S Bandstra
- 3. Division of Neonatology, Department of Pediatrics, University of Miami Leonard M. Miller School of Medicine
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Schweitzer JB, Riggins T, Ross TJ, Black MM, Salmeron BJ. Interpretation of prenatal drug exposure functional imaging data. Neurotoxicol Teratol 2015; 52:58-9. [PMID: 26518758 DOI: 10.1016/j.ntt.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/23/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis School of Medicine, United States.
| | - Tracy Riggins
- Department of Psychology, University of Maryland College Park, United States; Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, United States
| | - Thomas J Ross
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, United States
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, United States
| | - Betty Jo Salmeron
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, United States
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Nygaard E, Slinning K, Moe V, Walhovd KB. Cognitive function of youths born to mothers with opioid and poly-substance abuse problems during pregnancy. Child Neuropsychol 2015; 23:159-187. [DOI: 10.1080/09297049.2015.1092509] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Jaeger DA, Suchan B, Schölmerich A, Schneider DT, Gawehn N. ATTENTION FUNCTIONING IN CHILDREN WITH PRENATAL DRUG EXPOSURE. Infant Ment Health J 2015; 36:522-30. [PMID: 26331969 DOI: 10.1002/imhj.21530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Children born to drug abusers are exposed to teratogenic influences on intrauterine brain development and undergo postnatal withdrawal. We investigated the interplay of different domains and levels of attention functioning in 24 prenatally exposed and 25 nonexposed children who were 5 to 6 years old. Assessment included parent ratings and neuropsychological and electrophysiological methods. Exposed children had a higher prevalence of attention deficit hyperactivity symptoms, tended to have poorer performance in an attention test battery, and showed EEG alterations in P3 and N2c. Findings suggest long-term effects of prenatal drug exposure on specific domains and on different levels of attention functioning.
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Affiliation(s)
| | | | | | | | - Nina Gawehn
- Municipal Hospital Dortmund and University of Health Sciences, Bochum
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Nygaard E, Moe V, Slinning K, Walhovd KB. Longitudinal cognitive development of children born to mothers with opioid and polysubstance use. Pediatr Res 2015; 78:330-5. [PMID: 25978800 PMCID: PMC4539602 DOI: 10.1038/pr.2015.95] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/18/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Previous studies indicate an increased risk for neuropsychological difficulties in young children prenatally exposed to opioids and polysubstances, but longitudinal information is scarce. The present longitudinal study investigated whether these waned, persisted, or increased over time. METHODS The cognitive functioning of 72 children with prenatal opioid and polysubstance exposure and 58 children without any established prenatal risk was assessed at 1, 2, 3, 4½, and 8½ y. RESULTS The exposed boys had significantly and stably lower levels of cognitive functioning than the control group, whereas there were increasing differences over time for the girls. The exposed group had significantly lower IQ scores than the control group on Wechsler Intelligence Scale for Children--Revised at 8½ y after controlling for earlier cognitive abilities, and for children who were permanently placed in adoptive/foster homes before 1 y of age and whose mothers used heroin as their main drug during pregnancy (B = 17.04, 95% CI 8.69-25.38, P < 0.001). CONCLUSION While effects of prenatal substance exposure cannot be isolated, group effects on cognition rather increased than waned over time, even in adoptive/foster children with minimal postnatal risk.
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Affiliation(s)
- Egil Nygaard
- Research Group for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Oslo, Norway
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Vibeke Moe
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Kari Slinning
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Kristine B. Walhovd
- Research Group for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilition, Unit of Neuropsychology, Oslo University Hospital, Oslo, Norway
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63
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Riley E, Kopotiyenko K, Zhdanova I. Prenatal and acute cocaine exposure affects neural responses and habituation to visual stimuli. Front Neural Circuits 2015; 9:41. [PMID: 26379509 PMCID: PMC4548223 DOI: 10.3389/fncir.2015.00041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/04/2015] [Indexed: 12/17/2022] Open
Abstract
Psychostimulants have many effects on visual function, from adverse following acute and prenatal exposure to therapeutic on attention deficit. To determine the impact of prenatal and acute cocaine exposure on visual processing, we studied neuronal responses to visual stimuli in two brain regions of a transgenic larval zebrafish expressing the calcium indicator GCaMP-HS. We found that both red light (LF) and dark (DF) flashes elicited similar responses in the optic tectum neuropil (TOn), while the dorsal telencephalon (dTe) responded only to LF. Acute cocaine (0.5 μM) reduced neuronal responses to LF in both brain regions but did not affect responses to DF. Repeated stimulus presentation (RSP) led to habituation of dTe neurons to LF. Acute cocaine prevented habituation. TOn habituated to DF, but not LF, and DF habituation was not modified by cocaine. Remarkably, prenatal cocaine exposure (PCE) prevented the effects of acute cocaine on LF response amplitude and habituation later in development in both brain regions, but did not affect DF responses. We discovered that, in spite of similar neural responses to LF and DF in the TO (superior colliculus in mammals), responses to LF are more complex, involving dTe (homologous to the cerebral cortex), and are more vulnerable to cocaine. Our results demonstrate that acute cocaine exposure affects visual processing differentially by brain region, and that PCE modifies zebrafish visual processing in multiple structures in a stimulus-dependent manner. These findings are in accordance with the major role that the optic tectum and cerebral cortex play in sustaining visual attention, and support the hypothesis that modification of these areas by PCE may be responsible for visual deficits noted in humans. This model offers new methodological approaches for studying the adverse and therapeutic effects of psychostimulants on attention, and for the development of new pharmacological interventions.
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Affiliation(s)
- Elizabeth Riley
- Boston University Graduate Program in Neuroscience, Boston University School of Medicine Boston, MA, USA
| | - Konstantin Kopotiyenko
- Department of Anatomy and Neurobiology, Boston University School of Medicine Boston, MA, USA
| | - Irina Zhdanova
- Boston University Graduate Program in Neuroscience, Boston University School of Medicine Boston, MA, USA ; Department of Anatomy and Neurobiology, Boston University School of Medicine Boston, MA, USA
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Abstract
Consumption of drugs of abuse, tobacco and alcohol throughout pregnancy is a serious public health problem and results in an important economic cost to the health system. Drug and/or metabolites determination in biological matrices from mother and newborn is an objective measure of in utero drug exposure. We reviewed methods published for the determination of in utero drug exposure from 2007 to 2014, with special focus on meconium, placenta, umbilical cord and newborn hair. Accurate bioanalytical procedures are essential to obtain high-quality data to perform interventions and to establish correlations between analytical measures and clinical outcomes. We included a brief overview of clinical implications of in utero drug exposure to better understand the importance of this serious health issue.
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Prenatal alcohol exposure, adaptive function, and entry into adult roles in a prospective study of young adults. Neurotoxicol Teratol 2015; 51:52-60. [PMID: 26247662 DOI: 10.1016/j.ntt.2015.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/27/2015] [Accepted: 07/31/2015] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Although many studies have demonstrated effects of prenatal alcohol exposure (PAE) on physical, cognitive, and behavioral development in children, few have focused on the long term effects on adults. In this study, data are presented on adaptive function and entry into adult roles in a community sample of young adults with PAE. The expectation was that prenatally exposed adults would show lower adaptive functioning and more difficulty with entry into adult roles than the non-exposed control group and that these effects would be related to the severity of PAE effects. METHOD The predominantly African-American, low income sample included adults with a wide range of prenatal exposure (n = 123) as well as control groups for socioeconomic (SES) (n =5 9) and disability (n = 54) status. The mothers of the alcohol-exposed and SES-control group participants were recruited before birth and offspring have been followed up periodically. The disability control group was recruited in adolescence. The adults were interviewed about adaptive function in day-to-day life and adult role entry. Collateral adults who were well-acquainted with each participant were interviewed concerning adaptive function. RESULTS Results showed that adults who were dysmorphic and/or cognitively affected by PAE had difficulty with adaptive function and entry into adult roles. Males showing cognitive effects with no physical effects were the most severely affected. Results for exposed adults not showing physical or cognitive effects were similar to or more positive than those of the control group for most outcomes. CONCLUSION PAE has long-term effects on adaptive outcomes in early adulthood. Additional research should focus on possible interventions at this transition and on factors contributing to the adjustment of the exposed, but unaffected participants.
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Min MO, Minnes S, Lang A, Yoon S, Singer LT. Effects of prenatal cocaine exposure on early sexual behavior: Gender difference in externalizing behavior as a mediator. Drug Alcohol Depend 2015; 153:59-65. [PMID: 26088698 PMCID: PMC4509836 DOI: 10.1016/j.drugalcdep.2015.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prenatal cocaine exposure (PCE) is associated with increased risk for externalizing behavior problems; childhood externalizing behavior problems are linked with subsequent early sexual behavior. The present study examined the effects of PCE on early sexual initiation (sexual intercourse prior to age 15) and whether externalizing behavior in preadolescence mediated the relationship. METHODS Three hundred fifty-four (180 PCE and 174 non-cocaine exposed; 192 girls, 142 boys), primarily African-American, low socioeconomic status, 15-year-old adolescents participated in a prospective longitudinal study. Adolescents' sexual behavior was assessed at 15 years using the Youth Risk Behavior Surveillance System. Externalizing behavior was assessed at 12 years using the Youth Self-Report. RESULTS Logistic regression models indicated that adolescents with PCE (n=69, 38%) were 2.2 times more likely (95% CI=1.2-4.1, p<.01) to engage in early sexual intercourse than non-exposed peers (n=49, 28%) controlling for covariates. This relationship was fully mediated by self-reported externalizing behavior in girls but not in boys, suggesting childhood externalizing behavior as a gender moderated mediator. Blood lead level during preschool years was also related to a greater likelihood of early sexual intercourse (OR=2.6, 95% CI=1.4-4.7, p<.002). Greater parental monitoring decreased the likelihood of early sexual intercourse, while violence exposure increased the risk. CONCLUSIONS PCE is related to early sexual intercourse, and externalizing behavior problems mediate PCE effects in female adolescents. Interventions targeting externalizing behavior may reduce early sexual initiation and thereby reduce HIV risk behaviors and early, unplanned pregnancy in girls with PCE.
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Affiliation(s)
- Meeyoung O. Min
- Case Western Reserve University, Jack. Joseph, and Morton Mandel School of Applied Social Sciences, Cleveland, Ohio
| | - Sonia Minnes
- Case Western Reserve University, Jack. Joseph, and Morton Mandel School of Applied Social Sciences, Cleveland, Ohio
| | - Adelaide Lang
- Case Western Reserve University, Jack. Joseph, and Morton Mandel School of Applied Social Sciences, Cleveland, Ohio
| | - Susan Yoon
- Case Western Reserve University, Jack. Joseph, and Morton Mandel School of Applied Social Sciences, Cleveland, Ohio
| | - Lynn T. Singer
- School of Medicine, Departments of Environmental Health Sciences, Psychiatry & Pediatrics, Cleveland, Ohio
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Lamy S, Laqueille X, Thibaut F. Conséquences potentielles de la consommation de tabac, de cannabis et de cocaïne par la femme enceinte sur la grossesse, le nouveau-né et l’enfant : revue de littérature. Encephale 2015; 41 Suppl 1:S13-20. [DOI: 10.1016/j.encep.2014.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 01/30/2014] [Indexed: 12/17/2022]
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Liebschutz J, Crooks D, Rose-Jacobs R, Cabral HJ, Heeren TC, Gerteis J, Appugliese DP, Heymann OD, Lange AV, Frank DA. Prenatal substance exposure: What predicts behavioral resilience by early adolescence? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 29:329-37. [PMID: 26076097 PMCID: PMC4593628 DOI: 10.1037/adb0000082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Understanding behavioral resilience among at-risk adolescents may guide public policy decisions and future programs. We examined factors predicting behavioral resilience following intrauterine substance exposure in a prospective longitudinal birth-cohort study of 136 early adolescents (ages 12.4-15.9 years) at risk for poor behavioral outcomes. We defined behavioral resilience as a composite measure of lack of early substance use initiation (before age 14), lack of risky sexual behavior, or lack of delinquency. Intrauterine substance exposures included in this analysis were cocaine, tobacco, alcohol, and marijuana. We recruited participants from Boston Medical Center as mother-infant dyads between 1990 and 1993. The majority of the sample was African American/Caribbean (88%) and 49% female. In bivariate analyses, none and lower intrauterine cocaine exposure level predicted resilience compared with higher cocaine exposure, but this effect was not found in an adjusted model. Instead, strict caregiver supervision (adjusted odds ratio [AOR] = 6.02, 95% confidence interval (CI) [1.90, 19.00], p = .002), lower violence exposure (AOR = 4.07, 95% CI [1.77, 9.38], p < .001), and absence of intrauterine tobacco exposure (AOR = 3.71, 95% CI [1.28, 10.74], p = .02) predicted behavioral resilience. In conclusion, caregiver supervision in early adolescence, lower violence exposure in childhood, and lack of intrauterine tobacco exposure predicted behavioral resilience among a cohort of early adolescents with significant social and environmental risk. Future interventions should work to enhance parental supervision as a way to mitigate the effects of adversity on high-risk groups of adolescents. (PsycINFO Database Record
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Affiliation(s)
- Jane Liebschutz
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Denise Crooks
- Department of Family Medicine, Boston Medical Center, 840 Harrison Avenue, Boston, MA, 02118
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine, Boston, 72 East Concord Street, MA, 02118
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Timothy C Heeren
- Data Coordinating Center, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Jessie Gerteis
- Abt Associates, Inc., 55 Wheeler Street, Cambridge, MA, 02138
| | - Danielle P. Appugliese
- Data Coordinating Center, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Orlaith D. Heymann
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Allison V. Lange
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Deborah A. Frank
- Department of Family Medicine, Boston Medical Center, 840 Harrison Avenue, Boston, MA, 02118
- Department of Pediatrics, Boston University School of Medicine, Boston, 72 East Concord Street, MA, 02118
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Richardson GA, Goldschmidt L, Larkby C, Day NL. Effects of prenatal cocaine exposure on adolescent development. Neurotoxicol Teratol 2015; 49:41-8. [PMID: 25778776 DOI: 10.1016/j.ntt.2015.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/27/2015] [Accepted: 03/08/2015] [Indexed: 02/06/2023]
Abstract
The associations between prenatal cocaine exposure (PCE) and adolescent behavior, cognitive development, and physical growth were examined in 219 15-year-olds who have participated in a longitudinal study since their fourth gestational month. During the first trimester, 42% of the women used cocaine, with use declining across pregnancy. At the 15-year follow-up, the caregivers were, on average, 43 years old, had 13 years of education, and 50% were African American. First trimester PCE was not associated with global cognitive development or with measures of learning and memory. First trimester PCE was significantly related to adolescent-reported delinquent behavior, poorer problem solving and abstract reasoning, and reduced weight, height, and head circumference at 15 years. These results were significant after other factors that affect these domains were controlled in regression analyses. In addition, exposure to violence partially mediated the effect of PCE on delinquent behavior. These adolescent domains are important because they are predictors of poorer adult functioning.
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Affiliation(s)
- Gale A Richardson
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
| | - Lidush Goldschmidt
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
| | - Cynthia Larkby
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
| | - Nancy L Day
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
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Schweitzer JB, Riggins T, Liang X, Gallen C, Kurup PK, Ross TJ, Black MM, Nair P, Salmeron BJ. Prenatal drug exposure to illicit drugs alters working memory-related brain activity and underlying network properties in adolescence. Neurotoxicol Teratol 2015; 48:69-77. [PMID: 25683798 DOI: 10.1016/j.ntt.2015.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/12/2015] [Accepted: 02/05/2015] [Indexed: 12/17/2022]
Abstract
The persistence of effects of prenatal drug exposure (PDE) on brain functioning during adolescence is poorly understood. We explored neural activation to a visuospatial working memory (VSWM) versus a control task using functional magnetic resonance imaging (fMRI) in adolescents with PDE and a community comparison group (CC) of non-exposed adolescents. We applied graph theory metrics to resting state data using a network of nodes derived from the VSWM task activation map to further explore connectivity underlying WM functioning. Participants (ages 12-15 years) included 47 adolescents (27 PDE and 20 CC). All analyses controlled for potentially confounding differences in birth characteristics and postnatal environment. Significant group by task differences in brain activation emerged in the left middle frontal gyrus (BA 6) with the CC group, but not the PDE group, activating this region during VSWM. The PDE group deactivated the culmen, whereas the CC group activated it during the VSWM task. The CC group demonstrated a significant relation between reaction time and culmen activation, not present in the PDE group. The network analysis underlying VSWM performance showed that PDE group had lower global efficiency than the CC group and a trend level reduction in local efficiency. The network node corresponding to the BA 6 group by task interaction showed reduced nodal efficiency and fewer direct connections to other nodes in the network. These results suggest that adolescence reveals altered neural functioning related to response planning that may reflect less efficient network functioning in youth with PDE.
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Affiliation(s)
- Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, United States; MIND Institute, University of California Davis School of Medicine, United States.
| | - Tracy Riggins
- Department of Psychology, University of Maryland College Park, United States
| | - Xia Liang
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, United States
| | - Courtney Gallen
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, United States
| | - Pradeep K Kurup
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, United States
| | - Thomas J Ross
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, United States
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, United States
| | - Prasanna Nair
- Department of Pediatrics, University of Maryland School of Medicine, United States
| | - Betty Jo Salmeron
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, United States
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Black MM. Pioneers in pediatric psychology: integrating nutrition and child development interventions. J Pediatr Psychol 2015; 40:398-405. [PMID: 25619198 DOI: 10.1093/jpepsy/jsu114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/25/2014] [Indexed: 11/14/2022] Open
Abstract
As part of the Pioneers in Pediatric Psychology series, this article provides a brief personal account of Maureen Black's career as a pediatric psychologist. It traces the transition of the Society of Pediatric Psychology (SPP) from a section of the Division of Clinical Psychology of the American Psychological Association (APA) to an independent division of APA, which occurred during my presidency of SPP. The article addresses three aspects of pediatric psychology that have been central to my career: pediatric nutritional problems, global child development, and the advancement of children's health and development through policy-related strategies. The article concludes with Lessons Learned and Recommendations for the future of pediatric psychology.
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Affiliation(s)
- Maureen M Black
- Department of Pediatrics and Department of Epidemiology and Public Health, University of Maryland School of Medicine
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72
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Bennett DS, Birnkrant JM, Carmody DP, Lewis M. Effects of prenatal cocaine exposure on pubertal development. Neurotoxicol Teratol 2014; 47:146-53. [PMID: 25446013 DOI: 10.1016/j.ntt.2014.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 01/19/2023]
Abstract
The purpose of the current study was to examine the relationship between prenatal cocaine exposure (PCE) and pubertal development. Children (n=192; 41% with PCE) completed the Pubertal Development Scale (Petersen et al. 1988) and provided salivary dehydroepiandrosterone (DHEA) samples at 6month intervals from 11 to 13years. PCE was examined as a predictor of pubertal status, pubertal tempo, and DHEA levels in mixed models analyses controlling for age, sex, environmental risk, neonatal medical problems, other prenatal exposures, and BMI. PCE interacted with age such that PCE predicted slower pubertal tempo during early adolescence. PCE also interacted with age to predict slower increases in DHEA levels during early adolescence. These findings suggest that PCE may affect pubertal development and, if slower pubertal tempo continues, could lead to delayed pubertal status in mid-adolescence.
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Affiliation(s)
- David S Bennett
- Drexel University College of Medicine, GLAD Program, 4700 Wissahickon Avenue, Philadelphia, PA, 19144, United States.
| | - Jennifer M Birnkrant
- Rutgers Robert Wood Johnson Medical School, Institute for the Study of Child Development, 89 French Street, New Brunswick, NJ 08901, United States.
| | - Dennis P Carmody
- Rutgers Robert Wood Johnson Medical School, Institute for the Study of Child Development, 89 French Street, New Brunswick, NJ 08901, United States.
| | - Michael Lewis
- Rutgers Robert Wood Johnson Medical School, Institute for the Study of Child Development, 89 French Street, New Brunswick, NJ 08901, United States.
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73
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De Genna N, Goldschmidt L, Richardson GA. Prenatal cocaine exposure and age of sexual initiation: direct and indirect effects. Drug Alcohol Depend 2014; 145:194-200. [PMID: 25456330 PMCID: PMC4254808 DOI: 10.1016/j.drugalcdep.2014.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 10/06/2014] [Accepted: 10/16/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prenatal cocaine exposure (PCE) has been linked to child behavior problems and risky behavior during adolescence such as early substance use. Behavior problems and early substance use are associated with earlier initiation of sexual behavior. The goal of this study was to examine the direct and indirect effects of PCE on sexual initiation in a longitudinal birth cohort, about half of whom were exposed to cocaine in utero. METHODS Women were interviewed twice prenatally, at delivery, and 1, 3, 7, 10, 15, and 21 years postpartum. Offspring (52% female, 54% African American) were assessed at delivery and at each follow-up phase with age-appropriate assessments. At age 21, 225 offspring reported on their substance use and sexual behavior. RESULTS First trimester cocaine exposure was a significant predictor of earlier age of first intercourse in a survival analysis, after controlling for race, sociodemographic characteristics, caregiver pre- and postnatal substance use, parental supervision, and child's pubertal timing. However, the association between PCE and age of first sexual intercourse was mediated by adolescent marijuana and alcohol use prior to age 15. CONCLUSIONS Most of the effect of PCE on age of sexual initiation occurred between the ages of 13-18, when rates of initiation were approximately 10% higher among exposed offspring. This effect was mediated by early adolescent substance use. These results have implications for identification of the exposed offspring at greatest risk of HIV risk behaviors and early, unplanned pregnancy.
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Affiliation(s)
- Natacha De Genna
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213
| | - Lidush Goldschmidt
- University of Pittsburgh Medical Center, Program in Epidemiology, 3811 O'Hara Street, Pittsburgh, PA 15213
| | - Gale A. Richardson
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213
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74
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Prenatal cocaine exposure and adolescent neural responses to appetitive and stressful stimuli. Neuropsychopharmacology 2014; 39:2824-34. [PMID: 24903650 PMCID: PMC4200493 DOI: 10.1038/npp.2014.133] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/15/2014] [Accepted: 05/21/2014] [Indexed: 12/16/2022]
Abstract
Preclinical research has demonstrated the effects of prenatal cocaine exposure (PCE) on brain regions involved in emotional regulation, motivational control, and addiction vulnerability-eg, the ventral striatum (VS), anterior cingulate (ACC), and prefrontal cortex (PFC). However, little is known about the function of these regions in human adolescents with PCE. Twenty-two adolescents with PCE and 22 age-, gender-, and IQ-matched non-cocaine exposed (NCE) adolescents underwent functional magnetic resonance imaging (fMRI) during exposure to individually personalized neutral/relaxing, stressful, and favorite-food cues. fMRI data were compared using group-level two-tailed t-tests in the BioImage Suite. In comparison with NCE adolescents, PCE adolescents had reduced activity within cortical and subcortical brain regions, including the VS, ACC, and medial and dorslolateral PFC during exposure to favorite-food cues but did not differ in neural responses to stress cues. Subjective food craving was inversely related to dorsolateral PFC activation among PCE adolescents. Among PCE adolescents, subjective anxiety ratings correlated inversely with activations in the orbitofrontal cortex and brainstem during the stress condition and with ACC, dorsolateral PFC, and hippocampus activity during the neutral-relaxing condition. Thus adolescents with PCE display hypoactivation of brain regions involved in appetitive processing, with subjective intensities of craving and anxiety correlating inversely with extent of activation. These findings suggest possible mechanisms by which PCE might predispose to the development of addictions and related disorders, eg, substance-use disorders and binge-eating.
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Yolton K, Cornelius M, Ornoy A, McGough J, Makris S, Schantz S. Exposure to neurotoxicants and the development of attention deficit hyperactivity disorder and its related behaviors in childhood. Neurotoxicol Teratol 2014; 44:30-45. [PMID: 24846602 DOI: 10.1016/j.ntt.2014.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 05/08/2014] [Accepted: 05/13/2014] [Indexed: 01/28/2023]
Abstract
The purpose of this manuscript is to review the literature to determine evidence of associations between exposure to prenatal and postnatal environmental agents and the development of attention deficit hyperactivity disorder (ADHD) and related behaviors. A review of published research literature was conducted on associations between exposures to prenatal and postnatal cigarette smoke, prenatal exposure to alcohol, cocaine, and heroin, childhood exposure to lead, and prenatal exposure to organophosphate pesticides and outcomes of ADHD or behaviors related to ADHD. Review of the literature in these areas provides some evidence of associations between each of the exposures and ADHD-related behaviors, with the strongest evidence from prenatal cigarette and alcohol exposure and postnatal lead exposure. However, research on each exposure also produced evidence of weaknesses in these hypothesized links due to imprecise research methodologies and issues of confounding and inaccurate covariate adjustment. More rigorous studies are needed to provide definitive evidence of associations between each of these prenatal or postnatal exposures and the development of ADHD or symptoms of ADHD. Future studies need to clarify the underlying mechanisms between these exposures and the increased risk for ADHD and associated behaviors. More research is also needed utilizing study designs that include genetic information, as ADHD is highly heritable and there appear to be some protective mechanisms offered by certain genetic characteristics as evidenced in gene by environmental studies. Finally, while studies focusing on individual drugs and chemicals are an important first step, we cannot ignore the fact that children are exposed to combinations of drugs and chemicals, which can interact in complex ways with each other, as well as with the child's genetic makeup and psychosocial environment to influence ADHD risk.
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Affiliation(s)
- Kimberly Yolton
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7035, Cincinnati, OH 45229-3039, United States.
| | - Marie Cornelius
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States
| | - Asher Ornoy
- Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - James McGough
- Semel Institute for Neuroscience & Human Behavior, 300 UCLA Medical Plaza, Suite 1524C, Los Angeles, CA 90095, United States; David Geffen School of Medicine at the University of California, Los Angeles, 300 UCLA Medical Plaza, Suite 1524C, 300 UCLA Medical Plaza, Suite 1524C, Los Angeles, CA 90095, United States
| | - Susan Makris
- United States Environmental Protection Agency, National Center for Environmental Assessment, 1200 Pennsylvania Avenue, NW, Mailcode 8623P, Washington, DC 20460, United States
| | - Susan Schantz
- College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61802, United States
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Beeghly M, Rose-Jacobs R, Martin BM, Cabral HJ, Heeren TC, Frank DA. Level of intrauterine cocaine exposure and neuropsychological test scores in preadolescence: subtle effects on auditory attention and narrative memory. Neurotoxicol Teratol 2014; 45:1-17. [PMID: 24978115 DOI: 10.1016/j.ntt.2014.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 06/13/2014] [Accepted: 06/18/2014] [Indexed: 12/12/2022]
Abstract
Neuropsychological processes such as attention and memory contribute to children's higher-level cognitive and language functioning and predict academic achievement. The goal of this analysis was to evaluate whether level of intrauterine cocaine exposure (IUCE) alters multiple aspects of preadolescents' neuropsychological functioning assessed using a single age-referenced instrument, the NEPSY: A Developmental Neuropsychological Assessment (NEPSY) (Korkman et al., 1998), after controlling for relevant covariates. Participants included 137 term 9.5-year-old children from low-income urban backgrounds (51% male, 90% African American/Caribbean) from an ongoing prospective longitudinal study. Level of IUCE was assessed in the newborn period using infant meconium and maternal report. 52% of the children had IUCE (65% with lighter IUCE, and 35% with heavier IUCE), and 48% were unexposed. Infants with Fetal Alcohol Syndrome, HIV seropositivity, or intrauterine exposure to illicit substances other than cocaine and marijuana were excluded. At the 9.5-year follow-up visit, trained examiners masked to IUCE and background variables evaluated children's neuropsychological functioning using the NEPSY. The association between level of IUCE and NEPSY outcomes was evaluated in a series of linear regressions controlling for intrauterine exposure to other substances and relevant child, caregiver, and demographic variables. Results indicated that level of IUCE was associated with lower scores on the Auditory Attention and Narrative Memory tasks, both of which require auditory information processing and sustained attention for successful performance. However, results did not follow the expected ordinal, dose-dependent pattern. Children's neuropsychological test scores were also altered by a variety of other biological and psychosocial factors.
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Affiliation(s)
- Marjorie Beeghly
- Department of Psychology, Wayne State University, Detroit, MI, USA; Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA.
| | - Brett M Martin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA.
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Buckingham-Howes S, Bento SP, Scaletti LA, Koenig JI, Granger DA, Black MM. Prenatal drug exposure moderates the association between stress reactivity and cognitive function in adolescence. Dev Neurosci 2014; 36:329-37. [PMID: 24819393 DOI: 10.1159/000360851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/24/2014] [Indexed: 12/19/2022] Open
Abstract
Prenatal drug exposure (PDE) can undermine subsequent health and development. In a prospective longitudinal study we examine whether PDE moderates the link between stress reactivity and cognitive functioning in adolescence. Participants were 76 prenatally drug-exposed and 61 nonexposed (NE) community comparison African American youth (50% male, mean age 14.17 years) living in an urban setting. All participants completed neuropsychological and academic achievement tests (Children's Memory Scales, the California Verbal Learning Test - Children's version and the Wide Range Achievement Test 4) over the course of 1 day in a laboratory setting. Two mild stressors (Balloon Analog Risk Task - Youth and Behavioral Indicator of Resilience to Distress) were administered, with saliva samples (assayed for cortisol) collected pre- and poststress task. A higher percentage in the NE group, compared to the PDE group (26% vs. 12%, χ(2) = 4.70, d.f. = 1, n = 137, p = 0.03), exhibited task-related increases in salivary cortisol. PDE moderated the association between stress reactivity and 11 of 15 cognitive performance scales. In each case, the NE stress reactive group had better cognitive performance than either the NE lower cortisol reactive group or the PDE group regardless of stress reactivity status. Stress-related reactivity and regulation of the hypothalamic-pituitary-adrenal axis in adolescence may be disrupted by PDE, and the disruption may be linked to lower cognitive performance.
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Affiliation(s)
- Stacy Buckingham-Howes
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Md., USA
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Molnar DS, Levitt A, Eiden RD, Schuetze P. Prenatal cocaine exposure and trajectories of externalizing behavior problems in early childhood: examining the role of maternal negative affect. Dev Psychopathol 2014; 26:515-28. [PMID: 24622033 PMCID: PMC3981877 DOI: 10.1017/s0954579414000091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study examined the association between prenatal cocaine exposure (PCE) and developmental trajectories of externalizing behavior problems from 18 to 54 months of child age. A hypothesized indirect association between PCE and externalizing trajectories via maternal negative affect was also examined. Caregiving environmental risk and child sex were evaluated as moderators. This study consisted of 196 mother-child dyads recruited at delivery from local area hospitals (107 PCE, 89 non-PCE) and assessed at seven time points across the toddler to preschool periods. Results revealed no direct associations between PCE and externalizing behavior problem trajectories. However, results did indicate that PCE shared a significant indirect relationship with externalizing behavior problem trajectories via higher levels of maternal negative affect. The association between PCE and externalizing problem trajectories was also moderated by caregiving environmental risk such that PCE children in high-risk caregiving environments did not experience the well-documented normative decline in externalizing behavior problems beginning at around 3 years of age. This study suggests potential pathways to externalizing behavior problems among high-risk children.
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Mantovani CDC, Lima MB, Oliveira CDRD, Menck RDA, Diniz EMDA, Yonamine M. Development and practical application of accelerated solvent extraction for the isolation of cocaine/crack biomarkers in meconium samples. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 957:14-23. [DOI: 10.1016/j.jchromb.2014.02.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/17/2014] [Accepted: 02/22/2014] [Indexed: 10/25/2022]
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81
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Min MO, Minnes S, Lang A, Weishampel P, Short EJ, Yoon S, Singer LT. Externalizing behavior and substance use related problems at 15 years in prenatally cocaine exposed adolescents. J Adolesc 2014; 37:269-79. [PMID: 24636687 PMCID: PMC3980446 DOI: 10.1016/j.adolescence.2014.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 10/30/2013] [Accepted: 01/15/2014] [Indexed: 11/17/2022]
Abstract
The effect of prenatal cocaine exposure (PCE) on externalizing behavior and substance use related problems at 15 years of age was examined. Participants consisted of 358 adolescents (183 PCE, 175 non-cocaine exposed (NCE)), primarily African-American and of low socioeconomic status, prospectively enrolled in a longitudinal study from birth. Regression analyses indicated that the amount of PCE was associated with higher externalizing behavioral problems (β = .15, p = .02). Adolescents with PCE were also 2.8 times (95% CI = 1.38-5.56) more likely to have substance use related problems than their NCE counterparts. No differences between PCE adolescents in non-kinship adoptive/foster care (n = 44) and PCE adolescents in maternal/relative care (n = 139) were found in externalizing behavior or in the likelihood of substance use related problems. Findings demonstrate teratologic effects of PCE persisting into adolescence. PCE is a reliable marker for the potential development of problem behaviors in adolescence, including substance use related problems.
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Affiliation(s)
- Meeyoung O Min
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA.
| | - Sonia Minnes
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | - Adelaide Lang
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | - Paul Weishampel
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | | | - Susan Yoon
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | - Lynn T Singer
- School of Medicine, Department of Pediatrics, USA; School of Medicine, Department of Psychiatry, USA; School of Medicine, Department of Environmental Health Sciences, USA
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82
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Robey A, Buckingham-Howes S, Salmeron BJ, Black MM, Riggins T. Relations among prospective memory, cognitive abilities, and brain structure in adolescents who vary in prenatal drug exposure. J Exp Child Psychol 2014; 127:144-62. [PMID: 24630759 DOI: 10.1016/j.jecp.2014.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 01/15/2014] [Accepted: 01/16/2014] [Indexed: 01/30/2023]
Abstract
This investigation examined how prospective memory (PM) relates to cognitive abilities (i.e., executive function, attention, working memory, and retrospective memory) and brain structure in adolescents who vary in prenatal drug exposure (PDE). The sample consisted of 105 (55 female and 50 male) urban, primarily African American adolescents (mean age=15.5 years) from low socioeconomic status (SES) families. Approximately 56% (n=59) were prenatally exposed to drugs (heroin and/or cocaine) and 44% (n=46) were not prenatally exposed, but the adolescents were similar in age, gender, race, and SES. Executive functioning, attentional control, working memory, retrospective memory, and overall cognitive ability were assessed by validated performance measures. Executive functioning was also measured by caregiver report. A subset of 52 adolescents completed MRI (magnetic resonance imaging) scans, which provided measures of subcortical gray matter volumes and thickness of prefrontal, parietal, and temporal cortices. Results revealed no differences in PM performance by PDE status, even after adjusting for age and IQ. Executive function, retrospective memory, cortical thickness in frontal and parietal regions, and volume of subcortical regions (i.e., putamen and hippocampus) were related to PM performance in the sample overall, even after adjusting for age, IQ, and total gray matter volume. Findings suggest that variations in PM ability during adolescence are robustly related to individual differences in cognitive abilities, in particular executive function and retrospective memory, and brain structure, but do not vary by PDE status.
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Affiliation(s)
- Alison Robey
- Department of Psychology, University of Maryland-College Park, College Park, MD 20742, USA
| | | | - Betty Jo Salmeron
- National Institute on Drug Abuse-Intramural Research Program (NIDA-IRP), National Institutes of Health (NIH), Baltimore, MD 21224, USA
| | - Maureen M Black
- University of Maryland School of Medicine, Baltimore, MD 20201, USA
| | - Tracy Riggins
- Department of Psychology, University of Maryland-College Park, College Park, MD 20742, USA.
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Chiriboga CA, Kuhn L, Wasserman GA. Neurobehavioral and Developmental Traiectories Associated with Level of Prenatal Cocaine Exposure. ACTA ACUST UNITED AC 2014; 2. [PMID: 25664330 DOI: 10.13188/2332-3469.1000015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In experimental models, prenatal cocaine exposure has been found to perturb GABA and dopamine development. Clinically, abnormalities in tone, posture and state regulation are noted in early infancy but the evolution of these findings over time is not well described. The current study assesses the longitudinal effects of prenatal cocaine exposure in dose-dependent fashion on developmental & behavioral and neurological trajectories over the first 2 years of life. METHODS Three hundred and eighty infants, 113 cocaine-exposed, were enrolled at birth from an urban hospital from 2000 to 2004. Exposure was determined by maternal interview, segmental hair analyses (RIAH™) in all, and meconium and urine in a subset. Developmental, behavioral and neurological assessments were carried out blind to drug exposure at 6, 12 and 24 months of age in the 306 children who returned in follow-up. Mixed-effects linear modeling (developmental growth curve) assessed change in outcome over time. RESULTS The mental developmental growth curve showed a negative slope (2.2 points) in adjusted analyses among cocaine-exposed children over the first 2 years of life. (p=.04), while the slope of the motor development growth curve did not. Adjusting for microcephaly at 6 months diminished the strength of the association between cocaine exposure and mental developmental growth curve (effect modification). Cocaine exposure was marginally associated with behavioral outcomes in adjusted analyses. Total Behavior scores and Orientation/Engagement scores improved with age. At 1 year of age, prenatal cocaine exposure was significantly associated with lower motor development scores. High rates of hypertonia (global and diparesis) identified at the 6-month visit dropped dramatically in the first 2 years of life: cocaine-exposed children showed a more rapid rate of resolution of hypertonia than unexposed children, with hypertonia improving 2.2 times faster among those with heavy cocaine exposure. CONCLUSION We found differences in mental performance over the first 2 years of life associated with prenatal cocaine exposure that was mediated by microcephaly implying that cocaine exerts a sustained teratogenic effect on brain development. Early neurological (hypertonia) and behavioral findings associated with prenatal cocaine exposure improved over time. Hypertonia did not predict long-term development impairments. Conceivably, the transient nature of neurobehavioral manifestations reflects postnatally a tendency towards homeostasis of cocaine-related embryopathic perturbations of GABA and dopaminergic systems.
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Affiliation(s)
- Claudia A Chiriboga
- Division of Pediatric Neurology, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, USA ; Sergievsky Center, Columbia University, New York, NY, USA ; Harlem Hospital Center, New York, NY, USA
| | - Louise Kuhn
- Sergievsky Center, Columbia University, New York, NY, USA
| | - Gail A Wasserman
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University, New York, NY, USA ; New York Psychiatric Institute, New York, NY, USA
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84
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Abstract
The etiology of many brain diseases remains allusive to date after intensive investigation of genomic background and symptomatology from the day of birth. Emerging evidences indicate that a third factor, epigenetics prior to the birth, can exert profound influence on the development and functioning of the brain and over many neurodevelopmental syndromes. This chapter reviews how aversive environmental exposure to parents might predispose or increase vulnerability of offspring to neurodevelopmental deficit through alteration of epigenetics. These epigenetic altering environmental factors will be discussed in the category of addictive agents, nutrition or diet, prescriptive medicine, environmental pollutant, and stress. Epigenetic alterations induced by these aversive environmental factors cover all aspects of epigenetics including DNA methylation, histone modification, noncoding RNA, and chromatin modification. Next, the mechanisms how these environmental inputs influence epigenetics will be discussed. Finally, how environmentally altered epigenetic marks affect neurodevelopment is exemplified by the alcohol-induced fetal alcohol syndrome. It is hoped that a thorough understanding of the nature of prenatal epigenetic inputs will enable researchers with a clear vision to better unravel neurodevelopmental deficit, late-onset neuropsychiatric diseases, or idiosyncratic mental disorders.
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Affiliation(s)
- Chiao-Ling Lo
- Department of Anatomy and Cell Biology, Stark Neuroscience Research Institute, Indiana Alcohol Research Center, Indiana University School of Medicine, and Department of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Feng C Zhou
- Department of Anatomy and Cell Biology, Stark Neuroscience Research Institute, Indiana Alcohol Research Center, Indiana University School of Medicine, and Department of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana, USA.
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85
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Allen JWP, Bennett DS, Carmody DP, Wang Y, Lewis M. Adolescent risk-taking as a function of prenatal cocaine exposure and biological sex. Neurotoxicol Teratol 2013; 41:65-70. [PMID: 24334262 DOI: 10.1016/j.ntt.2013.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 11/27/2013] [Accepted: 12/06/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine the effects of prenatal cocaine exposure and biological sex on adolescent risk-taking while controlling for early environmental risk. METHODS Adolescents (n=114, mean age=16) were grouped according to high and low risk-taking propensity as measured by the Balloon Analogue Risk Task (BART). Prenatal cocaine exposure was assessed at birth, while environmental risk was assessed at three points during early childhood. RESULTS A binary regression analysis indicated that males were 3.5 times more likely than females to be high risk-takers. Biological sex and prenatal cocaine exposure interacted such that exposed males were most likely to be high risk-takers while exposed females were the least likely to be high risk-takers. This pattern held after controlling for prenatal alcohol exposure and early environmental risk. Early environmental risk did not predict adolescent risk-taking. CONCLUSIONS These findings complement and extend earlier research demonstrating that prenatal cocaine exposure interacts with biological sex in domains related to inhibitory control, emotion regulation, antisocial behavior, and health risk behaviors during preadolescence.
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Affiliation(s)
| | - David S Bennett
- Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Yiping Wang
- Institute for the Study of Child Development, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michael Lewis
- Institute for the Study of Child Development, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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86
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Lewis BA, Minnes S, Short EJ, Min MO, Wu M, Lang A, Weishampel P, Singer LT. Language outcomes at 12 years for children exposed prenatally to cocaine. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2013; 56:1662-76. [PMID: 24149136 PMCID: PMC4131682 DOI: 10.1044/1092-4388(2013/12-0119)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
PURPOSE In this study, the authors aimed to examine the long-term effects of prenatal cocaine exposure (PCE) on the language development of 12-year-old children using a prospective design, controlling for confounding prenatal drug exposure and environmental factors. METHOD Children who were exposed to cocaine in utero (PCE; n = 183) and children who were not exposed to cocaine (i.e., no cocaine exposure [NCE]; n = 181) were followed prospectively from birth to 12 years of age and were compared on language subtests of the Test of Language Development-Intermediate, Third Edition ( Hammill & Newcomer, 1997b), and phonological processing as measured by the Comprehensive Test of Phonological Processing ( Wagner & Torgesen, 1999). The authors evaluated the relationship of PCE to language development through a multivariate analysis of covariance and regression analyses while controlling for confounders. RESULTS Results show that PCE has small effects on specific aspects of language, including syntax and phonological processing. The caregiver variables of lower maternal vocabulary, more psychological symptoms, and a poorer home environment also had consistent effects on language and phonological processing scores. CONCLUSIONS These findings suggest that PCE continues to have small, subtle effects on specific aspects of language at age 12 years. Phonological processing skills were significantly related to the reading outcomes of letter-word identification, reading fluency, and reading comprehension, indicating that PCE also has small but lasting effects on the language skills that are related to later literacy skills.
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87
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Prenatal cocaine exposure is associated with variable, small effects on adolescent functioning. J Pediatr 2013; 163:925-6. [PMID: 23973240 DOI: 10.1016/j.jpeds.2013.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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88
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Richardson GA, Goldschmidt L, Larkby C, Day NL. Effects of prenatal cocaine exposure on child behavior and growth at 10 years of age. Neurotoxicol Teratol 2013; 40:1-8. [PMID: 23981277 DOI: 10.1016/j.ntt.2013.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
We examined physical growth and behavioral outcomes in 226 10-year-old children who were participants in a longitudinal study of prenatal cocaine exposure (PCE), while controlling for other factors that affect development. During the first trimester, 42% of the women used cocaine, with use declining across pregnancy. At the 10-year follow-up, the caregivers were 37years old, had 12.8years of education, and 50% were African American. First trimester cocaine exposure predicted decreased weight, height, and head circumference at 10years. First trimester cocaine use also predicted maternal ratings of less sociability on the EAS Temperament Survey and more withdrawn behavior problems on the Child Behavior Checklist, more anxious/depressed behaviors on the Teacher Report Form, and more self-reported depressive symptoms on the Children's Depression Inventory. In addition, exposure to violence mediated the effect of PCE on child and teacher reports of depressive symptoms, but not of maternal reports of sociability and withdrawn behaviors. These behaviors may be precursors of later psychiatric problems.
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Affiliation(s)
- Gale A Richardson
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
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89
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Li Z, Santhanam P, Coles CD, Lynch ME, Hamann S, Peltier S, Hu X. Prenatal cocaine exposure alters functional activation in the ventral prefrontal cortex and its structural connectivity with the amygdala. Psychiatry Res 2013; 213:47-55. [PMID: 23693086 PMCID: PMC3672335 DOI: 10.1016/j.pscychresns.2012.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 12/12/2012] [Accepted: 12/20/2012] [Indexed: 12/20/2022]
Abstract
Prenatal cocaine exposure (PCE) is associated with arousal dysregulation, and alterations of amygdala activity in response to emotional arousal have previously been reported. However, voluntary regulation of emotional affect, enabling appropriate neural response to different streams of stimuli, must also engage prefrontal regions, yet the impact of PCE on these prefrontal mechanisms has not been investigated. Recent neuroimaging studies have shown the involvement of ventral prefrontal cortex (vPFC) in the modulation of amygdala reactivity and the mediation of effective emotional regulation. Based on these findings, using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), the present study compared functional activations of the vPFC as well as its structural connectivity with the amygdala between groups of PCE and control adolescents. In a working memory task with emotional distracters, the PCE adolescents exhibited less capability of increasing their vPFC activation in response to increased memory load, which corresponded with their less suppressed amygdala activation. Reduced structural connectivity between the vPFC and the amygdala was also observed from DTI measurement in the PCE group. In addition, correlations between amygdala activation and (i) vPFC activation, as well as (ii) amygdala-vPFC structural connectivity, were observed in the control but not in the PCE group. These data complement previous findings of the impact of PCE on the activity of the amygdala and extend our understanding of the neurobiological mechanisms underlying the effect of PCE on arousal dysregulation reported in human and animal studies.
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Affiliation(s)
- Zhihao Li
- Biomedical Imaging Technology Center, Department of Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta 30322, Georgia U.S.A
| | - Priya Santhanam
- Biomedical Imaging Technology Center, Department of Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta 30322, Georgia U.S.A
| | - Claire D. Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta 30322, Georgia U.S.A
| | - Mary Ellen Lynch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta 30322, Georgia U.S.A
| | - Stephan Hamann
- Department of Psychology, Emory University, Atlanta 30322, Georgia U.S.A
| | - Scott Peltier
- Biomedical Imaging Technology Center, Department of Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta 30322, Georgia U.S.A
| | - Xiaoping Hu
- Biomedical Imaging Technology Center, Department of Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta 30322, Georgia U.S.A.,Correspondence: Xiaoping Hu, PhD., Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Woodruff Memorial Building, 101 Woodruff Circle, Suite 2001, Atlanta Georgia 30322, Tel: (404)-712-2615, Fax: (404)-712-2707,
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90
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Spronk DB, van Wel JHP, Ramaekers JG, Verkes RJ. Characterizing the cognitive effects of cocaine: a comprehensive review. Neurosci Biobehav Rev 2013; 37:1838-59. [PMID: 23876288 DOI: 10.1016/j.neubiorev.2013.07.003] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 12/20/2022]
Abstract
Understanding the cognitive sequela of repeated cocaine use is a growing area of research and is crucial to the development of cognitive models of addiction. We systematically reviewed all available placebo-controlled and case-controlled studies on the acute and long-term effects of cocaine on cognitive functioning. In order to compare the magnitude of cognitive effects across cognitive domains we conducted several meta-analyses on a subset of data from long-term effect studies. Studies on acute cocaine administration suggest enhancement of response inhibition and psychomotor speed, while all other domains appear to be unaffected or not investigated adequately. Long-term effects of cocaine show a wide array of deteriorated cognitive functions, indicating that long term cocaine use is characterized by a general cognitive impairment across functions, rather than by specific cognitive deficits. Literature on long-term cocaine effects is more substantial than literature on acute effects. This comprehensive review outlines possible dissociations and similarities of acute vs. long-term cocaine effects in the human brain. Atherosclerosis after cocaine exposure may underlie cognitive dysfunction, suggesting involvement of multiple brain areas. Acute drug studies are important to the future development of addiction models.
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Affiliation(s)
- Desirée B Spronk
- Department of Psychiatry (966), Radboud University Nijmegen Medical Centre, Nijmegen, Postbox 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.
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The destructive capacity of drug abuse: an overview exploring the harmful potential of drug abuse both to the individual and to society. ISRN ADDICTION 2013; 2013:450348. [PMID: 25938116 PMCID: PMC4392977 DOI: 10.1155/2013/450348] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/06/2013] [Indexed: 12/11/2022]
Abstract
From a public health perspective, substance abuse has long been a source of major concern, both for the individual's health and for wider society as a whole. The UK has the highest rates of recorded illegal drug misuse in the western world. In particular, it has comparatively high rates of heroin and crack cocaine use. Substances that are considered harmful are strictly regulated according to a classification system that takes into account the harms and risks of taking each drug (see the tables) (Nutt et al. (2007)). The adverse effects of drug abuse can be thought of in three parts that together determine the overall harm in taking it: (1) the direct physical harm of the substance to the individual user, (2) the tendency of the drug to induce dependence, and (3) the effect of abuse of the drug on families, communities, and society (Gable (2004, 1993)). In this report, we discuss published evidence relating to the harm of substance misuse and consider the neuropsychopharmacological mechanisms behind addiction in an attempt to gain an improved picture of the potential devastation that abuse of these substances may evoke.
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92
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Lloyd SA, Oltean C, Pass H, Phillips B, Staton K, Robertson CL, Shanks RA. Prenatal exposure to psychostimulants increases impulsivity, compulsivity, and motivation for rewards in adult mice. Physiol Behav 2013; 119:43-51. [PMID: 23739493 DOI: 10.1016/j.physbeh.2013.05.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 03/14/2013] [Accepted: 05/24/2013] [Indexed: 12/22/2022]
Abstract
Given the widespread use and misuse of methamphetamine (METH) and methylphenidate (MPD), especially in relation to women of childbearing age, it is important to consider the long-lasting effects of these drugs on the brain of the developing fetus. Male and female C57Bl/6J mice were prenatally exposed to METH (5mg/kg), MPD (10mg/kg), or saline. Following a 3-month washout, behavioral analysis using the 5-Choice Serial Reaction Time Task (5CSRTT) was performed on adult mice. After reaching training criteria, performance on a pseudo-random intertrial interval test session revealed decrements in 5CSRTT behavior. Prenatally-treated METH and MPD mice demonstrated significant increases in impulsivity, compulsivity, and motivation for reward compared to their saline controls. There were sex by drug interactions indicating a possible sexually dimorphic response to these prenatal drug exposures. Of particular clinical interest, we find that mice prenatally exposed to METH or MPD express characteristics of both inhibitory control decrements and heightened motivation for rewards, which represent core symptoms of addiction and other impulse control disorders.
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Affiliation(s)
- S A Lloyd
- Department of Psychological Science, University of North Georgia, Dahlonega, GA, USA.
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93
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Buckingham-Howes S, Berger SS, Scaletti LA, Black MM. Systematic review of prenatal cocaine exposure and adolescent development. Pediatrics 2013; 131:e1917-36. [PMID: 23713107 PMCID: PMC3666107 DOI: 10.1542/peds.2012-0945] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Previous research found that prenatal cocaine exposure (PCE) may increase children's vulnerability to behavior and cognition problems. Maturational changes in brain and social development make adolescence an ideal time to reexamine associations. The objective was to conduct a systematic review of published studies examining associations between PCE and adolescent development (behavior, cognition/school outcomes, physiologic responses, and brain morphology/functioning). METHODS Articles were obtained from PubMed, PsycInfo, Web of Science, and CINAHL databases through July 2012 with search terms: prenatal drug, substance, or cocaine exposure; adolescence/adolescent; and in utero substance/drug exposure. Criteria for inclusion were nonexposed comparison group, human adolescents aged 11 to 19, peer-reviewed, English-language, and adolescent outcomes. RESULTS Twenty-seven studies representing 9 cohorts met the criteria. Four outcome categories were identified: behavior, cognition/school performance, brain structure/function, and physiologic responses. Eleven examined behavior; 7 found small but significant differences favoring nonexposed adolescents, with small effect sizes. Eight examined cognition/school performance; 6 reported significantly lower scores on language and memory tasks among adolescents with PCE, with varying effect sizes varied. Eight examined brain structure/function and reported morphologic differences with few functional differences. Three examined physiologic responses with discordant findings. Most studies controlled for other prenatal exposures, caregiving environment, and violence exposure; few examined mechanisms. CONCLUSIONS Consistent with findings among younger children, PCE increases the risk for small but significantly less favorable adolescent functioning. Although the clinical importance of differences is often unknown, the caregiving environment and violence exposure pose additional threats. Future research should investigate mechanisms linking PCE with adolescent functioning.
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Affiliation(s)
- Stacy Buckingham-Howes
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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94
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Paltrow LM, Flavin J. Arrests of and forced interventions on pregnant women in the United States, 1973-2005: implications for women's legal status and public health. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2013; 38:299-343. [PMID: 23262772 DOI: 10.1215/03616878-1966324] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In November 2011, the citizens of Mississippi voted down Proposition 26, a "personhood" measure that sought to establish separate constitutional rights for fertilized eggs, embryos, and fetuses. This proposition raised the question of whether such measures could be used as the basis for depriving pregnant women of their liberty through arrests or forced medical interventions. Over the past four decades, descriptions of selected subsets of arrests and forced interventions on pregnant women have been published. Such cases, however, have never been systematically identified and documented, nor has the basis for the deprivations of liberty been comprehensively examined. In this article we report on 413 cases from 1973 to 2005 in which a woman's pregnancy was a necessary factor leading to attempted and actual deprivations of a woman's physical liberty. First, we describe key characteristics of the cases and the women, including socioeconomic status and race. Second, we investigate the legal claims made to justify the arrests, detentions, and forced interventions. Third, we explore the role played by health care providers. We conclude by discussing the implications of our findings and the likely impact of personhood measures on pregnant women's liberty and on maternal, fetal, and child health.
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95
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Abstract
Premature infants are at risk for growth failure, developmental delays, necrotizing enterocolitis, and late-onset sepsis. Human milk from women delivering prematurely has more protein and higher levels of bioactive molecules. Human milk must be fortified for premature infants to achieve adequate growth. Mother's own milk improves growth and neurodevelopment, decreases the risk of necrotizing enterocolitis and late-onset sepsis, and should be the primary enteral diet for premature infants. Donor milk is a resource for premature infants whose mothers are unable to provide an adequate supply of milk. Challenges include the need for pasteurization, nutritional and biochemical deficiencies, and limited supply.
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Affiliation(s)
- Mark A. Underwood
- Associate Professor, Department of Pediatrics, University of California, Davis, California, USA
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96
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Brown SD, Donelan K, Martins Y, Burmeister K, Buchmiller TL, Sayeed SA, Mitchell C, Ecker JL. Differing attitudes toward fetal care by pediatric and maternal-fetal medicine specialists. Pediatrics 2012; 130:e1534-40. [PMID: 23129074 DOI: 10.1542/peds.2012-1352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The expansion of pediatric-based fetal care raises questions regarding pediatric specialists' involvement in pregnancies when maternal conditions may affect pediatric outcomes. For several such conditions, we compared pediatric and obstetric specialists' attitudes regarding whether and when pediatrics consultation should be offered and their views about seeking court authorization to override maternal refusal of physician recommendations. METHODS We used a mail survey of 434 maternal-fetal medicine specialists (MFMs) and fetal care pediatric specialists (FCPs) (response rate: MFM, 60.9%; FCP, 54.2%). RESULTS FCPs were more likely than MFMs to indicate that pediatric counseling should occur before decisions regarding continuing or interrupting pregnancies complicated by maternal alcohol abuse (FCP versus MFM: 63% vs 36%), cocaine abuse (FCP versus MFM: 60% vs 32%), use of seizure medications (FCP versus MFM: 62% vs 33%), and diabetes (FCP versus MFM: 56% vs 27%) (all P < .001). For all conditions, MFMs were more than twice as likely as FCPs to think that no pediatric specialist consultation was ever necessary. FCPs were more likely to agree that seeking court interventions was appropriate for maternal refusal to enter a program to discontinue cocaine use (FCP versus MFM: 72% vs 33%), refusal of azidothymidine to prevent perinatal HIV transmission (80% vs 41%), and refusal of percutaneous transfusion for fetal anemia (62% vs 28%) (all P < .001). CONCLUSIONS Pediatric and obstetric specialists differ considerably regarding pediatric specialists' role in prenatal care for maternal conditions, and regarding whether to seek judicial intervention for maternal refusal of recommended treatment.
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Affiliation(s)
- Stephen D Brown
- Department of Radiology, Boston Children's Hospital, Boston, MA 02115, USA.
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97
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Bada HS, Bann CM, Whitaker TM, Bauer CR, Shankaran S, LaGasse L, Lester BM, Hammond J, Higgins R. Protective factors can mitigate behavior problems after prenatal cocaine and other drug exposures. Pediatrics 2012; 130. [PMID: 23184114 PMCID: PMC3507246 DOI: 10.1542/peds.2011-3306] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We determined the role of risk and protective factors on the trajectories of behavior problems associated with high prenatal cocaine exposure (PCE)/polydrug exposure. METHODS The Maternal Lifestyle Study enrolled 1388 children with or without PCE, assessed through age 15 years. Because most women using cocaine during pregnancy also used other substances, we analyzed for the effects of 4 categories of prenatal drug exposure: high PCE/other drugs (OD), some PCE/OD, OD/no PCE, and no PCE/no OD. Risks and protective factors at individual, family, and community levels that may be associated with behavior outcomes were entered stepwise into latent growth curve models, then replaced by cumulative risk and protective indexes, and finally by a combination of levels of risk and protective indexes. Main outcome measures were the trajectories of externalizing, internalizing, total behavior, and attention problems scores from the Child Behavior Checklist (parent). RESULTS A total of 1022 (73.6%) children had known outcomes. High PCE/OD significantly predicted externalizing, total, and attention problems when considering the balance between risk and protective indexes. Some PCE/OD predicted externalizing and attention problems. OD/no PCE also predicted behavior outcomes except for internalizing behavior. High level of protective factors was associated with declining trajectories of problem behavior scores over time, independent of drug exposure and risk index scores. CONCLUSIONS High PCE/OD is a significant risk for behavior problems in adolescence; protective factors may attenuate its detrimental effects. Clinical practice and public health policies should consider enhancing protective factors while minimizing risks to improve outcomes of drug-exposed children.
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Affiliation(s)
- Henrietta S. Bada
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Carla M. Bann
- RTI International, Research Triangle Park, North Carolina
| | - Toni M. Whitaker
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Charles R. Bauer
- Department of Pediatrics, University of Miami School of Medicine, Miami, Florida
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Linda LaGasse
- Department of Pediatrics, Brown University Medical School, Providence, Rhode Island; and
| | - Barry M. Lester
- Department of Pediatrics, Brown University Medical School, Providence, Rhode Island; and
| | - Jane Hammond
- RTI International, Research Triangle Park, North Carolina
| | - Rosemary Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
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Sirocco KY, Lynne-Landsman SD, Boyce CA. Developmental Cognitive Neuroscience to Inform Cognitive-Control Interventions for Drug Abuse: Introduction to the Special Section. CHILD DEVELOPMENT PERSPECTIVES 2012. [DOI: 10.1111/cdep.12002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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99
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Abstract
Substance use among pregnant women continues to be a major public health concern, posing potential risk to their drug-exposed children as well as burdens on society. This review is intended to discuss the most recent literature regarding the association between in utero cocaine exposure and developmental and behavioral outcomes from birth through adolescence across various domains of functioning (growth, neurobiology, intelligence, academic achievement, language, executive functioning, behavioral regulation and psychopathology). In addition, methodological limitations, associated biological, sociodemographic and environmental risk factors and future directions in this area of research are discussed. Given the large number of exposed children in the child welfare system and the increased need for medical, mental health and special education services within this population, more definitively documenting associations between prenatal cocaine exposure and later child outcomes is essential in order to be able to prospectively address the many significant public health, economic and public policy implications.
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100
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Courty P, Nacache L. [Perinatality in the context of addictions]. Presse Med 2012; 41:1241-7. [PMID: 23092710 DOI: 10.1016/j.lpm.2012.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/31/2012] [Indexed: 11/17/2022] Open
Abstract
We must remove bad representations the medical team has upon the pregnant drug users and the same way in reverse. Opiate substitution treatment (OST) improves prenatal prognosis for both mother and child. There is no need to change OST for a stabilized woman discovering pregnancy. Nevertheless, buprenorphine appears to be first-range medication. OST posology is the most important for prenatal prognosis. Practician must never hesitate to adapt it whether increasing or fractionate it. Neonatal abstinence syndrome (NAS) is not linked with OST's posology. OST is not contra-indicated for breast-feeding. Breast-feeding should be encouraged. It does not treat or cure NAS but allows a skin-to-skin contact that could lessens an occurring withdrawal.
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Affiliation(s)
- Pascal Courty
- CHU G. Montpied, SATIS, pôle de psychiatrie, 63003 Clermont-Ferrand cedex 1, France.
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