Sleep problems in children with prenatal substance exposure: the Maternal Lifestyle study

Associations between perinatal risk and physical health in pre-adolescence in the Adolescent Brain Cognitive Development (ABCD) Study®: the unexpected relationship with sleep disruption

BACKGROUND

To investigate relationships among different physical health problems in a large, sociodemographically diverse sample of 9-to-10-year-old children and determine the extent to which perinatal health factors are associated with childhood physical health problems.

METHODS

A cross-sectional study was conducted utilizing the Adolescent Brain Cognitive Development℠ (ABCD) Study (n = 7613, ages 9-to-10-years-old) to determine the associations among multiple physical health factors (e.g., prenatal complications, current physical health problems). Logistic regression models controlling for age, sex, pubertal development, household income, caregiver education, race, and ethnicity evaluated relationships between perinatal factors and childhood physical health problems.

RESULTS

There were significant associations between perinatal and current physical health measures. Specifically, those who had experienced perinatal complications were more likely to have medical problems by 9-to-10 years old. Importantly, sleep disturbance co-occurred with several physical health problems across domains and developmental periods.

CONCLUSION

Several perinatal health factors were associated with childhood health outcomes, highlighting the importance of understanding and potentially improving physical health in youth. Understanding the clustering of physical health problems in youth is essential to better identify which physical health problems may share underlying mechanisms.

IMPACT

Using a multivariable approach, we investigated the associations between various perinatal and current health problems amongst youth. Our study highlights current health problems, such as sleep problems at 9-to-10 years old, that are associated with a cluster of factors occurring across development (e.g., low birth weight, prenatal substance exposure, pregnancy complications, current weight status, lifetime head injury). Perinatal health problems are at large, non-modifiable (in this retrospective context), however, by identifying which are associated with current health problems, we can identify potential targets for intervention and prevention efforts.

Vaporized nicotine in utero results in reduced birthweight, increased locomotion, and decreased voluntary exercise, dependent on sex and diet in offspring

Rationale Clinical research has shown that prenatal exposure to nicotine may result in increased obesity risk later in life. Preclinical research has corroborated this finding, but few studies have investigated inhaled nicotine or the interaction with diet on obesity risk. Objective The aim of this study was to investigate the effects of prenatal nicotine exposure on both direct and indirect obesity measures, with both sex and diet as factors. Methods Pregnant rats were exposed to either vehicle or nicotine vapor (24 mg/mL or 59 mg/mL) throughout the entire gestational period. Offspring from each treatment group were given either a normal diet or a high fat diet starting at postnatal day 22. Caloric intake, body weight, spontaneous locomotion, sleep/wake activity, and voluntary exercise were measured throughout adolescence. Pregnancy weight gain and pup birthweights were collected to further measure developmental effects of prenatal nicotine exposure. Results Both maternal weight gain during pregnancy and pup weight at birth were decreased with prenatal nicotine exposure. Early adolescent males showed increased spontaneous activity in the open field following prenatal nicotine exposure compared to vehicle counterparts, particularly those given high-fat diet. Additionally, high dose nicotine prenatal treated males ran significantly less distance on the running wheel in late adolescence compared to vehicle counterparts, in the normal diet group only. Conclusion The results presented here show decreased birthweight, hyperactivity, and decreased voluntary exercise in adolescence following prenatal nicotine exposure in dose, sex, and diet dependent manners, which could lead to increased obesity risk in adulthood.

A Longitudinal Study of Stress During Pregnancy, Children's Sleep and Polygenic Risk for Poor Sleep in the General Pediatric Population

Early life stress is robustly associated with poor sleep across life. Preliminary studies suggest that these associations may begin already in utero. Here, we study the longitudinal associations of prenatal psychosocial stress with sleep across childhood, and assess whether prenatal stress interacts with genetic liability for poor sleep.The study is embedded in the Generation R population-based birth cohort. Caregivers reported on prenatal psychosocial stress (life events, contextual, parental or interpersonal stressors) and on children's sleep at ages 2 months, 1.5, 2, 3 and 6 years. The study sample consisted of 4,930 children; polygenic risk scores for sleep traits were available in 2,063.Prenatal stress was consistently associated with more sleep problems across assessments. Effect sizes ranged from small (B = 0.21, 95%CI: 0.14;0.27) at 2 months to medium (B = 0.45, 95%CI: 0.38;0.53) at 2 years. Prenatal stress was moreover associated with shorter sleep duration at 2 months (Bhrs = -0.22, 95%CI: -0.32;-0.12) and at 2 years (Bhrs = -0.04, 95%CI -0.07; -0.001), but not at 3 years (Bhrs = 0.02, 95%CI: -0.02;0.06). Prenatal negative life events interacted with polygenic risk for insomnia to exacerbate sleep problems at 6 years (Binteraction = 0.07, 95%CI: 0.02;0.13).Psychosocial stress during pregnancy has negative associations with children's sleep that persist across childhood, and are exacerbated by genetic liability for insomnia. Associations with sleep duration were more pronounced in infancy and seem to attenuate with age. These findings highlight the role of the prenatal environment for developing sleep regulation, and could inform early intervention programs targeting sleep in children from high-risk pregnancies.

Identification of the Obstetric Factors Increasing Tendency to Smoking Cessation During Pregnancy

INTRODUCTION

Cigarette, one of the various forms of tobacco, is the most commonly used tobacco product in Turkey and in the world. Cigarette has several negative effects on general health and is a major problem in the pregnancy period. This study aims to identify pregnancy-related factors that affect the tendency to smoking cessation and their effect levels in pregnant women who continue to smoke during pregnancy.

METHOD

The sample of this descriptive and cross-sectional study was 430 pregnant women who smoked. Data were collected through an original interview form and face-to-face interviews. Data analysis was performed using chi-square, independent t test, and multiple logistic regression model in terms of demographic, obstetric, maternal, and fetal features.

RESULTS

The average number of cigarettes smoked before pregnancy was 13.28 ± 8.62, whereas the average number of cigarettes smoked during pregnancy was 6.60 ± 7.64. The tendency to decrease smoking increases 2.8 times ( OR = 2.825, 95% CI [1.631, 4.895]) with the number of pregnancies and approximately 2 times in case of a planned pregnancy ( OR = 1.946, 95% CI [1.076, 3.520]). The frequency of having prenatal visits showed a weak but significant relationship with the number of abortuses and the number of living children.

CONCLUSIONS

Developing a risk map in line with the findings of the study and considering the obstetric features of smoking women could enable to hypothesize about the types of behaviors in smoking in the following processes of pregnancy. With the precautions to be taken, the negative effects of smoking on maternal and fetal health could be prevented or minimized.

Longitudinal associations of DNA methylation and sleep in children: a meta-analysis

BACKGROUND

Sleep is important for healthy functioning in children. Numerous genetic and environmental factors, from conception onwards, may influence this phenotype. Epigenetic mechanisms such as DNA methylation have been proposed to underlie variation in sleep or may be an early-life marker of sleep disturbances. We examined if DNA methylation at birth or in school age is associated with parent-reported and actigraphy-estimated sleep outcomes in children.

METHODS

We meta-analysed epigenome-wide association study results. DNA methylation was measured from cord blood at birth in 11 cohorts and from peripheral blood in children (4-13 years) in 8 cohorts. Outcomes included parent-reported sleep duration, sleep initiation and fragmentation problems, and actigraphy-estimated sleep duration, sleep onset latency and wake-after-sleep-onset duration.

RESULTS

We found no associations between DNA methylation at birth and parent-reported sleep duration (n = 3658), initiation problems (n = 2504), or fragmentation (n = 1681) (p values above cut-off 4.0 × 10^-8). Lower methylation at cg24815001 and cg02753354 at birth was associated with longer actigraphy-estimated sleep duration (p = 3.31 × 10^-8, n = 577) and sleep onset latency (p = 8.8 × 10^-9, n = 580), respectively. DNA methylation in childhood was not cross-sectionally associated with any sleep outcomes (n = 716-2539).

CONCLUSION

DNA methylation, at birth or in childhood, was not associated with parent-reported sleep. Associations observed with objectively measured sleep outcomes could be studied further if additional data sets become available.

Prenatal tobacco and alcohol exposures and the risk of anxiety symptoms in young adulthood: A population-based cohort study

BACKGROUND

Epidemiological studies have linked prenatal tobacco and alcohol exposures to internalizing behaviours in children and adolescents with inconsistent findings. Dearth of epidemiological studies have investigated the associations with the risk of experiencing symptoms of anxiety in young adulthood.

METHODS

Study participants (N = 1190) were from the Raine Study, a population-based prospective birth cohort based in Perth, Western Australia. Data on prenatal tobacco and alcohol exposures were available for the first and third trimesters of pregnancy. Experiencing symptoms of anxiety in young adulthood at age 20 years was measured by a short form of the Depression Anxiety Stress Scale (DASS 21). Relative risk (RR) of experiencing symptoms of anxiety in young adulthood for prenatal tobacco and alcohol exposures were estimated with log binomial regression.

RESULTS

After adjusting for potential confounders, we observed increased risks of experiencing symptoms of anxiety in young adults exposed to prenatal tobacco in the first trimester [RR = 1.52, 95% CI: 1.12-2.06, p-value < 0.01] and third trimester [RR = 1.53, 95% CI: 1.10-2.13, p-value  = 0.02]. However, we found insufficient statistical evidence for an association between first trimester [RR = 1.01, 95% CI: 0.76-1.22, p-value = 0.90] and third trimester [RR = 1.03, 95% CI: 0.80-1.34, p-value = 0.91] prenatal exposure to alcohol and the risk of experiencing symptoms of anxiety in young adults. There was a dose response association between prenatal tobacco exposure and increasing anxiety symptoms in offspring.

CONCLUSION

The findings of this study suggest that an association between prenatal tobacco exposure and risk of anxiety symptoms remains apparent into young adulthood.

Extracellular Vesicles in Premature Aging and Diseases in Adulthood Due to Developmental Exposures

The developmental origins of health and disease (DOHaD) is a paradigm that links prenatal and early life exposures that occur during crucial periods of development to health outcome and risk of disease later in life. Maternal exposures to stress, some psychoactive drugs and alcohol, and environmental chemicals, among others, may result in functional changes in developing fetal tissues, creating a predisposition for disease in the individual as they age. Extracellular vesicles (EVs) may be mediators of both the immediate effects of exposure during development and early childhood as well as the long-term consequences of exposure that lead to increased risk and disease severity later in life. Given the prevalence of diseases with developmental origins, such as cardiovascular disease, neurodegenerative disorders, osteoporosis, metabolic dysfunction, and cancer, it is important to identify persistent mediators of disease risk. In this review, we take this approach, viewing diseases typically associated with aging in light of early life exposures and discuss the potential role of EVs as mediators of lasting consequences.

Which healthy lifestyle habits mitigate the risk of obesity and cardiometabolic risk factors in Caucasian children exposed to in utero adverse gestational factors?

BACKGROUND AND AIMS

This study explored if lifestyle habits [physical activity (PA), sleep duration, intake of fruits and vegetables, grains, and dairy products] can moderate the positive associations between prenatal exposure to suboptimal gestational factors (SGF: i.e. gestational diabetes mellitus, hypertensive disorders during pregnancy, maternal smoking during pregnancy) and obesity and cardiometabolic risk factors in children.

METHODS AND RESULTS

Data from the "Quebec Adiposity and Lifestyle Investigation in Youth" (QUALITY) study collected between 2005 - 2008 in Montreal and Quebec City, were used. Analyses included a sample of 619 children aged 8-10 years. Children's PA and sleep duration were obtained using an accelerometer and daily servings of food were assessed using three 24 h diet recalls. Moderation analyses were performed to investigate if each lifestyle habit, in all children, and in boys and girls, could reduce the positive associations between SGF, and obesity and cardiometabolic risk factors. High LPA duration was protective against low levels of HDL cholesterol in boys who were exposed to more than one SGF (p = 0.005). Sleep duration did not have a protective effect respectively against high waist circumference and obesity in children and girls who were prenatally exposed to maternal smoking during pregnancy. Diet and MVPA did not moderate the positive associations between SGF, obesity and cardiometabolic risk factors in children.

CONCLUSION

Among the three lifestyle habits, only LPA had a protective effect against low levels of HDL-cholesterol in boys. More studies are needed to confirm these results to inform future lifestyle intervention in this population.

An investigation of the link between prenatal alcohol exposure and sleep problems across childhood

OBJECTIVE

To investigate the association between dose and frequency of prenatal alcohol exposure (PAE) and sleep problems in children, after controlling for established risk factors for sleep problems.

METHODS

Data from the birth cohort of the Longitudinal Study of Australian Children (LSAC) was used. Mothers of 3447 children provided information on alcohol consumption during pregnancy, children's sleep problems from 2- to 9-years, and potential confounders associated with sleep problems. Children were classified into PAE groups based on distinct patterns of maternal drinking during pregnancy: abstinent, occasional, low, moderate, and heavy. The effect of PAE on the number and persistence of sleep problems across childhood (2-9 years) was examined.

RESULTS

After controlling for multiple covariates that impact sleep, children with heavy PAE had 1.13 more sleep problems across childhood (2-9 years) relative to children whose mothers were abstainers, in particular 0.37 more at 2- to 3-years (0.504, 95 % CI 0.053, 0.956), and 0.34 more at 6- to 7-years (0.847, 95 % CI 0.299, 1.396). Compared to children of abstainers, heavy PAE increases the probability of having persistent sleep problems from 2- to 9-years by 22.57 %. No negative associations between moderate or low PAE and sleep were observed. Parenting, family, economic, and child health factors also significantly affected child sleep.

CONCLUSION

Heavy PAE was associated with significantly more sleep problems across childhood and a higher probability of reporting persistent sleep problems, relative to children with no PAE. Implications for the understanding and management of sleep in young children with PAE and FASD are discussed.

Prenatal Nicotine Exposure Disrupts Infant Neural Markers of Orienting

Introduction

Prenatal nicotine exposure (PNE) from maternal cigarette smoking is linked to developmental deficits, including impaired auditory processing, language, generalized intelligence, attention, and sleep. Fetal brain undergoes massive growth, organization, and connectivity during gestation, making it particularly vulnerable to neurotoxic insult. Nicotine binds to nicotinic acetylcholine receptors, which are extensively involved in growth, connectivity, and function of developing neural circuitry and neurotransmitter systems. Thus, PNE may have long-term impact on neurobehavioral development. The purpose of this study was to compare the auditory K-complex, an event-related potential reflective of auditory gating, sleep preservation and memory consolidation during sleep, in infants with and without PNE and to relate these neural correlates to neurobehavioral development.

Methods

We compared brain responses to an auditory paired-click paradigm in 3- to 5-month-old infants during Stage 2 sleep, when the K-complex is best observed. We measured component amplitude and delta activity during the K-complex.

Results

Infants with PNE demonstrated significantly smaller amplitude of the N550 component and reduced delta-band power within elicited K-complexes compared to nonexposed infants and also were less likely to orient with a head turn to a novel auditory stimulus (bell ring) when awake.

Conclusions

PNE may impair auditory sensory gating, which may contribute to disrupted sleep and to reduced auditory discrimination and learning, attention re-orienting, and/or arousal during wakefulness reported in other studies.

Implications

Links between PNE and reduced K-complex amplitude and delta power may represent altered cholinergic and GABAergic synaptic programming and possibly reflect early neural bases for PNE-linked disruptions in sleep quality and auditory processing. These may pose significant disadvantage for language acquisition, attention, and social interaction necessary for academic and social success.

Effect of maternal smoking in pregnancy and childhood on child and adolescent sleep outcomes to 21 years: a birth cohort study

BACKGROUND

The effects of prenatal maternal smoking have been studied extensively, however little research has examined the effects of prenatal exposure to maternal smoking on offspring sleep, particularly over several developmental periods. We examined the effects of prenatal maternal smoking and postnatal smoking from birth to 14 years, on offspring sleep at 6 months, 5, 14 and 21 years.

METHODS

This was a prospective, community-based birth cohort study involving 7223 women who delivered a singleton child in Brisbane, Australia between 1981 and 1983. Women were recruited at the first antenatal visit. Offspring sleep problems were reported by mothers at 6 months, 5 and 14 years, and by youth at 14 and 21 years. 3738 mothers prospectively reported their smoking status from pregnancy to 14 years postpartum. Youth snoring was reported by mothers at 14 years and by youth at 21 years. Multinomial logistic regression analyses were performed.

RESULTS AND DISCUSSION

Prenatal maternal smoking was independently associated with an increased risk of offspring adolescent parasomnias including walking and talking in sleep and nightmares, and an increased likelihood of being in the highest quintile for maternal and youth reported sleep problems at 14 years. Maternal postnatal smoking was associated with increased likelihood of offspring snoring at 14 years.

CONCLUSIONS

Exposure to maternal prenatal smoking has different effects on offspring sleep compared to exposure to postnatal smoking. Prenatal smoking exposure may be associated with changes in neurodevelopment whereas postnatal smoking is more likely to affect the respiratory system. These findings highlight the long lasting and potentially serious clinical effects of exposure to pre and postnatal maternal smoking on offspring, the mechanisms by which warrant further investigation.

Prenatal particulate air pollution exposure and sleep disruption in preschoolers: Windows of susceptibility

BACKGROUND

The programming of sleep architecture begins in pregnancy and depends upon optimal in utero formation and maturation of the neural connectivity of the brain. Particulate air pollution exposure can disrupt fetal brain development but associations between fine particulate matter (PM_2.5) exposure during pregnancy and child sleep outcomes have not been previously explored.

METHODS

Analyses included 397 mother-child pairs enrolled in a pregnancy cohort in Mexico City. Daily ambient prenatal PM_2.5 exposure was estimated using a validated satellite-based spatio-temporally resolved prediction model. Child sleep periods were estimated objectively using wrist-worn, continuous actigraphy over a 1-week period at age 4-5 years. Data-driven advanced statistical methods (distributed lag models (DLMs)) were employed to identify sensitive windows whereby PM_2.5 exposure during gestation was significantly associated with changes in sleep duration or efficiency. Models were adjusted for maternal education, season, child's age, sex, and BMI z-score.

RESULTS

Mother's average age was 27.7 years, with 59% having at least a high school education. Children slept an average of 7.7 h at night, with mean 80.1% efficiency. The adjusted DLM identified windows of PM_2.5 exposure between 31 and 35 weeks gestation that were significantly associated with decreased sleep duration in children. In addition, increased PM_2.5 during weeks 1-8 was associated with decreased sleep efficiency. In other exposure windows (weeks 39-40), PM_2.5 was associated with increased sleep duration.

CONCLUSION

Prenatal PM_2.5 exposure is associated with altered sleep in preschool-aged children in Mexico City. Pollutant exposure during sensitive windows of pregnancy may have critical influence upon sleep programming.

Prenatal and early life origins of adolescence sleep problems: evidence from a birth cohort

PURPOSE

This study aims to identify the prenatal and early life predictors of adolescence sleep problems.

METHODS

Sleep data (n = 5081) from the 14-year (13.92 ± 0.34 years) follow-up of a birth cohort were analyzed to explore the predictors of adolescence trouble sleeping, nightmares, snoring and sleep talking/walking. Data from the antenatal period till adolescence were explored for identifying predictors of adolescence sleep problems. Modified Poisson regression with a robust error variance was used to identify significant predictors.

RESULTS

Our results suggest that about a quarter of adolescents in our study sample had sleep maintenance problems (nightmares: 27.88%, snoring: 23.20%, sleepwalking/talking 27.72%). The prevalence rate of sleep initiation problems was even higher (trouble sleeping: 40.61%). Our results suggest that antenatal and early-life factors, e.g. maternal smoking, anxiety, sleep problems in childhood, attention deficit hyperactivity disorder (ADHD) symptoms, and poor health are significant predictors of adolescence sleep problems.

CONCLUSIONS

This study demonstrates the predictive role of prenatal and early life risk factors in adolescence sleep problems. It seems that exposure to prenatal and early life risk factors increase the vulnerability for sleep problems later in life, which is further supported by poor health and lifestyle choices in adolescence. Therefore, close observation and mitigation of factors associated with early life risk factors could be a potential strategy for preventing sleep problems later in life.

Enduring effects of perinatal nicotine exposure on murine sleep in adulthood

The long-term consequences of early life nicotine exposure are poorly defined. Approximately 8-10% of women report smoking during pregnancy, and this may promote aberrant development in the offspring. To this end, we investigated potential enduring effects of perinatal nicotine exposure on murine sleep and affective behaviors in adulthood (~13-15 wk of age) in C57Bl6j mice. Mothers received a water bottle containing 200 µg/ml nicotine bitartrate dihydrate in 2% wt/vol saccharin or pH-matched 2% saccharin with 0.2% (vol/vol) tartaric acid throughout pregnancy and before weaning. Upon reaching adulthood, offspring were tested in the open field and elevated plus maze, as well as the forced swim and sucrose anhedonia tests. Nicotine-exposed male (but not female) mice had reduced mobility in the open field, but no differences were observed in anxiety-like or depressive-like responses. Upon observing this male-specific phenotype, we further assessed sleep-wake states via wireless EEG/EMG telemetry. Following baseline recording, we assessed whether mice exposed to nicotine altered their homeostatic response to 5 h of total sleep deprivation and whether nicotine influenced responses to a powerful somnogen [i.e., lipopolysaccharides (LPS)]. Males exposed to perinatal nicotine decreased the percent time spent awake and increased time in non-rapid eye movement (NREM) sleep, without changes to REM sleep. Nicotine-exposed males also displayed exaggerated responses (increased time asleep and NREM spectral power) to sleep deprivation. Nicotine-exposed animals additionally had blunted EEG slow-wave responses to LPS administration. Together, our data suggest that perinatal nicotine exposure has long-lasting effects on normal sleep and homeostatic sleep processes into adulthood.

Poor actigraphic and self-reported sleep patterns predict delinquency and daytime impairment among at-risk adolescents

OBJECTIVE

To evaluate associations between actigraphic sleep patterns, subjective sleep quality, and daytime functioning (ie, sleepiness, symptoms of depression, and delinquency and other conduct problems) in at-risk adolescents.

DESIGN

Prospective, observational cohort study.

SETTING

Providence, RI, predominantly home and school and 2 visits to the Brown Center for the Study of Children at Risk.

PARTICIPANTS

A diverse group of low-income 13-year-olds (n = 49) with and without prenatal drug exposure.

INTERVENTIONS

None.

MEASUREMENTS

Actigraphy, sleep diaries, and sleep and health questionnaires.

RESULTS

Above and beyond the effects of prenatal drug exposure and postnatal adversity, actigraphic daytime sleep was a significant predictor of daytime sleepiness and delinquency. Subjective sleep quality was a significant predictor of daytime sleepiness, delinquency, and depressive symptoms. Later bed times predicted increased delinquency.

CONCLUSIONS

There was a unique effect of actigraphic daytime sleep duration, subjective nighttime sleep quality, and bedtime on daytime functioning (ie, sleepiness, symptoms of depression, and delinquency and other conduct problems) of at-risk adolescents. In these vulnerable youth, these problematic sleep patterns may contribute to feeling and behaving poorly. Intervention studies with at-risk teens should be conducted to further explore the role of these sleep parameters on daytime functioning.

Physical, behavioral, and cognitive effects of prenatal tobacco and postnatal secondhand smoke exposure

The purpose of this review is to examine the rapidly expanding literature regarding the effects of prenatal tobacco and postnatal secondhand smoke (SHS) exposure on child health and development. Mechanisms of SHS exposure are reviewed, including critical periods during which exposure to tobacco products appears to be particularly harmful to the developing fetus and child. The biological, biochemical, and neurologic effects of the small fraction of identified components of SHS are described. Research describing these adverse effects of both in utero and childhood exposure is reviewed, including findings from both animal models and humans. The following adverse physical outcomes are discussed: sudden infant death syndrome, low birth weight, decreased head circumference, respiratory infections, otitis media, asthma, childhood cancer, hearing loss, dental caries, and the metabolic syndrome. In addition, the association between the following adverse cognitive and behavioral outcomes and such exposures is described: conduct disorder, attention-deficit/hyperactivity disorder, poor academic achievement, and cognitive impairment. The evidence supporting the adverse effects of SHS exposure is extensive yet rapidly expanding due to improving technology and increased awareness of this profound public health problem. The growing use of alternative tobacco products, such as hookahs (a.k.a. waterpipes), and the scant literature on possible effects from prenatal and secondhand smoke exposure from these products are also discussed. A review of the current knowledge of this important subject has implications for future research as well as public policy and clinical practice.

Housing and child health

The connection between housing and health is well established. Physical, chemical, and biological aspects of the child's home, such as cleanliness, moisture, pests, noise, accessibility, injury risks, and other forms of housing environmental quality, all have the potential to influence multiple aspects of the health and development of children. Basic sanitation, reduced household crowding, other improvements in housing and expanded, and improved housing regulations have led to advances in children's health. For example, lead poisoning prevention policies have profoundly reduced childhood lead exposure in the United States. This and many other successes highlight the health benefits for families, particularly children, by targeting interventions that reduce or eliminate harmful exposures in the home. Additionally, parental mental health problems, food insecurity, domestic violence, and the presence of guns in children's homes all are largely experienced by children in their homes, which are not as yet considered part of the Healthy Homes agenda. There is a large movement and now a regulatory structure being put in place for healthy housing, which is becoming closely wedded with environmental health, public health, and the practice of pediatrics. The importance of homes in children's lives, history of healthy homes, asthma, and exposures to lead, carbon monoxide, secondhand/thirdhand smoke, radon, allergy triggers is discussed, as well as how changes in ambient temperature, increased humidity, poor ventilation, water quality, infectious diseases, housing structure, guns, electronic media, family structure, and domestic violence all affect children's health.

Influence of Site Differences between Urban and Rural American and Central European Opioid-Dependent Pregnant Women and Neonatal Outcome Characteristics

BACKGROUND

Multi-center trials enable the recruitment of larger study samples, although results might be influenced by site-specific factors.

METHODS

Site differences of a multi-center prospective double-blind, double-dummy randomized controlled trial (7 centers: Central Europe (Vienna)/USA (3 urban/3 rural centers)) comparing safety and efficacy of methadone and buprenorphine in pregnant opioid-dependent women and their neonates.

RESULTS

Urban US women had the highest rate of concomitant opioid (p = 0.050) and cocaine consumption (p = 0.003), the highest dropout rate (p = 0.001), and received the lowest voucher sums (p = 0.001). Viennese neonates had significantly higher Apgar scores 1 min (p = 0.001) and 5 min after birth (p < 0.001) and were more often born by cesarean section (p = 0.024). Rural US newborns had a significantly shorter neonatal abstinence syndrome treatment duration compared to Viennese and urban US sites (p = 0.006), in addition to other site-specific differences, suggesting a more severely affected group of women in the urban US sites.

CONCLUSION

This clinical trial represents a role model for pharmacological treatment in this unique sample of pregnant women and demonstrates the clinical importance of considering site-specific factors in research and clinical practice.

Lasting impacts of prenatal cannabis exposure and the role of endogenous cannabinoids in the developing brain

Cannabis is the most commonly used illicit substance among pregnant women. Human epidemiological and animal studies have found that prenatal cannabis exposure influences brain development and can have long-lasting impacts on cognitive functions. Exploration of the therapeutic potential of cannabis-based medicines and synthetic cannabinoid compounds has given us much insight into the physiological roles of endogenous ligands (endocannabinoids) and their receptors. In this article, we examine human longitudinal cohort studies that document the long-term influence of prenatal exposure to cannabis, followed by an overview of the molecular composition of the endocannabinoid system and the temporal and spatial changes in their expression during brain development. How endocannabinoid signaling modulates fundamental developmental processes such as cell proliferation, neurogenesis, migration and axonal pathfinding are also summarized.