Methamphetamine and other substance use during pregnancy: preliminary estimates from the Infant Development, Environment, and Lifestyle (IDEAL) study

Prenatal methamphetamine use increases risk of adverse maternal and neonatal outcomes

BACKGROUND

Although methamphetamine use has been increasing in recent years and occurring within new populations and in broader geographical areas, there is limited research on its use and effect in pregnancy.

OBJECTIVE

This study aimed to examine the association between prenatal methamphetamine use and maternal and neonatal outcomes in a large, contemporary birth cohort.

STUDY DESIGN

This was a retrospective cohort study using California-linked vital statistics and hospital discharge data from 2008 to 2019. Methamphetamine use was identified using the International Classification of Disease, Ninth Revision and Tenth Revision, codes. Chi-square tests and multivariable Poisson regression models were used to evaluate the associations between methamphetamine use and maternal and neonatal outcomes.

RESULTS

A total of 4,775,463 pregnancies met the inclusion criteria, of which 18,473 (0.39%) had methamphetamine use. Compared with individuals without methamphetamine use, individuals with methamphetamine use had an increased risk of nonsevere hypertensive disorders (adjusted risk ratio, 1.81; 95% confidence interval, 1.71-1.90), preeclampsia with severe features (adjusted risk ratio, 3.38; 95% confidence interval, 3.14-3.63), placental abruption (adjusted risk ratio, 3.77; 95% confidence interval, 3.51-4.05), cardiovascular morbidity (adjusted risk ratio, 4.30; 95% confidence interval, 3.79-4.88), and severe maternal morbidity (adjusted risk ratio, 3.53; 95% confidence interval, 3.29-3.77). In addition, adverse neonatal outcomes were increased, including preterm birth at <37 weeks of gestation (adjusted risk ratio, 2.85; 95% confidence interval, 2.77-2.94), neonatal intensive care unit admission (adjusted risk ratio, 2.46; 95% confidence interval, 2.39-2.53), and infant death (adjusted risk ratio, 2.73; 95% confidence interval, 2.35-3.16).

CONCLUSION

Methamphetamine use in pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes that persists after adjustment for confounding variables and sociodemographic factors. Our results can inform prenatal and postpartum care for this high-risk, socioeconomically vulnerable population.

Trans-generational effects of parental exposure to drugs of abuse on offspring memory functions

Recent evidence reported that parental-derived phenotypes can be passed on to the next generations. Within the inheritance of epigenetic characteristics allowing the transmission of information related to the ancestral environment to the offspring, the specific case of the trans-generational effects of parental drug addiction has been extensively studied. Drug addiction is a chronic disorder resulting from complex interactions among environmental, genetic, and drug-related factors. Repeated exposures to drugs induce epigenetic changes in the reward circuitry that in turn mediate enduring changes in brain function. Addictive drugs can exert their effects trans-generally and influence the offspring of addicted parents. Although there is growing evidence that shows a wide range of behavioral, physiological, and molecular phenotypes in inter-, multi-, and trans-generational studies, transmitted phenotypes often vary widely even within similar protocols. Given the breadth of literature findings, in the present review, we restricted our investigation to learning and memory performances, as examples of the offspring's complex behavioral outcomes following parental exposure to drugs of abuse, including morphine, cocaine, cannabinoids, nicotine, heroin, and alcohol.

Maternal inulin supplementation ameliorates prenatal methamphetamine exposure-induced hepatotoxicity and restores gut microbiota in mouse offspring

Prenatal exposure to methamphetamine (METH) is an issue of global concern due to its adverse effects on offspring, particularly its impact on liver health, an area still not fully understood. Inulin, a recognized prebiotic, is thought to potentially ameliorate these developmental disorders and toxic injuries in progeny. To investigate the effects of prenatal METH exposure on the liver and the role of gut microbiota, we established a murine model, the subjects of which were exposed to METH prenatally and subsequently treated with inulin. Our findings indicate that prenatal METH exposure causes liver damage in offspring, as evidenced by a decreased liver index, histopathological changes, diminished glycogen synthesis, hepatic dysfunction, and alterations in mRNA profiles. Furthermore, it impairs the antioxidant system and induces oxidative stress, possibly due to changes in cecal microbiota and dysregulation of bile acid homeostasis. However, maternal inulin supplementation appears to restore the gut microbiota in offspring and mitigate the hepatotoxic effects induced by prenatal METH exposure. Our study provides definitive evidence of METH's transgenerational hepatotoxicity and suggests that maternal inulin supplementation could be an effective preventive strategy.

Maternal use of methamphetamine alters cardiovascular function in the adult offspring

Methamphetamine is one of the most commonly used illicit drugs during pregnancy. Most studies investigating the impact of maternal use of methamphetamine on children have focused on neurological outcomes. In contrast, cardiovascular outcomes in these children have not been characterized. Recent studies in rodents provide evidence that prenatal exposure to methamphetamine induces changes in cardiac gene expression, changes in the heart's susceptibility to ischemic injury, and changes in vascular function that may increase the risk of developing cardiovascular disorders later in life. Importantly, these changes are sex-dependent. This review summarizes our current understanding of how methamphetamine use during pregnancy impacts the cardiovascular function of adult offspring and highlights gaps in our knowledge of the potential cardiovascular risks associated with prenatal exposure to methamphetamine.

Maternal use of methamphetamine induces sex-dependent changes in myocardial gene expression in adult offspring

Methamphetamine is a commonly abused illicit stimulant that has prevalent use among women of child-bearing age. While there are extensive studies on the neurological effects of prenatal methamphetamine exposure, relatively little is known about the effect of prenatal methamphetamine on the adult cardiovascular system. Earlier work demonstrated that prenatal methamphetamine exposure sex dependently (females only) sensitizes the adult heart to ischemic injury. These data suggest that prenatal exposure to methamphetamine may induce sex-dependent changes in cardiac gene expression that persist in adult offspring. The goal of this study was to test the hypothesis that prenatal methamphetamine exposure induces changes in cardiac gene expression that persist in the adult heart. Hearts of prenatally exposed female offspring exhibited a greater number of changes in gene expression compared to male offspring (184 changes compared with 74 in male offspring and 89 changes common between both sexes). Dimethylarginine dimethylaminohydrolase 2 and 3-hydroxybutyrate dehydrogenase 1 (genes implicated in heart failure) were shown by Western Blot to be under expressed in adult females that were prenatally exposed to methamphetamine, while males were deficient in 3-Hydroxybutyrate Dehydrogenase 1 only. These data indicate that prenatal methamphetamine exposure induces changes in gene expression that persist into adulthood. This is consistent with previous findings that prenatal methamphetamine sex dependently sensitizes the adult heart to ischemic injury and may increase the risk of developing cardiac disorders during adulthood.

Methamphetamine use during the first or second half of pregnancy worsens cardiac ischemic injury in adult female offspring

There is growing evidence that methamphetamine use during pregnancy may produce detrimental cardiovascular effects in the adult offspring. Prior work demonstrated that chronic methamphetamine exposure throughout the gestational period causes adult female offspring to become hypersensitive to myocardial ischemic injury. The goal of the present study was to determine whether this methamphetamine-induced effect occurs early or late in the gestational period. Pregnant female rats were divided into 4 experimental groups. Groups 1 and 2 received subcutaneous injections of saline (group 1) or methamphetamine (5 mg/kg) (group 2) throughout the gestational period. Group 3 received methamphetamine injections on days 1-11 and saline on days 12-22, and group 4 received saline on days 1-11 and methamphetamine on days 12-22. Hearts were isolated from adult (8 weeks) female offspring and subjected to 30 min ischemia and 2 hours reperfusion on a Langendorff isolated heart apparatus. Contractile function was measured via an intraventricular balloon, and infarct size was measured by triphenyltetrazolium chloride staining. Infarcts were significantly larger in methamphetamine exposed offspring regardless of whether they had been exposed to methamphetamine during the first half or the second half of the gestational period. Prenatal exposure to methamphetamine had no effect on preischemic contractile function or postischemic recovery of contractile function. These data indicate that methamphetamine use during either the first half or second half of pregnancy increases susceptibility to myocardial infarction in adult female offspring. These data provide further evidence that prenatal exposure to methamphetamine may increase the risk of developing cardiovascular diseases during adulthood.

Rates of substance and polysubstance use through universal maternal testing at the time of delivery

OBJECTIVE

To report substance and polysubstance use at the time of delivery.

STUDY DESIGN

A cross-sectional study was performed on mothers consented for universal drug testing (99%) during hospital admission at six delivery hospitals in Cincinnati, Ohio. Mass spectrometry urinalysis detected positivity rates of 46 substances. Rates of positive drug tests for individual and common co-occurring substances measured were reported.

RESULTS

2531 maternal samples were tested (88%) and 33% contained cotinine, 11.3% THC, 7.2% opioids, 3.8% cocaine, and 1.9% methamphetamines. Polysubstance use prevalence was as high as 15%. Among mothers testing positive for methadone or buprenorphine, 93% also tested positive for cotinine and 39% tested positive for a third substance in addition to cotinine.

CONCLUSIONS

Substance use at delivery is more prevalent than previously reported. Many mothers testing positive for opioids also test positive for other substances, which may increase overdose risk and exacerbate neonatal opioid withdrawal syndrome (NOWS).

Prenatal Exposure to Methamphetamine Causes Vascular Dysfunction in Adult Male Rat Offspring

Methamphetamine use during pregnancy can have negative consequences on the offspring. However, most studies investigating the impact of prenatal exposure to methamphetamine have focused on behavioral and neurological outcomes. Relatively little is known regarding the impact of prenatal methamphetamine on the adult cardiovascular system. This study investigated the impact of chronic fetal exposure to methamphetamine on vascular function in adult offspring. Pregnant female rats received daily saline or methamphetamine (5 mg/kg) injections starting on gestational day 1 and continuing until the pups were born. Vascular function was assessed in 5 month old offspring. Prenatal methamphetamine significantly decreased both the efficacy and potency of acetylcholine-induced relaxation in isolated male (but not female) aortas when perivascular adipose tissue (PVAT) remained intact. However, prenatal methamphetamine had no impact on acetylcholine-induced relaxation when PVAT was removed. Nitroprusside-induced relaxation of the aorta was unaffected by prenatal methamphetamine. Angiotensin II-induced contractile responses were significantly potentiated in male (but not female) aortas regardless of the presence of PVAT. This effect was reversed by L-nitro arginine methyl ester (L-NAME). Serotonin- and phenylephrine-induced contraction were unaffected by prenatal methamphetamine. Prenatal methamphetamine had no impact on acetylcholine-induced relaxation of third order mesenteric arteries and no effect on basal blood pressure. These data provide evidence that prenatal exposure to methamphetamine sex-dependently alters vasomotor function in the vasculature and may increase the risk of developing vascular disorders later in adult life.

Prenatal Nicotine or Cannabis Exposure and Offspring Neurobehavioral Outcomes

OBJECTIVE

To study the association between nicotine or cannabis metabolite presence in maternal urine and child neurodevelopmental outcomes.

METHODS

We conducted a secondary analysis of two parallel multicenter randomized controlled trials of treatment for hypothyroxinemia or subclinical hypothyroidism among pregnant individuals enrolled at 8-20 weeks of gestation. All maternal-child dyads with a maternal urine sample at enrollment and child neurodevelopmental testing were included (N=1,197). Exposure was urine samples positive for nicotine (cotinine) or cannabis 11-nor-9-carboxy-delta-9-tetrahydrocannabinol [THC-COOH]) or both metabolites. Primary outcome was child IQ at 60 months. Secondary outcomes included cognitive, motor and language, attention, behavioral and social competency, and differential skills assessments at 12, 24, 36, and 48 months. Quantile regression analysis was performed with confounder adjustment.

RESULTS

Of 1,197 pregnant individuals, 99 (8.3%) had positive cotinine samples and 47 (3.9%) had positive THC-COOH samples; 33 (2.8%) were positive for both. Groups differed in self-reported race and ethnicity, education, marital status, insurance, and thyroid status. Median IQ was similar between cotinine-exposed and -unexposed children (90 vs 95, adjusted difference in medians -2.47, 95% CI -6.22 to 1.29) and THC-COOH-exposed and -unexposed children (89 vs 95, adjusted difference in medians -1.35, 95% CI -7.76 to 5.05). In secondary outcome analysis, children with THC-COOH exposure compared with those unexposed had higher attention scores at 48 months of age (57 vs 49, adjusted difference in medians 6.0, 95% CI 1.11-10.89).

CONCLUSIONS

Neither prenatal nicotine nor cannabis exposure was associated with a difference in IQ. Cannabis exposure was associated with worse attention scores in early childhood. Longitudinal studies assessing associations between child neurodevelopmental outcomes and prenatal nicotine and cannabis exposure with a focus on timing and quantity of exposure are needed.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT00388297.

Factors associated with drug use during pregnancy and breastfeeding among females who use drugs (FWUDs) in Malaysia

Females who use drugs (FWUDs) are at risk of continuing illicit substance use during pregnancy and breastfeeding. We investigated the prevalence rates and factors associated with these practices in a sample of 200 FWUDs recruited from a publicly-run drug rehabilitation center. A semi-structured questionnaire was used to collect the data. The majority (86%) was Malay (n = 171/200), currently single (71%, n = 141/200), and 51% had nine years of education. The mean age of respondents was 32.2 years (SD = 8.61). Thirty-eight percent (n = 75/200) reported ever using illicit substances during pregnancy, while 15% (n = 30/200) had used them during breastfeeding. Higher odds of using drugs during pregnancy were associated with having an intimate male drug-using partner and with persons who reported abandoning an infant in the past. Lower odds were linked with women who used heroin with ATS (relative to those who used only ATS), and shorter-term ATS (≤3 years) relative to long term ATS users. At a lower level of significance (p = 0.054), being married also lowered the odds. Higher odds of drug use during breastfeeding were associated with having an intimate male drug-using partner, and previous methadone use history, while lower odds were associated with short-term ATS use and being employed. The findings highlight the need for timely and targeted interventions to inform, engage and promote the participation of FWUDs in pre- and post-natal care services.

Acute psychiatric illness and drug addiction during pregnancy and the puerperium

Pregnancy and the puerperium do not protect against acute psychiatric illness. During puerperium, the chance of acute psychiatric illness, such as a psychotic episode or relapse of bipolar disorder, is greatly increased. Suicide is a leading cause of maternal death. Both psychiatric disease and ongoing drug addiction impact not only the pregnant woman's somatic and mental health but also impact short-term and long-term health of the child. Indeed, prompt recognition and expeditious treatment of acute psychiatric illness during pregnancy and the puerperium optimize health outcomes for two patients. Pregnancy and puerperium represent a stage of life of great physiologic adaptations, as well as emotional and social changes. This conjunction of changes in somatic, emotional health and social health may mitigate the occurrence, clinical presentation, and clinical course of acute psychiatric illness and call for a multidisciplinary approach, taking into account both the medical and social domains. This chapter describes acute psychiatric illnesses during pregnancy and the puerperium and illicit substance abuse, from a clinical perspective, while also describing general principles of diagnosis and clinical management during this stage of life, which is an important window of opportunity for both the pregnant woman and the child.

Prenatal Methamphetamine Exposure: Effects on Child Development–A Systematic Review

BACKGROUND

In Germany, the 12-month prevalence of methamphetamine use among persons aged 15 to 34 is 1.9%. An increasing number of newborns are being born after a prenatal methamphetamine exposure (PME). In 2014, in the German state of Saxony, approximately four out of 1000 newborns were affected.

METHODS

This systematic review (Prospero registration number CRD42017060536) includes publications that were published between January 1990 and November 2019. The purpose was to determine the effects of PME on the peri- and neonatal condition of the affected children and on their further long-term development. Observational studies with a control group were included in the review and examined for their methodological quality.

RESULTS

31 publications, which dealt with two prospective and six retrospective cohort studies, were included in the review. The studies involved a total of 4446 mother-child pairs with PME, compared with 43 778 pairs without PME. A metaanalysis revealed that PME was associated with, among other findings, lower birth weight (SMD = -0.348; 95% confidence interval [-0.777; 0.081]), shorter body length (SMD= -0.198 [-0.348; -0.047]), and smaller head circumference (SMD= -0.479 [-1.047; 0.089]). Some differences between the groups with and without PME persist into the toddler years. Moreover, children with PME much more commonly display psychological and neurocognitive abnormalities, which are more severe in children growing up in problematic surroundings (discord, violence, poverty, low educational level of the parent or caregiver). A limitation of this review is that not all studies employed an objective or quantitative measure of methamphet - amine use.

CONCLUSION

The documented effects of PME on child development necessitate early treatment of the affected expectant mothers, children, and families. Emphasis should be placed on structured and interdisciplinary preventive measures for methamphetamine use.

Evidence for the Effectiveness and Acceptability of e-SBI or e-SBIRT in the Management of Alcohol and Illicit Substance Use in Pregnant and Post-partum Women

Alcohol and illicit psychoactive drug use during pregnancy have increased worldwide, putting women and their children's health and development at risk. Multiple drug use, comorbid psychiatric disorders, sexual and physical abuse are common in women who use alcohol and drugs during pregnancy. The effects on the mother include poor reproductive and life-long health, legal, family, and social problems. Additionally, the exposed child is at increased risk of long-term physical health, mental health, and developmental problems. The stigma associated with substance use during pregnancy and some clinicians' reticence to inquire about substance use means many women are not receiving adequate prenatal, substance abuse, and mental health care. Evidence for mHealth apps to provide health care for pregnant and post-partum women reveal the usability and effectiveness of these apps to reduce gestational weight gain, improve nutrition, promote smoking cessation and manage gestational diabetes mellitus, and treat depression and anxiety. Emerging evidence suggests mHealth technology using a public health approach of electronic screening, brief intervention, or referral to treatment (e-SBIRT) for substance use or abuse can overcome the typical barriers preventing women from receiving treatment for alcohol and drug use during pregnancy. This brief intervention delivered through a mobile device may be equally effective as SBIRT delivered by a health care professional in preventing maternal drug use, minimizing the effects to the exposed child, and providing a pathway to therapeutic options for a substance use disorder. However, larger studies in more diverse settings with women who have co-morbid mental illness and a constellation of social risk factors that are frequently associated with substance use disorders are needed.

Does Prenatal Exposure to CNS Stimulants Increase the Risk of Cardiovascular Disease in Adult Offspring?

Prenatal exposure to an adverse uterine environment can have long lasting effects on adult offspring through DNA methylation, histone acetylation, and other epigenetic effects that alter gene expression and physiology. It is well-known that consumption of CNS stimulants such as caffeine, nicotine, amphetamines, and cocaine during pregnancy can adversely impact the offspring. However, most work in this area has focused on neurological and behavioral outcomes and has been limited to assessments in young offspring. The impact of prenatal exposure to these agents on the adult cardiovascular system has received relatively little attention. Evidence from both animal and human studies indicate that exposure to CNS stimulants during the gestational period can negatively impact the adult heart and vasculature, potentially leading to cardiovascular diseases later in life. This review discusses our current understanding of the impact of prenatal exposure to cocaine, methamphetamine, nicotine, and caffeine on the adult cardiovascular system.

Prenatal Methamphetamine Exposure and Adverse Neonatal Outcomes: A Nationwide Cohort Study

BACKGROUND

There is limited knowledge on the adverse outcomes in newborns after maternal methamphetamine (MA) use during pregnancy.

OBJECTIVES

To compare neonatal outcomes in newborns exposed to MA with the newborns of opioid-exposed mothers and of mothers from the general population (GP).

METHOD

A cohort study using nationwide registries in Czechia (2000-2014). Women hospitalized with a main diagnosis of MA use disorder during pregnancy (n = 258) and their newborns were defined as MA-exposed. The comparison groups consisted of women (n = 199) diagnosed with opioid use disorder during pregnancy, defined as opioid-exposed, and women (n = 1,511,310) with no substance use disorder diagnosis (GP). The neonatal outcomes studied were growth parameters, gestational age, preterm birth, and Apgar score. To explore the associations between MA exposure and neonatal outcomes, regression coefficients (b) and odds ratios from multivariable linear and binary logistic regression were estimated.

RESULTS

MA-exposed women had similar socio-economic characteristics to opioid-exposed, both of which were worse than in the GP. After adjustment, MA exposure was associated with a more favourable birthweight when compared to the opioid-exposed (adjusted mean differences [aMD] b = 122.3 g, 95% CI: 26.0-218.5) and length (aMD b = 0.6 cm, 0.0-1.1). Unadjusted results from the comparison with the GP showed that the MA group had poorer neonatal outcomes, especially in the growth parameters. Adjustment for background characteristics had a profound effect on the comparison with the GP. After adjustment, MA exposure was associated only with a slightly reduced birthweight (aMD b = -63.0 g, -123.0 to -3.1) and birth length (aMD b = -0.3 cm, -0.6 to 0.0).

CONCLUSIONS

Although the observed negative outcomes were large in the MA-exposed newborns, the adjustment had a profound effect on the comparison with the GP, indicating the large influence of lifestyle and socio-economic factors in these high-risk pregnancies. MA-exposed newborns had better neonatal outcomes compared to opioids-exposed.

Prevalence of Illicit Drug Use During Pregnancy: A Global Perspective

The World Drug Report 2019 presented an alarming figure to the world: more than 5% of the world's population has been using some type of illicit drug, and that number is growing every year. While its use increases, its abuse during pregnancy has become a global public health problem, resulting in medical and social challenges related to maternal and child health. In this context, the objective of this review was to determine the prevalence of illicit drug use during gestation across the globe, alongside with a critical review of the evaluated studies. Research was performed by simultaneously searching terms ("pregnant woman OR pregnant" OR "gestation" OR "pregnancy" AND "illicit drugs" OR "street drugs") in the databases of the Scientific Electronic Library Online, PubMed, and Web of Science. Comparisons between studies were performed in software Statistica 10.0. The data presented worrying results in relation to the variation in prevalence of illicit drug use during pregnancy, when comparing studies based on interviews or questionnaires (self-reported) (1.65%) and studies based on toxicological analysis (12.28%). In addition, we emphasize the high prevalence (5.16%) of illicit drug use among adolescent pregnant women and the low number of studies on this population. This study reveals worrying data about pregnant drug-user population, mainly the underestimation of prevalence in studies that use only questionnaires or similar methods in comparison to studies that use toxicological analysis of biological matrices. This scenario reveals necessity for health systems in different countries to establish specific public health policies for this population.

Reduced fractional anisotropy in projection, association, and commissural fiber networks in neonates with prenatal methamphetamine exposure

Prenatal exposure to methamphetamine is associated with neurostructural changes, including alterations in white matter microstructure. This study investigated the effects of methamphetamine exposure on microstructure of global white matter networks in neonates. Pregnant women were interviewed beginning in mid-pregnancy regarding their methamphetamine use. Diffusion weighted imaging sets were acquired for 23 non-sedated neonates. White matter bundles associated with pairs of target regions within five networks (commissural fibers, left and right projection fibers, and left and right association fibers) were estimated using probabilistic tractography, and fractional anisotropy (FA) and diffusion measures determined within each connection. Multiple regression analyses showed that increasing methamphetamine exposure was significantly associated with reduced FA in all five networks, after control for potential confounders. Increased exposure was associated with lower axial diffusivity in the right association fiber network and with increased radial diffusivity in the right projection and left and right association fiber networks. Within the projection and association networks a subset of individual connections showed a negative correlation between FA and methamphetamine exposure. These findings are consistent with previous reports in older children and demonstrate that microstructural changes associated with methamphetamine exposure are already detectable in neonates.

Teratogen update: Amphetamines

Amphetamines are synthetic noncatecholamine sympathomimetic amines that act as psychostimulants. They have been prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD), narcolepsy, and additional health conditions. Amphetamines are also drugs of abuse. Some experimental animal studies suggested adverse developmental effects of amphetamines, including structural malformations. These effects were most often observed in experimental animals at higher dose levels than those used for treatment or abuse and at dose levels that produce maternal toxicity. Controlled studies of amphetamine use for the treatment of ADHD and other indications did not suggest that amphetamines are likely to cause structural malformations, although there are three studies associating medication for ADHD or methamphetamine abuse with gastroschisis. We did not locate studies on the neurobehavioral effects of prenatal exposures to therapeutic amphetamine use. Amphetamine abuse was associated with offspring neurobehavioral abnormalities, but lack of adequate adjustment for confounding interferes with interpretation of the associations. Adverse effects of methamphetamine abuse during pregnancy may be due to factors associated with drug abuse rather than methamphetamine itself. The adverse effects observed in methamphetamine abuse studies may not be extrapolatable to amphetamine medication use.

The experiences of pregnant women attending a specialist service and using methamphetamine

BACKGROUND

Pregnant women attending the Specialist Drug and Alcohol Service in Perth use methamphetamine as their primary drug of choice. This is the only tertiary service for pregnant and postnatal women with complex Alcohol and Other Drug Use in Western Australia. It is a midwifery-led multidisciplinary team. Many of the women struggle with addiction, polysubstance use, co-occurring mental health, family and domestic violence, complex trauma and fear of Child Protection and infant removal. Therefore, the aim of this study was to understand the impact of methamphetamine use of pregnant women attending the service and explore and highlight the potential barriers to engagement and follow-up.

METHODS

A qualitative study informed by phenomenological methods was undertaken using semi-structured interviews with 20 women with methamphetamine use attending the service in order to explore and understand the experience of using methamphetamine in pregnancy and the postpartum period. A thematic analysis was undertaken with data from the women in the study (n=20) to identify key themes.

RESULTS

Key themes that emerged from the women's experiences detail their resilience and experience with methamphetamine and the impact that methamphetamine has on their life. A key concern for women regarding methamphetamine use and engagement with specialist services was the welfare of their child(ren). Agencies charged with child protection was a barrier to treatment because women feared disclosure of methamphetamine use would result in loss of child custody. Themes highlighted the multiple layers of adversities, and trauma from childhood to adulthood including, co-occurring drug use, mental health and life histories of trauma (abuse, violence, and neglect; intergenerational trauma; intergenerational drug and alcohol use, and child removal), the omnipresence of methamphetamine, and the impact on pregnancy and mothering.

CONCLUSION

We conclude that understanding the experiences of women and the impact methamphetamine use has on their life is paramount to providing effective and appropriate care to support pregnant women in a trauma-informed and woman-centred approach. Poor engagement in pregnancy care for women with methamphetamine use has significant impacts on mother and infant.

Contextual influences on the perception of pregnant women who use drugs: Information about women's childhood trauma history reduces punitive attitudes

Punitive attitudes and consequences (e.g., incarceration) for prenatal illicit drug use persist in the United States despite evidence that these policies are ineffective and even harmful to women and children. For instance, the threat of these consequences can deter women from seeking healthcare, prenatal care, and drug treatment. Punitive responses may persist due to pejorative public perceptions of pregnant women who use illicit drugs. Although there is evidence that contextual information about prenatal drug use (e.g., drug type) can change such perceptions, other contextual influences are unknown. This experimental study tested whether receiving contextual information about a pregnant woman who uses drugs (specifically, her childhood trauma history) reduces punitive and increases supportive attitudes toward the woman. In a vignette-based 2(pregnancy status: pregnant/not pregnant) x 2(history of childhood trauma: interpersonal/non-interpersonal) between-subjects design, young adult university participants (N = 461) were randomly assigned to read a vignette about a woman who uses methamphetamine. Punitive attitudes were significantly reduced by information that the pregnant woman had a history of childhood trauma, especially interpersonal (versus non-interpersonal) trauma (η_p² = .115). Supportive attitudes were not impacted (η_p² = .005). Information about the pregnant woman's trauma history predicted less agreement with incarcerating her, only indirectly, through less punitive attitudes (R² = .21). Reductions in punitive attitudes were on the order of 1.5-2 points on 5-point self-report scales and controlled for participant gender and political conservatism. Results have practical implications for interdisciplinary work aimed at unlocking greater support for policies that help pregnant women make safe, informed decisions with dignity and access to healthcare.

Epidemiology of perinatal substance use: Exploring trends in maternal substance use

Over the last two decades, the prevalence of substance use among women of childbearing age has risen dramatically in the United States making substance use during pregnancy a significant public health concern. This article offers a general overview of the epidemiology of perinatal substance use focusing primarily on the United States but when available international trends will be presented as well.

Stimulant Use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women

Stimulant use, including cocaine, methamphetamines, ecstasy, and prescription stimulants, in pregnancy is increasingly common. In the United States, stimulants are the second most widely used and abused substances during pregnancy and pregnant women using stimulants in pregnancy are at increased risk of adverse perinatal, neonatal, and childhood outcomes. In this review, we describe the pharmacology, pathophysiology, and epidemiology of stimulants, summarize the maternal and neonatal effects of perinatal stimulant use, and outline treatment options for stimulant use disorders among pregnant women. Development of effective treatment strategies for stimulant use disorders identified among pregnant women are urgently needed.

Investigating Mechanisms of Stillbirth in the Setting of Prenatal Substance Use

Introduction

Intrauterine fetal demise affects between 0.4-0.8% of pregnancies worldwide. This significant adverse pregnancy outcome continues to be poorly understood. In utero exposure to substances increases the risk of stillbirth to varying degrees according to the type of substance and degree of exposure. The aim of this qualitative narrative review is to investigate common biologic relationships between stillbirth and maternal substance use.

Methods

A PubMed literature search was conducted to query the most commonly used substances and biologic mechanisms of stillbirth. Search terms included "stillbirth," "intrauterine fetal demise," "placenta," "cocaine," "tobacco," "alcohol," "methamphetamines," "opioids/ opiates," and "cannabis."

Results

There are very few studies identifying a direct link between substance use and stillbirth. Several studies demonstrate associations with placental lesions of insufficiency including poor invasion, vasoconstriction, and sequestration of toxic substances that inhibit nutrient transport. Restricted fetal growth is the most common finding in pregnancies complicated by all types of substance use.

Discussion

More research is needed to understand the biologic mechanisms of stillbirth. Such knowledge will be foundational to understanding how to prevent and treat the adverse effects of substances during pregnancy.

Prenatal methamphetamine exposure is associated with corticostriatal white matter changes in neonates

Diffusion tensor imaging (DTI) studies have shown that prenatal exposure to methamphetamine is associated with alterations in white matter microstructure, but to date no tractography studies have been performed in neonates. The striato-thalamo-orbitofrontal circuit and its associated limbic-striatal areas, the primary circuit responsible for reinforcement, has been postulated to be dysfunctional in drug addiction. This study investigated potential white matter changes in the striatal-orbitofrontal circuit in neonates with prenatal methamphetamine exposure. Mothers were recruited antenatally and interviewed regarding methamphetamine use during pregnancy, and DTI sequences were acquired in the first postnatal month. Target regions of interest were manually delineated, white matter bundles connecting pairs of targets were determined using probabilistic tractography in AFNI-FATCAT, and fractional anisotropy (FA) and diffusion measures were determined in white matter connections. Regression analysis showed that increasing methamphetamine exposure was associated with reduced FA in several connections between the striatum and midbrain, orbitofrontal cortex, and associated limbic structures, following adjustment for potential confounding variables. Our results are consistent with previous findings in older children and extend them to show that these changes are already evident in neonates. The observed alterations are likely to play a role in the deficits in attention and inhibitory control frequently seen in children with prenatal methamphetamine exposure.

Women on the Edge: Opioids, Benzodiazepines, and the Social Anxieties Surrounding Women's Reproduction in the U.S. "Opioid Epidemic"

The current "opioid epidemic" provides an opportunity to identify age-old social anxieties about drug use while opening up new lines of inquiry about how and why drug use epidemics become gendered. This paper reflects on the intertwined phenomena of opioid and benzodiazepine prescribing to U.S. women to examine how gender, race, and class inform social anxieties about reproduction and parenting. Multiple discourses abound about the relationship between women and the "opioid epidemic." Epidemiological reports attribute premature death among White women to the deadly combination of opioids and antianxiety medications. The National Institute on Drug Abuse reports that "every 25 minutes a baby is born suffering from opioid withdrawal," leading to costly hospital stays for infants and the potential for mother-child separation and other forms of family adjudication postpartum. Primary care providers are reluctant to distinguish diagnoses of chronic noncancer pain from anxiety among their female patients. Taken together, these discourses beg the question: What exactly are we worried about? I compare and contrast the narratives of two anxious women on opioids to raise larger structural questions about pregnancy, parenting, and drug use and to interrogate the public narrative that women on opioids threaten the American family and thwart the American Dream.

Detrimental effects of self-administered methamphetamine during pregnancy on offspring development in the rat

BACKGROUND

Methamphetamine (METH) abuse by pregnant women is a commonly observed phenomenon. While the harmful effects of METH are well described for adults, there is only limited knowledge of the effects of METH use during pregnancy on the developing child. In the present study, we investigated how intraveneous (iv) METH self-administration throughout pregnancy affected rat dams and their offspring through weaning, compared to controls.

METHODS

Female rats (n=16) were trained to self-administer METH iv; every drug infusion by a dam also resulted in a saline injection to a yoked control (n=16). When stable levels of self-administration were reached, all females were mated. Daily, 2-h self-administration sessions continued until litters were born. General health and weight was assessed daily in dams and pups. In addition, pups were evaluated for achievement of age-appropriate developmental milestones (i.e., righting reflex, negative geotaxis, pinna detachment, fur appearance, incisor eruption and eye opening).

RESULTS

Dams self-administered 2-3mg/kg/day METH throughout gestation without consequence to dam health or weight gain during pregnancy. All females produced viable litters, and litter size and composition did not differ between saline and METH dams. Similarly, maternal pup-directed behavior was not affected by prior METH self-administration. However, despite a lack of weight difference in pups, METH-exposed pups were significantly delayed in reaching all assessed developmental milestones compared to controls.

CONCLUSION

These results indicate that in utero exposure to moderate METH doses can profoundly and adversely affect offspring development, suggesting that even recreational METH use during pregnancy has potential for harm.

Patterns of polydrug use among pregnant substance abusers

Aim

Studies of drug use during pregnancy have generally focused on individual substances or specific combinations of drugs. The aim of this article is to increase our knowledge about polydrug use and pregnancy in a Nordic context by describing the sociodemographic characteristics of a clinical population of pregnant women with severe substance use, examining the scope and type of polydrug use and analysing factors associated with concurrent use of many, as opposed to a few, drugs.

Method

A cross-sectional study of pregnant women on admission to compulsory care for substance abuse in Sweden between 2000 and 2009 (n = 119 women, representing 128 pregnancies). Data were retrieved from administrative registers and client records. Univariate links between demographic, social, obstetrical, treatment history variables and polydrug use were examined. Binary logistic regression was used to analyse the association between explanatory variables and polydrug use.

Results

The average number of drugs being used concurrently was 2.65, and injection drug use was recorded in 73% of the pregnancies. Opiates and amphetamines were the most common primary drugs, followed by alcohol. The likelihood of polydrug use increased with first trimester pregnancy, planned (as opposed to emergency) committals, as well as the combination of partner substance abuse and injection drug use.

Conclusions

Polydrug use was widespread among pregnant substance abusers. Policies, interventions and research often focus on individual drugs separately, but for clinical populations in particular there is a need to address drug use broadly, including a systematic recording of smoking habits. This also entails awarding more attention to those not eligible for established interventions, such as opiate maintenance treatment, and giving more consideration to a variety of life circumstances, such as partner drug use.

Choosing to Live or Die: Online Narratives of Recovering from Methamphetamine Abuse

The goal of this study is to explore motivating factors for recovering from methamphetamine abuse. The source of data was 202 anonymous letters and stories submitted to an online support platform for methamphetamine users. Qualitative data were analyzed in Dedoose software using grounded theory methodology. Ten primary motivating factors for recovering from methamphetamine abuse were identified and mapped onto four constructs from the Health Belief Model: (1) perceived susceptibility (learning from others and learning from self); (2) perceived severity (fear of death and declining health); (3) perceived benefits (reconnecting with family, reconnecting with society, and recovering self-esteem); and (4) cues to action (hitting rock bottom, finding God, and becoming pregnant). By using data from an online support group and categorizing emerging themes within a theoretical framework, findings from this study provide a comprehensive understanding of factors involved in recovery from methamphetamine abuse and offer further insights in developing theoretically informed interventions for methamphetamine users. This study suggests the utility of online platforms for obtaining anonymous but unique experiences about drug abuse and recovery. Findings may benefit healthcare professionals, counselors, and researchers by helping to develop theoretically informed interventions for methamphetamine abuse.

Perinatal Illicit Drug and Marijuana Use

PURPOSE

To assess use, screening, and disclosure of perinatal marijuana and other illicit drugs during first obstetric visits.

DESIGN

Observational study that qualitatively assesses provider screening and patient disclosure of substance use.

SETTING

Study sites were five urban outpatient prenatal clinics and practices located in Pittsburgh, Pennsylvania.

PARTICIPANTS

Pregnant patients and obstetric providers were recruited as participants.

METHODS

We audio recorded patient-provider conversations during first obstetric visits and obtained patient urine samples for drug analyses. Audio recordings were reviewed for provider screening and patient disclosure of illicit drug use. Urine analyses were compared with audio recordings to determine disclosure.

RESULTS

Four hundred and twenty-two pregnant patients provided complete audio recordings and urine samples for analyses. Providers asked about illicit drug use in 81% of the visits. One hundred twenty-three patients (29%) disclosed any current or past illicit drug use; 48 patients (11%) disclosed current use of marijuana while pregnant. One hundred and forty-five samples (34%) tested positive for one or more substances; marijuana was most commonly detected (N = 114, 27%). Of patients who tested positive for any substance, 66 (46%) did not disclose any use; only 36% of patients who tested positive for marijuana disclosed current use.

CONCLUSION

Although marijuana is illegal in Pennsylvania, a high proportion of pregnant patients used marijuana, with many not disclosing use to their obstetric care providers.

Refining Measurement of Substance Use Disorders Among Women of Child-Bearing Age Using Hospital Records: The Development of the Explicit-Mention Substance Abuse Need for Treatment in Women (EMSANT-W) Algorithm

Substance use disorder (SUD) in women of reproductive age is associated with adverse health consequences for both women and their offspring. US states need a feasible population-based, case-identification tool to generate better approximations of SUD prevalence, treatment use, and treatment outcomes among women. This article presents the development of the Explicit Mention Substance Abuse Need for Treatment in Women (EMSANT-W), a gender-tailored tool based upon existing International Classification of Diseases, 9th Edition, Clinical Modification diagnostic code-based groupers that can be applied to hospital administrative data. Gender-tailoring entailed the addition of codes related to infants, pregnancy, and prescription drug abuse, as well as the creation of inclusion/exclusion rules based on other conditions present in the diagnostic record. Among 1,728,027 women and associated infants who accessed hospital care from January 1, 2002 to December 31, 2008 in Massachusetts, EMSANT-W identified 103,059 women with probable SUD. EMSANT-W identified 4,116 women who were not identified by the widely used Clinical Classifications Software for Mental Health and Substance Abuse (CCS-MHSA) and did not capture 853 women identified by CCS-MHSA. Content and approach innovations in EMSANT-W address potential limitations of the Clinical Classifications Software, and create a methodologically sound, gender-tailored and feasible population-based tool for identifying women of reproductive age in need of further evaluation for SUD treatment. Rapid changes in health care service infrastructure, delivery systems and policies require tools such as the EMSANT-W that provide more precise identification methods for sub-populations and can serve as the foundation for analyses of treatment use and outcomes.

Prenatal methamphetamine differentially alters myocardial sensitivity to ischemic injury in male and female adult hearts

Methamphetamine is one of the most common illicit drugs abused during pregnancy. The neurological effects of prenatal methamphetamine are well known. However, few studies have investigated the potential effects of prenatal methamphetamine on adult cardiovascular function. Previous work demonstrated that prenatal cocaine exposure increases sensitivity of the adult heart to ischemic injury. Methamphetamine and cocaine have different mechanisms of action, but both drugs exert their effects by increasing dopaminergic and adrenergic receptor stimulation. Thus the goal of this study was to determine whether prenatal methamphetamine also worsens ischemic injury in the adult heart. Pregnant rats were injected with methamphetamine (5 mg·kg(-1)·day(-1)) or saline throughout pregnancy. When pups reached 8 wk of age, their hearts were subjected to ischemia and reperfusion by means of a Langendorff isolated heart system. Prenatal methamphetamine had no significant effect on infarct size, preischemic contractile function, or postischemic recovery of contractile function in male hearts. However, methamphetamine-treated female hearts exhibited significantly larger infarcts and significantly elevated end-diastolic pressure during recovery from ischemia. Methamphetamine significantly reduced protein kinase Cε expression and Akt phosphorylation in female hearts but had no effect on these cardioprotective proteins in male hearts. These data indicate that prenatal methamphetamine differentially affects male and female sensitivity to myocardial ischemic injury and alters cardioprotective signaling proteins in the adult heart.

Examining the relationship between marijuana use, medical marijuana dispensaries, and abusive and neglectful parenting

The current study extends previous research by examining whether and how current marijuana use and the physical availability of marijuana are related to child physical abuse, supervisory neglect, or physical neglect by parents while controlling for child, caregiver, and family characteristics in a general population survey in California. Individual level data on marijuana use and abusive and neglectful parenting were collected during a telephone survey of 3,023 respondents living in 50 mid-size cities in California. Medical marijuana dispensaries and delivery services data were obtained via six websites and official city lists. Data were analyzed using negative binomial and linear mixed effects multilevel models with individuals nested within cities. Current marijuana use was positively related to frequency of child physical abuse and negatively related to physical neglect. There was no relationship between supervisory neglect and marijuana use. Density of medical marijuana dispensaries and delivery services was positively related to frequency of physical abuse. As marijuana use becomes more prevalent, those who work with families, including child welfare workers must screen for how marijuana use may affect a parent's ability to provide for care for their children, particularly related to physical abuse.

Developmental and behavioral consequences of prenatal methamphetamine exposure: A review of the Infant Development, Environment, and Lifestyle (IDEAL) study

This study reviews the findings from the Infant Development, Environment, and Lifestyle (IDEAL) study, a multisite, longitudinal, prospective study designed to determine maternal outcome and child growth and developmental findings following prenatal methamphetamine exposure from birth up to age 7.5 years. These findings are presented in the context of the home environment and caregiver characteristics to determine how the drug and the environment interact to affect the outcome of these children. No neonatal abstinence syndrome requiring pharmacologic intervention was observed but heavy drug exposure was associated with increased stress responses in the neonatal period. Poorer inhibitory control was also observed in heavy methamphetamine exposed children placing them at high risk for impaired executive function. Independent of methamphetamine exposure, children with more responsive home environments to developmental and emotional needs demonstrated lower risks for internalizing and externalizing behavior.

Global patterns of methamphetamine use

PURPOSE OF REVIEW

As the most popular psychostimulant in the world, methamphetamine use has reached epidemic proportions. Its enormous popularity has created subcultures of methamphetamine users all over the globe. The purpose of this review is to describe the geographic availability of different types of methamphetamine, the characteristics of each user population, and the psychosocial impact the two have on society.

RECENT FINDINGS

Methamphetamine has diversified immensely from the early days of its use. Different forms of methamphetamine - ICE, powder, and pills - have different pharmacokinetic characteristics that make them popular among certain types of users. New studies have shown that addiction to methamphetamine results in a very characteristic loss of inhibition that augments various risk-taking behaviors in its users. Also, recent seizure data suggest that its production and trafficking is spreading into new areas of the globe.

SUMMARY

From recreational use to addiction, methamphetamine use represents a serious risk to health and wellbeing of the community. Recognizing the pattern of abuse in specific populations is the key to assessing the risk, implementing prevention, and harm reduction measures, as well as making public policies.

Prevalence of meconium ileus marks the severity of mutations of the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene

RATIONALE

Meconium ileus (MI) is a perinatal complication in cystic fibrosis (CF), which is only minimally influenced by environmental factors. We derived and examined MI prevalence (MIP) scores to assess CFTR phenotype-phenotype correlation for severe mutations.

METHOD

MIP scores were established using a Canadian CF population (n = 2,492) as estimates of the proportion of patients with MI among all patients carrying the same CFTR mutation, focusing on patients with p.F508del as the second allele. Comparisons were made to the registries from the US CF Foundation (n = 43,432), Italy (Veneto/Trentino/Alto Adige regions) (n = 1,788), and Germany (n = 3,596).

RESULTS

The prevalence of MI varied among the different registries (13-21%). MI was predominantly prevalent in patients with pancreatic insufficiency carrying "severe" CFTR mutations. In this severe spectrum MIP scores further distinguished between mutation types, for example, G542X (0.31) with a high, F508del (0.22) with a moderate, and G551D (0.08) with a low MIP score. Higher MIP scores were associated with more severe clinical phenotypes, such as a lower forced expiratory volume in 1 second (P = 0.01) and body mass index z score (P = 0.04).

CONCLUSIONS

MIP scores can be used to rank CFTR mutations according to their clinical severity and provide a means to expand delineation of CF phenotypes.Genet Med 18 4, 333-340.

Prenatal methamphetamine exposure and neonatal and infant neurobehavioral outcome: results from the IDEAL study

BACKGROUND

Methamphetamine (MA) use among pregnant women is an increasing problem in the United States. How MA use during pregnancy affects neonatal and infant neurobehavior is unknown.

METHODS

The Infant Development, Environment, and Lifestyle (IDEAL) study screened 34,833 subjects at 4 clinical centers. Of the subjects, 17,961 were eligible and 3705 were consented, among which 412 were enrolled for longitudinal follow-up. Exposed subjects were identified by self-report and/or gas chromatography/mass spectroscopy (GC/MS) confirmation of amphetamine and metabolites in meconium. Comparison subjects were matched (race, birth weight, maternal education, insurance), denied amphetamine use, and had a negative meconium screen. Both groups included prenatal alcohol, tobacco, and marijuana use, but excluded use of opiates, lysergic acid diethylamide, or phencyclidine. The Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale (NNNS) was administered within the first 5 days of life and again at 1 month to 380 enrollees (185 exposed, 195 comparison). Analysis of variance (ANOVA) tested exposure effects on NNNS summary scores at birth and 1 month. General linear model (GLM) repeated-measures analysis assessed the effect of MA exposure over time on the NNNS scores with and without covariates.

RESULTS

By 1 month of age, both groups demonstrated higher quality of movement (P = .029), less lethargy (P = .001), and fewer asymmetric reflexes (P = .012), with no significant differences in NNNS scores between the exposed and comparison groups. Over the first month of life, arousal increased in exposed infants but decreased in comparison infants (P = .031) and total stress was decreased in exposed infants, with no change in comparison infants (P = .026).

CONCLUSIONS

Improvement in total stress and arousal were observed in MA-exposed newborns by 1 month of age relative to the newborn period.

The role of socioeconomic factors in Black-White disparities in preterm birth

OBJECTIVES

We investigated the role of socioeconomic factors in Black-White disparities in preterm birth (PTB).

METHODS

We used the population-based California Maternal and Infant Health Assessment survey and birth certificate data on 10 400 US-born Black and White California residents who gave birth during 2003 to 2010 to examine rates and relative likelihoods of PTB among Black versus White women, with adjustment for multiple socioeconomic factors and covariables.

RESULTS

Greater socioeconomic advantage was generally associated with lower PTB rates among White but not Black women. There were no significant Black-White disparities within the most socioeconomically disadvantaged subgroups; Black-White disparities were seen only within more advantaged subgroups.

CONCLUSIONS

Socioeconomic factors play an important but complex role in PTB disparities. The absence of Black-White disparities in PTB within certain socioeconomic subgroups, alongside substantial disparities within others, suggests that social factors moderate the disparity. Further research should explore social factors suggested by the literature-including life course socioeconomic experiences and racism-related stress, and the biological pathways through which they operate-as potential contributors to PTB among Black and White women with different levels of social advantage.

Methamphetamines and pregnancy outcomes

INTRODUCTION

Methamphetamine (MA) is one of the most commonly used illicit drugs in pregnancy, yet studies on MA-exposed pregnancy outcomes have been limited because of retrospective measures of drug use; lack of control for confounding factors; other drug use, including tobacco; poverty; poor diet; and lack of prenatal care. This study presents prospective collected data on MA use and birth outcomes, controlling for most confounders.

MATERIALS AND METHODS

This is a retrospective cohort study of women obtaining prenatal care from a clinic treating women with substance use disorders, on whom there are prospectively obtained data on MA and other drug use, including tobacco. Methamphetamine-exposed pregnancies were compared with non-MA exposed pregnancies and non-drug-exposed pregnancies, using univariate and multivariate analysis to control for confounders.

RESULTS

One hundred forty-four infants were exposed to MA during pregnancy, 50 had first trimester exposure only, 45 had continuous use until the second trimester, 29 had continuous use until the third trimester, but were negative at delivery, and 20 had positive toxicology at delivery. There were 107 non-MA-exposed infants and 59 infants with no drug exposure. Mean birth weights were the same for MA-exposed and nonexposed infants (3159 g vs 3168 g; P = 0.9), although smaller than those without any drug exposure (3159 vs 3321; P = 0.04), infants with positive toxicology at birth (meconium or urine) were smaller than infants with first trimester exposure only (2932 g vs 3300 g; P = 0.01). Gestation was significantly shorter among the MA-exposed infants than that among nonexposed infants (38.5 vs 39.1 weeks; P = 0.045), and those with no drug exposure (38.5 vs 39.5; P = 0.0011), the infants with positive toxicology at birth had a clinically relevant shortening of gestation (37.3 weeks vs 39.1; P = 0.0002).

CONCLUSIONS

Methamphetamine use during pregnancy is associated with shorter gestational ages and lower birth weight, especially if used continuously during pregnancy. Stopping MA use at any time during pregnancy improves birth outcomes, thus resources should be directed toward providing treatment and prenatal care.

Developmental consequences of fetal exposure to drugs: what we know and what we still must learn

Most drugs of abuse easily cross the placenta and can affect fetal brain development. In utero exposures to drugs thus can have long-lasting implications for brain structure and function. These effects on the developing nervous system, before homeostatic regulatory mechanisms are properly calibrated, often differ from their effects on mature systems. In this review, we describe current knowledge on how alcohol, nicotine, cocaine, amphetamine, Ecstasy, and opiates (among other drugs) produce alterations in neurodevelopmental trajectory. We focus both on animal models and available clinical and imaging data from cross-sectional and longitudinal human studies. Early studies of fetal exposures focused on classic teratological methods that are insufficient for revealing more subtle effects that are nevertheless very behaviorally relevant. Modern mechanistic approaches have informed us greatly as to how to potentially ameliorate the induced deficits in brain formation and function, but conclude that better delineation of sensitive periods, dose-response relationships, and long-term longitudinal studies assessing future risk of offspring to exhibit learning disabilities, mental health disorders, and limited neural adaptations are crucial to limit the societal impact of these exposures.

Nicotine during pregnancy: changes induced in neurotransmission, which could heighten proclivity to addict and induce maladaptive control of attention

Prenatal exposure to nicotine, occurring either via maternal smoking or via use of transdermal nicotine patches to facilitate cigarette abstinence by pregnant women, is associated with ∼ 13% of pregnancies worldwide. Nicotine exposure during gestation has been correlated with several negative physiological and psychosocial outcomes, including heightened risk for aberrant behaviors involving alterations in processing of attention as well as an enhanced liability for development of drug dependency. Nicotine is a terotogen, altering neuronal development of various neurotransmitter systems, and it is likely these alterations participate in postnatal deficits in attention control and facilitate development of drug addiction. This review discusses the alterations in neuronal development within the brain's major neurotransmitter systems, with special emphasis placed on alterations within the laterodorsal tegmental nucleus, in light of the role this cholinergic nucleus plays in attention and addiction. Changes induced within this nucleus by gestational exposure to nicotine, in combination with changes induced in other brain regions, are likely to contribute to the transgenerational burden imposed by nicotine. Although neuroplastic changes induced by nicotine are not likely to act in isolation, and are expected to interact with epigenetic changes induced by preconception exposure to drugs of abuse, unraveling these changes within the developing brain will facilitate eventual development of targeted treatments for the unique vulnerability for arousal disorders and development of addiction within the population of individuals who have been prenatally exposed to nicotine.