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Czobor NR, Ocsovszky Z, Roth G, Takács S, Csabai M, Székely E, Gál J, Székely A, Konkolÿ Thege B. ADHD symptomatology of children with congenital heart disease 10 years after cardiac surgery: the role of age at operation. BMC Psychiatry 2021; 21:316. [PMID: 34167512 PMCID: PMC8223303 DOI: 10.1186/s12888-021-03324-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the differences in ADHD symptomatology between healthy controls and children who underwent cardiac surgery at different ages. METHODS Altogether, 133 children (54 patients with congenital heart disease undergoing first cardiac surgery under 3 years of age, 26 operated at the age of 3 or later, and 53 healthy controls) were examined. Patients completed the Youth Self Report (YSR), while their parents completed the Child Behaviour Checklist (CBCL) and the ADHD Rating Scale-IV. RESULTS Children receiving surgery for the first time under the age of 3 years were more likely diagnosed with cyanotic type malformation and have undergone to a greater number of operations. However, ADHD symptoms of those treated surgically at or above 3 years of age were more severe than that of the control group or those who were treated surgically at a younger age. The control group and those treated surgically below the age of three did not differ across any of the ADHD symptom severity indicators. CONCLUSIONS The age at the time of cardiac surgery might be associated with later ADHD symptom severity - with lower age at operation associated with better outcomes. Further, adequately powered studies are needed to confirm these exploratory findings and investigate the moderators of this relationship.
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Affiliation(s)
- Nikoletta R. Czobor
- grid.11804.3c0000 0001 0942 9821School of Doctoral Studies, Semmelweis University, Budapest, Hungary ,Department of Anaesthesiology and Intensive Care, Medical Centre of Hungarian Defence Forces, Budapest, Hungary
| | - Zsófia Ocsovszky
- grid.9008.10000 0001 1016 9625Department of Personality, Clinical and Health Psychology, Institute of Psychology, University of Szeged, Szeged, Hungary
| | - György Roth
- grid.11804.3c0000 0001 0942 9821School of Doctoral Studies, Semmelweis University, Budapest, Hungary ,grid.417735.30000 0004 0573 5225Department of Paediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Szabolcs Takács
- grid.445677.30000 0001 2108 6518Institute of Psychology, Károli Gáspár University, Budapest, Hungary
| | - Márta Csabai
- grid.9008.10000 0001 1016 9625Department of Personality, Clinical and Health Psychology, Institute of Psychology, University of Szeged, Szeged, Hungary
| | - Edgár Székely
- grid.11804.3c0000 0001 0942 9821Department of Anaesthesiology and Intensive Care, Semmelweis University, Budapest, Hungary
| | - János Gál
- grid.11804.3c0000 0001 0942 9821Department of Anaesthesiology and Intensive Care, Semmelweis University, Budapest, Hungary
| | - Andrea Székely
- Department of Anaesthesiology and Intensive Care, Semmelweis University, Budapest, Hungary. .,Department of Paediatric Anaesthesiology and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
| | - Barna Konkolÿ Thege
- grid.440060.60000 0004 0459 5734Waypoint Centre for Mental Health Care, Waypoint Research Institute, Penetanguishene, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
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Struthers A, Metge C, Charette C, Enns JE, Nickel NC, Chateau D, Chartier M, Burland E, Katz A, Brownell M. Understanding the Particularities of an Unconditional Prenatal Cash Benefit for Low-Income Women: A Case Study Approach. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019870967. [PMID: 31434525 PMCID: PMC6709438 DOI: 10.1177/0046958019870967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We explored the particularities of the Healthy Baby Prenatal Benefit (HBPB), an
unconditional cash transfer program for low-income pregnant women in Manitoba,
Canada, which aims to connect recipients with prenatal care and community
support programs, and help them access healthy foods during pregnancy. While
previous studies have shown associations between HBPB and improved birth
outcomes, here we focus on how the intervention contributed to
positive outcomes. Using a case study design, we collected data from government
and program documents and interviews with policy makers, academics, program
staff, and recipients of HBPB. Key informants identified using evidence and
aligning with government priorities as key facilitators to the implementation of
HBPB. Program recipients described how HBPB helped them improve their nutrition,
prepare for baby, and engage in self-care to moderate the effect of stressful
life events. This study provides important contextualized evidence to support
government decision making on healthy child development policies.
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Affiliation(s)
- Ashley Struthers
- 1 George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Colleen Metge
- 2 Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Catherine Charette
- 1 George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada.,2 Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jennifer E Enns
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nathan C Nickel
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Elaine Burland
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marni Brownell
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Micalizzi L, Knopik VS. Maternal smoking during pregnancy and offspring executive function: What do we know and what are the next steps? Dev Psychopathol 2018; 30:1333-1354. [PMID: 29144227 PMCID: PMC6028309 DOI: 10.1017/s0954579417001687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Children exposed to maternal smoking during pregnancy (MSDP) exhibit difficulties in executive function (EF) from infancy through adolescence. Due to the developmental significance of EF as a predictor of adaptive functioning throughout the life span, the MSDP-EF relation has clear public health implications. In this paper, we provide a comprehensive review of the literature on the relationship between MSDP and offspring EF across development; consider brain-based assessments, animal models, and genetically informed studies in an effort to elucidate plausible pathways of effects; discuss implications for prevention and intervention; and make calls to action for future research.
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Affiliation(s)
- Lauren Micalizzi
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital
- Department of Psychiatry and Human Behavior, The Warren Alpert School of Medicine, Brown University
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University
| | - Valerie S. Knopik
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital
- Department of Psychiatry and Human Behavior, The Warren Alpert School of Medicine, Brown University
- Department of Human Development and Family Studies, Purdue University
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Brownell MD, Chartier MJ, Nickel NC, Chateau D, Martens PJ, Sarkar J, Burland E, Jutte DP, Taylor C, Santos RG, Katz A. Unconditional Prenatal Income Supplement and Birth Outcomes. Pediatrics 2016; 137:peds.2015-2992. [PMID: 27244846 DOI: 10.1542/peds.2015-2992] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Perinatal outcomes have improved in developed countries but remain poor for disadvantaged populations. We examined whether an unconditional income supplement to low-income pregnant women was associated with improved birth outcomes. METHODS This study included all mother-newborn pairs (2003-2010) in Manitoba, Canada, where the mother received prenatal social assistance, the infant was born in the hospital, and the pair had a risk screen (N = 14 591). Low-income women who received the income supplement (Healthy Baby Prenatal Benefit [HBPB], n = 10 738) were compared with low-income women who did not receive HBPB (n = 3853) on the following factors: low birth weight, preterm, small and large for gestational age, Apgar score, breastfeeding initiation, neonatal readmission, and newborn hospital length of stay (LOS). Covariates from risk screens were used to develop propensity scores and to balance differences between groups in regression models; γ sensitivity analyses were conducted to assess sensitivity to unmeasured confounding. Population-attributable and preventable fractions were calculated. RESULTS HBPB was associated with reductions in low birth weight (aRR, 0.71 [95% CI, 0.63-0.81]), preterm births (aRR, 0.76 [95% CI, 0.69-0.84]) and small for gestational age births (aRR, 0.90 [95% CI, 0.81-0.99]) and increases in breastfeeding (aRR, 1.06 [95% CI, 1.03-1.09]) and large for gestational age births (aRR, 1.13 [95% CI, 1.05-1.23]). For vaginal births, HBPB was associated with shortened LOS (weighted mean, 2.86; P < .0001). Results for breastfeeding, low birth weight, preterm birth, and LOS were robust to unmeasured confounding. Reductions of 21% (95% CI, 13.6-28.3) for low birth weight births and 17.5% (95% CI, 11.2-23.8) for preterm births were associated with HBPB. CONCLUSIONS Receipt of an unconditional prenatal income supplement was associated with positive outcomes. Placing conditions on income supplements may not be necessary to promote prenatal and perinatal health.
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Affiliation(s)
- Marni D Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and
| | - Mariette J Chartier
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and
| | - Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and
| | - Dan Chateau
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and
| | - Patricia J Martens
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and
| | | | - Elaine Burland
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and
| | - Douglas P Jutte
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Carole Taylor
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and
| | - Robert G Santos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and
| | - Alan Katz
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and
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Palmer RHC, Bidwell LC, Heath AC, Brick LA, Madden PAF, Knopik VS. Effects of Maternal Smoking during Pregnancy on Offspring Externalizing Problems: Contextual Effects in a Sample of Female Twins. Behav Genet 2016; 46:403-15. [PMID: 26826031 PMCID: PMC4860102 DOI: 10.1007/s10519-016-9779-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 01/01/2016] [Indexed: 11/30/2022]
Abstract
Studies of maternal smoking during pregnancy (MSDP) suggest increased risk for cognitive impairment and psychiatric outcomes. However, it is uncertain whether these associations are the direct result of MSDP or related to confounding familial variables associated with MSDP. The current study employed propensity score analysis to examine the effects of MSDP on offspring EXT using data from a large sample of 979 unrelated mothers. Logistic regression models were used to determine the propensity that the offspring of these mothers were likely to be exposed to MSDP [i.e., smoked during only the first trimester (MSDP-EARLY[E]) or smoked throughout their pregnancy (MSDP-THROUGHOUT[T])] given known familial confounders. Analyses focused on the effect of MSDP-E/T on the EXT behavior in offspring of these mothers (N = 1616) were conducted across the distribution of liability for MSDP-E/T and at different levels of risk for MSDP-E/T. MSDP-E/T was associated with offspring EXT problems, but the effects were partly confounded by the familial liability for MSDP. Further, the observed effects were not consistent across all levels of the MSDP risk distribution. These findings suggest a direct association between MSDP and offspring EXT behaviors, and that varied associations observed across studies may be the result of differences in the level of familial confounders that also have an effect on offspring EXT.
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Affiliation(s)
- Rohan H C Palmer
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, RI, 02903, USA.
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02903, USA.
- Bradley Hasbro Children's Research Center Coro West, 1 Hoppin St, Suite 204, Providence, RI, 02903, USA.
| | - L Cinnamon Bidwell
- Institute for Cognitive Sciences, University of Colorado at Boulder, Boulder, CO, USA
| | - Andrew C Heath
- Midwestern Alcohol Research Center, Washington University, St. Louis, MO, USA
| | - Leslie A Brick
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, RI, 02903, USA
| | - Pamela A F Madden
- Midwestern Alcohol Research Center, Washington University, St. Louis, MO, USA
| | - Valerie S Knopik
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, RI, 02903, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02903, USA
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Leppälahti S, Heikinheimo O, Paananen R, Santalahti P, Merikukka M, Gissler M. Determinants of underage induced abortion--the 1987 Finnish Birth Cohort study. Acta Obstet Gynecol Scand 2016; 95:572-9. [PMID: 26915819 DOI: 10.1111/aogs.12879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although underage pregnancies often end in induced abortion, data on girls who undergo termination of pregnancy are lacking. Our aim was to identify determinants of underage induced abortion and compare them with those of childbirth. MATERIAL AND METHODS All girls born in 1987 in Finland surviving the perinatal period (n = 29 041) were included in the study and divided into three study groups: Girls undergoing induced abortion (n = 1041, 3.6%) or childbirth (n = 395, 1.4%) at <18 years of age and girls with no underage pregnancies (n = 27 605, 95.0%). RESULTS Shared risk factors of underage induced abortion and childbirth included early onset behavioral and emotional disorders [adjusted OR 1.9 (1.4-2.5) and 2.7 (95% CI 1.8-3.9)], a history of foster care [1.5 [1.1-1.9] and 3.0 [2.3-4.1)], and socioeconomic factors, including living in a family receiving income support [1.8 (1.5-2.1) and 3.4 (2.7-4.4)], respectively. Specific risk factors of underage induced abortion were psychoactive substance use disorders [2.2 (1.3-3.5)], having a mother who smoked during pregnancy [1.5 (1.3-1.8)] or had undergone induced abortion [1.8 (1.5-2.2)]. Coping with a chronic physical illness [0.7 (0.5-0.9)], and perinatal problems [0.6 (0.4-0.7)] were inversely associated with underage induced abortion. CONCLUSIONS The traditionally acknowledged determinants of underage childbirth played a less prominent role in induced abortion. Novel risk factors of underage induced abortion were found, including severe substance abuse and adverse maternal reproductive history, and should be addressed at all levels offering youth healthcare and social welfare services.
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Affiliation(s)
- Suvi Leppälahti
- Department of Obstetrics and Gynecology, University of Helsinki and Kätilöopisto Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Kätilöopisto Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Reija Paananen
- THL, National Institute for Health and Welfare, Oulu, Finland
| | - Päivi Santalahti
- THL, National Institute for Health and Welfare, Helsinki, Finland
| | - Marko Merikukka
- THL, National Institute for Health and Welfare, Oulu, Finland
| | - Mika Gissler
- THL, National Institute for Health and Welfare, Helsinki, Finland
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Fellenzer JL, Cibula DA. Intendedness of pregnancy and other predictive factors for symptoms of prenatal depression in a population-based study. Matern Child Health J 2015; 18:2426-36. [PMID: 24752314 DOI: 10.1007/s10995-014-1481-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Prenatal depression (PD) as a risk factor for adverse birth outcomes is well documented. Less is known about maternal risks for PD, which could inform preventive strategies for perinatal and interconceptional care. This exploratory study investigates associations between prenatal depression symptoms and unintended and mistimed pregnancies and other maternal risk factors for PD. A subset of birth records from the New York Statewide Perinatal Data System (n = 19,219) was used in this secondary analysis of cross-sectional data. Univariate and multivariate multinomial regression was used to identify factors that are independently associated with four self-reported levels of prenatal depression symptoms. Women with unintended pregnancies were more likely (AOR, 95 % CI) to report severe (3.6, 2.6-5.1) or moderate (2.0, 1.6-2.5) prenatal depression symptoms and less likely to report no symptoms, compared to women with intended pregnancies. Likewise, women with mistimed pregnancies were more likely to report severe (2.7, 2.2-3.5) or moderate (1.7, 1.5-2.1) prenatal depression symptoms than no symptoms, compared to women with intended pregnancies. Low education, drug use, smoking, minority race, being unmarried and having Medicaid insurance were also significant, independent predictors of PD symptoms. Results suggest that routine screening for depression, intendedness of pregnancy and other associated risk factors such as smoking and drug use during prenatal and interconceptional care visits may enable coordinated interventions that can reduce prenatal depression and unintended and mistimed pregnancies and improve pregnancy outcomes.
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Affiliation(s)
- Jena L Fellenzer
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 760 Irving Avenue, 2263 Weiskotten Hall, Syracuse, NY, 13210, USA
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Rosenthal DG, Weitzman M. Examining the Effects of Intrauterine and Postnatal Exposure to Tobacco Smoke on Childhood Cognitive and Behavioral Development. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411400103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vandenbroucke T, Verheecke M, Van Calsteren K, Han S, Claes L, Amant F. Fetal outcome after prenatal exposure to chemotherapy and mechanisms of teratogenicity compared to alcohol and smoking. Expert Opin Drug Saf 2014; 13:1653-65. [PMID: 25382454 DOI: 10.1517/14740338.2014.965677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The treatment of cancer during pregnancy is challenging because of the involvement of two individuals and the necessity of a multidisciplinary approach. An important concern is the potential impact of chemotherapy on the developing fetus. AREAS COVERED The authors review the available literature on neonatal and long-term outcome of children prenatally exposed to chemotherapy. Chemotherapy administered during first trimester of pregnancy results in increased congenital malformations (7.5 - 17% compared to 4.1 - 6.9% background risk), whereas normal rates are found during second or third trimester. Intrauterine growth restriction is seen in 7 - 21% (compared to 10%), but children develop normal weight and height on the long term. Children are born preterm in 67.1%, compared to 4% in general population. Normal intelligence, attention, memory and behavior are reported, although intelligence tends to decrease with prematurity. Global heart function remains normal, although small differences are seen in ejection fraction, fractional shortening and some diastolic parameters. No secondary cancers or fertility problems are encountered, but follow up periods are limited. EXPERT OPINION Most evidence is based on retrospective studies with small samples and limited follow up periods, methodology and lack of control groups. A large prospective case-control study with long-term follow up is needed in which confounding factors are well considered.
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Affiliation(s)
- Tineke Vandenbroucke
- KU Leuven - University of Leuven, Department of Oncology , Herestraat 49, B-3000 Leuven , Belgium +32 16 34 42 52 ; +32 16 34 42 05 ;
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Qiu A, Rifkin-Graboi A, Chen H, Chong YS, Kwek K, Gluckman PD, Fortier MV, Meaney MJ. Maternal anxiety and infants' hippocampal development: timing matters. Transl Psychiatry 2013; 3:e306. [PMID: 24064710 PMCID: PMC3784768 DOI: 10.1038/tp.2013.79] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/06/2013] [Accepted: 08/12/2013] [Indexed: 01/28/2023] Open
Abstract
Exposure to maternal anxiety predicts offspring brain development. However, because children's brains are commonly assessed years after birth, the timing of such maternal influences in humans is unclear. This study aimed to examine the consequences of antenatal and postnatal exposure to maternal anxiety upon early infant development of the hippocampus, a key structure for stress regulation. A total of 175 neonates underwent magnetic resonance imaging (MRI) at birth and among them 35 had repeated scans at 6 months of age. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) at week 26 of pregnancy and 3 months after delivery. Regression analyses showed that antenatal maternal anxiety did not influence bilateral hippocampal volume at birth. However, children of mothers reporting increased anxiety during pregnancy showed slower growth of both the left and right hippocampus over the first 6 months of life. This effect of antenatal maternal anxiety upon right hippocampal growth became statistically stronger when controlling for postnatal maternal anxiety. Furthermore, a strong positive association between postnatal maternal anxiety and right hippocampal growth was detected, whereas a strong negative association between postnatal maternal anxiety and the left hippocampal volume at 6 months of life was found. Hence, the postnatal growth of bilateral hippocampi shows distinct responses to postnatal maternal anxiety. The size of the left hippocampus during early development is likely to reflect the influence of the exposure to perinatal maternal anxiety, whereas right hippocampal growth is constrained by antenatal maternal anxiety, but enhanced in response to increased postnatal maternal anxiety.
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Affiliation(s)
- A Qiu
- Department of Bioengineering, National University of Singapore, Singapore,Clinical Imaging Research Centre, National University of Singapore, Singapore,Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore,Department of Bioengineering, National University of Singapore, 9 Engineering Drive 1, Block EA #03-12, Singapore 117576, Singapore. E-mail:
| | - A Rifkin-Graboi
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore
| | - H Chen
- KK Women's and Children's Hospital (KKH), Singapore
| | - Y-S Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - K Kwek
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - P D Gluckman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - M V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital (KKH), Singapore
| | - M J Meaney
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore,Departments of Psychiatry and Neurology & Neurosurgery, McGill University, Montreal, Canada
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Söderström L, Perez-Vicente R, Juárez S, Merlo J. Questioning the causal link between maternal smoking during pregnancy and offspring use of psychotropic medication: a sibling design analysis. PLoS One 2013; 8:e63420. [PMID: 23667614 PMCID: PMC3648466 DOI: 10.1371/journal.pone.0063420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 04/02/2013] [Indexed: 11/24/2022] Open
Abstract
A recent population-based, longitudinal study from Finland observed a dose-response association between smoking during pregnancy (SDP) and use of psychotropic medications in exposed children and young adults. However, this association may be confounded by unmeasured familial characteristics related to both SDP and offspring mental health. Consequently, we aim to investigate the effect of SDP by means of a sibling design that to some extent allows controlling for unknown environmental and genetic confounders. Using the Swedish Medical Birth Register (1987–1993), which was linked to the Swedish Prescribed Drugs Register (July 2005–December 2008), we investigated 579,543 children and among them 39, 007 were discordant for use of psychotropic medication and 4,021 siblings discordant for both use of psychotropic medication and for smoking exposure. Replicating the Finnish study using traditional logistic regression methods we found an association between exposure to ≥10 cigarettes per day during pregnancy and psychotropic drug use (odds ratio = 1.61, 95% confidence interval 1.56, 1.66). Similar in size to the association reported from Finland (odds ratio = 1.63; 95% confidence interval 1.53, 1.74). However, in the adjusted sibling analysis using conditional logistic regression, the association was considerably reduced (odds ratio 1.22; 95% confidence interval 1.08, 1.38). Preventing smoking is of major public health importance. However, SDP per se appears to have less influence on offspring psychotropic drug use than previously suggested.
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Affiliation(s)
- Lovisa Söderström
- Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Raquel Perez-Vicente
- Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Sol Juárez
- Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- Centre for Economic Demography, Lund University, Malmö, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- * E-mail:
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Massey SH, Compton MT. Psychological differences between smokers who spontaneously quit during pregnancy and those who do not: a review of observational studies and directions for future research. Nicotine Tob Res 2012; 15:307-19. [PMID: 22949579 DOI: 10.1093/ntr/nts142] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although remarkable interindividual differences among pregnant smokers' decision/ability to quit have been documented, the psychological factors that may account for these differences have received less attention and comprised the primary aim of this review. METHODS We searched the medical and behavioral sciences literature from 1996 to November 2011 using PubMed and PsycINFO(®). Fifty-one articles were identified based on titles or abstracts. These articles were reviewed in full and searched for quantitative observational studies of population-based or clinical samples, with the main topic of comparing smokers who quit spontaneously during pregnancy with those who did not, utilizing multivariable analyses. RESULTS The eight pertinent studies reviewed herein included four longitudinal studies and four cross-sectional analyses. Amidst significant variability among measures used, social support, depressive symptoms, and anxiety appeared unrelated to smoking cessation during pregnancy. Furthermore, when severity of nicotine dependence was controlled, maternal history of attention-deficit/hyperactivity disorder, depression, bipolar disorder, and schizophrenia all showed no independent relationship with smoking cessation during pregnancy, whereas maternal history of conduct disorder did. Secure attachment, prosocial personality, self-esteem, and perceived parenting competence were additional predictors of cessation during pregnancy. CONCLUSIONS A greater understanding of psychological factors that differentiate smokers who spontaneously quit during pregnancy from those who do not is crucial to the design of more effective prenatal smoking cessation interventions and also may elucidate causal mechanisms that underlie the well-established link between maternal smoking during pregnancy and offspring behavioral problems. Directions for future research and public health and policy implications are discussed.
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Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences Washington, DC 20037, USA.
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Piper BJ, Gray HM, Birkett MA. Maternal smoking cessation and reduced academic and behavioral problems in offspring. Drug Alcohol Depend 2012; 121:62-7. [PMID: 21937170 PMCID: PMC3262955 DOI: 10.1016/j.drugalcdep.2011.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 08/02/2011] [Accepted: 08/06/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is some debate whether smoking during pregnancy causes or is only a risk factor for negative academic outcomes and increased risk of psychopathology in offspring. This study evaluated whether maternal smoking cessation would reduce the risk of adverse outcomes in school-aged children. METHODS Women completed an online survey that included items about child scholastic performance and the Child Behavior Checklist (CBCL). Mothers were divided based on pre-pregnancy and pregnancy smoking status into: (1) Nonsmokers (N=320); (2) Women that smoked in the 3 months preceding and throughout pregnancy (Smokers, N=83); and (3) Smoking before, but not during pregnancy (Quitters, N=72). RESULTS The Smokers and Quitters groups each had lower education and incomes compared to Nonsmokers but were indistinguishable from each other on these measures. The offspring of Smokers were more likely (p<.05) to be behind their peers on standardized tests in math (27.8%) relative to both Nonsmokers (17.4%) and Quitters (13.0%) with similar findings for reading. Smokers reported more behavioral problems by their children in several areas including Hyperactivity and Impulsivity, Social problems, and Externalizing problems including Aggression and Rule-Breaking. Further, the children of Quitters had significantly fewer Attention and Externalizing problems than Smokers. These outcomes were observed even after accounting for the variance attributable to maternal education and several other potential confounds. CONCLUSIONS Together, these findings indicate that smoking cessation is associated with reduced risk of having children with academic and neuropsychological difficulties. These outcomes are discussed within the framework that nicotine may be a neurobehavioral teratogen.
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Affiliation(s)
- Brian J. Piper
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon, USA,Methamphetamine Abuse Research Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Hilary M. Gray
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon, USA,Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Melissa A. Birkett
- Department of Psychology, Northern Arizona University, Flagstaff, Arizona, USA
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Brownell MD, Chartier M, Au W, Schultz J. Program for expectant and new mothers: a population-based study of participation. BMC Public Health 2011; 11:691. [PMID: 21896195 PMCID: PMC3178495 DOI: 10.1186/1471-2458-11-691] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 09/06/2011] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The Manitoba Healthy Baby Program is aimed at promoting pre- and perinatal health and includes two components: 1) prenatal income supplement; 2) community support programs. The goal of this research was to determine the uptake of these components by target groups. METHODS Data on participation in each of the two program components were linked to data on all hospital births in Manitoba between 2004/05 through 2007/08. Descriptive analyses of participation by maternal characteristics were produced. Logistic regression analyses were conducted to identify factors associated with participation in the two programs. Separate regressions were run for two groups of women giving birth during the study period: 1) total population; 2) those receiving provincial income assistance during the prenatal period. RESULTS Almost 30% of women giving birth in Manitoba received the Healthy Baby prenatal income supplement, whereas only 12.6% participated in any community support programs. Over one quarter (26.4%) of pregnant women on income assistance did not apply for and receive the prenatal income supplement, despite all being eligible for it. Furthermore, 77.8% of women on income assistance did not participate in community support programs. Factors associated with both receipt of the prenatal benefit and participation in community support programs included lower SES, receipt of income assistance, obtaining adequate prenatal care, having completed high school and having depressive symptoms. Having more previous births was associated with higher odds of receiving the prenatal benefit, but lower odds of attending community support programs. Being married was associated with lower odds of receiving the prenatal benefit but higher odds of participating in community support programs. CONCLUSIONS Although uptake of the Healthy Baby program in Manitoba is greater for women in groups at risk for poorer perinatal outcomes, a substantial number of women eligible for this program are not receiving it; efforts to reach these women should be enhanced.
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Affiliation(s)
- Marni D Brownell
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
| | - Mariette Chartier
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
| | - Wendy Au
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
| | - Jennifer Schultz
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
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Willoughby M, Greenberg M, Blair C, Stifter C. Neurobehavioral Consequences of Prenatal Exposure to Smoking at 6 to 8 Months of Age. INFANCY 2010. [DOI: 10.1111/j.1532-7078.2007.tb00244.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Willoughby
- FPG Child Development Institute, University of North Carolina at Chapel Hill
| | - Mark Greenberg
- Prevention Research Center, Pennsylvania State University
| | - Clancy Blair
- Human Development and Family Studies, Pennsylvania State University
| | - Cynthia Stifter
- Human Development and Family Studies, Pennsylvania State University
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Xepapadaki P, Manios Y, Liarigkovinos T, Grammatikaki E, Douladiris N, Kortsalioudaki C, Papadopoulos NG. Association of passive exposure of pregnant women to environmental tobacco smoke with asthma symptoms in children. Pediatr Allergy Immunol 2009; 20:423-9. [PMID: 19674350 DOI: 10.1111/j.1399-3038.2008.00820.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Environmental tobacco smoke (ETS) is a significant risk factor for the presence and increased severity of asthma- and allergy-related symptoms in children. Smoking during pregnancy has detrimental effects on asthma-associated outcomes in childhood. Whether passive exposure of pregnant women to ETS may also lead to asthma in their offspring, is not known. The aim of this study was to investigate the association of passive exposure of pregnant women to ETS and asthma- and/or allergy-related symptoms in Preschool children. Cross-sectional data were collected with questionnaires from 2374 Preschool children, recruited from public and private nurseries and day-care centers. Parental smoking was significantly associated with wheezing symptoms in their children. Mother's active smoking during pregnancy significantly increased the risk for occurrence of asthma symptoms and/or medically diagnosed asthma in Preschool children in a dose-dependent manner. Passive exposure to ETS, mainly during the third trimester of pregnancy, was significantly associated with asthma- and allergy-related symptoms after adjusting for several confounders in a multivariate analysis (current wheeze: OR = 1.42, 95% CI = 1.06-1.91, pruritic rash ever: OR= 1.45, 95% CI = 1.01-2.08). Passive exposure of pregnant women to ETS during the third trimester is positively associated with asthma- and allergy-related symptoms in their Preschool age children. Public health policies should be oriented not only towards smoking cessation, but also reinforce elimination of ETS exposure of pregnant women.
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Affiliation(s)
- Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, University of Athens, 13 Levadias str., Goudi 11527, Greece.
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Abstract
Maternal smoking during pregnancy (MSDP) is a major public health concern with clearly established consequences to both mother and newborn (e.g., low birth weight, altered cardiorespiratory responses). MSDP has also been associated with higher rates of a variety of poor cognitive and behavioral outcomes in children, including attention deficit hyperactivity disorder (ADHD), conduct disorder, impaired learning and memory, and cognitive dysfunction. However, the evidence suggesting causal effects of MSDP for these outcomes is muddied in the existing literature due to the frequent inability to separate prenatal exposure effects from other confounding environmental and genetic factors. Carefully designed studies using genetically sensitive strategies can build on current evidence and begin to elucidate the likely complex factors contributing to associations between MSDP and child outcomes.
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Affiliation(s)
- Valerie S Knopik
- Department of Community Health, Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island 02912, USA.
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Julvez J, Ribas-Fitó N, Torrent M, Forns M, Garcia-Esteban R, Sunyer J. Maternal smoking habits and cognitive development of children at age 4 years in a population-based birth cohort. Int J Epidemiol 2007; 36:825-32. [PMID: 17550944 DOI: 10.1093/ije/dym107] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Active maternal smoking during pregnancy has been associated with a higher risk of behavioural disorders in children, but a few cohort studies measuring smoking data prospectively have studied its specific effects on the cognitive abilities of pre-schoolers. METHOD A birth cohort was set up in Menorca Island in 1997 within the Asthma Multicenter Infants Cohort Study. A total of 420 (87% of those eligible) children had complete data for final analyses at age 4 years. Interviewer-administered questionnaires were completed by mothers during the third trimester of pregnancy and then every year up to age 4 years of their child. A standardized version of the McCarthy Scales of Children's Abilities (MCSA) was used to evaluate the child's motor and cognitive capabilities. Multivariable regressions were used with MCSA's assessed outcomes adjusting for: home location, maternal alcohol consumption, mother's social class and level of education during pregnancy, parity, marital status, father's education level, child's gender, birth weight and height, breastfeeding duration, passive smoking, school season, age during test administration and evaluator (psychologist). RESULTS A high global consistency in maternal smoking habits was found (total agreement = 88.7%). Maternal social class and education level were inversely associated with maternal smoking behaviour. Maternal smoking during pregnancy (in cig./day) was associated with a decrease (in points) of children's global cognitive score [beta = -0.60, (95% CI: -1.10; -0.09)]; as well as global cognitive sub-areas like verbal score [beta = -0.59, (95% CI: -1.11; -0.07)]; quantitative score [beta = -0.57, (95% CI: -1.08; -0.06)]; executive function score [beta = -0.71, (95% CI: -1.23; -0.20)]; and working memory score [beta = -0.46, (95% CI: -0.92; -0.01)]. CONCLUSION Our findings suggest an association with maternal smoking during pregnancy and lowered cognitive development in children at age 4 years.
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Affiliation(s)
- Jordi Julvez
- Centre for Research in Environmental Epidemiology, Institut Municipal d'Investigació Mèdica. Barcelona, Spain.
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Carroll KN, Gebretsadik T, Griffin MR, Dupont WD, Mitchel EF, Wu P, Enriquez R, Hartert TV. Maternal asthma and maternal smoking are associated with increased risk of bronchiolitis during infancy. Pediatrics 2007; 119:1104-12. [PMID: 17545377 DOI: 10.1542/peds.2006-2837] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal was to determine whether maternal asthma and maternal smoking during pregnancy are associated with the incidence and severity of clinically significant bronchiolitis in term, otherwise healthy infants without the confounding factors of small lung size or underlying cardiac or pulmonary disease. PATIENTS AND METHODS We conducted a population-based retrospective cohort study of term, non-low birth weight infants enrolled in the Tennessee Medicaid Program from 1995 to 2003. The cohort of infants was followed through the first year of life to determine the incidence and severity of bronchiolitis as determined by health care visits and prolonged hospitalization. RESULTS A total of 101,245 infants were included. Overall, 20% of infants had > or = 1 health care visit for bronchiolitis. Compared with infants with neither factor, the risk of bronchiolitis was increased in infants with maternal smoking only, maternal asthma only, or both. Infants with maternal asthma only or with both maternal smoking and asthma had the highest risks for emergency department visits and hospitalizations. Infants with a mother with asthma had the highest risk of a hospitalization > 3 days, followed by infants with both maternal asthma and smoking, and maternal smoking only. CONCLUSIONS Maternal asthma and maternal smoking during pregnancy are independently associated with the development of bronchiolitis in term, non-low birth weight infants without preexisting cardiac or pulmonary disease. The risk of bronchiolitis among infants with mothers who both have asthma and smoke during pregnancy is approximately 50% greater than that of infants with neither risk factor. Efforts to decrease the illness associated with these 2 risk factors will lead to decreased morbidity from bronchiolitis, the leading cause of hospitalization for severe lower respiratory tract infections during infancy.
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Affiliation(s)
- Kecia N Carroll
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Dryer R, Kiernan MJ, Tyson GA. Implicit theories of the characteristics and causes of attention-deficit hyperactivity disorder held by parents and professionals in the psychological, educational, medical and allied health fields. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2007. [DOI: 10.1080/00049530600730443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Rachel Dryer
- School of Social Sciences & Liberal Studies, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Michael J. Kiernan
- School of Social Sciences & Liberal Studies, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Graham A. Tyson
- School of Social Sciences & Liberal Studies, Charles Sturt University, Bathurst, New South Wales, Australia
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Huizink AC, Mulder EJH. Maternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring. Neurosci Biobehav Rev 2005; 30:24-41. [PMID: 16095697 DOI: 10.1016/j.neubiorev.2005.04.005] [Citation(s) in RCA: 304] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Revised: 02/16/2005] [Accepted: 04/18/2005] [Indexed: 11/28/2022]
Abstract
Teratological investigations have demonstrated that agents that are relatively harmless to the mother may have significant negative consequences to the fetus. Among these agents, prenatal alcohol, nicotine or cannabis exposure have been related to adverse offspring outcomes. Although there is a relatively extensive body of literature that has focused upon birth and behavioral outcomes in newborns and infants after prenatal exposure to maternal smoking, drinking and, to a lesser extent, cannabis use, information on neurobehavioral and cognitive teratogenic findings beyond these early ages is still quite limited. Furthermore, most studies have focused on prenatal exposure to heavy levels of smoking, drinking or cannabis use. Few recent studies have paid attention to low or moderate levels of exposure to these substances. This review endeavors to provide an overview of such studies, and includes animal findings and potential mechanisms that may explain the mostly subtle effects found on neurobehavioral and cognitive outcomes. It is concluded that prenatal exposure to either maternal smoking, alcohol or cannabis use is related to some common neurobehavioral and cognitive outcomes, including symptoms of ADHD (inattention, impulsivity), increased externalizing behavior, decreased general cognitive functioning, and deficits in learning and memory tasks.
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Affiliation(s)
- Anja C Huizink
- Erasmus Medical Center, Department of Child and Adolescent Psychiatry, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
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Thorsdottir I, Gunnarsdottir I, Kvaran MA, Gretarsson SJ. Maternal body mass index, duration of exclusive breastfeeding and children's developmental status at the age of 6 years. Eur J Clin Nutr 2005; 59:426-31. [PMID: 15674314 DOI: 10.1038/sj.ejcn.1602092] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate whether the duration of exclusive breastfeeding and maternal body mass index (BMI) are associated with children's developmental status at the time of beginning elementary school. DESIGN AND SUBJECTS The subjects in the sample came from a longitudinal study on infant nutrition in Iceland. Food records were made once a month from birth to the age of 12 months, from which duration of exclusive breastfeeding could be determined. Mothers filled in The Icelandic developmental inventory for evaluation of motor and verbal development close to their children's sixth birthday (n = 85). Maternal self-reported weight and height was recorded. Information on socioeconomic factors was gathered by a questionnaire. RESULTS Duration of exclusive breastfeeding, in months, was positively related to children's motor component (B = 0.5+/-0.5, P = 0.054) and to the total developmental index (B = 1.0+/-0.5, P = 0.044) at 6 y, adjusting for gender and socioeconomic factors (maternal and paternal education, and family income). Children's learning score was negatively related to maternal BMI (B = -0.5+/-0.2, P=0.047). An inverse association also appeared between maternal BMI and two out of the three developmental composite scores, that is, verbal component and the total developmental index (B = -0.6+/-0.3, P=0.049) and (B = -0.4+/-0.2, P=0.057), respectively. In multiple regression the developmental indexes were most strongly independently associated with maternal BMI (negatively) and infants' birth weight (positively). CONCLUSION Maternal BMI and duration of breastfeeding were associated with verbal and motor development of 6-y-old children, independent of socioeconomic factors. Birth weight was also an independent determinant for developmental scores.
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Affiliation(s)
- I Thorsdottir
- Unit for Nutrition Research, Landspitali-University Hospital & Department of Food Science, University of Iceland, IS-101 Reykjavik, Iceland.
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Abstract
BACKGROUND Knowledge of genetic influences, on developmental disorders such as autism spectrum, attention deficit/hyperactivity disorder and learning disabilities, has increased the opportunities for understanding the influences of the early environment. METHODS This paper provides a selective, narrative review for clinicians of the effects of factors such as exposure to toxins and stresses in utero and in postnatal life; brain injuries and perinatal compromise; neglect, malnutrition and selective food deficiencies. It also considers what is known about the mechanisms through which early adversities operate. RESULTS Gaps in the research are identified and suggestions made about clinical investigations. Several types of environmental adversity have associations with later disorders that suggest a causal role. The effects are often on a broad range of psychological processes, and are not always quickly reversible. Several adversities often coexist, calling for skilled judgement about priorities in treatment. CONCLUSIONS Individuals vary considerably in their exposure to adversity and their vulnerability to its effects, and genetic inheritance can influence both.
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Affiliation(s)
- Eric Taylor
- Institute of Psychiatry, Kings College, London, UK.
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25
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Neggers YH, Goldenberg RL, Ramey SL, Cliver SP. Maternal prepregnancy body mass index and psychomotor development in children. Acta Obstet Gynecol Scand 2003; 82:235-40. [PMID: 12694119 DOI: 10.1034/j.1600-0412.2003.00090.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In a prospective study, the association between maternal nutritional status and psychomotor development of low-income African-American children was evaluated. We hypothesized that low maternal body mass index (BMI) would predict worse neurodevelopmental status in children, while higher maternal BMIs would be associated with better neurodevelopmental outcomes. METHODS Psychomotor tests for general intelligence and motor skills were given to 355 children at a mean age of 5.3 years. Maternal nutritional status was assessed by prepregnancy body mass index (BMI) and weight gain during pregnancy. RESULTS Fifty-four percent of the women in this study were overweight or obese. The means of the general IQ, nonverbal and verbal ability, and Gross Motor Scales of the children were 82.1 +/- 12.6, 87.4 +/- 15.7, 80.1 +/- 10.8 and 332.3 +/- 13.2, respectively. Seventeen percent of the children had general IQ scores of less than 70. To our surprise, in multiple regression analyses, adjusting for other covariates, maternal prepregnancy BMI was a significant negative predictor of IQ (beta = - 0.25, P = 0.001) and nonverbal ability (beta = - 0.29, P = 0.02). The IQ and nonverbal scores of children of women who were obese before pregnancy were approximately 5 units lower than for children whose mothers had a normal prepregnancy BMI. The other significant predictors of IQ and nonverbal scores of the children were childcare status (beta = 3.5, P = 0.04 and beta = 0.26, P < 0.0001, respectively) and the mother's receptive language scores (beta = 5.2, P = 0.01 and beta = 0.25, P < 0.0001, respectively). CONCLUSION This study of low-income African-American children indicates that obese women are at risk of having children with diminished intellectual ability, but not motor skills.
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Affiliation(s)
- Yasmin H Neggers
- Department of Human Nutrition, University of Alabama in Tuscaloosa, AL, USA.
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Durkin M. The epidemiology of developmental disabilities in low-income countries. MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2002; 8:206-11. [PMID: 12216065 DOI: 10.1002/mrdd.10039] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although most of the world's children live in developing countries and may be at high risk for disability, very little is known about the prevalence and causes of developmental disabilities in these countries. This paper discusses methodological difficulties contributing to this lack of knowledge, and provides an overview of what is known about the epidemiology of developmental disabilities in low-income countries. At least some forms of developmental disability appear to be more common in low-income countries than in wealthier countries, despite the probability of higher mortality among children with disabilities in low-income countries. For example, most studies of severe mental retardation in low-income countries report prevalences greater than 5 per 1,000 children, while prevalence estimates from industrialized countries are consistently below this. Major risk factors for developmental disabilities in some low-income countries include specific genetic diseases, a higher frequency of births to older mothers, consanguinity, and specific micronutrient deficiencies and infections. Trauma and toxic exposures are also important risk factors, but their contributions to the etiology of developmental disabilities in low-income countries are not well documented. Though many of the causes of developmental disabilities are understood and preventable, proven methods of prevention are not being fully implemented in developing countries. Epidemiologic studies are needed to raise awareness of the public health impacts of developmental disabilities in low-income countries and to provide a basis for setting priorities and designing efficient interventions.
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Affiliation(s)
- Maureen Durkin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032,
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Richter L, Richter DM. Exposure to parental tobacco and alcohol use: effects on children's health and development. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2001; 71:182-203. [PMID: 11347360 DOI: 10.1037/0002-9432.71.2.182] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This review examines three ways in which parental tobacco and alcohol use compromises the physical and mental health of children: 1) direct exposure to the substances; 2) living with parents who may become ill from using these substances; and 3) children's modeling of parental substance use. Implications for prevention, intervention, and public education are discussed, and a reframing of the national dialogue on youth substance abuse is called for.
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Affiliation(s)
- L Richter
- National Center on Addiction and Substance Abuse, Columbia University, New York, USA.
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