Psychological Functioning of Women Taking Illicit Drugs during Pregnancy and the Growth and Development of Their Offspring in Early Childhood

Through a teratological lens: A narrative review of exposure to stress and drugs of abuse during pregnancy on neurodevelopment

Teratological research shows that both prenatal stress and prenatal substance exposure have a significant impact on neurodevelopmental outcomes in children. Using human research, the purpose of this narrative review is to explore the degree to which these exposures may represent complex prenatal and postnatal risks for the development of cognition and behavior in children. An understanding of the HPA axis and its function during pregnancy as well as the types and operationalization of prenatal stress provide a context for understanding the direct and indirect mechanisms by which prenatal stress affects brain and behavior development. In turn, prenatal substance exposure studies are evaluated for their importance in understanding variables that indicate a potential interaction with prenatal stress including reactivity to novelty, arousal, and stress reactivity during early childhood. The similarities and differences between prenatal stress exposure and prenatal substance exposure on neurodevelopmental outcomes including arousal and emotion regulation, cognition, behavior, stress reactivity, and risk for psychopathology are summarized. Further considerations for teratological studies of prenatal stress and/or substance exposure include identifying and addressing methodological challenges, embracing the complexity of pre-and postnatal environments in the research, and the importance of incorporating parenting and resilience into future studies.

Cannabis Use in Pregnancy and Neonatal Outcomes: A Systematic Review and Meta-Analysis

Objective: To determine whether prenatal cannabis use alone increases the likelihood of fetal and neonatal morbidity and mortality. Study Design: We searched bibliographic databases, such as PubMed, Embase, Scopus, Cochrane reviews, PsycInfo, MEDLINE, Clinicaltrials.gov, and Google Scholar from inception through February 14, 2022. Cohort or case-control studies with prespecified fetal or neonatal outcomes in pregnancies with prenatal cannabis use. Primary outcomes were preterm birth (PTB; <37 weeks of gestation), small-for-gestational-age (SGA), birthweight (grams), and perinatal mortality. Two independent reviewers screened studies. Studies were extracted by one reviewer and confirmed by a second using a predefined template. Risk of bias assessment of studies, using the Newcastle-Ottawa Quality Assessment Scale, and Grading of Recommendations Assessment, Development, and Evaluation for evaluating the certainty of evidence for select outcomes were performed by two independent reviewers with disagreements resolved by a third. Random effects meta-analyses were conducted, using adjusted and unadjusted effect estimates, to compare groups according to prenatal exposure to cannabis use status. Results: Fifty-three studies were included. Except for birthweight, unadjusted and adjusted meta-analyses had similar results. We found very-low- to low-certainty evidence that cannabis use during pregnancy was significantly associated with greater odds of PTB (adjusted odds ratio [aOR], 1.42; 95% confidence interval [CI], 1.19 to 1.69; I2, 93%; p=0.0001), SGA (aOR, 1.76; 95% CI, 1.52 to 2.05; I2, 86%; p<0.0001), and perinatal mortality (aOR, 1.5; 95% CI, 1.39 to 1.62; I2, 0%; p<0.0001), but not significantly different for birthweight (mean difference, -40.69 g; 95% CI, -124.22 to 42.83; I2, 85%; p=0.29). Because of substantial heterogeneity, we also conducted a narrative synthesis and found comparable results to meta-analyses. Conclusion: Prenatal cannabis use was associated with greater odds of PTB, SGA, and perinatal mortality even after accounting for prenatal tobacco use. However, our confidence in these findings is limited. Limitations of most existing studies was the failure to not include timing or quantity of cannabis use. This review can help guide health care providers with counseling, management, and addressing the limited existing safety data. Protocol Registration: PROSPERO CRD42020172343.

Opioid dependence among pregnant and post-partum incarcerated individuals: A review of the literature

BACKGROUND

Pregnant and post-partum women with opioid dependence are an extremely vulnerable population within correctional facilities. A significant number of maternal inmates, however, still lack adequate provision of medications for opioid use disorder (OUD) and are subsequently forced into withdrawal. Currently, there exist no comprehensive reviews on the scope of literature regarding the management of this population. We aimed to provide a review on the research surrounding these women.

DESIGN

A systematic search of PubMed Central was conducted to identify studies evaluating OUD among pregnant and post-partum incarcerated women. Citations from only the last 20 years were included to ensure both relevance and scope of information.

RESULTS

The topics that emerged from this review included medications for OUD (MOUD) administration vs detoxification practices, treatment upon incarceration and upon release, and maternal and fetal outcomes. Across all articles, current care management of this population appeared inadequate. We further compiled all author recommendations and perspectives into a framework that can inform potential improvements in care coordination.

CONCLUSIONS

This review identifies significant gaps in current management-particularly regarding administration of MOUDs-and emphasizes the need for standardization of addiction-related and perinatal healthcare. We also highlight gaps in the literature and potential areas for future research.

Systematic Review: Polysubstance Prevalence Estimates Reported during Pregnancy, US, 2009-2020

INTRODUCTION

The objective of this systematic review is to describe polysubstance studies and their prevalence estimates among pregnant people in the US.

METHODS

This review was not subject to protocol preparation or registration with the International Prospective Register of Systematic Reviews (PROSPERO) because outcome data were not reported. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist was followed. Four scientific literature databases were used to identify articles published from January 1, 2009 to June 3, 2020 reporting prenatal exposure to two or more substances in the US. A standardized process of title and abstract screening followed by a two-phase full-text review was used to assess study eligibility.

RESULTS

A total of 119 studies were included: 7 case-control studies, 7 clinical trials, 76 cohort studies, and 29 cross-sectional studies. Studies varied with respect to study design, time period, region, sampling and participant selection, substances assessed, and method of exposure ascertainment. Commonly reported polysubstance prevalence estimates among studies of pregnant people included combinations with alcohol, marijuana, and/or tobacco/nicotine. The range of prevalence estimates was wide (alcohol 1-99%; marijuana 3-95%; tobacco/nicotine 2-95%).

DISCUSSION

Polysubstance use during pregnancy is common, especially with alcohol, marijuana, and/or tobacco/nicotine. Future research to assess polysubstance use during pregnancy could help better describe patterns and ultimately help mitigate its effects on maternal and infant health outcomes.

Prenatal exposure to opioids and neurodevelopment in infancy and childhood: A systematic review

Aim

This systematic review aims to estimate the relationship between prenatal exposure to opioids and neurodevelopmental outcomes and examines potential sources of heterogeneity between the studies.

Methods

We searched four databases through May 21st, 2022: PubMed, Embase, PsycInfo and the Web of Science according to a specified search strings. Study inclusion criteria include: (1) cohort and case-control peer-reviewed studies published in English; (2) studies comparing neurodevelopmental outcomes among children with prenatal opioid-exposure (prescribed or used non-medically) vs. an unexposed group. Studies investigating fetal alcohol syndrome or a different primary prenatal exposure other than opioids were excluded. Two main performed data extraction using "Covidence" systematic review platform. This systematic review was conducted in accordance with PRISMA guidelines. The Newcastle-Ottawa-Scale was used for quality assessment of the studies. Studies were synthesized based on the type of neurodevelopmental outcome and the instrument used to assess neurodevelopment.

Results

Data were extracted from 79 studies. We found significant heterogeneity between studies due to their use of different instruments to explore cognitive skills, motor, and behavioral outcomes among children of different ages. The other sources of heterogeneity included: procedures to assess prenatal exposure to opioids; period of pregnancy in which exposure was assessed; type of opioids assessed (non-medical, medication used for opioid use dis-order, prescribed by health professional), types of co-exposure; source of selection of prenatally exposed study participants and comparison groups; and methods to address lack of comparability between exposed and unexposed groups. Cognitive and motor skills as well as behavior were generally negatively affected by prenatal opioid exposure, but the significant heterogeneity precluded a meta-analysis.

Conclusion

We explored sources of heterogeneity in the studies assessing the association between prenatal exposure to opioids and neurodevelopmental outcomes. Sources of heterogeneity included different approaches to participant recruitment as well as exposure and outcome ascertainment methods. Nonetheless, overall negative trends were observed between prenatal opioid exposure and neuro-developmental outcomes.

Reasons Washington State Women Use Marijuana During Pregnancy/Breastfeeding, Their Trusted Information Sources, and Communication Strategies for Informed Decision-Making

OBJECTIVE

To understand reproductive-aged women's marijuana use beliefs and attitudes.

METHODS

Qualitative research (10 focus groups and 2 bulletin boards) with 95 Washington State women, aged 18 to 44 years, segmented by marijuana-using pregnant/breastfeeding; marijuana-using not-pregnant/breastfeeding; and nonmarijuana users. Participants completed up to 10 survey questions. We used deductive and inductive coding to analyze findings.

RESULTS

Marijuana-using pregnant/breastfeeding participants use marijuana to manage physical/mental pain and because of stigma, feel guilty, and sometimes hide use. Medicines have failed to address symptoms. Participants perceived marijuana safer than alcohol, tobacco, and illicit substances. Participants believed in the legitimacy of marijuana for health maintenance and want others to take their personally experienced benefits seriously. Participants interpreted lack of conclusive research as marijuana use not being unsafe. They want more information. All segments preferred hearing from other women about marijuana use experiences, with the marijuana-using pregnant/breastfeeding segment feeling strongest about this.

CONCLUSIONS

Personal experiences with, and anecdotes from family/friends about, the effects of marijuana use during pregnancy/breastfeeding influence marijuana-using participants' decision making.

NURSING IMPLICATIONS

It is important to speak with perinatal patients in a nonjudgmental/nonthreatening manner that acknowledges why reproductive-aged women may use marijuana and that conveys validation of patients' positive experiences with marijuana and a harm-reduction goal.

Association of Comorbid Behavioral and Medical Conditions With Cannabis Use Disorder in Pregnancy

IMPORTANCE

Prenatal cannabis use continues to increase, yet studies of the demographic, psychiatric, and medical characteristics associated with cannabis use in pregnancy are limited by size and use of self-report, and often do not consider cannabis use disorder (CUD) or concomitant substance use disorders (SUDs). Understanding the factors associated with CUD in pregnancy is paramount for designing targeted interventions.

OBJECTIVE

To examine the prevalence of co-occurring psychiatric and medical conditions of US pregnant individuals hospitalized with and without CUD by concomitant SUDs.

DESIGN, SETTING, AND PARTICIPANTS

The study analyzed restricted hospital discharge data from the 2010 to 2018 Healthcare Cost and Utilization Project State Inpatient Databases in 35 states. Data were analyzed from January to August 2021. Weighted linear regressions tested whether the prevalence of psychiatric and medical conditions differed between individuals with and without a CUD diagnosis at hospitalization. Inpatient hospitalizations of pregnant patients aged 15 to 44 years with a CUD diagnosis were identified. Pregnant patients aged 15 to 44 years without a CUD diagnosis were identified for comparison. Patients were further stratified based on concomitant SUD patterns: (1) other SUDs, including at least 1 controlled substance; (2) other SUDs, excluding controlled substances; and (3) no other SUDs.

EXPOSURES

CUD in pregnancy.

MAIN OUTCOMES AND MEASURES

Prevalence of demographic characteristics, psychiatric disorders (eg, depression and anxiety), and medical conditions (eg, epilepsy and vomiting).

RESULTS

The sample included 20 914 591 hospitalizations of individuals who were pregnant. The mean (SD) age was 28.24 (5.85) years. Of the total number of hospitalizations, 249 084 (1.19%) involved CUD and 20 665 507 (98.81%) did not. The proportion of prenatal hospitalizations involving CUD increased from 0.008 in 2010 to 0.02 in 2018. Analyses showed significant differences in the prevalence of almost every medical and psychiatric outcome examined between hospitalizations with and without CUD diagnoses, regardless of concomitant SUDs. Elevations were seen in depression (0.089; 95% CI, 0.083-0.095), anxiety (0.072; 95% CI, 0.066-0.076), and nausea (0.036; 95% CI, 0.033-0.040]) among individuals with CUD only at hospitalization compared with individuals with no SUDs at hospitalization.

CONCLUSIONS AND RELEVANCE

Considerable growth was observed in the prevalence of CUD diagnoses among individuals hospitalized prenatally and in the prevalence of depression, anxiety, nausea, and other conditions in individuals with CUD at hospitalization. This study highlights the need for more screening, prevention, and treatment, particularly in populations with co-occurring CUD and psychiatric disorders. Research on the determinants and outcomes associated with CUD during pregnancy is needed to guide clinicians, policy makers, and patients in making informed decisions.

[Effect of Psychosocial Factors on Growth]

BACKGROUND

Genes, hormones and factors such as nutrition and psychosocial environment affect growth.

OBJECTIVE

What is the significance of various psychosocial factors on growth?

METHODS

Evaluation of results of a working meeting of paediatric endocrinologist with current literature research.

RESULTS

Psychosocial deprivation in children can be associated with growth hormone deficiency (GHD) and short stature. GHD can be reversed by a change of environment and psychosocial support. War and migration are often associated with underweight, growth disturbances and poor health care. These factors can improve after the end of conflicts, but children often remain too short. Consumption of alcohol or opiates during pregnancy are associated with lower birth weight and increased risk of early and small for gestational age (SGA) childbirth. Children with attention deficit hyperactivity disorder show a slight slowdown in growth after they started stimulant therapy. However, they reach normal adult height.

CONCLUSIONS

In children with idiopathic short stature, psychosocial causes should be taken into account in the differential diagnosis. Notably there is an increased risk of growth disturbances in children from conflict regions or after prenatal drug exposure.

Influence of Prevalence of Psychoactive Substance Use in Mexican Municipalities on Early Childhood Development

Children's early development is influenced by characteristics of the child, family, and environment, including exposure to substance abuse. The aim was to examine the association of early childhood development (ECD) with the prevalence of psychoactive substance use in Mexican municipalities. We obtained ECD data from the 2015 Survey of Boys, Girls, and Women (ENIM, for its Spanish acronym), measured with the ECD Index. The prevalence of psychoactive substance use was estimated at the municipal level, using the 2016 National Survey of Drug, Alcohol, and Tobacco Use (ENCODAT, for its Spanish acronym). Multilevel logistic models were fitted to evaluate the association between drug use and inadequacies in ECD overall and in four specific ECD domains: socio-emotional, literacy-numeric, learning, and physical. Inadequate ECD was directly associated with illegal drug use (OR = 1.10; 95% CI: 1.03, 1.17). For the specific ECD domains, inadequate socio-emotional development was directly associated with illegal drug use (OR = 1.08; 95% CI: 1.01, 1.15). These findings suggest that exposure to illegal drug use may influence ECD, and especially can lead to socio-emotional problems, although this cannot be considered the unanimous determinant of the problems presented. The implementation of evidence-based interventions to prevent drug abuse is necessary.

Impact of Acute and Chronic Cannabis Use on Stress Response Regulation: Challenging the Belief That Cannabis Is an Effective Method for Coping

Although research has only recently started to examine the impact of cannabis use on stress response, there is some evidence that indicates acute and chronic impacts of cannabis on these processes. In this paper, we review processes involved in regulating the stress response and we review the influence of acute and chronic exposure to cannabis on patterns and regulation of the stress response. We also highlight the role of stress as a risk factor for initiation and maintenance of cannabis use. In this context, we examine moderating variables, including sex and life adversity. In light of recent observations indicating increasing prevalence of cannabis use during pregnancy, we provide additional focus on cannabis use in this vulnerable population, including how acute and chronic stress may predispose some individuals to use cannabis during pregnancy. While this line of research is in its infancy, we review available articles that focus on the perinatal period and that examined the association between cannabis use and various life stressors, including partner violence, job loss, and lack of housing. We also review psychiatric co-morbidities (e.g., post-traumatic stress disorder, anxiety). A better understanding of the way stress and cannabis use relate within the general population, as well as within certain subgroups that may be at a greater risk of using and/or at greater risk for adverse outcomes of use, may lead to the development of novel prevention and intervention approaches.

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.

Preschool Language Development of Children Born to Women with an Opioid Use Disorder

Increasing evidence suggests that prenatal exposure to opioids may affect brain development, but limited data exist on the effects of opioid-exposure on preschool language development. Our study aimed to characterize the nature and prevalence of language problems in children prenatally exposed to opioids, and the factors that support or hinder language acquisition. A sample of 100 children born to pregnant women in methadone maintenance treatment and 110 randomly identified non-exposed children were studied from birth to age 4.5 years. At 4.5 years, 89 opioid-exposed and 103 non-exposed children completed the preschool version of the Clinical Evaluation of Language Fundamentals (CELF-P) as part of a comprehensive neurodevelopmental assessment. Children prenatally exposed to opioids had poorer receptive and expressive language outcomes at age 4.5 years compared to non-opioid exposed children. After adjustment for child sex, maternal education, other pregnancy substance use, maternal pregnancy nutrition and prenatal depression, opioid exposure remained a significant independent predictor of children’s total CELF-P language score. Examination of a range of potential intervening factors showed that a composite measure of the quality of parenting and home environment at age 18 months and early childhood education participation at 4.5 years were important positive mediators.

Diagnostic indicators of risk-prone health behaviors in pregnant adolescents

PURPOSE

This study aimed to identify diagnostic indicators associated with the nursing diagnosis risk-prone health behaviors in pregnant adolescents.

METHODS

We conducted a cross-sectional study. The sample consisted of 181 pregnant adolescents. A latent class analysis was conducted to verify associations between the defining characteristics of risk-prone health behaviors and diagnostic accuracy measures. Logistic regression was used to identify factors associated with the manifestation of risk-prone health behavior.

FINDINGS

The prevalence of risk-prone health behaviors in this sample was 31.04%. The defining characteristics failure to take action that prevents health problems and inappropriate eating habits achieved a high sensitivity. The related factors such as insufficient social support, stressors, low self-efficacy, social anxiety, isolated region of residence, and restricted access to health services presented significant associations with risk-prone health behavior.

CONCLUSIONS

The diagnostic indicators associated with the nursing diagnosis of risk-prone health behavior were failure to take action that prevents health problems inappropriate eating habits, insufficient social support, stressors, low self-efficacy, social anxiety, isolated region of residence, and restricted access to health services.

IMPLICATIONS FOR NURSING PRACTICE

This study contributes to knowledge about the diagnostic indicators of risk-prone health behavior, which may help nurses reach the proper diagnosis. This will facilitate the application of clinical judgment in nursing care to assist pregnant adolescents.

Personality traits in substance use disorders and obesity when compared to healthy controls

BACKGROUND AND AIMS

Although personality traits are implicated in substance use disorders (SUDs) and obesity, differences and similarities between them have not been assessed. Our main aim was to compare personality traits between people with different SUDs, obese people and healthy controls.

DESIGN

This was a secondary analysis of personality scores obtained from participants in neuroimaging studies from Brookhaven National Laboratory and the Laboratory of Neuroimaging, National Institutes of Health.

SETTING

United States.

PARTICIPANTS/CASES

Individuals with obesity (OB) n = 41, alcohol use disorder (AUD) n = 39, marijuana use disorder (MUD) n = 24, cocaine use disorder (CUD) n = 100, and healthy controls (HC) n = 117 (237 males and 84 females).

MEASUREMENTS

The Multidimensional Personality Questionnaire, which characterizes positive emotionality (PEM), negative emotionality (NEM) and constraint (CON) traits. Adjusted covariates included cigarette smoking status, age, gender and body mass index (BMI).

FINDINGS

Multivariate analysis of covariance showed a main group effect (i.e. OB, AUD, MUD, CUD and HC) only on NEM (P < 0.0001, η²  = 0.17) and CON (P = 0.005, η²  = 0.12). Specifically, NEM was higher in AUD (P < 0.0001, d = 10.4), CUD (P < 0.0001, d = 8.2) and MUD (P = 0.001, d = 9.2), but not in OB (P > 0.05, d = 2.8) relative to HC. CUD showed lower CON (P = 0.015, d = 5.4) and PEM (P = 0.018, d = 4.8) than HC; however, these differences were not significant in the other groups. NEM and CON were negatively correlated for groups combined (r = -0.26, P < 0.0001), and separately for OB (r = -0.49, P = 0.001) and CUD (r = -0.22, P = 0.03). Cigarette smoking status did not influence group differences in NEM, PEM or CON.

CONCLUSIONS

Compared with healthy controls, people with substance use disorders appear to show higher negative emotionality, and people with cocaine use disorders appear to show lower positive emotionality and constraint traits. Similar findings were not found among people with obesity.

Educational achievement at age 9.5 years of children born to mothers maintained on methadone during pregnancy

Recent research shows that preschool children born to opioid-dependent mothers are at increased risk for cognitive, psychomotor, attention, and social-emotional adjustment problems. But very little is known about their school-age functioning, particularly their educational achievement. This analysis examined the educational outcomes of a regional cohort of 100 prenatally methadone-exposed children who were prospectively studied from birth to age 9.5 years alongside a comparison group of 110 randomly identified non-exposed children born between 2003 and 2008. At age 9.5, as part of a comprehensive neurodevelopmental evaluation, children's teachers rated their achievement across the school curriculum, and children completed the Woodcock Johnson-III Tests of Achievement (WJ-III). Detailed information about the birth mother's social background, pregnancy substance use, and mental health was also collected during pregnancy/at term. Infant clinical data were collected after birth. Methadone-exposed children performed less well than non-exposed children across seven school curriculum areas rated by teachers (ps ≤.001), performed less well than non-exposed children on all reading and mathematics subtests of the WJ-III, and had higher rates of any educational delay on the WJ-III (57% vs. 15%), OR = 7.47 (3.71-15.02). Results were similar when children with severe intellectual impairment were excluded. After adjusting for confounding factors, methadone-exposed children had increased odds of educational delay, but this was only marginally significant (OR = 3.62, [1.01-13.01], p = .049). Maternal educational attainment level (OR = 0.69, [0.50-0.89], p = .006), and maternal benzodiazepine use during pregnancy (OR = 2.70 [1.03-7.12], p = .044) were also associated with later educational risk. Findings suggest that children born to opioid-dependent women enrolled in methadone maintenance are at high risk of educational delay by age 9.5 years. Children's academic difficulties appeared to reflect the effects of both adverse prenatal exposures and postnatal social risk.

Cognitive and Motor Outcomes of Children With Prenatal Opioid Exposure: A Systematic Review and Meta-analysis

IMPORTANCE

Prenatal opioid exposure (POE) is one of the fastest-growing global health problems, but its association with long-term neurologic and physical development remains unknown.

OBJECTIVE

To assess the association between POE and cognitive and motor development in children from age 6 months to 18 years.

DATA SOURCES

Key search terms included prenatal opioid exposure, neonatal abstinence syndrome, and neurocognitive development. Studies were searched using PubMed and Embase, with no publication date restriction, through August 20, 2018.

STUDY SELECTION

Only published cohort studies comparing the results of age-appropriate standardized cognitive and/or motor tests between children with any POE (aged 0-18 years) with drug-free controls were included. Data that were not convertible to means and SDs were excluded.

DATA EXTRACTION AND SYNTHESIS

This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Data were pooled using a random-effects model.

MAIN OUTCOMES AND MEASURES

Standardized mean difference of cognitive and motor tests between POE and nonexposed children.

RESULTS

Twenty-six peer-reviewed cohort studies were included. Cognitive outcomes were compared for a total of 1455 children with POE and 2982 nonexposed children across 3 age groups (mean [SE] age at cognitive testing was 13 [1.58] months for the toddler group; 4.5 [0.38] years for the preschool group; and 13 [2.36] years for the school-aged group). Motor outcomes were compared for 688 children with POE and 1500 nonexposed children up to age 6 years (mean [SD] age at motor testing, 2 [0.45] years). Standardized mean difference was lower in cognitive tests for children with POE at 0 to 2 years (d = -0.52; 95% CI, -0.74 to -0.31; P < .001) and 3 to 6 years (d = -0.38; 95% CI, -0.69 to -0.07; P < .001); the difference was not significant for those aged 7 to 18 years (d = -0.44; 95% CI, -1.16 to 0.28; P = .23). Motor scores were lower in children with POE (d = 0.49; 95% CI, 0.23-0.74; P < .001).

CONCLUSIONS AND RELEVANCE

Prenatal opioid exposure appeared to be negatively associated with neurocognitive and physical development from age 6 months, and this association persisted until adolescence. The cause and association of this with POE or other factors (eg, withdrawal treatment) are uncertain but suggest that POE necessitates long-term support and intervention.

Beliefs and attitudes regarding prenatal marijuana use: Perspectives of pregnant women who report use

OBJECTIVE

With the increasingly permissive legal and social environments regarding marijuana, it is important to understand prenatal marijuana use from the perspective of women who use marijuana. Our objective was to qualitatively describe the marijuana use experiences, beliefs, and attitudes of women who used marijuana during pregnancy.

METHODS

We conducted semi-structured interviews with pregnant women who had either reported current marijuana use or had urine testing positive for marijuana. Interviews were transcribed verbatim and analyzed for patterns and themes.

RESULTS

Twenty-five pregnant women who used marijuana during their pregnancies participated in our study interviews. Main themes that emerged from the interviews were that women: 1) reported higher amounts of marijuana use prior to pregnancy and attempted to reduce their use once they realized they were pregnant; 2) used marijuana to help with nausea and appetite changes during pregnancy or to improve mood; 3) described marijuana as "natural" and "safe" compared to other substances such as alcohol, tobacco, other recreational drugs, and prescribed medications; 4) had conflicting opinions regarding whether marijuana was addictive; and 5) were uncertain but had some concerns regarding potential risks of prenatal marijuana use.

CONCLUSION

Pregnant women who used marijuana in pregnancy held contradictory beliefs about continued use; they reported trying to reduce usage and were worried about potential risks, but also felt that marijuana is more natural and safer than other substances, including prescribed medicines. These findings have implications for how practitioners address prenatal marijuana use and highlight the need for further research on developmental outcomes.