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Tabachnick AR, Eiden RD, Labella MH, Dozier M. Effects of prenatal opioid exposure on infant sympathetic and parasympathetic nervous system activity. Psychophysiology 2024; 61:e14470. [PMID: 37888142 PMCID: PMC10939941 DOI: 10.1111/psyp.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
Prenatal opioid exposure has been associated with developmental problems, including autonomic nervous system dysregulation. However, little is known about the effects of prenatal opioid exposure on the autonomic nervous system beyond the first days of life, particularly across both the parasympathetic and sympathetic branches, and when accounting for exposure to other substances. The present study examined the effects of prenatal exposure to opioid agonist therapy (OAT, e.g., methadone) and other opioids on infant autonomic nervous system activity at rest and in response to a social stressor (the Still-Face Paradigm) at six months among 86 infants varying in prenatal opioid and other substance exposure. Results indicated that OAT and other opioids have unique effects on the developing autonomic nervous system that may further depend on subtype (i.e., methadone versus buprenorphine) and timing in gestation. Results are discussed in the context of theoretical models of the developing stress response system.
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Affiliation(s)
| | - Rina Das Eiden
- Department of Psychology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Madelyn H Labella
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
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2
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Maylott SE, Conradt E, McGrath M, Knapp EA, Li X, Musci R, Aschner J, Avalos LA, Croen LA, Deoni S, Derefinko K, Elliott A, Hofheimer JA, Leve LD, Madan JC, Mansolf M, Murrison LB, Neiderhiser JM, Ozonoff S, Posner J, Salisbury A, Sathyanarayana S, Schweitzer JB, Seashore C, Stabler ME, Young LW, Ondersma SJ, Lester B. Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes. J Pediatr 2023; 260:113468. [PMID: 37182662 PMCID: PMC10524438 DOI: 10.1016/j.jpeds.2023.113468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/30/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To predict behavioral disruptions in middle childhood, we identified latent classes of prenatal substance use. STUDY DESIGN As part of the Environmental influences on Child Health Outcomes Program, we harmonized prenatal substance use data and child behavior outcomes from 2195 women and their 6- to 11-year-old children across 10 cohorts in the US and used latent class-adjusted regression models to predict parent-rated child behavior. RESULTS Three latent classes fit the data: low use (90.5%; n = 1986), primarily using no substances; licit use (6.6%; n = 145), mainly using nicotine with a moderate likelihood of using alcohol and marijuana; and illicit use (2.9%; n = 64), predominantly using illicit substances along with a moderate likelihood of using licit substances. Children exposed to primarily licit substances in utero had greater levels of externalizing behavior than children exposed to low or no substances (P = .001, d = .64). Children exposed to illicit substances in utero showed small but significant elevations in internalizing behavior than children exposed to low or no substances (P < .001, d = .16). CONCLUSIONS The differences in prenatal polysubstance use may increase risk for specific childhood problem behaviors; however, child outcomes appeared comparably adverse for both licit and illicit polysubstance exposure. We highlight the need for similar multicohort, large-scale studies to examine childhood outcomes based on prenatal substance use profiles.
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Affiliation(s)
- Sarah E Maylott
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC; Department of Psychology, University of Utah, Salt Lake City, UT.
| | - Elisabeth Conradt
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC; Department of Psychology, University of Utah, Salt Lake City, UT
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD
| | - Judy Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Albert Einstein College of Medicine, Bronx, NY
| | - Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Sean Deoni
- Department of Pediatrics and Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI
| | - Karen Derefinko
- Department of Preventive Medicine and Department of Pharmacology, Addiction Science, and Toxicology, The University of Tennessee Health Science Center, Memphis, TN
| | - Amy Elliott
- Avera Research Institute and Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD
| | - Julie A Hofheimer
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leslie D Leve
- Prevention Science Institute, University of Oregon, Eugene, OR
| | - Juliette C Madan
- Department of Pediatrics, Psychiatry and Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Maxwell Mansolf
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Liza B Murrison
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Sally Ozonoff
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA
| | - Jonathan Posner
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Amy Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA
| | - Sheela Sathyanarayana
- Departments of Pediatrics, Environmental and Occupational Health Sciences, and Epidemiology, University of Washington, Seattle, WA; Seattle Children's Research Institute, Seattle, WA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, School of Medicine, Sacramento, CA
| | - Carl Seashore
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Meagan E Stabler
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH
| | - Leslie W Young
- Department of Pediatrics, University of Vermont Medical Center, Burlington, VT
| | - Steven J Ondersma
- Division of Public Health and Department of Obstetrics, Gynecology, & Reproductive Biology, Michigan State University, East Lansing, MI
| | - Barry Lester
- Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
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Ickowicz S, McLean M. Case report: rapid inpatient methadone titration during pregnancy. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1953167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sarah Ickowicz
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark McLean
- Department of Family Medicine, University of British Columbia, Vancouer, British Columbia, Canada
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Puls HT, Anderst JD, Farst K, Hall M. Intrauterine Substance Exposure and the Risk for Subsequent Physical Abuse Hospitalizations. Acad Pediatr 2020; 20:468-474. [PMID: 32081768 DOI: 10.1016/j.acap.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/24/2020] [Accepted: 02/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe the relative risk for a physical abuse hospitalization among substance exposed infants (SEI) with and without neonatal abstinence syndrome (NAS). METHODS We created a nationally representative US birth cohort using the 2013 and 2014 Nationwide Readmissions Databases. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify newborns, predictor variables, and subsequent hospitalizations for physical abuse within 6 months of discharge from newborns' birth hospitalization. Predictor variables included newborn demographics, prematurity or low birth weight, and intrauterine substance exposure: non-SEI, SEI without NAS, and SEI with NAS. Multiple logistic regression calculated adjusted relative risks and 95% confidence intervals. A subanalysis of newborns with narcotic exposure was performed. RESULTS There were 3,740,582 newborns in the cohort; of which 13,024 (0.4%) were SEI without NAS and 20,196 (0.5%) SEI with NAS. Overall, 1247 (0.03%) newborns were subsequently hospitalized for physical abuse within 6 months. Compared to non-SEI, SEI with NAS (adjusted relative risks: 3.84 [95% confidence intervals: 2.79-5.28]) were at increased risk for having a subsequent hospitalization for physical abuse, but SEI without NAS were not. A similar pattern was observed among narcotic-exposed infants; infants with NAS due to narcotics were at increased risk, but narcotic-exposed infants without NAS were not. CONCLUSIONS Our results suggest that newborns diagnosed with NAS are at increased risk of physical abuse during early infancy, above that of substance-exposed infants without NAS. These results should improve the identification of higher-risk infants who may benefit from more rigorous safety planning and follow-up care.
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Affiliation(s)
- Henry T Puls
- Division of Hospital Medicine, Department of Pediatrics (HT Puls and M Hall), Children's Mercy Kansas City, Kansas City, Mo.
| | - James D Anderst
- Child Adversity and Resilience, Department of Pediatrics (JD Anderst), Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Karen Farst
- Section for Children at Risk, Department of Pediatrics (K Farst), University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Matthew Hall
- Division of Hospital Medicine, Department of Pediatrics (HT Puls and M Hall), Children's Mercy Kansas City, Kansas City, Mo; Children's Hospital Association (M Hall), Lenexa, Kans
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Mravčík V, Nechanská B, Gabrhelík R, Handal M, Mahic M, Skurtveit S. Socioeconomic characteristics of women with substance use disorder during pregnancy and neonatal outcomes in their newborns: A national registry study from the Czech Republic. Drug Alcohol Depend 2020; 209:107933. [PMID: 32109712 DOI: 10.1016/j.drugalcdep.2020.107933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal substance use can pose a risk to the fetal health. We studied the background characteristics of women with substance use disorders (SUDs) and selected neonatal outcomes in their children. MATERIAL AND METHODS A database-linkage study was performed. The sample consisted of pregnant women with a SUD during pregnancy (ICD-10 diagnosis F10-F19 except F17, n = 1710), women not diagnosed with a SUD (n = 1,511,310) in Czechia in 2000-2014, and their children. The monitored neonatal outcomes were gestational age, birth weight, preterm birth, and small-for-gestational age (SGA). Binary logistic regression adjusted for age, marital status, education, concurrent substance use, and prenatal care was performed. RESULTS Women with illicit SUDs were younger, more often unmarried, with a lower level of education, a higher abortion rate, a higher smoking rate, and lower compliance to prenatal care than women with a SUD related to alcohol, or sedatives and hypnotics (SH). Women with a SUD had worse socioeconomic situations, poorer pregnancy care, and worse neonatal outcomes than women without a SUD. After adjustment, we found no difference in SGA between the illicit SUD groups and the alcohol and the SH groups. The newborns from all SUD groups had a higher risk of SGA when compared to women without a SUD. However after adjustment, the difference remained significant just in the alcohol group (OR = 1.9, 95 % CI = 1.4-2.6). CONCLUSION Mother's SUD during pregnancy increased risk of fetal growth restriction as measured by SGA. The role of maternal socioeconomic and lifestyle factors for the risk of SGA was substantial.
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Affiliation(s)
- Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic.
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Marte Handal
- Norwegian Institute of Public Health, Oslo, Norway
| | - Milada Mahic
- Norwegian Institute of Public Health, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway; Norwegian Centre for Addiction Research at the University of Oslo, Norway
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Prevalence of Fetal Alcohol Exposure by Analysis of Meconium Fatty Acid Ethyl Esters; A National Canadian Study. Sci Rep 2019; 9:2298. [PMID: 30783158 PMCID: PMC6381181 DOI: 10.1038/s41598-019-38856-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/09/2019] [Indexed: 01/02/2023] Open
Abstract
Our study aimed to estimate the prevalence of heavy fetal alcohol exposure through the analysis of meconium FAEEs as an objective biomarker of fetal exposure. We conducted a study on meconium samples collected nationwide through the Maternal-Infant Research on Environmental Chemicals (MIREC) Study Group. FAEE in meconium was quantified by an established headspace solid-phase microextraction coupled with gas chromatography-mass spectrometry (SPME GC-MS). Out of 1315 samples collected in 10 Canadian obstetric units coast to coast between 2008-2011, the estimated prevalence of positive meconium FAEE ranged between 1.16% and 2.40%, translating into at least 1800 new cases of FASD in Canada each year. Positive maternal self- reports of heavy alcohol use were tenfold lower (0.24%). Use of meconium FAEE revealed tenfold more cases of heavy exposure to maternal drinking than did maternal reports. The use of objective measures of maternal alcohol exposure is critical in accurately estimating risks and in monitoring effective prevention of FASD.
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Sanjuan PM, Pearson MR, Poremba C, Amaro HDLA, Leeman L. An ecological momentary assessment study examining posttraumatic stress disorder symptoms, prenatal bonding, and substance use among pregnant women. Drug Alcohol Depend 2019; 195:33-39. [PMID: 30572290 PMCID: PMC6359965 DOI: 10.1016/j.drugalcdep.2018.11.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Substance use disorder (SUD) during pregnancy requires efficacious interventions based on understanding the ebb and flow of risk and protective factors for substance use across time. To assess how these fluctuations are associated temporally with substance use, we used ecological momentary assessment (EMA) to evaluate substance use risk (posttraumatic stress disorder [PTSD] symptoms) and protective (prenatal fetal bonding) factors and their associations with prenatal substance use recorded in real time. METHODS Pregnant women in SUD treatment (N = 33) with prior trauma exposure received smartphones with an EMA application that queried them thrice daily for 28 days about PTSD symptoms, prenatal bonding, and substance use. RESULTS Nearly all (N = 32) provided EMA data resulting in 2049 EMA reports (74% compliance). Most participants reported tobacco (72%), alcohol (22%), heroin (41%), and/or other illicit drug (6%-31%) use at least once via EMA. There were moderate associations (average β = 0.23) between greater daily peak PTSD symptoms and substance use with significant effects on illicit drug (β = 0.37), cannabis (β = 0.35) and cigarette use (β = 0.24). Prenatal bonding subscales were modestly associated with substance use, with daily intensity of attachment low point associated with lower heroin (β=-0.34), but higher alcohol (β = 0.24) use. Quality of attachment low point was associated with higher cigarette use (β = 0.06). CONCLUSIONS Despite the SUD severity and social instability of this sample, we observed high rates of compliance. We found preliminary support suggesting daily PTSD symptoms as a risk factor and less consistent support for prenatal bonding as a protective factor for prenatal substance use.
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Affiliation(s)
- Pilar M Sanjuan
- The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM 87106, USA.
| | - Matthew R Pearson
- The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM 87106, USA
| | - Carly Poremba
- The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM 87106, USA
| | - Hortensia de Los Angeles Amaro
- Academic Health Center, Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC2, Miami, FL 33199, USA
| | - Lawrence Leeman
- Departments of Family and Community Medicine, Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM 87131 USA
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Wachman EM, Warden AH, Thomas Z, Thomas-Lewis JA, Shrestha H, Nikita FNU, Shaw D, Saia K, Schiff DM. Impact of psychiatric medication co-exposure on Neonatal Abstinence Syndrome severity. Drug Alcohol Depend 2018; 192:45-50. [PMID: 30205307 DOI: 10.1016/j.drugalcdep.2018.07.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Among opioid-exposed infants, psychiatric medication co-exposure is common. Our objective was to compare Neonatal Abstinence Syndrome (NAS) outcomes based on individual psychiatric medication co-exposures. METHODS A retrospective study of 744 opioid-exposed mother-infant dyads from a single institution was performed. Mothers on pharmacotherapy with methadone or buprenorphine at delivery were included. Data were collected on maternal demographics, psychiatric medication use, and NAS outcomes, including any medication treatment, adjunctive medication treatment, length of hospital stay (LOS), and opioid treatment days. The extent to which individual psychiatric medication and polypharmacy exposure were associated with NAS outcomes was assessed using multivariable regression. RESULTS Fifty-four percent of the mothers were on ≥1 psychiatric medication, with 32% on ≥2 or psychiatric medications (polypharmacy group). In adjusted models, polypharmacy exposure was associated with longer LOS (β = 4.31 days, 95% CI 2.55-6.06) and opioid treatment days (β = 3.98 days, 95% CI 2.24-5.72) and more treatment with adjunctive medication for NAS (aOR = 2.49, 95% CI 1.57-3.95). Benzodiazepines were associated with longer LOS (β = 4.94, 95% CI 2.86-7.03) and opioid treatment days (β = 4.86, 95% CI 2.61-6.75), and more adjunctive medication treatment (aOR = 2.57, 95% CI 1.49-4.42). Gabapentin was associated with longer LOS (β = 2.79, 95% CI 0.54-5.03), more NAS medication treatment (aOR = 2.96, 95% CI 1.18-7.42) including more adjunctive medications (aOR = 1.92, 95% CI 1.05-3.53). CONCLUSION For infants of mothers with OUD who are also on concurrent psychiatric medications, polypharmacy was associated with worse NAS severity. When medically indicated, limiting use of multiple psychiatric medications, particularly benzodiazepines and gabapentin, during pregnancy should be considered to improve NAS outcomes.
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Affiliation(s)
- Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - A Hutcheson Warden
- Department of Obstetrics and Gynecology, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - Zoe Thomas
- University of Massachusetts, 300 Massachusetts Ave, Amherst, MA, 01003, USA.
| | - Jo Ann Thomas-Lewis
- Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
| | - Hira Shrestha
- Department of Pediatrics, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - F N U Nikita
- Boston University School of Public Health, 715 Albany Street, Boston, MA, 021178, USA.
| | - Daniel Shaw
- Department of Psychiatry, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - Kelley Saia
- Department of Obstetrics and Gynecology, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - Davida M Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, 55 Fruit Street, Boston, MA, 02114, USA.
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Louw KA. Substance use in pregnancy: The medical challenge. Obstet Med 2018; 11:54-66. [PMID: 29997687 PMCID: PMC6038015 DOI: 10.1177/1753495x17750299] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/20/2017] [Indexed: 01/04/2023] Open
Abstract
Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.
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Affiliation(s)
- Kerry-Ann Louw
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Nygaard E, Slinning K, Moe V, Due-Tønnessen P, Fjell A, Walhovd KB. Neuroanatomical characteristics of youths with prenatal opioid and poly-drug exposure. Neurotoxicol Teratol 2018; 68:13-26. [PMID: 29679636 DOI: 10.1016/j.ntt.2018.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/21/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022]
Abstract
Neuroanatomical and cognitive differences have been documented during childhood between children with prenatal opioid- and poly-drug exposure and controls in small samples. We investigated whether these differences persisted in larger samples of youth at older ages. Quantitative MRI and cognitive data were compared between 38 youths in the risk group and 44 youths in the non-exposed group (aged 17 to 22 years) who had been followed prospectively since birth. Most drug-exposed youths (84%) moved to permanent foster or adoptive homes before one year of age. The drug-exposed group displayed smaller neuroanatomical volumes (0.70 SD difference in total brain volume, p = 0.001), smaller cortical surface areas and thinner cortices than the comparison group. The birth weight accounted for some of the intergroup differences. Neuroanatomical characteristics partially mediated group differences in cognitive function. The present study cannot differentiate between causal factors but indicates persistent neurocognitive differences associated with prenatal opioid or poly-drug exposure.
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Affiliation(s)
- Egil Nygaard
- Department of Psychology, University of Oslo, Postbox 1094 Blindern, 0317 Oslo, Norway; Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Postbox 4623 Nydalen, 0405 Oslo, Norway.
| | - Kari Slinning
- Department of Psychology, University of Oslo, Postbox 1094 Blindern, 0317 Oslo, Norway; Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Postbox 4623 Nydalen, 0405 Oslo, Norway.
| | - Vibeke Moe
- Department of Psychology, University of Oslo, Postbox 1094 Blindern, 0317 Oslo, Norway; Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Postbox 4623 Nydalen, 0405 Oslo, Norway.
| | - Paulina Due-Tønnessen
- Department of Psychology, University of Oslo, Postbox 1094 Blindern, 0317 Oslo, Norway; Department of Radiology, Rikshospitalet University Hospital, Oslo, Norway.
| | - Anders Fjell
- Department of Psychology, University of Oslo, Postbox 1094 Blindern, 0317 Oslo, Norway.
| | - Kristine B Walhovd
- Department of Psychology, University of Oslo, Postbox 1094 Blindern, 0317 Oslo, Norway.
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Yoo SH, Jansson LM, Park HJ. Sensorimotor outcomes in children with prenatal exposure to methadone. J AAPOS 2017; 21:316-321. [PMID: 28709965 DOI: 10.1016/j.jaapos.2017.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/16/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the presentation and characteristics of strabismus in children with prenatal methadone exposure. METHODS The medical records of children with prenatal methadone exposure were retrospectively reviewed. Those who were evaluated by pediatric ophthalmology were included. Information on the timing and types of prenatal exposure by trimester of pregnancy was then collected from the patients' mothers' charts. The children's perinatal histories and ophthalmologic findings were collected from their pediatric clinic charts and ophthalmology clinic charts, respectively. RESULTS A total of 210 children with prenatal methadone exposure were identified, of whom 32 (15.2%) underwent eye examinations and 21 (10%) had strabismus. Five patients had esodeviations, with a mean age of onset of 11.6 months; 16 had exodeviations, with a mean age of onset of 6.8 months. Three patients with strabismus were born prematurely, and 2 had intracranial disease. Two patients underwent strabismus surgery. CONCLUSIONS The incidence of strabismus in patients with prenatal methadone exposure was higher than in the general population (10% vs 3%-4%). Intermittent exotropia was the most common type of strabismus and presented earlier than in the general population, with no association with other systemic disease. Prenatal exposure to methadone was likely confounded by exposure to other substances, environmental factors, and genetics. Poor compliance with follow-up reduced the power of the study.
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Affiliation(s)
- Sylvia H Yoo
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts.
| | - Lauren M Jansson
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland
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Reitan T. Patterns of polydrug use among pregnant substance abusers. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:145-159. [PMID: 32934478 PMCID: PMC7450863 DOI: 10.1177/1455072516687256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
Aim Studies of drug use during pregnancy have generally focused on individual substances or specific combinations of drugs. The aim of this article is to increase our knowledge about polydrug use and pregnancy in a Nordic context by describing the sociodemographic characteristics of a clinical population of pregnant women with severe substance use, examining the scope and type of polydrug use and analysing factors associated with concurrent use of many, as opposed to a few, drugs. Method A cross-sectional study of pregnant women on admission to compulsory care for substance abuse in Sweden between 2000 and 2009 (n = 119 women, representing 128 pregnancies). Data were retrieved from administrative registers and client records. Univariate links between demographic, social, obstetrical, treatment history variables and polydrug use were examined. Binary logistic regression was used to analyse the association between explanatory variables and polydrug use. Results The average number of drugs being used concurrently was 2.65, and injection drug use was recorded in 73% of the pregnancies. Opiates and amphetamines were the most common primary drugs, followed by alcohol. The likelihood of polydrug use increased with first trimester pregnancy, planned (as opposed to emergency) committals, as well as the combination of partner substance abuse and injection drug use. Conclusions Polydrug use was widespread among pregnant substance abusers. Policies, interventions and research often focus on individual drugs separately, but for clinical populations in particular there is a need to address drug use broadly, including a systematic recording of smoking habits. This also entails awarding more attention to those not eligible for established interventions, such as opiate maintenance treatment, and giving more consideration to a variety of life circumstances, such as partner drug use.
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Affiliation(s)
- Therese Reitan
- Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Sweden
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Garrison L, Leeman L, Savich RD, Gutierrez H, Rayburn WF, Bakhireva LN. Fetal Growth Outcomes in a Cohort of Polydrug- and Opioid-Dependent Patients. THE JOURNAL OF REPRODUCTIVE MEDICINE 2016; 61:311-319. [PMID: 29075045 PMCID: PMC5654486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the effects of prenatal polydrug and exclusive opioid use on fetal growth outcomes. METHODS This analysis relied on the data obtained from two prospective cohorts at the University of New Mexico. For both cohorts, pregnant women were recruited during one of their prenatal care visits and followed up to delivery. The merged sample included 59 polydrug users, 22 exclusive opioid users, and 278 abstinent controls. Continuous growth measures (birth weight, height, occipital frontal circumference [OFC], and corresponding sex-specific percentiles) were compared by ANOVA and ANCOVA in bivariate and multivariable analyses, respectively. Categorical outcomes (prevalence of small-for-gestational age [SGA] for weight, length, and OFC) were compared among groups by Chi-square and multivariable logistic regression analyses.. RESULTS The sample included a large proportion of ethnic minorities (78.8% Hispanic) and patients with low educational attainment (68% ≤ high school). The risk of microcephaly (OFC<10th percentile) was significantly greater in the polydrug (OR=4.7; 95% CI: 2.0; 10.8) and exclusive opioid (OR=2.8; 95% CI: 1.0; 8.1) groups compared to abstinent controls. CONCLUSION Given that microcephaly is often associated with serious neurocognitive and behavioral deficits later in life, our finding of 49.2% incidence of microcephaly among polydrug users is alarming and requires further investigation.
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Nygaard E, Slinning K, Moe V, Walhovd KB. Behavior and Attention Problems in Eight-Year-Old Children with Prenatal Opiate and Poly-Substance Exposure: A Longitudinal Study. PLoS One 2016; 11:e0158054. [PMID: 27336798 PMCID: PMC4918960 DOI: 10.1371/journal.pone.0158054] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/09/2016] [Indexed: 01/08/2023] Open
Abstract
Multiple studies have found that children born to mothers with opioid or poly-substance use during pregnancy have more behavior and attention problems and lower cognitive functioning than non-exposed children. The present study aimed to investigate whether behavior and attention problems are more prominent than general cognitive deficits in this risk group and whether the problems wane or increase over time. This prospective longitudinal cross-informant study compared 72 children who were prenatally exposed to heroin and multiple drugs with a group of 58 children without known prenatal risk factors. Group differences in caregivers' and teachers' reports of the children's behavior and attention problems based on the Child Behavior Check List and the ADHD Rating Scale were compared based on group differences in general cognitive functioning at 4 ½ and 8 ½ years of age. Both parent and teacher reports suggest that the exposed group has significantly more problems in several behavioral areas than the comparison group, particularly with regard to attention problems. The preschool teachers had already reported these problems when the children were 4 ½ years old, whereas the caregivers reported these problems mainly when the children were 8 ½ years old. The group differences in behavioral and attentional problems were not significantly greater and some were even significantly smaller than the group differences in general cognitive abilities. These findings suggest that children subject to prenatally drug exposure have increasing problems in multiple areas related to behavior from preschool age to 8 ½ years but that these problems do not seem to be specific; i.e., they are not more severe than the problems with general cognitive abilities found for this group.
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Affiliation(s)
- Egil Nygaard
- Research Group for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Oslo, Norway
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Kari Slinning
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Vibeke Moe
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Kristine B. Walhovd
- Research Group for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Unit of Neuropsychology, Oslo University Hospital, Oslo, Norway
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Madadi P, Kelly LE, Ross CJ, Kepron C, Edwards JN, Koren G. Forensic Investigation of Methadone Concentrations in Deceased Breastfed Infants. J Forensic Sci 2015; 61:576-580. [PMID: 26513313 DOI: 10.1111/1556-4029.12972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/16/2015] [Accepted: 04/11/2015] [Indexed: 11/29/2022]
Abstract
There is a paucity of data to aid in assessing whether postmortem methadone findings in breastfed infants are clinically and/or toxicologically significant. Two cases are reported in which methadone was detected in deceased neonates whose mothers were enrolled in methadone maintenance programs and were breastfeeding. In addition to a complete autopsy and toxicological testing for alcohol, prescription medications, and drugs of abuse, pharmacogenetic analysis was performed for variants in genes related to methadone metabolism and response. In both cases, the postmortem methadone concentration measured in neonatal heart blood was higher than the maximum serum methadone concentration reported in living breastfed infants whose mothers were receiving methadone. However, additional analysis of antemortem blood indicated postmortem redistribution of methadone. Pharmacogenetic results were suggestive of a potential predisposition to methadone toxicity based on studies in adults; the significance of these findings in breastfed neonates requires further research. The medical cause of death was unascertained in both cases.
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Affiliation(s)
- Parvaz Madadi
- Toxicology Section, Centre of Forensic Sciences, Toronto, ON, Canada
| | - Lauren E Kelly
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, and Ivey Chair in Molecular Toxicology, Western University, London, ON, Canada
| | - Colin J Ross
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.,Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Charis Kepron
- Ontario Forensic Pathology Service, Ottawa, ON, Canada
| | | | - Gideon Koren
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, and Ivey Chair in Molecular Toxicology, Western University, London, ON, Canada.,Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
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Nygaard E, Slinning K, Moe V, Walhovd KB. Cognitive function of youths born to mothers with opioid and poly-substance abuse problems during pregnancy. Child Neuropsychol 2015; 23:159-187. [DOI: 10.1080/09297049.2015.1092509] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Nygaard E, Moe V, Slinning K, Walhovd KB. Longitudinal cognitive development of children born to mothers with opioid and polysubstance use. Pediatr Res 2015; 78:330-5. [PMID: 25978800 PMCID: PMC4539602 DOI: 10.1038/pr.2015.95] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/18/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Previous studies indicate an increased risk for neuropsychological difficulties in young children prenatally exposed to opioids and polysubstances, but longitudinal information is scarce. The present longitudinal study investigated whether these waned, persisted, or increased over time. METHODS The cognitive functioning of 72 children with prenatal opioid and polysubstance exposure and 58 children without any established prenatal risk was assessed at 1, 2, 3, 4½, and 8½ y. RESULTS The exposed boys had significantly and stably lower levels of cognitive functioning than the control group, whereas there were increasing differences over time for the girls. The exposed group had significantly lower IQ scores than the control group on Wechsler Intelligence Scale for Children--Revised at 8½ y after controlling for earlier cognitive abilities, and for children who were permanently placed in adoptive/foster homes before 1 y of age and whose mothers used heroin as their main drug during pregnancy (B = 17.04, 95% CI 8.69-25.38, P < 0.001). CONCLUSION While effects of prenatal substance exposure cannot be isolated, group effects on cognition rather increased than waned over time, even in adoptive/foster children with minimal postnatal risk.
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Affiliation(s)
- Egil Nygaard
- Research Group for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Oslo, Norway
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Vibeke Moe
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Kari Slinning
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Kristine B. Walhovd
- Research Group for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilition, Unit of Neuropsychology, Oslo University Hospital, Oslo, Norway
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Chen CY, Lien YT, Yeh HH, Su LW, Ho IK. Comparison of adverse obstetric outcomes and maternity hospitalization among heroin-exposed and methadone-treated women in Taiwan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:191-8. [DOI: 10.1016/j.drugpo.2014.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/07/2014] [Accepted: 07/22/2014] [Indexed: 10/25/2022]
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Goettler SM, Tschudin S. Care of Drug-Addicted Pregnant Women: Current Concepts and Future Strategies – an Overview. WOMENS HEALTH 2014; 10:167-77. [DOI: 10.2217/whe.14.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review focuses on drug use during pregnancy and the perinatal period, a constellation that is seen more often. Drug use in pregnant women poses an increased risk for adverse health outcomes both for the mother and child. Care is often complicated by social and environmental factors, as well as psychiatric comorbidities. It is, therefore, very important to provide drug-using pregnant women with optimal ante-, peri- and post-natal care. Health professionals should approach them in a nonjudgmental and supportive way, and provide them with the same care and attention as nondrug-using women. Adequate care requires interdisciplinary teams. Ideally, healthcare providers should be specialized in the care of drug-using pregnant women.
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Affiliation(s)
- Simone M Goettler
- Department of Obstetrics & Gynecology, University Hospital Basel, Basel, Switzerland
| | - Sibil Tschudin
- Department of Obstetrics & Gynecology, University Hospital Basel, Basel, Switzerland
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