1
|
Li Q, Cai X, Zhou H, Ma D, Li N. Maternal smoking cessation in the first trimester still poses an increased risk of attention-deficit/hyperactivity disorder and learning disability in offspring. Front Public Health 2024; 12:1386137. [PMID: 39081356 PMCID: PMC11286595 DOI: 10.3389/fpubh.2024.1386137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
Background Studies have found maternal smoking during pregnancy was linked to attention-deficit/hyperactivity disorder (ADHD) risk. It is unclear if maternal smoking cessation during pregnancy lowers ADHD and learning disability (LD) risk in offspring. This study aimed to explore the associations between maternal smoking cessation during pregnancy and ADHD and LD risk in offspring. Methods Data from the National Health and Nutrition Examination Survey 1999-2004 (8,068 participants) were used. Logistic regression was used to analyze the associations between maternal smoking and smoking cessation during pregnancy and ADHD and LD risk in offspring. Results Compared to non-smokers' offspring, maternal smoking during pregnancy increased the risk of ADHD (odds ratios [OR] = 2.07, 95% confidence interval [CI]: 1.67-2.56) and LD (OR = 1.93, 95% CI: 1.61-2.31) in offspring, even if mothers quit smoking later (ORADHD = 1.91, 95%CIADHD: 1.38-2.65, ORLD = 1.65, 95%CILD: 1.24-2.19). Further analysis of the timing of initiation of smoking cessation during pregnancy revealed that, compared to non-smokers' offspring, maternal quitting smoking in the first trimester still posed an increased risk of ADHD (OR = 1.72, 95% CI: 1.41-2.61) and LD (OR = 1.52, 95% CI: 1.06-2.17) in offspring. Maternal quitting smoking in the second or third trimester also had a significantly increased risk of ADHD (OR = 2.13, 95% CI: 1.26-3.61) and LD (OR = 1.82, 95% CI: 1.16-2.87) in offspring. Furthermore, maternal smoking but never quitting during pregnancy had the highest risk of ADHD (OR = 2.17, 95% CI: 1.69-2.79) and LD (OR = 2.10, 95% CI: 1.70-2.58) in offspring. Interestingly, a trend toward a gradual increase in the risk-adjusted OR for ADHD and LD risk was observed among the three groups: maternal quitting smoking in the first trimester, maternal quitting smoking in the second or third trimester, and maternal smoking but never quitting. Conclusion Maternal smoking cessation in the first trimester still poses an increased risk of ADHD and LD in offspring. Furthermore, it seems that the later the mothers quit smoking during pregnancy, the higher the risk of ADHD and LD in their offspring. Therefore, early intervention of maternal smoking in preconception and prenatal care is vital for offspring neurodevelopment.
Collapse
Affiliation(s)
- Qiu Li
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiaotang Cai
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Hui Zhou
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Dan Ma
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Na Li
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| |
Collapse
|
2
|
Cinciripini PM, Green CE, Shete S, Minnix JA, Robinson JD, Cui Y, Kim S, Kypriotakis G, Beneventi D, Blalock JA, Versace F, Karam-Hage M. Smoking Cessation After Initial Treatment Failure With Varenicline or Nicotine Replacement: A Randomized Clinical Trial. JAMA 2024; 331:1722-1731. [PMID: 38696203 PMCID: PMC11066767 DOI: 10.1001/jama.2024.4183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024]
Abstract
Importance Most people who smoke do not quit on their initial attempt. Objective To determine the best subsequent strategy for nonabstinence following initial treatment with varenicline or combined nicotine replacement therapy (CNRT). Design, Setting, and Participants Using a double-blind, placebo-controlled, sequential multiple assignment randomized trial, 490 volunteers were randomized to receive 6 weeks of varenicline or CNRT. After 6 weeks, nonabstainers were rerandomized to continue, switch, or increase medication dosage for 6 additional weeks. The study was conducted from June 2015 through October 2019 in a Texas tobacco treatment clinic. Interventions The initial treatment was 2 mg/d of varenicline or the combined replacement therapy of a 21-mg patch plus 2-mg lozenge. The rerandomized participants either continued with their initial therapies, switched between varenicline and CNRT, or increased dosages either to 3-mg or more of varenicline or to a 42-mg patch and lozenges. All received weekly brief counseling. Main Outcomes and Measures Biochemically verified 7-day point prevalence abstinence at the end of treatment at 12 weeks. Results The 490 randomized participants (210 female [43%], 287 non-Hispanic White [58%], mean age, 48.1 years) smoked an average of 20 cigarettes per day. After the first phase, 54 participants in the CNRT group were abstinent and continued their therapy; of the 191 who were not abstinent, 151 were rerandomized, and the 40 who did not return for rerandomization were assigned to continue their initial CNRT condition in phase 2. The end-of-treatment abstinence rate for the 191 phase 1 nonabstainers was 8% (95% credible interval [CrI], 6% to 10%) for the 90 (47%) who continued at the dosage condition, 14% (CrI, 10% to 18%) for the 50 (33%) who increased their dosage, and 14% (95% CrI, 10% to 18%) for the 51 (34%) who switched to varenicline (absolute risk difference [RD], 6%; 95% CrI, 6% to 11%) with more than 99% posterior probability that either strategy conferred benefit over continuing the initial dosage. After the first phase, 88 participants in the varenicline group were abstinent and continued their therapy; of the 157 who were not abstinent, 122 were rerandomized and 35 who did not return for rerandomization were assigned to continue with the varenicline condition. The end-of-treatment abstinence rate for the 157 phase 1 nonabstainers was 20% (95% CrI, 16% to 26%) for the 39 (32%) who increased their varenicline dosage, 0 (95% CrI, 0 to 0) for the 41 (34%) who switched CNRT, and 3% (95% CrI, 1% to 4%) for the 77 (49%) who were assigned to the continued varenicline condition (absolute RD, -3%; 95% CrI, -4% to -1%) with more than 99% posterior probability that continuing varenicline at the initial dosage was worse than switching to a higher dosage. Furthermore, increasing the varenicline dosage had an absolute RD of 18% (95% CrI, 13% to 24%) and a more than 99% posterior probability of conferring benefit. The secondary outcome of continuous abstinence at 6 months indicated that only increased dosages of the CNRT and varenicline provided benefit over continuation of the initial treatment dosages. Conclusions and Relevance For individuals who smoked but did not achieve abstinence after treatment with varenicline, increasing the dosage enhanced abstinence vs continuing, whereas for nonabstainers initially treated with CNRT, a dosage increase or switch to varenicline enhanced abstinence and may be viable rescue strategies. Trial Registration ClinicalTrials.gov Identifier: NCT02271919.
Collapse
Affiliation(s)
- Paul M. Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Charles E. Green
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, University of Texas at Houston Health Sciences Center, Houston
| | - Sanjay Shete
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Jennifer A. Minnix
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Jason D. Robinson
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Yong Cui
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Seokhun Kim
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, University of Texas at Houston Health Sciences Center, Houston
| | - George Kypriotakis
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Diane Beneventi
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Janice A. Blalock
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Francesco Versace
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Maher Karam-Hage
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
3
|
Soares AR, Picciotto MR. Nicotinic regulation of microglia: potential contributions to addiction. J Neural Transm (Vienna) 2024; 131:425-435. [PMID: 37778006 PMCID: PMC11189589 DOI: 10.1007/s00702-023-02703-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
Clinical and preclinical studies have identified immunosuppressive effects of nicotine, with potential implications for treating nicotine addiction. Here we review how nicotine can regulate microglia, the resident macrophages in the brain, and corresponding effects of nicotine on neuroimmune signaling. There is significant evidence that activation of α7 nicotinic acetylcholine receptors (nAChRs) on microglia can trigger an anti-inflammatory cascade that alters microglial polarization and activity, cytokine release, and intracellular calcium concentrations, leading to neuroprotection. These anti-inflammatory effects of nicotine-dependent α7 nAChR signaling are lost during withdrawal, suggesting that neuroimmune signaling is potentiated during abstinence, and thus, heightened microglial activity may drive circuit disruption that contributes to withdrawal symptoms and hyperkatifeia. In sum, the clinical literature has highlighted immunomodulatory effects of nicotine and the potential for anti-inflammatory compounds to treat addiction. The preclinical literature investigating the underlying mechanisms points to a role of microglial engagement in the circuit dysregulation and behavioral changes that occur during nicotine addiction and withdrawal, driven, at least in part, by activation of α7 nAChRs on microglia. Specifically targeting microglial signaling may help alleviate withdrawal symptoms in people with nicotine dependence and help to promote abstinence.
Collapse
Affiliation(s)
- Alexa R Soares
- Department of Psychiatry, Yale University, 34 Park Street-3rd floor Research, New Haven, CT, 06508, USA
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, 06508, USA
| | - Marina R Picciotto
- Department of Psychiatry, Yale University, 34 Park Street-3rd floor Research, New Haven, CT, 06508, USA.
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, 06508, USA.
| |
Collapse
|
4
|
Balbuena L, Mela M, Ahmed AG. Parental factors predicting social deviance and psychological outcomes in offspring: Evidence from the Avon Longitudinal Study of Parents and Children (ALSPAC). NORDIC STUDIES ON ALCOHOL AND DRUGS 2024; 41:186-199. [PMID: 38645967 PMCID: PMC11027850 DOI: 10.1177/14550725231206015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/21/2023] [Indexed: 04/23/2024] Open
Abstract
Objective: The objective of the present study was to examine whether exposure to prenatal psychoactive substances is associated with psychological outcomes and deviant behaviour. Methods: This was a secondary analysis of 7,769 mother-child dyads in the Avon Longitudinal Study of Parents and Children (ALSPAC) who were followed until the children were aged approximately 12 years. Parental characteristics and maternal use of various substances were collected in pregnancy and entered as predictors of psychological outcomes in childhood and deviant behaviours in early adolescence. The psychological outcomes were IQ, social cognition, working memory and inhibition, while the deviant behaviours were threatening others, truancy and cruelty to animals. Weighted logistic regression models were used to predict deviant behaviours and weighted linear regression for the psychological outcomes. Results: High prenatal alcohol exposure predicted truancy and cruelty to animals. Tobacco exposure predicted lower IQ, a greater social communication deficit, lower working memory, truancy and threatening others. Illicit drugs predicted a higher social communication deficit and truancy. All prenatal substance exposures remained significant after adjustment for peer influences and covariate imbalance. Conclusion: Alcohol, tobacco and illicit drugs were associated with deviant behaviours in early adolescence and these behaviours were preceded by psychological deficits in childhood. The present study supports the guideline that no amount of alcohol is safe to consume in pregnancy and that tobacco and illicit drugs should be avoided.
Collapse
Affiliation(s)
- Lloyd Balbuena
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mansfield Mela
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - AG Ahmed
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
5
|
Çetin Ç, Bakar RZ, Takmaz T, Pasin Ö, Kütük MS. The effects of maternal smoking on fetal cranial development. Findings from routine midtrimester sonographic anomaly screening. J OBSTET GYNAECOL 2023; 43:2176205. [PMID: 36772953 DOI: 10.1080/01443615.2023.2176205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The aim of this study was to assess the effect of continued smoking before and during pregnancy on mid-trimester fetal head development. A total of 250 pregnant women enrolled in the study. All participants were confirmed to be smokers or non-smokers by verifying breath carbon monoxide readings. Biparietal diameter (BPD), head circumference (HC), lateral ventricle (LV), and cisterna magna (CM) were evaluated by ultrasound between 20-22 weeks of pregnancy. Gender and gestational age-adjusted BPD z- scores were not statistically different between smokers and non-smokers (-0.75 ± 1.6 vs -0.51 ± 1, p = .3). HC measurements and z- scores were significantly lower in the smoking group than in the non-smoking groups (183.38 ± 14.56 vs. 189.28 ± 12.53, p = .003, 0.18 ± 1.39 multiple of median (MoM) vs. 0.56 ± 0.92, respectively, p = .023). At linear regression analysis, maternal smoking was the only independent factor associated with fetal HC z score (p = .041). In conclusion, continued smoking during pregnancy reduces fetal HC and has no effect on BPD, LV, or CM measurements at mid-gestation.IMPACT STATEMENTWhat is already known on this subject? Smoking during pregnancy is one of the most common environmental factors affecting fetal and neonatal growth and well-being. Despite the well-known effects of smoking on somatic growth, current studies have shown that it selectively affects some parts of the fetal brain, even in appropriately growing fetuses.What do the results of this study add? Continued smoking during pregnancy reduces fetal HC and has no effect on BPD, LV or CM measurements at mid-gestation. Since smoking is well known for its early and late childhood behavioral and neurological consequences, smaller mid-trimester fetal HC measurements should bring maternal smoking to mind as one of the potentially reversible causes.What are the implications of these findings for clinical practice and/or further research? The harmful effects of smoking start before the third trimester and antenatal counseling should be started early in the gestation. Every effort should be made to quit smoking before or early in pregnancy.
Collapse
Affiliation(s)
- Çağlar Çetin
- Department of Obstetrics and Gynecology, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Rabia Zehra Bakar
- Department of Obstetrics and Gynecology, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Taha Takmaz
- Department of Obstetrics and Gynecology, Memorial Bahçelievler Hospital, Istanbul, Turkey
| | - Özge Pasin
- Department of Biostatistics, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Serdar Kütük
- Department of Obstetrics and Gynecology, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
6
|
Camerota M, McGowan EC, Aschner J, Stroustrup A, Karagas MR, Conradt E, Crowell SE, Brennan PA, Carter BS, Check J, Dansereau LM, DellaGrotta SA, Everson TM, Helderman JB, Hofheimer JA, Kuiper JR, Loncar CM, Marsit CJ, Neal CR, O'Shea TM, Pastyrnak SL, Sheinkopf SJ, Smith LM, Zhang X, Lester BM. Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the ECHO Program. Pediatr Res 2023; 94:762-770. [PMID: 36841884 PMCID: PMC10440230 DOI: 10.1038/s41390-023-02540-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/23/2022] [Accepted: 02/06/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Single-cohort studies have identified distinct neurobehavioral profiles that are associated with prenatal and neonatal factors based on the NICU Network Neurobehavioral Scale (NNNS). We examined socioeconomic, medical, and substance use variables as predictors of NNNS profiles in a multi-cohort study of preterm and term-born infants with different perinatal exposures. METHODS We studied 1112 infants with a neonatal NNNS exam from the Environmental influences on Child Health Outcomes (ECHO) consortium. We used latent profile analysis to characterize infant neurobehavioral profiles and generalized estimating equations to determine predictors of NNNS profiles. RESULTS Six distinct neonatal neurobehavioral profiles were identified, including two dysregulated profiles: a hypo-aroused profile (16%) characterized by lethargy, hypotonicity, and nonoptimal reflexes; and a hyper-aroused profile (6%) characterized by high arousal, excitability, and stress, with low regulation and poor movement quality. Infants in the hypo-aroused profile were more likely to be male, have younger mothers, and have mothers who were depressed prenatally. Infants in the hyper-aroused profile were more likely to be Hispanic/Latino and have mothers who were depressed or used tobacco prenatally. CONCLUSIONS We identified two dysregulated neurobehavioral profiles with distinct perinatal antecedents. Further understanding of their etiology could inform targeted interventions to promote positive developmental outcomes. IMPACT Prior research on predictors of neonatal neurobehavior have included single-cohort studies, which limits generalizability of findings. In a multi-cohort study of preterm and term-born infants, we found six distinct neonatal neurobehavioral profiles, with two profiles being identified as dysregulated. Hypo- and hyper-aroused neurobehavioral profiles had distinct perinatal antecedents. Understanding perinatal factors associated with dysregulated neurobehavior could help promote positive developmental outcomes.
Collapse
Affiliation(s)
- Marie Camerota
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA.
| | - Elisabeth C McGowan
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Judy Aschner
- Departments of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Annemarie Stroustrup
- Division of Neonatology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Elisabeth Conradt
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | - Brian S Carter
- Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lynne M Dansereau
- Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA
| | | | - Todd M Everson
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer B Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Julie A Hofheimer
- Department of Pediatrics, University of North Carolina and Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jordan R Kuiper
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia M Loncar
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Carmen J Marsit
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Charles R Neal
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Thomas Michael O'Shea
- Department of Pediatrics, University of North Carolina and Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Steven L Pastyrnak
- Department of Pediatrics, Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI, USA
| | - Stephen J Sheinkopf
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, USA
| | - Lynne M Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Xueying Zhang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barry M Lester
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
7
|
Margolis AE, Lee SH, Liu R, Goolsby L, Champagne F, Herbstman J, Beebe B. Associations between prenatal exposure to second hand smoke and infant self-regulation in a New York city longitudinal prospective birth cohort. ENVIRONMENTAL RESEARCH 2023; 227:115652. [PMID: 36894114 DOI: 10.1016/j.envres.2023.115652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/11/2023] [Accepted: 03/06/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Prenatal exposure to active or passive maternal smoking -also referred to as second hand smoke (SHS) exposure - are associated with externalizing behaviors, hyperactivity and attention deficit hyperactivity disorder, problems which derive in part from altered self-regulation. OBJECTIVES Determine the influence of prenatal SHS on infant self-regulation using direct measures of infant behavior in 99 mothers from the Fair Start birth cohort followed at the Columbia Center for Children's Environmental Health. METHODS Self-regulation was operationalized with self-contingency, the likelihood of maintaining/changing behavior from second-to-second, measured via split-screen video recordings of mothers playing with their 4-month infants. Mother and infant facial and vocal affect, gaze-on/-off partner, and mother touch were coded on a 1 s time-base. Third trimester prenatal SHS was assessed via self-report of a smoker in the home. Weighted-lag time-series models tested conditional effects of SHS-exposure (vs. non-exposure) on infant self-contingency for eight modality-pairings (e.g., mother gaze-infant gaze). Individual-seconds time-series models and analysis of predicted values at t0 interrogated significant weighted-lag findings. Because prior findings link developmental risk factors with lowered self-contingency, we hypothesized that prenatal SHSSHS would predict lowered infant self-contingency. RESULTS Relative to non-exposed infants, those who were prenatally exposed to SHS had lower self-contingency (more variable behavior) in all eight models. Follow-up analyses showed that, given infants were likely to be in the most negative facial or vocal affect, those with prenatal SHS were more likely to make larger behavioral changes, moving into less negative or more positive affect and to alternate between gaze-on and off mother. Mothers who were exposed to SHS during pregnancy (vs. non-exposed) showed a similar, albeit less prevalent, pattern of larger changes out of negative facial affect. CONCLUSION These findings extend prior work linking prenatal SHS with youth dysregulated behavior, showing similar effects in infancy, a critically important period that sthe stage for future child development.
Collapse
Affiliation(s)
- Amy E Margolis
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA.
| | - Sang Han Lee
- Center for Biomedical Imaging and Neuromodulation, The Nathan Kline Institute, Orangeburg, NY, 10962, USA
| | - Ran Liu
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Lindsay Goolsby
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Frances Champagne
- Department of Psychology, University of Texas, Austin, TX, 78712, USA
| | - Julie Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Beatrice Beebe
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
| |
Collapse
|
8
|
Mantelli AR, Kramer PF, Vítolo MR, Alves AC, Sarmento N, Feldens CA. Clinical manifestations of tooth eruption in the first year of life and related risk factors in three regions of Brazil: multicenter birth cohort study. Eur Arch Paediatr Dent 2023; 24:63-73. [PMID: 36239737 DOI: 10.1007/s40368-022-00761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/30/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Estimate the incidence of teething symptoms and investigate risk factors at three centers in different regions of Brazil. METHODS A prospective cohort study enrolled children at birth in the cities of Manaus (northern region), Porto Alegre (southern region) and Salvador (northeast region). Sociodemographic and anthropometric variables were collected at baseline and 6 months. At 12 months, data were collected on the child's health through structured interviews and dental examinations, including the primary outcome: occurrence of signs and symptoms of tooth eruption reported by parents. Statistical analysis involved Poisson regression with robust variance, with calculation of relative risks (RR). RESULTS The incidence of teething symptoms was 82.4% (238/289). The multivariate analysis revealed a higher occurrence of the outcome in the city of Salvador (RR = 1.39; 95% CI 1.23-1.58), when mother's education was more than 11 years (RR = 1.31; 95% CI 1.04-1.65), when a larger number of individuals resided in the home (RR = 1.15; 95% CI 1.02-1.29), when a smoker resided in the home (RR = 1.16; 95% CI 1.03-1.31) and when the child presented flu or cold in the first year of life (RR = 1.23; 95% CI 1.09-1.38). The most reported symptoms were fever (50.5%), irritability (42.6%), itching (40.8%) and diarrhea (35.3%). Most parents (82%) took some action to alleviate symptoms, including unprescribed systemic medication, such as analgesic, anti-inflammatory and anti-diarrheic agents. CONCLUSION Reports of teething symptoms were associated with the city investigated, socioeconomic factors of the families and characteristics of the child's health. A high rate of administering unprescribed medication was also found.
Collapse
Affiliation(s)
- A R Mantelli
- Department of Pediatric Dentistry, Universidade Luterana do Brasil, Canoas, Brazil
| | - P F Kramer
- Department of Pediatric Dentistry, Universidade Luterana do Brasil, Canoas, Brazil
- Department of Pediatric Dentistry, Pontifícia Universidade Católica, Porto Alegre, Brazil
| | - M R Vítolo
- Graduate Program in Pediatrics: Child and Adolescent Health Care, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - A C Alves
- Department of Pediatric Dentistry, Universidade Federal da Bahia, Salvador, Brazil
| | - N Sarmento
- Department of Pediatric Dentistry, Universidade do Estado do Amazonas, Manaus, Brazil
| | - C A Feldens
- Department of Pediatric Dentistry, Universidade Luterana do Brasil, Canoas, Brazil.
| |
Collapse
|
9
|
Chang CW, Chang CH, Chuang HY, Cheng HY, Lin CI, Chen HT, Yang CC. What is the association between secondhand smoke (SHS) and possible obstructive sleep apnea: a meta-analysis. Environ Health 2022; 21:58. [PMID: 35710478 PMCID: PMC9202174 DOI: 10.1186/s12940-022-00868-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/30/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Association between smoking and sleep apnea is well-known from previous studies. However, the influence of secondhand smoke (SHS), which is a potential risk factor of obstructive sleep apnea (OSA), remains unclear. Our aim was to investigate the relationship between SHS and OSA using a meta-analysis. MATERIALS AND METHODS For the meta-analysis, searches were performed in MEDLINE, EMBASE, and Web of Science databases on January 10, 2022, by combining various keywords including "SHS exposure" and "OSA". Data were extracted using defined inclusion and exclusion criteria. Fixed-effects model meta-analyses were used to pool risk ratio (RR) estimates with their 95% confidence intervals (CI). I2 was used to assess heterogeneity. Moreover, we performed subgroup meta-analyses of children-adults, and smoker fathers and mothers. RESULTS In total, 267 articles were obtained through an electronic search. Twenty-six articles were included in our analysis according to the inclusion and exclusion criteria. We found evidence of an association between SHS exposure and possible OSA (RR 1.64, 95% CI 1.44-1.88). The results of the subgroup analyses showed that children passive smokers (RR 1.84, 95% CI 1.60-2.13) were at greater risks of possible OSA than adult passive smokers (RR 1.35, 95% CI 1.21-1.50). Also, significant differences were observed in mothers with smoking exposure (RR 2.61, 95% CI 1.62-4.21, p < 0.0001), as well as in fathers with smoking exposure (RR 2.15, 95% CI 0.98-4.72, p = 0.06). SHORT CONCLUSION Our meta-analysis confirmed that SHS exposure is significantly associated with OSA. In the subgroup analyses, the association of SHS and possible OSA was significant in both children and adults, as well as in smoker mothers and fathers.
Collapse
Affiliation(s)
- Chen-Wei Chang
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ching-Hsiung Chang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hung-Yi Chuang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Public Health and Environmental Medicine, and Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Han-Yun Cheng
- Health Management Center, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chia-I Lin
- Health Management Center, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hsiang-Tai Chen
- College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Chen-Cheng Yang
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| |
Collapse
|
10
|
Morton SMB, Napier C, Morar M, Waldie K, Peterson E, Atatoa Carr P, Meissel K, Paine SJ, Grant CC, Bullen P, Fenaughty J, Bird A, Underwood L, Wall C, Exeter D, Prickett K, Kingi TK, Liang R, Fa’alili-Fidow J, Gerritsen S, Marks E, Walker C, Langridge F, Evans R, Neumann D, Grant M, Lai H, Taufa S, Smith A, Cha J. Mind the gap – unequal from the start: evidence from the early years of the Growing Up in New Zealand longitudinal study. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2058026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Susan M. B. Morton
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
| | - Carin Napier
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Manisha Morar
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
| | - Karen Waldie
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Psychology and the Centre for Brain Research, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Elizabeth Peterson
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Polly Atatoa Carr
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- National Institute of Demographic and Economic Analysis, University of Waikato, Hamilton, New Zealand
| | - Kane Meissel
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Learning, Development and Professional Practice, Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand
| | - Sarah-Jane Paine
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cameron C. Grant
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Pat Bullen
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Learning, Development and Professional Practice, Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand
| | - John Fenaughty
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Counselling, Human Services and Social Work, Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand
| | - Amy Bird
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- COMPASS, Faculty of Arts, University of Auckland, Auckland, New Zealand
| | - Clare Wall
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Department of Nutrition, School of Medical Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Daniel Exeter
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kate Prickett
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Roy McKenzie Centre for Study of Families and Children School of Government, Victoria University, Wellington, New Zealand
| | - Te Kani Kingi
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Māori Health, Te Whare Wānanga o Awanuiārangi, Whakatāne, New Zealand
| | - Renee Liang
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Jacinta Fa’alili-Fidow
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Moana Research, Auckland, New Zealand
| | - Sarah Gerritsen
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Emma Marks
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Caroline Walker
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Fiona Langridge
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rebecca Evans
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Denise Neumann
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Molly Grant
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Hakkan Lai
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Seini Taufa
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Moana Research, Auckland, New Zealand
| | - Ash Smith
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jane Cha
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
11
|
Ratsch A, Bogossian F, Burmeister EA, Steadman K. Central Australian Aboriginal women's placental and neonatal outcomes following maternal smokeless tobacco, cigarette or no tobacco use. Aust N Z J Public Health 2021; 46:186-195. [PMID: 34821425 DOI: 10.1111/1753-6405.13186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/01/2021] [Accepted: 10/01/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the placental characteristics and neonatal outcomes of Central Australian Aboriginal women based on maternal self-report of tobacco use. METHODS Placental and neonatal variables were collected from a prospective maternal cohort of 19 smokeless tobacco chewers, 23 smokers and 31 no-tobacco users. RESULTS Chewers had the lowest placental weight (460 g) while the no-tobacco group had the heaviest placental weight (565 g). Chewers and the no-tobacco group had placental areas of similar size (285 cm2 and 288 cm2 , respectively) while the placentas of smokers were at least 13 cm2 smaller (272 cm2 ). There were two stillbirths in the study and more than one-third (36%) of neonates (newborns) were admitted to the Special Care Nursery, with the chewers' neonates having a higher admission rate compared with smokers' neonates (44% vs. 23%). The cohort mean birthweight (3348 g) was not significantly different between the groups. When stratified for elevated maternal glucose, the chewers' neonates had the lowest mean birthweight (2906 g) compared to the neonates of the no-tobacco group (3242 g) and smokers (3398 g). CONCLUSIONS This research is the first to demonstrate that the maternal use of Australian Nicotiana spp. (pituri) as smokeless tobacco may negatively impact placental and neonatal outcomes. Implications for public health: Maternal smokeless tobacco use is a potential source of placental and foetal nicotine exposure. Maternal antenatal screening should be expanded to capture a broader range of tobacco and nicotine products, and appropriate cessation support is required.
Collapse
Affiliation(s)
- Angela Ratsch
- Wide Bay Hospital and Health Services, Queensland.,Rural Clinical School, The University of Queensland, Queensland
| | - Fiona Bogossian
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland.,School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland
| | - Elizabeth A Burmeister
- Wide Bay Hospital and Health Services, Queensland.,School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland
| | | |
Collapse
|
12
|
Isaacs KR, Atreyapurapu S, Alyusuf AH, Ledgerwood DM, Finnegan LP, Chang KHK, Ma TX, Washio Y. Neonatal Outcomes after Combined Opioid and Nicotine Exposure in Utero: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10215. [PMID: 34639512 PMCID: PMC8508043 DOI: 10.3390/ijerph181910215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/03/2021] [Accepted: 09/21/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND The majority of women who are pregnant with opioid use disorder (OUD) also smoke tobacco but are rarely offered tobacco cessation counseling. While the effects of exposure to opioids and nicotine in utero are well-understood separately, understanding the impact of the combined exposure to these substances on neonatal outcomes is lacking. METHODS A scoping review was conducted using PubMed and Scopus databases for studies addressing the combined exposure to opioids and nicotine during pregnancy published between 1 January 1980 and 9 July 2019. A total of 29 papers met the eligibility criteria for inclusion, with nine being identified as clinical trials (three from the MOTHER study) and two as secondary data analysis of clinical trial data. RESULTS Neonatal outcomes for infants who had a combined exposure to opioids and nicotine in utero indicated a reduction in birth weight and birth length. Findings in infants exposed to both nicotine and opioids were mixed with regard to the duration of neonatal abstinence syndrome (NAS), the likelihood of treatment for NAS, doses of medicine used to treat NAS, and NAS scores when compared with infants who had opioid exposure without nicotine. CONCLUSIONS The combined exposure to nicotine and opioids during pregnancy may lead to a reduction in neonatal birth weight and birth length and more severe NAS signs, compared with opioid use alone, but more research is necessary to identify the minimum dosage and length of nicotine exposure to accurately predict these outcomes.
Collapse
Affiliation(s)
- Krystyna R. Isaacs
- Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA; (K.R.I.); (S.A.); (A.H.A.); (K.H.K.C.); (T.X.M.)
| | - Sravanthi Atreyapurapu
- Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA; (K.R.I.); (S.A.); (A.H.A.); (K.H.K.C.); (T.X.M.)
| | - Amal H. Alyusuf
- Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA; (K.R.I.); (S.A.); (A.H.A.); (K.H.K.C.); (T.X.M.)
| | - David M. Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Drive, Detroit, MI 48201, USA;
| | - Loretta P. Finnegan
- Executive Officer of the College on Problems of Drug Dependence and Finnegan Consulting, Philadelphia, PA 19140, USA;
| | - Katie H. K. Chang
- Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA; (K.R.I.); (S.A.); (A.H.A.); (K.H.K.C.); (T.X.M.)
| | - Tony X. Ma
- Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA; (K.R.I.); (S.A.); (A.H.A.); (K.H.K.C.); (T.X.M.)
| | - Yukiko Washio
- Substance Use, Gender and Applied Research, RTI International, 3040 E Cornwallis Rd, Durham, NC 27709, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Lewis Katz School of Medicine, 3500 N Broad St, Philadelphia, PA 19140, USA
| |
Collapse
|
13
|
Passively inhaled tobacco smoke - pregnancy and neonatal outcomes in correlation with placental histopathology. Placenta 2021; 112:23-27. [PMID: 34243117 DOI: 10.1016/j.placenta.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/03/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We aimed to investigate the effect of maternal passive smoking (MPS) during pregnancy-on placental pathology and pregnancy outcomes. METHODS A prospective case-control study. We recruited low-risk laboring women at 37+0-41 + 0 weeks between 9/2019-7/2020. MPS was defined as exposure to in-house spouse tobacco smoking of >20 cigarettes/day in the absence of maternal active-smoking. In attempt to "purify" the effect of MPS on placental pathology-we excluded cases with preeclampsia, diabetes, suspected fetal growth restriction (FGR), preterm labor, and illicit drug use. Maternal characteristics, pregnancy outcomes, and placental pathology were compared between the MPS group and a control group matched for gestational age, maternal age, and delivery date. Placental lesions were classified according to the "Amsterdam" criteria. The study was powered to detect a 33% difference in placental malperfusion lesions. Multivariable regression was performed to identify independent associations with placental malperfusion lesions. RESULTS In labor, the MPS group (n = 115) had higher rates of meconium stained amniotic fluid (MSAF, p < 0.001) and non-reassuring fetal heart-rate (NRFHR,p = 0.006), compared to controls (n = 115). Neonates in the MPS group had higher rates of undiagnosed FGR (p = 0.01) and NICU admissions (p = 0.004). The MPS group had higher rates of placental-hypoplasia (p = 0.02) and fetal vascular malperfusion (FVM) lesions (p = 0.04). In regression analysis MPS was associated with FVM lesions independent of background confounders (aOR = 1.24 95% CI 1.10-2.65). DISCUSSION In otherwise low-risk pregnancies, MPS was associated with higher rates of MSAF, NRFHR, undiagnosed FGR, and NICU admissions, probably mediated via placental FVM. These worrisome findings mandate patient counseling and further investigation in larger population-based studies.
Collapse
|
14
|
Abstract
OBJECTIVES To study the impact of sociodemographic factors on length of stay (LOS) for infants with neonatal opioid withdrawal syndrome (NOWS) secondary to fetal opioid exposure. METHODS In this retrospective cohort study, we included term infants with NOWS, excluding those with other significant medical issues. Comprehensive clinical and sociodemographic data were collected. Multivariate regression modeling was used to identify factors which contributed to excess LOS, which was defined as the number of days beyond the standard monitoring and/or treatment protocol. RESULTS In all, 129 infants were identified; mean gestational age of 37.9 ± 1.3 weeks and mean body weight of 2880 ± 496 g. Among them, 68% of infants were exposed to opioids; 27% were exposed to methadone; and 67% required pharmacologic treatment. The degree of poverty was assessed using the Area Deprivation Index (ADI) based on the mother's address at the time of birth. Median LOS for treated infants was 23 days versus 8 days for those who did not need pharmacologic treatment. The median excess LOS was 4 days (range 0-24).Excess hospital days were strongly correlated with degree of deprivation in the mother's community (r = 0.55, P < 0.01). ADI remained a strong predictor of excess LOS, even when controlling for pharmacologic treatment, placement in state's custody, race, and gestational age at birth. CONCLUSIONS These results suggest poverty is associated with excess LOS and that early allocation of resources for at-risk families may help to reduce overall length of hospital stay.
Collapse
|
15
|
Froggatt S, Reissland N, Covey J. The effects of prenatal cigarette and e-cigarette exposure on infant neurobehaviour: A comparison to a control group. EClinicalMedicine 2020; 28:100602. [PMID: 33294816 PMCID: PMC7700948 DOI: 10.1016/j.eclinm.2020.100602] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Infant neurobehaviour provides an insight into the development of the central nervous system during infancy, with behavioural abnormalities highlighting a cause for concern. Research has demonstrated that prenatal exposure to cigarettes leads to deficits within neurobehavioural development, along with negative birth outcomes detrimental to subsequent development. With the growing use of e-cigarettes amongst pregnant women, this study explores how prenatal e-cigarette exposure compares to prenatal cigarette exposure. METHODS Eighty-three infants were involved in the study, either exposed prenatally to cigarettes or e-cigarettes or not exposed to either. Differences were assessed between these three groups for birth outcomes and scores on the Neonatal Behavioural Assessment Scale (NBAS) at one month of age. FINDINGS Both cigarette and e-cigarette exposed infants had a significantly greater number of abnormal reflexes (p = ·001; p = ·002). For both self-regulation and motor maturity, cigarette exposed infants performed significantly worse (p = ·010; p = ·002), with e-cigarette exposed infants having decreased motor maturity (p = ·036) abilities and marginally decreased for self-regulation (p = ·057). Birth outcomes, namely birthweight, gestation and head circumference, did not differ for e-cigarette exposed infants compared with infants who were not prenatally exposed to nicotine. Cigarette exposed infants had a significantly lower birthweight (p = ·021) and reduced head circumference (p = ·008) in comparison to non-exposed infants. INTERPRETATION To our knowledge, this is the first research study assessing a neurological outcome as a result of e-cigarette exposure. Findings of this have potentially important implications for public health policies regarding the safety and use of e-cigarettes throughout pregnancy. FUNDING This research was funded by a doctoral training partnership scholarship via the ESRC, ES/P000762/1.
Collapse
|
16
|
McDaniel CE, Test M, Deodhar P, Jennings R, Bove J, Carlin K. Effects of polysubstance exposure on neonatal outcomes for infants with intrauterine opioid exposure. J Perinatol 2020; 40:1489-1496. [PMID: 32641774 DOI: 10.1038/s41372-020-0717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/21/2020] [Accepted: 06/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Quantify the effect of prenatal polysubstance exposure on neonatal outcomes compared to methadone exposure alone. STUDY DESIGN This retrospective cohort study compared infants with methadone-only exposure to methadone with additional psychoactive substances. Outcomes included time to maximum Finnegan scores, proportion requiring scheduled morphine, and length of stay (LOS). RESULTS We identified 323 subjects. The median time to maximum Finnegan score was 38.0 h with 94% peaking within 96 h. Forty-five percent of methadone-only infants were started on scheduled morphine compared to 54% of polysubstance infants (p = 0.10). LOS for polysubstance-exposed infants was 1.30 times longer than infants with methadone-only exposure (95% confidence interval: 1.05, 1.60). CONCLUSIONS Exposure to methadone with additional psychoactive substances is associated with longer LOS, but not postnatal morphine use or peak withdrawal symptoms. Most infants experience peak withdrawal symptoms within 4 days and may not benefit from longer observation.
Collapse
Affiliation(s)
- Corrie E McDaniel
- Department of Pediatrics, University of Washington, Seattle, WA, USA. .,Division of Women and Children's, Providence St. Joseph's Health System, Renton, WA, USA.
| | - Matthew Test
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Division of Women and Children's, Providence St. Joseph's Health System, Renton, WA, USA
| | - Parimal Deodhar
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Division of Women and Children's, Providence St. Joseph's Health System, Renton, WA, USA
| | - Rebecca Jennings
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Joanna Bove
- Department of Internal Medicine, Providence St. Vincent Hospital, Portland, OR, USA
| | | |
Collapse
|
17
|
Nishihama Y, Nakayama SF, Tabuchi T, Isobe T, Jung CR, Iwai-Shimada M, Kobayashi Y, Michikawa T, Sekiyama M, Taniguchi Y, Nitta H, Yamazaki S. Determination of Urinary Cotinine Cut-Off Concentrations for Pregnant Women in the Japan Environment and Children's Study (JECS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155537. [PMID: 32751831 PMCID: PMC7432074 DOI: 10.3390/ijerph17155537] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/18/2020] [Accepted: 07/29/2020] [Indexed: 01/25/2023]
Abstract
Few studies have assessed the accuracy of self-reported questionnaires to determine smoking habits relative to urinary biomarkers. This study investigated urinary cotinine cut-off concentrations distinguishing active, passive and non-smokers among pregnant women who participated in the Japan Environment and Children's Study, a nationwide birth cohort study. Pregnant participants with measured urinary cotinine concentrations (UCCs) and who completed self-reported questionnaires on smoking status were included (n = 89,895). The cut-off values (COVs) for active and passive smokers were calculated by fitting mixed normal distribution functions to UCCs. The sensitivity and specificity of the questionnaires were subsequently evaluated. The median (interquartile range) UCC was 0.24 (0.083-0.96) µg/g-creatinine, with the detection rate of 89%. The COV for distinguishing active smokers from passive and non-smokers was 36.8 µg/g-creatinine. When this COV was considered to represent the true condition, the questionnaire had a sensitivity of 0.523, a specificity of 0.998, a positive predictive value (PPV) of 0.967 and a negative predictive value (NPV) of 0.957. The COV for distinguishing passive smokers from non-smokers was 0.31 µg/g-creatinine, with the questionnaire having a sensitivity of 0.222, a specificity of 0.977, a PPV of 0.868 and an NPV of 0.644. As many as 78% of passive smokers might be misclassified as non-smokers.
Collapse
Affiliation(s)
- Yukiko Nishihama
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Shoji F. Nakayama
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
- Correspondence: ; Tel.: +81-29-850-2786
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan;
| | - Tomohiko Isobe
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Chau-Ren Jung
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Miyuki Iwai-Shimada
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Yayoi Kobayashi
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Takehiro Michikawa
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo 143-8540, Japan
| | - Makiko Sekiyama
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Yu Taniguchi
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Hiroshi Nitta
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Shin Yamazaki
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | | |
Collapse
|
18
|
Włodarska A, Doboszyńska A. Tobacco smoke exposure as a risk factor for obstructive sleep apnea in children. Pediatr Int 2020; 62:840-847. [PMID: 32034991 DOI: 10.1111/ped.14191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 01/09/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The most common respiratory disturbance in sleeping children is obstructive sleep apnea syndrome (OSAS). Passive smoking is one of factors predisposing to OSAS. The aim of this study was to determine the correlations between exposure to tobacco smoke (passive smoking) and development of respiratory disorders in children during sleep. METHODS One hundred and sixty school-aged children (6-18 years) were included in the study. The inclusion criterion was exposure to tobacco smoke at home (n = 90). The control group were school-aged children who had had no contact with tobacco smoke at home (n = 70). Exclusion criteria were obesity and children with impaired patency of the nose. Each child had a polygraphic examination performed at home. The children and their parents completed a questionnaire to assess the level of child's exposure to tobacco smoke. The study ran from December 15, 2012 to February 26, 2016. RESULTS OSAS was observed in 12% of children with an apnea-hypopnea index >1.5 (<13 years of age) and an apnea-hypopnea index >5 (for children >13 years), and with diurnal and nocturnal symptoms. Children exposed to tobacco smoke presented more apnea-hypopnea events (n = 17) than the control group (n = 3; P < 0.001). In the group exposed to tobacco smoke the following issues were noted: concentration problems (38.9%), tiredness/lethargy (46.7%), and irritability/hyperactivity (36.7%). No statistically significant differences were found in waking up, snoring, or sleep apnea. CONCLUSIONS OSAS occurs more often in children exposed to tobacco smoke and these children demonstrate concentration problems, tiredness, and irritability/hyperactivity to a greater extent than control group.
Collapse
Affiliation(s)
| | - Anna Doboszyńska
- Department of Pulmonology, Faculty of Health Sciences, University of Warmia and Mazury, Olsztyn, Poland
| |
Collapse
|
19
|
Froggatt S, Covey J, Reissland N. Infant neurobehavioural consequences of prenatal cigarette exposure: A systematic review and meta-analysis. Acta Paediatr 2020; 109:1112-1124. [PMID: 31821600 PMCID: PMC7317476 DOI: 10.1111/apa.15132] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 12/19/2022]
Abstract
AIM Prenatal exposure to cigarettes leads to alterations in brain development during pregnancy. This has an impact on postnatal psychological and behavioural processes, affecting an infant's neurobehavioural profile with little known about which aspects are affected. The evidence was synthesised to assess the effects of prenatal cigarette smoke exposure on neurobehavioural outcomes within the first year of life. METHODS Six databases were searched (Web of Science Core Collections, MEDLINE, PsycINFO, CINAHL, EBSCOhost eBook Collection and OpenGrey) in November 2018. Eligible studies (n = 17) had to include a measure of prenatal cigarette exposure and a neurobehavioural assessment ≤1 year of age. RESULTS In the first year of life, specific areas of neurobehavioural functioning are related to prenatal cigarette exposure with eight out of 10 areas of neurobehaviour having significant medium (negative affect, attention, excitability, irritability and orientation) or small (muscle tone, regulation and difficult temperament) pooled effect sizes. Only lethargy and stress did not show any significant pooled effects. CONCLUSION Prenatal cigarette exposure affects a significant range of behaviours during the first year of life.
Collapse
Affiliation(s)
| | - Judith Covey
- Department of PsychologyDurham UniversityDurhamUK
| | | |
Collapse
|
20
|
Stroud LR, Bublitz MH, Crespo FA, Lester B, Salisbury AL. Maternal smoking in pregnancy, fetal activity & newborn behavioral state: An observational ultrasound study. Neurotoxicol Teratol 2020; 81:106894. [PMID: 32407872 DOI: 10.1016/j.ntt.2020.106894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022]
Abstract
Maternal smoking during pregnancy (MSDP) remains one of the most common prenatal drug exposures in the US and worldwide. MSDP is associated with medical risk for the fetus and altered behavioral development in infants; however, fewer studies have examined the impact of MSDP on fetal behavior or newborn behavioral state. We investigated associations between MSDP and (a) fetal motor activity and (b) newborn behavioral state following handling. Participants were 79 healthy mother-fetus/newborn pairs (57% MSDP-exposed). MSDP was measured by maternal interview and verified by saliva biomarkers. Mothers completed an observational fetal ultrasound assessment between 24 and 37 weeks gestation (M = 28 weeks), including baseline, vibro-acoustic stimulus and recovery periods. Total fetal motor activity and complex body movements were coded from ultrasound videos. Following delivery, newborn post-handling behavioral state was assessed by direct observational coding. MSDP exposure was associated with higher baseline fetal motor activity, particularly at younger gestational ages. Further, motor reactivity to stimulation emerged at later gestational ages in MSDP-exposed fetuses, while motor reactivity was consistent across gestational ages in unexposed fetuses. Finally, heavy MSDP exposure was associated with more arousal following handling and greater need for soothing interventions in the newborn period. Monitoring of fetal behavior via ultrasound may offer a unique opportunity to identify at-risk infants and provides data for stronger public health messaging regarding risks of MSDP. Associations between MSDP and increased newborn fussiness highlight opportunities for education and anticipatory guidance in the postpartum period.
Collapse
Affiliation(s)
- Laura R Stroud
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.
| | - Margaret H Bublitz
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Women's Medicine Collaborative, The Miriam Hospital, Providence, RI, USA.
| | - Frank A Crespo
- Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA.
| | - Barry Lester
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Amy L Salisbury
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI, USA.
| |
Collapse
|
21
|
Mammel B, Kvárik T, Szabó Z, Gyarmati J, Ertl T, Farkas J, Helyes Z, Atlasz T, Reglődi D, Kiss P. Prenatal cigarette smoke exposure slightly alters neurobehavioral development in neonatal rats: Implications for developmental origins of health and disease (DoHAD). Physiol Int 2020; 107:55-66. [PMID: 32598332 DOI: 10.1556/2060.2020.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/04/2019] [Indexed: 11/19/2022]
Abstract
Numerous studies indicate that smoking during pregnancy exerts harmful effects on fetal brain development. The aim of this study was to determine the influence of maternal smoking during pregnancy on the early physical and neurobehavioral development of newborn rats. Wistar rats were subjected to whole-body smoke exposure for 2 × 40 min daily from the day of mating until day of delivery. For this treatment, a manual closed-chamber smoking system and 4 research cigarettes per occasion were used. After delivery the offspring were tested daily for somatic growth, maturation of facial characteristics and neurobehavioral development until three weeks of age. Motor coordination tests were performed at 3 and 4 weeks of age. We found that prenatal cigarette smoke exposure did not alter weight gain or motor coordination. Critical physical reflexes indicative of neurobehavioral development (eyelid reflex, ear unfolding) appeared significantly later in pups prenatally exposed to smoke as compared to the control group. Prenatal smoke exposure also resulted in a delayed appearance of reflexes indicating neural maturity, including hind limb grasping and forelimb placing reflexes. In conclusion, clinically relevant prenatal exposure to cigarette smoke results in slightly altered neurobehavioral development in rat pups. These findings suggest that chronic exposure of pregnant mothers to cigarette smoke (including passive smoking) results in persisting alterations in the developing brain, which may have long-lasting consequences supporting the concept of developmental origins of health and disease (DoHAD).
Collapse
Affiliation(s)
- B Mammel
- 1Department of Obstetrics and Gynecology, Department of Neonatology, University of Pécs, Pécs, Hungary.,2Department of Anatomy,University of Pécs Clinical Centre, Pécs, Hungary
| | - T Kvárik
- 1Department of Obstetrics and Gynecology, Department of Neonatology, University of Pécs, Pécs, Hungary.,2Department of Anatomy,University of Pécs Clinical Centre, Pécs, Hungary
| | - Zs Szabó
- 2Department of Anatomy,University of Pécs Clinical Centre, Pécs, Hungary
| | - J Gyarmati
- 1Department of Obstetrics and Gynecology, Department of Neonatology, University of Pécs, Pécs, Hungary
| | - T Ertl
- 1Department of Obstetrics and Gynecology, Department of Neonatology, University of Pécs, Pécs, Hungary
| | - J Farkas
- 2Department of Anatomy,University of Pécs Clinical Centre, Pécs, Hungary
| | - Zs Helyes
- 3Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary.,5Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - T Atlasz
- 2Department of Anatomy,University of Pécs Clinical Centre, Pécs, Hungary.,4Department of Sportbiology, University of Pécs, Pécs, Hungary
| | - D Reglődi
- 2Department of Anatomy,University of Pécs Clinical Centre, Pécs, Hungary
| | - P Kiss
- 2Department of Anatomy,University of Pécs Clinical Centre, Pécs, Hungary
| |
Collapse
|
22
|
Zhang X, Spear E, Gennings C, Curtin PC, Just AC, Bragg JB, Stroustrup A. The association of prenatal exposure to intensive traffic with early preterm infant neurobehavioral development as reflected by the NICU Network Neurobehavioral Scale (NNNS). ENVIRONMENTAL RESEARCH 2020; 183:109204. [PMID: 32311904 PMCID: PMC7325861 DOI: 10.1016/j.envres.2020.109204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/09/2020] [Accepted: 01/30/2020] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Traffic-related air pollution has been shown to be neurotoxic to the developing fetus and in term-born infants during early childhood. It is unknown whether there is an increased risk of adverse neurobehavioral outcome in preterm infants exposed to higher levels of air pollution during the fetal period. OBJECTIVE To assess the association between prenatal exposure to traffic-related air pollution on early preterm infant neurobehavior. METHODS Air pollution exposure was estimated by two methods: density of major roads and density of vehicle-miles traveled (VMT), each at multiple buffering areas around residential addresses. We examined the association between prenatal exposure to traffic-related air pollution and performance on the Neonate Intensive Care Unit (NICU) Network Behavioral Scale (NNNS), a measure of neurobehavioral outcome in infancy for 240 preterm neonates enrolled in the NICU-Hospital Exposures and Long-Term Health cohort. Linear regression analysis was conducted for exposure and individual NNNS subscales. Latent profile analysis (LPA) was applied to classify infants into distinct NNNS phenotypes. Multinomial logistic regression analysis was conducted between exposure and LPA groups. Covariates included gestational age, birth weight z-score, post-menstrual age at NNNS assessment, socioeconomic status, race, delivery type, maternal smoking status, and medical morbidities during the NICU stay. RESULTS Among all 13 NNNS subscales, hypotonia was significantly associated with VMT (104 vehicle-mile/km2) in 150 m (β = 0.01, P-value<0.001), 300 m (β = 0.01, P-value = 0.003), and 500 m (β = 0.01, P-value = 0.002) buffering areas, as well as with road density in a 500 m buffering area (β = 0.03, P-value = 0.03). We identified three NNNS phenotypes by LPA. Among them, high density of major roads within 150 m, 300 m, and 500 m buffers of the residential address was significantly associated with the same phenotype (P < 0.05). CONCLUSION Prenatal exposure to intensive air pollution emitted from major roads may impact early neurodevelopment of preterm infants. Motor development may be particularly sensitive to air pollution-related toxicity.
Collapse
Affiliation(s)
- Xueying Zhang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
| | - Emily Spear
- Division of Newborn Medicine, Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Paul C Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Allan C Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jennifer B Bragg
- Division of Newborn Medicine, Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Annemarie Stroustrup
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Division of Newborn Medicine, Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| |
Collapse
|
23
|
Clark CAC, Massey SH, Wiebe SA, Espy KA, Wakschlag LS. Does early maternal responsiveness buffer prenatal tobacco exposure effects on young children's behavioral disinhibition? Dev Psychopathol 2019; 31:1285-1298. [PMID: 30428950 PMCID: PMC6520205 DOI: 10.1017/s0954579418000706] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Children with prenatal tobacco exposure (PTE) exhibit early self-regulatory impairments, reflecting a life-course persistent propensity toward behavioral disinhibition. Previously, we demonstrated the protective role of parental responsiveness for reducing the risk of exposure-related disruptive behavior in adolescence. Here, we expanded this line of inquiry, examining whether responsiveness moderates the relation of PTE to a broader set of behavioral disinhibition features in early childhood and testing alternative diathesis-stress versus differential susceptibility explanatory models. PTE was assessed prospectively using interviews and bioassays in the Midwestern Infant Development Study (MIDS). Mother-child dyads (N = 276) were re-assessed at approximately 5 years of age in a preschool follow-up. We quantified maternal responsiveness and child behavioral disinhibition using a combination of directly observed activities in the lab and developmentally sensitive questionnaires. Results supported a diathesis-stress pattern. Children with PTE and less responsive mothers showed increased disruptive behavior and lower effortful control compared with children without PTE. In contrast, exposed children with more responsive mothers had self-regulatory profiles similar to their non-exposed peers. We did not observe sex differences. Findings provide greater specification of the protective role of maternal responsiveness for self-regulation in children with PTE and help clarify mechanisms that may underscore trajectories of exposure-related behavioral disinhibition.
Collapse
Affiliation(s)
- Caron A C Clark
- Department of Educational Psychology,University of Nebraska-Lincoln,Lincoln, NE,USA
| | - Suena H Massey
- Department of Psychiatry and Behavioral Sciences,Northwestern University Feinberg School of Medicine,Chicago, IL,USA
| | - Sandra A Wiebe
- Department of Psychology,University of Alberta,Edmonton,Alberta,Canada
| | - Kimberly Andrews Espy
- Office of the Provost,University of San Antonio at Texas, San Antonio, TX, USA;Developmental Cognitive Neuroscience Laboratory,University of Nebraska-Lincoln,Lincoln, NE, USA
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University,Chicago,IL, USA
| |
Collapse
|
24
|
Ostlund BD, Vlisides-Henry RD, Crowell SE, Raby KL, Terrell S, Brown MA, Tinajero R, Shakiba N, Monk C, Shakib JH, Buchi KF, Conradt E. Intergenerational transmission of emotion dysregulation: Part II. Developmental origins of newborn neurobehavior. Dev Psychopathol 2019; 31:833-846. [PMID: 31057128 PMCID: PMC6790984 DOI: 10.1017/s0954579419000440] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We investigated whether neurobehavioral markers of risk for emotion dysregulation were evident among newborns, as well as whether the identified markers were associated with prenatal exposure to maternal emotion dysregulation. Pregnant women (N = 162) reported on their emotion dysregulation prior to a laboratory assessment. The women were then invited to the laboratory to assess baseline respiratory sinus arrhythmia (RSA) and RSA in response to an infant cry. Newborns were assessed after birth via the NICU Network Neurobehavioral Scale. We identified two newborn neurobehavioral factors-arousal and attention-via exploratory factor analysis. Low arousal was characterized by less irritability, excitability, and motor agitation, while low attention was related to a lower threshold for auditory and visual stimulation, less sustained attention, and poorer visual tracking abilities. Pregnant women who reported higher levels of emotion dysregulation had newborns with low arousal levels and less attention. Larger decreases in maternal RSA in response to cry were also related to lower newborn arousal. We provide the first evidence that a woman's emotion dysregulation while pregnant is associated with risks for dysregulation in her newborn. Implications for intergenerational transmission of emotion dysregulation are discussed.
Collapse
Affiliation(s)
| | | | - Sheila E. Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - K. Lee Raby
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Sarah Terrell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Mindy A. Brown
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Ruben Tinajero
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Nila Shakiba
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Catherine Monk
- Department of Psychiatry, Columbia University, New York, NY, USA
- Department of Obstetrics & Gynecology, Columbia University, New York, NY, USA
| | - Julie H. Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Karen F. Buchi
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
25
|
Bertini G, Elia S, Lori S, Dani C. Abnormal neurological soft signs in babies born to smoking mothers were associated with lower breastfeeding for first three months. Acta Paediatr 2019; 108:1256-1261. [PMID: 30788864 DOI: 10.1111/apa.14762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 02/02/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022]
Abstract
AIM We examined associations between neurological alterations in infants born to smoking mothers and breastfeeding success at discharge and three months of age. METHODS This 2016 study compared 35 normal weight infants born to smoking mothers at 37-41 weeks and 35 matched controls born to non-smoking mothers at the Maternity Hospital of Careggi University, Florence, Italy. Neonatal behaviour was evaluated using the neurological soft signs (NSS) component of the Graham-Rosenblith Scale. Breastfeeding variables were measured using the LATCH score that covers: breast latching, audible swallowing, type of nipple, mother's comfort and help they needed to hold their baby to their breast. A questionnaire on excessive crying and feeding was distributed at discharge, and further data were collected during a three-month telephone interview. RESULTS At discharge, the infants born to smoking mothers had a significantly lower LATCH score and significantly poorer performance on several items of the NSS component than the controls. The LATCH score and number of NSS were inversely proportional. At the three-month follow-up only 57.1% of the smoking group infants were breastfeeding compared with 87.5% of the control infants (p < 0.01). CONCLUSION Infants with smoking mothers displayed altered neurobehavioural profiles and had a difficult start to breastfeeding.
Collapse
Affiliation(s)
- G Bertini
- Division of Neonatology Careggi University Hospital Florence Italy
| | - S Elia
- Division of Neonatology Careggi University Hospital Florence Italy
| | - S Lori
- Neurophysiology Unit Neuro‐Musculo‐Skeletal Department Careggi University Hospital Florence Italy
| | - C Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health Careggi University Hospital of Florence Florence Italy
| |
Collapse
|
26
|
Jones HE, Kraft WK. Analgesia, Opioids, and Other Drug Use During Pregnancy and Neonatal Abstinence Syndrome. Clin Perinatol 2019; 46:349-366. [PMID: 31010564 DOI: 10.1016/j.clp.2019.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
When opioid misuse rises in the United States, pregnant women and their neonates are affected. This article summarizes the use of Food and Drug Administration-approved products, including methadone, buprenorphine, and the combination formulation of buprenorphine and naloxone to treat adult opioid use disorder during the perinatal period. All labels include pregnancy, neonatal, and lactation information and note the accepted use of these medications during the perinatal period if the benefits outweigh the risks. A summary of the neonatal abstinence syndrome definition, its assessment tools, treatment approaches, and future genetic directions are provided.
Collapse
Affiliation(s)
- Hendrée E Jones
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, UNC Horizons, 410 North Greensboro Street, Chapel Hill, NC, USA; Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Walter K Kraft
- Clinical Research Unit, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1170 Main Building, 132 South 10th Street, Philadelphia, PA 19107-5244, USA
| |
Collapse
|
27
|
Whalen BL, Holmes AV, Blythe S. Models of care for neonatal abstinence syndrome: What works? Semin Fetal Neonatal Med 2019; 24:121-132. [PMID: 30926259 DOI: 10.1016/j.siny.2019.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Opioid use disorders and the prescription of long-acting medications for their treatment have increased dramatically over the last decade among pregnant women. Newborns who experience prolonged in utero opioid exposure may develop neonatal abstinence syndrome (NAS). Until recently, much of the focus on improving care for NAS has been on pharmacologically-based care models. Recent studies have illustrated the benefits of rooming-in and parental presence on NAS outcomes. Single center Quality Improvement (QI) initiatives demonstrate the benefits of non-pharmacologic care bundles and symptom prioritization in decreasing the proportion of infants pharmacologically treated and length of hospital stay. Little remains known about the impact of these varied cared models on maternal-infant attachment and mental health. In this review article, we will propose an optimal model of care to improve short- and long-term outcomes for newborns, their mothers and families, and perinatal care systems.
Collapse
Affiliation(s)
- Bonny L Whalen
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Dartmouth-Hitchcock Medical Center, DHMC Pediatrics, One Medical Center Dr., Lebanon, NH, 03756, USA.
| | - Alison V Holmes
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Dartmouth-Hitchcock Medical Center, The Dartmouth Institute, DHMC Pediatrics, One Medical Center Dr, Lebanon, NH, 03756, USA.
| | - Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University, Translational Health Research Institute (THRI), Locked Bag 1797, Western Sydney University, Penrith, NSW, 2751, Australia.
| |
Collapse
|
28
|
Tuhkanen H, Pajulo M, Jussila H, Ekholm E. Infants born to women with substance use: Exploring early neurobehavior with the Dubowitz neurological examination. Early Hum Dev 2019; 130:51-56. [PMID: 30677638 DOI: 10.1016/j.earlhumdev.2018.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 12/07/2018] [Accepted: 12/27/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is a special concern regarding substance using pregnant women due to the possible adverse effects on the infant. While the immediate effects of prenatal substance exposure are well known, the long-term data on the infants' neurodevelopment is inconclusive. AIMS The purpose of this study was to assess early neurobehavior of infants of mothers with substance use using the Dubowitz examination and to follow their neuromotor development until one year of age. STUDY DESIGN AND SUBJECTS Ninety-five pregnant women with a recent history of substance use were recruited and followed up at the maternity outpatient clinic. Follow-up data was collected from hospital records and maternal interviews. The Dubowitz neurological examination was performed to the 54 clinically healthy term infants. The results were converted into optimality scores and compared to normative values from clinically healthy term infants derived from a separate normative population. The infant's neuromotor development was followed up to one year of age. RESULTS Only 7% of the infants born to women with recent or current substance use reached optimal scores (<30.5) in the Dubowitz neurological examination compared to 95% reported in normative population. Sixty-three percent of the newborns needed follow-up based on physiotherapeutic assessment of neurobehavior. By 12 months of age, the neuromotor status of 88% (n = 30) of these infants was found normal. CONCLUSIONS A high percentage of infants of mothers who were referred prenatally to hospital due to substance use showed suboptimal neurological findings during their first days of life.
Collapse
Affiliation(s)
- H Tuhkanen
- Department of Obstetrics and Gynecology, University of Turku, Kiinamyllynkatu 4-8, PL 52, 20521 Turku, Finland.
| | - M Pajulo
- Department of Child Psychiatry and Finn Brain, Institute of Clinical Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521 Turku, Finland.
| | - H Jussila
- Department of Child Psychiatry, Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland.
| | - E Ekholm
- Department of Obstetrics and Gynecology, University of Turku, Kiinamyllynkatu 4-8, PL 52, 20521 Turku, Finland.
| |
Collapse
|
29
|
Alkam T, Nabeshima T. Molecular mechanisms for nicotine intoxication. Neurochem Int 2019; 125:117-126. [PMID: 30779928 DOI: 10.1016/j.neuint.2019.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 01/25/2023]
Abstract
Nicotine, one of the more than 4700 ingredients in tobacco smoke, is a neurotoxin and once used as pesticides in agriculture. Although its use in agriculture is prohibited in many countries, nicotine intoxication is still a problem among the workers in tobacco farms, and young children as well as adults due to the accidental or suicidal ingestions of nicotine products. Understanding the mechanism of nicotine intoxication is important not only for the prevention and treatment but also for the appropriate regulatory approaches. Here, we review pharmacokinetics of nicotine and the molecular mechanisms for acute and chronic intoxication from nicotine that might be relevant to the central and the peripheral nervous system. We include green tobacco sickness, acute intoxication from popular nicotine products, circadian rhythm changes, chronic intoxication from nicotine through prenatal nicotine exposure, newborn behaviors, and sudden infant death syndrome.
Collapse
Affiliation(s)
- Tursun Alkam
- Japanese Drug Organization of Appropriate Use and Research, Nagoya, Japan; Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA.
| | - Toshitaka Nabeshima
- Japanese Drug Organization of Appropriate Use and Research, Nagoya, Japan; Advanced Diagnostic System Research Laboratory, Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan.
| |
Collapse
|
30
|
Davidson L, Rawat M, Stojanovski S, Chandrasekharan P. Natural drugs, not so natural effects: Neonatal abstinence syndrome secondary to 'kratom'. J Neonatal Perinatal Med 2019; 12:109-112. [PMID: 30149482 PMCID: PMC6484255 DOI: 10.3233/npm-1863] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/27/2018] [Accepted: 08/02/2018] [Indexed: 06/03/2023]
Abstract
BACKGROUND Mitragyna speciosa, also known as kratom, is obtained from the coffee plant family 'Rubiaceae.' Kratom is available in the form of capsules, whole, processed and powdered leaves, and as liquids. Secondary to its 'natural herb' status and opioid effects, it is misconceived to be a safe alternative for the treatment of chronic pain. The use of kratom has increased by tenfold in the United States since 2010. METHODS AND RESULTS We report a term neonate who was born to a chronic kratom user and required treatment with opiates for neonatal drug withdrawal. CONCLUSION Physicians should be aware of these herbal supplements and its potential withdrawal effects in newborn which cannot be picked up by the standard toxicology screen.
Collapse
Affiliation(s)
- L. Davidson
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Oishei Children’s Hospital, Buffalo, NY, USA
| | - M. Rawat
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Oishei Children’s Hospital, Buffalo, NY, USA
| | - S. Stojanovski
- Department of Pharmacy, Oishei Children’s Hospital, Buffalo, NY, USA
| | - P. Chandrasekharan
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Oishei Children’s Hospital, Buffalo, NY, USA
| |
Collapse
|
31
|
Gutvirtz G, Wainstock T, Landau D, Sheiner E. Maternal smoking during pregnancy and long-term neurological morbidity of the offspring. Addict Behav 2019; 88:86-91. [PMID: 30172166 DOI: 10.1016/j.addbeh.2018.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 06/28/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the long-term pediatric neurological morbidity of children born to mothers who reported smoking during pregnancy as compared with children born to non-smoking mothers. STUDY DESIGN A population-based cohort analysis was performed comparing all deliveries of mothers who reported smoking during pregnancy and non-smoking mothers between 1991 and 2014 at a single tertiary medical center. Hospitalizations of the offspring up to the age of 18 years involving neurological morbidities were evaluated according to a predefined set of ICD-9 codes, including autism, development and movement disorders, cerebral palsy and more. A Kaplan-Meier survival curve was used to compare cumulative hospitalization rate in exposed and unexposed offspring and a Cox proportional hazards model was used to control for confounders. RESULTS During the study period, 242,342 deliveries met the inclusion criteria. Of them, 2861 (1.2%) were children of smoking mothers. Neurological-related hospitalizations were significantly higher in children born to smoking mothers, as compared with the non-smoking group (5.3% vs. 3.1%, p < 0.01). Specifically, these children had higher rates of movement, eating and developmental disorders as well as attention deficit hyperactive disorder. The Kaplan-Meier survival curve demonstrated a significant higher cumulative incidence of neurological-related hospitalizations in the smoking group (log rank p < 0.01). Using a Cox proportional hazards model, controlling for potential confounders, maternal tobacco use was found to be independently associated with long-term neurological morbidity of the offspring (adjusted HR = 1.58, CI 1.33-1.89, p value < 0.01). CONCLUSION Maternal smoking during pregnancy is an independent risk factor for long-term neurological morbidity of the offspring.
Collapse
Affiliation(s)
- Gil Gutvirtz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
32
|
Stroud LR, Papandonatos GD, McCallum M, Kehoe T, Salisbury AL, Huestis MA. Prenatal tobacco and marijuana co-use: Impact on newborn neurobehavior. Neurotoxicol Teratol 2018; 70:28-39. [PMID: 30266574 PMCID: PMC6239899 DOI: 10.1016/j.ntt.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/17/2022]
Abstract
Tobacco and marijuana are some of the most common prenatal substance exposures worldwide. The social acceptability and political landscape of marijuana and its potency have changed dramatically in the last two decades leading to increased use by pregnant women. Despite evidence for increasing marijuana use and high rates of co-use of tobacco (TOB) and marijuana (MJ) during pregnancy, the impact of prenatal exposure to each substance is typically studied in isolation. We investigated the influence of co-exposure to TOB and MJ on infant neurobehavioral development over the first postnatal month. Participants were 111 mother-infant pairs from a low-income, diverse sample (Mean age = 25 ± 5; 54% minorities). TOB and MJ use were assessed by Timeline Followback interview with biochemical confirmation. Three groups were identified: (a) prenatal MJ + TOB, (b) prenatal TOB only, (c) controls. Newborn neurobehavior was assessed at seven time points over the first postnatal month using the NICU Network Neurobehavioral Scale. MJ + TOB-exposed infants showed decreased ability to self-soothe (Self-regulation) and attend to stimuli (Attention), and increased need for examiner soothing (Handling) and low motor activity (Lethargy) versus unexposed infants. Despite low levels of MJ use in MJ + TOB co-users, co-exposure was associated with nearly double the impact on infant self-soothing and need for examiner soothing versus TOB-exposure alone. Effects of MJ + TOB co-exposure appeared more pronounced for daughters than for sons. Although results are preliminary, they highlight additional risk from dual exposure to MJ + TOB vs. TOB exposure alone, particularly for daughters. Results also highlight the critical importance of investigating prenatal exposures in concert and the need for intervention efforts to address MJ co-use in pregnant TOB users.
Collapse
Affiliation(s)
- Laura R Stroud
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, United States; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, United States.
| | - George D Papandonatos
- Department of Biostatistics, School of Public Health, Brown University, 121 South Main Street, Room 703, Providence, RI 02903, United States.
| | - Meaghan McCallum
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, United States.
| | - Tessa Kehoe
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, United States.
| | - Amy L Salisbury
- Department of Pediatrics, Warren Alpert Medical School, Brown University, Box G-RIH, Hasbro 129, Providence, RI 02903, United States; Brown Center for the Study of Children at Risk, Women & Infants' Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, United States.
| | - Marilyn A Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA 19107, United States.
| |
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
Stroud LR, McCallum M, Salisbury AL. Impact of maternal prenatal smoking on fetal to infant neurobehavioral development. Dev Psychopathol 2018; 30:1087-1105. [PMID: 30068428 PMCID: PMC6541397 DOI: 10.1017/s0954579418000676] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite recent emphasis on the profound importance of the fetal environment in "programming" postnatal development, measurement of offspring development typically begins after birth. Using a novel coding strategy combining direct fetal observation via ultrasound and actocardiography, we investigated the impact of maternal smoking during pregnancy (MSDP) on fetal neurobehavior; we also investigated links between fetal and infant neurobehavior. Participants were 90 pregnant mothers and their infants (52 MSDP-exposed; 51% minorities; ages 18-40). Fetal neurobehavior at baseline and in response to vibro-acoustic stimulus was assessed via ultrasound and actocardiography at M = 35 weeks gestation and coded via the Fetal Neurobehavioral Assessment System (FENS). After delivery, the NICU Network Neurobehavioral Scale was administered up to seven times over the first postnatal month. MSDP was associated with increased fetal activity and fetal limb movements. Fetal activity, complex body movements, and cardiac-somatic coupling were associated with infants' ability to attend to stimuli and to self-regulate over the first postnatal month. Furthermore, differential associations emerged by MSDP group between fetal activity, complex body movements, quality of movement, and coupling, and infant attention and self-regulation. The present study adds to a growing literature establishing the validity of fetal neurobehavioral measures in elucidating fetal programming pathways.
Collapse
|
35
|
Lin B, Ostlund BD, Conradt E, Lagasse LL, Lester BM. Testing the programming of temperament and psychopathology in two independent samples of children with prenatal substance exposure. Dev Psychopathol 2018; 30:1023-1040. [PMID: 30068412 PMCID: PMC6074047 DOI: 10.1017/s0954579418000391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Prenatal programming models have rarely been applied to research on children with prenatal substance exposure, despite evidence suggesting that prenatal drug exposure is a form of stress that impacts neurodevelopmental outcomes and risk for psychopathology. Utilizing data from two longitudinal multisite studies comprising children prenatally exposed to substances as well as a nonexposed comparison group (Maternal Lifestyle Study, n = 1,388; Infant Development, Environment, and Lifestyle study, n = 412), we tested whether early phenotypic indicators of hypothesized programming effects, indexed by growth parameters at birth and infant temperament, served as a link between prenatal substance exposure and internalizing and externalizing behavior at age 5. Latent profile analysis indicated that individual differences in reactivity and regulation for infants prenatally exposed to substances was best characterized by four temperament profiles. These profiles were virtually identical across two independent samples, and demonstrated unique associations with adjustment difficulties nearly 5 years later. Results of path analysis using structural equation modeling also showed that increased prenatal substance exposure was linked to poorer growth parameters at birth, profiles of temperamental reactivity in infancy, and internalizing and externalizing behavior at age 5. This pathway was partially replicated across samples. This study was among the first to link known individual-level correlates of prenatal substance exposure into a specific pathway to childhood problem behavior. Implications for the developmental origins of a child's susceptibility to psychopathology as a result of intrauterine substance exposure are discussed.
Collapse
|
36
|
Cinciripini PM, Minnix JA, Green CE, Robinson JD, Engelmann JM, Versace F, Wetter DW, Shete S, Karam-Hage M. An RCT with the combination of varenicline and bupropion for smoking cessation: clinical implications for front line use. Addiction 2018; 113:10.1111/add.14250. [PMID: 29679432 PMCID: PMC6196126 DOI: 10.1111/add.14250] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/15/2017] [Accepted: 04/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Despite the availability of several efficacious smoking cessation treatments, fewer than 25% of smokers who quit remain abstinent 1 year post-treatment. This study aimed to determine if varenicline and bupropion combination treatment would result in higher abstinence rates than varenicline alone. DESIGN A double-blind, randomized, parallel-group smoking cessation clinical trial in which participants were exposed to 12 weeks of treatment and followed for 12 months. SETTING Hospital-based out-patient clinic in Texas, USA specializing in cancer prevention. PARTICIPANTS A total of 385 community smokers (58.44% male) who smoked 1 pack of cigarettes/day [mean = 19.66 cigarettes/day, standard deviation (SD) = 9.45]; had average carbon monoxide (CO) of 26.43 parts per million (SD = 13.74); and were moderately dependent (Fagerström Test for Cigarette Dependence = 4.79; SD = 2.07). INTERVENTIONS AND COMPARATOR Smokers were randomized in a 3 : 1 (active: Placebo) ratio to 12 weeks of treatment as follows: placebo (n = 56), varenicline (Var; n = 166), and varenicline + bupropion (Combo; n = 163). MEASUREMENTS A priori primary outcome: prolonged abstinence at 12 months. SECONDARY OUTCOMES 7-day point prevalence abstinence and continuous abstinence; all abstinence measures at end of treatment and 6-month follow-ups. FINDINGS Intention-to-treat analysis: the Combo group (n = 163) failed to demonstrate superiority to the Var group (n = 166) for prolonged abstinence at 12 months [odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.50-1.64], supported by Bayes factor = 0.06. Both the Var (OR = 6.66, 95% CI = 1.61-59.27) and Combo groups (OR = 6.06, 95% CI = 1.45-54.09) demonstrated superiority to the Placebo group (n = 56; score = 8.38, P < 0.016). CONCLUSIONS The addition of bupropion to varenicline treatment does not appear to increase smoking abstinence rates above that of varenicline alone. The findings support previous research showing a consistently favorable effect of both varenicline and the combination of varenicline and bupropion on smoking cessation compared with placebo.
Collapse
Affiliation(s)
- Paul M. Cinciripini
- The University of Texas MD Anderson Cancer Center Department of Behavioral Science
| | - Jennifer A. Minnix
- The University of Texas MD Anderson Cancer Center Department of Behavioral Science
| | - Charles E. Green
- The University of Texas at Houston Health Sciences Center Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine
| | - Jason D. Robinson
- The University of Texas MD Anderson Cancer Center Department of Behavioral Science
| | | | - Francesco Versace
- The University of Texas MD Anderson Cancer Center Department of Behavioral Science
| | - David W. Wetter
- University of Utah, Department of Population Health Sciences and the Huntsman Cancer Institute
| | - Sanjay Shete
- The University of Texas MD Anderson Cancer Center Department of Behavioral Science
| | - Maher Karam-Hage
- The University of Texas MD Anderson Cancer Center Department of Behavioral Science
| |
Collapse
|
37
|
O'Neill HC, Wageman CR, Sherman SE, Grady SR, Marks MJ, Stitzel JA. The interaction of the Chrna5 D398N variant with developmental nicotine exposure. GENES BRAIN AND BEHAVIOR 2018; 17:e12474. [PMID: 29573323 DOI: 10.1111/gbb.12474] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/26/2018] [Accepted: 03/14/2018] [Indexed: 12/14/2022]
Abstract
A single nucleotide polymorphism (SNP) in CHRNA5 (rs16969968, change from an aspartic acid [D] to asparagine [N] at position 398 of the human α5 nicotinic acetylcholine receptor subunit) has been associated with increased risk for nicotine dependence. Consequently, carriers of the risk variant may be at elevated risk for in utero nicotine exposure. To assess whether this gene-environment interaction might impact nicotine intake in developmental nicotine-exposed offspring, we utilized a mouse expressing this human SNP. D and N dams drank nicotine (100 μg/mL) in 0.2% saccharin water or 0.2% saccharin water alone (vehicle) as their sole source of fluid from 30 days prior to breeding until weaning of offspring. The nicotine (D Nic, N Nic) or vehicle (D Veh, N Veh) exposed offspring underwent a 2-bottle choice test between postnatal ages of 30 to 46 days. N Nic offspring consumed the most nicotine at the highest concentration (400 μg/mL) compared with all other groups. In contrast, D Nic offspring drank the least amount of nicotine at all concentrations tested. Nicotine-stimulated dopamine (DA) release measured from striatal synaptosomes was increased in D Nic offspring, while decreased in N Nic offspring relative to their genotype-matched controls. These data suggest that the α5 variant influences the effect of developmental nicotine exposure on nicotine intake of exposed offspring. This gene-environment interaction on striatal DA release may provide motivation for increased nicotine seeking in N Nic offspring and reduced consumption in D Nic offspring.
Collapse
Affiliation(s)
- H C O'Neill
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado
| | - C R Wageman
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado
| | - S E Sherman
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado
| | - S R Grady
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado
| | - M J Marks
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado.,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado
| | - J A Stitzel
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado.,Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| |
Collapse
|
38
|
Makadia LD, Roper PJ, Andrews JO, Tingen MS. Tobacco Use and Smoke Exposure in Children: New Trends, Harm, and Strategies to Improve Health Outcomes. Curr Allergy Asthma Rep 2017; 17:55. [PMID: 28741144 DOI: 10.1007/s11882-017-0723-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Every day in the USA, approximately 4000 adolescents begin smoking and the adolescent brain is particularly susceptible to nicotine addiction. We present current pediatric trends on tobacco use and exposures, various new products used by adolescents, the adverse biological and behavioral effects of tobacco use and exposures, and tobacco control strategies to eliminate tobacco-related illnesses and deaths in the pediatric population. RECENT FINDINGS Twelve-20% of women continue to smoke during pregnancy. New research reveals cognitive differences and behavior-control disorders are seen in elementary school children from prenatal and postnatal exposures. Traditional cigarette smoking has decreased in adolescents; novel and appealing tobacco products have captured their attention, particularly electronic cigarettes, and rates double and often triple from middle to high school. Children with asthma and those living in multi-housing units have higher rates of secondhand smoke exposure than non-asthmatics and children living in single-home dwellings. There is no "safe or risk-free" level of tobacco use or exposure. Tobacco use and exposure in childhood and adolescence must be decreased using evidenced-based strategies to improve child health.
Collapse
Affiliation(s)
- Luv D Makadia
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - P Jervey Roper
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Martha S Tingen
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta University, HS-1755, 1499 Walton Way, Augusta, GA, 30912, USA.
| |
Collapse
|
39
|
Coleman-Cowger VH, Schauer GL, Peters EN. Marijuana and tobacco co-use among a nationally representative sample of US pregnant and non-pregnant women: 2005-2014 National Survey on Drug Use and Health findings. Drug Alcohol Depend 2017; 177:130-135. [PMID: 28599211 DOI: 10.1016/j.drugalcdep.2017.03.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/02/2017] [Accepted: 03/14/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Marijuana and tobacco are the most commonly used illicit and licit drugs during pregnancy. This study aimed to examine a nationally representative sample of US pregnant women and to: (1) determine the prevalence of past month marijuana and tobacco co-use, (2) identify characteristics that distinguish marijuana and tobacco co-users from users of marijuana only, tobacco only, or neither, and (3) compare characteristics that differ between pregnant and non-pregnant co-users of marijuana and tobacco. METHODS Data were obtained from 497,218 US women (8721 pregnant) ages 12-49 who participated in the 2005-2014 National Survey on Drug Use and Health. Prevalence and demographic and substance use characteristics were compared across groups using weighted estimates and chi-squared tests. Multinomial logistic regression identified demographic and substance use correlates of co-use. RESULTS Co-use among pregnant and non-pregnant women was significantly more prevalent than marijuana-only use but was less common than tobacco-only use. In unadjusted frequencies, pregnant co-users significantly differed from non-pregnant co-users across several domains. Among pregnant women, multivariate correlates of co-use of tobacco and marijuana vs. tobacco-only use were ages 12-17, non-Hispanic black race, Hispanic ethnicity, and past month polytobacco, any alcohol, and other drug use (all adjusted odds ratios≥2.0). CONCLUSIONS In this first examination of the prevalence and correlates of co-use of marijuana and tobacco among a nationally representative group of pregnant women, pregnant co-users were more likely to report other high risk behaviors compared with non-pregnant co-users and users of a single substance, suggesting disparities worthy of further investigation.
Collapse
Affiliation(s)
| | - Gillian L Schauer
- Health Services Department, School of Public Health, University of Washington, Seattle, WA, United States
| | - Erica N Peters
- Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States
| |
Collapse
|
40
|
Environmental Tobacco Smoke Exposure during Pregnancy and Child Neurodevelopment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070796. [PMID: 28714930 PMCID: PMC5551234 DOI: 10.3390/ijerph14070796] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/06/2017] [Accepted: 07/09/2017] [Indexed: 11/18/2022]
Abstract
The developing fetus is especially vulnerable to environmental toxicants, including tobacco constituents. The aim of this study was to assess the impact of environmental tobacco smoke (ETS) exposure during pregnancy on child neurodevelopment within the first two years of life. The study population consisted of 461 non-smoking pregnant women (saliva cotinine level <10 ng/mL). Maternal passive smoking was assessed based on the cotinine level in saliva analyzed by the use of high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC-ESI + MS/MS) and by questionnaire data. The cotinine cut-off value for passive smoking was established at 1.5 ng/mL (sensitivity 63%, specificity 71%). Psychomotor development was assessed in children at the age of one- and two-years using the Bayley Scales of Infant and Toddler Development. Approximately 30% of the women were exposed to ETS during pregnancy. The multivariate linear regression model indicated that ETS exposure in the 1st and the 2nd trimesters of pregnancy were associated with decreasing child language functions at the age of one (β = −3.0, p = 0.03, and β = −4.1, p = 0.008, respectively), and two years (β = −3.8, p = 0.05, and β = −6.3, p = 0.005, respectively). A negative association was found for cotinine level ≥1.5 ng/mL in the 2nd trimester of pregnancy and child cognition at the age of 2 (β = −4.6, p = 0.05), as well as cotinine levels ≥1.5 ng/mL in all trimesters of pregnancy and child motor abilities at two years of age (β = −3.9, p = 0.06, β = −5.3, p = 0.02, and β = −4.2, p = 0.05, for the 1st, the 2nd, and the 3rd trimester of pregnancy, respectively; for the 1st trimester the effect was of borderline statistical significance). This study confirmed that ETS exposure during pregnancy can have a negative impact on child psychomotor development within the first two years of life and underscore the importance of public health interventions aiming at reducing this exposure.
Collapse
|
41
|
Ekblad M, Lehtonen L, Korkeila J, Gissler M. Maternal Smoking During Pregnancy and the Risk of Psychiatric Morbidity in Singleton Sibling Pairs. Nicotine Tob Res 2017; 19:597-604. [PMID: 28403473 PMCID: PMC5441922 DOI: 10.1093/ntr/ntx001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 01/24/2017] [Indexed: 11/14/2022]
Abstract
Introduction Maternal smoking during pregnancy has been associated with an increased risk for psychiatric morbidity. We further studied this with Finnish siblings to control for genetic/familial factors. Methods From the Finnish Medical Birth Register, sibling pairs were selected as the first two children born 1987-1995 to the same mother (n = 150 168 pairs), along with information on maternal smoking (no smoking/smoking). Information on the children's psychiatric diagnoses related to outpatient care visits (1998-2013) and inpatient care (1987-2013), and the mothers' psychiatric morbidity (1969-2013) was derived from the Finnish Hospital Discharge Register. The first pair analysis compared siblings of mothers who only smoked in the first pregnancy (Quitters, 4.7%) and mothers who smoked in both pregnancies (Smokers, 9.6%); the second analysis included mothers who smoked only in the second pregnancy (Starters, 3.3%) and mothers who did not smoke in either pregnancy (Nonsmokers, 77.5%). Smoking information was missing for 5.0% of pairs. Psychiatric morbidity of the siblings and mother was included in the statistical analyses. Results The risk of psychiatric diagnoses was significantly lower for the second child of quitters (adjusted OR 0.77, 95% CI 0.72-0.83) compared to the risk among smokers. A higher risk for psychiatric diagnoses was found for the second child of starters (1.39, 1.30-1.49) compared to the risk among nonsmokers. The effect of smoking was more robust for externalizing diagnoses. Conclusions Maternal smoking was independently associated with a higher risk for psychiatric morbidity in children, even when controlling thoroughly for genetic and familial factors. Implications Maternal smoking during pregnancy has an independent effect on the risk of psychiatric morbidity in children, even after controlling for non-measurable genetic/familial factors by using a sibling pair design. The effect of maternal smoking was robust for externalizing diagnoses. Maternal smoking during pregnancy had an effect on diagnoses both in outpatient and inpatient care.
Collapse
Affiliation(s)
- Mikael Ekblad
- Department of General Practice, Turku University Hospital, Turku, Finland.,Institute of Medicine, University of Turku, Turku, Finland.,Central Satakunta Federation of Municipalities, Harjavalta, Finland
| | - Liisa Lehtonen
- Institute of Medicine, University of Turku, Turku, Finland.,Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Jyrki Korkeila
- Department of Psychiatry, Institute of Medicine, University of Turku, Turku, Finland.,Harjavalta Hospital, Harjavalta, Finland
| | - Mika Gissler
- Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
42
|
Cinciripini PM, Green CE, Robinson JD, Karam-Hage M, Engelmann JM, Minnix JA, Wetter DW, Versace F. Benefits of varenicline vs. bupropion for smoking cessation: a Bayesian analysis of the interaction of reward sensitivity and treatment. Psychopharmacology (Berl) 2017; 234:1769-1779. [PMID: 28275830 PMCID: PMC5901731 DOI: 10.1007/s00213-017-4580-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
RATIONALE We have shown that differences in the level of neural activation to stimuli associated with smoking vs. natural rewards, a biomarker related to reward sensitivity, predict treatment outcome. OBJECTIVES This paper examined whether this biomarker moderates the impact of bupropion or varenicline on smoking cessation. METHODS Prior to treatment randomization, smokers (N = 180) in a placebo-controlled trial using bupropion and varenicline completed event-related potential recording (late positive potential, LPP) while viewing pleasant (P), cigarette (C)-related, and other pictures. We used Bayesian models to estimate the probability of interaction between treatment and the LPP for both efficacy and comparative effectiveness analyses. RESULTS Efficacy analysis showed that smokers with more neural activation to pleasant vs. cigarette-related stimuli (P > C) had a 98-99% chance of achieving greater abstinence than placebo (OR >1.00), using either medication from the end of treatment (EOT, primary outcome) through the 3-month follow-up. Relative to placebo, smokers with higher activation to cigarette-related vs. pleasant stimuli (C > P) had a 99% chance of increased benefit from varenicline at both time points (OR >1), but only 67 and 43% with bupropion at the EOT and 3-month follow-up, respectively. Comparative effectiveness analysis found that smokers with the C > P activation pattern had a 95-98% chance of benefit from varenicline vs. bupropion, while P > C smokers had a 50-58% chance of similar improvement with varenicline at the EOT and 3 months. CONCLUSIONS Varenicline appears to be the treatment of choice for smokers with the C > P pattern of neural activation, while for those showing P > C, varenicline and bupropion have similar efficacy.
Collapse
Affiliation(s)
- Paul M. Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX 77230-1439, USA
| | - Charles E. Green
- The University of Texas at Houston Health Sciences Center, Houston, TX, USA
| | - Jason D. Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX 77230-1439, USA
| | - Maher Karam-Hage
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX 77230-1439, USA
| | - Jeffrey M. Engelmann
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX 77230-1439, USA
| | - Jennifer A. Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX 77230-1439, USA
| | | | - Francesco Versace
- University of Oklahoma Health Sciences Center and Oklahoma Tobacco Research Center, Oklahoma City, USA
| |
Collapse
|
43
|
England LJ, Aagaard K, Bloch M, Conway K, Cosgrove K, Grana R, Gould TJ, Hatsukami D, Jensen F, Kandel D, Lanphear B, Leslie F, Pauly JR, Neiderhiser J, Rubinstein M, Slotkin TA, Spindel E, Stroud L, Wakschlag L. Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products. Neurosci Biobehav Rev 2017; 72:176-189. [PMID: 27890689 PMCID: PMC5965681 DOI: 10.1016/j.neubiorev.2016.11.013] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 12/24/2022]
Abstract
While the health risks associated with adult cigarette smoking have been well described, effects of nicotine exposure during periods of developmental vulnerability are often overlooked. Using MEDLINE and PubMed literature searches, books, reports and expert opinion, a transdisciplinary group of scientists reviewed human and animal research on the health effects of exposure to nicotine during pregnancy and adolescence. A synthesis of this research supports that nicotine contributes critically to adverse effects of gestational tobacco exposure, including reduced pulmonary function, auditory processing defects, impaired infant cardiorespiratory function, and may contribute to cognitive and behavioral deficits in later life. Nicotine exposure during adolescence is associated with deficits in working memory, attention, and auditory processing, as well as increased impulsivity and anxiety. Finally, recent animal studies suggest that nicotine has a priming effect that increases addiction liability for other drugs. The evidence that nicotine adversely affects fetal and adolescent development is sufficient to warrant public health measures to protect pregnant women, children, and adolescents from nicotine exposure.
Collapse
Affiliation(s)
- Lucinda J England
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kjersti Aagaard
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Michele Bloch
- Division of Cancer Control and Population Science, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Kevin Conway
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Rockville, MD, USA
| | - Kelly Cosgrove
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rachel Grana
- Division of Cancer Control and Population Science, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Thomas J Gould
- Department of Biobehavioral Health, Pennsylvania State University, PA, USA
| | | | - Frances Jensen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Denise Kandel
- Department of Psychiatry and Mailman School of Public Health, Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | | | - Frances Leslie
- Department of Pharmacology, School of Medicine, University of California, Irvine, CA, USA
| | - James R Pauly
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Jenae Neiderhiser
- Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Mark Rubinstein
- Department of Pediatrics, School of Medicine, University of California, San Francisco, CA, USA
| | - Theodore A Slotkin
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Eliot Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| | - Laura Stroud
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Lauren Wakschlag
- Department of Medical Social Sciences Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
44
|
Stroud LR, Papandonatos GD, Salisbury AL, Phipps MG, Huestis MA, Niaura R, Padbury JF, Marsit CJ, Lester BM. Epigenetic Regulation of Placental NR3C1: Mechanism Underlying Prenatal Programming of Infant Neurobehavior by Maternal Smoking? Child Dev 2016; 87:49-60. [PMID: 26822442 DOI: 10.1111/cdev.12482] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epigenetic regulation of the placental glucocorticoid receptor gene (NR3C1) was investigated as a mechanism underlying links between maternal smoking during pregnancy (MSDP) and infant neurobehavior in 45 mother-infant pairs (49% MSDP-exposed; 52% minorities; ages 18-35). The Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale was administered 7 times over the 1st postnatal month; methylation of placental NR3C1 was assessed via bisulfite pyrosequencing. Increased placental NR3C1 methylation was associated with increased infant attention and self-regulation, and decreased lethargy and need for examiner soothing over the 1st postnatal month. A causal steps approach revealed that NR3C1 methylation and MSDP were independently associated with lethargic behavior. Although preliminary, results highlight the importance of epigenetic mechanisms in elucidating pathways to neurobehavioral alterations from MSDP.
Collapse
|
45
|
Un Lam C, Hsu CYS, Yee R, Koh D, Lee YS, Chong MFF, Cai M, Kwek K, Saw SM, Gluckman P, Chong YS. Early-life factors affect risk of pain and fever in infants during teething periods. Clin Oral Investig 2016; 20:1861-1870. [PMID: 26592811 DOI: 10.1007/s00784-015-1658-2] [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: 03/05/2015] [Accepted: 11/10/2015] [Indexed: 12/25/2022]
Abstract
AIM This longitudinal study aimed to investigate the prevalence of teething-related pain and fever and the early-life factors that may affect the risk of experiencing these disturbances within the first 1.5 years of life. MATERIALS AND METHODS Participants were recruited (n = 1033) through the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort (n = 1237). Interviews were performed tri-monthly regarding the prevalence of teething pain and fever in children from 6 to 18 months of age. Crude and multivariable analyses were conducted using Poisson-log regression models. RESULTS Prevalence rates for teething pain and fever were 35.5 and 49.9 % respectively. Multivariable Poisson regression analysis showed maternal second-hand tobacco smoke (SHS) exposure to increase the risk of both pain (mean ratio = 1.35; p = 0.006) and fever (mean ratio = 1.22; p = 0.025), whereas SHS exposure plus active smoking further increased risk of teething pain in the children (mean ratio = 1.89; p = 0.029). Delivery via Caesarean section increased risk of teething pain (mean ratio = 1.27; p = 0.033), while prenatal plasma vitamin D insufficiency lowered such a risk (mean ratio = 0.62; p = 0.012). Compared to Chinese infants, Indian babies exhibited lower risk of teething pain and fever (both p ≤ 0.001). CONCLUSIONS Early-life factors such as tobacco smoke exposure and vitamin insufficiency during pregnancy, ethnicity and childbirth via Caesarean section may significantly affect the child's susceptibility to teething-related pain and fever. CLINICAL RELEVANCE Knowledge of prevalence and risk factors of teething disturbances may better equip primary caregivers and healthcare professionals to accurately detect teething-related local and/or systemic signs/symptoms and effectively facilitate tobacco cessation among pregnant women.
Collapse
Affiliation(s)
- Carolina Un Lam
- Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Chin-Ying Stephen Hsu
- Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
| | - Robert Yee
- Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - David Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore, Singapore
| | - Meijin Cai
- Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Kenneth Kwek
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital (KKH), Singapore, Singapore
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
46
|
Godleski SA, Eiden RD, Schuetze P, Colder CR, Huestis MA. Tobacco exposure and maternal psychopathology: Impact on toddler problem behavior. Neurotoxicol Teratol 2016; 57:87-94. [PMID: 27498223 PMCID: PMC6059373 DOI: 10.1016/j.ntt.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/03/2016] [Accepted: 07/29/2016] [Indexed: 02/07/2023]
Abstract
Prenatal exposure to tobacco has consistently predicted later problem behavior for children. However, little is known about developmental mechanisms underlying this association. We examined a conceptual model for the association between prenatal tobacco exposure and child problem behavior in toddlerhood via indirect paths through fetal growth, maternal depression, and maternal aggressive disposition in early infancy and via maternal warmth and sensitivity and infant negative affect in later infancy. The sample consisted of 258 mother-child dyads recruited during pregnancy and assessed periodically at 2, 9, and 16months of child age. Pathways via maternal depression and infant negative affect to toddler problem behavior were significant. Further, combined tobacco and marijuana exposure during pregnancy and reduced fetal growth also demonstrated important associations with infant negative affect and subsequent problem behavior. These results highlight the importance of considering the role of maternal negative affect and poor fetal growth as risk factors in the context of prenatal exposure.
Collapse
Affiliation(s)
| | - Rina D Eiden
- Research Institute of Addictions, University at Buffalo, State University of New York, United States
| | - Pamela Schuetze
- Psychology Department, Buffalo State College, State University of New York, United States
| | - Craig R Colder
- Psychology Department, University at Buffalo, State University of New York, United States
| | | |
Collapse
|
47
|
Appleton AA, Murphy MA, Koestler DC, Lesseur C, Paquette AG, Padbury JF, Lester BM, Marsit CJ. Prenatal Programming of Infant Neurobehaviour in a Healthy Population. Paediatr Perinat Epidemiol 2016; 30:367-75. [PMID: 27004434 PMCID: PMC5054721 DOI: 10.1111/ppe.12294] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Identifying the prenatal origins of mental conditions is of increasing interest, yet most studies have focused on high-risk populations and cannot disentangle prenatal and postnatal programming effects. Thus, we examined whether profiles of neurobehaviour indicative of future risk could be identified in healthy 1-3-day-old infants, and examined associations with perinatal risk factors. METHODS Participants included 627 healthy mothers and term infants from a population-based US cohort. Neurobehaviour was assessed within 24-72 h after delivery with the NICU Network Neurobehavioural Scales (NNNS). A model-based clustering algorithm was used to derive neurobehavioural profiles from NNNS scores. Maternal health histories, pregnancy conditions and behaviours, labour/delivery factors, and infant attributes were examined in relation to the neurobehavioural profiles. RESULTS Seven discrete neurobehavioural profiles were identified, including one average functioning profile, and two inversely patterned below and above average profiles. Higher pregnancy weight gain (OR 1.44, 95% CI 1.10, 1.88) and birthweight percentiles (OR 1.46, 95% CI 1.10, 1.95) were associated with greater odds of below average newborn neurobehaviour. Above average neurobehaviour was associated with experiencing longer gestations (OR 1.29, 95% CI 1.02, 1.64) and higher 5-min APGAR scores (OR 2.43, 95% CI 1.07, 5.52). Maternal pregnancy alcohol use (OR 0.54, 95% CI 0.33, 0.89), and fetal distress (OR 0.10, 95% CI 0.01, 0.72) were associated with lower likelihood of having average neurobehaviour. CONCLUSION Distinct profiles of neurobehaviour can be derived in a healthy population of newborns, with different sets of perinatal factors predicting different patterns of neurobehaviour. These findings suggest a potential in utero origin for mental health risk.
Collapse
Affiliation(s)
- Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY
| | - Megan A. Murphy
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Devin C. Koestler
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
| | - Corina Lesseur
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Alison G. Paquette
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - James F. Padbury
- Department of Pediatrics, Women and Infants Hospital, Providence, RI
| | - Barry M. Lester
- Department of Pediatrics, Women and Infants Hospital, Providence, RI,Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI
| | - Carmen J. Marsit
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH,Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH
| |
Collapse
|
48
|
Scott-Goodwin A, Puerto M, Moreno I. Toxic effects of prenatal exposure to alcohol, tobacco and other drugs. Reprod Toxicol 2016; 61:120-30. [DOI: 10.1016/j.reprotox.2016.03.043] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 03/08/2016] [Accepted: 03/28/2016] [Indexed: 01/21/2023]
|
49
|
Holbrook BD. The effects of nicotine on human fetal development. BIRTH DEFECTS RESEARCH. PART C, EMBRYO TODAY : REVIEWS 2016; 108:181-92. [PMID: 27297020 DOI: 10.1002/bdrc.21128] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Maternal smoking during pregnancy continues to represent a major public health concern. Nicotine is extremely harmful to the developing fetus through many different mechanisms, and the harms increase with later gestational age at exposure. Pregnancies complicated by maternal nicotine use are more likely to have significant adverse outcomes. Nicotine-exposed children tend to have several health problems throughout their lives, including impaired function of the endocrine, reproductive, respiratory, cardiovascular, and neurologic systems. Poor academic performance and significant behavioral disruptions are also common, including ADHD, aggressive behaviors, and future substance abuse. To diminish the adverse effects from cigarette smoking, some women are turning to electronic cigarettes, a new trend that is increasing in popularity worldwide. They are largely perceived as being safer to use in pregnancy than traditional cigarettes, although there is not adequate evidence to support this claim. At this time, electronic cigarette use during pregnancy cannot be recommended. Birth Defects Research (Part C) 108:181-192, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Bradley D Holbrook
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
| |
Collapse
|
50
|
Katner SN, Neal-Beliveau BS, Engleman EA. Embryonic Methamphetamine Exposure Inhibits Methamphetamine Cue Conditioning and Reduces Dopamine Concentrations in Adult N2 Caenorhabditis elegans. Dev Neurosci 2016; 38:139-49. [PMID: 27233671 DOI: 10.1159/000445761] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/23/2016] [Indexed: 11/19/2022] Open
Abstract
Methamphetamine (MAP) addiction is substantially prevalent in today's society, resulting in thousands of deaths and costing billions of dollars annually. Despite the potential deleterious consequences, few studies have examined the long-term effects of embryonic MAP exposure. Using the invertebrate nematode Caenorhabditis elegans allows for a controlled analysis of behavioral and neurochemical changes due to early developmental drug exposure. The objective of the current study was to determine the long-term behavioral and neurochemical effects of embryonic exposure to MAP in C. elegans. In addition, we sought to improve our conditioning and testing procedures by utilizing liquid filtration, as opposed to agar, and smaller, 6-well testing plates to increase throughput. Wild-type N2 C. elegans were embryonically exposed to 50 μM MAP. Using classical conditioning, adult-stage C. elegans were conditioned to MAP (17 and 500 μM) in the presence of either sodium ions (Na+) or chloride ions (Cl-) as conditioned stimuli (CS+/CS-). Following conditioning, a preference test was performed by placing worms in 6-well test plates spotted with the CS+ and CS- at opposite ends of each well. A preference index was determined by counting the number of worms in the CS+ target zone divided by the total number of worms in the CS+ and CS- target zones. A food conditioning experiment was also performed in order to determine whether embryonic MAP exposure affected food conditioning behavior. For the neurochemical experiments, adult worms that were embryonically exposed to MAP were analyzed for dopamine (DA) content using high-performance liquid chromatography. The liquid filtration conditioning procedure employed here in combination with the use of 6-well test plates significantly decreased the time required to perform these experiments and ultimately increased throughput. The MAP conditioning data found that pairing an ion with MAP at 17 or 500 μM significantly increased the preference for that ion (CS+) in worms that were not pre-exposed to MAP. However, worms embryonically exposed to MAP did not exhibit significant drug cue conditioning. The inability of MAP-exposed worms to condition to MAP was not associated with deficits in food conditioning, as MAP-exposed worms exhibited a significant cue preference associated with food. Furthermore, our results found that embryonic MAP exposure reduced DA levels in adult C. elegans, which could be a key mechanism contributing to the long-term effects of embryonic MAP exposure. It is possible that embryonic MAP exposure may be impairing the ability of C. elegans to learn associations between MAP and the CS+ or inhibiting the reinforcing properties of MAP. However, our food conditioning data suggest that MAP-exposed animals can form associations between cues and food. The depletion of DA levels during embryonic exposure to MAP could be responsible for driving either of these processes during adulthood.
Collapse
Affiliation(s)
- Simon N Katner
- Department of Psychiatry, Institute of Psychiatric Research, Indianapolis, Ind., USA
| | | | | |
Collapse
|