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Koponen AM, Gissler M, Nissinen NM, Autti-Rämö I, Kahila H, Sarkola T. Cumulative risk factors for injuries and poisoning requiring hospital care in youth with prenatal substance exposure: A longitudinal controlled cohort study. Nordisk Alkohol Nark 2024; 41:156-174. [PMID: 38645973 PMCID: PMC11027846 DOI: 10.1177/14550725231202074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/04/2023] [Indexed: 04/23/2024] Open
Abstract
Aim: To investigate whether the youth with prenatal substance exposure (PSE) (aged 15-24 years, n = 615) had been in hospital care more often due to injuries and poisoning in comparison with unexposed matched controls (n = 1787). Methods: Data from medical records (exposure) and national health and social welfare registers (outcome and confounders) were combined and youths were monitored from birth until either outpatient or inpatient hospital care for injury or poisoning, death or the end of the study period (December 2016). Cox regression models were used in the analyses accounting for associated child and maternal risk factors. Results: Half (50.4%) of the exposed group and 40.6% of controls had been in hospital care due to injury or poisoning during the follow-up (p < 0.001). The difference between groups was diminished after controlling for postnatal child and maternal risk factors (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.72-1.07, p > 0.05). Cumulative adversity, especially out-of-home care in combination with a diagnosed attention or behavioural dysregulation problem, posed the highest risk in both groups (exposed: HR = 1.65, 95% CI 1.24-2.19, p < 0.001; controls: HR = 1.84, 95% CI 1.33-2.56, p < 0.001). Conclusion: Hospital care for injury and poisoning is more common in youth with PSE, but this is largely explained by the related postnatal child and maternal factors. Long-term support to families with maternal substance abuse problems could prevent injury and poisoning among youth with PSE.
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Affiliation(s)
- Anne M. Koponen
- Department of Public Health, and Social Psychology Unit, Folkhälsan Research Center, and University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland; Research Centre for Child Psychiatry, University of Turku, Turku, Finland; Academic Primary Health Care Centre, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Ilona Autti-Rämö
- Department of Child Neurology, Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Hanna Kahila
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland; Minerva Foundation Institute for Medical Research, Helsinki, Finland
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Lee C, Rizzi S, Bierrenbach AL, Antunes L, Nissinen NM, Rocha O, Campbell J, Minassian C, Hodgson S, Broe A. Identification of misclassified pregnancy episodes in women of childbearing potential exposed to drugs with known teratogenic potential in the CPRD GOLD Pregnancy Register. Pharmacoepidemiol Drug Saf 2024; 33:e5761. [PMID: 38362650 DOI: 10.1002/pds.5761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024]
Affiliation(s)
| | | | | | | | | | | | | | | | - Susan Hodgson
- Clinical Practice Research Datalink (CPRD), London, UK
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Nissinen NM, Rangmar J, Autti-Rämö I, Gissler M, Kahila H, Raitasalo K, Sarkola T. Financial difficulties among youth prenatally exposed to substances: a longitudinal register-based cohort study. Drugs: Education, Prevention and Policy 2023. [DOI: 10.1080/09687637.2023.2176285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Niina-Maria Nissinen
- Faculty of Social Sciences, Health Sciences Unit, Tampere University, Tampere, Finland
| | - Jenny Rangmar
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Ilona Autti-Rämö
- Division of Child Neurology, University of Helsinki, Children’s Hospital, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Hanna Kahila
- Obstetrics and Gynecology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Kirsimarja Raitasalo
- Department of Public Health and Welfare, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Taisto Sarkola
- Children’s Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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Koponen AM, Nissinen NM, Gissler M, Autti-Rämö I, Kahila H, Sarkola T. Adverse childhood experiences and neurodevelopmental disorders among youth with and without prenatal substance exposure: A longitudinal matched register-based cohort study. Nordic Studies on Alcohol and Drugs 2022; 40:176-198. [PMID: 37063820 PMCID: PMC10101169 DOI: 10.1177/14550725221110190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Previous research has shown an association between adverse childhood experiences (ACEs) and secondary mental health problems in youth with prenatal substance exposure (PSE), but the association between ACEs and neurodevelopmental disorders is less clear. Methods: This longitudinal register-based cohort study investigated relationships between health at birth, ACEs (out-of-home care (OHC) and maternal adversities), and neurodevelopmental disorders among youth with PSE (alcohol/drugs, n = 615) and matched unexposed controls ( n = 1787). Hospital medical records and register data were merged and analysed using Cox regression models. Results: Conduct and emotional disorders (International Statistical Classification of Diseases and Related Health Problems ICD-10, F90–F94) were more common among the exposed than the controls but only when the exposed and controls with no OHC were compared. The difference appeared in hyperkinetic disorders (ADHD, F90), mixed disorders of conduct and emotions (F92) and emotional disorders with onset specific to childhood (F93). Among the exposed and controls with OHC, over 40% had received an F90–F94 diagnosis. Regarding specific developmental disorders (F80–F83, e.g., impairments in speech and language and scholastic skills) the moderate difference between the exposed and controls attenuated after adjustment for OHC. Again, the rates were highest among the exposed with OHC and the controls with OHC. OHC and maternal risks were interrelated and, together with male sex and low birth weight, were associated with neurodevelopmental disorders both among the exposed and controls and decreased the difference between them. Conclusions: A strong association between ACEs and neurodevelopmental disorders was found. Brain research is needed to examine whether ACEs worsen neurodevelopmental outcomes caused by PSE.
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Affiliation(s)
- Anne M. Koponen
- Folkhälsan Research Center; and University of Helsinki, Helsinki, Finland
| | | | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland; University of Turku, Turku, Finland; Academic Primary Health Care Centre, Stockholm, Sweden; and Karolinska Institutet, Stockholm, Sweden
| | | | - Hanna Kahila
- Helsinki University Central Hospital, Helsinki, Finland
| | - Taisto Sarkola
- Children’s Hospital, University of Helsinki; Helsinki University Hospital, Helsinki, Finland; and Minerva Foundation Institute for Medical Research, Helsinki, Finland
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Nissinen NM, Sarkola T, Autti-Rämö I, Gissler M, Kahila H, Koponen AM. Mood and neurotic disorders among youth with prenatal substance exposure: A longitudinal register-based cohort study. J Affect Disord 2022; 308:328-336. [PMID: 35439464 DOI: 10.1016/j.jad.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prenatal substance exposure is associated with mood and neurotic disorders but this association is complex and understudied. This study investigated the recorded use of specialised healthcare services for mood and neurotic disorders among youth with prenatal substance exposure in comparison with an unexposed matched cohort. Furthermore, the influence of adverse maternal characteristics and out-of-home care (OHC) is investigated. METHODS This longitudinal register-based matched cohort study included 594 exposed and 1735 unexposed youth. Cox proportional hazard regression models were applied to study the first episode of mood and neurotic disorders in specialised healthcare from 13 years of age, and the influence of adverse maternal characteristics and OHC. Mediation analysis was applied to study the mediating effect of OHC on the association between prenatal substance exposure and the disorders. RESULTS The exposed cohort had a two-fold higher likelihood of being treated at specialised healthcare for mood and neurotic disorders compared with the unexposed cohort (HR 2.34, 95% CI 1.86-2.95), but this difference was attenuated to non-significant levels (AHR 1.29, 95% CI 0.92-1.81) following adjustments with adverse maternal characteristics and OHC. OHC mediated 61% (95% CI 0.41-0.94) of the association between prenatal substance exposure and youth's mood and neurotic disorders. LIMITATIONS Register data likely include more severe cases of disorders, and as an observational study, causality cannot be assessed. CONCLUSION Mood and neurotic disorders are more common following prenatal exposure to substances and interlinked with significant adversities in the postnatal caregiving environment and OHC.
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Affiliation(s)
- Niina-Maria Nissinen
- Folkhälsan Research Center, Helsinki, Finland; Tampere University, Faculty of Social Sciences, Health Sciences Unit, Tampere, Finland.
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland; Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Ilona Autti-Rämö
- University of Helsinki, Children's Hospital, Division of Child Neurology, Helsinki, Finland
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland; Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden and Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden; University of Turku, Research Centre for Child Psychiatry, Turku, Finland
| | - Hanna Kahila
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Anne M Koponen
- Folkhälsan Research Center, Helsinki, Finland; University of Helsinki, Department of Public Health, Helsinki, Finland
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Nissinen NM, Gissler M, Sarkola T, Kahila H, Autti-Rämö I, Koponen AM. Completed secondary education among youth with prenatal substance exposure: A longitudinal register-based matched cohort study. J Adolesc 2020; 86:15-27. [PMID: 33264707 DOI: 10.1016/j.adolescence.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The dual impact of prenatal substance exposure (i.e. alcohol/drugs) and adverse postnatal caregiving environment on offspring secondary education completion is an understudied research area. The aim was to investigate the influence of childhood adversities, out-of-home care, and offspring's mental and/or behavioural disorders on secondary education completion among prenatally exposed offspring in comparison to matched unexposed offspring. METHODS This is a longitudinal register-based matched cohort study in Finland including offspring with a history of prenatal substance exposure and a matched unexposed cohort. The study sample included 283 exposed and 820 unexposed offspring aged 18-23 years. RESULTS The results showed a time lag in secondary education completion and lower educational attainment overall among exposed compared with unexposed (37.8% vs. 51.0%, respectively). The results from the multivariate logistic regression models showed that the differences in the secondary education completion between exposed and unexposed were diminished in the presence of covariates. A cumulative childhood adversity score and out-of-home care were not associated with secondary education completion in the multivariate models, whereas the different domains of offspring's mental and/or behavioural disorders including psychiatric disorders (AOR 0.65, 95% CI 0.45-0.96), neuropsychological disorders (AOR 0.35, 95% CI 0.23-0.54) and dual psychiatric and neuropsychological disorder (AOR 0.29, 95% CI 0.18-0.48) showed an independent negative effect on secondary education completion. CONCLUSIONS Inferior educational outcomes may not be directly linked with prenatal substance exposure but may rather reflect the extent of evolving offspring's mental and/or behavioural disorders over time influenced by childhood adversities.
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Affiliation(s)
- Niina-Maria Nissinen
- Folkhälsan Research Center, Helsinki, Finland; Tampere University, Faculty of Social Sciences, Health Sciences Unit, Tampere, Finland.
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland; Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden; University of Turku, Research Centre for Child Psychiatry, Turku, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, And Helsinki University Hospital, Helsinki, Finland; Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Hanna Kahila
- Department of Obstetrics and Gynecology, University of Helsinki, And Helsinki University Central Hospital, Helsinki, Finland
| | - Ilona Autti-Rämö
- Council for Choices in Health Care in Finland, Department for Steering of Healthcare and Social Welfare, Ministry of Social Affairs and Health, Helsinki, Finland; University of Helsinki, Children's Hospital, Division of Child Neurology, Helsinki, Finland
| | - Anne M Koponen
- Folkhälsan Research Center, Helsinki, Finland; University of Helsinki, Department of Public Health, Helsinki, Finland
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Koponen AM, Nissinen NM, Gissler M, Sarkola T, Autti-Rämö I, Kahila H. Cohort profile: ADEF Helsinki - a longitudinal register-based study on exposure to alcohol and drugs during foetal life. Nordisk Alkohol Nark 2020; 37:32-42. [PMID: 32934591 PMCID: PMC7434186 DOI: 10.1177/1455072519885719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/23/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose: The need for longitudinal studies on prenatal substance exposure (PSE)
extending into adulthood is widely recognised. In particular, studies on the
dual effect of exposure to substances and adverse childhood experiences are
needed. This register-based matched cohort study investigates the effect of
this dual exposure on the health and development of youth with PSE. The
follow-up is from birth to young adulthood. Participants: The exposed youth were born in 1992–2001 to mothers with a significant
substance misuse problem during pregnancy. The mothers were identified in
primary care maternity clinics in the Helsinki metropolitan area and
referred for intensified pregnancy follow-up in a tertiary care setting
(HAL-clinics). Data from hospital medical records were collected for the
mothers during the pregnancy follow-up and linked with register data from
multiple national health and social welfare registers obtained for each
mother–child dyad from birth until the end of 2015–2018. Similar register
data were gathered for three matched mother–child dyads without any evidence
of the mother’s substance misuse in national health and social welfare
registers. The study consists of 615 exposed and 1787 unexposed youth aged
15–24 years. Findings to date: A majority of the exposed youth (64%) had been in out-of-home care at least
once compared with 8% among the unexposed. Outpatient and inpatient hospital
care due to mental or behavioural disorders were two to three times more
common among the exposed than among the unexposed. The exposed had less
often completed secondary school education and had more often needed social
assistance. Future plans: The data comprise a wide range of information on infant health, youth’s
mental and somatic health and development, out-of-home care history, and
mother’s life situation at the delivery and later health. Risk and
protective factors for different long-term developmental outcomes in
adolescence or in young adulthood will be studied.
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Affiliation(s)
- Anne M Koponen
- Folkhälsan Research Center, and University of Helsinki, Finland
| | | | - Mika Gissler
- National Institute for Health and Welfare, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, and Helsinki University Hospital, Finland
| | | | - Hanna Kahila
- Helsinki University Central Hospital, Helsinki, Finland
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Koponen AM, Nissinen NM, Gissler M, Autti-Rämö I, Sarkola T, Kahila H. Prenatal substance exposure, adverse childhood experiences and diagnosed mental and behavioral disorders - A longitudinal register-based matched cohort study in Finland. SSM Popul Health 2020; 11:100625. [PMID: 32685656 PMCID: PMC7358713 DOI: 10.1016/j.ssmph.2020.100625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/08/2020] [Accepted: 06/24/2020] [Indexed: 01/21/2023] Open
Abstract
Both prenatal substance exposure (PSE, alcohol/drugs) and experiences during the first years of life have powerful effects on brain development. However, only a few studies have investigated the combined effect of PSE and adverse childhood experiences (ACEs) on mental and behavioral disorders among exposed adolescents and adults. This longitudinal register-based cohort study 1) compared the nature and extent of diagnosed mental and behavioral disorders among youth with PSE and matched unexposed controls, and 2) investigated the influence of PSE, health in infancy and ACEs (maternal risk factors and out-of-home care, OHC) on diagnoses of mental and behavioral disorders. The data consisted of 615 exposed youth aged 15-24 years and 1787 matched unexposed controls. Data from hospital medical records and nine registers were merged for the analysis. Descriptive analysis methods and Cox regression were used. The results showed that the prevalence of mental and behavioral disorders was twice as high among exposed compared with controls. The highest levels of mental and behavioral disorders and ACEs were found among exposed with at least one OHC episode. The difference in the risk of mental and behavioral disorders between exposed and controls diminished after controlling for the effect of ACEs. Low birth weight, maternal risk factors, and OHC were the strongest predictors of mental and behavioral disorders. The results suggest that PSE alone does not explain poorer mental health among exposed youth. Risk factors accumulate, and low birth weight and ACEs are strongly associated with increased risk of mental and behavioral disorders.
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Affiliation(s)
- Anne M. Koponen
- Folkhälsan Research Center, And University of Helsinki, Department of Public Health, Helsinki, Finland
| | - Niina-Maria Nissinen
- Folkhälsan Research Center, Helsinki, Finland and University of Tampere, Department of Health Sciences, Tampere, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Ilona Autti-Rämö
- University of Helsinki, Children's Hospital, Department of Child Neurology, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, And Helsinki University Hospital, Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Finland
| | - Hanna Kahila
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
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