Diklah Geva

Effect of prenatal marijuana exposure on the cognitive development of offspring at age three.

Marijuana is the most commonly used illicit substance among pregnant women. Although there has been substantial concern about the effects of substance use during pregnancy, few studies have assessed the effects of prenatal exposure to marijuana and even fewer have provided longitudinal data on the developmental outcome of offspring. This is a report from a longitudinal study of substance use during pregnancy. The women in the cohort were of lower socioeconomic status, most were single, half were white and half were African-American. Women were interviewed at the fourth and seventh prenatal months, and women and children were assessed at delivery, 8, 18, and 36 months. Pediatric assessment included physical and cognitive development. At each study phase, mothers were interviewed about life style, living situation, current substance use, sociodemographic, and psychological status. Findings are reported on 655 women and children who were assessed at the third year. There were significant negative effects of prenatal marijuana exposure on the performance of 3-year-old children on the Stanford-Binet Intelligence Scale. The effects were associated with exposure during the first and second trimesters of pregnancy. Among the offspring of white women, these effects were moderated by the childs attendance at preschool/day-care at age three.

Neonatal seizures : electroclinical dissociation

Electroclinical dissociation is a phenomenon in which the clinical component of a seizure occurs at times with or without an electrical correlate. The epidemiology of this observation was studied in a neonatal intensive care unit from July, 1983 to December, 1988. Infants demonstrating electroclinical dissociation were compared to those having exclusively electroclinical seizures. Sixteen percent of infants with electrographically-confirmed seizures and 19% of 243 analyzed seizures demonstrated electroclinical dissociation. The two groups revealed very few differences with respect to perinatal factors, etiology, and outcome. The subsequent electroencephalographic background was more disturbed in the electroclinical dissociation group, but did not correlate with clinical outcome. Extremity movements occurred at a statistically significant higher rate during electroclinical seizures. Electroclinical dissociation seizures arise from foci not consistently reflected in surface electrodes.

Effects of Prenatal Substance Exposure: Altered Maturation of Visual Evoked Potentials

We investigated the effects of prenatal substance use on visual evoked potentials (VEPs). Seventy-four children were tested at birth and 1 month of age with binocular flash VEPs and at 4, 8, and 18 months of age with binocular pattern VEPs. Regressions were run by trimester to assess the independent effects of substance exposure. Variables included in the regression model were alcohol, marijuana, tobacco, other drug use for each trimester, maternal age, education, income, race, marital status, infant sex, birthweight, and Dubowitz score. Changes in specific components of the binocular VEP were both substance- and trimester-specific. First trimester alcohol use was associated with prolonged P1 wave latencies at 1 month of age. Prolonged P1 wave latencies at birth and 18 months were associated with tobacco use during each of the three trimesters, at 1 and 18 months with third trimester marijuana use, and at 1 and 18 months with first trimester other illicit drug use. Although these women were moderate substance users during pregnancy, their offspring exhibited maturational changes in components of the VEP in the absence of neonatal behavioral disturbances.

Patterns and Covariates of Tobacco Use in a Recent Sample of Pregnant Teenagers

PURPOSE Little is known about the prevalence and patterns of smoking among pregnant teenagers. We provide a comprehensive description of the prevalence, patterns and correlates of smoking from a recent sample of 199 pregnant adolescents. METHODS We interviewed pregnant teenagers at mid-pregnancy and delivery to obtain information on tobacco and other substance use before and during pregnancy and on demographic, medical and psychosocial status. RESULTS The average age was 16.1 years (range 12-18); 70% were African-American. Smoking was prevalent and increased from first (59%) to third (62%) trimesters. This increase was in sharp contrast to decreases in other substances. Caucasians had higher rates of smoking and heavier smoking. For Caucasians, third trimester smoking was predicted by peer smoking and early onset of sexual activity. For African-Americans, third trimester smoking was related to older age, not living with parent(s), dissatisfaction with social support, early pregnancy binge drinking, peer smoking, and early onset of sexual activity. CONCLUSIONS The high prevalence and increasing pattern of prenatal smoking in teenagers is a major public health concern. Effective education and cessation programs must be targeted at pregnant teenagers.