Gale A. Richardson

Prenatal substance exposure : Effects on attention and impulsivity of 6-year-olds

Attention and impulsivity of prenatally substance-exposed 6 year olds were assessed as part of a longitudinal study. Most of the women were light to moderate users of alcohol and marijuana who decreased their use after the first trimester of pregnancy. Tobacco was used by a majority of women and did not change during pregnancy. The women, recruited from a prenatal clinic, were of lower socio-economic status, and over half were African American. Attention and impulsivity were assessed using a Continuous Performance Task. Second and third trimester tobacco exposure and first trimester cocaine use predicted increased omission errors. Second trimester marijuana use predicted more commission errors and fewer omission errors. There were no significant effects of prenatal alcohol exposure. Lower Stanford-Binet Intelligence Scale composite scores, male gender, and an adult male in the household also predicted more errors of commission. Lower SBIS composite scores, younger child age, maternal work/ school status, and higher maternal hostility scores predicted more omission errors. These findings indicate that prenatal substance use has an effect on attentional processes.

Prenatal cocaine exposure: effects on the development of school-age children.

The offspring of 28 women who reported light to moderate cocaine use during pregnancy were compared with those of 523 women who reported no cocaine use during pregnancy and none for the year prior to pregnancy. Subjects were participants in two prospective, longitudinal studies of prenatal substance use. Women were interviewed during their fourth and seventh months of pregnancy, at delivery, and at 8, 18, 36, and 72 months postpartum regarding cocaine, alcohol, marijuana, tobacco, and other drug use. At 6 years, children underwent physical examination, and their cognitive development, academic achievement, and behavior were assessed. The women in the cocaine group were more likely to be Caucasian and to use more alcohol, marijuana, tobacco, and other illicit drugs than those in the comparison group. When demographic and substance use differences between the groups were controlled, there were no significant effects of prenatal cocaine exposure on the growth, intellectual ability, academic achievement, or teacher-rated classroom behavior of the 6-year-old offspring. Children prenatally exposed to cocaine did show deficits in their ability to sustain attention on a computerized vigilance task.

Effects of prenatal marijuana exposure on child behavior problems at age 10

This is a prospective study of the effects of prenatal marijuana exposure on child behavior problems at age 10. The sample consisted of low-income women attending a prenatal clinic. Half of the women were African-American and half were Caucasian. The majority of the women decreased their use of marijuana during pregnancy. The assessments of child behavior problems included the Child Behavior Checklist (CBCL), Teachers Report Form (TRF), and the Swanson, Noland, and Pelham (SNAP) checklist. Multiple and logistic regressions were employed to analyze the relations between marijuana use and behavior problems of the children, while controlling for the effects of other extraneous variables. Prenatal marijuana use was significantly related to increased hyperactivity, impulsivity, and inattention symptoms as measured by the SNAP, increased delinquency as measured by the CBCL, and increased delinquency and externalizing problems as measured by the TRF. The pathway between prenatal marijuana exposure and delinquency was mediated by the effects of marijuana exposure on inattention symptoms. These findings indicate that prenatal marijuana exposure has an effect on child behavior problems at age 10.

The effects of prenatal alcohol and marijuana exposure: disturbances in neonatal sleep cycling and arousal.

ABSTRACT: Neonatal EEG and sleep findings are presented from a longitudinal study of the effects of maternal alcohol and marijuana use during pregnancy. Infant outcome has been examined relative to the trimester(s) of pregnancy during which use occurred. Disturbances in sleep cycling, motility, and arousals were noted that were both substance and trimester specific. Alcohol consumed during the first trimester of pregnancy was associated with disruptions in sleep and arousal, whereas marijuana use affected sleep and motility regardless of the trimester in which it was used. Although these findings are preliminary and based on a small sample of women exhibiting only moderate substance use during pregnancy, they do suggest that specific neurophysiological systems may be differentially affected by prenatal alcohol or marijuana exposure even in the absence of morphological abnormalities.

Prenatal alcohol and marijuana exposure: effects on neuropsychological outcomes at 10 years.

This report from a longitudinal study of the effects of prenatal alcohol and marijuana exposure investigates whether these drugs affect neuropsychological development at 10 years of age. Women were recruited from a medical assistance prenatal clinic and interviewed about their substance use at the end of each trimester of pregnancy, at 8 and 18 months, and at 3, 6, 10, 14, and 16 years. Half of the women were African American, and half were Caucasian. The women were generally from lower socioeconomic status families and had obtained high school degrees. At the 10-year follow-up, 593 children completed a neuropsychological battery, which focused on problem solving, learning and memory, mental flexibility, psychomotor speed, attention, and impulsivity. Prenatal alcohol use was found to have a significant negative impact on learning and memory skills, as measured by the WRAML. Prenatal marijuana exposure also had an effect on learning and memory, as well as on impulsivity, as measured by a continuous performance task. The effects of prenatal alcohol and marijuana exposure persisted when other predictors of learning and memory were controlled. We continue to follow these offspring into the adolescent years when further neuropsychological deficits may become evident.

Verbal and visuospatial learning and memory function in children with moderate prenatal alcohol exposure.

BACKGROUND This study investigated the effects of moderate prenatal alcohol exposure on learning and memory in 14-year-old adolescents. The Childrens Memory Scale was used to assess learning and memory function in the verbal/auditory and visual/spatial domains. In addition, both short- and long-term memory function were assessed. METHODS Data were collected as part of the Maternal Health Practices and Child Development Project, a longitudinal study including 580 children and their mothers. Women were assessed during each trimester of pregnancy and with their children from birth to 16 years of age. At age 14, memory function was evaluated using the Childrens Memory Scale, an assessment tool that measures learning and immediate and delayed memory function in the verbal and visual-spatial domains. RESULTS Prenatal alcohol exposure during the first trimester predicted deficits in learning, short-term memory, and long-term memory, specifically in the verbal domain. Deficits in performance were specific to learning and memory of word-pairs. In addition, deficits in memory were mediated by learning performance. CONCLUSIONS Results demonstrated that prenatal alcohol exposure lead to deficits in encoding processes as indicated by deficits in verbal learning. Initial deficits in acquisition were responsible for deficits in immediate and delayed recall of verbal information in children who were exposed to alcohol during pregnancy but did not have fetal alcohol syndrome.

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.

A systematic review of the effects of postnatal maternal anxiety on children

Several decades of research have focused on the impact of exposure to postnatal depression on children, while anxiety has been largely overlooked. Estimates of the prevalence of postnatal maternal anxiety (PMA) range from 3% to 43%, suggesting PMA may be an important risk factor for adverse outcomes in children. This review summarizes what is known about the effects of PMA exposure on children and makes recommendations for future research. A systematic search of Ovid MEDLINE® and PsychINFO® through 2008 identified 18 studies that evaluated child outcomes associated with PMA exposure. Identified studies covered three domains: somatic, developmental, and psychological outcomes. The strongest evidence for an adverse effect of PMA exposure is in somatic and psychological outcomes; the evidence for an effect of PMA on child development is inconclusive. Methodological differences among the studies make comparisons difficult and there are a number of common limitations that challenge the validity of these studies.

The epidemiology of alcohol, marijuana, and cocaine use among women of childbearing age and pregnant women

Although most women report alcohol use, women generally are light drinkers. Those who drink and drink heavily are more likely to be young, white, single, to have a higher education and income, and to be employed outside the home. However, women who drink during pregnancy, and particularly, those who continue to drink through the third trimester are different. They are older, more likely to be black, and they have higher rates of illicit drug use, less education, and lower social status. Marijuana and cocaine are used less frequently. However, women of childbearing age have the highest rates of use for both these drugs. Women who use marijuana during pregnancy are more often black, unmarried, and of lower social class. Cocaine users tend to be black, older, unmarried, and also of lower socioeconomic status. Both groups more frequently use other illicit drugs and, in general, receive less prenatal care. Therefore, for alcohol, marijuana, and cocaine, the highest rates of use are found among women of childbearing age. The women most likely to use substances during pregnancy are women who also have other characteristics that are, in themselves, significant risk factors for poor pregnancy outcome. These covariates must be considered in the evaluation of the effects of prenatal substance use.

Prenatal alcohol, marijuana, and tobacco use: Infant mental and motor development

These data are from a longitudinal study of prenatal alcohol and marijuana use in a low income sample. Half of the women were black and half were white. Women who used alcohol and/or marijuana during their pregnancies were light to moderate users; most decreased or discontinued their use after the first trimester. At the first follow-up phase, which occurred at a median age of 9 months, the children were functioning above average on the Bayley Scales of Infant Development (BSID). Prenatal alcohol and tobacco use did not predict BSID mental or motor scores at this phase. Third trimester marijuana use was associated with decreased BSID mental scores. Age at assessment was the most important predictor at this phase. The second follow-up occurred at a median age of 19 months when the group means for the BSID were lower. Prenatal alcohol and marijuana use did not predict outcome at this phase. Prenatal and current cigarette use were associated with decreased BSID mental scores. Demographic and environmental variables were important predictors at this phase.