Nadine Robles

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.

Prenatal marijuana use and neonatal outcome.

In a longitudinal study of marijuana and other substance use during pregnancy, women were interviewed at each trimester of pregnancy. Growth parameters, morphological abnormalities and gestational age were assessed for the 519 liveborn singletons. There were few significant effects of marijuana use during pregnancy on birth weight, head or chest circumference, gestational age, or growth retardation after adjustment for covariates using a regression model for analysis. There was a small but significant negative effect of marijuana use during the first two months of pregnancy on birth length and a positive effect of marijuana use during the third trimester on birth weight.

The effects of prenatal tobacco and marijuana use on offspring growth from birth through 3 years of age

This is a prospective study of prenatal substance use. Women were interviewed during their fourth and seventh months of pregnancy, at delivery, and at 8, 18, and 36 months postpartum. At birth, there were 763 liveborn, singleton offspring in the sample. At each phase, the offspring were examined and measured for growth. Data are presented on the relationship between tobacco and marijuana use and the size of the offspring at birth, 8, 18, and 36 months of age. At birth, there was a significant inverse relationship between tobacco use and weight, length, and head circumference. At 8 months of age, only length continued to be associated with prenatal tobacco exposure. By 18 months of age, there was no relationship between prenatal tobacco exposure and size of the offspring. Prenatal marijuana exposure was only associated with decreased length at birth. Neither tobacco nor marijuana use predicted gestational age or morphological abnormalities.

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.

Retention of resistant subjects in longitudinal studies: description and procedures.

This paper discusses efforts to retain resistant subjects (N = 88) in a prospective research project which investigates the effects of prenatal substance use on pregnancy and infant outcome. Resistant subjects were women for whom we had valid addresses and/or phone numbers. They did not refuse to participate but were reluctant to schedule appointments and/or keep scheduled appointments. The persistent resistance we encountered led us to develop procedures which established and maintained rapport with resistant respondents and facilitated access to the 18-month assessment. No significant differences were found between the resistant participants and nonresistant subjects on six sociodemographic factors and on substance use. However, resistant subjects were significantly more depressed than nonresistant subjects. Anxiety and hostility did not differ at any time point. Resistant subjects who were finally interviewed, reported a significantly higher number of recent life events than nonresistant subjects at the 18-month postpartum interview. The follow-up rates for retaining the 88 resistant subjects were 44.3, 72.7, and 79.6% at Phases 4, 5. and 6, respectively.

A longitudinal study of prenatal marijuana use: Effects on sleep and arousal at age 3 years

OBJECTIVE To test the hypothesis that sleep disruptions would be evident in 3-year-old children with a history of prenatal marijuana exposure. DESIGN A prospective study using stratified random sampling beginning in the fourth month of pregnancy. Marijuana and other substance use were assessed by interviews at multiple time points. Offspring were followed up through age 3 years with multidomain assessments at fixed time points, including electroencephalographic sleep studies in the newborn period and at age 3 years. SETTING Primary care, prenatal clinic at a university hospital. SUBJECTS The sample included 18 children with prenatal marijuana exposure (mean [+/- SD] age, 39.0 +/- 4.4 months) and 20 control children (mean [+/- SD] age, 39.7 +/- 4.4 months). The two groups were similar in relationship to maternal age, race, income, education, or maternal use of alcohol, nicotine, and other substances in the first trimester. MAIN OUTCOME MEASURE Sleep variables from polysomnographic recordings at age 3 years. RESULTS Children with prenatal marijuana exposure showed more nocturnal arousals (mean [+/- SD], 8.2 +/- 5.3 vs 3.2 +/- 4.6; P < .003), more awake time after sleep onset (mean [+/- SD], 27.4 +/- 20.0 vs 13.7 +/- 12.4 min; P < .03), and lower sleep efficiency (mean [+/- SD], 91.0 +/- 3.8 vs 94.4 +/- 2.1; P < .03) than did control children. CONCLUSION Prenatal marijuana exposure was associated with disturbed nocturnal sleep at age 3 years.

Medical Students' Evaluation of live Psychiatric Interviews.

A central concern of psychiatric educators is how medical students learn to evaluate psychopathology and clinically relevant behaviors during a psychiatric clerkship. The purpose of this study is to determine what characteristics of the students studied correlated with their accuracy in rating patient psychopathology and also whether the students show improved accuracy in rating after a 6-week clerkship in a university medical school department of psychiatry. The study analyzes student ratings of various aspects of psychopathology in live patient-faculty interviews. The accuracy of student ratings compared with faculty ratings constitutes the dependent variable. The role of students’ attitudes toward psychiatry, overall grade performance, and personal background constitute the independent variables; these variables are analyzed in relation to the accuracy of student ratings. The authors attempt to determine if student ratings improve during clerkship. The ability to rate clinical phenomenology in psychiatric patients in a live format is shown to be a measurable trait that improves slightly over time in some areas and varies in relation to some of the independent variables studied. Results of the study are compared with previous work in this area. The limitations of the paradigm employed and the requirements for studying the problem in a more systematic and effective way are outlined.