Nancy L. Day

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.

Effects of prenatal alcohol exposure on social behavior in humans and other species

Alcohol exposure during development causes central nervous system alterations in both humans and animals. Although the most common behavioral manifestation of these alterations is a reduction in cognitive abilities, it is becoming increasingly apparent that deficits in social behavior may be very prevalent sequelae of developmental alcohol exposure. In infancy and early childhood, deficits in attachment behavior and state regulation are seen in both alcohol-exposed people and animals, suggesting that these changes are largely the result of the alcohol exposure rather than maternal behavior. In the periadolescent period, people exposed to alcohol during development show a variety of difficulties in the social domain as measured by checklists filled out by either a parent or teacher. Rats exposed to alcohol during development show changes in play and parenting behaviors. In adulthood, prenatal alcohol exposure is related to high rates of trouble with the law, inappropriate sexual behavior, depression, suicide, and failure to care for children. These high rates all suggest that there may be fundamental problems in the social domain. In other animals, perinatal alcohol exposure alters aggression, active social interactions, social communication and recognition, maternal behavior, and sexual behavior in adults. In conclusion, research suggests that people exposed to alcohol during development may exhibit striking changes in social behavior; the animal research suggests that these changes may be largely the result of the alcohol insult and not the environment.

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.

A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care.

BACKGROUND Previous studies have shown that alcohol consumption is associated with decreased medication adherence, but this association may be confounded by characteristics common among those who drink heavily and those who fail to adhere (e.g., illicit drug use). Our objective was to determine whether there are temporal and dose-response relationships between alcohol consumption and poor adherence. METHODS We administered telephone interview surveys to participants in the Veterans Aging Cohort Study, an eight-site observational study of HIV+ and matched HIV- veterans in care, to determine whether alcohol consumption on a particular day was associated with nonadherence to prescribed medications on that same day. We used the Time Line Follow Back to measure alcohol consumption and the Time Line Follow Back Modified for Adherence to measure adherence. Individuals were categorized as abstainers (no alcohol in past 30 days), nonbinge drinkers (alcohol in past 30 days but < or =four standard drinks on each day), or binge drinkers (> or =five standard drinks on at least one day). RESULTS Among 2702 respondents, 1582 (56.6%) were abstainers, 931 (34.5%) were nonbinge drinkers, and 239 (8.9%) were binge drinkers. Abstainers missed medication doses on 2.4% of surveyed days. Nonbinge drinkers missed doses on 3.5% of drinking days, 3.1% of postdrinking days, and 2.1% of nondrinking days (p < 0.001 for trend), and this trend was more pronounced among HIV+ individuals than HIV- individuals. Binge drinkers missed doses on 11.0% of drinking days, 7.0% of postdrinking days, and 4.1% of nondrinking days (p < 0.001 for trend), and this trend was comparably strong for HIV+ and HIV- individuals. CONCLUSIONS Among veterans in care, self-reported alcohol consumption demonstrates a temporal and dose-response relationship to poor adherence. HIV+ individuals may be particularly sensitive to alcohol consumption.

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.

Alcohol consumption patterns and predictors of use following liver transplantation for alcoholic liver disease

For patients who receive a liver transplant (LTX) for alcoholic liver disease (ALD), investigators are focusing beyond survival to determine specific alcohol use outcomes. Studies suggest the use of alcohol ranges from 8 to 22% for the first post‐transplant year with cumulative rates reaching 30 to 40% by 5 years following transplantation. Yet while investigators are interested in determining specific rates of alcohol use and predictors of use, only three studies since 1990 have been prospective. In 1998, we began a prospective study of post‐LTX alcohol consumption in ALD recipients using multiple repeated measures of alcohol use. After 5 years of follow‐up, we found that 22% had used any alcohol by the first year and 42% had a drink by 5 years. By 5 years, 26% drank at a heavier use (binge) pattern and 20% drank in a frequent pattern. In a univariate model, predictors of alcohol use included pre‐transplant length of sobriety, a diagnosis of alcohol dependence, a history of other substance use, and prior alcohol rehabilitation. Liver Transpl 12:813–820, 2006.

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.