Natacha M. De Genna

Effects of prenatal cigarette smoke exposure on neurobehavioral outcomes in 10-year-old children of adolescent mothers.

In this prospective study, adolescent mothers (mean age=16; range=12-18; 70% African-American) were interviewed about their tobacco use during pregnancy. When their children were ten, mothers reported on their childs behavior and the children completed a neuropsychological battery. We examined the association between prenatal cigarette smoke exposure (PCSE) and offspring neurobehavioral outcomes on data from the 10-year phase (n=330). Multivariate regression analyses were conducted to test if PCSE predicted neurobehavioral outcomes, adjusting for demographic characteristics, maternal psychological characteristics, prenatal exposure to other substances, and exposure to environmental tobacco smoke. Independent effects of PCSE were found. Exposed offspring had more delinquent, aggressive, and externalizing behaviors (CBCL). They were more active (Routh, EAS, and SNAP) and impulsive (SNAP) and had more problems with peers (SNAP). On the Stroop test, deficits were observed on the more complex interference task that requires both selective attention and response inhibition. The significant effects of PCSE on neurobehavioral outcomes were found for exposure to as few as 10 cigarettes per day. Most effects were found from first trimester PCSE exposure. These results are consistent with results from an earlier assessment when the children were age 6, demonstrating that the effects of prenatal tobacco exposure can be identified early and are consistent through middle childhood.

From risky behavior to health risk: continuity across two generations.

ABSTRACT. The purpose of this study was to determine the impact of childhood aggression and social withdrawal on adolescent health risk behaviors and adult health outcomes, and to examine the transfer of health risk to preschool offspring. This was a prospective, longitudinal, and intergenerational study of 114 mothers from disadvantaged neighborhoods, who were identified in childhood as being highly aggressive and/or withdrawn or with low scores on these 2 behavioral risk dimensions, and their preschool offspring aged 1 to 6 years old. The health histories of mothers (adolescent health risk behavior, health during pregnancy, current symptoms) and target children were taken during structured interviews conducted at home. Regression analyses tested the relationship between maternal childhood risk status and subsequent health outcomes, and these were followed by structural equation modeling of a proposed intergenerational pathway. Maternal childhood aggression predicted current health risk behaviors (e.g., daily cigarette smoking), whereas maternal childhood social withdrawal was not associated with maternal health risk at the time of testing. Mothers who had high scores on both aggression and withdrawal were more likely to engage in adolescent health risk behavior, which was directly related to health problems in preschoolers (even after controlling for covariates, such as neonatal health status and sex). In summary, there are distinct health trajectories for women who are highly aggressive and socially withdrawn in childhood, with implications for womens long-term health. Specifically, aggression in girls is likely to lead to health risk behaviors that may also place the next generation at risk for pediatric illness. Results are interpreted in terms of the health-hostility link, best known in adult men and intergenerational models.

Race and Sexually Transmitted Diseases in Women With and Without Borderline Personality Disorder

BACKGROUND The purpose of this study was to examine the history of sexually transmitted diseases (STDs) among women with borderline personality disorder (BPD) with and without a lifetime substance use disorder (SUD) and to compare their histories to those of a group of women with a current nonpsychotic axis I disorder. METHODS Two-hundred fifteen women completed the Structured Clinical Interview for DSM-IV Axis I diagnoses (SCID-I), Structured Interview for DSM-IV Personality for Axis II diagnoses (SIDP-IV), and a sexual health interview. African American women were oversampled because little is known about BPD in African American women and because they are at greater risk for STDs than non-African American women. RESULTS Women with a lifetime SUD (especially cannabis use disorder) reported more STD risk factors and STDs than women without a lifetime SUD. BPD dimensional scores and African American race were predictors of STD, even after controlling for age, socioeconomic status (SES), SUDs, and participation in the sex trade. CONCLUSIONS Determining predictors of STDs within at-risk subpopulations may help reduce the spread of STDs and prevent HIV infection within these groups by helping providers identify women at the highest risk of infection.

Pregnancies, Abortions, and Births among Women with and without Borderline Personality Disorder

BACKGROUND The purpose of this study was to examine history of pregnancies among women with and without borderline personality disorder (BPD), to determine whether BPD symptoms are associated with teenage pregnancies, unplanned pregnancies, elective and spontaneous abortions, and live births. METHODS Three hundred seventy-nine women completed the Structured Clinical Interview for DSM-IV Axis I diagnoses, Structured Interview for DSM-IV Personality for Axis II diagnoses, and a reproductive health interview. African-American (AA) women were oversampled, because little is known about BPD in AA women and they are at greater risk of teenage pregnancy, unplanned pregnancies, and spontaneous abortions. RESULTS BPD symptom severity was associated with a teenage pregnancy, even after controlling for race and socioeconomic status. Symptom severity was also associated with unplanned pregnancies and live births, but only for women without a history of a substance use disorder. BPD symptom severity was not associated with abortion. CONCLUSION Women with BPD become pregnant and have children, often during the period when BPD symptoms emerge and intensify. They are at increased risk of teenage pregnancies and unintended pregnancies compared with women with Axis I disorders. Treatment planning for this population should include attention to their reproductive health and better integration of physical and mental health services.

Prenatal cocaine exposure and age of sexual initiation: direct and indirect effects.

BACKGROUND Prenatal cocaine exposure (PCE) has been linked to child behavior problems and risky behavior during adolescence such as early substance use. Behavior problems and early substance use are associated with earlier initiation of sexual behavior. The goal of this study was to examine the direct and indirect effects of PCE on sexual initiation in a longitudinal birth cohort, about half of whom were exposed to cocaine in utero. METHODS Women were interviewed twice prenatally, at delivery, and 1, 3, 7, 10, 15, and 21 years postpartum. Offspring (52% female, 54% African American) were assessed at delivery and at each follow-up phase with age-appropriate assessments. At age 21, 225 offspring reported on their substance use and sexual behavior. RESULTS First trimester cocaine exposure was a significant predictor of earlier age of first intercourse in a survival analysis, after controlling for race, sociodemographic characteristics, caregiver pre- and postnatal substance use, parental supervision, and childs pubertal timing. However, the association between PCE and age of first sexual intercourse was mediated by adolescent marijuana and alcohol use prior to age 15. CONCLUSIONS Most of the effect of PCE on age of sexual initiation occurred between the ages of 13-18, when rates of initiation were approximately 10% higher among exposed offspring. This effect was mediated by early adolescent substance use. These results have implications for identification of the exposed offspring at greatest risk of HIV risk behaviors and early, unplanned pregnancy.

Prenatal and Postnatal Maternal Trajectories of Cigarette Use Predict Adolescent Cigarette Use

INTRODUCTION The goal of this study was to identify maternal patterns of prenatal and postnatal cigarette smoking associated with adolescent smoking. We hypothesized that maternal use at multiple time points, especially at later assessments when the offspring were adolescents, would predict offspring use. METHODS Pregnant women (N = 456: ages 13-42) were recruited from a prenatal clinic and interviewed during pregnancy and at delivery, providing data on cigarette use (any/none) for the first and third trimesters. Mothers were re-assessed at 6, 10, 14, and 16 years postpartum. Offspring reported cigarette use at age 16. Covariates included maternal race, age, education, family income, child age, parenting behavior, and other maternal and child substance use. RESULTS A growth mixture model revealed five patterns of tobacco use: infrequent/nonuse (39%), postpartum quitters (5%), later quitters (7%), increasing likelihood of being smokers (17%), and chronic users (32%). Offspring of postpartum quitters and the increasing likelihood of being smokers groups were more likely to use cigarettes, compared to adolescents of mothers from the infrequent/nonuse group, controlling for significant covariates. CONCLUSIONS This is the first study to examine trajectories of maternal cigarette use from pregnancy to 16 years postpartum, linking prenatal and postnatal patterns of maternal use to use in adolescent offspring. Our findings highlight the risk associated with prenatal exposure, because mothers who used during pregnancy but quit by 6 years postpartum still had offspring who were 3.5 times more likely to smoke than non/infrequent users. IMPLICATIONS This is the first study to examine trajectories of maternal cigarette use from the prenatal period to 16 years postpartum, and to link prenatal and postnatal patterns of use to use in adolescent offspring. We identified two long-term patterns of maternal cigarette use that were associated with offspring smoking at age 16, including one where offspring were exposed prenatally, but much less likely to be exposed to maternal cigarette use postpartum. Our findings highlight the risk associated with prenatal exposures for cigarette use in offspring, even if mothers quit in the postpartum.

Improvement in intelligence test scores from 6 to 10 years in children of teenage mothers.

Objective: This study investigates change in IQ scores among 290 children born to teenage mothers and identifies social, economic, and environmental variables that may be associated with change in intelligence test performance. Methods: The children of 290 teenage mothers (72% African-American and 28% European American) were assessed with the Stanford-Binet Intelligence Scale-4th Edition at ages 6 and 10. Results: The mean composite score at age 6 was 84.8 and 91.2 at age 10, an improvement of 6.4 points. Significant cross-sectional predictors at both ages 6 and 10 of higher Stanford-Binet Intelligence Scale scores were maternal cognitive ability, school grade, white ethnicity, and caregiver education. Having more children in the household significantly predicted lower Stanford-Binet Intelligence Scale scores at age 6. Higher satisfaction with maternal social support predicted higher Stanford-Binet Intelligence Scale scores at age 10. Change in IQ scores was not related to maternal socioeconomic status, social support, home environment, ethnicity, or family interactions. Custodial stability was associated with an improvement in IQ scores, whereas increase in caregiver depression was related to decline in IQ scores. Conclusions: Our findings suggest that improvement in IQ scores of offspring of teenage mothers may be related to stability of maternal custody. More research is needed to determine the impact of the maturation of adolescent mothers’ parenting and the role of early education on improvement in cognitive abilities.

Abusive Experiences and Young Women's Sexual Health Outcomes: Is Condom Negotiation Self-Efficacy a Mediator?

CONTEXT Intimate partner violence and reproductive coercion are associated with unintended pregnancies and STDs. Greater condom negotiation self-efficacy among young women may mediate these associations. METHODS A sample of 841 female adolescents (aged 16-19) and 1,387 young adult women (aged 20-24) recruited from 24 family planning clinics in western Pennsylvania in 2011-2012 reported on intimate partner violence, reproductive coercion, condom negotiation self-efficacy and sexual health outcomes at baseline and four- and 12-month follow-ups. Mixed models were used to test associations of intimate partner violence and reproductive coercion with unintended pregnancy and STD diagnosis. The Sobel test of mediation was used to measure indirect effects of condom negotiation self-efficacy. RESULTS At baseline, 15% of adolescents and 11% of young adults reported recent intimate partner violence victimization; 7% and 6%, respectively, reported recent reproductive coercion. For both age-groups, intimate partner violence and reproductive coercion were associated with a reduced level of condom negotiation self-efficacy (coefficients, -0.27 to -0.13) and increased odds of STD diagnosis (odds ratios, 1.03-1.1). However, only reproductive coercion was associated with unintended pregnancy (odds ratios, 1.1 for each group). The only association that condom negotiation self-efficacy mediated was between reproductive coercion and unintended pregnancy among young adults (17% of total effect). CONCLUSIONS Targeting condom negotiation self-efficacy alone in abusive relationships would likely not translate into improved sexual health outcomes in this population. Other strategies are needed to prevent unintended pregnancy and STDs.

Prenatal tobacco exposure, maternal postnatal nicotine dependence and adolescent risk for nicotine dependence: Birth cohort study

AIMS The goals of this study are to determine if there is (a) a threshold effect for prenatal tobacco exposure (PTE) on adolescent risk for nicotine dependence, and (b) an additive effect of PTE and maternal postnatal nicotine dependence on adolescent risk for nicotine dependence. METHODS Pregnant women were recruited in their 4th or 5th gestational month and asked about cigarette use during the first trimester. Mothers reported on third trimester cigarette use at delivery. Sixteen years post-partum, mothers and offspring reported on current levels of cigarette use (N=784). Nicotine dependence was assessed in both using a modified Fagerström questionnaire. RESULTS Based on the results of a threshold analysis for PTE, four groups were created: threshold PTE only (10+ cigarettes per day), maternal nicotine postnatal dependence with no-low PTE (0-<10 cigarettes per day), threshold PTE+maternal postnatal nicotine dependence, and a referent group with no-low PTE and no maternal postnatal nicotine dependence. Adolescents in the PTE-only group and the PTE+maternal postnatal nicotine dependence group were significantly more likely to be at risk for nicotine dependence than the offspring from the referent group. However, there was no evidence for an additive effect of maternal postnatal nicotine dependence, and maternal nicotine dependence was not a significant predictor of adolescent risk for nicotine dependence in regression models including prenatal tobacco exposure. CONCLUSIONS Bivariate analysis revealed a threshold effect for PTE of 10 cigarettes per day. In multivariate analysis, PTE remained significantly related to risk for offspring nicotine dependence, after controlling for maternal postnatal nicotine dependence and other covariates associated with adolescent cigarette use.

Prenatal alcohol and other early childhood adverse exposures: Direct and indirect pathways to adolescent drinking.

We examined direct and indirect pathways between adverse environmental exposures during gestation and childhood and drinking in mid-adolescence. Mothers and their offspring (n=917 mother/child dyads) were followed prospectively from second trimester to a 16-year follow-up assessment. Interim assessments occurred at delivery, 6, 10, and 14years. Adverse environmental factors included gestational exposures to alcohol, tobacco, and marijuana, exposures to childhood maltreatment and violence, maternal psychological symptoms, parenting practices, economic and home environments, and demographic characteristics of the mother and child. Indirect effects of early child behavioral characteristics including externalizing, internalizing activity, attention, and impulsivity were also examined. Polytomous logistic regression analyses were used to evaluate direct effects of adverse environmental exposures with level of adolescent drinking. Structural equation modeling (SEM) was applied to simultaneously estimate the relation between early adversity variables, childhood characteristics, and drinking level at age 16 while controlling for significant covariates. Level of drinking among the adolescent offspring was directly predicted by prenatal exposure to alcohol, less parental strictness, and exposures to maltreatment and violence during childhood. Whites and offspring with older mothers were more likely to drink at higher levels. There was a significant indirect effect between childhood exposure to violence and adolescent drinking via childhood externalizing behavior problems. All other hypothesized indirect pathways were not significant. Thus most of the early adversity measures directly predicted adolescent drinking and did not operate via childhood behavioral dysregulation characteristics. These results highlight the importance of adverse environmental exposures on pathways to adolescent drinking.