Rina D. Eiden

Identifying Prenatal Cannabis Exposure and Effects of Concurrent Tobacco Exposure on Neonatal Growth

BACKGROUND Cannabis is the most frequently used illicit drug among pregnant women, but data describing the effects of prenatal cannabis exposure and concurrent nicotine and cannabis exposures on neonatal growth are inconsistent. Testing of meconium, the first neonatal feces, offers objective evidence of prenatal cannabis exposure, but the relative ability of meconium testing and maternal self-report to identify affected neonates remains unclear. METHODS Eighty-six pregnant women provided detailed self-reports of daily cannabis and tobacco consumption throughout pregnancy. Cannabinoids and tobacco biomarkers were identified in oral fluid samples collected each trimester and quantified in meconium at birth. RESULTS Cannabis-using women were significantly more likely to also consume tobacco, and smoked similar numbers of cigarettes as non-cannabis-using tobacco smokers. As pregnancy progressed, fewer women smoked cannabis and those who continued to use cannabis reported smoking a smaller number of cannabis joints, but positive maternal oral fluid tests cast doubt on the veracity of some maternal self-reports. More neonates were identified as cannabis exposed by maternal self-report than meconium analysis, because many women quit cannabis use after the first or second trimester; meconium was more likely to be positive if cannabis use continued into the third trimester. Cannabis exposure was associated with decreased birth weight, reduced length, and smaller head circumference, even after data were controlled for tobacco coexposure. CONCLUSIONS Prenatal cannabis exposure was associated with fetal growth reduction. Meconium testing primarily identifies prenatal cannabis exposure occurring in the third trimester of gestation.

Behavior problems in 18- to 36-month-old children of alcoholic fathers : Secure mother-infant attachment as a protective factor

This study examined the relationship between paternal alcoholism and toddler behavior problems from 18 to 36 months of age, as well as the potential moderating effects of 12-month infant-mother attachment security on this relationship. Children with alcoholic fathers had higher levels of internalizing and externalizing behavior than children of nonalcoholic fathers. Simple effects testing of an interaction effect of child age, group, and attachment security with mothers on externalizing behaviour suggested that at 24 and 36 months of age mother-infant attachment security moderated the relationship between alcohol group status and externalizing behaviour. Namely, within the alcohol group, those children with secure relationships with their mothers had significantly lower externalizing than insecure children of alcoholics. A similar pattern was noted for internalizing behavior at 36 months of age. Implications for intervention are discussed.

The association between prenatal exposure to cigarettes and cortisol reactivity and regulation in 7‐month‐old infants

We examined the association between prenatal exposure to cigarettes and adrenocortical responses to stress in 7-month-old infants. Cortisol levels were assessed twice prior to and twice following affect-eliciting procedures in 111 (59 exposed and 52 nonexposed) infants. Cortisol reactivity was defined as the difference between the peak poststressor cortisol level and the pretask cortisol level. Higher values indicated higher cortisol reactivity. Exposed infants had higher peak cortisol reactivity than nonexposed infants. There were no differences in pretask cortisol levels. Maternal hostility mediated the association between cigarette exposure and peak cortisol reactivity. Furthermore, infant gender moderated this association such that exposed boys had significantly higher peak cortisol reactivity than nonexposed infants or exposed girls. These findings provide additional evidence that prenatal cigarette exposure is associated with dysregulation during infancy and that early adverse, nonsocial experiences may have relatively long-lasting effects on cortisol reactivity in infants.

Paternal alcohol use and the mother-infant relationship

The purpose of this study was to examine the association between paternal alcohol use and the mother-infant relationship. A related goal was to investigate the role of maternal depression and marital satisfaction in moderating this relationship. Subjects were 55 mother-infant dyads (12–24-month-old infants) who were observed in the Strange Situation paradigm to assess infant attachment and in structured play interactions. There were 23 families with heavy drinking fathers and 32 with light drinking fathers. As predicted, infants of heavy drinking fathers were more likely to be insecurely attached compared to infants of light drinking fathers. Contrary to expectations, neither maternal depression nor marital interaction mediated the relationship between paternal alcohol use and mother-infant interactions. However, maternal depression did interact with paternal alcohol use to predict infant attachment security and maternal sensitivity. There was also an interactive effect of marital satisfaction and paternal alcohol use on maternal sensitivity. The results suggest that paternal alcohol use may influence family functioning and the mother-child relationship as early as infancy and suggest one possible pathway toward maladjustment among infants of heavy drinking fathers. However, in addition to investigating the impact of paternal alcohol use on the father-infant relationship, the influence of various familial factors associated with paternal alcohol use need to be more closely examined from a longitudinal perspective.

Effects of prenatal cocaine exposure on infant reactivity and regulation

The purpose of this study was to examine the role of prenatal cocaine exposure and associated risk factors on infant reactivity and regulation at 7 months of infant age. Participants consisted of 167 mother-infant dyads participating in an ongoing longitudinal study of prenatal cocaine exposure, who completed the arm restraint procedure at the 7-month assessment (87 cocaine exposed, 80 non-cocaine exposed). We hypothesized that cocaine exposed infants would display higher arousal or reactivity and lower regulation during a procedure designed to arouse anger/frustration. Results indicated that cocaine exposed infants were more reactive to increases in the level of stress from trial 1 to trial 2 but exhibited no change in the number of regulatory strategies as stress increased, unlike the control group infants. Infant birth weight moderated the association between cocaine exposure and infant regulation. Among cocaine exposed infants, those with lower birth weight displayed higher reactivity compared to those with higher birth weight. Contrary to expectations, there were no indirect effects between cocaine exposure and infant reactivity/regulation via environmental risk, parenting, or birth weight. Results are supportive of a teratological model of prenatal cocaine exposure for infant reactivity/regulation in infancy.

Prenatal Cocaine Exposure and Infant Cortisol Reactivity

This study examined the effects of prenatal cocaine exposure on infant hypothalamic-pituitary-adrenal axis activity and reactivity at 7 months of infant age. Participants were 168 caregiver-infant dyads (87 cocaine exposed, 81 not cocaine exposed; 47% boys). Maternal behavior, caregiving instability, and infant growth and behavior were assessed, and childrens saliva was sampled before, during, and after standardized procedures designed to elicit emotional arousal. Results revealed cocaine-exposed infants had a high amplitude trajectory of cortisol reactivity compared to non-cocaine-exposed infants. Infant gender and caregiving instability moderated this association. The findings support a dual hazard vulnerability model and have implications for evolutionary-developmental theories of individual differences in biological sensitivity to context.

Conceptual model for maternal behavior among polydrug cocaine-using mothers: The role of postnatal cocaine use and maternal depression.

This study examined the association between maternal cocaine use and maternal behavior and tested a conceptual model predicting maternal insensitivity during mother-infant interactions. Participants included 130 mother-infant dyads (68 cocaine-exposed and 62 non-cocaine-exposed) who were recruited after birth and assessed at 4-8 weeks of infant age. Results of model testing indicated that when the effects of prenatal cocaine use were examined in the context of polydrug use, maternal psychopathology, maternal childhood history, and infant birth weight, only postnatal cocaine use and maternal depression/anxiety were unique predictors of maternal insensitivity during mother-infant interactions.

Analyzing family data: A GEE approach for substance use researchers.

INTRODUCTION Analyzing data that arises from correlated observations such as husband-wife pairs, siblings, or repeated assessments of the same individuals over time requires more specialized analytic tools. Additionally, outcomes that are not normally distributed such as count data, (e.g., number of symptoms or number of problems endorsed) also require specialized analytic tools. Generalized estimating equations (GEE) are a very flexible tool for dealing with correlated data (such as data derived from related individuals such as families). The objective of this report was to compare traditional ordinary least squares regression (OLS) to a GEE approach for analyzing family data. METHODS Using data from an ongoing five-wave longitudinal study of newlywed couples, we examined a subset of 173 families with children between the ages of 4 and 11 at two data collection points. The relation between parental risk factors (e.g., heavy drinking, aggression, marital quality) and child internalizing symptoms was examined within the context of two regression-based models: traditional OLS regression and a GEE approach. RESULTS Overall, the GEE approach allowed a more complete use of the available data, provided more robust findings, and produced more reliable parameter estimates. CONCLUSION GEE models are a flexible regression-based approach for dealing with related data that arises from correlated data such as family data. Further, given the availability of the models in common statistical programs, family researchers should consider these models for their work.

Maternal Cocaine Use and Infant Behavior

This study examined the impact of maternal cocaine use and associated risk factors such as polysubstance use, maternal functioning, and caregiving on affect regulation during infancy. Participants were 45 mother-infant dyads (19 cocaine exposed and 26 control infants) recruited at birth. Observations and maternal reports of infant behavior were obtained at 2 and 7 months of age, along with measures of pre- and postnatal substance use, maternal functioning, and caregiving stability. Maternal cocaine use accounted for significant variance in infant positive affect at 2 months. Other substance use and gestational age predicted infant distress to novelty and arousal during developmental assessments. At 7 months, the impact of prenatal cocaine exposure on infant affect regulation was mediated by postnatal alcohol use and caregiving stability. These findings, if replicated, suggest that 1 pathway to later problem behavior reported among substance-exposed children may be through early regulatory problems and the quality of postnatal caregiving.

Maternal cocaine use and mother-infant interactions: Direct and moderated associations.

This study examined the associations between prenatal cocaine exposure and quality of mother-infant play interactions at 13 months of infant ages. We investigated whether maternal psychological distress and infant reactivity mediated or moderated this association. Participants consisted of 220 (119 cocaine exposed and 101 non-cocaine exposed) mother-infant dyads participating in an ongoing longitudinal study of prenatal cocaine exposure. Results indicated that mothers who used cocaine during pregnancy displayed higher negative affect and lower sensitivity toward their infant during play interactions at 13 months, and that their infants were less responsive toward them. Contrary to hypothesis, this association was not mediated by maternal psychological distress or by infant reactivity. However, results for both the cocaine and non-cocaine exposed infants were supportive of a transactional model where lower maternal sensitivity at 1 month was predictive of higher infant reactivity at 7 months, which in turn was predictive of lower maternal warmth/sensitivity at 13 months, controlling for potential stability in maternal behavior. Results also indicated that as hypothesized, infant reactivity moderated the association between maternal cocaine use during pregnancy and maternal warmth/sensitivity at 13 months of age. Cocaine-using mothers who experienced their infants as being more reactive in early infancy were less warm/sensitive toward them in later infancy. Results have implications for parenting interventions that may be targeted toward improving maternal sensitivity among cocaine-using mothers with more reactive infants.