Sonia Minnes

Relationship of prenatal cocaine exposure and maternal postpartum psychological distress to child developmental outcome

Maternal cocaine use during pregnancy can affect the infant directly through toxic effects or indirectly through cocaines influence on maternal psychological status. We followed 160 cocaine exposed and 56 nonexposed infants and their mothers identified at birth through interview and/or urine screen. Although cocaine exposure defined the groups, infant exposure to alcohol, marijuana, and tobacco was allowed to vary. Infants were 99% African American and poor. All mothers completed the Brief Symptom Inventory (BSI) and infants were given the Bayley Scales of Mental (MDI) and Motor (PDI) Development at a mean corrected age of 17 +/- 8 months. Both MDIs (94 +/- 17 vs. 103 +/- 16) and PDIs (101 +/- 16 vs. 108 +/- 12) were lower for cocaine exposed infants. Psychological distress was greater in cocaine using mothers. Hierarchical multiple regression was used to assess the relative effects of gestational age, maternal psychological distress, and cocaine and polydrug exposure on infant outcomes. Both psychological distress and cocaine and alcohol exposure predicted lower MDIs after controlling for prematurity. Neither psychological distress nor alcohol exposure predicted motor outcome, while cocaine had a significant effect. Tobacco and marijuana exposure were unrelated to outcome. These findings provide further support for direct effects of cocaine and alcohol on infant development as well as highlight the need for studies to document maternal psychological factors, which may increase child risk for poorer outcomes.

Effects of cocaine/polydrug exposure and maternal psychological distress on infant birth outcomes

To assess teratogenic effects of cocaine exposure and maternal psychological distress on birth outcomes, we conducted a longitudinal prospective study of 415 infants (218 cocaine-exposed--CE, 197 nonexposed--NE). Drug exposure was determined through a combination of maternal self-report, urine, and meconium screens. Maternal psychological distress postpartum was evaluated through a standardized, normative, self-report assessment. An extensive set of confounding variables was controlled, including severity of exposure to alcohol, tobacco, marijuana and other drugs, maternal age, race, parity, number of prenatal care visits, educational, marital, and socioeconomic status, and verbal and nonverbal intelligence. CE infants were smaller on all birth parameters and more likely to be preterm, small for gestational age, and microcephalic than NE infants. Forty-one percent of cocaine users had clinically significant psychological symptoms, compared to 20% of a high-risk comparison group of noncocaine users. Consistent with a teratologic model, cocaine exposure independently predicted offspring birthweight, length, and head circumference. Maternal psychological distress self-reported postnatally also independently predicted head circumference. Tobacco, alcohol, and marijuana exposures were also significant independent predictors of some fetal growth parameters. In addition, maternal distress symptoms, which may be reflective of maternal mental health disorders or responses to stress, added significantly to the risk for poorer fetal growth.

Neurobehavioral outcomes of cocaine-exposed infants

The present study investigated the neurobehavioral outcomes of fetal cocaine exposure. Attempts were made to control, by design or statistical analysis, for significant confounders. Timing and amount of drug exposures were considered, and biologic measures of exposure were quantified to classify exposure severity. One hundred sixty-one non-cocaine and 158 cocaine-exposed (82 heavily and 76 lightly exposed) infants were seen at a mean-corrected age of 43 weeks post-conception and administered the Neurobehavioral Assessment (NB Assessment). Heavily cocaine-exposed infants had more jitteriness and attentional problems than lightly and non-exposed infants. They also had more movement and tone abnormalities, and sensory asymmetries than non-exposed infants. Heavily exposed infants were more likely to be identified with an abnormality than non-exposed infants and there was a trend toward heavily exposed infants being more likely to be identified with an abnormality than lightly exposed infants. Furthermore, there was a trend for heavily exposed infants to be less likely to be testable than non-exposed infants. After the confounding and mediating factors were considered, heavily cocaine-exposed infants were four times as likely to be jittery and nearly twice as likely to demonstrate any abnormality than lightly and non-exposed infants, but all other effects were no longer significant. Higher concentrations of the cocaine metabolites of cocaine, cocaethylene, and benzoylecgonine (BZE) were related to higher incidence of movement and tone abnormalities, jitteriness, and presence of any abnormality. Higher cocaethylene levels were related to attentional abnormalities and higher meta-hydroxybenzoylecgonine (m-OH-BZE) was related to jitteriness. Drug effects on attention were mediated by maternal psychological distress, suggesting that this factor should be considered in future studies of drug exposure effects.

Executive Functioning in Preschool‐Age Children Prenatally Exposed to Alcohol, Cocaine, and Marijuana

BACKGROUND Reports from clinical and experimental (animal) research converge on the suggestion that prenatal exposure to alcohol, cocaine, or marijuana undermines executive functioning (EF) and its neurological underpinnings. However, large, adequately controlled, prospective studies of alcohol and marijuana effects on EF have reported conflicting findings, and there have been no such studies of cocaine exposure. METHODS EF was investigated in a cohort (n = 316) of 4-year-old children the majority of whose mothers had used varying combinations of cocaine, alcohol, and marijuana during pregnancy. With use of postpartum maternal report and biological assay, children were assigned to overlapping prenatal cocaine-exposed, alcohol-exposed, and marijuana-exposed groups and to complementary control groups. The postnatal environmental assessment included measures of maternal intellectual and psychosocial functioning, current drug or alcohol use, and home environment. RESULTS The children in the alcohol-exposed group had worse tapping-inhibition performance than children in the non-alcohol-exposed group, and this effect persisted when potential confounding environmental variables, other drug variables, and concurrent verbal intelligence were controlled for. CONCLUSIONS Prenatal alcohol is predictive of decreased EF in early childhood that could not be attributed to environmental factors. The results are discussed in terms of the age and overall high-risk status of the children.

Children Prenatally Exposed to Cocaine: Developmental Outcomes and Environmental Risks at Seven Years of Age

ABSTRACT. Data are equivocal regarding the long-term consequences of prenatal exposure to cocaine on school-aged children. We compared 101 children exposed prenatally to cocaine with 130 unexposed children on measures of intelligence, visual motor, and motor abilities at age 7 years. Bivariate analyses revealed that cocaine-exposed children scored significantly lower than comparison children on the abbreviated Wechsler Intelligence Scale for Children-Third Edition Verbal and Full Scale IQ scores, the Visual Motor Integration and Motor Coordination standardized scores, and the Bruininks-Oseretsky Fine Motor Composite score. Regression analyses indicated that the biological mothers vocabulary and home environment assessed at the same 7-year visit were stronger predictors of developmental outcome than prenatal drug exposure. Level of cocaine exposure, however, predicted visual motor and motor skills. The results indicate that although prenatal cocaine exposure may confer some degree of developmental disadvantage in the visual motor domain, it frequently occurs in the context of an inadequate rearing environment, which may be a stronger determinant than prenatal cocaine exposure of childrens outcome.

Prenatal Cocaine Exposure: Drug and Environmental Effects at 9 years

OBJECTIVE To assess school-age cognitive and achievement outcomes in children with prenatal cocaine exposure, controlling for confounding drug and environmental factors. STUDY DESIGN At age 9 years, 371 children (192 cocaine exposure [CE]; 179 non-cocaine exposure [NCE]) were assessed for IQ and school achievement in a longitudinal, prospective study from birth. An extensive number of confounding variables were controlled, including quality of caregiving environment, polydrug exposure, blood lead level, iron-deficiency anemia (IDA), and foster/adoptive care. RESULTS Prenatal cocaine exposure predicted poorer perceptual reasoning IQ, with a linear relationship of the concentration of the cocaine metabolite benzoylecgonine to the degree of impairment. Effects were mediated through birth head circumference, indicating a relationship with fetal brain growth. Negative effects of alcohol, lead, and marijuana exposure and positive effects of the home environment were additive. The CE children in foster/adoptive care had better home environments and lower lead levels. School achievement was not affected. CONCLUSIONS Persistent teratologic effects of CE on specific cognitive functions and additive effects of alcohol, lead, and marijuana exposure; IDA; and the home environment were identified. Documenting environmental factors in behavioral teratology studies is important, because in this sample, CE was associated with better home environment and lower environmental risk in a substantial number of children.

The effects of prenatal cocaine exposure on problem behavior in children 4-10 years

BACKGROUND Children prenatally exposed to cocaine may be at increased risk for behavioral problems due to disruptions of monaminergically regulated arousal systems and/or environmental conditions. OBJECTIVE To assess behavioral outcomes of cocaine (CE) and non-cocaine-exposed (NCE) children, 4 through 10 years old, controlling for other prenatal drug exposures and environmental factors. METHODS Low socioeconomic status (SES), primarily African American children (n=381 (193 (CE), 188 (NCE)) were recruited from birth. Generalized Estimating Equation (GEE) analyses were used to assess the predictive relationship of prenatal cocaine exposure to odds of caregiver reported clinically elevated behavioral problems at 4, 6, 9 and 10y ears of age, controlling for confounders. RESULTS Prenatal cocaine exposure was associated with increased rates of caregiver reported delinquency (OR=1.93, CI: 1.09-3.42, p<0.02). A significant prenatal cocaine exposure by sex interaction was found for delinquency indicating that only females were affected (OR=3.57, CI: 1.67-7.60, p<0.001). There was no effect of cocaine on increased odds of other CBCL subscales. Higher prenatal tobacco exposure was associated with increased odds of externalizing symptoms at 4, 9 and 10 years of age. For CE children, those in foster or adoptive care were rated as having more behavior problems than those in biologic mother or relative care. Greater caregiver psychological distress was associated with increased behavioral problems. There were no independent effects of elevated blood lead level on increased behavior problems after control for prenatal drug exposure and other environmental conditions. CONCLUSION Prenatal cocaine and tobacco exposure were associated with greater externalizing behavior after control for multiple prenatal drug exposures, other environmental and caregiving factors and lead exposure from 4 through 10 years of age. Greater caregiver psychological distress negatively affected caregiver ratings of all CBCL domains. Since cocaine and tobacco use during pregnancy and maternal psychological distress have the potential to be altered through prenatal educational, drug treatment and mental health interventions, they warrant attention in efforts to reduce rates of problem behaviors in children.

Fatty Acid Ethyl Esters in Meconium are Associated with Poorer Neurodevelopmental Outcomes to Two Years of Age

OBJECTIVE To determine the relationship between fatty acid ethyl esters (FAEE) in meconium and neurodevelopment in infants exposed to alcohol in utero at 6.5 months, 1 year, and 2 years of age. STUDY DESIGN A secondary analysis of a prospective cohort of mothers at high risk and their infants recruited after admission to a labor and delivery unit. Mothers were screened for drug and alcohol use during pregnancy by clinical interview and urine screening. Meconium was analyzed for FAEE in 216 newborn infants. Outcome measures included the Bayley Scales of Infant Development Mental (MDI) and Psychomotor (PDI) Developmental Index scores in infants at 6.5 months, 1 year, and 2 years of age. RESULTS After controlling for prenatal visits and maternal factors, increasing concentrations of FAEE were significantly associated with poorer mental and psychomotor development (beta +/- standard error) at all follow-up visits: ethyl myristate (MDI -2.46 +/- 1.24, P = .05; PDI -3.88 +/- 1.67, P = .02), ethyl oleate (MDI -1.94 +/- 0.65, P < .01; PDI -2.60 +/- 0.93, P < .01), ethyl linoleate (MDI -1.92 +/- 0.60, P < .01; PDI -2.28 +/- 0.84, P < .01), ethyl linolenate (MDI -1.99 +/- 0.74, P < .01; PDI -2.98 +/- 1.04, P < .01), and ethyl arachidonate (MDI -2.40 +/- 1.11, P = .03; PDI -3.32 +/- 1.51, P = .03). CONCLUSION FAEE in meconium may be a marker for identifying newborns at risk for neurodevelopmental delay from alcohol exposure in utero.

Prenatal Cocaine and Tobacco Effects on Children's Language Trajectories

OBJECTIVE. The objective of this study was to examine the effects of prenatal cocaine and polydrug exposure on language development of preschool children using a prospective longitudinal model, controlling for confounders. METHODS. Children who were exposed to cocaine in utero (n = 209) and nonexposed children (n = 189) were followed prospectively at birth and at 1, 2, 4, and 6 years of age and were compared on receptive, expressive, and total language scores across time using random coefficient models, controlling for confounders. RESULTS. A significant, stable effect of cocaine exposure on language development was observed over time for all language domains, with cocaine exposure related to poorer language performance. Cigarette exposure was related to lower receptive language scores. Environmental influences on language scores were also observed. Both the cocaine-exposed and nonexposed children declined in language performance over time. CONCLUSIONS. Prenatal cocaine exposure has a stable negative effect on language skills during the first 6 years of life. Both cocaine-exposed and nonexposed children showed decreased language growth over time; however, cocaine-exposed children demonstrated linguistic deficits compared with nonexposed peers and did not catch up. Cigarette and environmental influences were also noted.

Increased psychological distress in post-partum, cocaine-using mothers ☆

This study investigated psychological symptoms, self-reported postpartum by poor, primarily African American women who used cocaine during pregnancy. Ninety-nine cocaine-using mothers (COC+) were compared to 44 noncocaine-using mothers (COC-) on standardized measures of psychological distress and verbal comprehension. Mothers were interviewed to determined extent of drug involvement. COC+ mothers reported using alcohol, marijuana, and tobacco at two to three times the rate of comparison mothers during pregnancy and reported earlier initiation of marijuana use. COC+ women were more likely to admit to interpersonal difficulties and to report phobic anxiety and paranoid ideational symptoms. The COC+ group was also more likely to have clinically elevated scores on subscales indicating feelings of personal inadequacy, phobic anxiety, and paranoia. The use of cocaine, in combination with either alcohol or marijuana, was the best predictor of psychoticism, hostility, and total number of distress symptoms.