Effects of cocaine and alcohol use in pregnancy on neonatal growth and neurobehavioral status

doi:10.1016/0892-0362(92)90025-6

Neurotoxicology and Teratology

Volume 14, Issue 1, January–February 1992, Pages 23-33

https://doi.org/10.1016/0892-0362(92)90025-6 Get rights and content

Abstract

Effects on fetal growth and neonatal behavior of cocaine and alcohol use in pregnancy were investigated in infants born to women in a low-income, predominantly black population. Despite the increased use of cocaine by pregnant women and the accompanying public concern, behavioral studies of exposed neonates are limited in number and scope. In most studies, confounding factors (e.g., polydrug abuse, prematurity, infant health status) have not been controlled so the actual effects of cocaine and other drug exposure are not clear. Accordingly, this study investigated effects of prenatal drug exposure although controlling experimentally for other factors known to be associated with poor outcomes in infants: prematurity, other illicit drug use, associated diseases (e.g., sexually transmitted diseases [STDs]), and duration of drug use. In addition, other factors statistically controlled were: experimenter effects, timing of assessment, and effects of duration, amount, and frequency of cocaine, alcohol, marijuana, and nicotine exposure.

One hundred and seven full-term infants were assessed at 2, 14, and 28 days using the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) by testers blind to infant status. Growth factors (i.e., birthweight, length, head circumference) were also assessed.

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Cited by (218)

Longitudinal changes of amygdala functional connectivity in adolescents prenatally exposed to cocaine
2019, Drug and Alcohol Dependence
Prenatal cocaine exposure (PCE) is associated with arousal dysregulation, but interactions between exposure and age are rarely investigated directly with longitudinal study designs. Our previous study had examined task-elicited emotional arousal and noted persistently high amygdala activations in the development of adolescents with PCE. However, while externally imposed emotional arousal could be considered a “state” effect depending on specific task stimuli, it is still unclear whether similar developmental alterations extend to intrinsic functional connectivity (FC), reflecting more of a “trait” effect.
We used a longitudinal design and analyzed resting-state functional magnetic resonance imaging data acquired twice from 25 adolescents with PCE and 16 non-exposed controls. Both groups were each scanned first at the mean age of 14.3 and then again at 16.6 years. Seeding in bilateral amygdalae and comparing the 2^nd scan with the 1^st, we examined the interaction effect between PCE and age on FCs in the emotional network.
Compared with the younger age, we observed a generally decreased FC in the emotional network of the control group at the older age, but these FCs were generally increased at the older age in this same network of the PCE group. Additionally, this interaction effect of exposure by age in the right fusiform was positively correlated with the emotional interference imposed by external task stimuli.
These results provided additional data directly characterizing developmental changes in the emotional network of adolescents with PCE, complementing and extending the notion of a PCE-associated long-term teratogenic effect on arousal regulation.
Passive Addiction and Teratogenic Effects
2018, Volpe's Neurology of the Newborn
Drugs can exert major effects on the developing central nervous system (CNS). In the broadest sense, drugs may disturb specific developmental events in the brain and, in turn, produce teratogenic effects. In addition, maternal ingestion of certain drugs can result in passive addiction of the fetus and postnatally lead to a neonatal withdrawal or abstinence syndrome. Although some effects may be transient, most are likely to persist in some form into childhood and adolescence with multiple systems affected spanning cognition, motor function, language, and behavior. This chapter provides a comprehensive overview of the neurological effects of a range of licit and illicit drugs on the infant and growing child. Drugs reviewed include fetal exposure to alcohol, antiepileptic drugs, stimulants, opioids, selective serotonin reuptake inhibitors (SSRIs), sedatives, anesthetics, and marijuana. Clinical considerations in the evaluation and care of the drug-exposed neonate are also discussed.
Effects of prenatal alcohol exposure in a prospective sample of young adults: Mental health, substance use, and difficulties with the legal system
2017, Neurotoxicology and Teratology
Citation Excerpt :
Blood samples also were analyzed for level of gamma glutamyl transferase (GGT); high levels of this enzyme are associated with excessive alcohol use. The Drug Grid (Coles et al., 1992), a short self-report measure used to collect information on current and historic substance use, also was administered. The measure provides information on current use as well as frequency and amount of use for tobacco, alcohol, and several other drugs.
Few studies have focused on the transition to adulthood in adults with prenatal alcohol exposure (PAE). In this study, we examine the occurrence of problem behavior at this transition, including mental health problems, substance use, and difficulties with the legal system. The sample is prospective and provides an opportunity to examine effects of a wide range of prenatal exposure. Adults with PAE were expected to show more problem behavior; the impact of level of exposure was examined as well.
The sample was drawn from a predominantly low-income, African-American population. Mothers of the alcohol-exposed participants (n = 123) and those in the non-exposed SES-Control group (CONT) (n = 59) were recruited at a prenatal visit when information on alcohol and drug use during pregnancy was collected. A disability contrast group (n = 54) was recruited at adolescence. The adults with PAE were assigned to three groups varying in physical and cognitive effects of exposure. This report is based on the adults' responses to interviews or questionnaires on problem behavior and laboratory tests related to substance use.
Adults with PAE showed more problem behavior in all three areas than adults from the CONT group. For mental health problems, the exposed group showing cognitive, but not physical effects, had the highest scores; their scores were similar, however, to those of the disability contrast group on several scales. Results for outcomes on substance use and legal difficulties were less consistent, but, when significant effects occurred, the group that was exposed, but neither physically nor cognitively affected, was more likely to show negative outcomes. Males in this group were most involved in these behaviors.
Effects of PAE continue into early adulthood and affect mental health problems, substance use, and interactions with the legal system. Adults who are exposed, but less physically affected, seem to be the most involved in problem behavior. More research is necessary to examine environmental effects in conjunction with PAE on these outcomes and to provide a basis for developing potential interventions.
Medical marijuana laws and pregnancy: implications for public health policy
2017, American Journal of Obstetrics and Gynecology
Although there is much to learn yet about the effects of prenatal marijuana use on pregnancy and child outcome, there is enough evidence to suggest that marijuana, contrary to popular perception, is not a harmless drug, especially when used during pregnancy. Consequently, the public health system has a responsibility to educate physicians and the public about the impact of marijuana on pregnancy and to discourage the use of medical marijuana by pregnant women or women considering pregnancy.
Longitudinal changes of amygdala and default mode activation in adolescents prenatally exposed to cocaine
2016, Neurotoxicology and Teratology
Prenatal cocaine exposure (PCE) is associated with long-term and negative effect on arousal regulation. Recent neuroimaging studies have examined brain mechanisms related to arousal dysregulation with cross-sectional experimental designs; but longitudinal changes in the brain, reflecting group differences in neurodevelopment, have never been directly examined. To directly assess the interaction of PCE and neurodevelopment, the present study used a longitudinal design to analyze functional magnetic resonance imaging (fMRI) data collected from 33 adolescents (21 with PCE and 12 non-exposed controls) while they performed the same working memory task with emotional distracters at two points in time. The mean age of participants was 14.3 years at time_1 and 16.7 years at time_2. With confounding factors statistically controlled, the fMRI data revealed significant exposure-by-time interaction in the activations of the amygdala and default mode network (DMN). For the control adolescents, brain activations associated with emotional arousal (amygdala) and cognitive effort (DMN) were both reduced at time_2 as compared to that at time_1. However, these activation reductions were not observed in the PCE group, indicating persistently high levels of emotional arousal and cognitive effort. In addition, correlations between longitudinal changes in the brain and in behavior have shown that adolescents with persistently high emotional arousal were more likely in need of high cognitive effort; and their cognitive performance was more likely to be affected by distractive challenges. The present results complement and extend previous findings from cross-sectional studies with further evidence supporting the view of PCE associated long-term teratogenic effects on arousal regulation.
Prenatal cocaine exposure alters functional activation in the ventral prefrontal cortex and its structural connectivity with the amygdala
2013, Psychiatry Research - Neuroimaging
Citation Excerpt :
The fMRI and DTI sample used in the present study, respectively, included 56 (23 control vs. 33 PCE) and 73 (31 control vs. 42 PCE) participants. Information about maternal cocaine and other drug use was obtained both from abstraction of medical records and from the birth mother's self-report at recruitment in the immediate postpartum period using the Addiction Severity Index (McLellan et al., 1985) and the Drug Grid (Coles et al., 1992). The Addiction Severity Index allows assessment of the degree of addiction as well as the social and medical impact of the mother's substance use.
Prenatal cocaine exposure (PCE) is associated with arousal dysregulation, and alterations of amygdala activity in response to emotional arousal have previously been reported. However, voluntary regulation of emotional affect, enabling appropriate neural response to different streams of stimuli, must also engage prefrontal regions, yet the impact of PCE on these prefrontal mechanisms has not been investigated. Recent neuroimaging studies have shown the involvement of ventral prefrontal cortex (vPFC) in the modulation of amygdala reactivity and the mediation of effective emotional regulation. Based on these findings, using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), the present study compared functional activations of the vPFC as well as its structural connectivity with the amygdala between groups of PCE and control adolescents. In a working memory task with emotional distracters, the PCE adolescents exhibited less capability of increasing their vPFC activation in response to increased memory load, which corresponded with their less suppressed amygdala activation. Reduced structural connectivity between the vPFC and the amygdala was also observed from DTI measurement in the PCE group. In addition, correlations between amygdala activation and (i) vPFC activation, as well as (ii) amygdala-vPFC structural connectivity, were observed in the control but not in the PCE group. These data complement previous findings of the impact of PCE on the activity of the amygdala and extend our understanding of the neurobiological mechanisms underlying the effect of PCE on arousal dysregulation reported in human and animal studies.

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ArticleEffects of cocaine and alcohol use in pregnancy on neonatal growth and neurobehavioral status

Abstract

Life Sci.

Neurotoxicol. Teratol.

J. Pediatr.

J. Pediatr.

J. Pediatr.

Am. J. Obstet. Gynecol.

Lancet

Am. J. Obstet. Gynecol.

Neurotoxicol. Teratol.

Infant Behavior and Development

Neurotoxicol. Teratol.

Effect of in utero cocaine exposure on startle and its modification

Dev. Pharmacol. Ther.

Neonatal assessment scale

Prenatal drug exposure: Effects on neonatal and infant growth and development

Neurotoxicol. Teratol.

Maternal cocaine use and genitourinary tract malformations

Teratology

Temporal patterns of cocaine use in pregnancy: Perinatal outcome

JAMA

The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida

N. Engl. J. Med.

Maternal cocaine use during early pregnancy as a risk factor for congenital urogenital anomalies

JAMA

Cohort study of alkaloidal cocaine (“Crack”) in pregnancy

Obstet. Gynecol.

The effect of cocaine abuse on birth weight and gestational age

Obstet. Gynecol.

Effects of prenatal alcohol exposure on maternal perception of infant behavior

Neonatal neurobehavioral characteristics as correlates of maternal alcohol use during gestation

Alcoholism

Article
Effects of cocaine and alcohol use in pregnancy on neonatal growth and neurobehavioral status