Maternal Substance Abuse Research Articles

Child neglect and the development of externalizing behavior problems: associations with maternal drug dependence and neighborhood crime.

Given the high prevalence of child neglect among maltreatment subtypes, and its association with exposure to additional environmental adversity, understanding the processes that potentiate child neglect and link neglect to subsequent child externalizing psychopathology may shed light on key targets for preventive intervention. Among 170 urban low-income children (ages 4-9) and their mothers, this 5-year prospective study examined the effects of early neglect severity and maternal substance abuse, as well as neighborhood crime, on children's later externalizing behavior problems. Severity of child neglect (up to age 6 years) mediated the relation between maternal drug dependence diagnosis (MDDD), determined at children's age of 4 years, and children's externalizing behavior problems at age 9. Rates of neighborhood crime mediated the link between presence of child neglect and children's externalizing behavior problems. The roles of MDDD, child neglect, and community violence in the development of child psychopathology are discussed in terms of their implications for intervention.

Moderators of the Relationship Between Maternal Substance Abuse Symptoms and Preschool Children’s Behavioral Outcomes

While maternal substance use problems increase the likelihood of behavior problems in children, child outcomes are varied, leading to interest in understanding additional family factors that contribute to the development of behavior problems in children impacted by maternal substance abuse. The purpose of this study is to examine harsh parenting and family conflict as potential moderators of the relationship between symptoms of maternal substance use problems and child externalizing behavior problems. The non-clinical sample for this study included 250 low-income parents whose preschool age children were enrolled in Head Start programs in a Southern state. This study utilized data collected during two home visits, an average of 10 months apart, with data on family functioning and maternal symptoms of substance use problems collected at the first time point and child externalizing behavior collected at the second time point. Over one-third of the children (38.1 %) had clinically elevated externalizing behavior scores. We used regression analysis to examine whether harsh parenting or family conflict moderated the relationship between maternal substance use symptoms and child externalizing behavior. In this community sample, we found that in the absence of family risks related to harsh parenting and family conflict, maternal symptoms of substance use problems did not have a significant impact on child externalizing behavior in preschool children. However, when high levels of family conflict or harsh parenting were present, symptoms of maternal substance use problems increased the risk of externalizing behavior problems in children.

Linking illicit substance misuse during pregnancy and child abuse: what is the quality of the evidence?

AbstractIn most Australian states, legislation makes provision for professionals to report their concerns about the future welfare of an unborn child to appropriate authorities. The legislation establishes guidance for the implementation of family supports to minimize future child protection involvement. Given the legislation and the potential benefits, empirical research linking substance misuse during pregnancy and child protection involvement is relatively limited. We review 21 original studies linking substance misuse during pregnancy with child protection outcomes and the potential generalizability of results to the Australian context. The majority of studies reviewed were conducted in the USA and were mostly retrospective. Other differences between studies include sample sizes, comparison groups, study setting, participants’ ethnicity and pattern of drug use. In the postnatal literature, it is well established that child abuse is associated with a complex array of factors including partner, as well as broader family factors and yet, the studies reviewed focus upon maternal substance abuse without including the wider context. Given the available evidence‐based literature, it is difficult to come to definitive conclusions that can assist clinicians involved in frontline decision‐making for early intervention. Well‐designed research, accessible by antenatal health‐care professionals, is needed to adopt an evidence‐based approach to risk assessment in the prenatal context.

Psychotherapy groups and individual support to enhance mental health and early dyadic interaction among drug-abusing mothers.

The purpose of this controlled study was to examine the outcome of psychodynamic mother-infant group psychotherapy (PGT) outpatient intervention for drug-abusing perinatal mother-infant dyads. PGT comprised 20 to 24 weekly 3-hr sessions with 3 to 5 months of follow-up. A comparison intervention group was formed of mothers participating in individually tailored psychosocial support (PSS) lasting, on average, 12 months and providing mother-infant support and practical counseling. We hypothesized that positive changes would occur in maternal drug abuse, mental health, and mother-infant interaction, especially in the PGT group due to its more intensive therapeutic focus. Participants were 26 drug-abusing dyads in PGT, 25 in PSS, and 50 dyads in a non-drug-abusing comparison group. Assessments were pre-intervention and at 4 and 12 months' follow-up, including maternal depressive symptoms and mother-child interaction assessed by the Emotional Availability Scales (EA). As hypothesized, in dyadic interaction maternal hostility decreased significantly in the PGT group, and intrusiveness decreased in both intervention groups, but especially in the PTG group. However, both interventions showed a general improvement in the quality of mother-infant interaction. They also succeeded in sustaining high maternal abstinence, treatment retention, and alleviating depressive symptoms. The findings are discussed in relation to preventing negative transgenerational interaction patterns in the high-risk dyads.

Prevalence of hospitalized live births affected by alcohol and drugs and parturient women diagnosed with substance abuse at liveborn delivery: United States, 1999-2008.

To describe prevalence trends in hospitalized live births affected by placental transmission of alcohol and drugs, as well as prevalence trends among parturient women hospitalized for liveborn delivery and diagnosed with substance abuse problems in the United States from 1999 to 2008. Comparison of the two sets of trends helps determine whether the observed changes in neonatal problems over time were caused by shifts in maternal substance abuse problems. This study independently identified hospitalized live births and maternal live born deliveries from discharge records in the Nationwide Inpatient Sample, one of the largest hospital administrative databases. Substance-related diagnosis codes on the records were used to identify live births affected by alcohol and drugs and parturient women with substance abuse problems. The analysis calculated prevalence differences and percentage changes over the 10 years, with Loess curves fitted to 10-year prevalence estimates to depict trend patterns. Linear and quadratic trends in prevalence were simultaneously tested using logistic regression analyses. The study also examined data on costs, primary expected payer, and length of hospital stays. From 1999 to 2008, prevalence increased for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid. The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women to reduce the number of substance-affected live births.

Maternal drug abuse history, maltreatment, and functioning in a clinical sample of urban children

ObjectiveThis study examined the association between maternal drug abuse history, maltreatment exposure, and functioning, in a clinical sample of young children seeking therapy for maltreatment. MethodsData were collected on 91 children, mean age 5.3years (SD 1.0). The Preschool and Early Childhood Functional Assessment Scales (PECFAS) was used to measure functional impairment. A child maltreatment exposure (CME) score was developed based on maltreatment history. Data on maternal risk factors including maternal drug abuse (MDA) were obtained. Data were analyzed using descriptive statistics and regression modeling. ResultsApproximately half (47.3%) of the children had a history of MDA. MDA history was associated with increased odds of neglect (OR=5.6, 95% CI=2.2–14.6) and abandonment (OR=3.3, 95% CI=1.3–8.3), and decreased odds of sexual abuse (OR=0.35, 95% CI=0.2–0.8). There were no statistically significant differences in CME scores for children with MDA history when compared to children without MDA history. Children with MDA history had an increased mean functional impairment score (mean 15 points; 95% CI=1.3–29.2) compared to children without MDA history. Following adjustment for maltreatment, no difference in impairment score was found. ConclusionAlthough MDA history was associated with higher odds of neglect and abandonment, it was not associated with total CME or functional impairment. Adverse socio-environmental experiences associated with urban environments may confer a high risk of CME and functional impairment, irrespective of MDA history. Practice implicationsIn addition to maternal drug abuse, clinicians working with children need to identify other factors which could place the child at added risk for maltreatment. Further research is needed to better understand the role of adverse socio-environmental experiences on maltreatment and functional impairment in children. This study highlights the need for a multi-disciplinary approach to prevention and intervention programs needed to diminish adverse socio-environmental conditions prevalent in urban environments.

Intercepting the intergenerational cycle of maternal trauma and loss through mother–infant psychotherapy: A case study using attachment-derived methods

Some mothers who have recently lost a significant attachment figure may become mentally incoherent and sporadically even enter a trancelike, dissociative state. Such states of mind have been shown to predict infant attachment disorganization. Infants born close to the time of a parental loss are at a greater risk for intergenerational trauma. A background of maternal substance abuse is also known to increase such risk. We illustrate by way of a case study how a mother-infant group psychotherapy programme aimed at substance-abusing mothers may help to prevent the transmission of mother's unresolved trauma to the infant. Another goal was to discuss how attachment-derived methods (namely, Adult Attachment Interview, Strange Situation Procedure and the Emotional Availability Scales) may aid in understanding the effects of the intervention.

Assessment of exposure to drugs of abuse during pregnancy by hair analysis in a Mediterranean island

This study aims to estimate the prevalence of drug use by pregnant women living in Ibiza, using structured interviews and biomarkers in maternal hair. In addition, the potentially detrimental effects of maternal drug abuse on their newborns were investigated. Ibiza has a large international night-life resort associated with clubs, music and use of recreational drugs. Hair samples were collected prospectively from January to March 2010 from a cohort of consecutive mothers after giving birth in the Hospital Can Misses in Ibiza. Opiates, cocaine, cannabis, methadone, amphetamines, 3,4-methylenedioxymethamphetamine (MDMA) and their metabolites were detected in a 3-cm-long proximal segment of maternal hair corresponding to the last trimester of pregnancy by gas chromatography coupled to mass spectrometry (n = 107). Data on socio-demographic characteristics and on tobacco, alcohol, drugs of prescription and drugs of abuse consumption during pregnancy were collected using a structured questionnaire. Hair analysis showed an overall 16% positivity for drugs of abuse in the third trimester of pregnancy, with a specific prevalence of cannabis, cocaine, MDMA and opiates use of 10.3, 6.4, 0.9 and 0%, respectively. In the questionnaires, only 1.9% of mothers declared using drugs of abuse during pregnancy. Gestational drug of abuse consumption was associated with active tobacco smoking, a higher number of smoked cigarettes and the mother being Spanish. Illicit drug use is substantially under-reported among pregnant women living in Ibiza, particularly among Spanish nationals. Voluntary, routine objective biological toxicology screening should be considered as part of routine examinations in antenatal clinics on this Mediterranean island.

An audit against current guideline for the management of children born to VDRL+ mothers

Background and aimsUntreated maternal syphilis results in perinatal loss/morbidity. Congenital infection results in deafness, bone, teeth and eye abnormalities. Children have serology at birth (maternal pairing) and are followed up...

Psychopathy traits and parental dysfunction in sexual offending and general delinquent adolescent males

The failure to account for differences between adolescent males who offend against children and those who offend against peers may account for the similarities found between sex-offending samples and non-sexual delinquents. Psychopathy traits (grandiosity, impulsivity, lack of empathy, interpersonally exploitative and risk-taking) and antisocial behaviour, including behaviours and age of onset for delinquent behaviours and drug use, were explored in male adolescents with sex offences against children, sex offences against peer/adults, sexual offences against both and non-sex delinquents. Youths who committed sexual offences were similar on psychopathic traits and level of antisocial behaviour. Higher levels of grandiosity and lack of empathy were found in those whose offences were non-sexual. Parental dysfunction was consistent across all groups, but maternal psychiatric difficulties were more frequent in youths with histories of sexual offending and a history of maternal substance abuse was more common for cross-over sexual offenders. These data indicate that most psychopathy traits and antisocial behaviour are similar in all sexual offenders, while maternal dysfunction and narcissistic traits distinguish them from non-sex delinquents.

Psychopathology and Parenting Practices of Parents of Preschool Children With Behavior Problems

Objective . This study investigated associations among different types of parental psychopathology and several specific parenting practices. Design . Mothers (n = 182) and fathers (n = 126) of preschool-aged children with behavior problems completed questionnaires assessing parental psychopathology and parenting practices and participated in observed parent–child interactions. Results . Maternal depression, anxiety, substance abuse, and several different personality disorder traits were related to maternal negativity, laxness, and lack of warmth. Paranoid, schizoid, schizotypal, and borderline personality disorder symptoms predicted mothers' parenting practices, even when statistically controlling for other types of psychopathology. For fathers, those same symptoms, dependent and avoidant symptoms, and substance abuse symptoms were associated with self-reported lax parenting. Some evidence emerged that psychopathology in one parent was associated with less overreactivity in the other. Conclusions . Many aspects of parents' psychological functioning play a role in determining specific parenting practices, including personality disorder symptoms.

Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not

Women with substance abuse disorders typically have psychosocial characteristics that put them at risk for disrupted parenting. Prior research indicates that comprehensive, accessible services tailored to the mothers' needs can contribute to family stability. This study further explores the complicated interplay of how maternal risk and protective characteristics and service elements are associated with reunification. The study contributes to existing literature by following mothers for three years; examining service needs as identified by the mother herself; using a summary proportion score to reflect the totality of services received to matched service needs identified; and using logistic regression to examine interactions of services received with critical maternal characteristics. The sample is comprised of 458 substance-abusing mothers enrolled during pregnancy or postpartum in the Washington State Parent–Child Assistance Program (PCAP), an evidence-based case management intervention. Participants' custody status was well distributed among four categories based on continuity of parenting. Findings indicate that at program exit 60% of the mothers were caring for their index child. These mothers had more treatment and mental health service needs met, had more time abstinent from alcohol and drugs, secure housing, higher income, and support for staying clean and sober. Among women with multiple psychiatric diagnoses, the odds of regaining custody were increased when they completed substance abuse treatment and also had a supportive partner. Mothers who lost and did not regain custody had more serious psychiatric problems and had fewer service needs met. We discuss implications of our findings for child welfare policy and practices.

Birth Outcomes Following Self‐Inflicted Poisoning During Pregnancy, California, 2000 to 2004

To describe birth outcomes following intentional acute poisoning during pregnancy. California Linked Vital Statistics-Patient Discharge Database, 2000 to 2004. Pregnant women age 15 to 44, who had a singleton live birth or fetal death that occurred between gestational ages 20 and 42 weeks who were discharged from the hospital for an intentional poisoning were compared to pregnant women discharged from the hospital for any nonpoisoning diagnosis. Intentional acute poisoning hospital discharges were identifed by the presence of an ICD-9-CM E-Codes E950-E952 (suicide, attempted suicide and self-inflicted injuries specified as intentional.) Through a retrospective cohort design, birth outcomes including low birth weight; preterm birth; fetal, neonatal, and infant death; and congenital anomalies were identified by the presence of ICD-9-CM diagnosis codes or by notation in the dataset. There were 430 hospital discharges for an intentional poisoning during pregnancy documented in the dataset (rate=25.87/100,000 person years). The rate of intentional poisoning was greatest in the first weeks of gestation and declined with increasing gestational age. Analgesics, antipyretics, and antirheumatics were most commonly implicated. Adverse birth outcomes associated with intentional poisoning included preterm birth (odds ratio [OR]=1.34; 95% Confidence Interval [CI] [1.01, 1.77]), low birth weight (OR=1.49; 95% CI [1.04, 2.12]), and circulatory system congenital anomalies (OR=2.17; 95% CI [1.02, 4.59]). Intentional acute poisoning during pregnancy was associated with several adverse birth outcomes; however, these relationships may be confounded by concomitant maternal substance abuse.

An in-depth analysis of domestically adopted children with special needs and their biological mothers

• Summary: In 2001, federal research funding (#90-CO-0960) was awarded to conduct an in-depth study of one agency’s experience with domestic special needs adoption placements (US Department of Health and Human Services, 2001). This private Ohio agency has been involved in the placement of special needs children since the beginning of the US special needs adoption movement in 1976. A rigorous and comprehensive chart review was conducted profiling 362 consecutively referred special needs adoption cases from 1997 to 2005, providing one of the most accurate and in-depth profiles of both special needs adoption children and their biological mothers to date. • Findings: In summing the major child and biological mother risk factors reported in this study (i.e. child neglect + child physical abuse + child sexual abuse + child prenatal drug exposure + child positive toxicology screen at birth + maternal mental illness + maternal substance abuse + maternal homelessness + maternal history of domestic violence + parental incarceration + and death of a significant person), youth averaged 4.7 (SD = 1.61) cumulative risk factors, not including poverty, multiple placement disruptions, and other undocumented risk factors. • Applications: Accurate and comprehensive profiling of child and biological parent characteristics are required to inform the service needs of at-risk families, domestic special needs adopted children, and adoptive parents. Implications for adoptive parent recruitment, training, and support, as well child monitoring and treatment are discussed.

P02-393 - The effects of prenatal morphine exposure on pain response

BackgroundDrug abuse during pregnancy is a growing problem in all developed countries of the world. Maternal drug abuse affects the developing system and its long-term effects can persist till adulthood so it can decreases the rate of their maturation. Since endogenous opioid induced analgesia, and morphine can interact with it, Thus the present study was designed to determine whether the exposure to the morphine during gestation permanently alter pain response.ObjectiveTo determine the effects of prenatal morphine exposure on pain responseMaterials and methods12 Pregnant rats were divided to morphine and control groups.Morphine was administrated (S.C) to female rats twice a day (08 h and 20 h) on gestational days 11–18, (5 mg/kg morphine for 3 days and 10 mg/kg for 5 days). Analgesic response of pups (P90, n = 6) were tested by formaline test.FindingThe results of our experiment demonstrated that prenatal morphine exposure rats exhibited significantly lower pain thersholds.ConclusionPrenatal morphine exposure impair pain sensitivity

Maternal-Related Predictors of Self-Regulation Among Low-Income Youth

The association between self-regulation and various adaptive outcomes has become a topic of growing interest to researchers. Yet, there is not much research on predictors of self-regulation in children. Using a cross-sectional design and an array of psychometrically sound scales and measures from multiple informants, this study examined whether maternal characteristics, namely maternal mental health, substance abuse, parenting practices, and child monitoring predicted self-regulation in children. Participants included a culturally diverse group of 155 youths (ages 8–17) and their mothers, all of whom were part of a larger investigation of low-income families in a mid-sized Northeastern city in the United States. Results showed that maternal substance abuse, parenting practices and parental monitoring independently predicted children’s self-regulation, accounting for 23% of the variance. Additional analyses indicated that parenting practices may partly mediate the effect of maternal mental health on children’s self-regulation. Implications for intervention and practice, especially those aimed to mitigate the detrimental effects of maternal mental health problems on children’s self-regulation, are discussed. Further research, both longitudinal and experimental, is warranted in order to extend this line of investigation.

The impact of maternal HIV infection on cord blood lymphocyte subsets and cytokine profile in exposed non-infected newborns

BackgroundChildren born to HIV+ mothers are exposed intra-utero to several drugs and cytokines that can modify the developing immune system, and influence the newborn's immune response to infections and vaccines. We analyzed the relation between the distribution of cord blood lymphocyte subsets and cytokine profile in term newborns of HIV+ mothers using HAART during pregnancy and compared them to normal newborns.MethodsIn a prospective, controlled study, 36 mother-child pairs from HIV+ mothers and 15 HIV-uninfected mothers were studied. Hematological features and cytokine profiles of mothers at 35 weeks of pregnancy were examined. Maternal and cord lymphocyte subsets as well as B-cell maturation in cord blood were analyzed by flow cytometry. The non-stimulated, as well as BCG- and PHA-stimulated production of IL2, IL4, IL7, IL10, IL12, IFN-γ and TNF-alpha in mononuclear cell cultures from mothers and infants were quantified using ELISA.ResultsAfter one year follow-up none of the exposed infants became seropositive for HIV. An increase in B lymphocytes, especially the CD19/CD5+ ones, was observed in cord blood of HIV-exposed newborns. Children of HIV+ hard drug using mothers had also an increase of immature B-cells. Cord blood mononuclear cells of HIV-exposed newborns produced less IL-4 and IL-7 and more IL-10 and IFN-γ in culture than those of uninfected mothers. Cytokine values in supernatants were similar in infants and their mothers except for IFN-γ and TNF-alpha that were higher in HIV+ mothers, especially in drug abusing ones. Cord blood CD19/CD5+ lymphocytes showed a positive correlation with cord IL-7 and IL-10. A higher maternal age and smoking was associated with a decrease of cord blood CD4+ cells.Conclusionsin uninfected infants born to HIV+ women, several immunological abnormalities were found, related to the residual maternal immune changes induced by the HIV infection and those associated with antiretroviral treatment. Maternal smoking was associated to changes in cord CD3/CD4 lymphocytes and maternal hard drug abuse was associated with more pronounced changes in the cord B cell line.

African American and White Mothers’ Substance Abuse, Depression, and Criminality as Risk Factors for Child Behavior Problems

This study, using data from the National Longitudinal Survey of Youth, examines the correlation among maternal substance abuse, depression, and criminality and their impact on child behavior problems within a sample of African American and White mothers. Results show that maternal depression is the strongest predictor of child behavior problems. Race was significantly associated with income, a mother's age at the time of her first child's birth, and depression. Implications for practice include the need for practitioners to prioritize the treatment of maternal depression when working with children who have behavior problems and to not look at race as a cultural descriptor alone, but rather to consider how it may be associated with other risk factors for child behavior problems.

Nutrition précoce et devenir neurologique du prématuré

There have been inconsistent findings on the associations among prematurity, poor fetal growth, and depression. We examined the associations among gestational age, poor fetal growth, and depression in individuals aged 5 to 25 years.We identified 37,682 case subjects based on International Classification of Diseases, Ninth Revision code 2961 and International Classification of Diseases, Tenth Revision codes F32.0-F32.9 and F33.0-F33.9 from the Care Register for Health Care, and 148,795 matched controls from the Finnish Central Population Register. Conditional logistic regression examined the associations between gestational age by each gestational week, poor fetal growth, and depression. The associations were adjusted for parental age and psychopathology, paternal immigrant status, maternal substance abuse, depression, number of previous births, marital status, socio-economic status, smoking during pregnancy, and the infant’s birthplace.In the adjusted models, increased risk of depression was found in children born ≤25 weeks (adjusted odds ratio [aOR] 1.89, 95% CI 1.08–3.31), at 26 weeks (aOR 2.62, 95% CI 1.49–4.61), at 27 weeks (aOR 1.93, 95% CI 1.05–3.53), and ≥42 weeks (aOR 1.11, 95% CI 1.05–1.19). In girls, extremely preterm birth was associated with depression diagnosed at 5 to 12 years (aOR 2.70, 95% CI 1.83–3.98) and 13 to 18 years (aOR 2.97, 95% CI 1.84–4.78). In boys, postterm birth (≥42 weeks) was associated with depression diagnosed at 19 to 25 years (aOR 1.28, 95% CI 1.07–1.54). Poor fetal growth was associated with an increased risk of depression in full-term infants (aOR 1.06, 95% CI 1.03–1.10) and postterm infants (aOR 1.24, 95% CI 1.08–1.43).Preterm birth before 28 weeks of gestation appeared to play a role in the development of childhood depression. Smaller effects were also seen in postterm births, especially in boys.

Assessment of Risk Factors for Infantile Cataracts Using a Case-Control Study: National Birth Defects Prevention Study, 2000–2004

To identify risk factors for infantile cataracts of unknown etiology. Case-control study. Case infants (n = 152) and control infants (n = 4205) enrolled in the National Birth Defects Prevention Study for birth years 2000-2004. Multivariate analysis was performed exploring associations for risk factors for bilateral and unilateral infantile cataracts of unknown etiology. Infantile cataracts of unknown etiology. Maternal interviews were completed for 43 case infants with bilateral and 109 with unilateral infantile cataracts of unknown etiology. Very low birth weight (<1500 g) was associated with both unilateral (adjusted odds ratio [OR], 6.0; 95% confidence interval [CI], 2.2-16.3) and bilateral (OR, 13.2; 95% CI, 4.2-41.1) cataracts, whereas low birth weight (1500-2499 g) was only associated with bilateral cataracts (OR, 3.3; 95% CI, 1.3-8.1). Infants with unilateral cataracts were more likely to be born to primigravid women (OR, 1.6; 95% CI, 1.0-2.7) than women with > or =2 previous pregnancies, although this was of borderline significance. Although not significant, effect estimates were elevated suggesting a possible association between unilateral cataracts and maternal substance abuse during pregnancy, and between bilateral cataracts and urinary tract infection during pregnancy and aspirin use during pregnancy. Very low birth weight is associated with both bilateral and unilateral cataracts, whereas low birth weight is associated with bilateral cataracts and primigravidity with unilateral cataracts. Other associations, although not statistically significant, suggest risk factors that merit further research.