Substance Exposure Research Articles

Prenatal marijuana exposure and visual perception in toddlers: Evidence of a sensory processing deficit.

Research has identified a link between prenatal marijuana exposure and multiple outcomes in children, including cognitive development. Several studies have found specific differences in sensory processing and attention, with visual perception especially impacted in school age children. The current study explored whether this effect is evident at an earlier age, and thus our goal was to investigate the relationship between in-utero marijuana exposure and sensory processing capabilities in toddlers. We hypothesized that in-utero marijuana exposure throughout pregnancy would specifically predict visual sensory hyperactivity in children as young as 15 months of age. Participants were 225 15-month-old children whose mothers were recruited during pregnancy. Substance exposure was prospectively collected and biochemically verified, with marijuana coded as no exposure, 1st trimester exposure only, or exposure throughout pregnancy. The Infant Toddler Sensory Profile evaluated 5 domains of sensory processing (visual, auditory, tactile, vestibular, oral). Prenatal marijuana exposure throughout pregnancy, but not when limited to the first trimester, predicted a two-fold increased likelihood of scoring in a range indicating high levels of seeking out and potentially over-attending to visual stimulation after controlling for potentially confounding factors including other prenatal exposures. Marijuana exposure was not significantly related to other processing domains. Results indicate that links previously identified between prenatal marijuana exposure and visual function and attention may already be evident at 15 months of age, and also suggest an impact related to continuous/later pregnancy exposure. Our findings, as well as those from previous studies, all suggest visual processing differences for exposed children, differences that may predict emerging issues with visual attention and habituation. As legalization of marijuana continues to increase, further research is clearly needed to examine specific teratologic effects associated with use during pregnancy.

Explicit and implicit bias among parents of sexual and gender minority youth.

Sexual and gender minority (SGM) youth are at disproportionate risk for poor mental health outcomes, in part due to experiences and expectations of anti-SGM bias including from their own parents. We examined explicit anti-SGM and implicit antisexual minority bias in parents of SGM youth and associations with parenting and parent and youth psychosocial functioning. Heterosexual/cisgender parents (N = 205, Mage = 46.9 years, SD = 8.5) of SGM youth (≤ 29 years old, Mage = 19.4, SD = 4.7) completed an online study including measures of explicit anti-SGM and implicit anti-SM bias, parental acceptance and psychological control, parent-child unfinished business (unresolved negative feelings related to their child's identity), parental depression and anxiety, and youth anxiety, depression, substance use, and exposure to bullying. In models including both explicit anti-SGM and implicit anti-SM bias as predictors of parent and youth outcomes, explicit bias was uniquely associated with lower parental acceptance and greater parental psychological control, parent-child unfinished business, parental anxiety and depression, and youth substance use and exposure to bullying, whereas implicit bias was uniquely associated with greater parent-child unfinished business and parental depression. Further, the combination of high levels of both explicit and implicit bias was associated with the highest levels of parent-child unfinished business, parental depression, and youth anxiety, depression, and exposure to bullying. Results suggest that both types of bias jointly contribute to parenting and parent and youth psychosocial functioning and can help identify families at greatest risk for maladjustment. Findings can inform the development of interventions designed to reduce anti-SGM bias in parents of SGM youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Abstract 64: Prenatal Per- and Polyfluoroalkyl Substance (PFAS) Exposures, Individually and as a Mixture, Are Associated With Obesity Risk at 16-20 Years in the Project Viva Prospective Cohort: Implications for PFAS as Hazardous Substances for Developmental Health

Introduction: PFAS are obesogenic in adults, but findings on the associations between prenatal PFAS exposures and child obesity risk are inconsistent, and it is not clear if such associations extend up to mid- to late adolescence. We investigated the individual and joint associations of prenatal PFAS exposures with obesity risk at 16-20 years. Methods: In the prospective pre-birth cohort Project Viva, we measured PFAS in maternal plasma samples collected in the first trimester and child body mass index (BMI) at the mid-adolescent visit (median: 17.4y; range: 15.9-20.0y). We defined obesity as BMI ≥ 95 th percentile for age and sex based on the CDC Growth Charts. We used Poisson regression with robust variance estimates to examine associations of each PFAS, and Bayesian kernel machine regression (BKMR) to examine PFAS mixtures, with obesity. We adjusted for maternal age, education, pre-pregnancy BMI, race/ethnicity, parity, and smoking status during pregnancy. Results: Among 545 participants, 73 (13%) had a BMI in the obese range. Children with higher prenatal PFOS and PFNA exposures had a greater risk of obesity [relative risk = 1.59 (95% CI: 1.19, 2.11) per doubling of PFOS and 1.48 (95% CI: 1.11, 1.98) per doubling of PFNA] in multivariable-adjusted models. In BKMR models, PFOS and PFNA were similarly associated with greater risk of obesity when accounting for co-exposures of other PFAS (Panel A) . There was an interaction between PFOS and PFOA: the positive association between PFOS and obesity was stronger when PFOA levels were lower (Panel B) , while there was a negative association between PFOA and obesity when PFOS levels were higher (Panel C) . Children with higher concentrations of the mixture PFAS had greater obesity risk in a dose-dependent fashion (Panel D) . Conclusions: Prenatal PFAS exposures may have long-lasting, intergenerational obesogenic effects. Our findings support the U.S. Environmental Protection Agency’s recent designation of PFAS as hazardous substances for human health, including developmental health.

Abstract P169: Prenatal Per- and Polyfluoroalkyl Substance (PFAS) Exposures and Offspring Blood Pressure From Birth to Late Adolescence: A Prospective Study in Project Viva

Introduction: Mice studies showed that prenatal PFAS exposures increase offspring blood pressure (BP), but findings in human studies are inconsistent. Prior studies did not have repeated BP measurements from birth to late adolescence or use a mixture approach to investigate the interactions or overall effects of prenatal PFAS exposures. Methods: Participants are from the prospective pre-birth cohort Project Viva. We measured PFAS in maternal plasma samples collected in the 1 st -trimester (median: 9.6w) and child systolic (SBP) and diastolic BP (DBP) at six follow-up visits: 1) birth; 2) infancy (median: 6m); 3) early childhood (median: 3.2y); 4) mid-childhood (median: 7.7y); 5) early adolescent (median: 13.0y), 6) mid-adolescent (median: 17.5y). At each study visit, BP was measured 4-5 times, and the average value was taken. We used linear regression to examine associations of each individual PFAS, and Bayesian kernel machine regression (BKMR) to examine PFAS mixtures, with BP at each visit, adjusting for maternal age, race/ethnicity, education, pre-pregnancy body mass index, parity, smoking status, and chronic hypertension before pregnancy. Results: Sample sizes at each visit ranged from 549-919 ( Legend ). Prenatal PFAS was not consistently associated with offspring SBP or DBP across all visits. PFOS was associated with higher SBP in mid-childhood ( Panel A1 ), EtFOSAA was associated with higher SBP in infancy and in mid-childhood ( Panel A5 ), and MeFOSAA was associated with higher SBP in infancy ( Panel A6 ). PFOS, PFNA, EtFOSAA, and MeFOSAA were associated with lower DBP only in early childhood but not at other visits ( Panels B1, B4, B5, B6 ). BKMR did not suggest prenatal PFAS interactions or the overall effects of exposure to multiple PFAS on offspring SBP or DBP. Conclusions: There are no consistent associations between prenatal PFAS exposures and BP from birth to late adolescence. Future studies should examine whether there are other critical windows (e.g., mid- or late pregnancy) of susceptibility for PFAS on offspring BP.

Perfluoroalkyl substance exposure is associated with asthma and innate immune cell count in US adolescents stratified by sex.

Exposure to perfluoroalkyl substances (PFAS) may be harmful to humans; however, previous studies have been inconsistent regarding the potential for PFAS-induced immunosuppresion. This study explored the relationship between PFAS exposure and risks of asthma, wheezing, and immunosuppression in 12-19year-olds using the National Health and Nutrition Examination Survey (NHANES) data. Logistic regression models were used to reveal associations between serum PFAS levels and risks of asthma, wheezing, asthma attack, and emergency department visits. Pearson's correlation was used to determine the relationship between serum PFAS levels and leukocyte count. Data were also stratified by sex. We found that medium-low levels of serum perfluorooctane sulfonate (PFOS) (6.90-12.40ng/mL) and serum perfluorooctanoic acid (PFOA) (2.43-3.60ng/mL) were negatively related, respectively, to current asthma and wheezing in boys, and to wheezing in girls. Meanwhile, boys with medium-high levels (1.50-3.00ng/mL) of serum perfluorohexanesulfonate (PFHxS) had a high risk of wheezing. Among asthmatic participants, both medium-high levels (3.75-5.07ng/mL) of serum PFOA and high levels (> 3.92ng/mL) of PFHxS correlated with asthma attacks in boys; likewise, medium-low levels (0.70-0.99ng/mL) of serum PFNA correlated with asthma attacks in girls. Also, PFOA and PFNA levels were weakly positively correlated with basophil count, whereas PFOS levels were weakly negatively correlated with eosinophils in asthmatic boys, indicating that basophils may be important in the immune response to PFAS exposure among asthmatics.

Expansion and commentary on a two generation approach to prenatal opioid exposure - a commentary on Conradt et al. (2023).

Early child neurodevelopment, including psychopathology, is influenced by a myriad of factors and interactions. These factors are both intrinsic to the caregiver-child dyad such as genetics and epigenetics as well as extrinsic such as social environment and enrichment. Additional layers of complexity may be at play within families with parental substance use, as outlined by Conradt et al. (2023) in their review article titled "Prenatal Opioid Exposure: A Two-Generation Approach to Conceptualizing Risk for Child Psychopathology.". Conradt et al. provide an overarching synthesis of many findings related to substance use that goes beyond the in utero exposure to the transgenerational interface of pregnancy and early childhood, including biologic sensitivities such as genetic predisposition, overrepresentation of social risk factors including early adversities of caregivers and poverty, and transgenerational interactional susceptibilities. Altered dyadic interactions may relate to joint changes in neurobehavior and are not isolated from the influence of infant genetics, epigenetics, and environment. The early neurodevelopmental correlates of prenatal substance exposure including risks of childhood psychopathology are then a composite of many different forces. This nuanced reality, described as an "inter-generational cascade," does not centralize parental substance use or prenatal exposure as a singularly causative moment but positions it within the ecologic milieu of the total lived experience.

Specialist medical toxicologist consultations provided by the New Zealand National Poisons Centre, 2018-2020.

The National Poisons Centre (NPC) provides 24/7 specialist medical toxicologist consultations to healthcare professionals regarding the clinical management of poisoning cases. The use of toxicologist services was investigated to characterise the extent and content of consults to inform further development of this service. A retrospective analysis of 2018-2020 medical toxicologist consultations summarised contact numbers, professional backgrounds and district health boards (DHBs) of the people contacting the NPC, and the patient(s) and substance(s) involved. There were 3,451 medical toxicologist consultations with 2,400 (67%) provided directly to healthcare professionals. Crude rates of consults increased across all DHBs. Of all 2,603 therapeutic substances that were consulted about during the study period, 1,492 (57.3%) were drugs affecting the nervous system, and paracetamol was the most common individual drug (528; 20.3%). Of all 1,185 non-therapeutic substance exposures that were advised on, 66 (5.6%) were unidentified mushrooms, 51 (4.3%) unidentified substances, and 47 (4.0%) lead exposures. There was increasing utilisation of the NPC service by healthcare professionals from all 24 areas of the country, covering a wide range of substance exposures and scenarios. The growing utilisation suggests healthcare professionals derive value from this consultation service for the care of their patients.

Prenatal tobacco and cannabis co-exposure and offspring obesity development from birth to mid-childhood.

Although the association between prenatal tobacco exposure and child obesity risk is well-established, less is known about co-exposure to tobacco and cannabis. Determine the relation between prenatal substance co-exposure and obesity risk. In a diverse sample of pregnant women, we examined the association between prenatal substance exposure (tobacco-only and co-exposure) and child BMI (kg/m2 ) trajectories from birth to mid-childhood (n=262), overweight/obese status based on BMI percentiles from toddlerhood (24 months) to mid-childhood (9-12 years), and adiposity outcomes at mid-childhood (fat mass [kg], fat mass [%] and fat free mass [kg]; n=128). Given that the major goal of this study was to examine the associations between prenatal substance exposure and child outcomes, we oversampled pregnant women for substance use (with tobacco as the primary focus). Multilevel models demonstrated that children in both exposure groups had a steeper increase in BMI trajectory from birth to mid-childhood and among co-exposed children, girls had a steeper increase than boys. Odds ratio of having obesity by mid-childhood was 12 times higher among those co-exposed than non-exposed. Co-exposure led to significantly greater fat mass and fat mass % compared with no exposure, but exposure to only tobacco was no different than no exposure. Results highlight potentiating effects of cannabis exposure in the context of maternal tobacco use in pregnancy on obesity risk and the importance of multi-method assessments of obesity.

Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults

Per- and polyfluoroalkyl substances (PFAS) are widespread pollutants with demonstrated hepatotoxicity. Few studies have examined the association between PFAS and fatty liver disease (FLD) risk in an adult population. In this cross-sectional study of participants from the 2017-2018 National Health and Nutrition Examination Survey, serum PFAS were measured, and FLD cases were ascertained by vibration-controlled transient elastography. Logistic regression models were used to examine the association between circulating PFAS levels and FLD risk. Analyses were stratified into non-alcoholic FLD and alcoholic FLD risk groups by alcohol intake status, as well as controlling for other risk factors, including personal demographics, lifestyle factors, and related health factors. Among 1,135 eligible participants, 446 had FLD. For FLD risk, the multivariable-adjusted odds ratio per log-transformed SD increase (ORSD) in perfluorohexane sulfonate (PFHxS) was 1.13 (95% CI 1.01-1.26). The association between PFHxS and FLD appeared stronger among individuals with obesity or high-fat diets (both p interaction <0.05). When limiting the analysis to 212 heavy drinkers (≥2 drinks/day for women and ≥3 drinks/day for men), significantly higher risk of alcoholic FLD was found for higher levels of perfluorooctanoic acid (ORSD 1.79; 95% CI 1.07-2.99), PFHxS (ORSD 2.06; 95% CI 1.17-3.65), and perfluoroheptane sulfonic acid (ORSD 1.44; 95% CI 1.00-2.07), and marginally significant higher risk for total PFAS (ORSD 2.12; 95% CI 0.99-4.54). In never or light drinkers, we did not observe any significant association between PFAS and non-alcoholic FLD. Significant positive associations were found for PFAS with aspartate aminotransferase, gamma-glutamyl transaminase, total bilirubin, and albumin (β ranged from 0.008 to 0.101, all p <0.05). Higher serum PFAS was moderately associated with FLD risk and worse liver function in the general population, and among those with independent risk factors, including heavy alcohol intake, obesity, or high-fat diets, PFAS increased the risk. These results suggest synergistic effects on hepatic steatosis between PFAS exposures as measured through biomonitoring data and lifestyle risk factors in a nationally representative US population. The per- and polyfluoroalkyl substances (PFAS) may convey higher risk for chronic liver disease in humans. Among 1,135 US adults in the 2017-2018 National Health and Nutrition Examination Survey, we found that higher serum PFAS was associated with higher fatty liver disease risk and worse liver function, especially among those with liver disease risk factors, including heavy alcohol intake, obesity, or high-fat diets. Continuously monitoring PFAS in the population and examining how they potentiate risk to the liver are essential.

A descriptive study of aripiprazole, brexpiprazole, and cariprazine exposures in children ages 0 to 5 years reported to United States poison centers

Introduction Increased prescribing of antipsychotics and availability of new antipsychotics has resulted in increased exposures in children. Current data on aripiprazole, brexpiprazole, and cariprazine are limited. Methods This was a retrospective database study utilizing the National Poison Data System from 2015 through 2021. We included cases of single substance exposures to aripiprazole, brexpiprazole, cariprazine, or lumateperone in children ages 0 to 5 years old with follow-up to a known outcome. Key outcomes were medical outcomes, clinical effects, and level of care if treated in a healthcare facility. Results There were 3,573 aripiprazole, 137 brexpiprazole, 249 cariprazine, and one lumateperone exposure over the period. Primary outcomes were evaluated in 2,655 cases (2,390 aripiprazole, 96 brexpiprazole, and 169 cariprazine). Fifty-one percent were male and 77% were between 0 and 2 years old. Moderate effect was coded in 16.6% of aripiprazole, 23% of brexpiprazole, and 12% of cariprazine exposures. Major effect was coded in 0.6% of aripiprazole, 1% of brexpiprazole, and 2.4% of cariprazine exposures. Duration of symptoms was mostly between 8 and 24 h for 34.6% of aripiprazole, 30% of brexpiprazole, and 32% of cariprazine exposures. Over 60% of the children seen in a health care facility were discharged from the emergency department. The lowest doses resulting in at least a moderate effect and admission to a health care facility was 0.46 mg/kg for aripiprazole, 2.1 mg/kg for brexpiprazole, and 1.9 mg/kg for cariprazine. Important clinical effects included central nervous system depression, tremors, tachycardia, agitation, and vomiting. Conclusion Reported ingestions of aripiprazole, brexpiprazole, or cariprazine may result in neurologic symptoms like central nervous system depression or seizures in children. The prolonged duration of symptoms resulted in admission for at least a day for many cases. Further research should address optimal monitoring time and location for these exposures.

371 - Congenital scoliosis: a case of vacterl with prenatal substance exposure

371 - Congenital scoliosis: a case of vacterl with prenatal substance exposure

Determinants of hair cortisol in preschool children and their mothers: A Brazilian birth cohort study

ObjectiveFew large-scale studies have provided population-based estimates of hair cortisol levels and its determinants. Hair cortisol and potential determinants were measured in children and their mothers in a population-based sample in a Brazilian city with large variations in socioeconomic conditions. MethodsWe used data from the 4-year follow-up of the 2015 Pelotas (Brazil) Birth Cohort Study. Hair samples were collected by trained fieldworkers to analyze average levels of cortisol over a 3-month period. Four groups of variables were tested as potential determinants: hair characteristics (natural color, treatment, type, and frequency of wash), use of corticosteroids and oral contraceptives, sociodemographic factors (sex, age, skin color, socioeconomic level, maternal relationship, pregnancy, daycare enrollment), maternal perceived stress, and substance exposure (smoking and illicit drug use). Linear regression with log transformation was used to test associations. Results3235 children and 3102 mothers were analyzed (80.7% and 77.4% of those interviewed when children were 4 years of age, respectively), for whom sufficient hair was collected for cortisol analysis. The median of hair cortisol concentration was 7.8 pg/mg (IQR = 5.6 – 11.0) for children, and 5.6 pg/mg (IQR = 4.2 – 7.8) for mothers. In adjusted models, sex and socioeconomic level were associated with child cortisol levels. For mothers, hair cortisol levels were associated with socioeconomic level, skin color, age, hair treatment and hair natural color. ConclusionThis study provides estimates of hair cortisol levels in a diverse population in a upper-middle income country. Although just a few predictors were associated with maternal/child cortisol levels, socioeconomic level was the key variable that should be incorporated in studies using hair cortisol to measure biological manifestations of stress, but other variables, such as some hair and sociodemographic characteristics are important to consider when using hair cortisol.

Prenatal substance exposure, early-life adversity, and parenting: Associations with adolescent stress response.

We tested a conceptual model examining associations between prenatal substance exposure and adolescent cortisol reactivity profiles in response to an acute social evaluative stressor. We included cortisol reactivity in infancy, and direct and interactive effects of early-life adversity and parenting behaviors (sensitivity, harshness) from infancy to early school age on adolescent cortisol reactivity profiles in model testing. Participants were 216 families (51% female children; 116 cocaine-exposed) recruited at birth, oversampled for prenatal substance exposure, and assessed from infancy to early adolescence (EA). Majority of participants self-identified as Black (72% mothers, 57.2% adolescents), and caregivers were primarily from low-income families (76%), were single (86%), and had high school or below education (70%) at recruitment. Latent profile analyses identified three cortisol reactivity patterns including elevated (20.4%), moderate (63.1%), and blunted (16.5%) reactivity groups. Prenatal tobacco exposure was associated with higher likelihood of membership in the elevated reactivity compared to the moderate reactivity group. Higher caregiver sensitivity in early life was associated with lower likelihood of membership in the elevated reactivity group. Prenatal cocaine exposure was associated with higher maternal harshness. Interaction effects among early-life adversity and parenting indicated that caregiver sensitivity buffered, and harshness exacerbated, the likelihood that high early adversity would be associated with the elevated and blunted reactivity groups. Results highlight the potential importance of prenatal alcohol and tobacco exposure for cortisol reactivity and the role of parenting as exacerbating or buffering the impact of early-life adversity on adolescent stress response.

Personas of pregnant and parenting women with substance use and their barriers and pathways to system engagement.

Women with prenatal substance use have been identified as at-risk for the lack of engagement in perinatal services, such as medical care and home visitation programs. This issue is of particular concern in Florida (United States) where rates of fetal substance exposure have been steadily increasing. To identify pathways of and barriers to perinatal system and service engagement, journey mapping was used to compile various personas of perinatal women with substance use. A structured guide was developed to elicit maternal personas, system and service touchpoints, and system strengths and weaknesses from focus group participants with statewide stakeholders, including perinatal service administrators and community coalition members within three Florida communities. Workshop transcripts, debriefing, and member-checking sessions were transcribed verbatim and analyzed manually. Six journey-mapping workshops and two member-checking meetings with mothers in-recovery were conducted with a total of 109 participants. Four personas were identified: women who (1) have substance use on a recreational basis, (2) have prescription drug use/misuse, (3) have chronic substance dependence, and (4) are in-recovery from substance dependence. Pathways that promote and barriers that prevent perinatal women with substance use from being identified, referred, or willing to accept and engage in medical care and social services were identified. While these personas shed light on differential pathways experienced by women with OUD, they were not intended as fixed-member groups but rather fluid descriptions of circumstances in which individuals could shift over time. These personas are beneficial to understand differences in circumstances, as well as variations in pathways and barriers to service engagement. Additionally, personas may be used to identify approaches to optimize service engagement by perinatal women with substance use and to support system improvements and integrations.

Perinatal Health Profiles Associated With Removal From the Home and Subsequent Child Protective Services Report in Maltreated Infants.

Infants face the highest risk of abuse and neglect nationally. There is a compelling need to understand the individual risk factors and needs of families of maltreated infants so that prevention efforts can be tailored for optimal effectiveness. Using linked birth certificate and CPS records data, we employed latent class analysis to identify distinct profiles of perinatal health factors associated with infant maltreatment. Classes were then regressed onto two key child welfare outcomes-removal from the home and re-report. Results indicated 10 latent classes primarily associated with supervisory neglect and presumed prenatal substance exposure. Rapid repeat pregnancy, smoking during pregnancy and inadequate prenatal care emerged as key risk factors. Presumed substance exposure was associated with high risk of removal from the home and low risk of re-report. The opposite was found for supervisory neglect. Substantial variation existed across classes and types of maltreatment, suggesting a need for tailored prevention strategies.

Estimating historical exposure to perfluoroalkyl acids in Security, Fountain, and Widefield Colorado: use of water-infrastructure blending and toxicokinetic models.

Drinking water can be a major source of poly- and perfluoroalkyl substance (PFAS) exposure for humans. The lack of historic data on PFAS drinking-water concentrations and consumption patterns are a limiting factor for developing estimates of past exposure. Here, in contribution to a community-scale PFAS health effects study near fire training facilities that contaminated a local aquifer with PFASs, we present a novel water-infrastructure, mass-balance mixing model coupled to a non-steady state, single-compartment toxicokinetic model that used Monte Carlo simulations to estimate the start of PFAS exposure in drinking water for individuals within three PFAS-impacted communities in El Paso County, Colorado. Our modeling focused on perfluorohexane sulfonic acid (PFHxS) because median serum PFHxS concentrations in a sample of local residents (n = 213) were twelve times the median observed in the U.S. National Health and Nutrition Examination Survey (2015-2016). Modeling results for study participants were grouped according to their community of residence, revealing a median start of exposure for the town of Fountain of 1998 (25-75% interquartile range [IQR], 1992 to 2010), 2006 (IQR 1995 to 2012) for Security, and 2009 (IQR 1996-2012) for Widefield. Based on the towns' locations relative to an identified hydraulically upgradient PFAS source, the modeled exposure sequencing does not completely align with this conceptual flow model, implying the presence of an additional PFAS source for the groundwater between Widefield and Fountain.

Ecigarette or Vaping Product Use Associated Lung Injury (EVALI) Reports to NPDS Implicated New Marijuana Substances

Context: Beginning Aug-2019, the Centers for Disease Control and Prevention (CDC) initiated investigation of e-cigarette or Vaping Product Use-Associated Lung Injury (EVALI). We examined all National Poison Data System (NPDS) EVALI cases through 31-Mar-2020 for substances, treatments, clinical effects, and medical outcome. We also examined all NPDS eCig exposures for earlier reports of EVALI. Methods: We extracted all exposures coded to EVALI product code 7322608 (E-Cigarette Associated Pulmonary Illness) and all single substance exposures to any of 6 NPDS eCig generic codes (GCs). We examined substance, patient characteristics, and exposure details on the severity of EVALI via multivariate analyses. We developed an EVALI clinical score (ECS) based on the EVALI clinical effects (CEs) and treatments weighted by the % of cases for each finding. We used ECS to search for EVALI candidate cases from 2001 to 31-Mar-2020. Descriptive statistics and change over time via linear and quadratic regression, and multivariate analyses were via (SAS JMP, 12.0.1). Discussion: Through 31-Mar-2020, PCs reported 822 EVALI cases. The EVALI profile over time 15-Aug - 12-Sep-2019 for 196 cases was described by an exponential increase with a doubling time [95% CI] of 8.31 [8.24, 8.37] days. Age: median [min, max] was 22 [1, 77] years, Male: 64.9%, Chronic 50.3%. Medical Outcomes included Death 1.95%, Major 17.9%, and Moderate 57.1%. Multivariate analysis of the first 107 EVALI cases as of 14-Sep-2019 implicated Marijuana Products (p=0.0007). Similar analyses of all 822 cases confirmed Marijuana (p&lt;0.00001), Chronicity (p=0.00031), and Age (p=0.0152) contributing to CE score. Of the 23,252 eCig exposures (23,463 - 211 EVALI cases), 133 (0.567%) had an ECS &gt; median and 370 (1.57%) scored &gt; 25%tile of EVALI cases (EVALI-25+). The time course of these 370 eCig cases showed a distinct increase (inflection) ~16- Aug-2019. Conclusions: The first 107 NPDS EVALI case scores were related to marijuana product exposure. This was confirmed via similar analyses for all 822 cases. The numbers of EVALI-25+ cases show a distinct increase in Aug-2019, suggesting EVALI was a newly emerging phenomenon. Our analysis should encourage public health agencies to utilize NPDS, especially in data collection.

Voices of Women With Lived Experience of Substance Use During Pregnancy: A Qualitative Study of Motivators and Barriers to Recruitment and Retention in Research.

Despite concerns about negative neurocognitive effects of in utero substance exposure on child and brain development, research in this area is limited. This study gathered perspectives of persons with lived experience of substance use (eg, alcohol, prescription and illicit opioids, and other illicit substances) during a previous pregnancy to determine facilitators and barriers to research engagement in this vulnerable population. We conducted structured, in-depth, individual interviews and 2 focus groups of adult persons with lived experience of substance use during a previous pregnancy. Questions were developed by clinical, research, bioethics, and legal experts, with input from diverse stakeholders. They inquired about facilitators and barriers to research recruitment and retention, especially in long-term studies, with attention to bio-sample and neuroimaging data collection and legal issues. Interviews and focus groups were audio-recorded, transcribed, and analyzed using inductive coding qualitative analysis methods. Ten participants completed in-depth interviews and 7 participated in focus groups. Three main themes emerged as potential barriers to research engagement: shame of using drugs while pregnant, fear of punitive action, and mistrust of health care and research professionals. Facilitative factors included trustworthiness, compassion, and a nonjudgmental attitude among research personnel. Inclusion of gender-concordant recovery peer support specialists as research team members was the most frequently identified facilitator important for helping participants reduce fears and bolster trust in research personnel. In this qualitative study, persons with lived experience of substance use during a previous pregnancy identified factors critical for engaging this population in research, emphasizing the involvement of peer support specialists as research team members.

Drug use in pregnancy in Ireland’s capital city: A decade of trends and outcomes

ObjectiveThe aim of this study was to present contemporary trends in opiate use disorder (OUD) and substance use in pregnancy in Ireland, with associated obstetric outcomes, over the last ten years. Study designThis retrospective observational cohort study was conducted at an Irish tertiary maternity unit. All women with OUD or substance use in pregnancy delivered under this service between 2010 and 2019 were included. Drug-exposure was self-reported. Data was collected by combining electronic and hand-held patient records. Trends and outcomes were analysed by year of delivery. Approval for the study was granted by the institution’s clinical governance committee. ResultsOf the 82,669 women delivered, 525 had OUD or substance use in pregnancy (1 in every 160 women booking). 11.6% were homeless, 20.0% were in full-time employment and 91.0% smoked tobacco in pregnancy. 66.3% had a history of psychiatric disorders.Over the ten years, there was a significant reduction in women delivered with OUD or substance use in pregnancy (0.8 % to 0.4 %, RR 0.55, 95 % CI 0.36–0.85), significant reduction in the proportion of women on Opioid-Substitute-Treatment (OST, RR 0.66 95 % CI 0.51–0.87) and an increase in mean maternal age (30.7to32.0 years). Rates of cocaine and cannabis consumption increased (20.6 %, RR 3.8, 95 % CI 1.57–9.44: 24.0 %, RR 3.7, 95 % CI 1.58–8.86 respectively).The maternal mortality rate was 380.9:100,000 births. The perinatal mortality rate was 15.6:1000 births. The preterm birth rate was 17.9 %, with a mean birth weight of 2832 g. The rate of NICU admission was 52.0 % and the mean length of stay was 22.4 days. Amongst the smaller OUD population, the rate of NICU admission for Neonatal Abstinence Syndrome (NAS) and treatment for NAS increased over the study timeframe (36.0 %, RR 2.97, 95 % CI 1.86–4.75: 28.5 %, RR 2.92, 95 % CI 1.70–5.0 respectively). ConclusionsThe obstetric population attending an Irish antenatal service with opiate use disorder or substance exposure is reducing in size with older patients, less opioid substitute therapy and increasing cocaine and cannabis use. These women have high rates of maternal and perinatal morbidity and mortality. Specialist antenatal addiction services, coordinated by the drug-liaison midwife, are critical in adapting care to respond to this dynamic and vulnerable patient cohort.

Adverse childhood experiences and neurodevelopmental disorders among youth with and without prenatal substance exposure: A longitudinal matched register-based cohort study.

Background: Previous research has shown an association between adverse childhood experiences (ACEs) and secondary mental health problems in youth with prenatal substance exposure (PSE), but the association between ACEs and neurodevelopmental disorders is less clear. Methods: This longitudinal register-based cohort study investigated relationships between health at birth, ACEs (out-of-home care (OHC) and maternal adversities), and neurodevelopmental disorders among youth with PSE (alcohol/drugs, n = 615) and matched unexposed controls (n = 1787). Hospital medical records and register data were merged and analysed using Cox regression models. Results: Conduct and emotional disorders (International Statistical Classification of Diseases and Related Health Problems ICD-10, F90-F94) were more common among the exposed than the controls but only when the exposed and controls with no OHC were compared. The difference appeared in hyperkinetic disorders (ADHD, F90), mixed disorders of conduct and emotions (F92) and emotional disorders with onset specific to childhood (F93). Among the exposed and controls with OHC, over 40% had received an F90-F94 diagnosis. Regarding specific developmental disorders (F80-F83, e.g., impairments in speech and language and scholastic skills) the moderate difference between the exposed and controls attenuated after adjustment for OHC. Again, the rates were highest among the exposed with OHC and the controls with OHC. OHC and maternal risks were interrelated and, together with male sex and low birth weight, were associated with neurodevelopmental disorders both among the exposed and controls and decreased the difference between them. Conclusions: A strong association between ACEs and neurodevelopmental disorders was found. Brain research is needed to examine whether ACEs worsen neurodevelopmental outcomes caused by PSE.