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Background: Most studies of the effects of prenatal alcohol exposure (PAE) on cognitive function have assumed that the dose-response curve is linear. However, data from a few animal and human studies suggest that there may be an inflection point in the dose-response curve above which PAE effects are markedly stronger and that there may be differences associated with pattern of exposure, assessed in terms of alcohol dose per drinking occasion and drinking frequency. Methods: We performed second-order confirmatory factor analysis on data obtained at school age, adolescence, and early adulthood from 2227 participants in six US longitudinal cohorts to derive a composite measure of cognitive function. Regression models were constructed to examine effects of PAE on cognitive function, adjusted for propensity scores. Analyses based on a single predictor (absolute alcohol (AA)/day) were compared with analyses based on two predictors (dose/occasion and drinking frequency), using (1) linear models and (2) nonparametric general additive models (GAM) that allow for both linear and nonlinear effects. Results: The single-predictor GAM model showed virtually no nonlinearity in the effect of AA/day on cognitive function. However, the two-predictor GAM model revealed differential effects of maternal drinking pattern. Among offspring of infrequent drinkers, PAE effects on cognitive function were markedly stronger in those whose mothers drank more than ~3 drinks/occasion, and the effect of dose/occasion was strongest among the very frequent drinkers. Frequency of drinking did not appear to alter the PAE effect on cognitive function among participants born to mothers who limited their drinking to ~1 drink/occasion or less. Conclusions: These findings suggest that linear models based on total AA/day are appropriate for assessing whether PAE affects a given cognitive outcome. However, examination of alcohol dose/occasion and drinking frequency is needed to fully characterize the impact of different levels of alcohol intake on cognitive impairment. [ABSTRACT FROM AUTHOR]

Purpose: A longitudinal cohort of adolescents who initiated drinking before age 15 were studied to determine which factors distinguished between early initiators who continued to drink (persisters) from those who stopped drinking (desisters). There were 308 early initiators in the total sample (n = 917); 247 were persisters, and 61 were desisters. Method: A stepwise discriminant analysis identified differences between the two groups. Considered risk/protective factors were parenting practices, peer drinking, child and maternal depression, child behavior, prenatal alcohol exposure, home environment, and demographic factors. Results: Desistence was significantly related to African American race and more parental strictness. Exposure to =1 drink/day during pregnancy and high levels of autonomy from parents were significant predictors of persistent drinking. Conclusions: Early initiation places adolescents at risk for continued and heavier drinking. Identifying characteristics of those who start early but do or do not continue drinking can inform education programs to better target the most appropriate adolescents.

Summary: High levels of prenatal alcohol exposure (PAE) result in significant cognitive deficits in children, but the exact nature of the dose‐response relationship is less well understood. To investigate this relationship, data were assembled from six longitudinal birth cohort studies examining the effects of PAE on cognitive outcomes from early school age through adolescence. Structural equation models (SEMs) are a natural approach to consider, because of the way they conceptualise multiple observed outcomes as relating to an underlying latent variable of interest, which can then be modelled as a function of exposure and other predictors of interest. However, conventional SEMs could not be fitted in this context because slightly different outcome measures were used in the six studies. In this paper we propose a multi‐group Bayesian SEM that maps the unobserved cognition variable to a broad range of observed outcomes. The relation between these variables and PAE is then examined while controlling for potential confounders via propensity score adjustment. By examining different possible dose‐response functions, the proposed framework is used to investigate whether there is a threshold PAE level that results in minimal cognitive deficit. [ABSTRACT FROM AUTHOR]

Study aims were to examine the relations between multiple forms of childhood maltreatment (CM) and adult violent victimization (AVV) and to explore other significant covariates of the relations between CM and AVV. Data were collected from women (n = 477) who participated in two longitudinal studies in the Maternal Health Practices and Child Development Project. Women with a history of CM were more than twice as likely to experience AVV as women with no history of CM. Those who experienced one or two forms of CM were significantly more likely to report any AVV compared to women with no CM. The relationship between CM and AVV remained significant after controlling for illicit drug use at baseline. Among low-income women, a history of CM exposure increased the risk of AVV. Having had any CM exposure was more important that the specific form or combination of forms, of CM exposure (e.g., sexual abuse or physical abuse). (Contains 5 tables.)

To test the feasibility of conducting a pragmatic randomized controlled trial (RCT) comparing the International Association of Diabetes in Pregnancy Study Groups (IADPSG) versus Carpenter-Coustan diagnostic criteria for gestational diabetes (GDM), and to examine patient and provider views on GDM screening. A single-blinded pragmatic pilot RCT. Participants with a singleton pregnancy between 24 and 28 weeks gestation received a 50 g oral glucose challenge test and if the value was, Author(s): Christina M. Scifres[sup.1] , Kaleab Z. Abebe[sup.2] , Kelley A. Jones[sup.3] , Diane M. Comer[sup.2] , Tina Costacou[sup.3] , Matthew S. Freiberg[sup.2] , Hyagriv N. Simhan[sup.1] , Nancy L. [...]

This study examined relations among characteristics at ages 3 and 10 years and delinquent behavior at age 10. Findings indicated that race and gender were significant predictors of delinquent behavior at age 10, as were temperament, IQ, and emotional instability at age 3. Psychological status, perceived peer substance use, IQ, and temperament at age 10 correlated with delinquent behavior and were identified as 3 distinct pathways to delinquent behavior. (Author/KB)

Collected data on the drinking behavior of 415 pregnant adolescents over a five-year period to examine relationships between knowledge and attitudes about drinking and drinking behavior. Results indicate that knowledge about drinking was related to a decrease in drinking among drinkers during pregnancy. Other results are reported. (RJM)

Evidence from animal models and epidemiological studies has linked prenatal alcohol exposure (PAE) to a broad range of long-term cognitive and behavioural deficits. However, there is a paucity of evidence regarding the nature and levels of PAE associated with increased risk of clinically significant cognitive deficits. To derive robust and efficient estimates of the effects of PAE on cognitive function, we have developed a hierarchical meta-analysis approach to synthesize information regarding the effects of PAE on cognition, integrating data on multiple outcomes from six U.S. longitudinal cohort studies. A key assumption of standard methods of meta-analysis, effect sizes are independent, is violated when multiple intercorrelated outcomes are synthesized across studies. Our approach involves estimating the dose–response coefficients for each outcome and then pooling these correlated dose–response coefficients to obtain an estimated “global” effect of exposure on cognition. In the first stage, we use individual participant data to derive estimates of the effects of PAE by fitting regression models that adjust for potential confounding variables using propensity scores. The correlation matrix characterizing the dependence between the outcome-specific dose–response coefficients estimated within each cohort is then run, while accommodating incomplete information on some outcome. We also compare inferences based on the proposed approach to inferences based on a full multivariate analysis. [ABSTRACT FROM AUTHOR]

Alcohol use across pregnancy causes growth and other abnormalities in the offspring. Confirmation of pregnancy leads some women to discontinue alcohol use and other women to continue use. The study discussed in this article assessed alcohol use at the first and third trimesters and at delivery for 393 pregnant African American women in an urban area. At the first trimester, 118 women were moderate to heavy drinkers (one or more drinks per day), compared with 38 women who were at delivery. Socioenvironmental and psychological differences were identified for both women who reduced consumption and women who continued. An understanding of continued drinkers' vulnerability to factors that influence their drinking behaviors demands the development of appropriate, early, and effective intervention strategies. Social welfare implications are discussed. Key words African Americans alcohol use pregnancy women, ********** Alcohol use during pregnancy causes growth, morphological, and neurobehavioral abnormalities in the offspring (Boone, 1985; Day et al., 1992; Geva, Goldschmidt, Stoffer, & Day, 1993; Larkby & Day, 1997; [...]

Cocaine or cigarette use may increase the risk of miscarriage. Researchers measured the levels of cocaine in hair samples and nicotine metabolites in blood samples from 970 pregnant women, 400 of whom had a miscarriage during their pregnancy. Cocaine use as detected in hair samples increased the risk of a miscarriage 40% and tobacco use as detected in urine samples almost doubled the risk. Some women did not report their use of cocaine, indicating that hair analysis may be necessary. Both cocaine and nicotine decrease blood flow to the uterus.

Background: Cognitive and behavioral sequelae of prenatal alcohol exposure (PAE) continue to be prevalent in the United States and worldwide. Because these sequelae are also common in other neurodevelopmental disorders, researchers have attempted to identify a distinct neurobehavioral profile to facilitate the differential diagnosis of fetal alcohol spectrum disorders (FASD). We used an innovative, individual participant meta‐analytic technique to combine data from six large U.S. longitudinal cohorts to provide a more comprehensive and reliable characterization of the neurobehavioral deficits seen in FASD than can be obtained from smaller samples. Methods: Meta‐analyses were performed on data from 2236 participants to examine effects of PAE (measured as oz absolute alcohol/day (AA/day)) on IQ, four domains of cognition function (learning and memory, executive function, reading achievement, and math achievement), sustained attention, and behavior problems, after adjusting for potential confounders using propensity scores. Results: The effect sizes for IQ and the four domains of cognitive function were strikingly similar to one another and did not differ at school age, adolescence, or young adulthood. Effect sizes were smaller in the more middle‐class Seattle cohort and larger in the three cohorts that obtained more detailed and comprehensive assessments of AA/day. PAE effect sizes were somewhat weaker for parent‐ and teacher‐reported behavior problems and not significant for sustained attention. In a meta‐analysis of five aspects of executive function, the strongest effect was on set‐shifting. Conclusions: The similarity in the effect sizes for the four domains of cognitive function suggests that PAE affects an underlying component or components of cognition involving learning and memory and executive function that are reflected in IQ and academic achievement scores. The weaker effects in the more middle‐class cohort may reflect a more cognitively stimulating environment, a different maternal drinking pattern (lower alcohol dose/occasion), and/or better maternal prenatal nutrition. These findings identify two domains of cognition—learning/memory and set‐shifting—that are particularly affected by PAE, and one, sustained attention, which is apparently spared. [ABSTRACT FROM AUTHOR]

Tobacco and marijuana use during pregnancy by teenagers may affect newborns. Researchers examined the newborns of 310 adolescent mothers aged 12 to 18 years old. Of 70% African Americans and 30% white adolescents, half of all young mothers smoked tobacco before and during pregnancy. About one third of adolescents used marijuana before pregnancy but only 2.9% still did so by the last trimester. Adolescents who smoked tobacco during pregnancy gave birth to smaller babies. Specifically, smoking during the first trimester was associated with a lower birth weight of 202 g per daily cigarette pack. Body length, head circumference, and chest size were similarly diminished. Mothers who used marijuana early in the pregnancy gave birth to infants with slight physical handicaps. Marijuana was also associated with a slight reduction of gestational age at birth. Marijuana habits apparently did not affect infant weight or size., Objective. This longitudinal study examined the effects of tobacco and marijuana use during pregnancy on the gestational age, growth, and morphology of 310 offspring of adolescents. Data were collected during 1990 through 1993. Methodology. The adolescents were drawn from a prenatal clinic in Pittsburgh, PA. They were interviewed at mid-pregnancy and at delivery to obtain information on tobacco, marijuana, and other substance use before and during pregnancy. Infants were examined 24 to 36 hours after birth. Results. The average maternal age was 16.1 (range 12 to 18 years); 70% were African-American. Prenatal tobacco use was associated with reduced birth weight, length, head and chest circumferences, and ponderal index, but not gestational age or the number of morphological abnormalities. Prenatal marijuana exposure was associated with reduced gestational age. Among whites, first trimester marijuana exposure was associated with an increased rate of minor physical anomalies. Prenatal marijuana exposure was not associated with any growth outcomes. Conclusions. These effects of prenatal tobacco and marijuana use were prominent despite lower levels of prenatal exposure in the offspring of adolescent mothers as compared with the offspring of adult mothers from the same clinic. Young maternal age may increase the offspring's risk of negative effects from prenatal tobacco and marijuana exposure. Pediatrics 1995,95:738-743; tobacco, marijuana, pregnancy, adolescent, growth, morphology, gestational age., Twenty-eight percent of high school seniors in the United States used tobacco and 22% used marijuana in 1992.1 Prevalence rates for both substances were higher than in 1991.[1] Teenage pregnancy [...]

A comparison of the drinking patterns of 124 pregnant teenagers with 267 pregnant adults shows that adolescents indulge in more binge drinking during the first trimester than adult women. Although the use of cocaine and marijuana decreases during pregnancy for both the samples, smoking increases in teenagers. The binge drinking with its subsequent detrimental effects on the offspring, especially in the gas adolescents, highlights the need for educational programs.

This paper discusses efforts to retain resistant subjects (N = 88) in a prospective research project which investigates the effects of prenatal substance use on pregnancy and infant outcome. Resistant subjects were women for whom we had valid addresses and/or phone numbers. They did not refuse to participate but were reluctant to schedule appointments and/or keep scheduled appointments. The persistent resistance we encountered led us to develop procedures which established and maintained rapport with resistant respondents and facilitated access to the 18-month assessment. No significant differences were found between the resistant participants and nonresistant subjects on six sociodemographic factors and on substance use. However, resistant subjects were significantly more depressed than nonresistant subjects. Anxiety and hostility did not differ at any time point. Resistant subjects who were finally interviewed, reported a significantly higher number of recent life events than nonresistant subjects at the 18-month postpartum interview. The follow-up rates for retaining the 88 resistant subjects were 44.3, 72.7, and 79.6% at Phases 4, 5, and 6, respectively., INTRODUCTION Longitudinal epidemiological studies require long-term contact with large numbers of subjects. As a result, a major effort of epidemiological studies is directed toward retention of large cohorts, especially when [...]

Prenatal exposure to alcohol or other drugs can impair physical, intellectual, and behavioral development. An understanding of how these drugs act and interact with one another and with lifestyle factors […]