Prenatal Drug Exposure Moderates the Association between Stress Reactivity and Cognitive Function in Adolescence

Abstract

Prenatal drug exposure (PDE) can undermine subsequent health and development. In a prospective longitudinal study we examine whether PDE moderates the link between stress reactivity and cognitive functioning in adolescence. Participants were 76 prenatally drug-exposed and 61 nonexposed (NE) community comparison African American youth (50% male, mean age 14.17 years) living in an urban setting. All participants completed neuropsychological and academic achievement tests (Children's Memory Scales, the California Verbal Learning Test - Children's version and the Wide Range Achievement Test 4) over the course of 1 day in a laboratory setting. Two mild stressors (Balloon Analog Risk Task - Youth and Behavioral Indicator of Resilience to Distress) were administered, with saliva samples (assayed for cortisol) collected pre- and poststress task. A higher percentage in the NE group, compared to the PDE group (26% vs. 12%, χ² = 4.70, d.f. = 1, n = 137, p = 0.03), exhibited task-related increases in salivary cortisol. PDE moderated the association between stress reactivity and 11 of 15 cognitive performance scales. In each case, the NE stress reactive group had better cognitive performance than either the NE lower cortisol reactive group or the PDE group regardless of stress reactivity status. Stress-related reactivity and regulation of the hypothalamic-pituitary-adrenal axis in adolescence may be disrupted by PDE, and the disruption may be linked to lower cognitive performance.

Prenatal Drug Exposure and Adolescent Cortisol Reactivity: Association with Behavioral Concerns

“…Since cortisol can be influenced by glucose levels, participants fasted for three hours prior to their appointment and were scheduled for morning appointments with 85% arriving at 10:30 am or earlier. 4 Upon arrival, research assistants established rapport, and discussed consent/assent forms. After approximately 30 minutes, the first cortisol sample was collected (pre task; M =9:41am, SD =.85 hrs).…”

“…After approximately 30 minutes, the first cortisol sample was collected (pre task; M =9:41am, SD =.85 hrs). 4 Participants then were presented with computer-administered mild stressors, followed by a questionnaire. The second cortisol sample was collected (post task; M =10:42 am, SD =.86 hrs) approximately 30 minutes after the mild stressors.…”

“…99% of pre and 97% of post task collections were completed before noon. 4 After the completion of the pre and post task cortisol collections, adolescents completed structured tasks and assessments and were offered breakfast and lunch. A third cortisol collection occurred at the end of the visit, but only the pre and post task collections are considered in the analyses because they directly assess the response to mild stressors.…”

“…4,5 Postnatal stressors can continue to disrupt brain development and regulation of the HPA axis. 6 Chronic stress (e.g., poverty) often accompanies PDE which can lead to prolonged, repeated elevations in glucocorticoids, resulting in the hyporeactivity of the HPA axis response.…”

“…13 Adolescents with PDE have higher basal levels of cortisol than those not exposed, 13 and cortisol levels in response to a stressor have been both flattened but also more reactive. 4,13,14 Differences in the postnatal environment may be a reason for these mixed findings, as caregiving instability is associated with cortisol response in children with PDE. 15 Given the evidence linking low cortisol levels and cortisol reactivity with externalizing problems and the well-characterized effects of PDE on the function of the amygdala and hippocampus, cortisol reactivity may explain the association between PDE and externalizing problems.…”