Prenatal methamphetamine use and neonatal neurobehavioral outcome

Abstract

Background-Methamphetamine (MA) use among pregnant women is an increasing problem in the United States. How prenatal MA exposure affects neonatal neurobehavior is unknown.Objective-To examine the neurobehavioral effects of prenatal MA exposure.Design-The Infant Development, Environment and Lifestyle (IDEAL) study screened 13,808 subjects and 1632 were eligible and consented. 166 (n=74 exposed) were enrolled in a longitudinal follow up. Exposure was determined by meconium assay and self-report with alcohol, marijuana, and tobacco present in both groups. The NICU Network Neurobehavioral Scale (NNNS) was administered within the first 5 days of life. Analyses conducted on NNNS summary scores included exposure group effects, heavy MA use effects, association with frequency of use by trimester, and dose-response relationships with amphetamine metabolites.Results-After adjusting for covariates, exposure to MA was associated with increased physiological stress. Heavy MA use was related to lower arousal, more lethargy, and increased physiological stress. First trimester MA use was related to elevated physiological stress. Third trimester use was related to poorer quality of movement. Higher level of amphetamine metabolites in meconium was associated with increased CNS stress.Conclusions-Prenatal MA exposure was associated with neurobehavioral patterns of decreased arousal, increased stress, and poor quality of movement. The dose response relationships may represent neurotoxic effects from MA.

Earliest Appropriate Time for Administering Neurobehavioral Assessment in Newborn Infants

“…4 More recently, the NNNS has been used to describe neurobehavior among infants with other prenatal exposures or risk factors. 2,[5][6][7][8][9][10][11][12][13] The time of newborn examination reported in published studies ranges widely from several hours to several weeks, and no recommendation has been made as to the earliest age of reliable assessment. An early examination seems desirable because it may provide more valuable information on the immediate effects of prenatal exposures or other risk factors.…”

“…The primary purpose of the Maternal Lifestyles Study, 3 for which the NNNS was developed, was to examine the impact of prenatal exposure to cocaine and/or opiates on health and neurobehavioral outcomes from infancy through adolescence. 4 Subsequently, the NNNS has been used in studies of prenatal exposure to other substances such as methadone, 5 methamphetamine, 6 marijuana, 7 and tobacco. [8][9][10] It also has been used to identify the impact of being small for gestational age, 11 adolescent parenting, 12 and maternal depression 13 on infant neurobehavior.…”

Lower diffusion in white matter of children with prenatal methamphetamine exposure

“…Such abnormal brain development may account for the slower maturation of behavioral measures observed in neonates with prenatal methamphetamine exposure. 16,17 While the exact mechanism of how prenatal methamphetamine exposure may lead to lower brain diffusivity is unknown, lower WM diffusivity typically reflects more compact axonal fibers. Consistent with this interpretation, children with prenatal methamphetamine exposure showed smaller subcortical structures.…”

Prenatal Methamphetamine Exposure and Childhood Behavior Problems at 3 and 5 Years of Age

“…3 Research on the impact of prenatal MA exposure on child development is emerging from the only large, prospective longitudinal study of prenatal MA use, the Infant Development, Environment, and Lifestyle (IDEAL) study. 4 Previous MA findings from IDEAL include increased small for gestational size at birth 5 and decreased length through 3 years, 6 poor quality of movement, low arousal, and increased stress signs in the newborn period 7 and poor grasping ability at 1 and 3 years of age. 8 The only comparable study conducted in Sweden showed increased drowsiness during the newborn period 9 and increased behavior problems in amphetamineexposed children.…”