Prenatal substance exposure: What predicts behavioral resilience by early adolescence?

Abstract

Understanding behavioral resilience among at-risk adolescents may guide public policy decisions and future programs. We examined factors predicting behavioral resilience following intrauterine substance exposure (IUSE) in a prospective longitudinal birth-cohort study of 136 early adolescents (age 12.4–15.9) at-risk for poor behavioral outcomes. We defined behavioral resilience as a composite measure of lack of early substance use initiation (before age 14), lack of risky sexual behavior, or lack of delinquency. IUSEs included in this analysis were cocaine (IUCE), tobacco (IUTE), alcohol (IUAE), and marijuana (IUME). We recruited participants from Boston Medical Center as mother-infant dyads between 1990 and 1993. The majority of the sample was African-American/Caribbean (88%) and 49% female. In bivariate analyses, none and lower IUCE level predicted resilience compared to higher IUCE, but this effect was not found in an adjusted model. Instead, strict caregiver supervision (adjusted odds ratio (AOR)=6.02, 95% confidence interval (CI)=1.90–19.00, p=0.002), lower violence exposure (AOR=4.07, 95% CI=1.77–9.38, p<0.001), and absence of intrauterine tobacco exposure (AOR=3.71, 95% CI= 1.28–10.74, p=0.02) predicted behavioral resilience. In conclusion, caregiver supervision in early adolescence, lower violence exposure in childhood, and lack of intrauterine tobacco exposure predict behavioral resilience among a cohort of early adolescents with significant social and environmental risk. Future interventions should work to enhance parental supervision as a way to mitigate the effects of adversity on high-risk groups of adolescents.

Characterizing adverse prenatal and postnatal experiences in children

“…However, the frequent co‐occurrence of prenatal and postnatal exposures (Astley, ; Astley et al, ; Gibbard, ; Hyter, ; Koponena et al, ) suggests that models should incorporate both time periods. In addition to the small number of studies that have examined interactions between PAE and other prenatal exposures (Price et al, ), a few studies outside the PAE literature have examined the combined effects of prenatal cocaine exposure and postnatal adversity on development (Eiden, Coles, Schuetze, & Colder, ; Eiden, Godleski, Colder, & Schuetze, ; Eiden, Granger, Schuetze, & Veira, ; Liebschutz et al, ) or the differential impacts of stress during prenatal and postnatal periods (Jensen et al, ; Jensen et al, ). Together, this literature highlights the importance of incorporating information from both prenatal and postnatal periods into the assessment of individual exposure profiles.…”

Cannabis use during pregnancy and its relationship with fetal developmental outcomes and psychiatric disorders. A systematic review

“…The review includes 4 articles that focus on the prevalence of prenatal exposure to cannabis [3,5,6,45], 7 articles that discuss detection methods for the use of drugs in pregnant women [7][8][9][10][11][12]46], 9 molecular studies [13][14][15][16][17][18][19][20]47], 6 studies on rodents [21][22][23][24][25]48] and 33 articles on the relationship between cannabis exposure and developmental/psychopathological consequences [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][49][50][51][52][53]…”

Adult consequences of prenatal drug exposure

“…For example, a survey of 19 303 middle to high school students from 82 Norwegian schools found that specific factors, such as the quality of parent–child relationships and absence of negative drug‐related beliefs, close relationships with drug users, low delinquency rates, regular tobacco use and alcohol intoxication, predicted resilience to teenage cannabis use . Behavioural resilience, defined as the lack of early (<14 years) substance use, risky sexual behaviour or delinquency, is also positively influenced by strict caregiver supervision, lower violence exposure and absence of intra‐uterine tobacco exposure even in children exposed to prenatal drugs, such as cocaine . There is ample evidence to show that programmes designed to enhance and support individual and family resilience have lasting effects, not only on drug use but also on suicidal risk, depression, anxiety, disruptive behaviours and even intergenerational vulnerability to such adversities …”

“…55 Behavioural resilience, defined as the lack of early (<14 years) substance use, risky sexual behaviour or delinquency, is also positively influenced by strict caregiver supervision, lower violence exposure and absence of intra-uterine tobacco exposure even in children exposed to prenatal drugs, such as cocaine. 56 There is ample evidence to show that programmes designed to enhance and support individual and family resilience have lasting effects, not only on drug use 57 but also on suicidal risk, 58 depression, anxiety, disruptive behaviours 58 and even intergenerational vulnerability to such adversities. 59…”