The effect of prenatal substance use and maternal contingent responsiveness on infant affect

Abstract

Background The effects of prenatal substance exposure on neurobehavioral outcomes are inherently confounded by the effects of the postnatal environment, making it difficult to disentangle their influence. The goal of this study was to examine the contributing effects of prenatal substance use and parenting style (operationalized as contingent responding during the play episodes of the Still-face paradigm [SFP]) on infant affect. Methods A prospective cohort design was utilized with repeated assessment of substance use during pregnancy and the administration of the SFP, which measures infant response to a social stressor, at approximately 6 months of age. Subjects included 91 dyads classified into four groups: 1) Control (n=34); 2) Medication assisted therapy for opioid dependence (MAT; n=19); 3) Alcohol (n=15); 4) Alcohol+MAT (n=23). Mean % of positive infant affect and mean % of maternal responsiveness (watching, attention seeking, and contingent responding) was compared among the five SFP episodes across the four study groups by MANOVA. Mixed effects modelling was used to estimate the contributing effects of the study groups and maternal responsiveness on infant affect. Results Maternal contingent responding was associated with increase (β̂ =0.84; p<0.0001) and attention seeking with decrease (β̂ =−0.78; p<0.0001) in infant positive affect. The combined effect of prenatal exposures and covariates explained 15.8% of the variability in infant positive affect, while the model including contingent responding and covariates explained 67.1% of the variability. Conclusions Higher maternal responsiveness was a much stronger predictor of infant behavior than prenatal exposures, providing the basis for future intervention studies focusing on specific parenting strategies.

Association between prenatal opioid exposure, neonatal opioid withdrawal syndrome, and neurodevelopmental and behavioral outcomes at 5–8 months of age

“…The ENRICH study methodology has been described elsewhere [4, 17, 18]. Briefly, patients receiving prenatal care at UNM-affiliated clinics in the Albuquerque, NM metropolitan area are invited to participate.…”

“…Recent estimates show that nearly one-fourth of pregnant women in the U.S. fill a prescription for opioids [1], while gestational opioid use has increased five-fold from 1999 to 2013 [2]. For pregnant women with opioid use disorder (OUD), medication assisted therapy (MAT) is associated with improved perinatal outcomes, decreased risk of relapse, and lower rates of maternal criminal involvement [3, 4]. While adverse outcomes are lower among women on MAT, many infants with prenatal opioid exposure (POE) − whether illicit, prescription, or MAT – have neonatal opioid withdrawal syndrome (NOWS), which is now estimated to affect as many as 2% of all births [5].…”

Forty Years of Assessing Neurodevelopmental and Behavioral Effects of Prenatal Alcohol Exposure in Infants: What Have We Learned?

“…The third of these, from our own cohort, utilized the still‐face paradigm (SFP) in 6‐month‐old infants. We found significantly lower positive infant affect across repeated measures in the univariate analyses, but these differences did not reach significance after adjusting for covariates (Lowe et al., ).…”

“…Early‐life experiences have been shown to affect brain development dramatically and produce measurable, long‐lasting alterations in specific regions of the brain that are associated with behavioral and cognitive functioning (Graham et al., ; Smith et al., ). Our own research has suggested that supportive parenting interaction style, which is modifiable through teaching and specialized support, might be a key early intervention area that could benefit NDB outcomes in alcohol‐ and drug‐exposed infants during the first year of life (Lowe et al., ). Future studies can use the information in this report to more closely investigate and identify which assessments or assessment domains should become the focus of research and, ultimately, shape clinical guidelines for infant evaluations and the development of early interventions.…”

Prevalence of alcohol use in pregnant women with substance use disorder

“…Additionally, we were not able to include measures of socioeconomic status in this report, as this variable was only collected from participants after enrollment in the ENRICH cohort. A prior report of ENRICH cohort participants indicate that annual household income <$20,000 is more than twice as prevalent among OUD/MAT participants compared to those without OUD/MAT (Lowe et al, 2017). Thus, in addition to the increased risks associated with polysubstance use among MAT patients, poverty represents an important consideration when planning early interventions.…”