Cognitive with outcomes of preschool children prenatal cocaine exposure
ABSTRACT Because of methodological limitations, the results of the few prospective studies assessing long-term cognitive effects of prenatal cocaine exposure are inconsistent.
To assess effects of prenatal cocaine exposure and quality of caregiving environment on 4-year cognitive outcomes.
Longitudinal, prospective, masked comparison cohort study from birth (September 1994-June 1996) to 4 years.
Research laboratory of a US urban county teaching hospital.
A total of 415 consecutively enrolled infants identified from a high-risk population screened for drug use through clinical interview, urine, and meconium screens. Ninety-three percent retention for surviving participants at 4 years of age resulted in 376 children (190 cocaine-exposed and 186 nonexposed).
The Wechsler Preschool and Primary Scales of Intelligence-Revised.
After control for covariates, prenatal cocaine exposure was not related to lower full-scale IQ (cocaine exposed [80.7] vs nonexposed [82.9]; P =.09) scores or summary verbal (cocaine exposed [79.9] vs nonexposed [81.9]; P =.11) or performance (cocaine exposed [85.5] vs nonexposed [87.5]; P =.18) IQ scores at age 4 years. However, prenatal cocaine exposure was related to small but significant deficits on several subscales (mean [SE]): visual-spatial skills (cocaine exposed [7.3 (0.22)] vs nonexposed [8.2 (0.22)]; P =.01), general knowledge (cocaine exposed [6.1 (0.18)] vs nonexposed [6.7 (0.17)]; P =.04), and arithmetic skills (cocaine exposed [6.2 (0.20)] vs nonexposed [6.8 (0.20)]; P =.05). Prenatal cocaine exposure was also associated with a lower likelihood of achievement of IQ above normative means (odds ratio, 0.26 [95% confidence interval, 0.10-0.65]; P =.004). The quality of the caregiving environment was the strongest independent predictor of outcomes. Cocaine-exposed children placed in nonrelative foster or adoptive care lived in homes with more stimulating environments and had caregivers with better vocabulary scores, and they attained full-scale and performance IQ scores (83 and 87, respectively) similar to nonexposed children in biological maternal or relative care (full-scale IQ, 82; performance IQ, 88) and higher than cocaine-exposed children in biological maternal or relative care (full-scale IQ, 79; performance IQ, 84).
Prenatal cocaine exposure was not associated with lower full-scale, verbal, or performance IQ scores but was associated with an increased risk for specific cognitive impairments and lower likelihood of IQ above the normative mean at 4 years. A better home environment was associated with IQ scores for cocaine-exposed children that are similar to scores in nonexposed children.
[Show abstract] [Hide abstract]
ABSTRACT: Neocortical development involves ordered specification of forebrain cortical progenitors to various neuronal subtypes, ultimately forming the layered cortical structure. Modeling of this process using human pluripotent stem cells (hPSCs) would enable mechanistic studies of human neocortical development, while providing new avenues for exploration of developmental neocortical abnormalities. Here we show that preserving hPSCs aggregates, allowing embryoid body formation, while adding bFGF during neuroepithelial development, generates neural rosettes showing dorsal forebrain identity, including Mash1(+) dorsal telencephalic GABAergic progenitors. Structures which mirrored the organization of the cerebral cortex formed after rosettes were seeded and cultured for three weeks in the presence of FGF18, BDNF and NT3. Neurons migrated along radial glia scaffolding, with deep-layer CTIP2(+) cortical neurons appearing after one week and upper-layer SATB2(+) cortical neurons forming during the second and third weeks. At the end of differentiation, these structures contained both glutamatergic and GABAergic neurons, with glutamatergic neurons being most abundant. Thus, this differentiation protocol generated an hPSC-based model which exhibits temporal patterning and a neuronal subtype ratio similar to that of the developing human neocortex. This model was used to examine effects of cocaine during neocorticogenesis. Cocaine caused premature neuronal differentiation and enhanced neurogenesis of various cortical neuronal subtypes. These cocaine-induced changes were reversed by the cytochrome P450 inhibitor cimetidine. This in vitro model enables mechanistic studies of neocorticogenesis, and can be used to examine the mechanisms through which cocaine alters the development of the human neocortex.Disease Models and Mechanisms 10/2014; DOI:10.1242/dmm.017251 · 5.54 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background. In the absence of a comprehensive analysis of the pediatric age population, a classification is proposed that analyzes the use or administration of drugs in three stages: (1) intrauterine, (2) newborn to school-age and (3) adolescence, with special emphasis on the Mexican population. Methods. Information was searched for in Medline, Pub Med, Embase, Inbiomed, Lilacs, and Artemisa. Results. Stage 1 describes the effects of maternal drugs on the fetus fetus such as fetal death, withdrawal syndrome, prematurity, and learning disorders. Stage 2 reports the damage due to the administration by the parents of over-the-counter (OTC) medications such as opioids, dextromethorphan, or psychostimulants. Stage 3 emphasizes that drug use among adolescents has increased in recent years and is accentuated in older ages. In 2008 it was reported as 5.7%, with marijuana, cocaine, inhalants and heroin being dominant. Conclusions. We propose to conduct a national survey in Mexico that includes the three stages, extending the investigation of stage 3 by 7 years to 21 years. Simultaneously, a national outreach and educational program should be established, enabling an intelligent and permanent impact on the population as a whole. Key words: drug use in children, drug use in adolescents, three stages of drug use in children.
[Show abstract] [Hide abstract]
ABSTRACT: Objective: Studies examining the association between prenatal cocaine exposure (PCE) and child behavior problems have yielded mixed results, suggesting a need to identify additional mediating and moderating influences. We hypothesized that the relation between PCE and behavior problems in kindergarten would be mediated/moderated by child exposure to violence and that maternal warmth/sensitivity and harshness would moderate the association between violence exposure and behavior problems. Methods: Participants consisted of 216 (116 cocaine-exposed and 100 noncocaine-exposed) mother-child dyads participating in an ongoing longitudinal study of PCE. Results: Results yielded no direct or mediated/moderated association between PCE and child behavior problems and no significant interaction effects between PCE and parenting quality. However, higher exposure to violence in kindergarten was significantly associated with higher child behavior problems. This association was moderated by maternal warmth/sensitivity and harshness. High maternal warmth/sensitivity buffered the association between violence exposure and behavior problems whereas high maternal harshness exacerbated this association. Conclusion: This study highlights the role of violence exposure in the development of behavior problems among high-risk children and emphasizes the significance of parenting quality in buffering or exacerbating this risk among these children. Implications for prevention include targeting the potential role of maternal warmth/sensitivity as a protective influence among children exposed to violence.Psychology of Violence 07/2014; 4(3):266-280. DOI:10.1037/a0036157 · 1.83 Impact Factor