Systematic Review of Prenatal Cocaine Exposure and Adolescent Development

Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.
PEDIATRICS (Impact Factor: 5.47). 05/2013; 131(6). DOI: 10.1542/peds.2012-0945
Source: PubMed


Background and objective:
Previous research found that prenatal cocaine exposure (PCE) may increase children's vulnerability to behavior and cognition problems. Maturational changes in brain and social development make adolescence an ideal time to reexamine associations. The objective was to conduct a systematic review of published studies examining associations between PCE and adolescent development (behavior, cognition/school outcomes, physiologic responses, and brain morphology/functioning).

Articles were obtained from PubMed, PsycInfo, Web of Science, and CINAHL databases through July 2012 with search terms: prenatal drug, substance, or cocaine exposure; adolescence/adolescent; and in utero substance/drug exposure. Criteria for inclusion were nonexposed comparison group, human adolescents aged 11 to 19, peer-reviewed, English-language, and adolescent outcomes.

Twenty-seven studies representing 9 cohorts met the criteria. Four outcome categories were identified: behavior, cognition/school performance, brain structure/function, and physiologic responses. Eleven examined behavior; 7 found small but significant differences favoring nonexposed adolescents, with small effect sizes. Eight examined cognition/school performance; 6 reported significantly lower scores on language and memory tasks among adolescents with PCE, with varying effect sizes varied. Eight examined brain structure/function and reported morphologic differences with few functional differences. Three examined physiologic responses with discordant findings. Most studies controlled for other prenatal exposures, caregiving environment, and violence exposure; few examined mechanisms.

Consistent with findings among younger children, PCE increases the risk for small but significantly less favorable adolescent functioning. Although the clinical importance of differences is often unknown, the caregiving environment and violence exposure pose additional threats. Future research should investigate mechanisms linking PCE with adolescent functioning.

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    • "The point of the comparison group is to establish the range of variability in adolescents who are as similar as possible to the PDE group but lacking prenatal exposure to drugs of abuse. As members of our group and others have shown (Ackerman et al., 2010; Buckingham-Howes et al., 2013), there are few performance differences that can be attributed to PDE. Thus, we stand by the language we used in our article as it reflects an appropriately cautious interpretation of the data with care taken not to consider our participants to be performing in a manner that would be described " in surprisingly pathological terms " (McAllister and Hart, 2015) for we do not consider their behavior to be pathological. "

    Full-text · Article · Oct 2015 · Neurotoxicology and Teratology
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    • "Although there is a well-known association between child's substance use and timing of first sexual intercourse, no studies to date have examined the direct and indirect effects of PCE on the full range of age at initiation of sexual behavior. Children with PCE are vulnerable to early sexual intercourse and associated reproductive health outcomes (such as STIs/HIV and unintended pregnancy) because of the strong association of PCE with early substance use (Delaney-Black et al., 2011; Frank et al., 2011; Minnes et al., 2014; Richardson et al., 2013b) and other risk factors (Ackerman et al., 2010; Buckingham-Howes et al., 2013; Richardson et al., 2011). Thus, exposed individuals may enter the period of adolescence " primed " for earlier substance use and sexual intercourse, and are more likely to engage in these behaviors at a less optimal time than unexposed individuals. "
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    ABSTRACT: Prenatal cocaine exposure (PCE) has been linked to child behavior problems and risky behavior during adolescence such as early substance use. Behavior problems and early substance use are associated with earlier initiation of sexual behavior. The goal of this study was to examine the direct and indirect effects of PCE on sexual initiation in a longitudinal birth cohort, about half of whom were exposed to cocaine in utero. Women were interviewed twice prenatally, at delivery, and 1, 3, 7, 10, 15, and 21 years postpartum. Offspring (52% female, 54% African American) were assessed at delivery and at each follow-up phase with age-appropriate assessments. At age 21, 225 offspring reported on their substance use and sexual behavior. First trimester cocaine exposure was a significant predictor of earlier age of first intercourse in a survival analysis, after controlling for race, sociodemographic characteristics, caregiver pre- and postnatal substance use, parental supervision, and child's pubertal timing. However, the association between PCE and age of first sexual intercourse was mediated by adolescent marijuana and alcohol use prior to age 15. Most of the effect of PCE on age of sexual initiation occurred between the ages of 13-18, when rates of initiation were approximately 10% higher among exposed offspring. This effect was mediated by early adolescent substance use. These results have implications for identification of the exposed offspring at greatest risk of HIV risk behaviors and early, unplanned pregnancy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Dec 2014 · Drug and Alcohol Dependence
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    • "Prenatal cocaine exposure (PCE) is associated with negative behaviors during early childhood, including externalizing and behavioral problems (Ackerman et al, 2010) and poor sustained attention (Ackerman et al, 2010), inhibitory control (Bridgett and Mayes, 2011) and working memory (Mayes et al, 2007). By contrast, effects of PCE during adolescence and young adulthood may be more subtle than those observed during early childhood (Liu and Lester, 2011) and are less well understood (Buckingham-Howes et al, 2013). Data suggest increased rates of substance use and obesity during middle childhood and adolescence following PCE (Delaney-Black et al, 2011; LaGasse et al, 2011; Rando et al, 2013; Richardson et al, 2013). "
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    ABSTRACT: Preclinical research has demonstrated effects of prenatal cocaine exposure (PCE) on brain regions involved in emotional regulation, motivational control and addiction vulnerability - e.g., the ventral striatum (VS), anterior cingulate (ACC) and prefrontal cortex (PFC). However, little is known about the function of these regions in human adolescents with PCE. Twenty-two adolescents with PCE and 22 age-, gender-, and IQ-matched non-cocaine exposed (NCE) adolescents underwent functional magnetic resonance imaging (fMRI) during exposure to individually personalized neutral/relaxing, stressful and favorite-food cues. fMRI data were compared using group-level two-tailed t-tests in BioImage Suite. In comparison to NCE adolescents, PCE adolescents had reduced activity within cortical and subcortical brain regions including the VS, ACC and medial and dorslolateral PFC during exposure to favorite-food cues, but did not differ in neural responses to stress cues. Subjective food craving was inversely related to dorsolateral PFC activation among PCE adolescents. Among PCE adolescents, subjective anxiety ratings correlated inversely with activations in the orbitofrontal cortex and brainstem during the stress condition, and with ACC, dorsolateral PFC and hippocampus activity during the neutral-relaxing condition. Thus, adolescents with PCE display hypoactivation of brain regions involved in appetitive processing, with subjective intensities of craving and anxiety correlating inversely with extent of activation. These findings suggest possible mechanisms by which PCE might predispose to the development of addictions and related disorders; e.g., substance-use disorders, binge-eating.Neuropsychopharmacology accepted article preview online, 6 June 2014; doi:10.1038/npp.2014.133.
    Full-text · Article · Jun 2014 · Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology
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