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A study assessed the relationship between identified prenatal substance use and the risk of subsequent maltreatment allegations among 277 families involved with child protective services. Parents in the substance-exposed infant (SEI) group were more likely to have subsequent SEI-related allegations but not more likely to incur other types of allegations. (Contains references.) (CR)

Clarifies policy options for reporting and serving children testing positive at birth for controlled substances. Advocates the strengthening of existing state policies regarding child abuse reporting and response. (JPB)

Investigated whether maltreated, substance-exposed infants have higher risk of out-of-home placement than non-abused, substance-exposed children, as well as a higher risk of death than children overall. Followed 480 infants through Illinois death registry and computerized central registry of child abuse reports. Found out-of-home placement and death distinctly more likely if children had been exposed to drugs and maltreated. (EV)

A survey of 171 American Indian women in California who were pregnant or parenting and were considered at risk for problem substance abuse covered demographic information; personal and family history; alcohol, tobacco, and drug use; HIV risk; and a needs assessment regarding health care, economic needs, and parenting and children's needs. (LP)

Case files (n=284) from a social services agency and juvenile court were reviewed to investigate how cases involving drug-exposed infants were processed. Data showed an overrepresentation of African American and Hispanic cases and underrepresentation of Caucasian and Asian cases. About 80% of children were removed from the mother; about one-third were later returned. (Author/JDD)

This article addresses the advantages, disadvantages, and possible solutions to increased administrative problems posed by five proposed new categories of behavioral disorders: (1) attention deficit disorder, (2) traumatic brain injury, (3) fetal alcohol syndrome, (4) prenatal substance abuse, and (5) fragile X syndrome. (DB)

This article reviews 46 experimental studies on behavioral and developmental outcomes associated with prenatal exposure to illicit drugs. Only half of the 460 individual outcomes significantly indicated adverse effects of prenatal exposure. The greatest number of these outcomes was for infants younger than one month, with relatively few outcomes in older toddler and preschool age groups. (Author/DB)

This article reviews current research on the long-term outcomes of children exposed to alcohol, cocaine, heroin, marijuana, and multiple drugs in utero. Differential intervention efforts based primarily on knowledge of a child's intrauterine exposure to drugs were unsupported by available evidence. The use of an ecological model for assessment and intervention is urged. (Author/DB)

Although prenatal drug exposure places children in high-risk categories, educators must guard against preconceptions regarding outcomes. Environmental influences play a crucial role in determining long-term outcomes, ranging from minimal to severe. Effective intervention entails prevention at all levels, combined with a comprehensive approach. Terms such as "crack baby" imply blame and should be deleted from discussions of such children. (MLH)

Notes that, to deal with problems of substance-exposed infants, California must develop and adopt concerted interagency policy outlining uniform criteria for local health care workers, social service agencies, and educators; consistent guidelines governing interagency exchange of information; and increased prevention and early intervention services for these infants and their families. (Author/NB)

Presents a conceptual framework that can be used to estimate the costs of prenatal exposure to tobacco, alcohol, and illegal drugs. Cost estimates that have been made are presented. It is obvious that preventing drug use or smoking should be a first priority of public policymakers. (SLD)

Addresses the issue of drug-exposed infants from the perspective of a reproductive rights attorney. States genuinely interested in promoting healthy children will stop ignoring women or treating them as potential child abusers and will change the current punitive legal focus to a focus on treatment. (SLD)

Drug-exposed infants are having a profound impact on the child welfare system. When community resources are not available to meet the needs of these children and families, requirements of current child welfare laws cannot be met. The range of services necessary for effective child welfare responses is discussed. (SLD)

Estimates the number of infants exposed to legal and illegal substances before birth, drawing on 27 published reports and National Institute on Drug Abuse data. The following are estimated exposure levels: (1) cocaine, 2-3 percent; (2) marijuana, 3-12 percent; (3) cigarettes, 38 percent; and (4) alcohol, 73 percent. (SLD)

Reviews studies of the effects of prenatal drug exposure on child development, and reviews ideal early intervention programs. Researchers agree that prenatal drug exposure is only one of many factors that can influence a child's development. Specialized treatment programs and family support can ameliorate prenatal drug exposure effects. (SLD)

Reviews the effects of prenatal exposure to the following: (1) cigarettes; (2) alcohol; (3) heroin; (4) narcotics; (5) marijuana; and (6) cocaine. Also discussed are the effects of exposure to multiple drugs and research issues in assessing drug effects. The importance of environment in long-term outcome is emphasized. (SLD)

Summarizes and analyzes the following issues in developing policy to address the problems of drug-exposed infants: (1) degree of harm; (2) identification; (3) interventions; (4) needs assessment; (5) child protection; and (6) drug treatment. Significant interventions, including expanded prenatal care and drug treatment programs, are proposed. (SLD)

This article reviews the literature on children prenatally exposed to drugs and alcohol, the potential impact on the educational and social services systems, and implications for programing for children identified as behaviorally disordered. (Author/JDD)

Discusses legislation aimed at prevention, identification, and treatment of prenatal exposure to controlled substances and the consequences of such exposure. Coercive state intervention can include involuntary civil commitment, child protection; and criminal prosecution. Such intervention raises constitutional issues of privacy and self-incrimination for the woman. (GH)

Advocates the use of criminal prosecution of pregnant women who abuse illegal substances. Discusses the views that use of drugs is a form of illness and that pregnant women should be exempt from laws. Concludes that court supervision and sanctions can improve treatment. Argues that punishment and treatment need not be mutually exclusive and advocates universal prenatal drug testing. (GH)

Discusses the effect that fetal exposure to cocaine and other drugs is having on infants and small children. Disputes the most widely cited estimate of the numbers of crack babies. Calls for restructuring foster care, group home placement, adoption, and general social welfare provision. Termination of parental rights is difficult but probably necessary for the sake of the children. (GH)

The role of public health nurses in the health care of infants and children prenatally exposed to drugs is discussed. Such nurses work in the family setting to promote health and prevent disease. Concepts of Kathryn Barnard have been used to develop policies and protocols for services to families with infants exposed to controlled substances. (GH)

The lack of agreement on the nature and extent of the problem of prenatal exposure to substances is discussed. Comprehensive coordination of services is called for. The 14 programs in the Los Angeles County Interagency Council on Child Abuse and Neglect (ICAN) are discussed. (GH)

Describes a Department of Human Services project to research and recommend appropriate strategies to address the needs of boarder babies, infants prenatally exposed to substance abuse, and children living in substance abusing environments in the District of Columbia. Training seminars and the five project objectives are reviewed. (SLD)

Child protection system removal within the first 30 days of life in the setting of prenatal substance exposure was associated with short interpregnancy intervals and repeat substance-exposed birth for the mother. Child protection systems often intervene after substance-exposed births but are not designed to address the postpartum needs of the delivering parent. In this retrospective cohort study, we aimed to estimate the association between early child protection system removal and high-risk subsequent birth trajectories among a cohort of mothers with substance-exposed births in California. Of 6,893 births in 2015 with documented prenatal drug and alcohol exposure, 20.4% of mothers experienced child protection system removal within 30 days after birth. First-month child protection system removal was associated with short-interval birth (adjusted hazard ratio [HR] 1.61, 95% CI, 1.09–2.36) and short-interval birth with documentation of substance exposure (adjusted HR 3.17, 95% CI, 1.65–6.08). We found that child separation was associated with an increase, not a reduction, in subsequent substance-exposed births. These findings indicate the need for focused public health and supportive services to address the treatment, health care, family-building, and psychological needs of parents with substance use during pregnancy. [ABSTRACT FROM AUTHOR]

This study examined the relationship between perceived stigma in healthcare settings during pregnancy and psychological distress and well-being in the postpartum period among individuals who took opioids while pregnant. Analyses included 134 birth mothers of opioid-exposed infants. At 0–1 months postpartum, perceived stigma and psychological distress were measured using the Prenatal Opioid use Perceived Stigma scale and measures from the Patient-Reported Outcome Measurement Information System (PROMIS). Food insecurity, housing instability, and Adverse Childhood Experiences (ACEs) were also assessed. Linear and generalized linear mixed-effect models were conducted to compare PROMIS scale scores and unmet needs by stigma, adjusting for site/location, age, race/ethnicity, marital status, education, public insurance, and parity. More than half of participants (54%) perceived stigma in healthcare settings. Individuals reporting stigma had higher depression, anxiety, and anger scores (p < 0.001) indicating greater psychological distress in the postpartum period compared to those reporting no stigma, after controlling for demographic characteristics. In addition, they scored significantly lower on the PROMIS meaning and purpose scale, an indicator of well-being (p = 0.002). Those reporting stigma were more likely to have food insecurity (p = 0.003), three or more ACEs (p = 0.040), verbal or physical abuse during pregnancy (p < 0.001), and less emotional support (p = 0.006) than those who did not. An association was observed between perceived stigma in the prenatal period and psychological distress in the postpartum period, providing support for stigma reduction interventions and education for healthcare providers on trauma-informed care. [ABSTRACT FROM AUTHOR]

The use, misuse, and abuse of substances are a continued public health concern in this country and around the world. Perinatal exposure to substances of abuse is associated with several long-term negative consequences for the neonate. Limited resources exist to assist perinatal health professionals on this very complex subject. The purpose of this document is to provide additional information about selecting monitoring protocols, the specifics of appropriate testing methodologies, and the interpretation of toxicological findings. Understanding these concepts better allows perinatal healthcare professionals to be a voice for the voiceless in order to protect and enrich lives during this unprecedented opioid epidemic.

Adolescence is the peak period for the emergence of substance use, which can lead to long-term psychosocial, occupational and interpersonal complications. Ongoing large-scale, longitudinal, consortium initiatives, such as the Adolescent Brain and Cognitive Development (ABCD) study, offer unprecedented opportunities to elucidate key risk factors for problematic substance use in a well-powered sample and to examine how changes in risk factors relate to symptoms across time. Delay discounting has been proposed as a putative risk marker for early substance-use initiation and other forms of psychopathology. However, the extent to which other factors (e.g., socio-economic status and cognitive ability) influence discounting behaviour in young adolescents is not well established. The present study leverages data from the ABCD study (n = 11 045) to assess associations between core demographic and familial variables and delay discounting in youth-operationalized using hyperbolic discounting rates (k)-before the onset of significant psychopathology. Model estimates revealed significant effects of individual difference factors (e.g., sex and socio-economic status) and alcohol risk status (based on family history) on delay discounting. No significant differences were observed in the primary sample when comparing the presence of parent drug problems or prenatal drug exposures. These effects will require replication in later waves of ABCD. Nonetheless, these results provide support for delay discounting as a potential risk marker for problematic alcohol use and demonstrate a relationship between key demographic variables and adolescent discounting behaviour. Further, these results provide an empirical baseline from which developmental trajectories of delay discounting and substance use may be tracked throughout future waves of ABCD. [ABSTRACT FROM AUTHOR]

This document is an editorial published in Frontiers in Behavioral Neuroscience titled "Neuroepigenetics and biological mechanisms of stress-induced socio-cognitive changes." The editorial highlights the need for further research into the biological mechanisms underlying stress-induced socio-cognitive changes, as there is a significant gap in existing research in this area. The document introduces a research topic that includes three full research articles and two review articles, all of which focus on the biological mechanisms underlying trauma and fear, stress-induced depression, substance abuse, and social homeostasis. The editorial emphasizes the importance of understanding these mechanisms in order to advance the management and treatment of central nervous system disorders. [Extracted from the article]

Objectives. To estimate use of medication for opioid use disorder (MOUD) and prescription opioids in pregnancy among mothers of infants with neonatal opioid withdrawal syndrome (NOWS). Methods. We used linked 2016–2018 North Carolina birth certificate and newborn and maternal Medicaid claims data to identify infants with an NOWS diagnosis and maternal claims for MOUD and prescription opioids in pregnancy (n = 3395). Results. Among mothers of infants with NOWS, 38.6% had a claim for MOUD only, 14.3% had a claim for prescription opioids only, 8.1% had a claim for both MOUD and prescription opioids, and 39.1% did not have a claim for MOUD or prescription opioids in pregnancy. Non-Hispanic Black women were less likely to have a claim for MOUD than non-Hispanic White women. The percentage of infants born full term and normal birth weight was highest among women with MOUD or both MOUD and prescription opioid claims. Conclusions. In the 2016–2018 NC Medicaid population, 60% of mothers of infants with NOWS had MOUD or prescription opioid claims in pregnancy, underscoring the extent to which cases of NOWS may be a result of medically appropriate opioid use in pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Daily opioid dependence for maternal pain management, methadone maintenance, or buprenorphine/naloxone therapy is an increasing trend in modern obstetrics. Opioids may produce depressive effects on fetal neurobehavioral status and thus on fetal heart rate patterns. Our primary objective was to describe the current methods utilized in antenatal monitoring of the daily opioid exposed fetus; and to describe interventions based upon monitoring which precipitated a recommendation for delivery. Our ultimate goal was to determine an optimal, evidence-based recommendation for fetal assessment of the daily opioid exposed pregnancy.Study design: A retrospective review of patients undergoing antenatal assessment from January 2016 through April 2017 at two maternal-fetal medicine testing centers identified singleton, fetuses without a known major genetic abnormality with daily opioid exposure. Nonstress tests, amniotic fluid indexes, biophysical profiles, umbilical artery Doppler measurements, and serial biometry were analyzed. Test characteristics and frequency of interventions for abnormal monitoring were quantified.Results: Criteria for daily opioid exposure was identified in 27 patients (77.8% on methadone (n = 21), 14.8% on prescription opioid for chronic pain (n = 4), and 7.4% on buprenorphine/naloxone (n = 2)). Mean maternal age was 30.3 years ±5.5 (range 21-42 years). Parity zero was 6/27 (22.2%). Identified race was 52% Caucasian, 26% African American, 19% Hispanic, and 4% Pacific Islander. There were 112 growth scans, 102 biophysical profiles, 10 isolated nonstress tests, and 81 umbilical artery Doppler studies reviewed. Delivery precipitated by abnormal testing occurred in 6/27 patients (22.2%). Gestational ages of delivery were all between 36 and 38 weeks. Indications for delivery were isolated oligohydramnios 2/6 (one at 37 weeks, one at 38 weeks), oligohydramnios with associated intrauterine growth restriction 2/6 (both at 36 weeks), isolated nonreactive nonstress test 1/6 (occurring at 38 weeks), and low biophysical profile score 1/6 (occurring at 36 weeks). The average nonstress test baseline was 131 (±11) beats per minute (range of 120-150), with no episodes of significant fetal bradycardia or tachycardia. Overall, 94.6% (106/112) of the nonstress tests were reactive, all nonstress tests had variability, 96.4% (108/112) had moderate variability, and 99.1% (111/112) had no decelerations. Time to nonstress test reactivity was <20 min in 93% (104/112), with a mean time to first acceleration of 5.3 (±7.7) min (range of 1-44). Umbilical artery Doppler measurements had an elevated systolic to diastolic ratio >95% for gestational age in 9/83 cases, with no measurements demonstrating absent or reversed end diastolic flow. Umbilical artery Doppler studies did not initiate changes in management.Conclusion: In our population, antepartum assessment with a biophysical profile at no later than 36-week gestation identified all fetuses with testing abnormalities necessitating delivery in the daily opioid exposed fetus (6/27, 22.2%). Oligohydramnios was the most frequent indication for delivery. Serial growth ultrasounds by 32 weeks were necessary to identify the 11.1% of growth restricted, opioid exposed fetuses. A depressive effect of daily opioids on nonstress test reactivity or variability was not evident in our cohort. Future studies should attempt to define optimal monitoring based upon category of opioid dependence, type and dose of opioid consumed, and timing of opioid administration. [ABSTRACT FROM AUTHOR]

Aims: Infants with fetal exposure to opioids have varying pattern of feeding difficulties mainly manifesting as difficulties with aerodigestive adaptation and disruptive feeding behavior. The reasons are unclear; in a pilot study, we determined basal and adaptive pharyngo-esophageal motility in a group of infants with fetal exposure to opioids and persistent feeding difficulties impeding their discharge. Methods: Six infants with fetal opioid exposure compared to 12 controls who underwent basal and adaptive pharyngo-esophageal manometry to characterize the basis for their symptoms. Spontaneous swallows (N = 180) and pharyngeal stimuli (N = 113)-induced swallowing responses were analyzed. Results: Resting upper esophageal sphincter (UES) pressure was similar in both the groups, but resting lower esophageal sphincter (LES) pressure was significantly high and it relaxed slowly and inadequately in opioid-exposed infants (p < .05). Upon pharyngeal provocation, opioid-exposed infants had higher LES nadir pressure, increased duration of esophageal body contraction at proximal-, mid-, and distal-esophagus, as well as greater area under the curve with distal esophageal waveforms, compared to controls (all p < .05). Conclusions: These pilot observations are suggestive of up-regulation of central vagal effects with heightened cholinergic excitatory responses and inadequate relaxation responses at the foregut, and may form the basis for persistent feeding difficulties in opioid-exposed infants. Abnormality with both sensory and motor aspects of vagal reflexes may be contributory. [ABSTRACT FROM AUTHOR]