Prenatal Drug Exposure and Drug-Abusing Environments

Research Findings from February, 2002 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the consequences of prenatal drug exposure. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Buprenorphine Treatment of Pregnant Opioid-dependent Women: Maternal and Neonatal Outcomes

Researchers at the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine reported an open-label prospective study that examined maternal and neonatal safety and efficacy outcome measures during and following prenatal buprenorphine exposure. Three opioid-dependent pregnant women received 8 or 12 mg sublingual buprenorphine tablets daily for 15-16 weeks prior to delivery. Results showed that buprenorphine in combination with comprehensive prenatal care was safe and effective in these women. Prenatal exposure to buprenorphine resulted in normal birth outcomes, a mean of 4.33 days (minimum possible=4) hospitalization, and a 'relatively mild' neonatal abstinence syndrome comprised primarily of tremors (disturbed), hyperactive moro and shortened sleep after feeding. The infants required no pharmacological treatment. Onset of neonatal abstinence signs occurred within the first 12 h after birth, peaked by 72 h and returned to below pre-12 h levels by 120 h. It is concluded that buprenorphine has potential utility for the treatment of pregnant opioid-dependent women. Johnson, R.E., Jones, H.E., Jasinski, D.R., Svikis, D.S., Haug, N.A., Jansson, L.M., Kissin, W.B., Alpan, G., Lantz, M.E., Cone, E.J., Wilkins, D.G., Golden, A.S., Huggins, G.R., and Lester, B.M. Buprenorphine Treatment of Pregnant Opioid--Dependent Women: Maternal and Neonatal Outcomes. Drug Alcohol Depend, 63(1), pp. 97-103, 2001.

Prenatal Cocaine Exposure and Intrauterine Growth

Researchers at the University of Miami, with collaborators at Johns Hopkins University, have recently reported findings of a specific cocaine-related deficit in fetal growth and gestational age. The analyses in this report involved a high degree of covariate control (e.g., prenatal substance exposures other than cocaine, maternal age, maternal education), using structural equations and multiple regression models. The findings support previously reported research regarding influences of prenatal cocaine on fetal growth and gestational age, and call into question the notion that head circumference is disproportionately affected compared to overall somatic growth. Head circumference was affected, but not disproportionately. There was also evidence that some of the cocaine effects on fetal growth were direct and some were indirect, mediated by a cocaine influence on gestational age. The study sample was drawn from the Miami Prenatal Cocaine Study, which involved 476 full-term infants born to inner-city, African-American women. Bandstra, E.S., Morrow, C.E., Anthony, J.C., et al. Intrauterine Growth of Full-Term Infants: Impact of Prenatal Cocaine Exposure. Pediatrics, 108, pp. 1309-1319, 2001.

The Adult Antisocial Syndrome with and without Antecedent Conduct Disorder: Comparisons from an Adoption Study

DSM antisocial personality disorder (ASPD) requires a retrospective diagnosis of conduct disorder-historical behavior not present in everyone with adult ASPD criteria. Using adoption study data, we examined the impact of this requirement on biological and environmental risk associations. We defined three subgroups: DSM-III ASPD (n = 30), adult antisocials without conduct disorder (n = 25), and controls (n = 142). Having an antisocial biological parent was a specific risk factor for ASPD. In contrast, fetal alcohol exposure, male gender, and adverse environment were associated with the adult antisocial syndrome, regardless of conduct disorder history. The two antisocial groups were similar with respect to sociopathy scales, co-occurring diagnoses, and the incidence of most individual symptoms. However, the phenotypic expression of the biological-possibly genetic-risk for ASPD appears to be manifest before adulthood. Despite this, we could not detect clinically important differences between the two sociopathic groups. The conduct disorder requirement therefore may be more relevant to etiological than clinical understanding of adult antisocial behavior. Langbehn, D.R., and Cadoret, R.J. Comprehensive Psychiatry, 42(4), pp. 272-282, 2001.